S&T: April 7th 2020 – “Ethical dilemma: Should we allow people to volunteer to be deliberately infected with coronavirus to substantially accelerate vaccine development?”

Dominic Cummings recently tweeted: “J Phillips, a brilliant young neuroscientist I recruited to no10, argued for immediate Human Challenge Trials, as did others. We were *far* too slow to listen to such advice. The science ‘misfits’ who urged this early were clearly right, the ‘ethicists’ disastrously wrong”

Below is a blog post I wrote April 7th 2020, for a blog now offline (orion-society.com). My own opinion was that we should proceed with challenge trials if they would accelerate vaccine deployment, as it was clear then that the risks of COVID19 for twenty year olds were low, and that remains so today, and the risks taken in war to save far fewer lives were far higher. For example, 40% (53/133) of the aircrew on the dam busters missions died. The amount of time saved would also be a function of how quickly, and thus how much risk, one would be prepared to tolerate.

Should we allow people to volunteer to be deliberately infected with coronavirus to substantially accelerate vaccine development?

Is it ethical to bring the Covid crisis to an end more quickly by allowing a small number of individuals to take a calculated personal risk? 

Coronavirus is a war-like situation. In war, risky operations are performed, often by volunteers, to produce large collective benefits, and we should consider approaches like this to coronavirus. With infections growing exponentially each week, coronavirus now looks to cost hundreds of thousands to multiple millions of lives worldwide and trillions of dollars of economic damage, which in turn produces major harms to public health and wellbeing. This makes development of an effective vaccine a global imperative.

We already have vaccine candidates, and are building factories to produce them, but we urgently need to find out which vaccines actually work before rolling them out, which could take a year. 

Unusual solutions, even ethically troublesome ones, may not be getting voice for fear of being ‘the first to speak up’. A crucial delay at present in the process of vaccine development is safety testing of the vaccine in healthy volunteers, and then waiting for another cohort of the public to be given it and see if they later develop COVID-19. This can take many months, causing vast additional suffering. 

A faster strategy would be to treat a small cohort of volunteers with the best vaccine candidates and then deliberately infect them to test whether this ‘quasi-vaccinated’ group is immune to the coronavirus. This would quickly (a few weeks) identify effective vaccines and, if successful, this would likely directly save hundreds of thousands of lives by accelerating a vaccine by many months. So the question is: should we risk the lives of a handful of low risk, young human volunteers to likely bring the coronavirus crisis to an end many months earlier, cutting out several stages of testing? 

We in the west recoil at this kind of ‘deliberate infection’, but we note that we already do this for some diseases with recent success such as for Typhoid in Oxford (Thanks to @DrKatHolt for highlighting this in tweet). Also, frontline healthcare workers are essentially already volunteering for a very high risk of infection, potentially with much higher viral load, yet we have no treatment to protect them. Why should we prevent others, in lower risk categories, doing something equally noble out of choice to help humanity?

In recent days this question has been gaining traction in the academic world. Science magazine has just (April 3rd) published a piece titled ‘Infect volunteers to speed a coronavirus vaccine?’, a partner to a piece on overall vaccine development for COVID-19, based in part on this detailed proposal from March 31st in the Journal of Infectious Diseases (see this tweet)

We are writing this out of conviction that this decision should not be left only in the hands of academics, but rather should be actively debated in the public realm and the decision made by an informed, elected and accountable prime minister or president, not only ethics committees. This is the kind of proposal that might be slow to pass through a bureaucracy due to its risky nature, and those on the front line have more pressing priorities than getting approval for exploring new approaches.

There are three questions that need to be addressed urgently in direct advice to the leaders of countries:

  1. Would going straight to direct infection of healthy volunteers substantially accelerate vaccine development, and if so by how much and how many volunteers? We should assume we need to test multiple vaccines which means more volunteers.
  2. Can the knowable risks, benefits, and ethical considerations be communicated accurately to decision makers, volunteers, and the general public?
  3. What is the opinion of informed (of point 2) members of the public on this?

Ultimately, the decision whether to allow people to volunteer should be made by a democratically elected leader based upon the input of a diversity of experts, parliamentarians and public polling, and we feel this must be elevated to their level of attention. If the decision is yes, the output would be to make the necessary changes in law and provide funding. It has the potential to save hundreds of thousands of lives and trillions of dollars if it is judged the ethical thing to do.

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