Considerable new power also falls into the hands of national health authores such as the United States Public Health Service-as a result of WHO'S perating procedures. If abused, this power could deprive minorities of the protection they normally enjoy under constitutional processes.

LEGISLATION BY DEFAULT

Health authorities, for example, can permit WHO legislation to become national aw merely by pigeonholing it for a period of time decided by WHO. Unless each parliament or congress kept careful track of decisions made by the world bealth assembly, it might never realize the law was coming into effect. WHO s zot obliged to notify parliaments of its decisions.

I: an extreme case, if a congress were not alert, the present powers assumed ty WHO and the national health authorities could be stretched to cover the exactment of compulsory national health programs or the imposition of mass dication in a form which the congress might disapprove if presented in the tal way-as a bill to be acted upon.

It would be necessary, however, for WHO to classify such measures as procedures designed to prevent the international spread of disease. The WHO &nstitution limits its legislative authority to this and related spheres. And ional parliaments retain veto power when they choose to use it.

The new U. N. code, the first significant use by WHO of its power, is entitled *International Sanitary Regulations." It was voted by the WHO assembly in Geneva on May 25, 1951.

WHO officials say the code is intended to simplify travel by codifying and r; acing 15 existing treaties and making frontier quarantine practices uniform ghout the world.

No state affected by the code is permitted to make regulations which are severe than those outlined in it. WHO officials say the code was drawn pin a liberal spirit-that the ceiling was placed lower than some states wished and that it will require the easing of some present restrictions.

Many observers who have studied it carefully, however, believe the code may have significant effects in other directions.

INDIRECT PRESSURE

One result already is being felt in the United States. The United States Pe Health Service is reconsidering an exemption from smallpox vaccination which has been available to persons entering the country with medical evidence that they have not been exposed to smallpox abroad.

Other countries also are authorized and encouraged by the code-though not required to tighten their smallpox vaccination requirements. At least 32 sations, including most of the major countries of Western Europe, do not now requre smallpox vaccination on entering the country. At least 19 other countries aire it only under certain conditions.

In addition to encouraging universal vaccination for international travelers, the code will provide a form of indirect pressure on governments which do not w require all their citizens to do so in the future. Travelers from areas where Taccination laws are liberal may find themselves subjected to delays and inconTerience, if not more severe discrimination.

Still another result of the new U. N. sanitary_regulations will be the conous compiling, publishing, and broadcasting of statistics on every so-called Zajor communicable disease in the world. WHO at present has an office which performs this task on a somewhat smaller scale.

Dr. Leonard A. Scheele, Surgeon General of the United States Public Health nice, took a leading part in formulating the regulations and was president of the WHO assembly which voted them.

The code is part of a "terrific drive," Dr. Scheele said in an interview recently, !r "more enlightened health procedures" throughout the world, especially in derdeveloped countries. The United States, he said, is actively encouraging "enlightenment."

OBJECTIONS CITED

There is by no means unanimous agreement, however, even in medical circles, at vaccination and enlightenment are synonymous. A substantial and growing ority has religious or other conscientious objections to vaccination. ComFry vaccination, these persons argue, is a violation of religious freedom.

ward compulsory vaccination and the manner 129 being directed, in the United States, to Conrers to the U. N. and the world health assembly. er cuntries. ase firm of amendments to the WHO constitution, ed the international sanitary regulations, orSAVEZ WHO through congressional action. The 5 sach withdrawal when it approved entry into

s on the manner in which the 115 articles of the Lerested by the governmental health authorities who

tealth administrations. They will administer the with WHO, bypassing heads of State, cabinets, and airports are given wide discretionary power. asry medical examination of incoming or outgoing bere ez a frontier health authority anywhere in the

Even if a "healthy" ship merely stops at a port nder does not get off, health authorities may come pulsory examination.

smallpox vaccination are contained in article 83. sales It provides:

ay require any person on an international voyage ea evidence of protection by a previous attack of small1. a certificate of vaccination against smallpox. Any "oduce such a certificate may be vaccinated; if he d. may be placed under surveillance for not more than e date of his departure from the last territory visited

14-DAY PERIOD

national voyage who during a period of 14 days before • <nd an infected local area and who, in the opinion of the is not sufficiently protected by vaccination or by a previous a gen mat de required to be vaccinated, or may be placed under na de vaccinated and then placed under surveillance; if he vacciated, he may be isolated. The period of serveillance or cbe more than 14 days, reckoned from the date of his departure ever bval area. A valid certificate of vaccination against smallpox vandeved as evidence of sufficient protection.

sclocities say this article is loosely drafted and susceptible of more

Named 1, it is agreed, applies to persons who are not considered to have AM CLAP smallpox, while paragraph 2 applies to those who are considered

10 question of whether a traveler is considered to have been exposed or not AANWYcher he has visited an infected local area. The regulations define a sostar perid case or two cases derived from an imported case.

o ase as a local area where there is one case of smallpox derived from

ewed local," however, is not precisely defined. It may refer to an area as a port or airport. But in at least one instance where a smiliar probdave a quarantine officer of the United States Public Health Service interAvery JP Mean an entire country-England.

UNDER SUSPICION

Pro if there is anywhere in England a single case of smallpox thought to have been caused by an infected person within the country, all travelers who have vix and any part of England, no matter how remote, may be faced with a che ce between forcible vaccination and 2 weeks' quarantine at the next frontier. Kven it a person is considered to have been exposed, medical authorities do not 6 ve that vaccination after exposure serves a useful purpose so far as protecting echers nom contagion is concerned.

Doctors say the smallpox vaccine-which they describe as the virus of cowpox, a cattle disease ordinarily has no curative power, and, indeed, may have ill

They say an exposed person who thereafter is vaccinated will develop the disin a milder form and be a menace to society in much the same fashion as who is not, unless he is vaccinated almost immediately after exposure. Thus the provisions of article 83, paragraph 2-for vaccinating a person who as been exposed-appear to observers to be a form of discipline rather than a -tive measure.

INTERPRETATION VITAL

If a traveler has not visited an infected local area and thus is not considered to „te heen exposed, his treatment will depend upon the interpretation health aurities place under paragraph 1 of article 83.

The first sentence provides, without any qualification, that a health authority require any person arriving in the country to have a vaccination certificate the person has not had smallpox-and the next sentence says he may be vac2 a'ed if he does not have such a certificate.

There is then a semicolon and the phrase "if he refuses" is used. Whether traveler is unconditionally free to refuse is not made clear.

As a minimum, however, if a person has a conscientious objection to vaccina1-c, he can be placed under surveillance, a form of medical probation. He will the isolated and may move about freely, according to article 27 of the code erning surveillance. But he may be required to report to the health authority at spec fied intervals and subjected to "medical investigation."

Dr. Calvin Spencer, Chief of the Division of Foreign Quarantine of the United Mates Public Health Service, the man immediately in charge of enforcing vactation laws at American ports, is one of those who place a strict interpretation © the code.

Dr. Spencer said in a recent interview that article 83 "does appear to contra"ee" present exemptions from vaccination in American law. A departmental ai team is studying the code with a view to tightening United States Public Beth Service regulations, if necessary, he said.

ite relevant portion of the health-service regulations is section 71. As it now ds, this section provides that persons arriving at an American port may saty the smallpox vaccination requirement by presenting a statement from a local national health authority at the place of embarkation, affirming that they were not in an area where smallpox was present in the 14 days, immediately prior *-mbarkation for a port under the control of the United States.

These certificates ordinarily are accepted. A quarantine officer, however, is not and to accept them in all circumstances. Such travelers may be held under servation for not more than 14 days if the quarantine officer has reason to ve they have been exposed to smallpox within 14 days prior to arrival.

COVER WIDE RANGE

The International Sanitary Regulations cover a very wide range of topics. Key lay down standards for the control of plague, cholera, yellow fever, typhus, relapsing fever, as well as smallpox. They apply to boats, automobiles, Tars, and all other media of transporting as well as to persons.

Vaccinations against plague, typhus, and relapsing fever, the code provides, l not be required as a condition of entry into a country. WHO officials say an on typhus injections will require removal of this requirement by some

Vaccinations against yellow fever shall be required—that is, are mandatory— travelers leaving an infected local area and proceeding to a yellow-fever --¡tive area. The latter area is defined as one in which yellow fever does not but where conditions would permit its development if introduced. Persons without yellow fever vaccination certificates who are traveling from nfected area to a receptive area may be isolated for as long as 6 days. WHO I say this period is shorter than some countries have required.

With regard to cholera, even a vaccination certificate will not protect a traveler * surveillance, if he has come from an infected local area. If he does not Lave a certificate, he may be isolated for up to 5 days.

TIMETABLE TRACED

The regulations establish a vast clearinghouse for information about disease. Bth authorities in all countries are required to notify the World Health Or"zation daily, weekly, monthly, and annually, sometimes even hourly, of the

number, type, and symptoms of diseases in men and animals; of the countermeasures taken; and of important changes in its health laws and practices.

The timetable followed by WHO in enacting the sanitary regulations was as follows:

May 25, 1951: WHO assembly voted them unanimously.

June 6, 1951: Dr. Brock Chisholm, Canadian Director-General of WHO, for mally notified the health administrations of member governments. (He was not required to notify heads of state or foreign ministers; the code authorized him to bypass usual channels.)

June 6, 1951 to March 6, 1952: 25 countries submitted reservations; thereupon, the 9-month period having elapsed, no further reservations could ever be offered (except for colonies, in which case the deadline is extended to December 6, 1952). March 6 to October 1, 1952: The reservations were discussed in WHO committees; all but four countries withdrew them, modified them, or convinced WHO they should be accepted as minor.

October 1, 1952: The regulations will come into effect, having the force of domestic law in all member countries except Australia, Argentina, Burma, and Saudi Arabia.

UNUSUAL POWERS

No organ of the United Nations except WHO has the power to legislate for member governments. Article 22 of the WHO constitution entitles this specialized agency to make regulations within its field of operation which shall come into force for all members after due notice has been given of their adoption by the World Health Assembly except for such members as may notify the Director-General, of rejection or reservations within thhe period stated in the

notice.

"Due notice" is not defined. In the case of the Sanitary Regulations, it was 9 months. WHO may decide in each instance how much notice it chooses to give. WHO also may decide whom to notify. In the present case, it decided that any notification or information sent by the Organization to the Health Administration shall be considered as having been sent to the state.

Thus no governments, let alone legislatures, were notified directly that the Sanitary Regulations had been enacted on their behalf.

Observers consider this circumstance especially significant in the case of the United States, which exercises great if not decisive influence in WHO, as in most other U. N. organs.

The United States Congress, like other legislatures, agreed to a partial delegation of sovereignty when it approved the WHO constitution in 1948. Those who recall the debate, however, say they doubt that Congress realized how broadly the grant would be interpreted.

STOP, LOOK, AND QUESTION

(An editorial)

In 1948 when Congress debated joining the World Health Organization efforts were made to insure that the United States would not be inadvertently committed to a program of compulsory insurance for medical care. Reasons for this caution and for a reservation enabling the United States to withdraw from WHO are now becoming more apparent.

For on October 1 WHO regulations incorporating even greater infringements of individual rights than are involved in compulsory insurance will go into effect. An article describing this situation appears on the first page of our second section today. We believe it should cause a sharp questioning of WHO'S procedures and results.

The purpose of cooperating to prevent the spread of disease is a wholly laudable one, and we have the greatest respect for all unselfish efforts to that end. But we believe mistaken methods are being used, not only in the treatment of disease but in the disregard of constitutional procedures and civil liberties.

We do not question the right of those who desire vaccination and inoculation to have it. We do not question the right of those who declare such treatment that provides immunization to force it on others for their own protection. Moreover, we strongly question procedures which permit WHO to bypass the government of any country and place very great discretionary power in the hands of an administrative agency.

The rather remarkable constitution of WHO gives it the power to legislate ! - member countries unless they object. And in setting up the new regulations international travel WHO did not even trouble to notify the State DepartLent or Congress-which presumably could exercise a veto. One remedy would be for Congress to curb the arbitrary authority now exercised by the Public Health Service, which appears to be acting both as promoter and agent of WHO. Another remedy would be to insure by constitutional amendment that limitatons be placed on so-called self-executing international agreements. This newspaper does not wish to be alarmist. As we understand it, WHO is alone among Urted Nations agencies in its power to legislate for member nations. We be ve that the rights of individuals and states under the American Constitution can be protected from infringement by an international organization or through treaties. But the situation now precipitated by WHO indicates that a properly framed constitutional amendment may be required.

THE NATURE AND PURPOSE OF THE WHO INTERNATIONAL SANITARY REGULATIONS The story under the caption "Pattern for Compulsory Medication," and the editorial under the title "Stop, Look, and Listen," which appeared in the Christian Science Monitor of September 26, 1952, reveal a basic misunderstandTg of the nature and purpose of the international sanitary regulations to which they refer, and of the procedures under which they were adopted. They also unfortunately, to relate the provisions of these regulations to quarantine practices in which the United States and other states have been engaged for ny years.

The reader of this story and editorial is told, in effect, that an international anization, the World Health Organization, in adopting the international Nitary regulations, usurped the power of sovereign states and, purposely byassing normal channels of communication between the World Health Organizaand member governments, conferred wide discretionary power directly the health administrations of national governments which could readily be used to infringe upon individual liberty-for example, by requiring vaccinatons. The reader is told, among other things, that "the U. N. World Health runization, acting largely at the instance of the United States, has launched *hat one official calls a terrific drive' for worldwide smallpox vaccination of "avelers"; that "considerable new power also falls into the hands of national beath authorities such as the United States Public Health Service"; that "in an extreme case, if Congress were not alert, the present powers assumed by WHO and the national health authorities could be stretched to cover the enactment of pulsory national health programs or the imposition of mass medication in a form which the Congress might disapprove if presented in the normal way— as a bill to be acted upon"; that "no governments, let alone legislatures, were Dified directly that the sanitary regulations had been enacted upon their bef" and that “WHO did not even trouble to notify the State Department or Congress."

The purpose of this memorandum is to explain the nature and purposes of these egulations, and to describe the way in which they were drafted, reviewed, and ad pred.

To begin with, it might be pointed out that international sanitary regulations, quarantine regulations, as they are sometimes called, are not new. They have been in existence for 50 years in the form of treaties. These treaties were ecluded to unite states on measures to prevent the international spread of pdemics of cholera, plague, smallpox, typhus, and yellow fever, and at the same time to prevent undue interference with the movement of persons travelng outside the borders of their own countries and of goods, ships, and aircraft in ernational commerce. Without regulations of this kind, ships and airplanes as well as United States nationals traveling abroad, might be subjected to ali wars of restrictions on their freedom of movement through the arbitrary applition by other governments of their own quarantine laws.

These treaties were considered to have certain disadvantages, however, stemz largely from the relatively slow procedure involved in bringing them into tor in getting them modified. Thus, long delays occurred in bringing into any new regulations designed to take account of scientific discoveries and neal advances in the control of communicable diseases as well as in transmation facilities. Some 40 countries, many of them important in air traf20572-53-20