"Canada's experience with SARS outlines the challenges of such constitutional division of powers when it comes to managing public health crises," says the team, led by Dr Kumanan Wilson of the University of Toronto's Joint Centre for Bioethics.
In Canada, the management of outbreaks falls under provincial jurisdiction and the transfer of data on outbreaks from the provinces to the federal government is voluntary. This situation hindered the federal government's ability to obtain data on SARS from the Province of Ontario and to effectively communicate the status of the outbreak to the World Health Organization (WHO).
In the aftermath of SARS, and in anticipation of avian flu, the international health community has recognized that pandemic planning and response is an inherently multi-governmental concern. This concern is reflected in the WHO's newly revised International Health Regulations, which originally date back to the nineteenth century when cholera epidemics overran Europe, and which are intended to ensure maximum global security against the international spread of disease.
The fragmentation of powers within federations, say Dr Wilson and colleagues, could make it difficult for them to comply with the new regulations, which include very detailed requirements for countries to report information to the WHO. All WHO member nations are required to notify the WHO "within 24 hours of assessment of public health information, of all events which may constitute a public health emergency of international concern within its territory."
Yet, say Dr Wilson and colleagues, federal governments may not have the authority to collect the data necessary for such reporting, while regional governments may have many reasons to keep such data to themselves--including concerns about the impact of disclosure on their economy and aversion to federal scrutiny.
It is apparent, say the authors, that this "federalism dilemma" will need to be addressed, both by WHO member nations and by the WHO itself, if the revised International Health Regulations are to be implemented successfully.
Citation: Wilson K, McDougall C, Upshur R, the Joint Centre for Bioethics SARS Global Health Ethics Research Group (2006) The new international health regulations and the federalism dilemma. PLoS Med 3(1): e1.
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