Lawrence Gostin
Georgetown University, Georgetown University Law Center, Faculty Member
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Lawrence O. Gostin is University Professor, Georgetown University’s highest academic rank, and Founding O’Neill Chair... moreLawrence O. Gostin is University Professor, Georgetown University’s highest academic rank, and Founding O’Neill Chair in Global Health Law. He directs the World Health Organization Center on National and Global Health Law. Gostin is Professor of Medicine at Georgetown University and Professor of Public Health at Johns Hopkins University. edit
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The disciplines of medicine and public health are different in their goals and practices (Mann 1997: 6), and this difference is centrally important in the context of human genetics. Medical genetics concerns the clinical decision made by... more
The disciplines of medicine and public health are different in their goals and practices (Mann 1997: 6), and this difference is centrally important in the context of human genetics. Medical genetics concerns the clinical decision made by a doctor to use genetic technology for the ...
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Recognizing marked limitations of global health law in the COVID-19 pandemic, a rising number of states are supporting the development of a new pandemic treaty. This prospective treaty has the potential to clarify state obligations for... more
Recognizing marked limitations of global health law in the COVID-19 pandemic, a rising number of states are supporting the development of a new pandemic treaty. This prospective treaty has the potential to clarify state obligations for pandemic preparedness and response and strengthen World Health Organization authorities to promote global health security. Examining the essential scope and content of a pandemic treaty, this column analyzes the policymaking processes and substantive authorities necessary to meet this historic moment.
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Decision Making, Political Science, Global Health, Diplomacy, General Internal Medicine, and 15 moreMedicine, Disease Outbreaks, Intersectoral Collaboration, Humans, United States, Security Measures, Health Security, World Health Organization, Pandemics, Betacoronavirus, The Lancet, CoVid, SARS-CoV-2, Coronavirus infections, and Medical and Health Sciences
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Development Economics, Philosophy of Agency, Public Health Law, Human Rights, Economic Growth, and 11 morePolitical Science, Law and Politics, International Humanitarian Law, Public Health, Administrative Law, Social Science Research Network, Notice, Health Law and Policy, Disease Control, Control Management, and Pandemic
IntroductionNine events have been assessed for potential declaration of a Public Health Emergency of International Concern (PHEIC). A PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through... more
IntroductionNine events have been assessed for potential declaration of a Public Health Emergency of International Concern (PHEIC). A PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been criticised for being non-transparent and contradictory to the International Health Regulations (IHR). This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO’s legitimacy in future outbreaks.Methods66 EC statements were reviewed from nine public health outbreaks of influenza A, Middle East respiratory syndrome coronavirus, polio, Ebola virus disease, Zika, yellow fever and coronavirus disease-2019. Statements were analysed to determine...
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Dixie E. Snider, Jr. In an ideal society, all public health policies would be based on a plethora of sound scientific evidence and would achieve maximum health impact, impose no risk on individuals, and be cost saving. In the real world,... more
Dixie E. Snider, Jr. In an ideal society, all public health policies would be based on a plethora of sound scientific evidence and would achieve maximum health impact, impose no risk on individuals, and be cost saving. In the real world, these conditions never exist. And, even ...
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Law, Applied Ethics, Public Opinion, Evidence Based Medicine, Politics, and 14 moreScience, Religion and medicine, Public Health, Risk assessment, Health Policy, Medicine, Policy making, Humans, Biomedical Research, Public Health Administration, United States, Information Dissemination, Risk Assessment, and Cooperative Behavior
While the proliferation of human genetic information promises to achieve many public benefits, the acquisition, use, retention, and disclosure of genetic data threatens individual liberties. States (and to a lesser degree, the federal... more
While the proliferation of human genetic information promises to achieve many public benefits, the acquisition, use, retention, and disclosure of genetic data threatens individual liberties. States (and to a lesser degree, the federal government) have responded to the anticipated and actual threats of privacy invasion and discrimination by enacting several types of genetic-specific legislation. These laws emphasize the differences between genetic information and other health information. By articulating these differences, governments afford genetic data an "exceptional" status. The authors argue that genetic exceptionalism is flawed for two reasons: (1) strict protections of autonomy, privacy, and equal treatment of persons with genetic conditions threaten the accomplishment of public goods; and (2) there is no clear demarcation separating genetic data from other health data; other health data deserve protections in a national health information infrastructure. The authors...
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Law, Information Management, Privacy, Political Science, Risk assessment, and 15 moreMedicine, Humans, Disclosure, Genetic Testing, Federal Government, Legislation, Pubmed, Genetic discrimination, Jurimetrics, Exceptionalism, Risk Assessment, Medical Records, Information Privacy, Genetic privacy, and Government Regulation
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Compulsory treatment for drug users is often rejected as neither an effective nor an acceptable exercise of state authority. Recent research studies indicate that compulsory treatment can work and that, if carefully put into effect, it... more
Compulsory treatment for drug users is often rejected as neither an effective nor an acceptable exercise of state authority. Recent research studies indicate that compulsory treatment can work and that, if carefully put into effect, it can represent an important public health component of the response to drug use. Finally, a program of compulsory treatment can be shaped with concerns for due process in mind, so that civil liberties will not be violated.
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Demography, Criminal Law, Civil Rights, Resource Allocation, Public Health, and 13 moreRisk assessment, Medicine, Humans, Federal Government, United States, Patient Rights, Public health systems and services research, Risk Assessment, Behavior Control, Substance-Related Disorders, Personal autonomy, Government Regulation, and Patient selection
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Health services research develops methods and measures to assess the quality of care provided by health plans, hospitals, physician groups, and individual physicians. Recognizing the probabilistic nature of health outcomes, health... more
Health services research develops methods and measures to assess the quality of care provided by health plans, hospitals, physician groups, and individual physicians. Recognizing the probabilistic nature of health outcomes, health services research seeks to separate systematic ...
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This JAMA Forum discusses the harms of Title 42 on health, the lack of public health justification for its use in the US and how it violates international law, and the proposed reforms to promote public health instead of border control.
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This JAMA Forum discusses state-level abortion restrictions and protections, emergency care, abortion medication, and abortion counseling 1 year after the Dobbs decision that overturned Roe v Wade.
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global... more
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholder...
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International Law, Global Governance, Political Science, Global Health, Forecasting, and 9 moreMedicine, Humans, Global Public Health, Health Diplomacy, Public health systems and services research, International Health Regulations, Sustainable Development Goals, Health Priorities, and Health funding
This JAMA Forum discusses key historical landmarks of the World Health Organization and proposes reforms to make the agency the global health leader it was meant to be.
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Demography, Epidemiology, Political Science, Global Health, Politics, and 11 morePublic Health, Medicine, Disease Outbreaks, Humans, United States, Vulnerable Populations, Preparedness, Public health systems and services research, Health Services Accessibility, Population surveillance, and Disaster planning
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This JAMA Forum discusses pandemic drivers and the lessons learned by health systems during the COVID-19 pandemic, including global cooperation, equity, health communication, and childhood vaccinations, and provides 5 steps toward a more... more
This JAMA Forum discusses pandemic drivers and the lessons learned by health systems during the COVID-19 pandemic, including global cooperation, equity, health communication, and childhood vaccinations, and provides 5 steps toward a more secure future with information on prevention, preparedness, response, recovery, and resilience.
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Integral to the Affordable Care Act\u27s (ACA’s) conceptual design is the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. Despite the vociferous... more
Integral to the Affordable Care Act\u27s (ACA’s) conceptual design is the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. Despite the vociferous opposition, the mandate is the most “market-friendly” financing device because it relies on the private sector. Ironically, less market-oriented reforms such as a single-payer system clearly would have been constitutional. It is common sense for everyone to purchase health insurance and thus gain security against the potentially catastrophic costs of treating a serious illness or injury. However, Congress’ method of ensuring that everyone has health insurance is actually novel. It appears that Congress has never before mandated that individuals enter into a contract with a private company. Although some scholars have pointed to precedents—such as the requirement that everyone pay into the Medicare system—these appear distinguishable—in the case of Medica...
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Nearly a quarter century ago, the Supreme Court asked pro-choice and right-to-life advocates “to end their national division by accepting a common mandate rooted in the Constitution.” Nothing of the sort materialized. If anything, the... more
Nearly a quarter century ago, the Supreme Court asked pro-choice and right-to-life advocates “to end their national division by accepting a common mandate rooted in the Constitution.” Nothing of the sort materialized. If anything, the social and political battles intensified, with states enacting 1074 abortion restrictions. The Court has not considered various appeals in the face of an avalanche of legislation, but on June 27, 2016, it struck down 2 onerous restrictions on physicians and clinics offering abortion services. In Whole Woman’s Health v Hellerstedt, the Court found Texas’s requirements that physicians conducting abortions obtain admitting privileges at local hospitals and that licensed abortion facilities meet the standards of ambulatory surgical centers to be unconstitutional. Stephen Breyer, writing for a 5-3 majority, held that the restrictions failed to offer medical benefits sufficient to justify the burdens on women’s access to abortion. This article explores the i...
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Tobacco use kills more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, tobacco-related diseases will kill hundreds of millions more in coming decades, mostly in low- and middle-income countries.... more
Tobacco use kills more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, tobacco-related diseases will kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming healthcare budgets, robbing families of their primary wage earners, and hindering economic development. Tobacco consumption is shifting from industrialized to developing countries, spurred by rising incomes, trade liberalization, and intensive marketing. Although Congress empowered the U.S. Food and Drug Administration to regulate tobacco domestically, the United States has failed to lead globally. The United States is among a small minority of countries that has signed, but not ratified, the World Health Organization (WHO) Framework Convention on Tobacco Control. A tiny percentage of U.S. funding for global health is dedicated to inte...
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This article searches for solutions to the most perplexing problems in global health - problems so important that they affect the fate of millions of people, with economic, political, and security ramifications for the world\u27s... more
This article searches for solutions to the most perplexing problems in global health - problems so important that they affect the fate of millions of people, with economic, political, and security ramifications for the world\u27s population. There are a variety of solutions scholars propose to improve global health and close the yawning health gap between rich and poor: global health is in the national interests of the major State powers; States owe an ethical duty to act; or international legal norms require effective action. However, arguments based on national interest, ethics, or international law have logical weaknesses. The coincidence of national and global interests is much narrower than scholars claim. Ethical arguments unravel when searching questions are asked about who exactly has the duty to act and at what level of commitment. And international law has serious structural problems of application, definition, and enforcement. What is truly needed, and which richer countr...
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The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered,... more
The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and reform the organization to be better able to address the next epidemic. In this Briefing Paper we lay out the present landscape, including reforms needed of the International Health Regulations, and assess the strengths and weaknesses of the outcomes of the 68th WHA, including integrating WHO’s outbreak and emergency response programs; cr...
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A new report by The Lancet-O’Neill-Georgetown University Commission on Global Health and the Law shows how law can fulfill the global pledge of the human right to health, while “leaving no one behind.” I call this “global health with... more
A new report by The Lancet-O’Neill-Georgetown University Commission on Global Health and the Law shows how law can fulfill the global pledge of the human right to health, while “leaving no one behind.” I call this “global health with justice.” We need both health and justice. By global health, I mean ever increasing indicators of good health and increased longevity in all countries around the world. By justice I mean that the global “good” of health must be fairly distributed both within and among countries. The Lancet Commission report offers a comprehensive roadmap towards realizing the law’s power to make us healthier and safer, describing how principles – like fairness, participation, and wielding evidence – can shape policies throughout government. It also vividly illustrates how good governance and the rule of law can advance both health and justice. We tend to think of science and medicine as the major drivers of good health. And, of course, these disciplines are vital to dev...
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Vaccines and drugs to prevent and treat Ebola Virus Disease that have never been tested in humans, and in scarce supply raise profound ethical challenges. What if good evidence emerged demonstrating safety and efficacy of drugs? What... more
Vaccines and drugs to prevent and treat Ebola Virus Disease that have never been tested in humans, and in scarce supply raise profound ethical challenges. What if good evidence emerged demonstrating safety and efficacy of drugs? What would be an ethical method of allocating scarce beneficial resources? The apparent preference given to foreign aid workers over West Africans provoked a firestorm. In addition to discussing the ethical allocation of scarce drugs, this article also asks a more fundamental question: Why did it take nearly 40 years after the first Ebola outbreak in 1976 to launch clinical trials