Short Wave - People Are Volunteering To Be Exposed To The Coronavirus...For Science

Episode Date: June 9, 2020

In this episode, Maddie Sofia talks with Invisibilia's Alix Spiegel about the bioethics of conducting human challenge trials with the aim of producing a viable coronavirus vaccine. We hear from James Kublin, a clinical health professor in the Department of Global Health at the University of Washington, and from Lehua Gray, a 32-year-old woman interested in participating in a trial.See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Maddie Safai here. So today on Shortwave, Elise Spiegel, one of the hosts of Invisibilia, NPR's podcast about human behavior, has a story for us. Hey, Elise. Hey, Maddie. So I do have a story for you. And I want to start by telling you about this woman, Lahua Gray. She lives in Texas.

And about a month ago, she saw this Facebook post from a kind of sciencey friend of hers that starts. with words feeling brave. Oh. And then went on to talk about this opportunity where people like her, just normal everyday people, could purposefully get infected with the coronavirus. What? And Lahuo was just like, you know what? That's exactly what I want to do. I 100,000 percent don't want to die very strongly, but I'm not super afraid of death. Huh. Yeah. I mean, in fact, for her, she sees this as the most moral personal choice that she can

possibly make, because even though she might get hurt, it is from her perspective for the greater good. How old is Lahua? She's 32. Okay. So she wants to get the coronavirus, and she thinks it's like her moral, obligation to get infected? At least, what is going on? Well, I mean, the thing that she saw a posting for was this thing called a human challenge trial.

Oh, okay. Yeah. You've heard about those? Yes. Yeah, I know that. I know this. I know. So what, how do you understand it? So, okay, so my understanding is that scientists give people a vaccine. In this case, they would give them the coronavirus vaccine after it was developed. And then instead of just sending them out into the world where they may or may not be exposed to it, scientists intentionally infect people in a lab to see if the vaccine works. Right. The examples I know of are like for the flu and stuff like that. And it is a faster way to get a vaccine, but there's also some like really bad dark history there. Yeah.

I mean, there was a whole kind of Nazi research program where people were deliberately infected with tuberculosis for vaccine development. And there have been other horrible examples. But people have started talking about it because, you know, the cost of coronavirus. has just been so high in terms of lives, in terms of the economy. Lahua works at this organization in Texas, and their job is to kind of connect people with social services. And she says that after the virus hit, people just started contacting them like crazy, looking for food, looking for shelter. After lockdown started, we just saw those searches skyrocket. She says she felt

completely helpless. And then she saw that post and suddenly it felt like there was a much more concrete way that she could help. If this could take three months off of the development of a vaccine, then that's three months, but people aren't worrying about rent, about food, and people aren't dying. So today in the show, we look more closely at human challenge trials. and ask the question, from a moral standpoint, a bioethics standpoint, should we do coronavirus human trials or not? Stick around. Okay, Elise, so challenge trials.

Are they the right thing to do? I mean, how do you even go about answering a question like that? Well, the way that I went about answering that question was by reaching out to a man named James Kublin. He is a professor in the Department of Global Health at the University of Washington. And I wanted to talk to him not only because he's worked on vaccine development for years, but also because he himself has presided over human challenge trials. Actually, he's done a bunch of them. About a dozen?

Has anyone ever died? No. I'd like to keep it that way. So what does James say about doing challenge trials for coronavirus? Well, that's the thing that surprised me. You know, I mean, even though he, as a practitioner, obviously, is supportive of challenged trials in general, he did not think it was a good idea when it came to coronavirus. At this point in time, no, I would not. That actually doesn't surprise me at all, Elise.

Really? Why not? I mean, from a microbiologist's perspective, which you know is the only one I have, we don't actually even know how much of the virus it takes at this point. point to get somebody sick. So, you know, there'd be this period of figuring out what dose is the right dose to give people, which, you know, can take a lot of time in itself. And you certainly do not want to rush that part. Yeah, sure. And I think, like James has related feelings. I think his main concern is that there is just so little that is known about how the virus affects people, both in the short term and in the long term, that he just could not imagine going forward with that kind of research himself.

You know, as a physician, as having gone through my training and focused on premium non-nasserie and this notion of first do no harm, I'm obligated not to, you know, put anybody's life at risk at this point in time. The bottom line is, I don't think it's safe enough. It's a very real dilemma. It's a dilemma for him because. Because, you know, if you step back and think about it, whether it's the right thing to do or not depends a lot on how you think about and calculate harm. Okay. What do you mean by that?

Well, in America at this moment, there are about a thousand deaths a day from coronavirus. And Kublin estimates that a human challenged trial could shave roughly four months off of the process of getting a working vaccine. So if you started the trial today and you do the math, using the current number of deaths per day, which again is around 1,000, four months at 1,000 a day is about 120,000 people who might be saved, whereas the number of people that you would be putting at risk of some harm in one of those trials is a much, much smaller number. Got it. So stand back and ask yourself for a second, what is the greater harm? This is one of these philosophical paradoxes, right? You know, the trolley problem. He's talking about that famous ethical thought experiment called the trolley problem.

Are you familiar with that, Maddie? Well, okay, I took a single psychology class in college, at least, but I think I remember it. What do you remember about it? Oh, boy. Okay. It's something like there's a runaway trolley on some tracks headed for five people or something like that. And you are standing next to a lever, which if you pulled would switch the train to a track where only one person would die. So I think the question is, do you choose to kill five people by doing nothing?

Or do you kill one person by taking an action that will kill them? Yeah, yeah, you got it. And Couplin says that's the problem that people like him are really facing now. You know, this is perhaps what we're facing now more than ever before. I don't think we've ever been presented with such a dilemma as we are today. Generally speaking, if you think you should save the greatest number, the five, that's called the utilitarian approach. But some people think that an action should be measured not by its consequences, but by whether the action itself is a moral action. Like, you should never knowingly cause a death, even if your responsibility lies only in flipping the track switch.

And for James, even though he can see that human challenged trials have the potential to save many, many more people than would be harmed by them. For him, as a doctor, ethically, it still comes down to whether or not he personally puts a person at risk. So, Maddie, I'm curious, what would you do? Oh, okay. I mean, honestly, at least I think at this point, it's too early maybe to make that decision at all. Hmm. Why? I mean, I think it's like, you know, stuff that we've talked about. We don't know enough about the disease yet for me to feel comfortable with the risk.

And, you know, another thing I've been thinking about with challenged trials is that the people I'm most worried about with COVID are people that are immunocompromised. elderly folks, people with preexisting conditions, that kind of stuff. And generally, it's not safe for those types of people to be included in these studies. So challenge trials really only tell you how well the vaccine works for healthy people. And then you kind of have to extrapolate. And especially for COVID, that makes me nervous, if that makes sense. Yeah, that does make sense. I will say that I did talk to a bunch of people.

and it seems like whether or not this is the right thing to do, there is absolutely pressure building to do challenge trials. Even Kublin thinks so. If you were a betting man, would you bet that we're going to go through with it? Boy, that's a good question. I'm not a betting man, so fortunately. But I think that some people will go through with it. I think there will be challenge studies.

All right, Elise Spiegel. will stay tuned, I guess. I appreciate you. Thanks for the story. Thank you, Maddie. This episode was produced by Abby Wendell, edited by Deborah George, and fact-checked by Emily Vaughn. I'm Maddie Safaya, back tomorrow with more shortwave, the Daily Science podcast from NPR. This week on It's Been a Minute, I talk out the news with my Aunt Betty. I'm more concerned about the black men that I love than anything in the world because I just don't want to get that call. Also, parenting in the age of Black Lives Matter and the history of police reform. Listen and subscribe to It's Been a Minute from NPR.