WHEN SHOULD FORCE BE USED TO PROTECT PUBLIC HEALTH?

Author:Sullum, Jacob
 
FREE EXCERPT

DURING AN APRIL 2 interview with Chris Wallace on Fox News, Surgeon General Jerome Adams compared deaths caused by COVID-19 to deaths caused by smoking and drug abuse. "More people will die, even in the worst projections, from cigarette smoking in this country than are going to die from coronavirus this year," he said.

Wallace questioned the analogy. "Dr. Adams," he said, "there's a big difference between opioids and cigarettes, which are something that people decide to use or not to use, [and] the coronavirus, which people catch. It's not an individual choice."

The distinction that Wallace considered commonsensical is not one that public health officials like Adams recognize. As they see it, their mission is minimizing "morbidity and mortality," whether those things are caused by communicable diseases or by lifestyle choices.

Equating true epidemics with metaphorical "epidemics" of risky behavior distracts public health agencies from their central mission of protecting people against external threats such as pollution and pathogens. It undermines their moral authority by implying that the rationale for that uncontroversial mission also justifies a wide-ranging paternalism, and it damages their credibility by involving them in high-handed, manipulative propaganda.

The ambiguity about what it means for the government to protect public health also makes it harder to think clearly about the limits of state power in responding to literal epidemics. The classical liberal tradition has always recognized that the state has a legitimate role to play in protecting the public from contagious diseases. When we are confronted by an actual public health crisis like the COVID-19 pandemic, the question is not whether the use of force can be justified but whether a particular policy is appropriate. That question is hard to answer when there is a high degree of uncertainty about the threat posed by the disease and the cost of limiting its spread.

THE VAPING 'EPIDEMIC'

BEFORE THE NEW coronavirus came along, the U.S. Centers for Disease Control and Prevention (CDC) spent a lot of time and effort warning us about a very different kind of "epidemic": an increase in e-cigarette use by teenagers, coupled with an outbreak of vaping-related lung injuries. The first concern did not involve any sort of disease; the latter did, but unlike COVID-19, the condition that the CDC dubbed "e-cigarette, or vaping, product use-associated lung injury" (EVALI) was not contagious. And contrary to the CDC's misleading nomenclature and dangerously misguided initial advice, the two developments appeared to be completely unrelated.

Even under a broad understanding of public health, the CDC's conflation of EVALI with vaping in general was counter productive, impeding the harm-reducing shift from conventional cigarettes to nicotine delivery systems that are far less dangerous. By fostering confusion about the relative hazards of smoking and vaping, the CDC hurt its own credibility on the eve of a public health crisis in which policy makers and the rest of us were expected to rely on its expertise.

As Chris Wallace probably would agree, vaping is something people choose to do. In that respect it resembles many other phenomena that politicians, bureaucrats, and academics have described as public health problems, including smoking, drinking, illegal drug use, overeating, physical inactivity, riding a motorcycle or bicycle without a helmet, gambling, playing violent video games, and watching pornography. COVID-19, by contrast, is something that happens to people.

There is a strong argument for coercive measures to deal with a potentially deadly disease that moves from person to person. That argument is much less compelling when we are talking about actions that may lead to disease or injury but do not inherently endanger other people.

The tendency to describe nearly anything that large numbers of people do as an epidemic when...

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