Is prevention enough? The precautionary principle and disease outbreaks
In the wake of the devastating consequences of the Covid-19 pandemic, both in terms of human suffering and economic impact, the importance of preventingfuture pandemics and other planetary crises related to global warming and loss of biodiversity, among others, hasgained renewed prominence. A consensus has emerged that global focus should shift towards minimizing and anticipatingfuture pandemics risks, rather than relying onrapid detection, reactive adaptation, and crisis management strategies. This call for prevention at source, or “deep prevention”, has been underscored by the One Health High-Level Expert Panel in addressing zoonoticdiseases (OHHLEP, 2023)and is echoed by scholars (Vinualeset al., 2021). Together with the One Health Approach, the concept ofprevention has been systematically incorporated into the various iterations of the ongoing discussions on the World Health Organization (WHO) Agreement on Pandemic Prevention, Preparedness and Response (PPPR).
This greateremphasis on prevention representsa commendable step towards a more reasoned and resource-efficient management of the risk of pandemics. Yet is prevention enough?Considering thescientific uncertainty associated to pandemics prevention, would it not be important to also incorporate the precautionary principle? This article reflectson whether the legal principle of prevention will suffice to tackle the multifaceted challenges and serious risks posed by future pandemics and other interconnected human-driven crises.
The principle of prevention is a core principle of international environmental law. According to this principle, countries should make reasonable efforts to preventdamage, whether on their territory or beyond their borders. They must take steps to curtail, restrict or regulate activities that could precipitate or exacerbate such harm, intervening at an early stage and before the harm materializes (Sands,2018). The evolution from the earlier remediation-focused measures to prevention signified a progressive shift in approach (Saledeer, 2022).However, one must bear in mind that forthe principle of prevention to become actionable in legal terms, there needs to be a demonstrated causal link between the action and the anticipatedoutcome. In other words, there needs to be clear scientific evidence that a specific action will result in a predictable harm. Yet, scientific opinion, as we know, can be ambiguous or non-uniform,which can preclude clear risk determination. In such instances,the precautionary principlerepresentsa shiftin risk reductionparadigms, by providing decision makers with a tool to act -or refrain from action- in the face of scientific uncertainty (Saledeer, 2022).
The precautionary principle rapidly extended beyond the domain of international environmental law to encompass food safety and public health, among other sectors where risk management is key. The precautionary principleempowers decision- makers to consider potential risks in the absence of unequivocal scientific evidence. Whenscience is not considered sufficiently unanimous or clear to direct decision-making, the application of the precautionary principle enablesdecisionsto be grounded on the need to safeguard public interestsand to advancelong-term societal objectives.That being said, theprecautionary principle must be judiciously applied to avoid hinderinginnovation. Establishing regulated procedures for its application is paramount to pre-empt speculative or “more-than-hypothetical”risks, and safeguard public goods.
In today's world, where complex and interlinked issuessuch as One Health, climate change, and agrifood systems require holistic thinking, it is not unusual for there to be some scientific uncertainty which may impact on decision-making. This makes adopting a precautionary approach crucial. The Covid-19 Pandemicand the myriad public decisions that were taken in response– from lockdown measures to prophylactic interventions- exemplified this imperative. Covid-19 prompted copious literature and case law1 on the precautionary approachinthe absence of definitive scientific consensus (Sánchez Barroso, 2020), and the potentially devastating consequences of inaction (Nordgren, 2023) (Frediani, 2021).
Consequently, addressing complex multisectoral challenges such as the One Health approach, agrifood systems transformation, climate changeor pandemics management, would appear to require a shift away from exclusive reliance on preventive strategies and a greater adoption of precautionary strategies.If this is to happen, it will be important for societal values and objectives to be defined, foreseeable risks identified and related mitigation measures formulated that are proportionate.
Given the inherent lack of clarity of the precautionary principlein terms of what the appropriate or correct threshold of uncertainty that may trigger its application, lawemerges as a vital tool to facilitateits judicious and regulated implementation across specific sectors.Legislation should be in place that recognizes the precautionary principle in the context of disease management and pandemic prevention, preparedness and response. National regulators must be guided by legal frameworks and established jurisprudence that will allow them to make timely and equitable decisions on the application of the precautionary principle, which requires transparent and proportionate application to effectively address potential risks.
In summary, the experience of COVID-19 highlights the importance of incorporating the precautionary principle into decision-making, alongside the principle of prevention. The world needs to be not only prepared for future health crises butalso at all timesbe able to safeguard public health and societal well-being in an increasingly uncertain world.
Carmen Bullon (FAO)
References
De Saledeer, Nicholas. 2022. EnvironmentalPrinciples. From Political Slogans to Legal Rules. Oxford University Press.
European Commission. 2000. Communication from the Commission on the precautionary principle. COM (2000) 1 final.
One Health High-Level Expert Panel. 2023. Prevention of zoonotic spillover. From relying on response to reducing the risk at source. Available at https://cdn.who.int/media/docs/default-source/one-health/ohhlep/ohhlep-prevention-of-zoonotic-spillover.pdf?sfvrsn=652707eb_1&download=true
Nordgren, Anders. 2023. Pandemics and the precautionary principle: an analysis taking the Swedish Corona Commission’s report as a point of Departure. Medicine, Health care and Philosophy. 26: 163-173. https://doi.org/10.1007/s11019-023-10139-x
Sánchez Barroso, Borja. El principio de precaución frente a las pandemias: un análisis a la luz de la Covid-19. En Amo Usanos, Rafael y de Montalvo Jaakelainen, Federico. 2020. La Humanidad Puesta a Prueba: Bioética y Covid-19. Universidad Pontificia de Comillas. Available at http://hdl.handle.net/11531/53325
Sands, Philippe, Peel, Jacqueline, Fabra, Adriana, MacKenzie, Ruth. 2018. Principles of International Environmental Law. Cambridge University Press. Fourth edition.
Vinuales, Jorge; Moon, Suerie; Le Moli, Ginevra; Burci, Gianluca. 2021. A Global Pandemic Treaty should aim for deep prevention. doi:https://doi.org/10.1016/S0140-6736(21)00948-X
Frediani, Emiliano. 2021. The Administrative Precautionary Approach at the Time of Covid-19: The Law of Uncertain Science and the Italian Answer to Emergency. Utrecht Law Review. Available at https://utrechtlawreview.org/articles/10.36633/ulr.644#4-some-indications-about-precaution-in-action-and-the-risk-assessment-in-the-italian-case