Public Health Law Map - Beta 5 - Medical and Public Health Law Site

programs in most health departments. The diminished support for disease control is
exacerbated by the burden of indigent medical care. Although indigent medical care is
a critical community service, it is so expensive and demanding that it saps the
resources of the much smaller preventive programs.
1. Disease Control and the Individual
The price of disease prevention in the group may be injury to an occasional
individual. The fact that polio vaccine prevents thousands of cases of paralytic polio
is little comfort to the rare individual who gets polio from the vaccine. Most
mandatory immunization laws contain exceptions for individuals who have a high
probability of being injured by an immunization. Many of these laws also exempt
persons who have religious objections to immunization. The U.S. Constitution allows
mandatory immunization of religious objectors, but most states do not take
advantage of this power.
The effectiveness of the immunization laws depends on compliance by physicians
and parents. If physicians give medical exemptions to a large percentage of their
patients, the level of immunity in their school system might drop low enough to
support a disease epidemic. The physician might be liable for the results of the
disease in any child he or she exempted improperly. The physician also might be
liable for injuries to children who are not the physician’s patients who would not
have been exposed to the disease but for the physician’s improper behavior.
2. Epidemics and Plagues
The technical meaning of the word epidemic is an “excess of cases of a disease over
the number expected in a given population.” This is an important concept for a
physician who may be required to report any unusual disease or group expression of
disease to the health department. Influenza normally infects large numbers of people
every winter. A few cases of influenza may herald the beginning of the season, but
they are expected. Public health reports on the epidemic may even use the term
“excess deaths.” Only when a substantial number of people are ill and medical
resources are strained does it become an epidemic. In contrast, one or two cases of a
rare disease may constitute an epidemic. The occurrence of a few cases of diphtheria
anywhere in the United States is an epidemic because we do not expect any cases of
this disease.
To most people, the word plague brings to mind images of the decimation of Europe
by the Black Death in the Middle Ages. Plague is not a technical term like epidemic.
It is generally used to describe epidemic disease that is perceived as a disaster for a
community or a specific group. A plague of locusts may be a disaster, but it is not an
epidemic. The potential for disease epidemics that qualify as plagues is ever present.
Many of these diseases appear and disappear without warning or in cycles that are
poorly understood. The sudden appearance of HIV infection is not unusual for a
plague. Bubonic plague goes through cycles that last about 400 years; on this cycle,
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