Radiolab - Dispatch 13: Challenge Trials

Episode Date: November 25, 2020

What if someone asked you to get infected with the COVID-19 virus, deliberately, in order to speed up the development of a vaccine? Would you do it? Would you risk your life to save others? For months, dozens of companies have been racing to create coronavirus vaccines. Finally, three have done it. But according to the experts, we’re not out of the woods yet; we’ll need several vaccines to satisfy the global demand. One way to speed up the development process is a controversial technique called a human challenge trial, in which human subjects are intentionally infected with the virus. Senior correspondent Molly Webster gets the lowdown from Public News Service reporter Laura Rosbrow-Telem and then tracks down some of the tens of thousands of people who have volunteered to participate in a challenge trial. Special thanks to Jonathan Miller. This episode was reported by Molly Webster and Laura Rosbrow-Telem and produced by Molly Webster and Pat Walters. Support Radiolab by becoming a member today at Radiolab.org/donate.    

Before we start, just want to let you know there's a moment or two of strong language in the story. Oh, wait, you're listening. Okay. All right. Okay. All right. Door listening.

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Kind of grew out of a simple conversation between our senior correspondent Molly Webster and reporter Laura Ross Browell tell him how did you Stumble into the world of the story. So let's see so So, I mean, actually, it's sort of funny. Like, I'm just gonna say all of this in case it's helpful. Yeah, me and everything. So, I actually had this like very kooky, like fiction idea. Normally, Laura's a reporter for public news service, but given how crazy everything's been, she was sort of wondering if she could come up

with a cool fictional scenario to do a story about. Yeah, and so in any case, I was sort of like, okay, would it be like a black mirror episode? If like, there was like a rehab facility that only like super super rich people went to, and they would like get in fact to a COVID, but then they would get just like state-of-the-art treatment and you know, have these parties and would just be this like super, super-mind-or-thing and they'd like have fun with people and it'd be like essentially going to resort

but you're gonna get COVID. Yeah, it's like a spa, like a COVID spa. Right, right. That was kind of what I was thinking. I was like, oh, that could actually be kind of cool. And then she says the journalist side of her kind of kicked in and she thought to herself, hmm, I wonder if the situation actually exists. So she hopped on Google. And then I started seeing people are volunteering to get infected with COVID for the purposes of making a vaccine making a vaccine trial faster.

Now I should say, Laura and I had this conversation a few months ago, and since then, hundreds of thousands of people have died of coronavirus. The other thing that has happened in that time though. Pfizer executives are calling it one of the biggest medical breakthroughs in the past 100 years. Basically, all of this vaccine news started to come out. American pharmaceutical company Moderna says its vaccine

candidate is nearly 95% effective. Breaking news from AstraZeneca overnight, the pharmaceutical company says its vaccine may be 90% effective in late-stage trials, making it the third drug maker. As most of you probably know, in the last few weeks, three different companies, Pfizer, Moderna, and AstraZeneca, all announced COVID vaccines.

Yeah, they tested those vaccines on hundreds of thousands of people. In record time, it was blisteringly fast. Usually it takes years, and in this case, it took months. And one of the reasons it happened so fast is there are just so many people out there with COVID right now. Like usually these trials take such a long time because you enroll tens of thousands of people

and you give half of them the vaccine and half of them the placebo and then you just wait for the subjects to become naturally infected. And because we've done such a bad job of controlling the virus, scientists just didn't have to wait very long. And look, these three vaccines are amazing. But it doesn't mean we're out of the woods just yet. If you actually just simply look at the numbers, Pfizer says, I can do a billion, 1.2 billion doses by the end of 2021. Moderna says something pretty similar. AstraZeneca says three billion. You're like, oh, five billion vaccines. That's amazing. But you need

two doses per person. So take that five billion and have that. So you're at, you know, 2.5 billion. And then it's a little hard to say like how many people in the world will need to be vaccinated in order to provide some sort of like what everyone talks about as the herd immunity. But I think the world has 8 billion people. A number that has been thrown around is 70 percent. That's 5 billion people that would need to get vaccinated. And what we just broke down was the three vaccines that exist get us to 2.5 billion by the end of 2021. And so there's a long way to go. I think I thought of it in those numerical terms as well.

It's long in it. I talked to one expert and he was saying five to seven vaccines sounds like the better number. And because of that, you need to have more vaccines in development and you need to keep that development moving fast. So one of the techniques researchers are using to speed up that process is this thing that Laura came across when she was Googling. It's a trial where people intentionally get infected

with COVID. Exactly, right. It's called a human challenge trial. Basically, the point of it is instead of doing these field trials, which can be very expensive, it can take a while to recruit people. You have to be following thousands of people. Instead of doing that, you can instead recruit, let's say, around 100 people.

What? Yeah. That's so small. Yeah, it's, it's, it was surprisingly low. It was surprisingly low. Okay. Half the people get the vaccine candidate, half the people get the placebo,

then you infect all of them. And you know, you wait to see if the vaccine candidate works or not. And the challenge trial would typically take about a month because you're intentionally infecting people who you know you're not gonna give a vaccine candidate to in this scenario. But how do they know that they can keep subjects in this study safe?

I mean, because what we do know about COVID is that some people get it, no symptoms, and then some people get it and they die within a few weeks. Yeah. So, this is actually pretty well outlined by the World Health Organization. They wrote a report about whether it was ethical to do this in the absence of a rescue treatment for COVID-19. That is exactly what I'm saying.

It's not like you have a good treatment if you're sick. We still don't know how to treat it. We don't even know why some people are fine and some people end up not being able to breathe. Exactly. Right. Some thought it was still worth it because it had enough societal good to speed up a vaccine process that could potentially save thousands of lives if a vaccine became available sooner. And the other part of the ethical debate around these types of trials, Laura says, is their history, which isn't good. In the 40s, the University of Chicago and Illinois and the US Army collaborated on challenge experiments, they were actually testing malaria drugs.

on challenge experiments. They were actually testing malaria drugs, and this is a whole other kind of messed up part of human challenge trial history in prisoners. And so this is really messed up. So, not the doctors, they actually included these malaria tests as like justification for their own medical experiments. Uh, whoa. Yeah, this was like one of their defenses at Nuremberg in 47.

So, so, so people would say that the, um, the medical experiments that the Nazis did were in a sense, or, or, or are the original challenge trials? Actually not, they're not the original one. The original one, and this is a whole other world that's quite fascinating, is that the first vaccine, smallpox, that was developed by this man named Edward Jenner. Okay, this was in 1796. Okay. Okay. And guess how he first came to this wild pox vaccine? I always feel like there's like testing on children that are involved or something. You are very close. Okay, so he purposely infected his gardeners at your old son. Oh, did it work? Yeah, so it worked. That's the thing. I mean, that was the first

step to getting the small box vaccine. Wow. So human challenge drives are really kind of at the heart of vaccine history. But I thought the whole point of challenge trials was volunteering. Okay, so that's the thing is they've now developed into becoming much more informed and they have to volunteer to be in the studies because of the risk that you're asking people to go through. They are much, much, much more monitored than a typical phase three trial. So they're not going to go about their normal lives. They're going to live in some quarantine facility. They're going to get state of the art medical treatment.

It's like the virus needs to coronavirus. It's like real world, coronavirus. Yeah. So they can't talk to each other. I mean, they're isolated. They're like in their room, you know, and not able to interact with like, even though they've all been sick, they're not allowed to just hang out. They've all been like, oh, what? I have a feeling no, because also, if you're thinking about a controlled setting, that could really complicate things as like,

what if people get sicker if they're interacting with each other more, right? Do you think you'd do it? No. No. I mean, let's play this way at this exact moment in time definitely not because I have a one-year-old son. It's just like, yeah, that's not gonna happen. I'm trying to imagine anyone that would do this. Well, look, I ended up covering this nonprofit called One Day Sooner. And this is pretty interesting.

So One Day Sooner basically, they created this website and created this call for people who wanted to volunteer for such a thing and people quickly signed up. Oh, so this became live. I believe this was in April. Yeah, April May. And now over 30,000 people have signed up.

Holy wow. Damn. Yeah. 30,000 people have said I will knowingly risk my life to help vaccine research. Right. Wow. And not only that, after we talked to Laura, the United Kingdom came out and said

that they wanted to start a challenge trial with COVID, with humans in January of 2021. So just, you know, but weeks away and it just made me think about those volunteers. Like we are all working very hard to avoid coronavirus and not get it. And they're like, okay, how can I put myself in front of this moving train? At least, that's what it sounds like to me. That's, who would do that? Why? I can tell you who would do it.

And I can tell you why just after the break. Okay. This is Radio Lab. We'll continue in a moment. Hi, this is Dustin Routzong from Troy, Alabama. Radio Lab is supported in part by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org.

Science reporting on Radio Lab is supported in part by Science Sandbox, a Simon's Foundation initiative dedicated to engaging everyone with the process of science. All right, ready? Three, two, one, Chad. Molly? Radio lap. So before the break, we heard about this peculiar kind of vaccine trial, which involves people volunteering to deliberately be infected with COVID, which sounds insane to me. Although very noble, but Molly, you say there are thousands and thousands of people who have volunteered to do this? Yeah, there's a list out there that has, I think at this point, over 37, 38,000 people on it who have said, jab me with COVID, I'll take it.

And we thought, okay, we have to go out and see who these people are, like who is the San Gellik, who is this good? And they had a lot of different reasons for signing up, not all of which felt exactly like the kind of altruism I expected to find. Yeah, a little who are they? Okay, so the first one was Estafaña. Yes, I am Estafaña Idalgo, I am a photography student, I live in Bristol and I am from Caracas, Venezuela.

And so what point did you bump into the notion of a challenge trial? Well, I do night shifts at a petrol station. I've been there three nights a week for the past two years now. I'm a student and I did this like brilliant plant in my mind where I was gonna go to work at night and then study the daytime and I didn't buy her in sleeping time. What is that like? Like what are the the ebbs and flow at the petrol station

during COVID? Like were there moments where it just was dead quiet with no one or just a petrol station always stay busy? It was kind of like this dystopian reality going out while everyone was just staying in. Everything was deserted. I have to travel by bus and it's like a four-minute bus drive. It was just me and the driver.

And she told me those nights at the petrol station were like living on a planet of one. She'd be out there for hours, just her, nobody else. And so she would listen to podcasts to pass the time. Yeah, so I actually learned about the campaign through a podcast. So I heard about one day sooner and I went on the website while I was listening to the podcast. And you can see messages from people that have already signed in,

the reasons to do it. Do you remember any of the things that you read that night? I mean, I can't remember specifically, but I remember being from all parts of the world. People from the world, people from Brazil, people from Russia. There were scientists, nurses, doctors, I think I read. And it makes you really, I think I was reading it and my hands were shaking. It was something about, I'm with them. I felt that I was with them. It just feels like, oh my God, there's a quiet movement growing in the background and I had no idea. And I was just working at this petrol station and like all is lost in the middle of the open. Yeah, that's exactly it. So this has been happening

so I can actually do something and I don't have to feel like shit here all alone in this dark night. And I put my name for it. That was her first thought. Simply, I'm not alone. And then she had a second thought, which is that as a brown person, she had to enter. Medicine is biased when it comes to dealing with racial minorities. But I also want to have a voice in the table. I want to be someone who advocates for people like us. It felt good. I mean scary, but in a good way, it felt hopeful. Wow, that's cool.

Next up, hi, hi, this is Molly Webster Radio Lab. How are you? I'm surviving. Antonio. My name is Antonio Cisnettoes. I live in Los Angeles and I'm a filmmaker. I'm going to jump into how you found out first about one day sooner and about challenge trials. It's actually kind of silly. I actually saw a piece on the PBS News Hour about it, maybe back in April, and I immediately looked it up and within five minutes I signed up, honestly, because it made sense. Wow, that's very fast. That's a very fast decision. I mean, it's kind of funny, because I really thought it would have happened sooner. Challenge trials. You know, it makes sense to me.

I mean, there's there's. Well, I think I just wonder probably more than 37,000 people watch that PBS news hour. So what I'm really trying to understand is like what is in you Antonio that got you to the to the sign up. Man, this is a real therapy session here. I mean, what is in me? I mean, I don't have a family. I'm single. I don't have a lot to lose. It's something was bad to happen, but at the same time, maybe it's more just like, oh, I don't want my parents to get it and then die. But I think, you know, growing up in a few decades ago, there was a lot more sense of

a commuicent of America and being American. And I think it's one thing that I wish we could still hold on to in this point in time. I mean, there should be thinking that, you know, 200,000 people have died since, since, unnecessarily, since what February or March. I mean, I mean, what the heck? It doesn't make any sense to me, and I don't want the numbers to getting that bigger. Like, there should be a sense of duty that if we can do something, we should do it. Volunteer number three.

Hello, my name's David Guilman. David. I am a Homo sapiens male, age 31 years. For David, his motivation didn't have to do with community or family or a sense of duty. It was more so about getting unstuck. You know, we're basically in this helpless situation. We're all being told to stay at home

and we are powerless. This is one thing that you can do that will, you know, be a part of the kind of core solution, which is the vaccine. I just don't think a lot of people are thinking about how they can help others. And so I'm just wondering where you think that God built into you. I was very zealously religious when I was growing up, brought up in a Christian home, but sort of attended an evangelical church

when I was a teenager. I think from a very young age, I had this idea that life was about being like Jesus and being good to people. And when you've grown up with a sort of cosmology, a complete and consistent cosmology that explains the universe and your part in it, to basically not overnight,

but over a relatively short period of time, realize that it's all garbage, leaves you kind of floundering and thinking, well, fuck, I need to replace it with something else. I need some sense of purpose. I'm restless unless I know I'm doing something that's kind of making the better place, not a worse place. Huh, so he's saying that signing up for a challenge trial is sort of like making up for the faith

in God that he lost at some point. Yeah, I think something like that. And I would also say he said if he was being totally honest, signing up also had a little to do with boredom. Like, I did, I retrained as a software developer in this chair that I'm sitting in. I searched for a new job in this chair. I started a new job in this chair, and now I'm talking about it in the same chair.

And it's like, I could really use a change of scenery. I started a new job in this chair, and now I'm talking about it in the same chair. And it's like, I could really use a change of scenery. Actually going to a biocontamines center for a bit would be quite exciting, quite nice. Volunteer number four. Hello. Hi, is this Lehua. It is. Hi. Lehua, who had a little bit more of an analytical utilitarian sort of approach. I could get COVID at any second, but it wouldn't be doing anything. You know, like it wouldn't be productive. Like I would be just as sick,

just as miserable, have just as much of a chance of all these big long-term health effects that we're still discovering and it would not have done anything, you know. Like this is an opportunity to catch it, but for the purposes of helping thousands of other people not catch it. If she got COVID in the wild, it sort of wouldn't be for anything, you know, at least if she's in a trial, scientists can learn from it, right? Interesting. She's like,

if I'm going to get sick with this damn novel virus, I might as well do it in a way that's productive. Exactly. And our fifth and for now, last volunteer. Oh, Molly. Hello. It's finally. Bill.

I'm Bill Phillips. I'm an experimental physicist and you happen to be a Nobel Prize winning scientist. Yeah, so being look, having a Nobel Prize in physics does not qualify me to make pronouncements about any of these things. Any more than any other these things, any more than any other person is a scientist and loves to have good data. If a trial has some probability of losing a few people, but you save more lives than you lose, as long as everybody is clear on informed consent, it seems to me the perfectly reasonable moral position. And so I signed up for a challenge trial. And after people started to question me,

why are you doing this, Bill, are you crazy? Is that what happened? Well, yeah, I got a number of people asking me that because of my age. Wait, how old are you? So I'm almost 72. So I did a little bit of research to try to determine what were the

chances that I would die given my age if I got the coronavirus. And it turned out that it wasn't that different from the probability that I'll die within the next year anyway. Well, tell me, can you do you remember the numbers? Like what numbers are in the order of a couple percent? In other words, at my age, the chances of me dying in the next year are a couple percent. That's very similar to the chances of dying if I actually catch COVID. He's just saying, if I'm not scared to live another year, why would I be scared of getting COVID? Like, mathematically, the odds are the same. Huh. So after talking with all of these people, I'm curious, what do you left with in terms of, because you know, our simple question going in, if I, if I remember was just like, what,

I don't even know what the question was. It was just like, who are these people? What drives you? Why would you be motivated to do this? Yeah. Who is this altruistic? Yeah, exactly. What do you see as answers to that or is there anything? I would say that for me, altruism feels kind of like a catch all phrase that like hides

what people are actually like on about, like what they're really going for. Like this thing that we call altruism, it could interestingly be paired with like a selfishness or self-interest of like, you just want your life back. Yeah. Or it could be because you're looking out for a family member, you know, your dad, your grandmother, it could be want of representation or there's a feeling of duty or country or community.

It could be just math. None of these things necessarily feel like altruism, but I don't know, maybe they are. Maybe they're the true or form of the word. Hmm. Hmm. Special thanks for this episode goes to Aby Rouric, Andrew Catchpole and our volunteers, including Mary Gavriel, Paul Gregory, Thanks for this episode goes to Aby Rouric, Andrew Catchpole, and our volunteers, including Mary Gavriel, Paul Gregory, Danica Jennifer, and Debo.

Thank you, Molly. Sure. Senior correspondent Molly Webster. Thanks also to reporter Laura Ross-Brown-Tellum. This is Zoe Buonniuto, calling from Fayetteville, Arkansas. Radio Lab was created by Chad Abemrod and is edited by Soren Wheeler. Lulu Miller and Lachifnosser are our co-hosts. Dylan Keith is our director of sound design. Susie Lichtenberg is our executive producer.

Our staff includes Simon Adler, Jeremy Bloom, Becca Bresler, Rachel Kusik, David Gabel, Matt Kielte, Tobin Lowe, Annie McEwan, Sarah Carrey, Ari Ann Wack, Pat Walters, and Molly Webster. With help from Shima Oli Aile, Sarah Sandbach, and Johnny Moan, our fact-jekker is Michelle Harris.