Although the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster, Homeland Security Secretary Michael Chertoff told policy-makers, government officials, constitutional law experts and law students at a symposium April 11 in Washington, D.C.

"Preparation won't eliminate the problems and the stress, and it is often said that no battle plan has ever survived first contact with the enemy," Chertoff told the roughly 200 people attending the event, "Germ Warfare, Contagious Disease and the Constitution," hosted by Stanford Law School and the Constitution Project, a nonprofit organization.

"But I can tell you this," Chertoff continued. "If you don't have a plan, you are definitely going to have the worst-case outcome. A plan at least gives you a running start."

During the symposium, experts discussed the need to reform the complex web of federal and state laws to enable agencies to respond effectively to deadly natural or manmade epidemics—from pandemic flu to smallpox and aerosolized anthrax—while protecting individual rights.

Earlier that day, about 60 people from the current and two previous presidential administrations, public health officials, Stanford academics and law students participated in a closed-door, fictitious scenario that explored the federal government's response to an unfolding deadly epidemic as it crossed state lines. Lynn Eden, associate director for research at Stanford's Center for International Security and Cooperation (CISAC) at the Freeman Spogli Institute for International Studies, moderated the session, which was developed in cooperation with experts from the Department of Homeland Security.

"I think it's the first time detailed issues of constitutional law have been brought to bear in a natural pandemic or bioterrorism exercise," Eden said afterward. "It's very hard to plan for a catastrophe. This approach brought another facet to bear on disaster planning."

Margaret Hamburg, a former assistant secretary in the Department of Health and Human Services, opened the symposium, which was broadcast live on C-SPAN from the Dirksen Senate Office Building. Kathleen Sullivan, director of the Stanford Constitutional Law Center, moderated a panel featuring Stanford law Professors Pamela Karlan and Robert Weisberg; Christopher Chyba, director of the Program on Science and Global Security at Princeton and a former CISAC co-director; Jeff Runge, assistant secretary in the Department of Homeland Security; Michael Greenberger, director of the Center for Health and Human Security at the University of Maryland; and Martin Cetron, director of the Division of Global Migration and Quarantine at the U.S. Centers for Disease Control and Prevention.

Sullivan opened the panel by reflecting on how recent health crises have informed ongoing legal and policy debates: "West Nile virus. Anthrax mailings. Avian flu—responses to these infectious disease issues and concern about bioterrorism are running about our minds as we think about the response to 9/11 and Hurricane Katrina, and the complex web of local, state and federal authority to deal with such emergencies. What does the Constitution have to say about our ability to deal with infectious disease, whether it's naturally occurring or composed as a weapon of violence?"

In the 21st century, Cetron explained, health officials still rely on a "14th-century toolbox of isolation and quarantine" to control an outbreak. That is "part of our modern reality," he said. "The biggest area is not lack of specific authority, but the fact that jurisdictions are highly complex when it comes to international ports of entry [and] interstate movement. There are often overlapping jurisdictions and overlapping authorities. If there's a gap in some of this, the risk is that neither the state nor the feds would want to step up to that responsibility."

Greenberger said state officials are often ignorant about what they can do in an emergency. "The powers given to governors are extraordinary," he said. Three statutes exist in Maryland to authorize declarations of emergency and allow the governor to enforce isolation and quarantine of infected people, order citizens to take treatment against their will, force doctors to serve in dangerous situations and seize hospitals. "What's extraordinary is that most governors don't even know they have this power," Greenberger said. "The extent of legal illiteracy in this area is shocking."

Despite such challenges, Chertoff praised the participants for tackling the issue. "I think for the first time we've begun to think very seriously and in a disciplined fashion about how to plan for dealing with a major natural pandemic or a major biological attack," he said. "I wish I could tell you these things are unthinkable. But the one thing I've learned in the last seven years is there's pretty much nothing that's unthinkable."

Stanford in Washington

Laura K. Donohue, a CISAC affiliate and a 2007 Stanford Law School graduate who is the inaugural fellow at the Stanford Constitutional Law Center, conceived the daylong event to bring together policy-makers and constitutional experts to discuss response to natural pandemics and bioterrorism. "It was a chance to bring together the policy world, both operational and strategic, and give them the opportunity to talk to legal experts," she said. "This helped policy-makers think through the issues and think outside the box, and it did so in a non-threatening manner."

Donohue said she was prompted to create the symposium after directing a CISAC-supported terrorism-response exercise in 2003 that involved more than 25 agencies at the national, state and local levels. "In these exercises involving first responders, legal issues always got pushed off the table," Donohue said. "I was struck by this. In an emergency, the law goes out the window. Then, when I got to law school, I saw the broader legal and constitutional context for this discussion."

With support from the directors at CISAC and Stanford Law School, and funding from donor Peter Bing and the Stanford Constitutional Law Center, Donohue brought the two groups together in a high-profile setting.

"This was Stanford in Washington," she said. "It was an opportunity for Stanford to be visible at the U.S. Senate with participation from leading people on these issues. There is no doubt we got an audience we wouldn't otherwise have attracted."

This article first appeared in Stanford Report, 4/16/2008.