Nov 24, 2020

Dispatch 13: Challenge Trials

What if someone asked you to get infected with the COVID-19 virus, deliberately, in order to speed up the development of a vaccine? Would you do it? Would you risk your life to save others?

For months, dozens of companies have been racing to create coronavirus vaccines. Finally, three have done it. But according to the experts, we’re not out of the woods yet; we’ll need several vaccines to satisfy the global demand. One way to speed up the development process is a controversial technique called a human challenge trial, in which human subjects are intentionally infected with the virus. Senior correspondent Molly Webster gets the lowdown from Public News Service reporter Laura Rosbrow-Telem and then tracks down some of the tens of thousands of people who have volunteered to participate in a challenge trial.

Special thanks to Jonathan Miller.

This episode was reported by Molly Webster and Laura Rosbrow-Telem and produced by Molly Webster and Pat Walters.

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Speaker 1: Before we start, I just want to let you know there's a moment or two of strong language in this story.

Speaker 2: Wait-- [laughs]

Intro: You're listening to Radiolab, from WNYC.

Laura: Hello.

Molly: Hi, Laura.

Laura: Yes.

Molly: Hey, it's Molly. How are you?

Laura: I figured. I'm good, how are you?

Jad: Hey, I'm Jad Abumrad. This is Radiolab. We have not done a coronavirus dispatch since this summer I think, so we're going to do one this week. This is dispatch number 13, a lucky number that it is. This dispatch grew out of a simple conversation between our senior correspondent, Molly Webster, and reporter, Laura Rosbrow-Telem.

Molly: How did you stumble into the world of the story?

Laura: Let's see. Actually, it's sort of funny. I'm just going to say all of this in case it's helpful.

Molly: Yes, say everything.

Laura: I actually had this very kooky fiction idea.

Molly: Normally, Laura's a reporter for Public News Service but given how crazy everything's been, she was wondering if she could come up with a cool fictional scenario to do a story about.

Laura: In any case, I was like, wouldn't it be like a black mirror episode if there was a rehab facility that only super, super-rich people went to and they would get infected with COVID but then they would get just state-of-the-art treatment and have these parties and it would just be this super monitored thing and they'd have fun with people and it'd be like essentially going to a resort where you know you're going to get COVID?

Molly: It's like a spa, like a COVID spa.

Laura: Right, that was what I was thinking. I was like, "Oh, that could actually be kind of cool."

Molly: Then she says the journalist side of her kicked in and she thought to herself, "I wonder if this situation actually exists." She hopped on Google.

Laura: Then I started seeing people are volunteering to get infected with COVID for the purposes of making a vaccine trial faster.


Molly: Now, I should say Laura and I had this conversation a few months ago and since then hundreds of thousands of people have died of coronavirus. The other thing that has happened in that time though.

Speaker 3: Pfizer executives are calling it one of the biggest medical breakthroughs in the past 100 years.

Molly: Basically all of this vaccine news started to come out.

Speaker 4: American pharmaceutical company Moderna says, its vaccine candidate is nearly 95% effective.

Speaker 5: Breaking news from AstraZeneca overnight, the pharmaceutical company says its vaccine may be 90% effective in late-stage trials, making it the third drug maker.

Molly: As most of you probably know, in the last few weeks, three different companies, Pfizer, Moderna, and AstraZeneca all announced COVID vaccines. They tested those vaccines on hundreds of thousands of people. In record time, it was blisteringly fast. Usually, it takes years and in this case it took months. One of the reasons it happened so fast is there are just so many people out there with COVID right now.

Usually, these trials take such a long time because you enroll tens of thousands of people and you give half of them the vaccine and half of them the placebo and then you just wait for the subjects to become naturally infected and because we've done such a bad job of controlling the virus, scientists just didn't have to wait very long. These three vaccines are amazing but it doesn't mean we're out of the woods just yet.

If you actually just simply look at the numbers, Pfizer says, I can do 1 billion, 1.2 billion doses by the end of 2021. Moderna says something pretty similar, AstraZeneca says three billion. You're like, "Five billion vaccines, that's amazing," but you need two doses per person so take that five billion and a half that so you're at 2.5 billion. It's a little hard to say how many people in the world will need to be vaccinated in order to provide some sort of what everyone talks about as the herd immunity but you think the world has 8 billion people, a number that has been thrown around is 70%. That's five billion people that would need to get vaccinated. What we just broke down was the three vaccines that exist get us to 2.5 billion by the end of 2021.

Jad: Wow. There's a long way to go [unintelligible 00:04:47] numerical terms.

Molly: It's long. I talked to one expert and he was saying five to seven vaccines sounds like the better number and because of that, you need to have more vaccines in development and you need to keep that development moving fast. One of the techniques researchers are using to speed up that process, is this thing that Laura came across when she was googling, is a trial where people intentionally get infected with COVID?

Laura: Exactly, right.

Molly: It's called a human challenge trial.

Laura: Basically the point of it is instead of doing these field trials, which can be very expensive, it can take a while to recruit people, you have to be following thousands of people. Instead of doing that, you can instead recruit, let's say around 100 people.

Molly: What?

Laura: Yes.

Molly: That's so small.

Laura: Yes, it was surprisingly low. Half the people get the vaccine candidate, half the people get the placebo, then you infect all of them and you wait to see if the vaccine candidate works or not. The challenge trial would typically take about a month because you're intentionally infecting people who you know you're not going to give a vaccine candidate to, in this scenario.

Molly: How do they know that they can keep subjects in this study safe? I mean because what we do know about COVID is that some people get it, no symptoms, and then some people get it and they die within a few weeks.

Laura: This is actually pretty well outlined by the World Health Organization. They wrote a report about whether it was ethical to do this in the absence of a rescue treatment for COVID-19.

Molly: That is exactly what I'm saying. It's not like you have a good treatment if you're sick, we still don't know how to treat it. We don't even know why some people are fine and some people end up not being able to breathe.

Laura: Exactly, right. Some thought it was still worth it because it had enough societal good to speed up a vaccine process that could potentially save thousands of lives if a vaccine became available sooner.

Molly: The other part of the ethical debate around these types of trials, Laura says, is their history, which isn't good.

Laura: In the '40s, the University of Chicago in Illinois and the US Army collaborated on challenge experiments, they were actually testing malaria drugs, and this is a whole other messed up part of human challenge trial history, in prisoners. This is really messed up. Nazi doctors, they actually included these malaria tests as justification for their own medical experiments.

Molly: Whoa.

Laura: This was one of their defenses at Nuremberg in '47.

Molly: People would say that the medical experiments that the Nazis did were in a sense or are the original challenge trials?

Laura: Actually not, they're not the original one. The original one then this is a whole other wormhole that's quite fascinating, is that the first vaccine, smallpox, that was developed by this man named Edward Jenner, this was in 1796. Guess how he first came to the smallpox vaccine.

Molly: I always feel there's testing on children that are involved or something.

Laura: You are very close. He purposely infected his gardener's eight-year-old son.

Molly: Did it work?

Laura: Yes, it worked. That's the thing. That was the first step to getting the smallpox vaccine.

Molly: Wow.

Laura: Human challenge trial is a really kind of at the heart of vaccine history.

Molly: I thought the whole point of challenge trials was volunteering.

Laura: That's the thing, is they've now developed into becoming much more informed and they have to volunteer to be in the studies because of the risk that you're asking people to go through, they are much, much, much more monitored than a typical phase III trial. They're not going to go about their normal lives, they're going to live in some quarantined facility, they're going to get state of the art medical treatment.

Molly: It's like real-world coronavirus.

Laura: Yes. [chuckles] They can't talk to each other when they're isolated, they're in their room not able to interact with like-

Molly: Even though they've all been sick, they're not allowed to just hang out?

Laura: No.

Molly: What?

Laura: I have a feeling no because also if you think about a controlled setting, that could really complicate things because what if people get sicker if they're interacting with each other more.

Molly: Do you think you'd do it?

Laura: No. Let's put it this way, at this exact moment in time, definitely not, because I have a one-year-old son. It's just like, yes, that's not going to happen.

Molly: I'm trying to imagine anyone that would do this.

Laura: Look, I ended up covering this non-profit called 1Day Sooner. This is pretty interesting. 1Day Sooner, basically, they created this website and create this call for people who wanted to volunteer for such a thing, and people quickly signed up. This became live, I believe this was in April, May and now over 30,000 people have signed up.

Molly: Holly, wow.

Jad: Damn. 30,000 people have said, "I will knowingly risk my life to help vaccine research."

Molly: Right.

Jad: Wow.

Molly: Not only that, after we talked to Laura, the United Kingdom came out and said that they wanted to start a challenge trial with COVID with humans in January of 2021 but weeks away. It just made me think about those volunteers. We are all working very hard to avoid coronavirus and not get it and they're like, "Okay, how can I put myself in front of this moving train?" At least that's what it sounds to me.

Jad: Who would do that? Why?

Molly: I can tell you who to do it and I can tell you why, just after the break.

Jad: Okay. This is Radiolab. We'll continue in a moment.

[advertisement playing]

Jad: All right, ready? Three, two, one, Jad.

Molly: Molly.

Jad: Radiolab. Before the break, we heard about this peculiar vaccine trial, which involves people volunteering to deliberately be infected with COVID, which sounds insane to me, although very noble. Molly, you say there are thousands and thousands of people who have volunteered to do this?

Molly: Yes, there's a list out there that has, I think at this point, over 37,000, 38,000 people on it, who have said, "Jab me with COVID, I'll take it." We thought, okay, we have to go out and see who these people are. Who is this angelic? Who is this good? They had a lot of different reasons for signing up, not all of which felt exactly like the altruism I expected to find.

Jad: Who were they?

Molly: The first one was Estefania.

Estefania: Yes, I am Estefania [unintelligible 00:13:14]. I am a photography student. I live in Bristol and I am from Caracas, Venezuela.

Molly: At what point did you bump into the notion of a challenge trial?

Estefania: I do night shifts at a petrol station. I've been there three nights a week for the past two years now. I'm a student and I did this brilliant plan in my mind where I was going to go work at night and then study during the daytime and I didn't factor in sleeping time.

Molly: What is that like? What are the ebbs and flow at the petrol station during COVID? Were there moments where it just was dead quiet with no one or does the petrol station always stay busy?

Estefania: It was like this dystopian reality going out while everyone was just saying in. Everything was deserted. I had to travel by bus and it's a 40-minute bus drive. It was just me and the driver. [chuckles]

Molly: She told me those nights at the petrol station, we're like living on a planet of one. She'd be out there for hours, just her, nobody else and so she would listen to podcasts to pass the time.

Estefania: I actually learned about the campaign through a podcast. I heard about 1Day Sooner and I went on the website while I was listening to the podcast. You can see the messages from people that have already signed in, their reasons to do it.

Molly: Do you remember any of the things that you read that night?

Estefania: I can't remember specifically, but I remember being from all parts of the world, people from Rwanda, people from Brazil, people from Russia. They were scientists, nurses, doctors, I think I read. It makes you read-- I was reading it and my hands were shaking. It was something about, I'm with them. I felt that I was with them.

Molly: It feels like, oh, my God, there was a quiet movement growing in the background and I had no idea. I was just working at this petrol station and like all is lost in the middle of COVID.

Estefania: [laughs] Yes, that's exactly it. This has been happening so I can actually do something and I don't have to feel like shit here all alone in this dark night and I put my name for it.

Molly: That was her first thought, simply, I'm not alone. Then she had a second thought, which is that as a brown person, she had to enter.

Estefania: Medicine is biased when it comes to dealing with racial minorities but I also want to have a voice on the table. I want to be someone who advocates for people like us. It felt scary, but in a good way, it felt hopeful.

Jad: Wow. That's cool.

[phone ringing]

Molly: Next up.

Antonio: Yes.

Molly: Hi. This is Molly Webster at Radiolab. How are you?

Antonio: I'm surviving.

Molly: Antonio.

Antonio: My name's Antonio Cisneros. I live in Los Angeles and I'm a filmmaker.

Laura: Can I jump into how you found out first about 1Day Sooner and about challenge trials?

Antonio: It's actually silly. I actually saw a piece on PBS NewsHour about it, maybe back in April. I immediately looked it up and within five minutes I signed up, honestly, because it made sense.

Molly: Wow, that's very fast. That's a very fast decision.

Antonio: It's funny because I really thought it would have happened sooner, the challenge trials. It makes sense to me. There's-

Molly: I think I just wonder probably more than 37,000 people watch that PBS NewsHour. What I'm really trying to understand is what is in you, Antonio, that got you to sign up?

Antonio: Man, this is a real therapy session here. [laughs] What is in me? I don't have a family, I'm single, I don't have a lot to lose if something was bad to happen, but at the same time, maybe it's more just like, "Oh, I don't want my parents to get it and then die." I think growing up in-- A few decades ago, there was a lot more sense of a community sense of America and being American.

I think it's one thing that I wish we could still hold onto in this point in time. There should be thinking that 200,000 people have died unnecessarily, since what? February or March. That doesn't make any sense to me and I don't want the numbers to get any bigger. There should be a sense of duty that if we can do something, we should do it

Molly: Volunteer number three.

David: Hello. My name is David Wildman.

Molly: David.

David: I am a homo-sapiens male, age, 31 years.

Molly: For David, his motivation didn't have to do with community or family or a sense of duty. It was more so about getting unstuck.

David: We're basically in this helpless situation. We're all being told to stay at home and we are powerless. This is one thing that you can do that will be a part of the core solution, which is the vaccine.

Molly: I just don't think a lot of people are thinking about how they can help others. I'm just wondering where you think that got built into you.

David: I was very zealously religious when I was growing up, brought up in a Christian home, but attended an evangelical church when I was a teenager. I think from a very young age, I had this idea that life was about being like Jesus and being good to people. When you've grown up with-- and a cosmology, a complete and consistent cosmology that explains the universe and your part in it to basically not overnight, but over a relatively short period of time, realize that it's all garbage, leaves you floundering and thinking, "Well, fuck I need to replace it with something else. I need some sense of purpose." That I'm restless unless I know I'm doing something that's making the world a better place, not a worse place.

Jad: He's saying that signing up for a challenge trial is like making up for the faith in God that He lost at some point.

Molly: Yes, I think something like that. I would also say he said if he was being totally honest, signing up also had a little to do with boredom.

David: I retrained as a software developer in this chair that I'm sitting in. I searched for a new job in this chair. I started a new job in this chair and now I'm talking about it in the same chair. It's like, "I can really use a change of scenery. Actually, going to a biocontainment center for a bit would be quite exciting, quite nice."

Molly: Volunteer number four.

Lehua: Hello.

Molly: Hi, is this Lehua?

Lehua: It is. Hi.

Molly: Lehua, who had a little bit more of an analytical, utilitarian approach.

Lehua: I could get COVID at any second, but it wouldn't be doing anything. It wouldn't be productive. I would be just as sick, just as miserable, have just as much of a chance of all these big, long-term health effects that we're still discovering, and it would not have done anything. This is an opportunity to catch it but for the purposes of helping thousands of other people not catch it.

Molly: If she got COVID in the wild, it wouldn't be for anything. At least if she's in a trial, scientists can learn from it.

Jad: Interesting. She's like, "If I'm going to get sick with this damn novel virus, I might as well do it in a way that's productive."

Molly: Exactly.

[phone ringing]

Molly: Our fifth, and for now, last volunteer.

Bill: Hi, Molly.

Molly: Hello.

Bill: Finally.

Molly: Bill.

Bill: I'm Bill Phillips. I'm an experimental physicist, and-

Molly: You happen to be a Nobel Prize-winning scientist?

Bill: Yes. Having a Nobel Prize in Physics does not qualify me to make pronouncements about any of these things, any more than any other person who is a scientist and loves to have good data. If a trial has some probability of losing a few people, but you save more lives than you lose, as long as everybody is clear on informed consent, it seems to me, the perfectly reasonable moral position. I signed up for a challenge trial and after people started to question me, "Why are you doing this, Bill? Are you crazy?"

Molly: Is that what happened?

Bill: Well, yes. I got a number of people asking me that because of my age.

Molly: How old are you?

Bill: I'm almost 72. I did a little bit of research to try to determine what were the chances that I would die, given my age, if I got the coronavirus. It turned out it wasn't that different from the probability that I'll die within the next year anyway.

Molly: Do you remember the numbers?

Bill: The numbers are in the order of a couple percent. In other words, at my age, the chances of me dying in the next year are a couple percent. That's very similar to the chances of dying if I actually catch COVID.

Molly: He's just saying if I'm not scared to live another year, why would I be scared of getting COVID? Mathematically, the odds are the same.

Jad: After talking with all of these people, I'm curious, what are you left with in terms of-- Because our simple question going in, if I remember, was just like-- I don't even know what the question was. Who are these people? What drives and why?

Molly: It was just like, why would you be motivated to do this? Who is this altruistic?

Jad: Exactly. What do you see as answers to that or is there anything?

Molly: I would say that for me, altruism feels like a catch-all phrase that hides what people are actually on about, what they're really going for. This thing that we call altruism, it could interestingly be paired with a selfishness or self-interest of, you just want your life back, or it could be because you're looking out for a family member, your dad, your grandmother. It could be want of representation or there's a feeling of duty or country or community. It could be just math. None of these things necessarily feel like altruism but maybe they are. Maybe they're the truer of the word.


Special thanks for this episode goes to Ab Rohrich, Andrew Catchpole, and our volunteers including Mary, Gabrielle, Paul, Gregory, Danica, Jennifer, and Debo.

Jad: Thank you, Molly.

Molly: Sure.

Jad: Senior correspondent, Molly Webster. Thanks also to reporter Laura Rosbrow-Telem.

Speaker: This is [unintelligible 00:25:51], calling from Fayetteville, Arkansas. Radiolab was created by Jad Abumrad and was edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts. Dylan Keefe is our director of sound design. Suzie Lechtenberg is our executive producer. Our staff includes Simon Adler, Jeremy Bloom, Becca Bressler, Rachael Cusick, David Gebel, Matt Kielty, Tobin Low, Annie McEwen, Sarah Qari, Arianne Wack, Pat Walters, and Molly Webster, with help from Shima Oliaee, Sarah Sandbach and Jonny Moens. Our fact-checker is Michelle Harris.


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