Op-ed on Pandemic Ethics

Co-authored with Peter Singer, 'Pandemic ethics: The case for experiments on human volunteers' was published online yesterday in the Washington Post!

We begin:

The pandemic has thrown previous moral assumptions into disarray. Most of us now accept restrictions on our freedom of movement and association that would have seemed unthinkable just a few months ago. Yet the research we are willing to do to combat the virus is still governed by assumptions developed in calmer times when less was at stake.

Research ethics normally prohibits exposing human subjects to significant risk. The overriding aim is to prevent their exploitation by researchers whose interests may not coincide with those of the individual patient. But in a pandemic, the overriding aim must be to avoid a potentially catastrophic toll. We all face such heightened risk that restrictions on promising research (beyond the basic requirement of informed consent) could easily prove counterproductive in humanitarian terms.

We discuss three kinds of "risky" research: (i) skipping lengthy animal trials for promising treatments, (ii) human challenge trials for vaccines (though what we say here could also extend to more speculative theories, e.g. using challenge trials to test the possibility of cross-immunity from cold coronaviruses), and (iii) variolation.  Regarding the latter, we argue:

The seriousness of the coronavirus cuts both ways: more risk from the initial low-dose infection, but greater benefits if it does protect them. If we can gain solid evidence that receiving a low dose of the virus leads to a mild case of covid-19, and that such mild cases then bring immunity to further exposure to the virus, we would have found a means of saving hundreds of thousands of lives — and millions of livelihoods. In these circumstances, it seems both reasonable and ethical to invite healthy young volunteers to receive a low dose of the virus, followed by quarantine and medical observation.

In fact, some individuals have already sought deliberately to infect themselves via uncontrolled “coronavirus parties,” despite medical experts urging them not to do so. It would be better for everyone if such individuals instead had the opportunity to volunteer to receive a low dose of the virus as part of a carefully monitored trial. That would be safer for the participants than an uncontrolled infection, and the knowledge that we would gain from such a trial could, in the best-case scenario, lead to a quick end to the pandemic.

We conclude:

There is too much that we don’t know about covid-19. The longer we take to find it out, the more lives will be lost. (That’s why the website asking for vaccine volunteers is called “1 Day Sooner.”) If healthy volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research, there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks.