Pandemic legislation in the European Union: Fit for purpose? The need for a systematic comparison of national laws.

Sound governance is central to effective pandemic management. Key international legal instruments governing pandemic management in the European Union (EU): the International Health Regulations (2005) and Decision 1082/13 require EU Member States to develop national plans and invite them to establish national legal frameworks to support compliance with this international legislation. Although Member States may design the legal framework as they choose, the strongest instrument of pandemic governance is national legislation. It is currently unclear what national pandemic governance exists in Member States as it has not been mapped, i.e. identified and collated. Legal analysis and empirical evaluation of implementation and impact have therefore not been possible. We propose comprehensive mapping to create the necessary comparative data for legal analysis assessing national legislation's compliance with international obligations and ethical principles. Empirical research could evaluate its effectiveness in promoting cross-border coherence and robust emergency response. We draw on the U.S. experience with "policy surveillance", the systematic scientific mapping of laws of public health importance. Until national pandemic governance is mapped and evaluated, we cannot know if it is lawful, ethical or effective

Gabriella Berki, Free Movement of Patients in the EU-A Patient’s Perspective

The right of EU citizens to receive health care in other Member States, paid by their home country, is a valuable benefit, capable of greatly improving the quality of life of those who use it, but involving legal complexity, cumbersome processes, and inequalities. Gabriella Berki’s book, which originated as a doctoral thesis, examines these flaws with the aim of identifying how ‘European cross-border patient mobility legislation can be improved in a way that better serves patients’ interests while respecting the responsibilities of the Member States in this field’ (p x). Dr Berki is now an Assistant Professor and lecturer at universities in Hungary, France, and Croatia, so she brings a useful pan-European..

The immediate futures of health law after Brexit: Law, ‘a-legality’ and uncertainty

The European Union (EU) is a rules-based international organisation with an exceptionally dense legal system. Likewise, the ways in which EU law has effects in domestic law are determined by (constitutional) law. The legal rights and obligations entailed for state and ‘third sector’ entities, companies and human beings of some 45 years of membership have had significant effects on domestic health law across the United Kingdom, even though health per se is a national competence. That said, the EU’s relationships with national legal orders are also determined by the politically possible. We therefore sketch the key legal questions for UK health law, and health law in each of the ‘devolveds’, in two possible immediate post-Brexit futures. By immediate future, we mean after 29 March 2019, the date on which the Article 50 TEU notification period ends. It will not be possible to answer these legal questions until the politics have crystallised into legal texts, which is not the case at the time we write. We go on to argue that the ways in which UK health law, policy and practice are currently determined by the UK’s membership of the EU, coupled with the short time frame within which the future EU-UK relationship must be determined, mean that law may be expected to be less of a determinant in immediate post-Brexit futures than it is at present. Our principal conclusion is that the uncertainties that surround the process of Brexit mean that at a level of specific policy and practice, such as in areas of health law, we might expect a period of ‘a-legality’, where the legal position of actors does not necessarily determine or explain their actions

Are We There Yet? In-Flight Food Safety and Cabin Crew Hygiene Practices

Amid the rapid expansion of global air traffic, aviation food safety is a critical issue (Huizer, Swaan, Leitmeyer, & Timen, 2015). More than 1 billion in-flight meals are served annually (Jones, 2006) and the aviation catering market is expected to be worth $18 billion by 2021 ("Global$18 billion in-flight catering services market," 2017). Food served on planes is prepared in industrial kitchens close to airports and then transported to planes where it is stored, reheated, and served. The process is complex, with many opportunities for food contamination. Although food preparation on the ground is subject to considerable regulation at both the national and international level, similar rules do not apply to food served in-flight. Airline caterers might need to comply with local food safety regulations, those of the country of the aircraft registration, those of the destination country, and international food safety guidelines (Solar, 2019). While there are greater challenges to ensuring in-flight food safety, we argue that the same food safety principles used in establishments "on-ground" should be applied to in-flight food services. This guest commentary considers one key factor of in-flight food hygiene: the availability of hand washing facilities for cabin crew

In-flight transmission of foodborne disease: How can airlines improve?

Food contamination during air travel presents unique risks to those affected. Foodborne pathogens can cause serious illness among all on board, and potentially jeopardize flight safety. These risks are likely to increase with current trends of “densification” and a predicted massive expansion of air travel. While aircraft are being equipped with ever newer designs with a focus on efficiency and comfort, regulations remained largely unmodified in terms of basic hygiene requirements. Strict guidelines for food hygiene exist for on-ground food settings and catering kitchens. There is uncertainty about hygiene standards on board commercial aircraft, and little regulatory oversight of what happens to food in-flight. In two hypothetical scenarios we indicate the potential risks associated with poor food handling practice onboard aircraft, with the ultimate aim of bringing aviation food safety in line with on-ground regulations. Changes in cabin design alongside adequate training in safe food handling have the potential to increase public health protection. We urge a review of existing in-flight hygiene protocols to better direct the development of regulation, prevention, and intervention measures for aviation food safety

Charging ‘overseas visitors’ for NHS treatment, from Bevan to Windrush and beyond

This paper explores the development and operation of law and policy concerning the charging of overseas visitors for healthcare in England from the beginnings of the NHS to the present day. It highlights how this has been a highly contentious issue for decades, often linked with immigration policy, and is an area that still lacks comprehensive reliable empirical data to inform the debate. It explores and analyses the recent reforms to the NHS Overseas Charging Regulations introduced in 2015 and 2017. It demonstrates the problems in implementing the most recent regulations in an era of the ‘hostile environment’ and argues that the approach which has been taken can be seen as undermining the covenant of trust between patient and clinician and thus the fundamental principles of the NHS