In an article published on the website of his cancer research laboratory, the professor from the University of Toronto proposes to set up special hospitals where volunteers could be deliberately infected with low doses of the COVID-19 virus, helping to build protective immunity in the herd in the year or more before a vaccine becomes available.
A colleague equated his suggestion with the Nazis’ medical experiments on prisoners in concentration camps.
But different versions of the provocative idea have slowly garnered support as the world searches for ways to escape devastating economic bottlenecks while protecting people from the new coronavirus.
Quebec Premier Françoise Legault said Thursday that she wants to prepare Quebecers for the concept of collective immunity. He said that science indicates that it would be a mistake to keep Quebecers locked out for the months to come. “If everyone stays at home, no one will be vaccinated,” said Legault.
An American group has recruited more than 2,000 volunteers ready to be infected with COVID-19 to test potential vaccines more quickly.
Meanwhile, some doctors and academics have gone further, suggesting that health workers are voluntarily infected to create a potentially immune medical army. This would revive an old tactic – called variolation – where people were given a limited dose of smallpox to try to avoid a more devastating infection.
“It sounds like a crazy idea – people say, ‘No, no, no’,” admitted biochemist Diamandis, who heads the Advanced Center for Detection of Cancer at Mt. Sinai Hospital. “(But) isolation leaves billions of people without immunity, and at the end of the day, we have to achieve immunity somehow. And that’s one way. “
Naturally, however, the concept is controversial, with some scientists and bio-ethicists warning that it would violate basic moral principles of medicine and research – whether or not someone receives a vaccine first.
“I don’t agree with any of these proposals,” said Michael Houghton, a virologist at the University of Alberta who is developing a coronavirus vaccine as part of a federal government grant. “Infecting people to strengthen collective immunity is a mistake – you do it with a vaccine, not the virus.”
The underlying debate is the notion that the world will not be completely free from the COVID-19 threat until there is enough immunity to cut the spread of the virus. This often represents around 60% of the population. The most likely way to get to this state is to use a vaccine. But despite many extremely accelerated development projects, experts estimate that one won’t be ready for another year to 18 months.
Vaccine efficacy trials usually involve a group randomly selected to receive the new agent and a group receiving a placebo, the immune response being measured during their normal lives. Bioethicist Nir Eyal and colleagues at Rutgers University in New Jersey proposed in an article last month to conduct trials in which subjects were voluntarily exposed to the virus to test the effectiveness of the vaccine, a measure that they believe could shorten the approval process by several months.
To this end, the grassroots group 1DaySooner said it had recruited nearly 2,400 volunteers in 52 countries Thursday afternoon to undergo such studies.
Houghton agreed that “stimulant” trials would speed up the process, but argued that they are only ethically acceptable if there is an effective treatment for the disease in case the vaccine does not work. COVID-19 does not yet exist.
At the end of the day, we have to get immunity somehow
Riam Shammaa, whose company Intellistemtech Technologies has developed a candidate vaccine, said he did not believe that provocation tests were even necessary, since regulators like Health Canada and the US FDA allow an accelerated process for approve COVID-19 injections.
And he has ethical concerns: “You should have a very, very good lawyer if you actively infect people. “
Meanwhile, others have touted the deliberate contamination as a stopper until there is a vaccine.
Economist Robin Hanson of George Mason University has suggested a “controlled infection” of segments of the population to help manage the pandemic.
Neuroscientist Michael Segal suggested in the Wall Street Journal a cautious infection of voluntary first responders, followed by quarantine in closed resorts, so that they can work freely with infected patients.
Diamandis says in his article that Canada should continue to take social distancing measures and consider its idea only if the peak of the epidemic has passed, the burden of health care lifted and no vaccine is in sight. Next, he proposed to infect young low-risk volunteers with a small dose of coronavirus, the assumption being that a low viral load would cause minimal disease, but possibly immunity.
This would be done in a hospital or facility specially equipped with intensive care units and ventilators, he said, with repeated waves of volunteers infected to work on collective immunity.
Udo Shuklenk, bioethicist at Queen’s University, said he could not guarantee the potential effectiveness of such a measure, but said it would be ethically acceptable for patients to be carefully chosen and consented after being fully informed of the risks.
He cited the legal principle Volenti non fit injuria – to a consenting person, no injury is done.
Diamandis’s article “is shocking in that it proposes the deliberate infection of healthy people in the prime of their lives by a dreaded virus,” said University of Calgary ethicist Juliet Guichon. But it’s thoughtful and “offers an important idea to discuss.”
Colleague Ian Mitchell, pediatrician and ethics expert at the University of Calgary, is unsure, noting that it is still unclear what type of immunity COVID-19 infection provides and for how much of time.
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