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Should volunteers get sick for science?
Why some volunteer
During COVID, some people were willing to take the virus in advance, along with a therapy, to help the world. In America this would be forbidden, though some other countries are understood to allow it. Supporters picture a volunteer who is not destitute and has been through multiple screenings with a psychologist or counselor, taking a risk much like going to the moon.
Their concern is the power imbalance when a poor person volunteers for the money. The bravery of an astronaut, a firefighter, a soldier, and a research volunteer all carry risk, and the ethics stay morally challenging and need careful thought.
Where critics draw the line
Critics draw the line at deliberately making healthy people sick. Firefighters take risks, yet nobody burns the skin of firefighters to study skin healing. Inoculating people with a disease to advance science still damages their health, and motive matters too: a wish to advance human health is admirable, but the reason someone is ready to get sick is worth asking about.
The snake handler
One man collected venomous snakes and injected himself with their venom to build up a tolerance so he could handle them. His blood plasma ended up helping make antidotes, and he is believed to have saved thousands of lives.
Why are challenge trials faster than ordinary trials?
A standard vaccine trial waits for volunteers to catch a disease in the community, so it needs large numbers. Pfizer's COVID vaccine trial enrolled about 44,000 people. A challenge study exposes volunteers on purpose in a controlled setting, so results arrive from far fewer people. A COVID challenge study run by Imperial College London in 2021 enrolled 36 volunteers.
Why did yellow fever volunteers sign contracts?
In 1900, Walter Reed's team in Cuba tested whether mosquitoes spread yellow fever. They recruited volunteers who signed written agreements, among the earliest documented consent in US-run research. Volunteers were offered 100 dollars in gold, with a further payment if they fell ill. Team member Jesse Lazear died after infection during the work.
How do ethics boards limit volunteering risks?
The Nuremberg Code of 1947 required voluntary consent for human experiments. The US Belmont Report of 1979 added principles of respect for persons, beneficence, and justice. Today institutional review boards examine each study's risks before it starts. Challenge studies commonly require that effective rescue treatment exists for the infection.
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