It’s time to reform public health law

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Earlier this year, I wrote that the Infectious Disease Prevention and Control Act 1988 (Law 342) is “much outdated and archaic”.

Law 342 is the main legislation providing for the prevention and control of infectious diseases in Malaysia. Adopted in 1988, it has remained roughly the same since.

It was arguably enacted at a time when public health was believed to have conquered infectious disease. But the re-emergence of infectious diseases – emerging infectious diseases (EIDs) – such as severe acute respiratory syndrome (2003), Ebola (2013), Middle East respiratory syndrome coronavirus infection (2014) and Zika (2016) over the past two decades as general public health issues has highlighted the 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 ongoing global Covid-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the worst SIA of the century. It’s in terms of incidence and number of deaths. Only the “Spanish flu” (1918-1919) had much higher case fatality rates and a much higher absolute number of deaths.

SAR-CoV-2 shares approximately 86% homology with the SARS virus from the SARS epidemic 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 reproduction number and a high proportion of asymptomatic infections which amplify the epidemic by silent spread.

Therefore, although the death rate from infection is lower than that of SARS, the total number of deaths is exponentially higher than that of 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 through rigorous top-down responses to the pandemic, with approximately 8,000 cases and 800 deaths. Covid-19 is – well, how else to describe it – ongoing.

If the law is an important intervention tool, then Law 342 of 1988 is – well, how to describe it otherwise – outdated.

Sadly, the Director General of Health, Dr Noor Hisham Abdullah, has said so too.

“This is an old law, which has been in force for about 32 years now,” Noor Hisham said at a press conference yesterday.

“Based on our experience during the Covid-19 epidemic, we believe that Law 342 must be improved so that it is adapted to the current situation and also to technological improvement”, he said added.

Law 342 does not only need to be improved, but to be transformed – a reform – to become an essential intervention tool to create the conditions for good health.

It must reflect at least three principles: duty, power and restraint. First, it should impose on the government a duty to promote the health and well-being of the people.

Second, it should give public health authorities broad powers to regulate individuals and businesses to achieve collective health and safety benefits.

Third, it should prevent the government from going too far in the name of public health. (see Lawrence O. Gostin, Public Health Law Reform, Am J Public Health, 91 (9), 2001, pp. 1365-1368)

Law 342 needs a complete overhaul, and not just in the form of the Infectious Disease Prevention and Control (Amendment) Bill 2021, which was tabled for first reading in Parliament yesterday. Bill can be seen here.

This does not mean that the bill is not necessary. This is, and necessary, because as Noor Hisham said, the provisions – taken from Emergency (Infectious Disease Prevention and Control) Ordinance 2020, which was rescinded, have been shown 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 must be strengthened to be robust, to deal with existing and re-emerging infectious diseases, as well as to protect public health against new and emerging infectious diseases. – December 15, 2021.

* Hafiz Hassan reads The Malaysian Insight.

* This is the opinion of the author or post and does not necessarily represent the views of The Malaysian Insight.

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