Photo: Graham Hughes The canadian Press
Thousands of people say they are willing to risk their lives to advance the research and accelerate an exit from the crisis.
To great evils, great remedies.
Experts warn us : the coronavirus will not disappear anytime soon, and no vaccine will not be available until at least a year. Also, several regions that had undergone an déconfinement, even shy, have had to backtrack when the number of infections started in arrow.
In this context, thousands of people say they are willing to risk their lives to advance the research and accelerate an exit from the crisis.
Some 20 000 volunteers from 102 countries have so far signed an online petition to claim to be willingly infected by the SARS-CoV-2, to allow doctors to study what happens next and to develop new strategies to combat this virus which is shaking the planet.
Such testing of types, ” challenge “, during which volunteers are exposed to a disease, are not new in medicine. That being said, they are normally organised after the development of a therapy or a vaccine, to test the effectiveness.
Their possible holding before that effective treatment is available raises ethical issues thorny.
Life in danger
The ” one “challenge trial”, this is what will give, from a scientific point of view, the fastest response to any sort of issues, whether it is the effectiveness of a vaccine, or the risk of re-infection, or the response […] immune means in terms of protection, said dr. Caroline Quach-Thanh, CHU Sainte-Justine. This, it is clear. “
But can a society tolerate that some of its members have put their security, and potentially, their lives in danger ?
The world Health Organization is of the opinion that yes. The un agency has recently published a paper of twenty pages, which at a minimum identifies eight criteria to guide such testing, such as evaluation of risks and potential benefits, or the manner in which participants would be selected.
“We accept a race car or downhill skiing or other things like that, commented the professor Bartha Knoppers, head, Centre of genomics and policy, faculty of medicine of McGill University. We accept that people can have lives with any kind of risks. It is a personal choice with which one may agree or not. It cannot be denied to adults, competent, having the mental capacities and any, in health care… if they want to offer […] to participate in a trial against a vaccine, to contribute. There are people like that. “
Professor Emmanuelle Marceau, the School of public health, University of Montreal, believes that the issue of the sacrifice that a society can afford or not to accept is really at the heart of the debate.
In normal times, she said, the answer would be rather ” no “than” yes ” when we would consider sacrificing a few lives in the name of a greater number.
The pandemic changes, however, gives, ” she says.
“The background screaming of a pandemic, the public health context leads us to say that this posture-there was more individualist ethics of the research must be weighed with considerations of public health, she said. It is that fact that we would perhaps be willing to expose some individuals to risks that they would not do in normal times, in the name of public health and well-being of the community. “
The two experts in quebec are not the only ones to believe that these tests “challenge” ought to be explored.
A leading american in the field, professor Arthur Caplan, wrote recently on the website Science Direct, ” despite the danger, we believe it would be ethical to search now for volunteers who would be informed of the risks, both known and unknown “.
Mr. Caplan added, in the pages of the Boston Globe : “The number of people who die from the novel coronavirus while we search for a vaccine is exponential. If the virus recedes, then returns, it will still require more time before understanding. The stakes are so high that risk [the lives] of volunteers is based on a moral base, solid “.
Two other experts, Peter Singer, and Richard Yetter Chappell, explain in the Washington Post that ” if we can get solid evidence that a low dose of the vaccine leads to mild cases of the COVID-19, and that such mild cases cause an immunity to the virus, we would have found the means of saving hundreds of thousands of lives “.
They then add that ” there are still too many things we don’t know about the COVID-19. The more we long to learn, the more we will lose of lives.”
They recommend accepting ” with gratitude the help of those who would be willing to participate in such trials.
Caution and vigilance
Professor Marceau says the importance eventually to organize such tests with caution and vigilance.
“I think that it is necessary to see what are the motivations of each person to take part in such a clinical trial, she said. If for some it is to protect or stop the pandemic, I agree. But if for others it is the hope of being immune or having access to the first treatment before all the world, this is what we call a therapeutic misconception and consent is flawed because people are not very aware that they will not necessarily be of benefit. Maybe yes, maybe no. “
According to professor Caplan, you should first administer the virus to subjects who have serologic evidence of previous infection, which would help to learn a little more about the immune response. Participants vaccinated or sero-negative could then be recruited.
European companies are working seriously in the organisation of trials of the type ” challenge “, but this will take time. Researchers should, for example, first determine what dose of the vaccine will be administered.
“It is rare that one uses ‘live viruses’, said Ms. Knoppers. It is something, there. This is not forbidden and not necessarily be excluded. “
Whatever it is, she says, the fact that the company is essentially paralyzed by the virus does not mean that everything is suddenly allowed.
“There is so much of expectations ! But that does not mean that we should not meet or exceed the ethics rules, concluded Ms. Knoppers. It must be done with great caution. If people are volunteers, and thank God it exists, it must be really well-framed, well-followed and well-informed. “
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