Moral Utilitarianism and Coronavirus Treatments

It is clear by now that the president's failed response to the pandemic has caused a painfully high human and economic toll. One might even call it a catastrophe. The longer it takes to develop and distribute an effective vaccine or drug, the greater the toll will be.

It usually takes 10-15 years to develop a new vaccine. New drugs tend to take 6-8 years to develop. One exception is the annual flu vaccine, which has to be developed for new strains each year. Producing the vaccine on that short timescale is greatly accelerated by decades of past experience with flu vaccines and the manufacturing infrastructure and methods that have been developed and built up over time. Despite some claims that a coronavirus vaccine will come sooner, it is reasonable to think that despite accelerated research and development efforts, it will take at least another year or two before an effective vaccine is found and begun to be produced in large quantities.

Could the process be sped up?

It is probably possible to significantly reduce the time needed to develop a coronavirus vaccine or drug if ethical concerns are addressable. Specifically, if people are allowed to volunteer to be infected with SARS-CoV-2, the process could be greatly accelerated, shaving months or even years off the process. At present it is unethical and illegal to allow people to be infected with such a deadly serious virus.

But from a utilitarian moral point of view, it is arguably immoral to not allow people to volunteer to be infected to test a vaccine or new drug candidate. Not only would a lot of time be saved, the number of people involved in clinical trials could probably be reduced by 10-fold or maybe more. Some of those people would die, but more people would die in the time it would take to develop a treatment under normal clinical ethical constraints. If that reasoning is correct, and I believe it is, the great human and economic toll could be reduced to the point that the anticipated deaths from clinical development would be morally justified.

A clinical trial that includes volunteers of 18 to about 50 years old could be set up. To minimize volunteer deaths the trial would require people who do not have any of the known or possible conditions that are correlated with increased SARS-CoV-2 deaths or uncertainty, e.g., pregnancy, obesity, lung conditions, high blood pressure or age above 50. Also, those people would be monitored and given the current standard of care when they become sick. The vaccine or drug would have to perform better than existing treatments to demonstrate a tangible clinical benefit.

A group of effective altruists (moral utilitarians) called One Day Sooner, points out that such human challenge trials have been used in the past to test vaccines. A 2016 WHO guidance document points out that in such challenge trials, humans were intentionally challenged or infected with an infectious disease organism, with or without vaccination. The challenge organism may be close to wild-type and pathogenic, adapted and/or attenuated from wild-type with less or no pathogenicity, or genetically modified in some manner. Some of the moral implications are discussed here.

The folks at One Day Sooner have recruited 30,108 volunteers from 140 countries who are willing to be infected with SARS-CoV-2.

Questions: Given the seriousness and toll that SARS-CoV-2 has caused and will continue to cause, should the US engage in SARS-CoV-2 human challenge trials to try to speed up vaccine and drug development? Should qualified prisoners be allowed to volunteer in return for a shortened sentence?