In the four years since the COVID-19 outbreak, we’ve seen a rapid proliferation of legislative attempts to limit foundational public health authorities, especially related to vaccines, including school-entry vaccination requirements. While only a small percentage of these bills were enacted, we continue to see attempts to limit public health measures and authority, including isolation and quarantine powers that extend beyond the scope of COVID-19. At the same time, some states are responding to these attacks by introducing legislation to modernize public health and prioritize foundational public health services and capabilities.

Since 2022, a partnership of public health law organizations has systematically tracked legislation addressing public health emergency authority and vaccination-related measures. For example, the partnership tracked vaccine-related bills between January 1 and May 22, 2023, finding that while 196 bills were introduced relating to school-entry vaccination requirements and provider scope of practice expansions, only 11 were ultimately enacted. This year, the partnership is also tracking bills restricting isolation and quarantine authority and highlighting a selection of bills on foundational public health services, including health department funding and community partnership development, to serve as positive examples for more proactive, equitable, and effective public health authority.

This presentation will detail results from the tracking, including (1) laws impacting public health emergency powers, (2) bills addressing school entry vaccination requirements and expansions to provider scopes of practice, (3) bills restricting isolation and quarantine authority, and (4) bills promoting the adoption of foundational public health services.

The Supreme Court recently announced the arrival of the major questions doctrine and invalidated an EPA rule to address greenhouse gas emissions. Under that doctrine, a federal agency may adopt a regulation of great political or economic significance only if Congress has clearly authorized it to do so. The Supreme Court had previously used similar reasoning to strike down the FDA’s efforts to regulate tobacco products, the CDC’s COVID-19 eviction moratorium, and OSHA’s vaccinate-or-test standard. Last year, deploying the same doctrine, the Supreme Court invalidated the federal student debt relief program. Today, major questions doctrine is one of the several tools that anti-regulatory interest groups have used to challenge various public health policies, including access to abortion, firearm regulation, climate change efforts, and others.

The use of the major questions doctrine is part of a broader legal campaign—including the nondelegation doctrine and efforts to overturn Chevron deference— to curtail the authority of administrative agencies, thus hampering their ability to regulate and address public health issues. These anti-administrative state doctrines are not limited to federal governments. In recent years, there has been an uptick in legislative efforts to roll back deference to expert administrative agencies at the state level.

Given the role the administrative agencies play in public health, including implementing legislative goals through regulation, responding to emergencies, leveraging their expertise to respond to technological advances, and seeking to close gaps in service-delivery, it is imperative that public health law practitioners understand the legal challenges that beset administrative agencies.

Public health measures to protect communities during the COVID-19 pandemic resulted in a significant backlash against the exercise of public health authority and a mistrust in public health and science. Over the past several years, public health agencies have witnessed a waive of enacted laws and judicial decisions that have weakened the authority needed to protect the public’s health. In response, many jurisdiction across the political spectrum have taken action to assess, reimagine and innovate to strengthen their public health’s ability systems, and to regain the trust in public health and science critical to effective protection and improvement of the health of their communities.

This presentation will highlight the most recent examples of public health officials and staff joining with community and governmental partners to evaluate past practices and implement new pathways forward with innovative law and policy. Innovations include more inclusive and transparent public health decision-making, with meaningful opportunities for community participation, a focus on lived experience, and the mandate to address long-standing health inequities. Modernization is underway for public health laboratories and interoperable data systems capable of real time effective disease surveillance and disaggregation of data by race and ethnicity. In a myriad of novel ways, jurisdictions are increasing public health capacity, e.g. through shared services among health departments, and support for the recruitment, capacity and retention of the public health workforce, with reliable, sustainable funding.

The discussion of these successful efforts will provide attendees with inspiration, strategies, and connections for strengthening public health in their respective jurisdictions.

The COVID-19 pandemic produced a tidal wave of litigation challenging public health legal authority at all levels of government. While it is true that, in the majority of cases, challenges to public health legal authority failed, the cases in which they succeeded have created a new environment of uncertainty with respect to the current status of public health authority, and what future changes might be on the horizon.

Since 2020, Public Health Law Watch (PHLW) has been tracking litigation that impacts the legal authority of public health officials to take action in the interest of public health. This presentation will provide an overview of what has changed in the law, what it means for the public health system now, and what potential new challenges may mean for the future. This presentation will discuss PHLW’s plans to continue tracking litigation with the added goal of identifying and analyzing challenges to public health authority at the earliest stages. Early intervention will make it easier to mount successful legal defenses that clearly articulate public heath methods and goals that can build trust in and out of court.

A significant portion of patients with behav­ioral health care needs enter U.S. hospitals, urgent care clinics, and other health care facilities each year. Many of these facilities lack procedures and resources for responding to behavioral health emergencies, and thus the presence of these patients leads to increased rates of violence, putting health care workers and other patients at risk. Attempts to resolve this problem through police intervention and proscribing increased criminal penalties for violence against health care workers have proven ineffective, as many patients experiencing behavioral health emergencies lack the requisite intent required for criminal prosecution or awareness for increased penalties to function as an effective deterrent. Likewise, when police are called to intercede, patients are often arrested and incarcerated without ever receiving the treatment they need, leading to a vicious cycle of recidivism and neglect, and putting strain on the public health infrastructure. Laws requiring health care settings to have Behavioral Health Emergency Response Teams (BERTs) comprised of appropriate staff available and trained to respond to patients who may experience behavioral health emergencies can be used to break this cycle. This presentation will review research regarding BERT composition, alert procedures, and responses, and compare the efficacy of BERT responses to criminalization and police enforcement. It will then review legislative efforts regarding BERTs in health care settings, focusing on CA Assembly Bill 1001 (Haney), and outline the legal framework required to make BERTs successful. The intended audience is public health professionals without legal expertise and public health policy professionals.