8292387 A precautionary framework for guiding occupational health policy: lessons from the COVID-19 pandemic

<h3>Objective</h3> One of many lessons for occupational epidemiologists from the COVID-19 pandemic was the importance of taking a precautionary approach to using science for policy recommendations. To prepare for future health emergencies, this presentation describes opportunities for integrating the Precautionary Principle (PP) into methods for synthesizing evidence and formulating occupational/environmental health guidance. <h3>Material, Methods and Results</h3> Authoritative reviews of global response to the emergence of the SARS-CoV-2 virus faulted public health agencies for being too slow to warn of a possible epidemic because they waited for ‘sufficient’ evidence of human-to-human transmission, rather than taking a precautionary approach and assuming airborne human transmission. A widely adopted definition of the Precautionary Principle (PP) states: ‘When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically’. Historical development of the PP is reviewed, and four key components are presented: taking preventive action in the face of uncertainty; explicitly considering the weight of evidence or ‘burden of proof’ needed to recommend one action over another; exploring a wide range of alternatives to possibly harmful actions; and increasing public participation in decision-making. Drawing lessons from past applications and missed opportunities, we propose that a precautionary framework should be a key component of a pragmatic approach to using science for evaluating occupational health risks and interventions. Criticisms of the PP are discussed, including: not providing guidance on when precaution should be invoked; not specifying how much precaution should be taken; and simply being unscientific. These criticisms are addressed, and we conclude that effectively acting with foresight requires a complex, multifactorial assessment that is best conducted within a precautionary framework. <h3>Conclusion</h3> The PP should be integral to a pragmatic scientific approach to evaluating occupational health risks.