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Some people in this thread are saying we should have allowed challenge trials in February 2020, soon after the initial vaccine candidates were developed. But re
by runako 6y ago
Some people in this thread are saying we should have allowed challenge trials in February 2020, soon after the initial vaccine candidates were developed. But reading TFA:
"The drug Remdesivir will be used as soon as volunteers start developing symptoms."
Remdesivir broadly wasn't available in February 2020 as an approved drug. It still isn't in the EU, and broad US availability didn't come until the fall. It cannot be overstated how new are many of the drugs involved in the Covid response. It's not just the vaccine platforms, of which at least 2(!) are seeing their first use.
Accepted therapeutic options have AFAIK always been a part of challenge trial protocols. The difference is that in e.g. March 2020, the doses given to healthy challenge trial participants would have been quite literally taken from a hospitalized patient on a respirator. That's obviously unethical.
(The other option is to ask physicians to violate their Hippocratic oaths during the trial, which is a slippery slope.)
- Closi 6y agoI think people are saying that we should have done challenge trials regardless of Remdesivir availability because if for example those trials shortened the pandemic by 1 day for example it would saved tens of thousands of lives. I don't see how taking supply of drugs away from someone in need to support a trial that could save more lives is 'obviously' unethical by the way - ethics aren't obvious and it's not at all clear to me that taking medicine away from a few people in an effort to save many more is inherently unethical. This is effectively the ethical debate between Utilitarianism and Deontology.
- runako 6y agoAgree with your last part, but it's an important tenet of medicine that a patient can trust her doctor. A challenge trial run as you described would either have to be run with no physicians, or with physicians who violate the Hippocratic oath. Either way is going to mar the results.
- Closi 6y agoIt don't see how it will make a difference to the quality of the results, as long as good scientific method is followed. With a strict reading of the hippocratic oath, physicians would rarely advise a patient take part in any phase 0/1 medical trial ever (see Theralizumab). In reality, trials need to be carried out to advance medicine and doctors do assist with them alongside researchers. Let's not forget that doctors are present during executions in the USA to give medical support, because the alternative is that people who aren't doctors will have to give medical support. And doctors would never elect to do unnecessary cosmetic surgeries and give ladies very big boobies. I think more benefit comes out of a doctor assisting with a challenge trial than putting even bigger breasts into Cardi B.
- runako 6y agoYou are correct that vaccine trials are required to meet a high bar. The reason for that is vaccines are not compulsory, so the process for arriving at them matters a great deal. If the process appears marred, healthy people will not take the vaccine and we all suffer. I don't think we want doctors in vaccine trials taking cues from elective cosmetic surgeries or executions.
- Closi 6y ago> I don't think we want doctors in vaccine trials taking cues from elective cosmetic surgeries or executions. I'm just saying that if the Hypocratic oath and system can flex to include executions, it can flex to include clinical trials :) Besides, who is to say that the doctors assisting executions aren't behaving rationally, ethically and trying to reduce suffering compared to what would have happened if they were not around? Maybe these are the kind of ethics you want to consider in this situation - i.e. a consequentialist viewpoint too rather than just the deontological argument.