Should we give people diseases in order to learn how to cure them?

| Science and nature books | The Guardian 01/11/2022 08:36

The big idea

Science and nature books
Should we give people diseases in
order to learn how to cure them?
With the right ethical safeguards, could ‘challenge trials’ defend
against future pandemics?

Saloni Dattani
Mon 31 Oct 2022 12.30 GMT

Illustration by Elia Barbieri.

I
n the 1770s an English doctor called Edward Jenner noticed that
milkmaids didn’t seem to catch smallpox, the terrifying disease that
caused around a third of the people who caught it to die. He thought
that their frequent exposure to cowpox, a similar but less severe virus,
might be what protected them. In order to test his hypothesis he gave his
gardener’s eight-year-old son cowpox and then deliberately infected him
with smallpox to see if he had become immune. He had, and Jenner
successfully repeated the experiment. “Vaccination”, from the Latin word for
cow, soon became commonplace.

It was of course highly irresponsible to expose a child to a deadly disease

with no sure knowledge that he would survive. Even so, with hindsight, we
can see that the benefits were immense: the vaccine was safe and highly
effective. Demonstrating that fact and publicising it encouraged untold
numbers of others to follow suit.

This is an example – albeit an unusual one – of a “challenge trial”. That is a

form of research where, rather than relying on data from natural infections,
we deliberately expose someone to a disease in order to test the effectiveness
of a vaccine or treatment. Things have changed a lot since Jenner’s time, of
course, when it was not uncommon for doctors to deliberately infect people
with pathogens to try to learn which diseases they caused. Even so, there’s
Most viewed
the lingering sense that there’s something unethical about making someone
Oligarch renounces Rus
ill on purpose. That’s not surprising – even in relatively recent history, deeply
citizenship over Ukraine
sinister medical experiments have been carried out that bear a superficial war
resemblance to this kind of work. During the second world war, for example,
imperial Japan set up a network of secret facilities to experiment on A visual guide to how th
prisoners: while some were injected with plague and tetanus toxin, others Seoul Halloween crowd
had their limbs amputated – both as a form of torture and a way to train army crush unfolded
surgeons for the battlefield. The grotesque crimes committed by the Nazis
under the guise of scientific research are well known. Taylor Swift becomes fir
musician to claim entire
But this poisonous history shouldn’t blind us to the extraordinary power of Top 10 on Billboard Hot
challenge trials under strict conditions based on informed consent and
designed to be as safe as possible. They could become increasingly important
weapons in the armoury of medical research, in an era when vaccine

Crowd crushes: how

https://www.theguardian.com/books/2022/oct/31/should-we-give-people-diseases-to-develop-cures Page 1 of 3
Should we give people diseases in order to learn how to cure them? | Science and nature books | The Guardian 01/11/2022 08:36

technology is advancing and the threat of diseases jumping from animals Crowd crushes: how
disasters like Itaewon
into human beings is increasing.
happen, how can they be
prevented, and the
Much has been done to mitigate the risks: challenge trials designed to ‘stampede’ myth
advance malaria research have proved to be very safe, because the disease is
now well understood and can be treated easily under close supervision. For Russia recruiting Afghan
special forces who fough
tuberculosis, trials have used the mild BCG vaccine as the challenge, instead
with US to fight in Ukrai
of the actual bacteria. For respiratory syncytial virus (RSV), researchers have
recruited adults who are at a low risk of severe illness. These experiments
have already whittled down a massive range of vaccine candidates and
helped refine their ingredients. With their help, the world will soon have two
effective vaccines against malaria, which kills hundreds of thousands of
people every year, as well as the first vaccines against RSV, which kills tens of
thousands of infants each year.

But not all diseases are like these ones. We don’t always know the dangers
volunteers might face; we don’t always have treatments ready. What then?
How does someone consent to risks that remain hard to quantify? How
should they be compensated for taking those risks?

WE COULD, of course, just avoid these questions entirely, and rely on other
types of research. But that doesn’t always work: sometimes, animal testing is
tricky and uninformative, because the disease doesn’t develop in the same
way as it would in humans. For human trials, such as those looking at the
effectiveness of a vaccine against Zika, it can take tens of thousands of
people and several years to run a single study, because only a fraction of the
participants in the placebo group will ever develop the disease, making it
hard to see how much difference the drug or vaccine would make.

In contrast, challenge trials can be deeply informative within weeks, with far
fewer volunteers. And the stakes can be staggeringly high. It’s easy for us to
grasp the risks that volunteers might face after being injected with a
pathogen, but harder to keep in mind how many people suffer from diseases
every day, and how many lives would be saved if a treatment or vaccine were
developed and rolled out sooner. Take the Covid‑19 pandemic. At the end of
last year, as the death toll is estimated to have reached about 17.8 million, it’s
also estimated that 20 million had been saved by vaccines. In the years to
come, they will hopefully save millions more. The burden of suffering
relieved by vaccines is immense – and the faster they arrive, the better.

Researchers around the world were able to rapidly develop Covid vaccines
through a combination of luck and initiative: similar vaccines were already in
development; the disease was so widespread that it was easy to recruit
people into studies; and research was massively well-funded and given high
priority because it was a global emergency. If that hadn’t been the case, we
would have been in dire straits – much like doctors hundreds of years ago,
we’d have been faced with a looming threat we didn’t understand and could
not beat.

In order to make sure we are as protected as possible from current and future
threats, we should try to eliminate the stigma that still haunts challenge
trials, making them a more familiar part of our toolkit. What if we thought of
the act of volunteering to be infected not as a rather peculiar and reckless
thing to do? What if we thought of volunteers more like first responders who
rush to help during a disaster? What if we recognised the sacrifices they
made on our behalf by holding them in especially high regard, like
firefighters or paramedics, rewarding them not just with money, but with
recognition, long-term support and respect?

Perhaps the greatest reward of all would be to make sure their efforts were
worthwhile: by designing trials to be open and transparent, applying them

https://www.theguardian.com/books/2022/oct/31/should-we-give-people-diseases-to-develop-cures Page 2 of 3
Should we give people diseases in order to learn how to cure them? | Science and nature books | The Guardian 01/11/2022 08:36

when and where they might make a real difference, and developing the tools
to learn as much from them as possible. In short, by helping them to save
thousands, if not millions of lives.

Saloni Dattani is a researcher at King’s College London and a founding editor of

Works in Progress.

Sign up to Inside Saturday Free weekly newsletter

The only way to get a look behind the scenes of our brand new magazine,
Saturday. Sign up to get the inside story from our top writers as well as all
the must-read articles and columns, delivered to your inbox every
weekend.
Enter your email address
Sign up

Privacy Notice: Newsletters may contain info about charities, online ads, and content funded by outside
parties. For more information see our Privacy Policy. We use Google reCaptcha to protect our website and the
Google Privacy Policy and Terms of Service apply.

Further reading
War Against Smallpox: Edward Jenner and the Global Spread of Vaccination
by Michael Bennett (Cambridge, £29.99)

Vaxxers: A Pioneering Moment in Scientific History by Sarah Gilbert and

Catherine Green (Hodder & Stoughton, £20)

The Mosquito: A Human History of Our Deadliest Predator by Timothy

Winegard (Text, £12.99)

The big idea

The big idea: is The Big Idea: Do The big idea: why the The big idea: do we
cooperation always a governments really maternal instinct is a experience the wor
force for good? control their myth in the same way?
economies?
24 Oct 2022 91 17 Oct 2022 352 10 Oct 2022 3 Oct 2022

More from Culture

The Crown < ‘Really given me The Last Heist review ‘Having limits is
‘Tampongate’ was just sleepless nights’ < < GrimNfaced Brit boring’ <
‘two middleNaged Readers on their gangster thriller is survivor Damo Suz
lovers being sweet’, scariest movie endings Reservoir Bodge on Can, cancer and
says Dominic West krautrock
2h ago 30m ago 2 37m ago 20h ago

Most viewed

https://www.theguardian.com/books/2022/oct/31/should-we-give-people-diseases-to-develop-cures Page 3 of 3