In defense of the precautionary principle

Let's not castigate public health officials who are slow to dial back restrictions

It’s difficult to keep up with the shifting and sometimes contradictory guidance from public health officials on how to prevent the spread of COVID-19. Recent articles in the Atlantic and the New York Times (here and here) have taken the CDC to task for offering overly cautious advice about the need for outdoor masking.

Fair enough. The latest scientific data suggest the risk of contracting COVID-19 outdoors from aerosolized particles containing the virus is, if not zero, pretty darn close. All my exaggerated swerving to avoid unmasked joggers during walks in the park (my scowl hidden behind a mask) appears to have been an unnecessary act of social aggression.

That said, will I feel comfortable this summer at the ballpark sitting amid half-drunk howling fans? No, I will not. Most of them will be half my age with a greater propensity than seniors like me to forego vaccination. Ditto for sitting out on the lawn in Chicago’s Grant Park during its jazz and classical music concert season.

The latest CDC report released today shows nearly 80% of Americans over 65 have received at least one vaccination shot. Unfortunately, just 46% of the general population (and that includes seniors) have reached the one-shot milestone.

Okay, seniors were first in line. But if reports about my home state of Illinois are being replicated elsewhere, there are now plenty of shots available and openings at pharmacies, hospitals and physician offices are going unused.

Over the last month, regional variation in vaccination rates and adherence to public health measures have received a lot of media attention. It parallels the red-blue split in the nation’s politics.

The five states with the highest percentage of people with at least one dose are Vermont, Massachusetts, Hawaii, Connecticut and New Hampshire. The lowest ranked states are Mississippi, Louisiana, Alabama, Wyoming and Idaho. You don’t have to be a Steve Kornacki to have forecast that outcome.

An ignominious record

Which brings me back to the CDC and whether its scientists should be taken to task for offering overly cautious advice. Let’s not forget that during the ten months of the pandemic – before vaccines became available – the U.S. managed to rack up one of the highest mortality rates in the world from COVID-19. Even now, despite the rapid ramp up in vaccine distribution, the U.S. still has the globe’s fifth highest mortality rate, trailing only Hungary, Italy, Brazil and Peru.

There can be little doubt that widespread public resistance to masking and social distancing, aided and abetted by the Trump White House, playe

d a huge role in driving that ignominious record. Recent stories about bodies still lying in freezers around New York City are a grim reminder of what things were like a year ago.     

So as new data arrives, and new guidances get written, let’s not pounce on the public officials who pleaded with Americans to adhere to what some epidemiologists refer to as the precautionary principle.

“The precautionary principle asserts that the burden of proof for potentially harmful actions by industry or government rests on the assurance of safety,” one public health physician wrote in 2001. “When there are threats of serious damage, scientific uncertainty must be resolved in favor of prevention.”

“When in doubt about the presence of a hazard, there should be no doubt about its prevention or removal,” noted two Israeli public health physicians in 2004. “It shifts the burden of proof from showing presence of risk to showing absence of risk (and) aims to do good by preventing harm.”

The American character instinctually rebels against the government’s use of the precautionary principle. The slogan “Don’t tread on me,” inscribed on the flags of our 1770s revolutionaries, is older than the Republic.

That national trait makes following the precautionary principle almost impossible in modern day America. We’re coming off nearly a half century where rugged individualism has been the dominant ideology and social solidarity has been in short supply.

Social solidarity flows from the understanding that near universal adherence to common restrictions is sometimes necessary to achieve the greatest good for the greatest number – in the current case, limiting the spread of a deadly infectious disease. The late health care economist Uwe Reinhardt often blamed America’s lack of social solidarity for our enduring inability to provide health insurance to every citizen.

Historians of the great flu pandemic after World War I say its lessons were rapidly forgotten by a population eager to move on. My greatest concern as we emerge from the darkest days of this pandemic is that the general population won’t even recognize the lessons never learned.