Coronavirus

Let Volunteers Expose Themselves to COVID-19 To Speed Up a Vaccine

"Economists are accustomed to thinking about tradeoffs," says economist and Nobel laureate Alvin Roth. "It appears that at least in some parts of the ethics community, they are not."

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Would you allow scientists to expose you to the novel coronavirus if it would speed up vaccine development? Nearly 40,000 people from more than 160 countries have signed up to express interest in doing just that. 

As the world waits for the results of traditional vaccine trials in which participants come into contact with the virus naturally, human challenge trials would deliberately expose a much smaller sample of young, healthy volunteers, potentially cutting the study time by several months. 

But this approach is controversial among some public health officials and bioethicists because it would allow participants to put their own health at risk without a foolproof rescue therapy. And this debate relates to a longstanding divide over whether people in low-risk groups should be allowed to jeopardize their own health to save the lives of others—and even get paid for doing so.       

"To save one day—ethically, that's a no-brainer," says Josh Morrison, a 34-year-old former corporate lawyer who founded the nonprofit 1Day Sooner to advocate for human challenge trials. By speeding the availability of a vaccine by just a single day, he estimates that 4,500 lives could be saved globally, not including secondary effects on things like medical care for other conditions, suicide, and poverty.

Morrison got involved with challenge trials through his work trying to solve the kidney shortage. He founded the nonprofit Waitlist Zero after donating a kidney himself to a stranger in 2011. When the coronavirus pandemic started, Morrison recognized the parallels between challenge trials and kidney donations: they're both ways for healthy volunteers to accept a small amount of risk to save the lives of the more vulnerable. 

But Dr. Anthony Fauci of the White House Coronavirus Task Force indicated in July that the government has no plans to encourage or move forward with its own challenge studies since the current infection rate in the U.S. is high enough to conduct traditional trials quickly.

Morrison says this view is shortsighted since challenge studies could still speed the development of multiple second-generation vaccines that would be safer, more effective, and easier to distribute around the world than the first ones approved. He also thinks U.S. officials shouldn't be counting on high infection rates to continue through the end of the year.

Conducting a challenge trial also requires Food and Drug Administration (FDA) approval, but an official at the agency said in July that this approach could cause "ethical heartburn" because "if something bad happens, you don't have a perfect fix for it."

"Economists are accustomed to thinking about tradeoffs. It appears that at least in some parts of the ethics community, they are not," says Stanford economist Alvin Roth, who studies so-called repugnant transactions, or exchanges that many people don't think others should be allowed to make. He's one of 15 Nobel laureates who signed an open letter published by 1Day Sooner urging the National Institutes of Health (NIH) to prepare for challenge trials. 

Roth analogizes allowing well-informed individuals to get infected with the coronavirus to letting firefighters run into a burning building in a crowded city, in that we pay firefighters to take on additional risk so that many more civilians are not hurt by the fire before it burns itself out.

He points out that traditional vaccine trials carry their own risks. Unlike in challenge trials, participants don't have the benefit of constant medical evaluation and first-rate care. And in a normal trial, thousands of participants get a placebo, meaning they can both get infected and infect other people. They may even engage in riskier behaviors if they think they've been vaccinated.

Roth received his Nobel Prize in 2012 in part for his work applying market principles to kidney donations. It's illegal to pay donors in the U.S., so he came up with ways of encouraging them without direct compensation. By using Roth's insights, policymakers were able to increase living donations by around 20 percent. But tens of thousands of people still die each year in the U.S. due to the kidney shortage, and Roth says that paying donors could save many more lives. Though some fear this approach because poor or desperate people would be taken advantage of.

"We pay people to become firemen who would not become firemen if we didn't pay them," says Roth. "We should think about how to be appropriately grateful so that we're not exploiting the people who give us these things we need."

Today, the world is on hold waiting for results, thousands are dying every day, and hundreds of millions are at risk of injury or poverty from the global pandemic. But researchers at Oxford University, who were the first to enter traditional human trials with a vaccine, have had trouble recruiting enough participants who are likely to become infected, as the natural virus transmission rate in the United Kingdom has fallen. They are currently racing to prepare a protocol for challenge trials that can pass muster with Oxford's ethical review board, with the aim of beginning them by the end of the year. 

In the U.S., Reuters reported in mid-August that, partly because of public pressure applied by 1Day Sooner, government scientists were just starting to prepare a protocol for challenge trials, two months after the NIH first said it would start that process. But the agency still has not committed to moving forward with challenge trials, and private efforts to develop a vaccine are following the government's lead.

Produced, written, and edited by Justin Monticello; graphics by Isaac Reese; audio production by Ian Keyser.

Music: Quincas Moreira and Ian Post.

Photos: CHINE NOUVELLE/SIPA/Newscom; CHINE NOUVELLE/SIPA/Newscom; Tia Dufour/White House/ZUMA Press/Newscom; CHINE NOUVELLE/SIPA/Newscom; Stefani Reynolds—CNP / MEGA / Newscom; Michael Brochstein/Sipa USA/Newscom; Wissam Nassar Xinhua News Agency/Newscom; John Green/ZUMAPRESS/Newscom; SUN/Newscom; SUN/Newscom; Rolf Vennenbernd/dpa/picture-alliance/Newscom; SAUL LOEB/UPI/Newscom; Kevin Dietsch—Pool via CNP/Newscom; Paul Hennessy/ZUMA Press/Newscom; Jose Luis CARRASCOSA Westend61/Newscom; FrankHoermann/SVEN SIMON/picture alliance / SvenSimon/Newscom; Fotogramma/IPA/ABACA/Newscom; John-Marshall Mantel/Polaris/Newscom; SOPA Images/Miguel Angel Valero / SOPA Image/Newscom

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  2. Sure, if I can leave my house whenever I please, eat at any restaurant, go to a football game, get a haircut at a salon, not wear a mask and never have to get a vaccine. You don’t even have to pay me for the risks I took.

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    2. This, exactly.

      Vaccines are a means to an end, and that end is herd immunity. So, by extension: Allow volunteers to expose themselves to COVID-19 to speed up herd immunity. This effect will begin immediately, and is not dependent upon the creation of a vaccine that may never come.

      In other words, get rid of all of the restrictions on businesses, crowds, gatherings, and the idiotic mask rules, and do what the government should have done from the start: let people choose for themselves whether they will expose themselves to risk (hence “volunteers”). Let individuals decide if they will go to a sports event, a movie, a restaurant, a bar, or anywhere else. Let those who are willing go out there and take the hit so that those that can’t or won’t don’t have to.

  3. So, simultaneously we are being told that there are thousands of people dying from this every day with millions of infections and also we’re being told we need to infect more people in order to have people to study because the transmission rate is falling…

    And this is considered ‘not stupid’ because…

    1. I think I’d phrase it this way:

      So, simultaneously we are being told that there are thousands of people dying from this every day with millions of infections and also we’re being told we cannot speed up development of a vaccine because a few volunteers in the human trial might die…

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  4. In the 1940s we would have filled the empty dorm rooms with low-risk volunteers, exposed them to the virus under medical supervision, and then allowed them to get on with their lives afterward.

    This would have sped herd immunity while protecting the vulnerable, would have given us MASSIVE amounts of information about the percentage of the population that’s vulnerable to begin with, and best of all would have been totally voluntary!

    Instead we’re letting the virus randomly burn through the population (when Cuomo isn’t infecting the at-risk). 2020 government in a nutshell.

    1. Ah the good old days.

      Certain doctors then did all kinds of things. There was one I recall. What was his name again? Joseph something.

    2. There was an experimental trial, the Diamond Princess. Herd immunity was reached when 20% got infected, under 5% of the infected got ill, and half the ill died.

      If every college and school was fully opened, we’d have herd immunity in three weeks. And with today’s treatments and experience, none of the students or faculty would die.

  5. Before I volunteer… do I get to choose who I get exposed with?

    1. I would agree if it were not for one thing … Covid-19 is not like the flu. Even if the flu vaccine doesn’t work particularly well in any given year, if one is relatively healthy, the consequences of infection are a fever and body aches for a week or so, then back to normal. With Covid, however, there are non-trivial, long-term side-effects like heart, liver, kidney, and brain damage from infection, even in healthy people who suffer little to no symptoms. If anyone volunteers for infection to test a vaccine, they should get a written agreement that any long-term side-effects from failure of the vaccine will be paid for by the vaccine creator.

  6. finally rolls around to Chicken Pox Parties …

  7. NO THANKS…keep your vaccines. I like the odds of my immune system doing a much better job and without all the poisons injected along with the vaccines. The average vaccine trials fail over 90% of the time and the average time for testing and evaluation is 5-10 years or even longer. No Coronavirus vaccine has ever been created and they have been trying for over 10 years. You expect me to believe this is going to be safe after a few months of testing when we will not have any clue as to the long term affects and fallout? Count me out.

    1. The other coronaviruses (Sars, Mers) did have vaccines developed. The trick is that they couldn’t be tested widely, because the diseases fizzled out. And without a need, commercial production never proceeded.

      But it’s factually inaccurate to claim there were no coronavirus vaccines before.

      In fact, it’s the earlier research that made the current coronavirus vaccines much easier to develop.

  8. This is one of the most unethical proposals I have heard.

    You do not want to open this door. Paying people to be exposed to known pathogens.

    1. You’d rather have them exposed out in the world, without them knowing it, without doctors, without treatment at hand? That is the sole alternative. They will be exposed eventually… we all will. Would you rather it be in a medical setting or at random?

      1. If you are part of a double blinded trial you are under medical supervision. You have a treatment group and a placebo control group. The direct observers and the person getting the vaccine or medication do not know which. There are other observers watching results who do.

        Otherwise the trial is worthless because of bias and placebo effect.

        So you monitor what happens and compare the results. Very often trials are abandoned when it becomes obvious that there is a strong result one way or the other.

        It introduces another confounding factor if you deliberately introduce the pathogen. Now you are not looking at what actually happens in real circumstances.

        In a vaccine this is very important because you are intending to do exactly that. Give it to the population who will then just go about their lives.

        The ethical part is if you have deliberately induced serious disease under those uncertainties. Some of these people are getting placebo.

        Medicals should not do that. There is a pushback in ethics. We do not make people sick with a known pathogen and see what happens. What Nature does we observe and treat.

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