The Perils of Panic: Ebola, HIV, and the Intersection of Global Health and Law

Michael S. Sinha; Wendy E. Parmet

doi:10.1177/0098858816658269

The Perils of Panic

Ebola, HIV, and the Intersection of Global Health and Law

Published online by Cambridge University Press: 06 January 2021

Michael S. Sinha and

Wendy E. Parmet

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Michael S. Sinha*: Affiliation:
Department of Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
Wendy E. Parmet: Affiliation:
Mathews University Distinguished Professor of Law and Professor of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
*: Email: [email protected]

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Abstract

This Article explores the connections between emerging infectious diseases, domestic disease panics, global health, and the law by comparing the American response to Ebola to the initial American response to the AIDS epidemic. We demonstrate that in both cases the arrival of a new deadly disease was initially met with fear, stigma and the use of law to “other” those associated with the disease. We begin by reviewing the initial responses to the AIDS epidemic. We then offer a brief history of emerging infectious disease scares over the past few decades, highlighting the problematic rhetoric that paved the way for the Ebola panic. We then review the 2014 Ebola outbreak, noting its similarities and distinctions from the early AIDS epidemic. Finally, we examine United States policies regarding HIV and Ebola in Africa. We conclude with some tentative observations about the relationship between germ panics, law, and public health.

Type: Articles
Information: American Journal of Law & Medicine , Volume 42 , Issue 2-3: Global Infectious Diseases: New Challenges and Solutions , May 2016 , pp. 223 - 255

DOI: https://doi.org/10.1177/0098858816658269 [Opens in a new window]
Copyright: Copyright © American Society of Law, Medicine and Ethics and Boston University 2016

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References

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38 Life, July 1985, at cover.

39 Bruce Lambert, Kimberly Bergalis is Dead at 23; Symbol of Debate over AIDS Tests, N.Y. Times (Dec. 9, 1991); Ohioan is 3d Dental Patient to Die from AIDS Infection, N.Y. Times (July 8, 1993), http://www.nytimes.com/1993/07/08/us/ohioan-is-3d-dental-patient-to-die-from-aids-infection.html.

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42 Ryan White Comprehensive AIDS Resources Emergency Act of 1990, Pub. L. No. 101-381, 104 Stat. 576.

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49 Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance 466 (1994) (observing the statement was met with shock because, “[t]he last time Germany had carried out tattoo-and-quarantine measures on its residents was during World War II … ”).

50 Raymond A. Smith & Patricia D. Siplon, Drugs Into Bodies: Global AIDS Treatment Activism 21 (2006).

51 Sember, Robert & Gere, David, “Let the Record Show…”: Art Activism and the AIDS Epidemic, 96 Am. J. Pub. Health 967, 968 (2006)Google Scholar. Public health practitioners draw a distinction between quarantine, which separates individuals who are suspected of being exposed to a communicable disease, from isolation, which applies to individuals who have been diagnosed with such a disease. See Presidential Commission, supra note 4, at 22-23. So understood, many of the calls for AIDS quarantines were actually calls for isolation. However, public discourse at the time generally did not distinguish between the two practices, as the Helms quote demonstrates.

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56 Id. at 89-90.

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58 Brier, supra note 55, at 85.

59 Id. at 46.

60 Urvashi Vaid, Virtual Equality: The Mainstreaming of Gay and Lesbian Liberation 69 (1995).

61 Pub. L. No. 100-202, 101 Stat. 1329 (1987).

62 Luthuli, supra note 57.

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64 Soto, Michael A. & Cosler, Leon E., Evaluation of Public Health Interventions, in Public Health Administration: Principles for Population-Based Management 512 (Novick, Lloyd F. et al. eds., 2d ed. 2008)Google Scholar. Even as early as the mid-1990s the scientific evidence was suggesting that needle exchange programs could be useful in preventing the transmission of HIV. See Salbu, supra note 63, at 131-49.

65 Health Omnibus Programs Extension of 1988, Pub. L. No. 100-607, 102 Stat. 3048 (1988); Salbu, supra note 63, at 117.

66 Peter Baldwin, Disease and Democracy: The Industrialized World Faces Aids, 180-81 (2005); Smith & Siplon, supra note 50, at 9-34; Siegel, Max D., Lessons from a Plague, 4 Wm. & Mary Pol’y Rev. 292, 310-18 (2013)Google Scholar.

67 Baldwin, supra note 66, at 180.

68 Id.

69 Janny Scott & Marlene Cimons, AIDS Drug Cancer Risk Told; Continued Use Urged, L.A. Times (Dec. 06, 1989), http://articles.latimes.com/1989-12-06/news/mn-70_1_cancer-risk/2 [http://perma.cc/5D3N-EXNY].

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73 Mary Fisher, Messenger: A Self-Portrait 104 (2012); Hancock, Stewart F. Jr., AIDS and the Law, 65 N.Y. St. B. J. 8, 8 (Feb. 1993)Google Scholar.

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75 Leonard, Arthur S., Employment Discrimination Against Persons with AIDS, 10 U. Dayton L. Rev. 681 (1985)Google Scholar. At the time the statute used the term “handicap” rather than “disability”.

76 29 U.S.C. § 794 (2012).

77 Sch. Bd. of Nassau Cty. v. Arline, 480 U.S. 273 (1987).

78 Id. at 282 n.7.

79 Id. at 284. Following the decision, the Justice Department reversed its own earlier position and issued a memorandum ruling that HIV infection was a protected status under the Act. See Memorandum from Douglas W. Kmiec, Acting Assistant Attorney General, U.S. Department of Justice, on Application of Section 504 of the Rehabilitation Act to HIV-Infected Individuals to Arthur B. Culvahouse, Jr., Counsel to the President (Sept. 27, 1988), http://www.justice.gov/sites/default/files/olc/opinions/1988/09/31/op-olc-v012-p0209.pdf [http://perma.cc/WLJ5-M59Q].

80 For example, the Civil Rights Restoration Act of 1987 stated that the “term [handicap] does not include an individual who has a currently contagious disease or infection and who, by reason of such disease or infection, would constitute a direct threat to the health or safety of other individuals…” Pub. L. No. 100-259, 102 Stat. 28, 31-32 (1988). This language limiting the Act’s protection when an individual with an infection creates a “direct threat to others” only makes sense if the individual is otherwise covered by the Act absent the threat.

81 See Parmet and Jackson, supra note 43, at 21-22.

82 Bragdon v. Abbott, 524 U.S. 624 (1998).

83 See generally Drass, Kriss A., Gregware, Peter R. and Musheno, Michael, Social, Cultural, and Temporal Dynamics of the AIDS Case Congregation: Early Years of the Epidemic, 31 L. & SOC. REV. 267 (1997)Google Scholar (making the important point that the legal affirmation of rights for persons living with HIV/AIDS applied disparately to the more privileged and less stigmatized groups who lived with HIV/AIDS. IV drug users, sex workers, and HIV-positive inmates continued to experience negative treatment from the judicial system.).

84 Julia Preston, Obama Lifts a Ban on Entry Into U.S. by H.I.V.-Positive People, N.Y. Times (Oct. 30, 2009), http://www.nytimes.com/2009/10/31/us/politics/31travel.html.

85 The ban was temporarily lifted in 2009 and then reinstated by Congress as part of 2010 budget negotiations. See Public Health and Welfare Act of 1988 and Salbu, supra note 63.

86 FDA, Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products, Guidance for Industry (Dec. 2015). http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM446580.pdf.

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88 See text accompanying notes 248-62 infra.

89 Tomes, Nancy, The Making of a Germ Panic, Then and Now, 90 Am. J. Pub. Health 191, 192 (2000)Google Scholar.

90 The classic exposition on moral panics is Stanley Cohen, Folk Devils and Moral Panics (3d ed. 2002). Sheldon Ungar distinguishes the reactions to emerging diseases from moral panics by noting that the risk presented by emerging infections is real and of unknown magnitude, whereas the risks associated with prototypical moral panics are not real (there were no witches). In addition, Ungar argues that elites play a lesser role in fomenting reactions to EIDs than they do in moral panics. Ungar, Sheldon, Moral Panic Versus the Risk Society: The Implications of the Changing Sites of Social Anxiety, 52 Brit. J. Soc. 271, 282 (2001)Google Scholar. But see text accompanying notes 91-130 infra. Other scholars have found that the reaction in the west to at least some recent emerging diseases has been more muted than panicked. For a discussion of the response to Ebola, see text accompanying notes 135-47 infra.

91 Sontag, supra note 37, at 69-70. See also Humphreys, Margaret, No Safe Place: Disease and Panic in American History, 14 Am. Literary Hist. 845 (2002)Google Scholar; Peter Washer, Emerging Infectious Diseases and Society 127-32 (2010).

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95 Inst. of Med., Emerging Infections: Microbial Threats to Health in the United States (Joshua Lederberg, Robert E. Shope, & Stanley C. Oaks, Jr. eds., 1992).

96 Id. at 47-112.

97 Id. at 53-54.

98 Id. at 39, 77-81.

99 Id. at 113-69.

100 This is reflected by the 1995 launching of a new CDC peer-reviewed journal, “Emerging Infectious Diseases.” See McDade, Joseph E., Potter, Polyxeni, & Peter Drotman, D., Emerging Infectious Diseases: 10 Years Running, 11 Emerging Infectious Diseases, 497 (2005)Google Scholar.

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102 Washer, supra note 91, at 149.

103 Id. at 127. The risks of bioterrorism played a large role in the discourse surrounding the build-up to the U.S. invasion of Iraq in 2003. See, e.g., Judith Miller, Threats and Responses: Biological Defenses; U.S. Deploying Monitor System for Germ Peril, N.Y. Times (Jan. 22, 2003), http://www.nytimes.com/2003/01/22/us/threats-responses-biological-defenses-us-deploying-monitor-system-for-germ-peril.html (noting that U.S. would deploy a national system of environmental monitors to detect anthrax, smallpox and other “deadly germs” as the Bush Administration contemplates invading Iraq).

104 See text accompanying notes 112-20 infra.

105 See Elizabeth Cohen, West Nile Outbreak Largest Ever in U.S., CNN (Aug. 23, 2012), http://www.cnn.com/2012/08/22/health/west-nile-virus/ [http://perma.cc/SDB2-DC2T]; Farnham, Andrea et al., Legionnaires’ Disease Incidence and Risk Factors, 20 Emerging Infectious Diseases 1795 (2014)Google Scholar; Susan Donaldson James, MRSA Outbreak Hits Cheerleaders at New Mexico High School, ABC News (Jan. 11, 2012), http://abcnews.go.com/Health/mrsa-outbreak-hits-students-mexicos-belen-high-school/story?id=15338881; New Mexico Reports 4th Hantavirus Case of 2014, Outbreak News Today (Sept. 17, 2014), http://outbreaknewstoday.com/new-mexico-reports-4th-hantavirus-case-of-2014 [http://perma.cc/PK2N-5BXB]; Oeltmann, John E. et al., Multidrug-Resistant Tuberculosis Outbreak Among US-bound Hmong Refugees, Thailand, 2015, 14 Emerging Infectious Diseases 1715, 1715–1717 (2008)Google Scholar, http://wwwnc.cdc.gov/eid/article/14/11/pdfs/07-1629.pdf [http://perma.cc/JY8X-FQ4V].

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107 See generally, Inst. of Med., The Threat of Pandemic Influenza: Are We Ready? (Stacey Knobler et al. eds., 2005).

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109 Choe Sang-Hun, South Korea: Government Declares End to MERS Outbreak, N.Y. Times (July 27, 2015), http://www.nytimes.com/2015/07/28/world/asia/south-korea-government-declares-end-to-mers-outbreak.html (reporting end of outbreak); WHO, MERS-CoV Outbreak Largest Outside Kingdom of Saudi Arabia (June 2, 2015), http://www.who.int/mediacentre/news/mers/briefing-notes/2-june-2015-republic-of-korea/en/ [http://perma.cc/U3KA-N9VJ] (noting that the index case to the South Korean outbreak had recently traveled from the Middle East).

110 Sabrina Tavernise, Zika Virus ‘Spreading Explosively’ in Americas, W.H.O. Says, N.Y. Times (Jan. 28, 2016), http://www.nytimes.com/2016/01/29/health/zika-virus-spreading-explosively-in-americas-who-says.html; see also Debra Goldschmidt, WHO: Zika Causes Microcephaly and Guillian-Barre Syndrome, CNN (Apr. 7, 2016) http://www.cnn.com/2016/04/07/health/zika-microcephaly-guillain-barre-who/.

111 Jeremy Ashkenas et al., How Many Ebola Patients Have Been Treated Outside of Africa?, N.Y. Times (Jan. 26, 2015), http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html.

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114 David Brown, Military’s Role in a Flu Pandemic, Wash. Post (Oct. 5, 2005), http://www.washingtonpost.com/wp-dyn/content/article/2005/10/04/AR2005100400681.html [http://perma.cc/QP2N-ASYZ].

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117 Id. In response to the threat of smallpox, the government instituted a smallpox vaccination program in 2003. See CDC, Update: Adverse Events Following Civilian Smallpox Vaccination, 53 Morbidity & Mortality Wkly. Rep. 106 (2004)Google Scholar.

118 Inst. of Med., The Smallpox Vaccination Program: Public Health in an Age of Terrorism, 1 (Alina Baciu et al. eds., 2005).

119 Benjamin, Georges C. & Moulton, Anthony D., Public Health Legal Preparedness: A Framework for Action, 36 J. L. Med. Ethics 13 (2008)Google Scholar.

120 See, e.g., The Ctr. for Law and the Pubs. Health at Georgetown and Johns Hopkins Univs., The Model State Emergency Powers Act (Dec. 21, 2001), http://www.jhsph.edu/research/centers-and-institutes/center-for-law-and-the-publics-health/model_laws/MSEHPA.pdf [http://perma.cc/XMV7-P7BT]. For a fuller discussion, see Mariner, Wendy K. et al., Pandemic Preparedness: A Return to the Rule of Law, 1 Drexel L. Rev. 341, 351-65 (2009)Google Scholar; Parmet, Wendy E., Dangerous Perspectives: The Perils of Individualizing Public Health Problems, 30 J. Legal Med. 83, 95–99 (2009)Google Scholar. George J. Annas argues that after 9/11 US policymakers increasingly conflated public health with national security, thereby encouraging the tendency to rely on highly coercive measures. Annas, George J., The Statue of Security: Human Rights and Post 9/11 Epidemics, 38 J. Health L. 319, 321–340 (2005)Google Scholar.

121 Richard Preston, The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus (1994).

122 Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (1994). The genre continues. See Sonia Shah, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond (2016).

123 Priscilla Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative (2007).

124 Randy Shilts presented the genesis of the AIDS epidemic in this fashion, tagging an airline attendant, Gaëtan Dugas, as patient zero and claiming “there’s no doubt that Gaëtan played a key role in spreading the new virus from one end of the United States to the other.” See Shilts, supra note 24, at 439.

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128 Stassa Edwards, From Miasma to Ebola: The History of Racist Moral Panic Over Disease, Jezebel (Oct. 14, 2014), http://jezebel.com/from-miasma-to-ebola-the-history-of-racist-moral-panic-1645711030 [http://perma.cc/CU2T-MZKA].

129 Parmet, Wendy E., Public Health & Social Control: Implications for Human Rights, at 14–18 (Northeastern Pub. Law and Theory Faculty Working Paper Series No. 44-2010, 2010)Google Scholar.

130 Rushton, Simon, Global Health Security: Security for Whom? Security from What? 59 Pol. Studs. 779, 782-87 (2011)Google Scholar (also adding that such policies place disproportionate costs on developing countries, so in effect these countries are asked to subsidize the “health security” of wealthy nations).

131 Kevin Sack et al., How Ebola Roared Back, N.Y. Times (Dec. 29, 2014), http://www.nytimes.com/2014/12/30/health/how-ebola-roared-back.html?_r=0.

132 See e.g., Ungar, Sheldon, Hot Crises and Media Reassurance: A Comparison of Emerging Diseases and Ebola Zaire, 40 Brit. J. Soc. 36 (1998)Google Scholar. Ungar’s research of Western media response to an outbreak in Zaire found that coverage of the “hot crisis” rapidly contained or “othered” the situation, suggesting that the threat was confined to rural Zaire, rather than the West.

133 WHO, Origins of the 2014 Ebola Epidemic (Jan. 2015), http://www.who.int/csr/disease/ebola/one-year-report/virus-origin/en/ [http://perma.cc/UH47-NVUU].

134 CDC, 2014 Ebola Outbreak in West Africa, http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ [http://perma.cc/8KP8-RZ2W].

135 WHO, Factors that Contributed to Undetected Spread of the Ebola Virus and Impeded Rapid Containment (Jan. 2015), http://www.who.int/csr/disease/ebola/one-year-report/factors/en/ [http://perma.cc/3X5M-P2JL].

136 Medicins Sans Frontieres, Ebola in West Africa: Epidemic Requires Massive Deployment of Resources (June 21, 2014), http://www.msf.org/article/ebola-west-africa-epidemic-requires-massive-deployment-resources [http://perma.cc/9F6Y-74U6].

137 WHO, Statement on the 1^st Meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in West Africa (Aug. 8, 2014), http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/ [http://perma.cc/73R6-CKHL].

138 Alan Blinder, Atlanta Hospital Admits Second American with Ebola, N.Y. Times (Aug. 5, 2014), http://www.nytimes.com/2014/08/06/us/nancy-writebol-kent-brantly-ebola-atlanta.html.

139 Google Image Search for “Ebola headline news 2014”, Google Images, http://www.google.com/imghp?hl=en&tab=wi&ei=YAQbVrH-LcX2-AGJn7PwDQ&ved=0CBUQqi4oAQ (last visited Oct. 11, 2015).

140 See, e.g., Mitman, Gregg, Ebola in a Stew of Fear, 371 New Eng. J. Med. 1763 (2014)Google Scholar.

141 Tribune Wire Reports, “Infected Ebola Relief Worker Due to Arrive in U.S. Today, Chi. Trib. (Aug. 1, 2014), http://www.chicagotribune.com/lifestyles/health/chi-ebola-virus-outbreak-20140801-story.html [http://perma.cc/2G4V-LRW5].

142 See Presidential Commission, supra note 4; Abby Haglage, Ebola Panic is Worse Than The Disease, The Daily Beast (Oct. 9, 2014), http://www.thedailybeast.com/articles/2014/10/09/ebola-panic-is-worse-than-the-disease.html [http://perma.cc/WB7L-44E3]; Tara C. Smith, America’s Ebola Panic: What Were the Worst Predictions A Year Ago, and Did they Come True?, Slate (Oct. 6, 2015), http://www.slate.com/articles/health_and_science/medical_examiner/2015/10/ebola_panic_anniversary_predictions_of_a_u_s_epidemic_didn_t_come_true.html [http://perma.cc/E3ST-BNVX].

143 See Figures 2 and 3 for Google Trends related to ALS and prostate cancer awareness, respectively. If Google Trends graphs were around in the 1980s and 1990s, searches for HIV and AIDS might have looked similar. Peaks would likely have occurred around the diagnoses of Ryan White and NBA star Magic Johnson, but in the years prior to Ryan White, we might expect a flat line around zero. By the late 1990s, the peaks would likely have faded as the panic receded.

144 Wainberg et al., supra note 72.

145 Am. Civil Liberties Union (hereinafter “ACLU”) and Yale Glob. Health Justice P’ship, Fear, Politics, and Ebola: How Quarantines Hurt the Fight Against Ebola and Violate the Constitution at 29 (2015), http://www.law.yale.edu/system/files/documents/pdf/Intellectual_Life/aclu_yale_ghjp_-_fear_politics_and_ebola-december_2015.pdf [http://perma.cc/UMH8-B733]. See also Ray Sanchez, Connecticut Girl Barred from School Amid Ebola Fears; Family Sues, CNN (Oct. 29, 2014), http://www.cnn.com/2014/10/29/us/connecticut-school-ebola-lawsuit/ [http://perma.cc/8VMV-JA97].

146 Chris Perez, Ebola Nurse Who Flew on Jet Slams Critics, N.Y. Post (Nov. 6, 2014), http://nypost.com/2014/11/06/ebola-nurse-who-flew-on-jet-slams-critics/ [http://perma.cc/7NJM-A6H9].

147 Id.

148 See text accompanying notes 29-30, supra.

149 Sam Stein, Ebola Vaccine Would Likely Have Been Found By Now If Not for Budget Cuts: NIH Director, Huffington Post (Oct. 16, 2014), http://www.huffingtonpost.com/2014/10/12/ebola-vaccine_n_5974148.html [http://perma.cc/4ZQW-CHBL].

150 Wainberg et al., supra note 72.

151 Thomas M. Burton, Why the Work of Dr. Nancy J. Sullivan Could Be Key to a Potential Ebola Vaccine, Wall Street J. (Oct. 20, 2014), http://www.wsj.com/articles/ebola-vaccine-push-ramps-up-1413762856.

152 Denise Grady, Ebola Vaccine, Ready for Test, Sat on the Shelf, N.Y. Times (Oct. 26, 2014), http://www.nytimes.com/2014/10/24/health/without-lucrative-market-potential-ebola-vaccine-was-shelved-for-years.html.

153 Questions and Answers: Phase 1 Clinical Trials of NIAD/GSK Investigational Ebola Vaccine, Nat’l Inst. of Allergy & Infectious Disease (Aug. 28, 2014), http://www.niaid.nih.gov/news/QA/Pages/EbolaVaxQA.aspx [http://perma.cc/YE82-EEXA].

154 Peter Loftus, Merck Obtains Rights to Experimental Ebola Vaccine, Wall Street J. (Nov. 24, 2014), http://www.wsj.com/articles/merck-obtains-rights-to-experimental-ebola-vaccine-1416845701.

155 Jonathan D. Rockoff & Peter Loftus, Johnson & Johnson to Begin Testing Ebola Vaccine in January, Wall Street J. (Oct. 22, 2014), http://www.wsj.com/articles/johnson-johnson-to-begin-testing-ebola-vaccine-in-january-1413957003.

156 Melissa Hogenboom, Ebola: Is Bushmeat Behind the Outbreak?, BBC News (Oct. 19, 2014), http://www.bbc.com/news/health-29604204 [http://perma.cc/L2DU-GCCT].

157 Agric. and Consumer Prot. Dep’t, Bats as Bushmeat: Implication for Global Public Health, http://www.fao.org/ag/againfo/programmes/en/empres/news_161110.html [http://perma.cc/SEA2-R9CY]; CDC, Facts about Bushmeat (2014), http://www.cdc.gov/vhf/ebola/pdf/bushmeat-and-ebola.pdf [http://perma.cc/S8B2-T2UH] (noting that butchering and processing the meat could lead to spread, but not consumption of cooked or smoked meat).

158 Davtyan, Mariam et al., Addressing Ebola-related Stigma: Lessons Learned from HIV/AIDS, 7 Global Health Action (2014)Google Scholar PubMed.

159 Joaquim Moreira Salles, The 5 Most Irresponsible Things Politicians Have Said about Ebola, Think Progress (Oct. 17, 2014), http://thinkprogress.org/health/2014/10/17/3581298/irresponsible-politicians-ebola/ [http://perma.cc/92YF-TJLX].

160 Id.

161 Wainberg et al., supra note 72.

162 Ted Barrett & Deidre Walsh, Ebola Becomes an Election Issue, CNN (Oct. 3, 2014), http://www.cnn.com/2014/10/03/politics/ebola-midterms/index.html [http://perma.cc/CY34-VJ9L].

163 See Salles, supra note 159.

164 Edward I. Koch, Senator Helms's Callousness Toward AIDS Victims, N.Y. Times (Nov. 7, 1987), http://www.nytimes.com/1987/11/07/opinion/senator-helms-s-callousness-toward-aids-victims.html; Cristina Marcos, Texas Republican Calls for Ebola Quarantine Facility at Dallas Airport, The Hill (Oct. 15, 2014), http://thehill.com/blogs/floor-action/house/220866-texas-republican-calls-for-ebola-quarantine-facility-at-dallas [http://perma.cc/FV6M-AP69].

165 Presidential Commission, supra note 4, at 15.

166 Cuomo, Christie Announce Mandatory Quarantine of Some Returning Travelers, WNYC News (Oct. 24, 2015), http://www.wnyc.org/story/cuomo-christie-announce-mandatory-quarantine-some-returning-travelers/ [http://perma.cc/MP48-25S5].

167 ACLU and Yale Glob. Health Justice P’ship, supra note 145, at 26.

168 Greg Botelho & Michael Martinez, Frustrated Woman Quarantined with Sheets, Towels Soiled by Ebola Patient, CNN (Oct. 3, 2014), http://www.cnn.com/2014/10/02/us/texas-woman-quarantine-ebola-thomas-duncan/ [http://perma.cc/F7N7-TCX5].

169 Hodge, James G. Jr., Legal Myths of Ebola Preparedness and Response, 29 Notre Dame J. L. Ethics & Pub. Pol’y 355, 367 (2015)Google Scholar. For a further discussion of Hickox’s case, see text accompanying notes 204-11 infra.

170 Robert J. Vickers, Ebola Aid Workers Can’t be Trusted, Seattle Times (Oct. 31, 2014), http://blogs.seattletimes.com/opinionnw/2014/10/31/ebola-aid-workers-cant-be-trusted/ [http://perma.cc/3ZM5-HJJ9].

171 Ian Tuttle, Kaci Hickox, Selfish Hero, Nat’l Rev. (Oct. 29, 2014), http://www.nationalreview.com/article/391415/kaci-hickox-selfish-hero-ian-tuttle [http://perma.cc/5PY6-E889].

172 Spencer, Craig, Having and Fighting Ebola — Public Health Lessons from a Clinician Turned Patient, 372 New Eng. J. Med. 1089, 1090 (2015)Google Scholar.

173 Rich Schapiro & Larry McShane, The Gutter, Visited by Dr. Craig Spencer, Declared Free of Ebola, N.Y. Daily News (Oct. 24, 2014), http://www.nydailynews.com/new-york/gutter-visited-dr-craig-spencer-declared-free-ebola-article-1.1986161.

174 See Frank Eltman, Top U.S. Health Official: Ebola Quarantines May Have Unintended Consequences, Huffington Post (Oct. 26, 2014), http://www.huffingtonpost.com/2014/10/26/ebola-quarantine_n_6049370.html [http://perma.cc/MSS5-PH7R].

175 See Order Pending Hearing, Mayhew v. Hickox, (D. Me. Oct. 31, 2014) (No. CV-2014-36), http://courts.maine.gov/news_reference/high_profile/hickox/order_pending_hearing.pdf [http://perma.cc/93YX-VHK7]; Hodge, supra note 169, at 367-68. An argument could be made for quarantining individuals who refused to comply with active monitoring. No such case was reported in the U.S.

176 See, e.g., Dr. Tom Frieden, CDC Director: Why I Don’t Support a Travel Ban to Combat Ebola Outbreak, CDC (Oct. 13, 2014), http://blogs.cdc.gov/global/2014/10/13/cdc-director-why-i-dont-support-a-travel-ban-to-combat-ebola-outbreak/ [http://perma.cc/XA7R-95AK]; Dr. Isabelle Nuttall, Ebola Travel: Vigilance, Not Bans, WHO (Nov. 5, 2014), http://www.who.int/mediacentre/commentaries/ebola-travel/en/ [http://perma.cc/3HT8-QTU7].

177 See text accompanying notes 193-95 infra.

178 See Hodge, supra note 169, at 369-70.

179 Id.

180 Id.

181 See, e.g., David Martosko, So What’s the Point? NYC Ebola Patient PASSED New ‘Enhanced Screening’ at JFK Airport – Only to Fall Victim Days Later, Daily Mail (Oct. 24, 2014), http://www.dailymail.co.uk/news/article-2806532/So-s-point-NYC-Ebola-patient-PASSED-new-enhanced-screening-JFK-Airport-fall-victim-days-later.html.

182 CDC, Update: CDC Ebola Response and Interim Guidance (Oct. 27, 2014), http://www.cdc.gov/media/releases/2014/t1027-ebola-response-interim-guidance.html [http://perma.cc/5XFY-GYJR]. The guidance has been updated several times since, most recently on Oct. 9, 2015, and retired on Feb. 16, 2016. See CDC, Notes on the Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure (Oct. 9, 2015), http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html [http://perma.cc/75U6-5KM7]. For a fuller discussion of the October 2014 guidance, see Gatter, Robert, Ebola, Quarantine, and Flawed CDC Policy, 23 U. Miami Bus. L. Rev. 375, 379-82 (2015)Google Scholar.

183 For this reason, Robert Gatter says “The recommendations in the CDC’s Guidance lack a basis in the science of Ebola transmission.” Gatter, supra note 182, at 378.

184 ACLU and Yale Glob. Health Justice P’ship, supra note 145, at 25-27.

185 See Frieden, supra note 176.

186 To Fight Ebola, West Africa Needs More Doctors and Nurses – Not Money, Huffington Post (Dec. 24, 2014), http://www.huffingtonpost.com/2014/10/24/ebola-doctors-shortage_n_6043286.html [http://perma.cc/VVG5-YWUA].

187 Asgary, Ramin et al., Ebola Policies that Hinder Epidemic Response by Limiting Scientific Discourse, 92 Am. J. Tropical Med. & Hygiene, 240, 240 (2015)Google Scholar.

188 Winston, Susanna E. & Beckwith, Curt G., The Impact of Removing the Immigration Ban on HIV-Infected Persons, 25 AIDS Patient Care & STDs 709, 709 (2011)Google Scholar.

189 Altman, supra note 26.

190 Glantz, Leonard H., Mariner, Wendy K. and Annas, George J., Risky Business: Setting Public Health Policy for HIV Infected Healthcare Professionals, 70 Milbank Q. 43, 43–70 (1992)Google Scholar.

191 Minkoff, Howard & Ecker, Jeffrey, Physicians’ Obligations to Patients Infected with Ebola: Echoes of Acquired Immune Deficiency Syndrome, 212 Am. J. Obstetrics & Gynecology 456, 456 (2015)Google Scholar.

192 Petrow, supra note 5.

193 Jeremy W. Peters, Cry of G.O.P. in Campaign: All is Dismal, N.Y. Times (Oct. 9, 2014), http://www.nytimes.com/2014/10/10/us/politics/republican-strategy-midterm-elections.html. This helped to reinforce broader messages about the President’s competence that were central to the Republican election strategy.

194 Matt Gertz & Rob Savillo, Ebola Coverage on TV News Plummeted after Midterms, Media Matters for America (Nov. 19, 2014), http://mediamatters.org/research/2014/11/19/report-ebola-coverage-on-tv-news-plummeted-afte/201619 [http://perma.cc/H36D-6XTE].

195 Id.

196 Ungar, supra note 132, at 48-52.

197 See, e.g., Mike Stobbe, At 1 Month, Ebola Monitors in U.S. Finding No Cases, Concord Monitor (Nov. 26, 2014), http://www.concordmonitor.com/news/nation/world/14547884-95/at-1-month-ebola-monitors-in-us-finding-no-cases [http://perma.cc/4YAK-TZM6].

198 E.g., Lena H. Sun, Ebola Cases Plummet in Liberian Hot Spot as Aid Groups Gain Community Trust, Wash. Post (Nov. 14, 2014), http://www.washingtonpost.com/national/health-science/ebola-cases-plummet-in-liberian-hot-spot-as-aid-groups-gain-community-trust/2014/11/14/5b2efc18-6b88-11e4-a31c-77759fc1eacc_story.html [http://perma.cc/TA5S-QZPH].

199 See text accompanying notes 119-20 supra.

200 Mariner et al., supra note 120, at 351-65; Parmet, supra note 120, at 95-99.

201 See, e.g., Marc Santora, First Patient Quarantined Under Strict New Policy Tests Negative for Ebola, N.Y. Times (Oct. 24, 2014), http://www.nytimes.com/2014/10/25/nyregion/new-york-ebola-case-craig-spencer.html.

202 Id.

203 See Hodge, supra note 169, at 367-68.

204 Researchers from Yale University and the ACLU concluded that during the outbreak, at least 40 individuals in the U.S. were formally quarantined, and at least 233 individuals either went into quarantine or had their movements severely restricted in the absence of formal quarantine orders. Many of these informal quarantines were effectively coercive in that individuals faced official pressure. ACLU and Yale Glob. Health Justice P’ship, supra note 145, at 29. The researchers found it impossible to determine the exact number of people quarantined, as states did not make that information public. Id. at 27-28.

205 Kate Zernike & Emma G. Fitzsimmons, Threat of Lawsuit Could Test Maine’s Quarantine Policy, N.Y. Times (Oct. 29, 2014), http://www.nytimes.com/2014/10/30/us/kaci-hickox-nurse-under-ebola-quarantine-threatens-lawsuit.html.

206 Id.

207 Order Pending Hearing, supra note 175.

208 Id.

209 Id.

210 Id.

211 Id.

212 See Staiano-Ross, Kathryn, Quarantine, 187 Semiotica 83 (2011)Google Scholar.

213 The opinion can be interpreted as suggesting that fear alone warranted the order for active monitoring.

214 Epstein, Brynn G., The Demographic Impact of HIV/AIDS, in The Macroeconomics of HIV/AIDS 1, 4 (Haacker, Marcus ed., 2004)Google Scholar.

215 CDC, Cases of Ebola Diagnosed in the United States, http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html [http://perma.cc/97JN-MB2H] (last updated Dec. 16, 2014).

216 CDC, supra note 134.

217 World Bank Grp., The Economic Impact of the 2014 Ebola Epidemic (2014), http://openknowledge.worldbank.org/bitstream/handle/10986/20592/9781464804380.pdf?sequence=6.

218 Id. at 2.

219 See Ungar, supra note 6, at 52.

220 Piot, Peter et al., Retrospective Seroepidemiology of AIDS Virus Infection in Nairobi Populations, 155 J. Infectious Diseases 1108, 1109 (1987)Google Scholar.

221 Id.

222 Stoneburner, Rand L. & Low-Beer, Daniel, Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda, 304 Science 714, 715 (2004)Google Scholar.

223 Id. at 716.

224 Gow, Jeff, The HIV/AIDS Epidemic in Africa: Implications for U.S. Policy, 21 Health Aff. 57, 60 (2002)Google Scholar.

225 The World Factbook, HIV/AIDS – Adult Prevalence Rate, CIA, http://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html [http://perma.cc/BD4F-TG5C].

226 Brier, supra note 55, at 79. As discussed above, this ban eventually came to pass. See text accompanying note 235 infra.

227 Id. at 105.

228 Id.

229 Id. at 107.

230 Family Planning and Population Assistance Activities, 48 C.F.R. § 752.7016(b) (1986).

231 Jones, Allegra A., The ‘Mexico City Policy’ and Its Effects on HIV/AIDS Services in Sub-Saharan Africa, 24 B.C. Third World L. J. 187, 194-95 (2004)Google Scholar.

232 Id. at 189.

233 Id. at 199-200.

234 Id. at 209.

235 Jake Tapper et al., Obama Overturns ‘Mexico City Policy’ Implemented by Reagan, ABC News (Jan. 23, 2009), http://abcnews.go.com/Politics/International/story?id=6716958.

236 Id.

237 Brier, supra note 55, at 111.

238 Id. at 115.

239 See John Novak, & Claude Betts, U.S. Agency for Int’l Dev. (hereinafter “USAID”), AIDS Technical Support Program (ATSP) Technical Review, http://pdf.usaid.gov/pdf_docs/PDABN130.pdf [http://perma.cc/K7NE-28CG].

240 Brier, supra note 55, at 115.

241 Id. at 112.

242 Id. at 103.

243 Id. at 115.

244 Id. at 119.

245 Id. at 118.

246 Id.

247 Id. at 119-20.

248 Smith & Siplon, supra note 50, at 53-65.

249 White House Office of Nat’l AIDS Policy, Leadership and Investment in Fighting an Epidemic (LIFE): A Global AIDS Initiative, http://clinton4.nara.gov/media/pdf/2pager.pdf [http://perma.cc/9UAY-U472].

250 Cohen, Jon & Linton, Malcolm, Ground Zero: AIDS Research in Africa, 288 Science 2150 (2000)Google Scholar.

251 Id. at 2152.

252 Harris, Paul G. & Siplon, Patricia, International Obligation and Human Health: Evolving Policy Responses to HIV/AIDS, 15 Ethics & Int’l Aff. 29, 33 (2001)Google Scholar.

253 Id.

254 Id.

255 James, John S., Bush Proposes Near Tripling of U.S. Commitment on Global HIV Epidemic, 388 AIDS Treatment News (2003)Google Scholar.

256 See, e.g., Lawrence O. Gostin, Global Health Law 324-35 (2014) (reviewing criticisms of PEPFAR); Hammer, Peter J. & Burill, Charla M., Global Health Initiatives and Health System Development: The Historic Quest for Positive Synergies, 9 Ind. Health L. Rev. 567 (2012)Google Scholar (discussing governance and structural deficiencies in PEPFAR and other HIV programs); Kavanagh, Matthew M. & Baker, Brook K., Governance and Transparency at PEPFAR, 2 The Lancet – Global Health e13 (2014)CrossRef Google Scholar (discussing lack of transparency in PEPFAR); Leventhal, Ilene, PEPFAR: Preaching Abstinence at the Cost of Global Health and Other Misguided Relief Policies, 24 Temple Int’l & Comp. L. J. 173 (2010)Google Scholar (criticizing PEPFAR for its emphasis on abstinence); Smith, William A., The Politicization of HIV Prevention: The Cynicism of U.S. Assistance to Africa, 35 Hum. Rts. 18 (2008)Google Scholar (offering a human rights critique of PEPFAR).

257 Emanuel, Ezekiel J., PEPFAR and Maximizing the Effects of Global Health Assistance, 307 JAMA 2097, 2097 (2012)Google Scholar.

258 Id.

259 Id.

260 See Gostin, supra note 256, at 146-48, 324 (discussing the Global Fund and its relationship to PEPFAR).

261 The Global Fund, Pledges and Contributions (Dec. 31, 2015), http://www.theglobalfund.org/documents/core/financial/Core_PledgesContributions_List_en/ [http://perma.cc/QLR5-5RAB].

262 Bilimoria, Natasha F., Lessons Learned from a Decade of Partnership Between PEPFAR and the Global Fund: A Case Study from Tanzania, 31 Health Aff. 1415, 1415 (2012)Google Scholar.

263 Id. at 1416.

264 Id.

265 See De Cock, Kevin M. and El-Sadr, Wafaa M., A Tale of Two Viruses: HIV, Ebola and Health Systems 29 AIDS 989 (2015)Google Scholar.

266 See notes 278-79 infra. A full discussion of the limitations of US policy toward HIV is beyond the scope of this article.

267 See, e.g., Champagne, Jennifer M., Access to Essential Medicines in Developing Countries: The Role of International Intellectual Property Law & Policy in the Access Crisis, 22 Alb. L. J. Sci. & Tech. 75 (2012)Google Scholar; Thornton-Millard, Angela G., Intellectual Property Rights and the AIDS Epidemic in Sub-Saharan Africa, 11 Transnat’l L. & Contemp. Probs. 517 (2001)Google Scholar.

268 Some critics argue that efforts that emphasizing HIV/AIDS U.S. global health efforts remain focused on diseases that have the potential to spread to the U.S. and other developed nations, rather than illnesses that burden people living in low income countries. See Rushton, supra note 130, at 782-84.

269 See text accompanying notes 121-24 supra.

270 CDC, Outbreaks Chronology: Ebola Virus Disease, http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html [http://perma.cc/73NR-F5T9] (last updated Feb 17, 2016).

271 Id.

272 Id.

273 Ostroff, Stephen M., Emerging Infectious Diseases in the Institutional Setting: Another Hot Zone, 17 Infection Control & Hosp. Epidemiology 484, 485 (1996)Google Scholar.

274 CDC, Outbreak of Ebola Viral Hemorrhagic Fever — Zaire, 1995, 44 Morbidity and Mortality Wkly. Rep. 381 (May 19, 1995)Google Scholar, http://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm [http://perma.cc/P3D2-KQB3].

275 Nat’l Sci. and Tech. Council Comm. on Int’l Sci., Eng’g, and Tech. Working Grp., Emerging and Re-emerging Infectious Diseases at 16 (Sept. 1995), http://pdf.usaid.gov/pdf_docs/PCAAA688.pdf [http://perma.cc/U4YA-6AE6].

276 Id.

277 Id.

278 Id.at 16-17.

279 Id.at 17.

280 Id.

281 CDC, supra note 270.

282 Containing the Ebola Virus, N.Y. Times (Dec. 4, 2000), http://www.nytimes.com/2000/12/04/opinion/containing-the-ebola-virus.html.

283 USAID, Preparedness and Response (P&R) (Nov. 14, 2014), http://www.usaid.gov/sites/default/files/documents/1864/preparedness-response-factsheet%20(1).pdf [http://perma.cc/TEL7-XM45].

284 Id.

285 The White House, Project Bioshield: Progress in the War on Terror, http://georgewbush-whitehouse.archives.gov/infocus/bioshield/ [http://perma.cc/8LD9-STCY].

286 Rich McManus, President Bush Announces ‘Project BioShield’ at NIH During Visit, NIH Rec. (Feb. 18, 2003), http://nihrecord.nih.gov/newsletters/02_18_2003/story01.htm [http://perma.cc/WJ7A-VT9R].

287 Project BioShield Act of 2004, Pub. L. No. 108-276, 118 Stat. 835, reauthorized by the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, Pub. L. No. 113-5, 127 Stat. 161.

288 Project BioShield II Act of 2005, S. 975, 109th Cong. (2005). This bill was introduced on May 9, 2005 in a previous session of Congress, but was not enacted.

289 Katie Sanders, Stephanie Cutter: Ebola Vaccine Research Was Cut in Half, and More Cuts Are Coming, Pundit Fact (Oct. 24, 2014), http://www.politifact.com/punditfact/statements/2014/oct/24/stephanie-cutter/stephanie-cutter-ebola-vaccine-research-was-cut-ha/ [http://perma.cc/E3DV-KRET].

290 Exec. Order No. 13295, 68 Fed, Reg. 17255 (2003). As noted earlier, this was the period in which lawmakers emphasized the need for public health legal preparedness. See text accompanying notes 119-20 supra.

291 USAID, Emerging Pandemic Threats Program - EPT -2 (2009), http://www.usaid.gov/news-information/fact-sheets/emerging-pandemic-threats-program [http://perma.cc/T2VJ-PKAK].

292 Rushton, supra note 130, at 787-89.

293 See id.

294 USAID, supra note 239.

295 USAID, supra note 291.

296 Pentagon to Mobilize 2,100 to Replace Troops in Ebola Fight, NBC News (Nov. 14, 2014), http://www.nbcnews.com/storyline/ebola-virus-outbreak/pentagon-mobilize-2-100-replace-troops-ebola-fight-n249096 [http://perma.cc/D39W-AHVF].

297 Joel Achenbach & Lena H. Sun, U.S. Ebola Fighters Head to Africa, But Will the Military and Civil Effort be Enough?, Wash. Post (Oct. 25, 2014), http://www.washingtonpost.com/national/health-science/us-ebola-fighters-head-to-africa-but-will-the-military-and-civilian-effort-be-enough/2014/10/25/1ceba6a8-5b99-11e4-8264-deed989ae9a2_story.html [http://perma.cc/4765-VGKW].

298 Andrew Taylor, Obama to Get Most of $6.2 Billion Request to Fight Ebola, Huffington Post (Dec. 5, 2014), http://www.huffingtonpost.com/2014/12/05/barack-obama-ebola-funding_n_6275928.html [http://perma.cc/V9W6-G3NK].

299 Id.

300 Id. In December 2014, Congress approved $5.4 billion of the President’s $6.2 billion request. Sarah Ferris, Ebola Funding in ‘Cromnibus’ Falls Just Short of Obama Request, The Hill (Dec. 10, 2014), http://thehill.com/policy/healthcare/226605-ebola-funding-in-cromnibus-falls-just-short-of-obama-request [http://perma.cc/U5SJ-7DLQ].

301 WHO, Ebola Response Funding, http://www.who.int/csr/disease/ebola/funding/en/ [http://perma.cc/TG6H-TSNG].

302 Grépin, Karen A., International Donations to the Ebola Virus Outbreak: Too Little, Too Late?, 350 Brit. Med. J. (2015)CrossRef Google Scholar.

303 See text accompanying notes 285-92 supra.

304 ACLU and Yale Glob. Health Justice P’ship, supra note 145, at 31.

305 See Presidential Commission, supra note 4, at 5-6.

306 See Davtyan et al., supra note 158.

307 Id. at 2.

308 See text accompanying notes 248-61 supra.

309 Mann, Jonathan M., Medicine and Public Health, Ethics and Human Rights, 27 Hastings Ctr. Rpt. 6 (1997)Google Scholar.

310 E.g., George J. Annas, American Bioethics: Crossing Human Rights and Health Law Boundaries, (2004); Burris, Scott, Kawachi, Ichiro & Sarat, Austin, Integrating Law and Social Epidemiology, 30 J. L. Med. & Ethics 510 (2002)Google Scholar; Chapman, Audrey R., The Social Determinants of Health, Health Equity, and Human Rights, 12 Health & Hum. Rgts. 17 (2010)Google Scholar.

311 For an early discussion of this point with respect to HIV, see generally Lawrence O. Gostin & Zita Lazzarini, Human Rights and Public Health in the AIDS Pandemic (1997).