Today we start a three-part series on Ben Bramble’s just published open access book Pandemic Ethics. Part 1 (“Three Problems for Human Challenge Trials, and A Way Forward”) is below. Part 2 (“How Should Onlookers Live and Feel in the Pandemic?”) will get started here Wed. And Part 3 (“A Revolutionary Argument: How and Why to Change Things Post-Pandemic”) will get started here Fri.
Three Problems for Human Challenge Trials, and A Way Forward
Human challenge vaccine trials for COVID-19 would expose healthy volunteers to the virus in order to hasten the development of a safe and effective vaccine. Here, I want to raise a few new problems for such trials, and then suggest a way they could be made permissible.
- Analogies With Other Professions
Defenders of such trials often say that allowing people to volunteer for them is just like allowing essential workers to go to work during the pandemic, or people to become firefighters, police officers, etc.
But there is a big difference. These other people are, as their name suggests, essential. By contrast, if we do not allow people to volunteer for challenge trials, society will not collapse or grind to a halt. There is a viable alternative: run trials in the normal way.
- Full Information
Can trial subjects be sufficiently well informed of the risks of participation? This is unclear. The very thing that makes them eligible to be subjects (i.e., their being young and healthy, and so unlikely to become severely ill or die) means that they necessarily lack important, relevant knowledge.
As healthy subjects, they will not have been severely ill before. While such people might be able to theoretically grasp the risks of infection with COVID-19, they will not have a good grasp of ‘what it is like’ to suffer in these ways (i.e., the phenomenology of this). But this is surely crucial.
As young subjects, their experience of the world will be limited indeed. Will they understand how bad it would be for them to be unable to complete their studies, find a partner, travel the world, have children of their own, care for their parents in old age, etc.? Or how their parents, spouse, friends, or children would feel if they were to succumb to the virus? Many of these young people would not have adequately thought these things through, and might be unable to do so at their early stage in life.
This is not to say that young people should not be allowed to make any choices about their lives—but normally, they are not being asked to expose themselves to a potentially lethal virus.
- Society’s Fault
Defenders of such trials often say that we can make them permissible by choosing only subjects who have a high chance of exposure to the virus anyway (through their work or living arrangements).
But this seems wrong to me. Why are such people already so exposed to the virus? In large part, because of society’s failures. We have let these people down, by not adequately protecting them from the virus. Given this, it seems very unfair to call on these people now to subject themselves to an even greater risk. If anyone should volunteer, it is those whom society has not let down, even if they are otherwise unlikely to be infected.
Speaking of which, it is worth asking why so many people are volunteering to take part in such trials. I have no doubt they are, by and large, good and altruistic people. But how many of them are doing so (also) because they feel a dearth of meaning in their lives? Society does not make it easy for ordinary people to contribute to the good in the normal course of life. We are told by parents, teachers, and our culture more broadly, to focus more or less exclusively on ourselves: work hard at school, get a good job that pays well even if it contributes little of true value to society, all so we can raise a family of our own, and keep on making as much money as we can.
If there were more avenues for helping others in the normal course of life, it is unclear whether so many people would still be volunteering for these trials now.
It seems rotten to give people so few ways of helping others safely, and then to allow them to do so when it is potentially lethal.
- A Way Such Trials Could Be Made Permissible
Suppose that our lockdowns, testing, and contact-tracing have been so effective that there is no longer enough of the virus circulating for vaccine trials to be run in the normal way. Here, we might face a choice between staying in various forms of lockdown indefinitely, and doing these challenge trials. Here, it might be permissible to conduct these challenge trials, since the alternative to doing so would be a permanent and substantial diminishment of our societies. Trial volunteers would then be truly analogous to our essential workers, needed to prevent a kind of societal collapse.
Suppose this is right. It seems to follow that right now, even though there is still a lot of the virus still circulating, we could count on doing permissible challenge trials in a couple of months from now if we committed to locking down properly, and engaging in proper testing and contact-tracing.
Yet another thing seems to follow. Suppose (as might actually be the case) that some of the vaccines are ready to be tested now, but that there is still enough of the virus circulating to do the trials in the normal way (but that this would take many months indeed). It would still be true that if we did properly lockdown, test, and contact-trace, then we could count on doing permissible challenge trials in a couple of months from now. In this case, though, we might as well do them immediately, on the proviso that we really do carry out the lockdown, testing, and contact-tracing. Why wait?! (If we went ahead with the challenge trials, but then failed to make good on our commitment to properly lock down, test, and contact-trace, then it would turn out that our having conducted them was morally wrong.)
The upshot? We can make challenge trials permissible, not only in several months from now, but immediately, by committing to properly locking down, testing, and contact-tracing, and then actually carrying out these things.