The Role of Federalism in Pandemic Disease

As the pandemic disease continues to be an ongoing threat to America, we must formulate the most effective response possible to alleviate the fears of the public, avoid mass hysteria, and provide relief to the American economy. Another primary goal is to ensure the health and safety of their citizens and prevent further death and illness. Social distancing as a government enforcement, for instance, is the curtailment of civil liberties rather than full citizen lockdown. A very different response from the public and the economy is formed when full quarantine on a national level is applied. The public health leaders and government leaders must unite to create awareness of highly coercive measures and the ramifications of their decisions. In compliance with the protection motivation theory, people may overact, create major concern, and strengthen mass hysteria as the disease spreads. Therefore, the federal government must acknowledge and act in more consideration of fear and civil liberties during pandemic crisis. Cognizant leadership is necessary and requires a close look at the economic consequences of their actions. Federal leadership must also work efficiently across federal and state lines.

In instances of pandemic diseases, the United States has not explicitly defined roles in the government on emergency preparedness (Howell, 2020). There are some federally suggested positions where the Federal Emergency Management Agency (FEMA) and the National Security Council are tasked with some response, but there are no specific instructions laid out in constitutional terms. Our constitution is very limited and does not apply to many things. In the place of constitutional guidelines, the executive government has prepared a “playbook” formed from past pandemic precedents to “assist U.S. Government experts and leaders in coordinating a complex U.S. Government response to a high-consequence emerging disease” (National Security Council, 2016). Each section of the playbook answers a different series of questions that should inform the decisions of federal leaders at every level of the disease spreading. The pandemic playbook, formed from past precedents, was formed to assist the U.S. government and leaders in formulating and coordinating policies and responses to emerging infectious diseases (National Security Council, 2016). However, when the COVID-19 pandemic began to emerge as a threat to U.S. citizens, the Trump administration failed to provide a unified response, broadcasting conflicting messages at both a federal and state level. Public health advisors continue to speak out about the importance of self-isolation, while executive leaders are discussing lifting federal bans on social distancing. The “playbook” was even deemed not a part of the current coronavirus strategy. But why have a document that lays out the rules if no one enforces or sets laws in place to utilize them? The playbook urges unification at a state and federal level, but our American reality during COVID-19 is acting far different than predicted. The answer is in part due to our constitution. The president has power over Health and Human Services and the Centers for Disease Control and Prevention (CDC) and can choose whatever guidelines he wants without legal or legislative consequence.

America does have some preparedness plans but none with such great detail that has prevented the mass casualties and economic despair the COVID-19 pandemic has brought. During the instance of the COVID-19 pandemic, state and federal are tested to an extent never seen before. Specifically, through the Commerce Clause, the power and authority can be granted to Congress to propose public health measures and quarantine restrictions. However, the Public Health Service Act also authorizes the secretary of Health and Human Services to lead federal public health responses. The 10th amendment also gives states the authority to take public health emergency actions within their own state jurisdictions. Therefore, emergency laws can vary by state. Under the presidency of Donald Trump, some claim he has power under the Commerce Clause to invoke national quarantines and public health emergency restrictions. The executive branch should have a clearly defined role to play and procedures to follow because the president has so much power. The role should be providing support to the states and acting as a figurehead of unification. There should be a procedure, like the pandemic playbook, where decisions are made based on the level of threat and set in place. This new and updated “playbook” would make sure necessary precautions are made and ensure there is no confusion. The primary goal of it would be to ensure healthy citizens and make a healthy path to recovery with clear hierarchy of decision-making, which our current system lacks. President Trump’s relief effort, for instance, aimed to provide relief for small businesses has not been deemed “a tremendous success” or “executed flawlessly,” which he boasts at his COVID conferences toward the American public. The bill holds major flaws bailing out large corporations and saving local businesses, serving rather as a gradual “stepping stone” in assuring financial assistance than complete relief.

It is important to recognize that diseases are a geographically confined issue, meaning there are different levels of disease contraction and risk depending on location. Although pandemic disease is a global issue, the necessitation of supplies and concentrations of the disease vary, demanding a different response from an epidemiological stance to different areas (Howell, 2020). For instance, during the COVID-19 pandemic, there is a higher volume of disease and death in New York, with over 200,000 confirmed cases compared to Wyoming with less than 250 confirmed cases. There is more demand for governmental assistance in New York as it has a higher level of disease on a geographical level. There is a gravitational pull down to the lower level of authority. It is rare in a public health crisis to have a national response because the situation is rare and because this is constitutionally structured according to our federalist system. Even when we have had federal responses, such as H1N1 and SARS, enumerated powers were not defined. Because emergency preparedness and the relationship between federal and state powers are not explicitly enforced in government documents such as the Constitution, the public debates the balance which the president and governors are to follow (Howell, 2020).

Past precedents of pandemic disease have rather ushered a limited framework to follow. FEMA, for instance, stresses the local quality of disasters, like natural disasters. The organization discusses the role of the federal government being there to support local organizations rather than create a new federal approach from scratch. In a similar way, FEMA’s pandemic template “provides guidance to assist organizations in developing a pandemic plan. Guidance and sample information is provided for reference and organizations are encouraged to tailor Pandemic Influenza Continuity Plans to meet specific organizational needs and requirements” (Federal Emergency Management Agency, 2006). Therefore, the decision made on both a federal and state level must be carefully produced, calculating the correct path based on the contrasting geographical needs and human nature itself. There are situations when federal decision-making is necessary during pandemic disease crisis. The federal government should lend its support to the state level of powers in order to provide a cohesive response to a pandemic crisis. With the current COVID-19 pandemic, there is limited inherent authority as president to manage public health crisis or deliver ventilators. Sometimes, the courts have allowed the executive office to take emergency actions without Congressional approval. The laws in this area are very enigmatic. For the president to take the lead in action during a pandemic crisis would be a last resort. The presidential “powers under pandemic disease do not substitute for essential vigorous actions by state and local governments” (Farber & Bell, 2020). The power that the president has during times of pandemic disease is the authority under Article II of the Constitution that comes from declaring a national state of emergency. There are not “any clear answers here, and the result could turn on the direness of the situation and the compelling need for the actions taken by the President” (Farber & Bell, 2020). But governors such as Governor Cuomo, the governor of New York, demanded President Trump use his power to instate the “Defense Production Act” in response to production needs. Governor Cuomo’s response to Trump’s refusal to sign the act into action echoed the disappointment and irritation present in many Americans. “I look at actions, not words” he states. “They’re doing the supplies? Here’s my question. Where are they? Where are the ventilators? Where are the gowns? Where’s the PPEs [personal protective equipment]? Where are the masks? Where are they? Where are they if they’re doing it?” (The Associated Press, 2020). His frustration with the federal government’s lack of support toward states is evident in this excerpt. The lack of ventilators and supplies becomes a prioritizing issue for the federal government to handle. Whereas a state-level official does not have the power to demand and create supplies, a federal official does. This is where FEMA’s definition of acting as support for the state governments is invoked. The federal government should aim its focus to help and provide support to the local governments rather than starting a new federal plan. This is because local governments know the area well and can predict the needs of the community more accurately in line with the protection motivation theory.

Benefit Analysis of an Interconnected World

There are moral and ethical concerns about the participation of the workforce and trade—not only how the participation of the workforce contributes to the economic recession but how it serves as a direct connection to other factors of the economy such as keeping children from school, reduction in inbound international travel, reduction in outbound travel/leisure activities, and reduction of transportation use (Prager et al., 2017). Pandemics would not occur if the world weren’t inter-connected, but also there would not be global trade that could shut down. In instances of global panic surrounding disease, consumerism is the first aspect of human culture to suffer. People stop spending on unnecessary products and services, such as eating out at restaurants and supporting small businesses. Fear stigmatizing foreign trade and its role in spreading disease strain trade relationships, as do the tweets from President Trump that blame China for the matter. This raises ethical concerns about the role a president as a figurehead plays during pandemic crisis and whether Trump is the correct person for easing the public’s fears and sustaining relationships with other countries. Unprofessional actions such as using Twitter as a mode of addressing major citizen and U.S. concerns lends citizens to question the reliability of their executive administration, heightening levels of fear due to the protection motivation theory.

During pandemic disease, it is difficult for the public to work, difficult to find a job, and hard for businesses to prosper as citizens are forced to stay inside. However, there is a class dimension to this concept. Wealthier people will find it easier to work from home and have spacious and accommodating spaces. Poorer communities, on the other hand, are in closer units and sometimes forced to be on the front lines to be working in menial labor jobs. When looking from a standpoint of an economist, the data interconnects when a person analyzes the demographic of who is contracting the COVID-19 disease. There is a differential impact on different races. According to the Illinois Health Department, “African Americans in Illinois, for example, accounted for 29% of confirmed cases and 41% of deaths, yet they make up only 15% of the state’s population” (Cooney, 2020). The issue of pandemic disease as a human right can be far more multifaceted than originally presented. African Americans may be contracting the disease at a higher rate than other races due to the racial wealth gap in the United States. Poorer communities lack the resources and education to prevent the spread of those diseases. Mortality and morbidity rates in association with pandemic disease correlate to socioeconomic status. Therefore, forced quarantine orders can be viewed as a racial dilemma as well as an economic one. The disparities are stark in cities where high concentrations of American Americans live. According to the Economic Policy Institute, “Only 20% of black workers reported being eligible to work from home, compared with about 30% of their white counterparts.” Many African Americans are more susceptible to the disease because they live in medically underserved areas and cannot economically compensate to work from home. It is necessary to improve health and wealth issues in these community-wide so that they are not disproportionately affected during times like pandemics. The suggestion of Universal Basic Income (UBI) programs may reduce health disparities by making sure every single person is granted money that would help them live above the poverty line. “UBI could be set at a level to ensure that everyone’s basic needs are met. This would reduce much of the stress faced by the working poor or families on benefits” (Smith, 2020). Smith claims that the UBI trials should measure health outcomes and the improvements associated with it. Cost-saving of the improved health outcomes, especially with mental health, would outset the cost of creating a universal income system. People are suffering under social distancing orders in both an economical sense and due to health disparities. A reduction of health disparities would lower stress and risk of fear, and according to the protection motivation theory, would likely reduce a pandemic’s negative effects. Human rights and economic considerations need to be made in order to inform the decisions to reopen the nation. Sometimes, the gap between human intention and human behavior in times of crisis makes results hard to predict. However, studies have formulated a predictable human response replacing the way one handles decision-making and policy formation. Pandemics “can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth” (Madhav et al., 2017). The comparison between past pandemic crisis and the downfall of global economies highlights the threat of disease as a major contributor, creating public fear which affects policies and the consequential actions of humans. Past precedents set by the SARS pandemic, the ongoing coronavirus pandemic, and the 2008 financial crisis serve as examples to be examined in relation to federal decision-making, economic recessions, and predictions of human behavior. As businesses start to fail under stressful conditions, investors pull their money and lose faith in these companies. Therefore, the GDP and stock markets start to lower at unprecedented levels. Studies of past pandemics in association with the economic conditions coupled with “stock-market history shows that investors do react to epidemics and pandemics. However, other issues also affect markets and, in common with victims of the diseases, market performance will also depend on the strength or weakness of prevailing conditions. For example, “the avian flu epidemic of 1997 coincided with the Asian crisis, and preceded the Russian debt and LTCM crises of 1998” (Fidelity International, 2006). Goods, services, and people can travel more easily in a globally connected world. Disease can spread more swiftly because of this, but also knowledge can spread more easily as well. Technology and trade act as a “double-edged sword” in terms of pandemic disease because with good knowledge other countries can prepare once there is an outbreak, coordinate with each other to help, and minimize the negative effects. When economic discourse under pandemics occurs, the United States’ reaction and policies are important to rebuilding the economy. With the collapse of the United States’ economy, effects reverberate on other countries due to the recession. The United States plays a major role in trade and consumerism in the world; therefore, recession would have a considerable negative impact on other parts of the globe. The United States must rework its emergency health policies to incorporate economic aspects, placing an emphasis on the role of fear in decision-making in order to avoid recession. With the development of the coronavirus pandemic, the United States must be prepared to plan and respond to the economic ramifications associated with an emergency response. Pandemic disease raises “an issue that economists have long grappled with: How can a society assess the trade-off between economic well-being and health?” (Porter & Tankersley, 2020). Diseases and viruses attacking at a mass scale have posed a theoretical threat, for public health and economic reasons, to the United States for decades (Prager et al., 2017). An evaluation of past epidemics and their responses such as SARS and influenza can provide insight on the complete economic and social ramifications of pandemic disease, and applying the protection motivation theory, we may be able to predict human behavior and minimize mass hysteria surrounding the pandemic. The protection motivation theory discusses the “efficacy of a protective response” but not the cultural and national implications of things like being to be told to stay home. Stay-at-home orders decrease the immediacy of the threat and catalyze anger as it decreases the threat that would increase fear. Angry protests such as those occurring in Michigan due to COVID-19 apply the protection motivation theory to both the disease and the steps we take to solve the disease. Citizens would be more hysterical if the stay-at-home orders were not put in place and the pandemic disease magnified on a rapid level. By applying the “protection motivation theory,” a calculation on whether fear would be higher with either stay-at-home orders or less government intervention can be made. Stay-at-home orders reduce the predicted pandemic’s level of noxiousness and the probability of the disease spread. However, the efficacy of a protective response can be interpreted in many ways. From an epidemiological standpoint, orders to isolate from each other stop the spread of disease and are very effective in managing levels of control. From a civil liberties standpoint, orders for self-isolation violate human rights as a need and can highlight the stark health disparities in America. Even though the efficacy of a protective response is questionable in its role in pandemic disease government orders, the decisions are effective in the other two areas of fear reduction when compared to what would happen with no set rules in place.

Civil Liberties as a Threat to Order

When civil liberty issues and public health interests’ conflict, the federal government should act as a consoling figurehead for citizens to follow. The United States government should have a clear and concise plan of how citizens should approach COVID-19 as case rates increase. A more direct power of authority and unified approach between Congress, States, and the Federal government leads to more efficient handlings of protocol. Therefore, mass confusion and questioning of authority would be reduced. The United States federal government should implement phases similar in nature to the Australian government’s COVID-19 protocol, which have numerical data to support the implementation of the restriction.

Congress and the president must work together to delegate supplies and provide an assurance of human rights. It is the job of leaders to decide which solution provides the most positive impact with the least number of detrimental effects. For instance, with an outbreak, inmates in jail are in close quarters, and the mechanisms in pandemics are not supplied first to inmates. Without basic materials such as soap, it would necessitate putting every inmate, despite their level of crime, in solitary confinement as a precautionary public health measure. Full solitary confinement for a low-level crime would not ethically stand (Sharfstein, 2020). A proposed solution would be to reduce the prison population. But morally letting prisoners out into the public would create fear, lose money for prison companies, and have multiple other consequences (Sharfstein, 2020). This scenario shows a solution does not necessarily stand without its consequences, but it is the job of leaders to decide which solution provides the most positive impact with least number of negative outcomes. But most prisons are run at the state level: there are 122 federal prisons and 1,719 state prisons. By the mentality presented here, the governors of the states have the most discretion in these matters to deal with the incarcerated.

The line between infringing on the individual rights of citizens and protecting the health of citizens is very blurred and difficult to define. Exploring the different possibilities toward managing fear on national and state levels may help formulate a correct national response. A strong and forceful approach in the early stages of disease progression is a very sound approach to pandemic disease. The World Health Organization (WHO) agrees with this approach, suggesting phases of recommended actions to reduce the spread of disease. The phases include “planning and coordination, situation monitoring and assessment, reducing the spread of disease, continuity of health care provision, and communications” in order to maintain “to and build public trust in public health authorities before, during and after an influenza pandemic, to support coordination and the efficient use of limited resources among local, national, regional and international public health partners, to provide relevant public health information to the public, to support vulnerable populations having the information they need to make well-informed decisions, to take appropriate actions to protect their health and safety; and to minimize social and economic disruption” (World Health Organization, 2008). If the government takes control early on, mass hysteria can be prevented and overall fear among the general public would be reduced. A reduction of fear, based on the protection motivation theory, would equate to a decrease in economic ramifications and would therefore shorten the necessary infringement on citizens’ civil liberties (Plotnikoff & Trinh, 2010).

Our government was founded upon the principles of freedom and civil liberties; however, there are laws that allow the limitation of civil liberties during times of national crises. National security should be weighed in higher consideration than human rights. Human rights need to be addressed after the mass hysteria and panic are controlled in order to provide the optimal path toward recovery—a state of emergency qualifies a state of necessary measures. The risk of disease and the heightening of fear shift the value that citizens equate to their freedom. We should rely on our government’s abilities to not completely undermine all civil liberties, and if they were to infringe on these rights, it is for the sake of stopping the spread of disease. We should not let this fear cloud our decision-making and instead look at the situation rationally before protesting or disagreeing with governmental steps of disease prevention. Investment in an emergency may not have immediate gratification and effects because pandemics are rare occurrences, but they help lessen the burden when disasters do occur (Madhav, 2017). Due to the myriad of factors that contribute to the negative impacts of pandemic disease, it is difficult to pinpoint a correct evaluation and solution to the problem of heightening fear and downfalls of the economy. But this study provides insight on preparation and how we must emphasize public health and emergency preparedness in our governmental spending. We should have heavy funding on vaccination developed, we should heavily emphasize public health education in our American school system, and we should allocate more money for emergency preparedness and supplies before events like COVID-19 occur.