Alex Greer, a chemistry student, runs the Effective Altruism Society at Durham University. “It’s about using evidence and careful analysis to do the most good in the world,” he says. With this mission in mind he recently received an offer he felt could not refuse: would he allow himself to be infected with Covid-19 in the name of science?
Uplifting altruism in action – Owl
Mr Greer, 20, is one of more than 2,500 Britons who have volunteered to take part in the world’s first coronavirus “human challenge trials”. Due to begin in a London hospital next month, they will involve participants being deliberately exposed to the virus in a secure bio-containment suite.
The aim is to accelerate research by studying, in a way not possible in other settings, how our bodies react to the bug and how well the next generation of vaccines can fend it off.
Dominic Wilkinson, a professor of medical ethics at Oxford University, believes the dangers are acceptable and that volunteering signals “an enormous amount of altruism and maturity”.
The project, led by Imperial College, will initially involve a few dozen 18 to 30-year-olds, free of risk factors such as heart disease or diabetes. For this age group studies put the chances of dying of Covid once you’ve caught it at somewhere in the region of one in 10,000. “It’s the sort of risk that women run of dying in childbirth,” Professor Wilkinson said.
On top of that there is the possibility of “long Covid”, where symptoms linger for weeks or months. “But a lot of people have caught the disease and had no say in it,” Mr Greer said. “Hopefully by giving my informed consent I can help prevent others being blindsided.”
At 66, Paul van den Bosch, a GP who has worked for Médecins Sans Frontières, will not be eligible for the first trials but he hopes that older people, a priority group for vaccines and treatments, will eventually be allowed to take part.
“We’ve become a little bit obsessed by an injunction to stay safe,” he said. “Our lives are finite and it’s not our job to to stay safe all the time. We’re going to die in the end — and if one wants to be romantic about it then, you know, dying gloriously is better than dying of dementia. And from a practical point of view, the risks aren’t huge. They’re much smaller than a lot of the things that people do, like climbing Everest [where about one in a hundred climbers beyond base camp die].”
What does his family think? “I’ve worked overseas in difficult environments and a few years ago I donated a kidney so I’m known as a risk taker.”
Over the past year scientists have developed vaccines at a pace that many doubted was possible, but it still was not fast enough to stop the world being turned upside down by the virus. By providing £34 million for the challenge trials, the UK government is signalling a belief that the process can be accelerated further still.
This seems plausible: the American company Moderna had created a coronavirus jab by February 24, although it took another eight months to show that it worked. This was done by recruiting 30,000 people for a field trial and giving half of them the real vaccine and half a placebo. The scientists had to sit back and wait for infections to strike naturally. It took until mid-November for 95 people to catch the bug, enough to assess with reasonable statistical certainty that it was effective.
Challenge trials offer a shortcut to that process because scientists can observe infections from the moment the pathogen meets its host. By scrutinising every detail from the outset the trials should help to define how the immune system mobilises to fend off the coronavirus, as well as the duration of vaccine-induced immunity and the measurable signs that a person is protected. The first step will involve working out the smallest amount of virus you can expose somebody to and cause an infection. (Volunteers will probably have it dripped into their nose.) This should help to minimise the risk of severe disease.
The Vaccine Task Force, the government body responsible for building stockpiles, has secured the first three challenge trial slots to test new jabs. A second generation of vaccines is likely to be needed, it says, for boosting protection, addressing supply challenges, tackling mutations in the virus and making immunisation campaigns cheaper. It envisages a “fast to fail” approach, where challenge trials quickly sort out the vaccine chaff. If transmission rates are low this may be the only way that the next swathe of inoculations could be tested. The option for large-scale field efficacy studies simply may not exist.
The volunteers are on board with this thinking. Jennifer Wright, 29, a physics PhD student at the University of Glasgow, says she has been motivated by the ability to gather otherwise unobtainable data. She would also like to feel as if she had done her bit. “I’m very sure that I would like to take a risk to help out,” she said. “Some of my friends work for the NHS and they’ve been taking risks all through the pandemic while I’ve been looked after and stayed safe.”
In the spring Seán McPartlin, 22, a philosophy student at Oxford, became involved with 1Day Sooner, the non-profit group through which all the volunteers interviewed here have signed up. It has held discussions with Imperial but the researchers may end up enrolling volunteers through other channels.
Volunteers for the Imperial trial are expected to be paid about £4,000 for a two or three-week stay at the Royal Free Hospital in London and probably about a year of follow-up appointments. Mr McPartlin has been calling would-be participants and says they have not seemed very interested in financial incentives. “They’re committed to the rationale,” he says.
Around the world 1Day Sooner has recruited more than 38,000 challenge volunteers and won the backing of several Nobel winners as well as Adrian Hill, one of the leaders of the Oxford vaccine team. Mr McPartlin has been making sure that the volunteers know what they are letting themselves in for.
“Most had done their due diligence,” he says. “The outstanding questions were practical. What exactly is the quarantine facility going to be like? Will there be wifi?”