The notion of testing covid-19 vaccines by deliberately infecting volunteers with the novel coronavirus — something that’s now on the table — isn’t necessarily crazy or unethical. It’s smart, and has benefits that far outweigh the risks.
So-called challenge trials, as scientists call them, vastly speed up the process of vaccine testing, and might also help us understand natural immunity of people who’ve already been infected.
This doesn’t mean abandoning the framework of medical ethics that protects human research subjects from abuse. It means recognizing that there are risks and benefits unique to this situation.
In the weekend’s Washington Post, philosopher Richard Yetter Chappell and bioethics professor Peter Singer made “The Case for Experiments on Human Volunteers,” below which a chorus of commenters fretted that this would exploit poor people, drawn by what few dollars the researchers would hand them as compensation. Some suggested that the authors go first.
That’s not a bad idea, though older males are not the right people to go first (Singer is 73). I should go first. I’m exactly the kind of person who should be part of this experiment. In fact, I just signed up for one….
The problem with ordinary vaccine efficacy trials is that they’re very slow. This is what led Anthony Fauci to warn that it could take 18 months or more to identify a safe vaccine. (The fastest vaccine developed so far — the one for mumps — took four years.) Researchers typically have to test the vaccine on large groups of people and compare them to large groups of unvaccinated people, waiting weeks or months until an appreciable number of both the vaccinated test subjects and the unvaccinated control group to become exposed to the illness in the course of their regular daily lives. Challenge trials short-circuit that process by exposing people deliberately to the virus.
So that I could learn more about volunteering for such a study, [Rutgers University ethicist Nir] Eyal put me in touch with Josh Morrison, who started a foundation called 1daysooner. The website has a place where I was able to add my name to a list of volunteers willing to be covid-19 vaccine study subjects. Morrison, a former lawyer, told me he started the organization after becoming interested in advocacy and health issues. He’s gathered signatures of more than 3,000 people.
Informed consent is a cornerstone of medical ethics. I’ve spent decades interviewing scientists, doing research, understanding new ideas and putting them into a readable format. Since February I’ve been on a steady stream of phone calls with virologists, immunologists, epidemiologists, pulmonologists, hematologists and risk communication experts. I’ve digested and understood what they’ve said. I know other vaccines have caused side effects. If anyone could give fully informed consent, I could.
Other volunteers could be selected from the ranks of scientists, medical students, medical ethicists, and others who have the relevant skills to become knowledgeable enough to give genuinely informed consent.
Stanley Plotkin of the University of Pennsylvania, who invented the rubella vaccine, the R in the standard MMR vaccines, told me they really want volunteers in their twenties, which rules a lot of people out, including me. But others have proposed a more diverse range of ages. While people over 65 would be at too high a risk to be deliberately infected, there’s growing evidence that the risks have more to do with comorbidities — existing health problems — than age…..
Though some ethicists have debated paying volunteers, this would be a mistake. It would lead to the perception that the scientists were preying on those who need money. Nobody should participate in this kind of trial for the money.
But we should also recognize that, unlike a kidney donation, participation in covid-19 vaccine trials wouldn’t be purely altruistic either. Unlike kidney donors, volunteers would benefit from being perhaps the first to feel safe from the disease. They’ll also share in the collective benefit accrued from a broader return to a normal life when more of us have the freedom to move about, do our jobs, and find love and companionship.
There’s always the possibility that something unpredictable could go wrong — and that could lead to a public relations nightmare that could derail vaccine research. But the bad PR might be worse if something happened to an innocent young person than to a considerably older, wiser, more informed person who knew what she was walking into.
Little about America’s approach to the pandemic has been ethical to date. We weren’t given informed consent about the lockdowns — many people don’t understand their purpose, or their limitations. There’s also been little informed consent on lifting them — it’s not clear whether people understand that the risk of contracting covid-19 remains as large as ever in the United States.
The lockdowns only delay deaths from the virus. A vaccine would end them. Surely that’s a reward for which some of us are willing to risk ourselves.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.