Unnecessary hesitancy on human vaccine tests

doi:10.1126/science.abc8264

GSTDTAP > 气候变化

DOI	10.1126/science.abc8264
	Unnecessary hesitancy on human vaccine tests
	Nir Eyal
	2020-07-10
发表期刊	Science
出版年	2020
英文摘要	In their Policy Forum “Ethics of controlled human infection to address COVID-19” (22 May, p. [832][1]), S. K. Shah and colleagues provide an ethical framework to determine whether controlled human infection studies (CHIs) are justifiable for studying potential vaccines and treatments for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Some of the Policy Forum authors reportedly disagreed that “the social value of such CHIs is sufficient to justify the risks” at this time. Their reluctance is unfounded. The risks of a properly conducted CHI are low enough, and the social value of expedited SARS-CoV-2 vaccine development is high enough, that properly conducted CHIs with a fair chance at accelerating that development remain a legitimate strategy. Shah et al. identify an ineliminable risk to participants: a 0.03% death rate among “healthy adults aged 20 to 29” infected with SARS-Cov-2. The source for this mortality rate ([ 1 ][2]) documents death among all infected 20- to 29-year-olds. In healthy people in this age range, death should be rarer. CHIs will only recruit healthy people. And, perhaps thanks to evolving COVID-19 treatment practices, the mortality rate is already lower in that age group than it was when the Policy Forum was published ([ 2 ][3]). Moreover, as shown in Shah et al. 's table S1, live kidney donation, a broadly accepted practice, carries a similar mortality risk of <0.03%. An alternative suggestion cited by Shah et al. would limit risk to below a 1% death rate ([ 3 ][4]), but that threshold is far higher than their own estimate of 0.03%. Further mitigating the overall risk, CHI participation could reduce participants' relative risk—i.e., their risk in the trial minus their risk if they decline to participate ([ 4 ][5], [ 5 ][6])—and improve their treatment access ([ 4 ][5]). Shah et al. agree that recruiting in “locations with high community spread of SARS-CoV-2 could be an acceptable way to reduce relative risks for participants” ([ 6 ][7]). CHIs should also guarantee participants critical care [which most young COVID-19 patients survive ([ 7 ][8]–[ 9 ][9])] and any novel therapeutics. Those may be scarce in some locations with high community spread ([ 6 ][7]), even absent economic or racial injustices that might create ethical complications ([ 5 ][6]). These factors push overall risk further below limits. Shah et al. question the social value of CHIs because of the necessary “coordination of stakeholders,” but no trial guarantees coordinated delivery. Even a fairly moderate chance at substantially curbing colossal ([ 10 ][10], [ 11 ][11]) mortality through an accelerated vaccine rollout would imbue CHIs with high expected social value. 1. [↵][12]1. R. Verity et al ., Lancet Infect. Dis. 20, 669 (2020). [OpenUrl][13][CrossRef][14][PubMed][15] 2. [↵][16]1. H. Salje et al ., Science 10.1126/science.abc3517 (2020). 3. [↵][17]1. D. B. Resnik , Theor. Med. Bioeth. 33, 137 (2012). [OpenUrl][18][CrossRef][19][PubMed][20] 4. [↵][21]1. R. Palacios, 2. S. K. Shah , Trials 20, 702 (2019). [OpenUrl][22] 5. [↵][23]1. N. Eyal , Ethics Hum. Res. 10.1002/eahr.500056 (2020). 6. [↵][24]1. N. Eyal, 2. M. Lipsitch, 3. P. G. Smith , J. Infect. Dis. 221, 1752 (2020). [OpenUrl][25][PubMed][26] 7. [↵][27]Intensive Care National Audit & Research Centre (ICNARC), “ICNARC report on COVID-19 in critical care 08 May 2020” (ICNARC, London, UK, 2020). 8. 1. G. Grasselli et al ., JAMA 323, 1574 (2020). [OpenUrl][28][PubMed][26] 9. [↵][29]1. X. Yang et al ., Lancet Respir. Med. 8, 475 (2020). [OpenUrl][30][CrossRef][31][PubMed][26] 10. [↵][32]1. P. G. T. Walker et al ., “The global impact of COVID-19 and strategies for mitigation and suppression,” (WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, 2020). 11. [↵][33]1. T. Roberton et al ., Lancet Infect. Dis. 8, E901 (2020). [OpenUrl][34] N.E. is funded by National Institute of Allergy and Infectious Diseases grant R01 AI114617-01A1. 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领域	气候变化 ; 资源环境
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引用统计
文献类型	期刊论文
条目标识符	http://119.78.100.173/C666/handle/2XK7JSWQ/283361
专题	气候变化资源环境科学
推荐引用方式 GB/T 7714	Nir Eyal. Unnecessary hesitancy on human vaccine tests[J]. Science,2020.
APA	Nir Eyal.(2020).Unnecessary hesitancy on human vaccine tests.Science.
MLA	Nir Eyal."Unnecessary hesitancy on human vaccine tests".Science (2020).