If your country is invaded, is it unethical to let young, healthy volunteers form an army and fight back, even at some risk to themselves? It shouldn't be illegal to let people take reasonable, calculated risks for the good of everyone.
The british army tested nerve agents on un-knowing Army recruits and accidentally killed people.
The Australian army tested anti-malarials with good intent and caused huge mental harms (they are pretty psychologically active and can trigger suicide ideation)
The US army has form for testing on recruits without adequate consent or information
Overall, the whole "for the good of humanity" story here is that the consent is weak, the support is weak, the costs are not borne equally. I would not advise any young person to be guilt-tripped into volunteering for this.
That's a false equivalence.
We are not talking about not testing vaccines at all or not, but how.
You are simply ignoring the responsibility of the vaccine maker of potentially not going through the adequate steps.
A better equivalence would be the question, how should your hypothetical army be equipped and trained. And would the people doing/deciding that be responsible for the choices made.
I would understand you saying, it doesn't matter we are under attack.
No, a better equivalence would be how long you let the invading army plunder before you start handing out spears and shields, because if you wait another month the shields might work better.
That metaphor sounds nice but conjurs the wrong image. The vaccine could very well be worse than a Covid infection, i.e. you grab your shield, but that newsly invented shield has spikes on the inside.
IMO, institutional review boards in charge of trials would not let this pass, for a good reason. Especially because you can't (obviously) use a control group.
It's different from a phase 1 study when you are testing on healthy volounteers. This would mean deliberately infecting people with a largely unknown virus after vaccination with a vaccine whose efficacy is still not yet determined fully (in fact, it would be to determine its efficacy).
Of course it involves some risk. But the alternative is that millions of others, many older and with compromised immune systems, would get the virus involuntarily because the vaccine trials took longer to run. Is it ethical to ban research that saves thousands of lives?
We should just use prisoners as the test subjects. Leave it up to and IRB and they will sit on it until we’re all dead...
If you ask under-40y/o non-violent offenders with >10yr sentence and say a $10k payout and guaranteed presidential pardon upon completion of the trial I’m sure there would be some takers.
Yes that’s crazy and I do know the governments history of shady vaccine testing, but we are facing a pandemic and each day sooner that we have a vaccine will be many lives saved.
There was an early experiment with variolation tried on someone sentenced to death, where he agreed to be variolated, then challenged with smallpox infection. his sentence was commuted after he survived.
the highest-profile prison experiments in the US were Project MKUltra, in which prisoners were injected with high doses of LSD, the Stateville Penitentiary Malaria Study, and some experiments with radioactive isotopes.
offering prisoners their freedom in exchange for participating in dangerous or harmful trials was widely viewed as coercive, and contrary to the Nuremberg code of medical voluntary consent established after the horrors of Nazi experimentation.
why should it be better to use prisoners than young, healthy volunteers? are their lives cheaper and expendible because they committed non-violent offenses? no IRB would sign off on that, and if you're bypassing IRBs anyway just use young people who think they're invincible..
It is absolutely unacceptable, that's why 2/3 answers to this comment so far use martial metaphors. It violates not the liberty of young men, who have every right to be reckless and volunteer, but integrity of the scientific community.
If the Oxford researchers made trials on Syrian kids in a refugee camp, in exchange for $100, I suppose more people would see a problem here.
I'd be willing to do it. It could save thousands or lives. Which part to you object to? Enthusiastic volunteers being able to choose to take a risk? The world has become far too nanny state and arse covering in my opinion.
I find the attitude puzzling that people are willing to value vague abstractions like "integrity of the community" over thousands of lives.
I agree with everything you say. If a rogue MD in a nanny state will talk you into a challenge trial, - by all means, let him do it and face the consequences (hopefully, tough).
But let's not pretend, that it would be an informed consent.
The reason for the vaccine research protocol we're settled on, is the ubiquity of wanna-be Pasteurs, and dearth of the real ones.
On a separate note. We have deprived ourselves of basic human rights under the premise, that lives are worth any economic outcome of shut down. Where I live, premeditated spreading of the Covid is considered by law an act of terrorism. Officially vetted challenge trials just don't add up.
Well, kids over 18 can give consent. And no one can give an informed consent to a challenge trial at this point.
If you and I stole the vaccine, injected it, and would try to get infected, as an amateur scientific endeavor, it would be perfectly ok. If an MD would inform us, that she "feels optimistic", in order to get a consent, she has no business being a researcher.
It's going to harm the integrity of the scientific community a lot more once the world starts counting up the lives human challenge trials could have saved.
They are volunteering and the risks are small to zero or negative. Do you think it's unethical to let people choose take any risk at all in their lives?
Every time you tell a doctor to go to work treating COVID patients, you're doing a challenge trial, except he has no chance of being vaccinated, and the risk he's taking doesn't contribute to the most important thing for the world, which is a working COVID vaccine.
We are allowing "essential" workers to be exposed to COVID. Who could be more of an essential worker than a vaccine trial participant right now?
This is exactly why you wouldn’t need a challenge trial: lots of people are already regularly exposed to the virus. Immunize some of them and see if the infection rate is lower in that group vs a control.
Except failed vaccines can induce a response that makes you more susceptible to the disease and with worse symptoms. It’s called antibody-dependent enhancement:
I said that there’s plenty of incidental exposure already: healthcare workers, yes, but also nearly everyone who’s leaving the home too. It is literally a pandemic!
This point is actually made in the article itself: they want to get it done while and where there’s community transmission to avoid the ethical fraught ness of a challenge trial.
For similar reasons, challenge trials also weren’t done for AIDS PrEP, since there were groups with enough lifestyle exposure to power a study.
We ask young people to risk their lives often, it's called 'The Army' (and other groups).
Also - this would be less risky than going to space.
My instinct says >50% of soldiers between 20-30 would instantly volunteer for this. Probably much higher, like 80%. Especially those unmarried.
There would be no lack of fit volunteers.
Its ethically problematic obviously, but so is asking grocery store workers to stock shelves as 'essential workers' during a pandemic when they have no PPE.
I think probably there's a 100% chance that so-called 'essential workers' who are not medical staff will die from Coronavirus due to the pandemic.
The rate of death among the 'very young' is exceedingly low, and I think there were always complications.
If we can narrow it to 19-26 year old, super healthy, without complications ... I think the 'possibility of harm' would be quite low.
It's not beyond the realm of ethical consideration.
Now - remove some ethnical barriers - such as what drug companies used to do by testing drugs in Africa, or what authoritarian governments do all the time (aka China) and you'll have this done in a heartbeat.
I think China/CCP wouldn't think twice about trying this on young men in jail. Is my cynical take.
Edit: I should add, I don't want to leave out other groups of individuals (and non-groups) who would gladly sign up for such an opportunity to help even with some risk. Healthcare workers, Police, probably most veterinarian staff and civil servants as well (!) if they were young and fit. And so many others.
