COVID-19 and the law in Uganda: a case study on development and application of the public health act from 2020 to 2021.

BACKGROUND: Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda. METHODS: This is a case study of Uganda's experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis. RESULTS: Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions. CONCLUSIONS: Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.

Shattering the Mirage: The FDA's Early COVID-19 Pandemic Response Demonstrates a Need for Reform to Restore Agency Credibility.

The power afforded to the administrative state is heavily reliant on public trust and the perception of evidence-based agency decision-making. Organizational reputation is key to preserving regulatory power. However, recent investigations reveal that existing scientific integrity policies may not be sufficient to preserve the credibility of many federal agencies. In fact, a significant number of career scientists across various entities - including the FDA - have observed unreported incidents of political interference. While political influence exerted by the executive branch to set policy goals and determine agency priorities can be beneficial, political pressures must not undermine public trust in scientific agencies. Recently, public perception regarding the FDA's COVID-19 response threatened to weaken the agency's longstanding reputation as the gold standard of review. The COVID-19 pandemic publicized vulnerabilities that exist across agencies, as well as those that are unique to the FDA. The FDA's evolution as an increasingly public health-focused agency that must function in the landscape of politicized science exposes the agency to a greater risk of political interference. After all, the FDA's involvement in public health requires increased participation in non-ideal, value-based decision-making. Throughout its history, the FDA has managed to maintain its reputation through its firm responses to scandal. The COVID-19 pandemic provides a platform for the FDA to - once again - look introspectively and institute safeguards addressing vulnerabilities that plagued the agency's pandemic response. This Article examines the FDA's early COVID-19 response to propose reforms that promote meaningful transparency, public accountability, and scientific integrity.

COVID-19 Law Lab: Building Strong Legal Evidence.

The COVID-19 Law Lab platform enables quantitative representation of epidemic law and policies in a given country for multiple years, enabling governments and researchers to compare countries, and learn about the impacts and drivers of policy choices. The Law Lab initiative is designed to address the urgent need for quality legal information to support the study of how law and policy can be used to effectively manage this, and future, pandemic(s).

Facilitating the Urgent Public Health Need to Improve Data Sharing With Tribal Epidemiology Centers.

Tribal epidemiology centers (TECs) are an essential and unique part of the public health system and an important part of federal efforts to improve the health status of American Indian and Alaska Native people. Pursuant to federal statute, TECs serve the 574 federally recognized tribes (hereinafter, "tribes") and their members across the United States, as well as American Indian and Alaska Native people in general. The COVID-19 pandemic has highlighted the need for timely, complete, and accurate public health data, particularly for American Indian and Alaska Native communities and others who may have been disproportionately impacted by COVID-19. This article reviews the history and importance of TECs and federal statutes governing TECs' ability to access and use protected health information for public health purposes. TECs and tribes often encounter difficulty receiving public health data from state and federal agencies despite their designation as "public health authorities" under the Health Insurance Portability and Accountability Act and associated regulations. Limited access to this information hinders the statutory mission of TECs as well as tribal monitoring of and response to public health threats such as SARS-CoV-2. Agency acknowledgment and compliance with current federal law regarding data sharing with TECs are essential to improve data access and the fragile public health of tribal communities.

Studying Public Health Law: Principles, Politics, and Populations as Patients

Public health law is firmly establishing itself as a crucial area of scholarly inquiry. Its vital importance has been sharply underscored following the outbreak of COVID-19, in response to which we have seen the institution of extreme legal measures—such as the UK's Coronavirus Act 2020—in efforts to control and contain the spread of the disease. The pandemic has also starkly exposed the complex nature of the regulatory challenges, nationally, internationally, and globally, to which such public health problems give rise. In approaching these, and other questions concerning the public's health, such as non-communicable disease, public health law, as a field, brings notable distinctive features: these include a practical focus on populations, institutions, the prevention of ill health, protection of good health, and the promotion of positive states of well-being;and concomitant critical approaches rooted in theories of social justice as contrasted with more narrow biomedical ethics. Such features make it in some senses atypical territory within the field of health law. Furthermore, the inherent role of political institutions places law conceptually within public health in a way that may be seen as distinguishable from law's relationship with clinical medicine. This chapter explains how the broad reach and distinct features of public health require a commensurately broad approach to conceptualising public health law, and how distinct practical and theoretical features may be integrated into academic public health law. It also shows how public health law, with its distinct conceptualisations concerning ‘the body' of medical jurisprudence, can both challenge and enrich medico-legal studies, and bring important perspectives within the broader field of health law. © 2020, The Author(s).

The legal determinants of health (in)justice.

The mutual influences of social epidemiology and ideas of justice, each on the other, have been seminal in the development of public health ethics and law over the past two decades, and to the prominence that these fields give to health inequalities and the social-including commercial, political, and legal-determinants of health. General and political recognition of injustices in systematised health inequalities have further increased given the crushingly unequal impacts of the COVID-19 pandemic; including impacts of the legal and policy responses to it. However, despite apparent attention from successive UK governments to injustices concerning avoidable inequalities in health opportunities and outcomes, significant challenges impede the creation of health laws and policy that are both effective and ethically rigorous. This article critically explores these points. It addresses deficiencies in a UK health law landscape where health care contexts and medico-ethical assumptions predominate, to the great exclusion of broader social and governmental influences on health. The article explains how a public health framing better serves analysis, and engages with a framework of justice-oriented questions that must be asked if we are to understand the proper place and roles of law and regulation for the public's health.

3D PRINTED MEDICAL DEVICES: ISSUES FOR PATIENT SAFETY

One consequence of the Covid19 pandemic in 2020 was disrupted supply chains for medical devices. In response, many providers began onsite 3d printing medical devices, without special training or custom tailored instructions. Traditional laws protecting patient safety and tort liability regarding possible malfunction of medical devices are not prepared to address the manufacture of medical devices by enduser health care facilities. The USA Food and Drug Administration (FDA) is one regulatory body that has expressed its desire to validate these uses of 3d printing in emergencies, despite concern about these home-grown devices from the standpoint of patient safety. This article explores the uncharted legal landscape concerning the growing need for national or international regulation addressing 3D printed medical devices in Health care facilities (HCFs) and point of care (POCs) venues. New laws may be needed to protect the integrity of medical products within an overarching duty to protect patient safety. © 2022, William S. Hein & Co., Inc.. All rights reserved.

Vaccinating Children: The COVID-19 Family Law Jurisprudence.

Australian, New Zealand, English and Canadian courts have made a number of orders, often in the context of parenting disputes, requiring children to be vaccinated. Complementary therapy options have generally not been permitted as an alternative to mainstream vaccination. Debates about parental entitlements to make decisions about such matters have taken place in the context of contested family law litigation during the COVID-19 era. However, by contrast with Ontario Superior Court of Justice decisions in 2022, a series of Australian decisions, including the judgment of Sutherland CJ in Clay & Dallas [2022] FCWA 18, have developed the law further, having regard to both the capacity of a minor to consent to vaccination and reviewing a variety of factors going to children's best interests at different junctures during the pandemic, finding it generally to be in the best interests of children to receive COVID-19 vaccinations. This is likely to flow back into curial decision-making about vaccinations more broadly, as well as cognate matters.

Enforcement of the Use of Digital Contact-Tracing Apps in a Common Law Jurisdiction.

Digital contact-tracing systems have been widely implemented worldwide with different system designs and implementation policies for the purpose of tracking potentially exposed individuals. The use of a digital contact-tracing app in Hong Kong has been mandated for visiting certain premises by legislations. This paper reviewed the regulations promulgated specifically for the prevention and control of COVID-19 and identified those associated with the digital contact-tracing system. A comprehensive search in newspaper databases was performed to explore the enforcement of the mandated use of the digital contact-tracing app. The three facets of regulations in relation to digital contact tracing were examined: duty to disclose information, requirements and directions to businesses, and compulsory testing. The use of digital contact-tracing data for non-public health purposes was also reported. Our analyses showed that prosecution of non-use or the use of fraudulent digital contact-tracing apps was not limited to COVID-19-specific legislations. The flexible approach ensured the enforcement of the use of the digital contact-tracing app, but the judiciary's test must be passed in future cases.

THE ETHICAL CONCERNS OF A PANDEMIC: A CRITICAL ANALYSIS AND OPINIONS OF THE INDIAN SITUATION IN COVID ERA

COVID-19 brought havoc in the world with its high infectivity and virulence. Many countries were caught unprepared in public health capacity and socio-economic parameters. In this trying time, public health ethics remain an unanswered question on many fronts of treatment and control of novel coronavirus. The objective of the paper is to analyse the significant ethical challenges faced during the COVID-19 pandemic. The pre-defined thematic areas based on critical issues are identified to understand the ethical concerns of prevention and control of COVID-19. Secondary sources of literature have been consulted, and pieces of evidence gathered to strengthen the arguments. The article also provides a recommendation on ethical measures for the preservation of human dignity and ethical practices. The human rights aspects of regulations during the pandemic of the coronavirus are discussed to understand various nuances of justice and liberty.

Occupational risks and public health in the social environment

The exceptional situation generated by the coronavirus pandemic has led the legal system being overcome, overflowing the regulatory framework and proving in these situations the importance of guaranteeing effective and adequate protection both as citizens and workers. The need to provide a public service in order to guarantee the protection of the health of workers, generates situations in which a fine line is maintained between what should be considered as public health and what corresponds to occupational health. It's necessary to review this framework, taking into account either the present or situations that may arise in the future. This article takes a tour of different issues that affect public health and occupational health, and the application of these criteria to the workplace. © 2021 Wolters Kluwer (UK) Ltd.. All rights reserved.

From the Shadows: The Public Health Implications of the Supreme Court's COVID-Free Exercise Cases.

This article analyzes the Supreme Court's "shadow docket" Free Exercise cases relating to COVID-19. The paper highlights the decline of deference, the impact of exemptions, and the implications of the new doctrine for vaccine and other public health laws.

The Political Determinants of China'S New Health Constitution.

The Basic Healthcare and Health Promotion Law 2019 became the new constitution of China's health system in June 2020, giving legal effect to ambitious health reform programmes like Healthy China 2030. The concurrent outbreak of coronavirus disease 2019 must not distract us from appreciating the fact that this Law will comprehensively overhaul the health regulatory framework of the world's most populous country during the coming decade, if not beyond. This article offers an original evaluation of the Law in its political context. The Law commendably promises to safeguard the right to health, assist citizens to live a 'complete cycle of life', and promote health using the resources of the public health system. However, it is also deeply politicised, guaranteeing extensive and penetrative political control in health campaigns, digitalised health data, the governance of health institutions, and the resolution of medical disputes. This can be explained by the consequential roles played by epidemics in China's historical dynastic cycles, but even more so by powerful tendencies of centralisation on the part of the Leninist Party-state. The Law's potential is thus subject to the overriding caveat that the Party-state's existence and influence over law and public health must be secured.

Introduction to Health Law.

In early February of 2020, attention was drawn to the increased number of deaths and the new cases of coronavirus infection. The epicentre of the outbreak was Wuhan in the People's Republic of China. In order to control the outbreak, Chinese leaders called on the city authorities in Wuhan to set up mass quarantine centres for infected people. The Chinese government took this step to protect the public against infectious disease. This is an example of the conflicts between public health and civil liberties/individual rights. Government authority is the pillar of the public health law. The government retains the power to achieve and maintain common good by restricting - within solid international and national limits - individual rights concerning autonomy, privacy, association, and liberty. Public health agencies have the right to collect, use, and disclose a considerable amount of personal health information and to enforce certain vaccinations, medical examinations, and treatments. In addition to the power to isolate individuals to protect the public against the spread of infectious disease, their powers can be used to control businesses and professions. There are several legal interventions to prevent injury and disease and promote the public's health. Among these tools are taxing policies, which encourage engaging in beneficial behaviour (fruit consumption) and disincentives to engage in high-risk activities (smoking).

International Access to Public Health Data: An Important Brazilian Legal Precedent.

Accurate, up-to-date data are the bedrock of effective public health responses, including in the context of the suffering caused by COVID-19. Any action to inhibit the compilation of such data has ramifications locally, nationally and internationally, and risks impairing the global capacity to respond to the virus. This article contextualises the decision of the government of President Bolsonaro of Brazil to reduce the accessibility of contemporary data about COVID-19 infections in Brazil within his views about, and responses to, the virus. It identifies the nature of actions taken to suppress such data by the Brazilian Ministry of Health and then scrutinises a decision by De Moraes J of Brazil's High Court in Sustainability Network v The President of the Republic of Brazil (ADPF 690 MC/DF, 8 June 2020), which quashed the attempted suppression of public health data. The article hails the decision as an important public health law precedent.

Compulsory medical intervention versus external constraint in pandemic control.

Would compulsory treatment or vaccination for COVID-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints-such as quarantine, isolation and 'lockdown'-that have already been authorised to control the pandemic in this jurisdiction. We argue that, if the permissive English approach to external constraints for COVID-19 has been justified, then there is a case for a similarly permissive approach to compulsory medical interventions.

The legal and medical necessity of abortion care amid the COVID-19 pandemic.

In response to the COVID-19 pandemic, states have ordered the cessation of non-essential healthcare. Unfortunately, many conservative states have sought to capitalize on those orders to halt abortion care. In this short paper, we argue that abortion should not fall under any state's non-essential healthcare order. Major medical organizations recognize that abortion is essential healthcare that must be provided even in a pandemic, and the law recognizes abortion as a time-sensitive constitutional right. Finally, we examine the constitutional arguments as to why enforcing these orders against abortion providers should not stand constitutional scrutiny. We conclude that no public health purpose can be served by this application because abortion uses less scarce resources and involves fewer contacts with healthcare professionals than prenatal care and delivery assistance, which is continuing to be provided in this public health emergency.

Isolation of patients in psychiatric hospitals in the context of the COVID-19 pandemic: An ethical, legal, and practical challenge.

Psychiatric inpatients are particularly vulnerable to the transmission and effects of COVID-19. As such, healthcare providers should implement measures to prevent its spread within mental health units, including adequate testing, cohorting, and in some cases, the isolation of patients. Respiratory isolation imposes a significant limitation on an individual's right to liberty, and should be accompanied by appropriate legal safeguards. This paper explores the implications of respiratory isolation in English law, considering the applicability of the common law doctrine of necessity, the Mental Capacity Act 2005, the Mental Health Act 1983, and public health legislation. We then interrogate the practicality of currently available approaches by applying them to a series of hypothetical cases. There are currently no 'neat' or practicable solutions to the problem of lawfully isolating patients on mental health units, and we discuss the myriad issues with both mental health and public health law approaches to the problem. We conclude by making some suggestions to policymakers.