By Brian Patrick Green, director of Technology Ethics at the Markkula Center for Applied Ethics at Santa Clara University. Views are his own.
It seems like every day that goes by, nature is cooking up another disaster; but it’s nothing personal: it’s merely the side-effects of nature’s constant processes of geology, weather, and biological change. All humanity can hope to do is to be prepared when these disasters appear. And how prepared we are for these disasters indicates what risk standard we are taking relative to them. It also raises the question, which risk standard is most ethical for a pandemic?
What it takes to prepare for a disaster varies depending on the type of disaster. For example, here in California, we tend to prepare for earthquakes, while other parts of the world prepare for volcanoes, hurricanes, tornadoes, and so on. Those preparations can be at the individual or family level, or at larger levels of organization, such as corporations, cities, counties, states, nations, and international organizations (like the the Red Cross or World Health Organization).
The SARS-CoV-2 virus (which causes the disease COVID-19) was a predictable disaster, like so many other outbreaks of disease over the course of human history. The very fact that the virus is named “SARS…2” should indicate to us that we have seen this type of problem before, and therefore ought to have been more prepared for it. However, it seems that much of the world was not adequately prepared. I think that this can be interpreted through the lens of risk standards.
With the perspective of some time since the origin of the outbreak, we can see that many decision-makers (if they were following any risk standard) were following Prudent Vigilance or the Gambler’s Principle when they should have been following the Precautionary Principle or the Prevention Principle. For a detailed explanation of what each of these risk standards means go here, however I’ll provide brief recaps below.
Prudent Vigilance—It is permissible to take risks, but with continuous analysis, re-evaluation, and correction when prudent, i.e., when risks become clear and direct. With regard to the risk of pandemics, it might counsel that we should have some pandemic responses prepared, but not too much until it looks like a real threat is directly on its way.
The Gambler’s Principle—Characterized by the phrase, “Don’t bet more than you can afford to lose”—which also implies that you can bet what you think you can afford to lose (and what exactly that entails is a judgment call made by those in power, often, but not solely, political leadership). With regards to pandemics, it might tend to ignore smaller diseases, such as influenza, while only preparing to deal with ones that have truly catastrophic risk potential, such as bioweapons.
Precautionary Principle—When facing an unknown, take the most cautious route to prevent whatever the worst outcome might be. Regarding pandemics, it would be highly prepared for numerous types of unknown pathogens to appear, and would have many and varied responses readied at all times.
Prevention Principle—When a threat is understood, it should be prepared for exactly as it is. Regarding pandemics, this would anticipate the constant natural production of pathogens, and like the precautionary principle, prepare many and varied responses.
East Asian nations, including China, Singapore, and South Korea, clearly were much more prepared for the SARS-CoV-2 virus than were Western nations. China, despite some initial mistakes in their preparation and response (e.g. permitting wild animal markets and concealing the initial viral outbreak) quickly switched to following the Precautionary or Prevention Principle. Once it became clear what was going on, the Chinese central government acted decisively to solve the problem, and at this point, it looks as though they may have succeeded. Superior preparation, brought about by practice and precise risk tolerances, saved millions of lives.
Other nations, including the United States, were not as prepared for the virus. To be precise, the U.S. federal government response, up until at least mid-March, likely reflects following the Gambler’s Principle. (Other nations may have been following this risk standard as well.) I’ll give two pieces of supporting evidence. First, the early analogy of SARS-CoV-2 to influenza and the corresponding idea that it was therefore not a high priority, indicate that the government did not believe that the novel coronavirus had exceeded the “Don’t bet more than you can afford to lose” threshold; rather, since we tolerate the flu each year, it was still in the “we can afford to lose on this (the stakes appear small), so we can take the risk.” Second, later examples of government officials questioning whether it was worse to risk the possibility of having millions of Americans die or to intentionally inflict significant damage on the economy through social distancing reflects that the “what you can afford to lose” threshold might indeed exist, but that it would be measured in economic activity rather than human lives. It’s difficult to interpret these two pieces of evidence in terms of Prudent Vigilance, and they are certainly inconsistent with the Precautionary or Prevention Principles.
Rather than sufficiently preparing in advance of the outbreak, or immediately reacting once the outbreak escaped China, the U.S. federal government accepted risky choices and waited. During this time, corporations, institutions such as universities and churches, local and state governments began a variety of responses to the epidemic, including recommending working from home, closing schools, recommending (or ordering) isolation and shelter-in-place orders, and so on. These institutions clearly have lower risk tolerances (and therefore higher risk standards) than the U.S. federal leadership. The U.S. as a whole is now in the middle of the exponential growth of coronavirus across the nation, and it is unclear exactly how bad the pandemic will become.
Due to the failure of prior risk-reduction strategies we are now in unknown territory and are forced to take drastic measures. These reflect that another risk standard has come into play: the Proactionary Principle, which encourages risk-taking in order to get out of unacceptably risky situations. Given the horrible situation we are now in, we must take huge economic risks (e.g., distancing, isolation, and shelter-in-place) in order to prevent the spread of the virus and get out of this unacceptable situation. We must explore risky biomedical solutions such as experiments with various drugs, newly developed devices, questionable product suppliers, and new vaccines (and make no mistake – these moves all are dangerous in their own ways). And supply chains and nearly every facet of life is now disrupted and must be patched back together with quick fixes and novel ideas. This is a time of crisis, but also one of innovation and new beginnings – however, these come at a monetary and human cost. Not all solutions will work, and some may even backfire.
So which risk standard is most ethical in regard to the current pandemic? The mothers, fathers, sisters, brothers, sons, daughters, spouses, and friends of the thousands who have perished would likely say that the Gambler’s Principle (and perhaps also Prudent Vigilance) has proven to be an approach with devastating results. If we value preserving human life, the Precautionary and Prevention Principles would seem to be the most ethical standards to help shape future preparedness.