The challenges of infection control can put the professional in conflict with political, legal, or administrative authorities. What is likely to be effective infection control policy may not be popular institutional policy. Economic implications of an outbreak investigation or infection control strategy may dominate a debate that should be informed by the greatest good for the public. Privacy concerns, legal liability fears, economic disincentives, and failures to confront issues that are embarrassing for the institution inhibit public health professionals whose helpful insights can protect the public health only when accompanied by policy change. We discuss key issues that can inhibit effective infection control responses, highlighting that personal and professional integrity is as vital a feature of disease control in the new millennium as it has been throughout the history of infection prevention and control.