Who would want to catch Covid-19 on purpose?
Healthy young people are risking their lives to help scientists develop a coronavirus vaccine. Luke Mintz reports
As most of the world does its best to keep coronavirus at bay, Josh Morrison is desperate to catch it. In March, the 34-year-old was sitting in his apartment in Brooklyn, New York, feeling “useless, depressed and scared for my family” as the Covid-19 pandemic swept across the globe. A lawyer who advocates on behalf of organ donors, Morrison decided that he would happily be infected with Sars-CoV-2 – the virus that causes Covid-19 – if doing so would speed up the development of a vaccine.
“That feeling of public service, that definitely resonates with me. It means, OK, now I’m not powerless – now I am doing something to work on this. I think it’s a better way to live than fear.”
Morrison created a website, 1 Day Sooner, through which members of the public can pledge their willingness to participate in so-called “challenge trials”, in which volunteers are deliberately infected with a virus. So far, almost 27,000 volunteers from 102 countries, including the UK, have signed up.
The idea of deliberately exposing somebody to a potentially deadly pathogen sounds counterintuitive, and the idea has a chequered medical history. In the 18th century, English doctor Edward Jenner scraped cowpox particles into the skin of eight-year-old James Phipps, the son of his gardener, and then tried to infect him with smallpox. The boy survived. In the Forties, the US army infected thousands of psychiatric patients as part of its now-infamous “Malaria Project”; one in 10 died.
Nowadays, these experiments would hardly pass ethical muster. Instead, the 80 groups around the world currently working on coronavirus vaccines are all following broadly the same model: volunteers are given an injection and then told to live as normal, in the hope that enough of them become exposed to the virus through the course of their day-to-day lives.
This includes the advanced trial at Oxford University’s Jenner Institute, on which the UK Government has pinned its hopes, agreeing to buy up to 100million doses.
Prof Adrian Hill, director of the Jenner Institute and one of five researchers leading that trial, says the main problem will be if the number of Covid-19 cases in the UK drops too low to produce any firm conclusions. And there are already signs this is happening.
Last week, Oxford announced that it was recruiting more healthcare workers into the trial, because they are likely to have a greater exposure to coronavirus than average, while pharmaceutical giant AstraZeneca, which has signed a deal to manufacture the Oxford vaccine, says it is “running against time” to complete the test while natural infections remain high.
As a result, scientists are coming around to the idea of challenge trials as a way of speeding up the process. The World Health Organisation lent its qualified approval to the idea earlier this month when it released a list of eight ethical hoops through which any trial would have to jump. Sir Terence Stephenson, the chairman of the Health Research Authority, which approves tests of NHS patients in England, says its research committees will consider any proposals. Challenge studies are already carried out in the UK for fo viruses like malaria, in whic which volunteers are placed in the vicinity of infected mosquitoes, as well as typhoid and tuberculosis. Meanwhile, the “Flu Camp” facility in east London runs intermittent trials in which volunteers – often medical students – are infected with influenza or the common cold, and then observed in quarantine for up to two weeks, where they are treated to an en suite bathroom and a PlayStation. And scientists have already given coronavirus to rhesus macaque monkeys: at one facility in New Delhi last week, a gang of primates attacked a lab assistant and escaped with a batch of coronavirus samples. According to the Times of India, one was later spotted up a tree chewing a sample.
But these trials are only conducted on humans when the virus is a relatively safe one, or it comes with an effective treatment. Sadly, no proven cure exists for Covid-19, despite promising advances with remdesivir, which was originally developed to treat hepatitis C, is now available for some coronavirus patients on the NHS. “The difference with malaria is that we can always treat it,” says Prof Hill. “We don’t do it for all infections – certainly, we don’t do it for HIV, which you can’t get rid of. Would it be ethical? And if you gave too much, how would you treat volunteers?”
For that reason, the WHO says that a coronavirus challenge study should only ever be carried out on healthy 18- to 30-year-olds, who are in the lowest-risk group. If it followed the same path as previous challenge trials, then doctors would administer a “Goldilocks dose” of the virus – small enough not to kill, but large enough to elicit an immune response – to be inhaled through the nose via a nebuliser. Volunteers would have to live in a quarantined lab for weeks and be paid only a modest sum.
And there is also the matter of the control group. For the trial to produce meaningful results, scientists say, half of the participants would have to be given a placebo, leaving doctors with the prospect of exposing somebody to coronavirus, without any protection.
Prof Lawrence Young of Warwick University Medical School says he supports the idea of challenge trials, “with all the right ethical controls”, and is considering signing up himself – although he accepts that, at 61 years old, he will probably be rejected. But he would feel “more comfortable” if doctors have a rescue therapy on hand, in case things go wrong.
“It seems we’re getting more information about how the virus is affecting parts of your body other than your lungs,” he says. “We don’t have a full understanding of the virology – that makes me more concerned.”
Some doctors are unconvinced of the ethical justification and regard even a tiny risk of illness as a betrayal of Primum non nocere, the “Do No
Harm” medical principle. Prof Eleanor Riley, an immunologist at Edinburgh University, says challenge trials “should be incapable of causing severe illness in healthy individuals, or there should be a highly effective drug to clear the infection”. She added: “None of these criteria are met for Covid-19, and I would be very concerned to hear challenge studies were being planned.”
But it is a risk that many volunteers are happy to take. The likelihood of death from Covid-19 for a healthy twentysomething is about one in 3,000, scientists say – roughly the same risk as donating a kidney, which thousands of people do for altruistic reasons every year.
Theo Sanderson, 30, a geneticist at London’s Francis Crick Institute, is one of the young, healthy volunteers who has signed up through Morrison’s 1 Day Sooner website: “There’s some level of risk, but we live with risk whenever we go skydiving. And it’s much less risk to me than it is to a 60-year-old doctor, say, who’s going to work to protect his patients.”
He also sees personal benefits: “I would know I’ve been infected, and in some ways that may put me in a decent position.”
Having read testimonies from other volunteers on his website, Morrison says that most are looking for “a sense of agency in this very bleak time. That sense of wanting to feel empowered, and wanting to protect the people who are close to them. Lots of people mention elderly relatives or their kids.”
Morrison admits that being “stuck in a facility for a month is not my idea of a good time”, and he hopes the lab will have Wi-Fi and food delivery.
“At least being stuck in my apartment for the last few months is good preparation,” he adds. “We think getting a vaccine just one day sooner is going to save thousands of lives. That’s worth it to me.”
‘Knowing that I’ve been infected may, in some ways, put me in a decent position’