Sophie Rose, a 22-year-old Stanford University Human Biology graduate and co-founder of 1 Day Sooner – an organisation recruiting volunteers for a potential human challenge trial – talks ethics, risks and the greater good to society when it comes to purposely infecting people with a disease that could kill them
What exactly is a human challenge trial, and how could it help develop a coronavirus vaccine?
Participants are given the coronavirus vaccine (and some are given a placebo) and then they are directly exposed to the coronavirus. Knowing 100 percent of participants have been exposed makes it easier to judge the vaccine’s effectiveness. In normal vaccine trials, the volunteers go about their regular lives and may or may not encounter the virus in the wild. We analyse to see if they get sick less often than those who received the placebo. If this is true, it means the vaccine is effective.
Why is a human challenge trial better than a regular vaccine trial?
HCT means you are not waiting for six months to a year and a half. We don’t have that kind of time to lose. Not only are people dying but there is also an economic and wellbeing toll to consider.
Talk us through the conception of 1 Day Sooner…
I read a paper published in the Journal of Infectious Diseases and it proposed the idea of using challenge trials for Covid-19. I really wanted to leverage my existing skill set in order to do something useful and HCT interested me. I decided to join forces with a couple of other people in my professional network and make the group a reality.
Who thought of the name?
One of our members, Josh Morrison, threw it around and it really resonated with the rest of the team. The idea being that even bringing a vaccine to the global community one day sooner has the potential to save thousands of lives.
Globally, there has now been over 400,000 deaths. But currently, No HCT is planned. What’s the next stage for 1 Day Sooner, now that you have your volunteers?
We are continuing to recruit volunteers and lay the groundwork so if the government decides these trials are the best option to developing a vaccine, we are ready to start them as soon as possible. We hope that recruiting enough willing people will help convince policymakers that a HCT is a viable option towards developing a vaccine against the coronavirus.
Is purposefully infecting people with a disease that could kill them ethical?
There are still important ethical and scientific conversations ongoing about whether these trials are the best option to finding a coronavirus vaccine. The World Health Organization (WHO) says the method of HCT research ‘can appear to conflict with the guiding principle in medicine to do no harm.’
But our current view is yes, there are risks to individuals, but we perceive those risks to be reasonable. Research from the US and China shows one in 3000 people die from Covid-19: this means the HCT trial risk is equal to donating a kidney, which so many of us would consider. The social benefit from these trials is potentially enormous and level of risk is reasonable. Plus, there would be a robust and informed consent process.
Who would be selected from the volunteers to take part?
We would select participants carefully – people who are young and with no underlying health conditions.
More than 2,300 people from 52 countries have indicated their interest in becoming a volunteer. Has this volume surprised you?
Yes and no. One of the things that has impressed me over the past few months has been people across the world have come together and shown collective action – in the face of Covid-19 and now racial injustice. It’s been inspiring to see.
Why would a person want to sign up for this potential trial, as it’s voluntary, not paid, participation?
There are many varied reasons, but largely people believe the level of risk to themselves is acceptable given the larger benefit to society. Interestingly, I’ve been told by medical students that they want to be involved because they have a good understanding of what these trials entail and they are frustrated as they are not able to practice medicine – because they are not far along enough in education. Volunteering is a way for them to contribute and potentially help find a coronavirus vaccine.
Do you personally know anyone who has been affected by Covid-19?
I do, sadly. A couple of close people in my life have lost loved ones due to Covid, which has been really hard to see. It’s been difficult because you can’t come together with your loved ones. I do worry about my grandparents, who are high risk and living in Australia.
How do your family feel about you living so far away from them, and doing the work that you do?
I grew up on the east coast of Australia in Brisbane and moved out when I was 17 to study Infectious Disease Epidemiology at John Hopkins University in California, and later I did my undergraduate course at Stanford in Human Biology, so for the past five years my family have become fairly used to having me at arm’s length. But we are very close and talk frequently, and they are very supportive of the work that I do. Last December I became a resident of Oxford, to do some research for the university for a year, so I’m currently the furthest away from home I’ve ever been.
Judging from your qualifications, it seems fair to say you’ve been interested in pandemics before they became the talk of the planet…
Selfishly, I sometimes feel quite lucky that I am living through something I am so passionate about working on. It’s an unexpected opportunity. Being prepared for a pandemic is something scientists have been talking about for a long time. I’m hoping this situation helps to inform health policy so we are in a better position for next time. I always want to try to improve the world around me.
For more information on the work of 1 Day Sooner see 1daysooner.org
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