An ethical argument for vigilant prevention

Abstract

In general, prevention is considered an epidemiologically good strategy because it decreases the likelihood of animal disease outbreaks (and thus epidemics), mainly by hindering the infectious agent spread and thereby lowering the number of diseased animals and the economical losses. Similarly, surveillance, i.e. monitoring and early detection of diseased animals, is generally considered as an epidemiologically good strategy because it increases the probability of controlling the outbreak before it reaches an epidemic scale. Both prevention and surveillance are proactive rather than reactive approaches, but there seems to be no clear a priori advantage of prevention over surveillance or vice versa. Nonetheless, some suggest that prevention offers better disease control results than surveillance and thus that both can be mutually exclusive. This discussion paper challenges this assumption and argues that both approaches should be seen as complimentary measures rather than opposing actions. A blended strategy that builds upon synergies between the prevention and surveillance approaches, will offer a stronger defense against epidemics than a single approach. The specific combination of prevention and surveillance measures depends on a series of factors, of which availability of technological innovations and economic benefits can be one. To bridge the suggested dichotomy between prevention and surveillance, we use a set of ethical arguments comprised of three principles: the ‘right-to-know’, the ‘right-not-to-know’, and the ‘duty-to-know’. For important animal diseases and with the emergence of advanced diagnostics/ monitoring technologies, the balance between these three principles shifts away from the right not to know towards a duty to know. This set of principles thus demonstrates the importance of surveillance within the overall strategy. We argue that, in a combined disease control strategy, prevention must be the most important component, which we would therefore term a ‘vigilant prevention strategy’.