Between prevention and precaution, what is the political responsibility of national governments?

An interesting theoretical nuance is used in the paper: the distinction between prevention and precaution, as the decision-making drivers of a government depending on its very understanding of of its own role, i.e.,which is closely tied to the room it allows for uncertainties to unfold. In the case of prevention, the state still exercises a certain control over a crisis — uncertainties are reduced to standardized and well-known policy options. In the face of an established risk, it can take preventive measures in an attempt to avoid it. The notion of prevention is close to the idea of insurance. If the risk, however, cannot be determined with enough certainty, or if its existence hasn’t even been established, it then falls under the scope of precaution. The authors argue it is the case of most contemporary risks which are hybrid forms of deeply intertwined scientific, technological and cultural issues.

“In this case, we initially thought that the state could have acted act within the scope of precaution", explains François Thoreau. “Even though it didn’t really know the risks of administering the vaccine, it nevertheless decided to order it. But despite the many criticisms surrounding the signing of the contract with GSK, the vaccine’s risks were fairly moderate compared with the risk of a pandemic which, at that time, was real. The state would have acted with precaution had debated over whether or not to sign the contract, if it had taken a little more time to gather more preliminary information and contradictory assessments within a context of scientific uncertainty, by thus refusing the diktat of urgency, and by considering that the epidemic was only a potential risk – and not an established one. This would have been difficult in concrete terms, considering the amount of pressure exerted on the authorities.”

The government therefore chose the path of prevention, by anticipating the risks of a so-called “established” risk and by giving itself the means to guarantee the health of almost the entire Belgian population. “According to its own concept, the state positioned itself as the guarantor of its citizens’ health, whatever the price." (2)

Lobbying and the neutrality of researchers, two other thorny points

In this great societal dance, the practices of lobbying and the relative neutrality of certain experts helping with the governments’ final decisions are also taken into account. Without making assumptions, or deciding on a criminal offence, the authors quote, for instance, the research of the investigative journalist David Leloup, who succeeding in making a large number of connections between GSK, the WHO and the expert committees close to the Belgian ministerial cabinets. Some received payments from pharmaceutical groups, and others were part of committees entirely financed by these very groups. Questions of independence and impartiality therefore arise. “In the current system”, the researchers write, “links between firms, universities and political authorities are strongly encouraged. This clearly raises the problem of guaranteeing the neutrality of the expert assignments. "

“As for lobbying”, the political analyst continues, “it cost GSK EUR 800 000 in 2011 for Europe and USD 5.4 million in the United States. Lobbying is a practice which is becoming institutionalised. Credit has to be given to GSK for explicitly, and voluntarily, reporting on it in its annual report, whereas most companies would shy away from it. That said, the fact that governments will ultimately buy millions of doses of vaccines obviously depends on the way in which they grant credibility to the risk of a pandemic. And yet, in this context, a pharmaceutical group has far greater power of conviction than the man in the street. Without talking of plots or corruption, we should nevertheless highlight this game of seduction."

(2) Ibid. p.45