By MOLLY TAFT and PHOEBE PINDER
“I want my kids to get coronavirus – and you should too,” reads the title of a recent op-ed in the Cincinnati Enquirer. You may be feeling the same way – if you’re young and healthy, wouldn’t it be better to get the disease and get over it? Here’s what you need to know.
What do we know about the science and history of deliberate infection?
Since Covid-19 is such a new disease, researchers are still gathering basic information about if – and for how long – people are immune to the virus after falling ill. But experts say that infection from the virus will most likely grant immunity for a period of time in some people. They also say that reaching “herd immunity” – when between 70 to 90 percent of the population has been exposed to coronavirus and is immune – could be a crucial turning point for recovery.
But they caution that attempting to turbocharge herd immunity could result in a catastrophic number of deaths. “We really can’t depend on herd immunity until we get either enough people infected, or enough people vaccinated,” Anthony Fauci told TIME this week.
In the absence of reliable treatment, and with thousands of people dying in overloaded hospitals and in their homes in the pandemic epicenters like New York, the idea is a nonstarter for millions.
Have there been times in history when deliberate infection has helped speed immunity or a cure?
In a recent NYT op-ed on viral dose and coronavirus, authors Joshua D. Rabinowitz, a professor of chemistry and genomics at Princeton & Caroline R. Bartman, look at how deliberate infection has been used in the past:
Humans also exhibit sensitivity to viral dose. Volunteers have allowed themselves to be exposed to low or high doses of relatively benign viruses causing colds or diarrhea. Those receiving the low doses have rarely developed visible signs of infection, while high doses have typically led to infections and more severe symptoms.
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Low-dose infections can even engender immunity, protecting against high-dose exposures in the future. Before the invention of vaccines, doctors often intentionally infected healthy individuals with fluid from smallpox pustules. The resulting low-dose infections were unpleasant but generally survivable, and they prevented worse incidents of disease when those individuals were later exposed to smallpox in uncontrolled amounts.
Are scientists talking about purposefully infecting people?
Global recovery from coronavirus, experts say, depends on creating an effective vaccine. But development of a new vaccine is a complex and multi-step process that typically takes at least a year to complete.
A large portion of this time is due to clinical trial requirements, which usually follow a three-phase process: initial testing of a small number of participants, then small group testing, and, finally, a large-scale test of several thousand participants, usually including a control group given a placebo or other vaccine.
To get a Covid-19 vaccine on the market faster, some researchers and medical professionals are suggesting ways to speed up this process. In a recent piece published in The Journal of Infectious Diseases, researchers from Rutgers University proposed replacing the typical third phase of clinical testing with a process called a controlled human challenge trial.
In normal vaccine trials, people either receive a vaccine or a placebo, and then are released to go back to their daily lives and potentially be exposed to the disease. Researchers monitor participants for up to a year afterwards, keeping tabs on how effective the vaccine is at staving off infection.
But in a human challenge trial, a smaller number of volunteer participants would receive either a vaccine or a placebo, and then would be intentionally infected with Covid-19 in a controlled research setting and monitored. Using this method, researchers say, could knock many months off of the licensure process, making vaccines available much sooner.
Human challenge trials have been used in the past to study vaccines and treatments like malaria and dengue. But using them in the case of newly emerging infectious diseases such as Covid-19, where we lack a great deal of knowledge and a specific cure, can be very ethically complex. There certainly are risks associated with intentionally infecting people with a dangerous virus, but study co-author Nir Eyal, a professor of bioethics at Rutgers University, pointed out that, if specific precautions were taken, a human challenge study could be designed to be surprisingly safe.
“The study should only involve participants who have a relatively low risk of death or severe complications from the disease — for example, otherwise healthy people ages 20 to 45 years old, who are likely to be exposed to the virus anyway because they live in high-transmission areas,” Eyal said in a press release sent to ClearHealthCosts. “A vaccine would need to be tested for safety, dosing and immune response through Phase 1 and 2 trials before a challenge study could begin. Participants also would need to be assured that their health will be closely monitored during the study, and that they would have access to intensive care and any available medicines if and immediately when they become infected.”
Some people want to make sure that if challenge trials move forward, scientists and vaccine makers can access a group of prepped volunteers. Josh Morrison, who works for a kidney transplant advocacy organization, said he was intrigued by Eyal’s ideas. He considered the trial something he would be interested in taking part in himself, and decided to recruit and educate others who may be interested in signing up for a challenge trial. He and other volunteers organized 1 Day Sooner, which has already organized a database of over 3,000 volunteers from 52 countries.
“Basically we want to create the preconditions for, if any vaccine manufacturers want to use a challenge trial, it’s as easy as possible to do that,” Morrison says. “Part of that is having really well-informed volunteers. Part of it is having broad public support.”
Lawmakers in Washington are also thinking about accelerating challenge trials. A bipartisan group of members from the House of Representatives sent a letter to the FDA and the Department of Health and Human Services last week backing challenge trials as a strategy to speed up a vaccine. “It is urgent that authorities like FDA and WHO give challenge studies immediate consideration, as they could speed up the use of vaccines even before formal licensure that would depend on additional data,” Stanley Plotkin, a leading vaccine researcher at the University of Pennsylvania, told Science.
What about infecting people outside of vaccine trials?
Purposefully infecting volunteers for vaccine development is a long process that would happen under highly controlled settings. But some people have argued for mass infection outside of vaccine trials.
In March, the conservative outlet The Federalist posted an essay by dermatologist Douglas Perednia in which he argued for a strategy of “Controlled Voluntary Infection.” In this hypothetical scenario, Perednia proposes that young people would be “exposed to the mildest form of Covid-19 virus available” and then quarantine together at a predesignated facility. (“Given the recent example of spring break 2020 for college students in Florida, one could imagine CVI even becoming a social activity,” Perednia writes.)
There was immediate backlash to the post – Twitter suspended The Federalist’s account in response. Scientists and medical experts were quick to decry Perednia’s ideas, pointing out his lack of expertise, and urged people to keep up social distancing.
Perednia’s idea doesn’t just exist in an online conservative vacuum. Police in Kentucky arrested several partygoers for violating social distancing orders in late March, and the governor speculated that the gathering was intended to intentionally spread coronavirus. Former presidential candidate Andrew Yang tweeted in early April about the idea that “soldiers and vets” should be deliberately infected to help study immunity and “provide an immune workforce.” The Justice Department in March sent a memo to district attorneys and law enforcement agencies across the country allowing them to prosecute those attempting to expose people – or threatening to expose people – to coronavirus.
Some governments have even floated letting infection spread as official policy. In early March, UK Prime Minister Boris Johnson announced that the country would try a strategy that avoided shutdowns and excessive social distancing policies. “The government believed this would result in a ‘herd immunity’ that would subsequently protect vulnerable groups from infection, while avoiding ‘behavioral fatigue’ that would cause people to stop cooperating with safety measures over time,” MIT Technology Review reported. Public health experts pushed back strongly against the strategy, warning that it would “likely result in hundreds of thousands of deaths,” and the government hastily reversed course days later.
Sweden says its strategy of voluntary social distancing, including keeping borders and some schools and businesses open, means that some portions of the population are now reaching “herd immunity,” the country’s chief epidemiologist said this week. But nearly two dozen scientists “wrote in the Swedish newspaper Dagens Nyheter that the public-health authorities had failed, and urged politicians to step in with stricter measures,” Science reported this week. “They point to the high number of coronavirus deaths in elder-care homes and Sweden’s overall fatality rate, which is higher than that of its Nordic neighbours — 131 per million people, compared with 55 per million in Denmark and 14 per million in Finland, which have adopted lockdowns.”
Even experts who urge social distancing policy say intentional infection could be in the future. “My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” Dr. Michele Barry, who directs the Center for Innovation in Global Health at Stanford University, told New York Times reporter Donald McNeil in his recent piece on the future of the pandemic in America.
Not every scientist thinks this is loopy.
“I think that we do need to be open-minded about all potential ideas if we don’t see a great effect from social distancing,” Dr. Daniel J. Morgan, a professor of epidemiology and public health at the University of Maryland School of Medicine, told the New York Times in response to Perednia’s post in the Federalist. “What do we do during the next phase of this?”
