Foreword

As someone who works deeply at the global level of health, ethics, law, and governance, I am struck by what a prescient publication this book has turned out to be. The World Health Organization (WHO) declares a Public Health Emergency of International Concern (PHEIC) for “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.” Such a designation denotes a situation that “carries implications for public health beyond the affected state’s national border” and requires “immediate international action.” In recent years, WHO has declared a PHEIC for the 2018–2020 Kivu Ebola epidemic, the 2020–2023 COVID-19 pandemic, and the 2022–2023 and 2024 mpox outbreaks. As I pen this foreword, other major public health threats have appeared on the global radar: A Marburg virus outbreak in Rwanda has claimed more than a dozen lives, and sporadic but alarming strains of avian flu (H5N1 and H5N2) have been detected in different parts of the world. Meanwhile, SARS-CoV-2, the causative agent of the COVID-19 pandemic, has continued to evolve and claim lives. Our response to such emerging and resurgent public health threats will determine not just their trajectories but their impact on society, too. What type of countermeasures ought we to adopt against novel, emerging, or resurgent public health threats? What type of resources ought we to dedicate to such threats? What constitutes adequate justificatory countermeasures? How should society determine whether the response of authorities is proportionate to the threat posed? To answer such questions, the benefit of hindsight allows us to critically appraise the lessons learned from the COVID-19 pandemic, which had an unprecedented disruptive impact on the world. Governments at all levels, globally, adopted an extraordinarily heterogeneous approach to the COVID-19 pandemic—including to the perceived severity of the crisis, surveillance, the need for mask wearing, social distancing, mobility restrictions, home and institutional isolation, monitoring, contact tracing, school attendance, workplace attendance, and vaccination—and most of their decisions and challenges boiled down to the proportionality of the measure in question. Looming public health threats on the horizon make Proportionality: A Guiding Principle in Public Health Law, Ethics and Policy a prescient publication. The contributors to this comprehensive body of work count among the leading scholars and practitioners globally on public health and the principle of proportionality. Armed with diverse geographic settings and illustrative real-world examples, this impressive multidisciplinary body of work offers a thorough, accessible, and engaging overview of how the principle of proportionality shaped, or failed to shape, decision-making processes and measures to counter the COVID-19 pandemic in settings across the globe. In so doing, this work serves as an invaluable resource for the management of future public health threats. More specifically, this solid body of work will undoubtedly improve our understanding of how the principle of proportionality can, and should, inform our response to future public health threats. In so doing, this work will help shape the ongoing evolution of international and local norms on the principle of proportionality and enhance our resilience to future public health threats.