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Column: Volunteers from the military could speed COVID-19 vaccine testing

For the Valley News
Published: 9/28/2020 10:10:05 PM
Modified: 9/28/2020 10:10:01 PM

In the United States, there have been more than 200,000 confirmed deaths caused by COVID-19. Worldwide, the number of deaths reported due to the disease is close to 1 million. The actual death toll is likely significantly higher due to under-reporting.

A safe and effective vaccine is the obvious answer to ending this pandemic. And the fact that an additional 750 Americans lose their lives to this disease every day lends urgency to the development of such a vaccine.

However, in spite of the continuing death toll, the pace of vaccine development is limited by the speed with which clinical data on efficacy and safety can be gathered. In turn, such speed is limited by the fact that all trials to date are being carried out with community-dwelling recipients, who receive either a trial vaccine or a placebo control. Trial results have to wait for a sufficient number of subjects to accidentally be exposed to coronavirus for a statistically valid difference in infection rates to emerge between vaccine recipients and controls. This yields a long delay before the efficacy question can be answered.

In the meantime, thousands of people continue to die for want of a vaccine.

One of the clear ways that the process might be accelerated is to conduct “challenge testing.” Challenge testing has the promise of eliminating the many uncertainties of standard testing and giving the vaccine developers the data they need in a much shorter time. Rather than wait for a sufficient number of vaccine or placebo recipients to be exposed in the community by chance, this approach entails deliberately exposing trial participants to the virus after a certain time has elapsed since vaccination. This approach would cut months off of the time required to determine efficacy of a candidate vaccine.

The ethical complaint of this approach lies in the possibility of causing harm to those individuals in the trial who contract the disease (whether placebo recipients, or those for whom the trial vaccine was not effective in preventing infection).

However, there is a segment of society for whom the deliberate assumption of personal risk, for the sake of saving lives, is part and parcel of their calling: the U.S. military.

When planning a military operation, a state assumes that it will lose some members as casualties, either killed or wounded. If a mission was brought to the state’s command that indicated the saving of over 1,000 innocent civilians, with the loss of four dead and 10 wounded , there would be no question as to whether the command would consider conducting the mission. It would.

If challenge testing was conducted on 1,000 military volunteers — based on the statistics that are widely available — it is likely that two or three would die and 10 to 20 might experience other significant injuries. Yet such a challenge test could easily bring a vaccine to the public as much as months earlier than the current Phase 3 tests underway. It doesn’t take a math wiz to understand that tens of thousands of lives might be saved by fielding a vaccine even 100 days earlier.

Ethically, many people would have concerns about intentionally infecting U.S. soldiers, knowing that some of them would likely die from the virus. There is, in fact, a large body of laws and regulations that deals with testing vaccines and medications on military members.

However, we live in unprecedented times, and arguably, a vaccine test program is not inherently any different from what is done in the military every day. Military members join up to take risks so that innocent American civilians will live.

If a call were made for volunteers to participate in a challenge trial within the ranks of the military, with the likely result that tens or hundreds of thousands of American lives could be saved, there is little doubt that a sufficient number of volunteers would emerge. Accepting personal risk for the greater good is in the nature of military service.

In this case, the mission’s risks and rewards could not be clearer. Every week of additional delay in fielding a vaccine equates to thousands of lost lives.

Our men and women in uniform, given an opportunity to shorten this pandemic, would likely ask, “What are we waiting for?”

Bruce Cox, of Yorktown, Va., is a retired Air Force B-52 pilot and officer with the Judge Advocate General’s Corps who deployed twice to Afghanistan and was involved in the 2011 Odyssey Dawn air campaign in Libya. He holds degrees in military history and British history and is a U.S. government attorney. John Wilson, of Hanover, is a retired engineer and physician.




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