Availability, Accessibility, Acceptability and Quality

1. Equal access to the applications of science, particularly where those applications are instrumental for the enjoyment of other economic, social and cultural rights.
2. Access to information about the risks and benefits of science and technology, without discrimination.
3. The open opportunity to participate in scientific progress, without discrimination. States should remove discriminatory barriers that stop people participating, for instance by facilitating access of marginalised populations to scientific education.

The third dimension is the one students most often miss. Accessibility is not only about receiving the products of science. It is about being allowed into the activity.

Quality

Quality refers to the most advanced, up to date and generally accepted and verifiable science available at the time, according to the standards generally accepted by the scientific community. It applies both to the process of scientific creation and to access to the applications and benefits.

Quality also includes regulation and certification, where necessary, to ensure the responsible and ethical development and application of science. States should rely on widely accepted scientific knowledge, in dialogue with the scientific community, to regulate and certify the circulation of new scientific applications that reach the public.

Two consequences follow that are worth stating. A State that gives its population access to something ineffective has not satisfied the right; access to a worthless remedy is not access to the benefits of scientific progress. And a State that certifies applications by a standard other than the accepted scientific one has failed this element even if the product is freely available.

Acceptability

Acceptability implies that efforts should be made to ensure that science is explained, and its applications disseminated in a way that facilitates their acceptance in different cultural and social contexts, provided this does not affect their integrity and quality. Scientific education and the products of science should be tailored to populations with special needs, and the Comment names persons with disabilities.

Acceptability also carries an ethical component. Scientific research has to incorporate ethical standards to ensure its integrity and the respect of human dignity, and the Comment points to the standards proposed in the Universal Declaration on Bioethics and Human Rights (2005). It lists some of them: benefits to research participants and other affected individuals should be maximised and possible harm minimised with reasonable protection and safeguards; the autonomy and free and informed consent of participants should be guaranteed; privacy and confidentiality respected; vulnerable groups or persons especially protected against discrimination; and cultural diversity and pluralism given due regard.

And a fifth: freedom of research

Paragraph 20 states that the protection of freedom of scientific research, dealt with at paragraph 13 and resting on article 15(3), is also an element of the right. It is treated in its own chapter, [Freedom Indispensable for Scientific Research], and is noted here so that the list is not given as four when the Comment gives five.

The proviso inside acceptability

The words "provided that this does not affect their integrity and quality" carry more weight than their length suggests. They are the answer to an obvious objection: if science must be made acceptable in different cultural contexts, may a State dilute what it teaches to suit local opinion?

The answer is no. Acceptability governs how science is explained and delivered, not what is true. Adapting the presentation is required; adapting the content until it is no longer the accepted science defeats the quality element. A candidate who can state that relationship between the third and fourth elements has understood the framework rather than memorised it.

Worked example

A State runs a childhood immunisation programme. Vaccines are procured centrally and are free. Uptake in three districts is under thirty per cent. Testing the programme element by element:

Availability. The vaccine exists, is procured and is distributed, and there is a cold chain. This element is largely satisfied. If the State had no procurement at all, the analysis would stop here.

Accessibility. The vaccine is free, so there is no cost barrier, but the nearest centre in the three districts is a day's travel and opens on two mornings a week. Access is formally equal and practically unequal. The second dimension is also engaged: is information about the risks and benefits reaching these districts in a language people read?

Quality. Is the vaccine the current one, stored correctly and administered by trained staff? A vaccine that has lost potency in an unreliable cold chain fails this element while appearing to satisfy the first two.

Acceptability. Has the programme been explained in a way that makes sense in the local context? Where refusal is driven by a rumour, the failure is at this element, and no amount of additional supply will fix it. The remedy is explanation, engagement with those the community trusts, and materials suited to the population, including those with disabilities.

The lesson of the example is the utility of the framework. "Low uptake" is not a finding a lawyer can work with. "Adequate on availability, deficient on accessibility in three districts, and failing on acceptability" is a finding that names the obligation breached and the remedy required.

What it does NOT mean

These are not four separate rights. They are elements of one right, and a State does not comply by satisfying three of them. The immunisation example is designed to show that a programme can be strong on the first two and fail entirely because of the fourth.

Availability is not the same as accessibility. A national library that exists in the capital is available. It is not accessible to a student six hundred kilometres away. The Committee treats the two separately because States routinely satisfy the first and report it as though it discharged the second.

Acceptability is not a veto. It does not entitle a community to demand that science be changed to match its beliefs. The proviso protects integrity and quality expressly.

Quality is not decided by the State alone. The standard is that generally accepted by the scientific community, and the Comment requires regulation to be undertaken in dialogue with it. A ministry that certifies a product against its own criteria has not met the element.

Distinctions

Quick revision

• General Comment 25 (2020), paragraphs 16 to 19, gives the right to science four essential elements: availability, accessibility, quality and acceptability. Paragraph 20 adds freedom of research as a further element.
• The framework is borrowed from General Comment 14 (2000) on the right to health.
• Availability: progress actually happening, knowledge protected and widely disseminated; libraries, museums, internet networks, research infrastructure, financing of scientific education; open science and public access to publicly funded findings and data.
• Accessibility: three dimensions, equal access to applications, access to information about risks and benefits, and the open opportunity to participate; remove discriminatory barriers, facilitate access of marginalised populations to scientific education.
• Quality: the most advanced, up to date, generally accepted and verifiable science available at the time; includes regulation and certification in dialogue with the scientific community.
• Acceptability: science explained and disseminated so as to be accepted in different cultural and social contexts, provided integrity and quality are not affected; tailored to persons with special needs; incorporates ethical standards, the Comment pointing to the Universal Declaration on Bioethics and Human Rights 2005.
• The Comment's own order is availability, accessibility, quality, acceptability.

Test yourself

1. Name the four elements and say where the framework comes from. Availability, accessibility, quality and acceptability, set out in paragraphs 16 to 19 of General Comment No. 25 (2020), with the protection of freedom of scientific research added at paragraph 20 as a further element of the same right. The framework is taken from General Comment No. 14 (2000) on the right to health, where the Committee first broke an economic and social right into these four elements so that compliance could be tested rather than merely asserted.

2. Give the three dimensions of accessibility. First, everyone should have equal access to the applications of science, particularly where those applications are instrumental for the enjoyment of other economic, social and cultural rights. Second, information about the risks and benefits of science and technology should be accessible without discrimination. Third, everyone should have the open opportunity to participate in scientific progress without discrimination, which requires States to remove discriminatory barriers, for example by facilitating access of marginalised populations to scientific education.

3. A government makes a traditional remedy freely available nationwide and promotes it energetically. Trials show it has no effect on the disease it is given for. Which element fails, and why does universal availability not save it? Quality fails. The element requires the most advanced, up to date, generally accepted and verifiable science available at the time, judged by standards generally accepted by the scientific community, and it applies to access to the applications and benefits of science as well as to the process of creation. An ineffective remedy is not a benefit of scientific progress, so distributing it universally satisfies availability and accessibility in form while defeating the right in substance. The element also covers regulation and certification, so a certification given against criteria the scientific community does not accept is itself part of the breach.

4. What work is done by the words "provided that this does not affect their integrity and quality" in the acceptability element? They prevent acceptability from becoming a licence to alter the content of science to suit local opinion. Acceptability governs how science is explained and how its applications are delivered, requiring adaptation of presentation to different cultural and social contexts and to populations with special needs. The proviso keeps that adaptation on the presentational side of the line, so that the quality element, which requires generally accepted and verifiable science, is not defeated by the element that follows it.

5. Which element does open access publishing belong to, and what exactly does the Comment ask for? Availability. The Comment states that States should promote open science and open source publication of research, and that research findings and research data funded by States should be accessible to the public. It sits under availability because that element concerns not only whether scientific progress is taking place but whether scientific knowledge is protected and widely disseminated, which is a question about diffusion rather than about individual access.