A decision-making model for public health authorities in circumstances of potentially high public risk

Background: An expert multidisciplinary panel was commissioned by a UK Health Security Agency led incident management team (IMT) to support decision making in the case of an individual with extensively drug-resistant tuberculosis. The behaviour and stated intentions of the individual were potentially a significant risk to public health, and the regional IMT felt unable to adequately balance the rights of the individual, versus the public health risk, within current processes and legal powers. Method: We describe the composition, organization, implementation, and conclusions of a national, expert, multidisciplinary panel. Results: The national panel convened over three structured virtual meetings to consider the balance between the rights of the individual to an unrestricted life, and the duty to protect the public’s health. Evidence included briefs from the regional IMT and input from a public consultation group. Following the first two meetings the need for a literature review examining the success of surgical interventions was identified and conducted. Conclusions: Evidence and conclusions were mapped onto a custom-designed risk assessment template. The panel provided authoritative advice regarding the case, and developed a review methodology that is transferable to similar complex public health scenarios both in the UK and internationally.