The race is to find a cure for coronavirus. This breed is divided into two approaches: testing existing drugs used for similar diseases and searching for vaccines. In both cases, important ethical decisions must be made. Is it good to reschedule treatment with side effects? And if thousands of people die from the corona virus every day, is it legal to cut steps in search of vaccines?
Last Friday, the World Health Organization announced the launch of Solidarity, a global study of four of the most promising treatment candidates for Covid-19: Remesivir, an antiretroviral treatment for Ebola; Chloroquine and hydroxychloroquine, both antimalarials; Ritonavir, HIV treatment; and interferon, treatment for hepatitis C. Both the Seattle-based Kaiser Permanent Research Institute and the Chinese Academy of Military Medicine have announced the start of human testing for new potential vaccines. About 30 other research groups around the world are working on vaccines.
However, WHO estimates that the vaccine will not be ready by June 2021. Requirements must be met. The gold standard for this type of research is clinical studies – administering vaccines to large numbers of people under controlled conditions and measuring their effectiveness. Scientists usually wait 14 months to monitor the effectiveness and possible side effects. So we might have to wait until next summer. Coronavirus vaccine testing faces the following dilemma: we need to be treated quickly, but we also need to know that it will work. The worst results for the medical industry are vaccines that don’t work or, worse, are dangerous or have side effects. Belief in vaccines is already low worldwide.
Decisions are taken by governments, in tandem with ethics committees. Every day they delay the development or introduction of an intervention found to be effective, a growing number will die. There have so far been 19,603 deaths, with 12% of those deaths occurring in a single day – yesterday (Tuesday 24 March). The economic devastation being wrought must also be considered – this will cost lives through depression, suicide and other effects of deprivation. In a pandemic, time is not only money. It is lives. Many lives.
Yet even promising possible treatments can prove to be ineffective or even harmful. Remdesivir, chloroquine, ritonavir and interferon all have serious side-effects, including heart arrhythmias and possibly death. Indeed, a man in Arizona died after ingesting chloroquine, believing it would protect him from Covid-19.
In terms of vaccine discovery, there are plenty of ways authorities could speed up the process. One is a human challenge study. This involves deliberately infecting a person with coronavirus to look at how the virus behaves and using that evidence to find the most promising vaccines. Today, healthy people are deliberately infected with flu, common cold, typhoid, malaria, dengue fever and streptococcal infections to study the disease, and more rapidly develop vaccines and treatments.
Challenging studies are suggested in Covid-19. Hvivo, a clinical research group in London, has attracted more than 20,000 volunteers who want to be infected with a mild corona virus that does not cause serious symptoms. Each paid £ 3,500. However, the benefits of examining related viruses may be limited. There are suggestions for challenging trials that infect younger participants with a lower risk of complications with Covid-19. This carries with it deep ethical consequences and consequences – but it can save thousands of lives. Another alternative is to recruit low-risk people who are likely to be exposed to Covid-19 in vaccine trials. This will have the advantage of gathering large sample groups to show whether treatment can be extended to large populations. It is noteworthy that vaccine testing in China is carried out in military facilities: it is recommended that tests be carried out on soldiers without consent.
Lines must be drawn for this war: what uncertainty must be accepted, whether unconscious patients can be examined without consent, what risks can be justified, etc. At present, this decision is usually made by an ethics committee based on guidelines developed for situations without a pandemic. We need government guidelines to continue research on all treatment options while ensuring adequate risk. In my opinion, the failure of the government to support this study is as wrong as adopting a dangerous policy.
How quickly we develop medications or treatments depends on the risk we want to take.