Human Challenge Trials for vaccines

From an anonymous reader:

As you are of course aware, testing on vaccines for Covid-19 are beginning to be undertaken. The scientific community has seemingly decided that Human Challenge Trials (HCT) where test subjects are directly exposed to the virus following vaccination are unethical, instead using the typical protocol of vaccine/placebo inoculation followed by months of observation in order to observe effectiveness. This seems to me a grave moral error based on the following argument.

1) There exists a large cohort of young, healthy, fully informed, willing participants who would undergo HCT.

2) Given the mortality profile of this disease, these participants would be undertaking an exceptionally small mortality risk (perhaps 5-10 per 100k, based on data from Spain/Italy/NYC, assuming zero vaccine effectiveness).

3) Society deems acceptable other activities with much higher fatality risk (at least 5-10x) in both professional (soldiers, logging workers) and recreational (motorcycling, mountaineering) capacities.

4) HCT would speed up the vaccine testing process by many months, saving tens of thousands of lives and avoiding enormous economic damage.

5) HCT actually poses significantly less risk to participants in terms of allergic reaction or ADE risk compared to a standard testing protocol since the number of participants could be much smaller and they would be medically observed.

I fail to find any ethical justification for the current stance of the medical community, from either a utilitarian or deontological perspective, and believe a highly consequential error is being made. This error may be based on false analogies to past unethical testing practices in history where participants were not informed or willing and danger was significant. The current case bears no ethical resemblance, in my judgement, to these past cases.

The simplest model of such errors is that many members of the biomedical establishment do not wish to have bad feelings about any “sins of commission” and to see their status lowered as a result of “dirty hands,” and the readily criticized logistics of Human Challenge Trials.  Since HCTs do not “feel right” to them, they self-deceive into associating that feeling with a concern for the greater public good.

You should not be surprised to see grave moral errors committed in a crisis, however.  Our “mainstream” protection against grave moral errors, in normal circumstances, simply is that usually we are not given the opportunity to commit them.

I do understand that a Human Challenge Trial does not necessarily suffice to show that a given vaccine is safe.  Nonetheless it should be in the “armor of our discourse,” so to speak, as a morally acceptable alternative.  So if you are a biomedical professional, or a public intellectual, I hope you will speak up.

Here is a Matt Yglesias piece on the urgency of developing a vaccine as quickly as possible.  Eric Weinstein notes that women risk their lives every time they proceed with having children.


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