back
4 comments
We've subsequently learned that even young healthy and initially asymptomatic people can become permanently ill from so called "long COVID". The ethicists were right to say no.
People join the military not knowing whether or not they will ever go to war, yet they still join. By doing so they risk death, dismemberment, and all manner of long term disability under the belief that doing so makes everyone else safer.

If exposing a few people on purpose is a moral wrong, then surely allowing millions of them to contract it by accident so that a few people in your RCT can become infected by chance is a moral abomination.

I don't follow, how is it worse to reach a lot of people in case some of them catch it in an unrelated manner worse than infecting them on purpose?
A traditional trial requires you to wait for the pandemic to spread in order to get enough positive people in your trial for significance. It's effectively like "challenging" random people in the public in the hopes that some of them are in your treatment group.
Sure, and betting that someone will die is still way way better than murdering them.
Actively preventing someone from saving a third person is murder. Even if there is risk involved.
Who is preventing whom from being saved?
This makes no sense to me. Preventing challenge trials causes more people to die and become permanently ill. What ethical system are you operating under where that is morally preferable?

FWIW, ethicists were split, but mostly on board with HCTs. It was mostly the government that was opposed.

IIRC, we were fairly unaware of the long term effects at that point. All we really knew was that age had a factor. So a bunch of healthy young people would have signed up, thinking that the chances of harm, even if they got the placebo, were fairly low, when in reality there were significant chances of being permanently (or at least very long term) maimed.

Essentially, no one signing up for the trial would have been properly able to give consent, because no one knew the real consequences.

Nobody knew what the long term effects were, but we knew that there was uncertainty about them. Informed consent doesn't require perfect information. Just the best possible information, and a fair appraisal of uncertainty.
As a young and healthy challenge trial volunteer, who is now watching the panic metastasize into an existential threat to free civilization, no they were not. Blocking these trials is the worst miscarriage of ethics that I have ever seen.
Good summary of problems with challenge trials for Covid:

https://www.statnews.com/2020/06/23/challenge-trials-live-co...

The point that challenge trials don't determine safety is accurate, but most of the article is again arguing about the ethics rather than the efficacy. Imagine if volunteers were not permitted by ethicists to storm the beaches of Normandy because their safety could not be guaranteed.

Our current testing protocol requires letting the virus rampage through the population before the trials will achieve statistical significance, which is surely more unethical than deliberately exposing a small number of people.

I tend to agree in the case of Covid, but I'll play devil's advocate...

Suppose we replace Covid with "car crashes" and vaccine with "seatbelts". This is a good analogy because crashes are rare and we can't cure trauma (like on Star Trek). It would be absurd to deliberately cause car crashes in order to study the effect of seatbelts. For the experimental group, there will still be some minor injuries. For the control group, many will die.

That sounds more like doing challenge trials for an ebola vaccine, for which I'd expect you'd get very few volunteers. Still though, if there are people willing to risk sacrificing themselves, and the information would definitely save lives, we should let people do that for the greater good. The world's militaries throw away far more lives for far less benefit.
Knowing the efficacy in few weeks is not going to speed up the vaccine trials (see my other comment).
Even once safety is established, our current protocol requires waiting for wave of infections to sweep so thoroughly through the population that some of the study volunteers are infected by chance.
That's incorrect. Both are determined from the same tests and determining safety takes longer.

Phase III trials for each of these new vaccines end long after the efficacy is determined. Estimated primary completion dates are in June 2021 (BioNTech/Pfizer) and November 2021 (Moderna).

Even after the drug is accepted, monitoring for safety continues.

Considering Russia and China started using their vaccines months ago we could have had the answer anyway. We just didn’t want to look.