Will Disease X End Federalism in the U.S.

At the recent World Government Summit, the World Health Organization (WHO) Director-General commented that the planet is "unprepared" for a Disease X outbreak or future pandemics.

While Dr. Tedros Adhanom Ghebreyesus did not comment on how to legally manage a Disease X pandemic, a team of experts shared some keen observations and recommendations.

A Stanford Health Policy (SHP) article by Beth Duff-Brown commented that recent state legal reforms have exacerbated rather than improved weaknesses in U.S. emergency powers, jeopardizing future public health responses.

Rather than enhancing health emergency legal infrastructures, many states have adopted reforms that make them worse, according to new research by SHP's Michelle Mello, JD, Ph.D.

Mello, a health policy and law professor, is the lead author of an analysis published by the BMJ that looks at the legal infrastructure's role in combatting the recent pandemic.

Mello and colleagues examined laws passed by state legislatures addressing the scope of public health powers held by health officials and governors.

Some legal reforms may "contort federalism" in ways that may undermine pandemic responses.

Although the U.S. Constitution grants public health powers to the federal government and the states, the national government can regulate only where it can tie its action to one of the existing federal powers.

The authors analyzed the content of 65 laws adopted in 24 states from January 2021 through April 2023. They found that many imposed important, substantive restrictions on what officials can do to combat health emergencies.

For example, four states adopted new prohibitions requiring vaccines or proof of vaccination.

Some of the procedural checks that states adopted could be helpful; the authors noted—for example, requirements that officials provide explanations for the health orders they issue.

An accompanying editorial in the BMJ notes the nation's pre-existing structural and systematic features contributed to the devastating pandemic outcomes.

Originally published by Stanford Health Policy, a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine, the unedited article was posted on February 12, 2024.

The term Disease X was included for the first time in February 2018 by the WHO Blueprint list of diseases. According to the WHO, Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.