What measures should be taken to control the spread of infectious disease? How do you weigh public health and individual rights to make appropriate decisions?
This issue has come up before, in the inoculation debates in 1721. It became a more serious problem in the late 19th and early 20th century as microbiologists quickly realized that many diseases (cholera, tuberculosis, typhoid, diphtheria, etc.) were caused by contagious bacteria. Both the “Discussion on the Advisability of the Registration of Tuberculosis” and Leavitt’s “Typhoid Mary” discuss what powers health officials should have over the lives and rights of individuals.
These debates recurred repeatedly throughout the 20th century: can states require children to receive immunizations? Can patients with tuberculosis be confined to hospitals to receive antibiotics? (the answer to these questions is yes). They are again emerging as active policy questions: with COVID-19, will individuals be hospitalized involuntarily, can cities be quarantined? etc. Many of the most contentious past debates are related to HIV/AIDS.
The year is 1983. America (and soon the rest of the world) is in the throes of a new epidemic. Over the past few years, a series of people from specific risk groups have developed a new disease, AIDS, characterized by severe immunodeficiency and opportunistic infections. A new virus, lymphadenopathy virus, has been identified that might be the cause of AIDS; but no test yet exists to detect the virus in infected patients. Even though AIDS can be rapidly progressive, some patients can live for years after showing the first signs of the disease. This creates a dilemma for public health officials. Several people known to have AIDS, notably Gaetan Dugas, a male flight attendant from Montreal, continue to engage in high risk behavior (in his case, unprotected sex with multiple male partners).
Should public health authorities have the right to confine people, as was done with Mary Mallon, to keep them from spreading the disease? Should all patients with AIDS be reported to health officials, as has been done with tuberculosis and syphilis, do that their behavior can be monitored?
One official at the CDC is interested in your thoughts on the topic. Things are crazy here at the CDC, so keep your answer short (between 150-200 words).
