DECEMBER 15 — More than a year ago, I wrote that the law is an indispensable tool in health promotion and protection, and that public health cannot be effective without laws.
The Prevention and Control of Infectious Disease Act 1988 (Act 342), the principal legislation that provides for the prevention and control of infectious diseases in the country, is “outdated and antiquated”.
Enacted in 1988, Act 342 has remained much the same since.
It was enacted arguably at a time when public health was thought to have conquered infectious diseases. Or as Health director-general Tan Sri Dr Noor Hisham Abdullah puts it, Act 342 was enacted with an epidemic situation in mind, which makes it inadequate for controlling a pandemic in 2021.
But the reemergence of infectious diseases — emerging infectious diseases (EID) — such as Severe Acute Respiratory Syndrome (SARS — 2003), Middle East Respiratory Syndrome Coronavirus Infection (MERS‑CoV — 2014), Ebola Virus Disease (EVD — 2013) and Zika Virus Infection (Zika — 2016) in the last two decades as a major public health concerns has called into prominence law as “an intervention tool to achieve particular public health goals. (see Scott Burris et al, “Making the Case for Laws That Improve Health: A Framework for Public Health Law”, The Milbank Quarterly, Vol. 88, No. 2, 2010 pp. 169 — 210).
The global pandemic of coronavirus disease 2019 (Covid-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the worst EID of the century. This is in terms of incidence and number of deaths.
Only the ‘Spanish flu’ (1918 — 1919) had much higher case-fatality rates and far higher absolute number of deaths. The pandemic caused at least 50 million deaths worldwide, 675 000 of which occurred in the United States. (see Centres for Disease Control and Prevention (CDC), “Pandemic influenza”, 2017. Available at: https://www.cdc.gov/flu/pandemic-resources/index.htm)
But that was at a time when there were very limited countermeasures to mitigate the global spread of or treat infections from the virus, called the 1918 H1N1. There were no diagnostic tests available to confirm infection, no vaccine available to prevent infection, and no antiviral medications that could reduce severity and duration of symptoms.
Critical care measures, such as intensive care support or mechanical ventilators, were also not available. The 1918 pandemic predated antibiotics, leaving those infected with limited treatment options for secondary bacterial coinfections. (see Barbara Jester et al, “100 Years of Medical Countermeasures and Pandemic Influenza Preparedness”, Am J Public Health, Vol 108(11), 2018 pp 1469 — 1472)
This is the new millennium.
SAR-CoV-2 shares about 86 per cent homology with the SARS virus from the SARS outbreak in 2003. The clinical and radiological manifestations of SARS and Covid-19 are very similar. But Covid-19 is much worse than SARS because of its higher reproductive number, and high proportion of asymptomatic infections that amplify the outbreak through silent spread.
Therefore, although the infection fatality rate is lower than for SARS, the overall number of deaths is exponentially higher than SARS. (see Annelies Wilder-Smith and Sarah Osman, “Public Health Emergencies of International Concern: A Historic Overview”, Journal of Travel Medicine, 2020, pp. 1 — 13)
SARS was effectively eradicated in 2003 as a result of rigorous top-down pandemic responses, with in total about 8000 cases and 800 deaths. Covid-19 is — well, how else to describe it — ongoing.
If law is an important intervention tool, then Act 342 of 1988 is — well, how else to describe it — outdated.
The Health DG, alas, has said it too.
“This is an old Act, which has been in use for around 32 years now,” said Noor Hisham said at a press conference yesterday.
“Based on our experience during the Covid-19 outbreak, we feel that Act 342 has to be improved in order for it to be relevant to the current situation and also to technological enhancement,” he added.
Act 342 needs not only improvement, but a transformation — a reform — to become an essential intervention tool for creating the conditions for people to be healthy.
It should reflect at least 3 principles — duty, power, and restraint. First, it should impose duties on the government to promote health and well-being within the population.
Second, it should afford public health authorities ample power to regulate individuals and businesses to achieve the communal benefits of health and security.
Third, it should restrain the government from overreaching in the name of public health. (see Lawrence Gostin, “Public Health Law Reform”, Am J Public Health, 91(9), 2001, pp. 1365 — 1368)
Act 342 needs a wholesome revision, and not just in the form of the Prevention and Control of Infectious Diseases (Amendment) Bill 2021, which was tabled for its first reading in Parliament yesterday. The Bill can be seen here.
This is not to say that the Bill is not needed. It is, and is necessary. It cannot wait to be tabled and passed in the next Parliament sitting, which is six months away because as Noor Hisham said, the provisions — taken from the Emergency (Prevention and Control of Infectious Diseases) Ordinance 2020 which has been annulled — have proved to be effective in curbing the spread of Covid-19 affecting more than 2.6 million Malaysians.
But more than that, our public health law needs to be strengthened to be robust to deal with existing and re-emerging infectious diseases, as well as safeguard public health against EID.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
