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首页> 外文期刊>Risk analysis >The 1991 Cholera Epidemic in Peru: Not a Case of Precaution Gone Awry
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The 1991 Cholera Epidemic in Peru: Not a Case of Precaution Gone Awry

机译：1991年秘鲁的霍乱疫情：不是一个预防措施出现了问题

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The precautionary principle calls on decisionmakers to take preventive action in light of evidence indicating that there is a potential for harm to public health and the environment, even though the nature and magnitude of harm are not fully understood scientifically. Critics of the precautionary principle frequently argue that unbridled application of the principle leads to unintended damage to health and ecosystems (risk tradeoffs) and that precautious decision making leaves us vulnerable to "false-positive" risks that divert resources away from "real risks." The 1991 cholera epidemic in Peru is often cited as an example of these pitfalls of the precautionary principle. It has been mistakenly argued that application of the precautionary principle caused decisionmakers to stop chlorinating the water supply due to the risks of disinfection byproducts (DBPs), resulting in the epidemic. Through analyses of investigations conducted in the cities of Iquitos and Trujillo, Peru, literature review, and interviews with leading Peruvian infectious disease researchers, we determined that the epidemic was caused by a much more complex set of circumstances, including poor sanitation conditions, poor separation of water and waste streams, and inadequate water treatment and distribution systems. The evidence indicates that no decision was made to stop chlorinating on the basis of DBP concerns and that concerns raised about DBPs masked more important factors limiting expansion of chlorination. In fact, outside of Peru's capital Lima, chlorination of drinking water supplies at the time of the epidemic was limited at best. We conclude that the Peruvian cholera epidemic was not caused by a failure of precaution but rather by an inadequate public health infrastructure unable to control a known risk: that of microbial contamination of water supplies.
机译：预防原则呼吁决策者根据证据表明采取预防措施，即使危害的性质和严重程度尚未得到科学的理解，也有可能危害公共健康和环境。对该预防原则的批评者经常争辩说，不加保护地应用该原则会导致对健康和生态系统的意外破坏（风险权衡），审慎的决策使我们容易遭受“假阳性”风险，使资源从“实际风险”转移到其他地方。经常提到1991年秘鲁霍乱疫情是预防原则的这些陷阱。有人错误地认为，由于存在消毒副产物（DBP）的风险，因此采取预防原则会使决策者停止对供水进行氯化处理，从而导致流行病。通过对在秘鲁伊基托斯和特鲁希略市进行的调查分析，文献回顾以及对秘鲁主要传染病研究人员的采访，我们确定该流行病是由一系列更为复杂的情况引起的，包括恶劣的卫生条件，不良的隔离水和废水流，以及水处理和分配系统不足。有证据表明，没有基于DBP的考虑做出停止氯化的决定，对DBP的担忧掩盖了限制氯化扩大的更重要的因素。实际上，在秘鲁首都利马以外，疫情爆发时饮用水供应的氯化作用最多是有限的。我们得出的结论是，秘鲁霍乱的流行不是由于未能预防，而是由于公共卫生基础设施不足，无法控制已知风险：微生物污染供水。

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