The Communicable Diseases Act
A new Communicable Diseases Act was accepted by the Riksdag in 2004. The Act enables public authorities to take measures to protect the population from communicable diseases while protecting the individual from unnecessarily intrusive intervention. The Communicable Diseases Act aims at creating a better balance between the population's need for protection and the infected person's integrity and statutory rights.
Why a new Communicable Diseases Act?
From an international perspective, Sweden is in a favourable situation with regard to the spread of communicable diseases. The spread of serious communicable diseases in this country has been limited. For several of the serious communicable diseases, the number of new cases has declined substantially over the past 10-15 years or has remained at a constant level. At the same time, communicable diseases are still among the most common causes of illness and are a serious problem, both for society and for the individual. Sweden must also be prepared to deal with changes in the nature of communicable diseases or their transmission that could once again lead to their posing a serious threat to the population.
The aim of legislation on the control of communicable diseases is primarily to protect the population against communicable diseases while guaranteeing the infected person's protection and support of society. The Act places greater emphasis on voluntary preventive work and on the responsibility of individuals, both those who are infected and those who are not, in preventing the spread of infection. The need for society to support those who are infected so that they are able to take this responsibility is also stressed.
Premises
One of the premises of the Communicable Diseases Act is that the emphasis of communicable disease control must be placed primarily on voluntary preventive measures. Most communicable disease control must apply a voluntary approach. The most effective means of controlling communicable diseases are, first, initiatives such as information on modes of transmission and how to protect oneself and second, medical treatment for persons who are already infected.
Communicable disease control is based on the equal value of all people and the integrity of the individual. Equally important is that communicable disease control must not extend beyond the limits necessary to protect people's health. A modern Communicable Diseases Act must satisfy all reasonable demands regarding individual statutory rights, including limits to the amount of coercion permitted and the conditions under which coercion may be used.
A more realistic and tolerant view of HIV/AIDS is necessary, as well as creating an open climate with regard to this disease. These efforts include avoiding special regulations for HIV infection.
The aim of the new Communicable Diseases Act
There is reason to be more explicit about the purpose of the provisions in the amended Communicable Diseases Act than has been the case with previous legislation. This is why the overall objective and some specific guidelines for communicable disease control are included in the text of the Act.
Aims of communicable disease control
Publicly provided communicable disease control must fulfil the need to protect the population against the spread of communicable diseases.
The focus of the Communicable Diseases Act
The Communicable Diseases Act focuses more specifically on communicable disease control measures targeted at people. Communicable disease control measures aimed at objects or animals will be regulated in their entirety by separate legislation.
Responsibility for communicable disease control measures
The Act does not entail any change, in principle, to responsibility. Responsibility for control measures targeted at people lie with county councils. Measures directed at objects and animals are the responsibility of municipalities and specific agencies.
The County Medical Officer, who has overall responsibility for communicable disease control in the county, will plan, organise and lead activities, promoting efficiency, coordination and conformity. However, responsibility for direct measures to prevent the spread of disease often lies with physicians in charge of treatment and other health and medical care staff.
The National Board of Health and Welfare is responsible for regulations and supervision in communicable disease control and for coordination of activities at the national level. In its role as expert agency, the Swedish Institute for Infectious Disease Control (SMI) is responsible for surveillance and analysis of the distribution of communicable diseases nationally and internationally and proposes measures to ensure that national disease control functions efficiently.
What diseases are covered by the Communicable Diseases Act?
The Communicable Diseases Act applies to all diseases that can be transmitted to or between people and that pose more than a minor threat to people's health. Control measures that may violate the integrity of the individual are reserved for certain specific diseases that are termed "dangerous to public health". However, in emergency situations and providing certain conditions are met, the Government can order that regulations applying to such diseases may be applied to another seriously infectious disease.
Reporting cases of disease
The aim in reporting new cases of communicable diseases is to enable rapid action to be taken and to provide long-term information on the extent of these diseases. This information provides a basis for evaluating communicable disease control and developing strategies for action.
The physician treating the patient should not only submit reports on diseases dangerous to public health but also on certain other infectious diseases that should be monitored. This obligation to report also applies to physicians at microbiological laboratories, those responsible for such laboratories and physicians performing autopsies. The report must be submitted to the County Medical Officer and to the Swedish Institute for Infectious Disease Control.
The rights and obligations of the individual
The rights and obligations of the individual is defined more clearly than previously. All individuals, infected and non-infected, have an interest in, and responsibility for preventing the transmission of infections. All individuals should, insofar as possible, be responsible for adopting reasonable precautionary measures to protect themselves and others from exposure to the risk of infection. At the same time, the person infected with a communicable disease inevitably has the prime responsibility for avoiding exposing others to infection. Anyone who knows or has reason to suspect that he or she is infected with a communicable disease is under an obligation to take the necessary measures to protect others from the risk of infection. An individual infected with a disease dangerous to public health and certain other diseases is required to seek medical attention, undergo examination and submit information to the physician to facilitate contact tracing. When screening for HIV infection, the individual is entitled to anonymity.
Duty to inform
The duty to inform others, if one suspects that one is infected with a communicable disease is extended to apply not only to HIV infections but to all diseases that are dangerous to public health. The basic premise of the Act is that individuals themselves must decide whether they wish to expose themselves to the risk of being infected. Every individual is entitled to information on existing conditions.
Duty to inform means that a person who knows that he/she is infected with a disease dangerous to public health is under an obligation to inform those with whom he/she is in sufficiently close contact for there to be a considerable risk that the infection will be transmitted to the persons in question.
Support for the infected person
By giving support and other help, community services must make it easier for the individual to take responsibility. If necessary to prevent further transmission of the disease, individuals should be offered psychosocial support. When individuals are affected by a disease that is dangerous to public health, they are offered the care and treatment necessary to prevent transmission of the disease.
The responsibility for taking precautionary measures and for informing other people about their disease may be a great burden for infected persons. To support them, the new Act allows scope for infected persons to take up these questions, in an atmosphere of trust, with physicians responsible for their treatment. If the physician considers that, with his or her assistance, the patient would be able to receive the support necessary to change his/her behaviour, the physician may postpone notifying the County Medical Officer of the difficulties discussed by the infected person.
General preventive measures
Different types of preventive action include information, counselling and various measures aimed at preventing individuals from catching a communicable disease, such as vaccination. A prerequisite for enabling infected and infection-free persons to take responsibility is often knowledge about modes of transmission and measures to prevent transmission. This type of preventive action is undertaken by health and medical care personnel, agencies and NGOs.
The focus of efforts directed at controlling communicable diseases must be preventive work undertaken voluntarily. A clause is included in the Act to the effect that county councils must ensure that the general public has access to the information and advice necessary to protect themselves from infections. The Act also states that the County Medical Officer must ensure that preventive measures are taken and that when necessary, health and medical care staff are to inform patients on ways of protecting themselves against communicable diseases.
Contact tracing
The process of finding an infection source and seeking persons who may have been infected - usually termed contact tracing or partner notification - is one of the most important instruments in preventing the spread of communicable diseases. To prevent the transmission of infections, persons who may have been infected must be contacted as soon as possible.
Contact tracing is particularly important for diseases that may be free of symptoms, such as HIV infection, since an infected person has no natural reason for seeking medical attention him/herself. Contact tracing should always be undertaken both for diseases dangerous to public health, and for certain others. The treating physician is responsible for contact tracing, but this may also be undertaken by other health and medical care personnel. The person responsible for contact tracing must notify persons who may have been infected.
