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"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.
For full text, links, and more, go to https://reason.com/video/let-volunteers-expose-themselves-to-covid-19-to-speed-up-a-vaccine
Produced, written, and edited by Justin Monticello; graphics by Isaac Reese; audio production by Ian Keyser.
Music: Quincas Moreira and Ian Post.
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