6 ms·

We could test that it's safe, yes. Effective, no. You have to have the people out in the community, for both the vaccinated group and the control group, and t

We could test that it's safe, yes. Effective, no. You have to have the people out in the community, for both the vaccinated group and the control group, and then compare who gets infected in each group. The testing actually took less time than they expected due to the unfortunately-high prevalence of COVID-19 in the community.

nostromo 6y ago
No, the testers would be directly exposed as part of the trial, which is why they'd be compensated -- as opposed to waiting around for 9 months for some percent of people to be exposed.
- dragontamer 6y ago
  And the control / placebo group? You're really going to force testers to potentially pick up the placebo, and then inject them with COVID19 forcefully? I mean yeah, it'd work, but its generally considered immoral under today's philosophy of science.
  - maxerickson 6y ago
    Why wouldn't they be willing volunteers? It would be quite possible for it to clearly be informed consent also, at least to the extent the disease was characterized at that point in time. The reason people keep bringing it up is that the consequences of the pandemic have been much worse than the consequences of allowing a few thousand people to intentionally expose themselves to an infection in a controlled setting¹. It's not guaranteed that challenge trials would have mitigated the pandemic, but it's weird to just outright circumscribe the possibility when the ongoing downside is huge. 1. I use the odd phrasing here because lots of people pretty much choose to expose themselves to the infection anyway; maybe not explicitly, but close enough.
  - marvin 6y ago
    Would it be immoral if they were offered a million dollars?Honest question, because it feels like the philosophy might not match up with common experience. It feels like an interesting question. People voluntarily risk worse for less pay in other fields, e.g. the military. And if it wasn't immoral, what is the dollar limit?
    - dragontamer 6y ago
      Money is worth different amounts to different people. Bill Gates or Jeff Bezos will never risk their life for "only" a million bucks. Find a depressed + suicidal dude somewhere else, and they may be personally willing to risk their life for just $100. Making an industry of people who are willing to harm themselves for money is... probably not the business we should be encouraging. And that's assuming everyone is "playing nice". At a minimum, it means that we'll be inclined to start experimenting upon the poor and depressed (and then shedding away moral qualms because they signed a piece of paper). Historically speaking in the USA, we have legacies like the Tuskegee Syphilis Study, where African Americans were chosen as the control group and lied to about getting a Syphilis treatment: leading to a generation+ long distrust in science. Yeah yeah, we can't "assume" scientists will be racist jackasses today. But... we still have to account for what happened in our history and why certain testing methodologies have become taboo.
      - marvin 6y ago
        Good points. It's obvious that the potential for ethical problems in such a situation is huge. I've thought for similar questions that a required baseline would be to at least have a society that provides a viable minimum social safety net, as well as free healthcare. When external conditions compel people to risk their health for survival, it is impossible to ensure sound ethics. The point about ensuring that science and scientists can be trusted in the future is also an excellent point.
  - bmj 6y ago
    Remember that in, say, a cancer treatment trial, patients are signing up to potentially not receive the treatment depending on the run-in and randomization phases. I'm not suggesting these patients are forced into that decision; rather, I'm just pointing that controlled, randomized trials have some ethical fuzziness around them.
    - dragontamer 6y ago
      But they already have cancer, and the treatment may (or may not) help them. What's being proposed here is for people to sign up and then inject a potentially deadly disease into them.
      - gojomo 6y ago
        But until treatments/vaccines were developed, everyone on Earth had the disease-equivalent, sometimes-fatal status of "no prior immunity to COVID". Sure, the scale is massively different for a young healthy person: "susceptible to COVID" would mean a moderate chance of catching the disease (growing over time), and then a small chance of death or previous complications. But the "susceptibility" is also a "health condition" with nonzero risk-of-death. And for society as a whole, COVID passed cancer as a cause of death last year, and in January 2021 has been killing about twice as many people as all cancers combined. So "diagnosed-with-cancer" versus "susceptible-to-COVID" shouldn't be that different in terms of the kinds of risks we'd let informed people take to address that danger.
  - mysterypie 6y ago
    Not forcefully. He said paid volunteers. Why does the idea of challenge trials cause a furious reaction? Let's compare it to the space shuttle: 135 missions with 2 missions in which everyone died. That's a case fatality rate of 1.5% -- in the neighborhood of the Covid CFR. And I'd expect a challenge trial on young healthy volunteers to have a much lower CFR. Why is risking people for the shuttle OK, but risking people for a vaccine that benefits all of humanity not OK?
    - krsdcbl 6y ago
      There's two big issues with this approach: 1) death is but only the worst outcome. Being on the space shuttle does bring risk, yes, but not a 50/50 chance of a significant impact to your general health. 2) you'll end up testing the vaccines largely on marginalized population and people with heavy financial problems, misrepresenting the population at large and showing biased result.
  - nostromo 6y ago
    For this age range, the survival rate for everyone is 99.98%. It'd be even higher if your screened aggressively for comorbidities / general health and provided everyone with top notch healthcare knowing in advance they have been exposed. I would sign up for this in a heartbeat. Not only for the cash payment -- but you'd be a local hero and you could feel good for the rest of your life about taking a small risk to save the lives of many ill or elderly people.
    - loriverkutya 6y ago
      So 2 person out of 10 000 dies. You would be a local hero and you would probably feel good for the rest of your life which is 2 weeks time. Also, let’s talk about long COVID. Nobody knows how long is it stay with you or if you even recover from it. You are a hero but you cannot climb the stairs anymore. And you will be forgotten in months.
      - Trasmatta 6y ago
        Except the point is people were willing to sign up knowing that is exactly the risk they're undertaking. The alternative that we chose was hundreds of thousands of more deaths and millions of more cases. From people who didn't sign up for it.
  - neelnanda 6y ago
    [1 Day Sooner](https://www.1daysooner.org/ https://www.1daysooner.org/) is an organisation pushing for these trials, that's found 38,000 informed volunteers who would be willing to do these trials. Force is completely unnecessary, there are enough altruistic people who are willing to do trials like this
- reillyse 6y ago
  Total ethical failure here. You are supposed to not make people ill.
  - nostromo 6y ago
    2,000,000+ people are dead because we didn't take this path. The risk to testers under 40 would have been negligible. I'm not being flippant about other peoples' lives -- I would have signed up myself if the compensation was high enough.
    - dragontamer 6y ago
      > The risk to testers under 40 would have been negligible. Luke Letlow (age 41) says otherwise, since he's dead. Okay, he's above 40, but he's high-profile and easy for me to remember. Plenty of sub 40 year olds have died. Even among the survivors... plenty of young and healthy 20-30 year olds are having month-long recoveries, unable to breath at their old capacity. Purposefully damaging the control group (who by definition, must NOT receive the vaccine) is immoral. Whether people in the control group believe in the potential harms of the disease or not.
      - deleted 6y ago
        [deleted]
      - nostromo 6y ago
        "One person died" isn't a refutation, it's just an appeal to emotion. Under 40 the survival rate is 99.98% for everyone -- including the already ill. If you screened for comorbidities and gave people great healthcare, you could get that 99.999% or higher. And save millions of lives (and trillions of dollars) by doing so.
        dragontamer 6y ago
        > Under 40 the survival rate is 99.98% for everyone -- including the already ill I doubt that. But I'm not entirely sure how to calculate the numbers you just said. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm I realize this page changes, so I've taken a screenshot here: https://imgur.com/0iM5FHC https://imgur.com/0iM5FHC This is the chart of who died in January 2021. Yes, most deaths are aged 65+, but there's been deaths in all age categories. I doubt its 99.98% as you suggest (especially since the current case-mortality-rate is ~2.5%, at least for my state) The official CDC numbers are stratified from 35 to 44, I'm not entirely sure who you are citing to get "below 40" age groups.
- namesbc 6y ago
  In order to use this method to test a vaccine for deployment to people over 65, you need people over 65 in your control group. This means you are choosing people to murder.
  - tinus_hn 6y ago
    A ridiculous exaggeration; you’re asking for volunteers to take a risk. Not killing them. People can decide for themselves to take risks. You may not agree with the choices they make and that is your problem. Not theirs.
    - namesbc 6y ago
      No, I am saying that volunteer challenge trials don't test what want to test so their results are useless at best, and murder at worst.
  - maxerickson 6y ago
    Do separate branches then. Use challenge trials to accelerate deployment to under 30s (or whatever) and natural infection for other age brackets. I honestly haven't thought deeply about the ethics, but it's really concerning that it has become such a hard rule that preventing people from injuring themselves in a particular way (we don't prevent lots of other forms of injury) is somehow obviously superior to letting tens of thousands of people die for lack of information.
    - namesbc 6y ago
      The vaccine is going to be deployed to communities at risk first, you can't test vulnerable populations via volunteer challenge trials.
      - maxerickson 6y ago
        That's circular. If the challenge trial is successful, start deploying it to the groups tested using that method and then shift to the at risk groups as data justifies it. It won't hurt the at risk groups to start up high volume manufacturing earlier (it will likely help them), and there is a benefit to everyone each time anyone is vaccinated (the reduction in transmission efficiency).

nostromo 6y ago

No, the testers would be directly exposed as part of the trial, which is why they'd be compensated -- as opposed to waiting around for 9 months for some percent of people to be exposed.

dragontamer 6y ago
And the control / placebo group? You're really going to force testers to potentially pick up the placebo, and then inject them with COVID19 forcefully? I mean yeah, it'd work, but its generally considered immoral under today's philosophy of science.
- maxerickson 6y ago
  Why wouldn't they be willing volunteers? It would be quite possible for it to clearly be informed consent also, at least to the extent the disease was characterized at that point in time. The reason people keep bringing it up is that the consequences of the pandemic have been much worse than the consequences of allowing a few thousand people to intentionally expose themselves to an infection in a controlled setting¹. It's not guaranteed that challenge trials would have mitigated the pandemic, but it's weird to just outright circumscribe the possibility when the ongoing downside is huge. 1. I use the odd phrasing here because lots of people pretty much choose to expose themselves to the infection anyway; maybe not explicitly, but close enough.
- marvin 6y ago
  Would it be immoral if they were offered a million dollars?Honest question, because it feels like the philosophy might not match up with common experience. It feels like an interesting question. People voluntarily risk worse for less pay in other fields, e.g. the military. And if it wasn't immoral, what is the dollar limit?
  - dragontamer 6y ago
    Money is worth different amounts to different people. Bill Gates or Jeff Bezos will never risk their life for "only" a million bucks. Find a depressed + suicidal dude somewhere else, and they may be personally willing to risk their life for just $100. Making an industry of people who are willing to harm themselves for money is... probably not the business we should be encouraging. And that's assuming everyone is "playing nice". At a minimum, it means that we'll be inclined to start experimenting upon the poor and depressed (and then shedding away moral qualms because they signed a piece of paper). Historically speaking in the USA, we have legacies like the Tuskegee Syphilis Study, where African Americans were chosen as the control group and lied to about getting a Syphilis treatment: leading to a generation+ long distrust in science. Yeah yeah, we can't "assume" scientists will be racist jackasses today. But... we still have to account for what happened in our history and why certain testing methodologies have become taboo.
    - marvin 6y ago
      Good points. It's obvious that the potential for ethical problems in such a situation is huge. I've thought for similar questions that a required baseline would be to at least have a society that provides a viable minimum social safety net, as well as free healthcare. When external conditions compel people to risk their health for survival, it is impossible to ensure sound ethics. The point about ensuring that science and scientists can be trusted in the future is also an excellent point.
- bmj 6y ago
  Remember that in, say, a cancer treatment trial, patients are signing up to potentially not receive the treatment depending on the run-in and randomization phases. I'm not suggesting these patients are forced into that decision; rather, I'm just pointing that controlled, randomized trials have some ethical fuzziness around them.
  - dragontamer 6y ago
    But they already have cancer, and the treatment may (or may not) help them. What's being proposed here is for people to sign up and then inject a potentially deadly disease into them.
    - gojomo 6y ago
      But until treatments/vaccines were developed, everyone on Earth had the disease-equivalent, sometimes-fatal status of "no prior immunity to COVID". Sure, the scale is massively different for a young healthy person: "susceptible to COVID" would mean a moderate chance of catching the disease (growing over time), and then a small chance of death or previous complications. But the "susceptibility" is also a "health condition" with nonzero risk-of-death. And for society as a whole, COVID passed cancer as a cause of death last year, and in January 2021 has been killing about twice as many people as all cancers combined. So "diagnosed-with-cancer" versus "susceptible-to-COVID" shouldn't be that different in terms of the kinds of risks we'd let informed people take to address that danger.
- mysterypie 6y ago
  Not forcefully. He said paid volunteers. Why does the idea of challenge trials cause a furious reaction? Let's compare it to the space shuttle: 135 missions with 2 missions in which everyone died. That's a case fatality rate of 1.5% -- in the neighborhood of the Covid CFR. And I'd expect a challenge trial on young healthy volunteers to have a much lower CFR. Why is risking people for the shuttle OK, but risking people for a vaccine that benefits all of humanity not OK?
  - krsdcbl 6y ago
    There's two big issues with this approach: 1) death is but only the worst outcome. Being on the space shuttle does bring risk, yes, but not a 50/50 chance of a significant impact to your general health. 2) you'll end up testing the vaccines largely on marginalized population and people with heavy financial problems, misrepresenting the population at large and showing biased result.
- nostromo 6y ago
  For this age range, the survival rate for everyone is 99.98%. It'd be even higher if your screened aggressively for comorbidities / general health and provided everyone with top notch healthcare knowing in advance they have been exposed. I would sign up for this in a heartbeat. Not only for the cash payment -- but you'd be a local hero and you could feel good for the rest of your life about taking a small risk to save the lives of many ill or elderly people.
  - loriverkutya 6y ago
    So 2 person out of 10 000 dies. You would be a local hero and you would probably feel good for the rest of your life which is 2 weeks time. Also, let’s talk about long COVID. Nobody knows how long is it stay with you or if you even recover from it. You are a hero but you cannot climb the stairs anymore. And you will be forgotten in months.
    - Trasmatta 6y ago
      Except the point is people were willing to sign up knowing that is exactly the risk they're undertaking. The alternative that we chose was hundreds of thousands of more deaths and millions of more cases. From people who didn't sign up for it.
- neelnanda 6y ago
  [1 Day Sooner](https://www.1daysooner.org/ https://www.1daysooner.org/) is an organisation pushing for these trials, that's found 38,000 informed volunteers who would be willing to do these trials. Force is completely unnecessary, there are enough altruistic people who are willing to do trials like this
reillyse 6y ago
Total ethical failure here. You are supposed to not make people ill.
- nostromo 6y ago
  2,000,000+ people are dead because we didn't take this path. The risk to testers under 40 would have been negligible. I'm not being flippant about other peoples' lives -- I would have signed up myself if the compensation was high enough.
  - dragontamer 6y ago
    > The risk to testers under 40 would have been negligible. Luke Letlow (age 41) says otherwise, since he's dead. Okay, he's above 40, but he's high-profile and easy for me to remember. Plenty of sub 40 year olds have died. Even among the survivors... plenty of young and healthy 20-30 year olds are having month-long recoveries, unable to breath at their old capacity. Purposefully damaging the control group (who by definition, must NOT receive the vaccine) is immoral. Whether people in the control group believe in the potential harms of the disease or not.
    - deleted 6y ago
      [deleted]
    - nostromo 6y ago
      "One person died" isn't a refutation, it's just an appeal to emotion. Under 40 the survival rate is 99.98% for everyone -- including the already ill. If you screened for comorbidities and gave people great healthcare, you could get that 99.999% or higher. And save millions of lives (and trillions of dollars) by doing so.
      - dragontamer 6y ago
        > Under 40 the survival rate is 99.98% for everyone -- including the already ill I doubt that. But I'm not entirely sure how to calculate the numbers you just said. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm I realize this page changes, so I've taken a screenshot here: https://imgur.com/0iM5FHC https://imgur.com/0iM5FHC This is the chart of who died in January 2021. Yes, most deaths are aged 65+, but there's been deaths in all age categories. I doubt its 99.98% as you suggest (especially since the current case-mortality-rate is ~2.5%, at least for my state) The official CDC numbers are stratified from 35 to 44, I'm not entirely sure who you are citing to get "below 40" age groups.
namesbc 6y ago
In order to use this method to test a vaccine for deployment to people over 65, you need people over 65 in your control group. This means you are choosing people to murder.
- tinus_hn 6y ago
  A ridiculous exaggeration; you’re asking for volunteers to take a risk. Not killing them. People can decide for themselves to take risks. You may not agree with the choices they make and that is your problem. Not theirs.
  - namesbc 6y ago
    No, I am saying that volunteer challenge trials don't test what want to test so their results are useless at best, and murder at worst.
- maxerickson 6y ago
  Do separate branches then. Use challenge trials to accelerate deployment to under 30s (or whatever) and natural infection for other age brackets. I honestly haven't thought deeply about the ethics, but it's really concerning that it has become such a hard rule that preventing people from injuring themselves in a particular way (we don't prevent lots of other forms of injury) is somehow obviously superior to letting tens of thousands of people die for lack of information.
  - namesbc 6y ago
    The vaccine is going to be deployed to communities at risk first, you can't test vulnerable populations via volunteer challenge trials.
    - maxerickson 6y ago
      That's circular. If the challenge trial is successful, start deploying it to the groups tested using that method and then shift to the at risk groups as data justifies it. It won't hurt the at risk groups to start up high volume manufacturing earlier (it will likely help them), and there is a benefit to everyone each time anyone is vaccinated (the reduction in transmission efficiency).