We are Abie Rohrig, Gavriel Kleinwaks, and Wilson Wilson, and we are volunteers to be deliberately exposed to COVID-19 if it can speed up vaccine development.

I think it's amazing what you're doing, but my only real question is: Your name is really Wilson Wilson? Best of luck, I hope it works well and your recovery goes as planned. Very brave.

Hey doomedroadtrips, thanks for the kind words!

As for your question: yes.

-Wilson

Did you sign that with your first name or last name?

Yes. -Wilson

This is for Abie. I saw you on Good Morning America about your kidney donation and I applaud you for your compassion and altruism. Now this time, you'll sacrifice your health once again for the whole world this time! What drives you to do the most good for the world? What is your motivation?

Thanks for the question!

Kidney donation and challenge trial volunteering are emotionally jarring ways of trying to help the world, but the actual risk involved is rather low! Neither is riskier than a bike trip from NYC to LA. (Check the micromorts here.) Nurses and doctors were up to 12x more likely to get COVID-19 by showing up to work when hospitals were overcrowded and under-resourced. That's a serious risk, and the fact that no medical ethics board made nurses and doctors stay home is the same reason I think they should not only allow thoughtfully-designed challenge trials, but pursue them with Manhattan Project-like urgency.

With regards to my motivations, I'm not sure! I'm quite influenced by the philosophers St. Augustine and Ludwig Wittgenstein. In my mind, they have some sublime things to say about our ability to communicate with, love, and see one another. I sort of also just want everyone to get along and have fun, and dialysis + COVID-19 are salient hurdles.

-- Abie

Wow all my respect to what you guys are doing! This might be a silly question but I’m wondering what’s the level of risk in trials like this? In worse cases, is it just that the vaccine won’t have any effect or could there be potential side effects we already know of?

Again, so much appreciation to what you guys are doing.

Good question, not at all silly! That was essentially my first question when I signed up.

The biggest individual risk in the trial is basically that you get an ineffectual or a placebo vaccine. Vaccines have already been administered to people in earlier safety trials, so the risk for side effects is low--we'd know already if there were side effects from the vaccines themselves. With vaccines in general, the main possible side effect is basically just that you get the symptoms of the disease you're supposed to be inoculating against. -Gavriel

Hey lemonlemonlemonade! I think that's a great question! Since challenge trials involve being exposed to the virus as well as the vaccine, both are potential risk factors.

According to a study published in Lancet Scientific, COVID-19 has an average short-term fatality rate of 3/10,000 among Americans 20-29 years of age. That's something to take seriously, for sure, but its comparable to other activities such as kidney donations or pregnancy. Additionally, we will be under continuous medical supervision in a medical facility by leading researchers during the trial, which lowers risk. Personally, I don't have any known underlying conditions, and am at the bottom of that study's age bracket, so my risk is likely lower. My biggest worry about getting COVID as a young healthy person would be that it may have some serious long-term effect we don't know about, much like we later found was the case with SARS or MERS.

As far as the dangers from the vaccine go, that's less quantifiable, and it will depend on what the vaccine candidate is. By the time that a human challenge trial volunteer would be exposed to the vaccine, it will have already been tested on smaller numbers of humans, so there's that. These dangers will also exist for non-challenge trial volunteers. --Wilson

Do you guys get informed on how well you are and how the virus has progressed through your bodies? And how's the progress for you right now?

Hey uncoded_decimal! Great question. I don't know what the answer is--we'll get back to you!

To clear up one thing: none of us are currently in a challenge trial, as there are none taking place yet! We believe preparations for challenge trials need to start as quickly as possible. Then, if challenge trials will be useful (as we believe they will be), challenge trials can start immediately. --Wilson

Wilson Wilson?Where have I heard that name before?Was it from Utopia?

Yep, Wilson Wilson is a character in Utopia. This Wilson doesn't look remotely the same, or have a British accent. -Gavriel

If it helps at all, here's the chart I usually look at when I need to remember which one I am. -Wilson

Are you getting paid?

TLDR: No. E

There will not be firm details until a vaccine manufacturer steps forward with specifics, but my understanding is that pay is unlikely. I believe most medical ethicists agree that volunteers should not incur any expenses related to the trial, including travel, food, medical care, etc.. If that is the case, I suppose I will be saving on my grocery bill! EDIT: Just to be clear, I mean that I don't expect vaccine manufacturers to pay volunteers. 1Day Sooner is a nonprofit, and has a few salaried positions to allow our staff to advocate for human challenge trial volunteers full-time, including Abie as Communications Director. Gavriel and I are solely volunteers.

EDIT: After talking about this more with Josh Morrison, it seems to be very possible that volunteers will receive some amount of payment. -Wilson

I'm no medical ethicist, but I'd argue that paying people to participate in such studies also poses an ethical dilemma, as it will most certainly attract lower income participants who need the money.

I think that’s a really interesting point! I can see what you are saying—any talk of paying volunteers needs to weigh concerns that it would coerce people to take risks they might not otherwise take. But it also bothers me that this logic doesn’t seem to be applied to other places in society: we do and should pay lumberjacks, (non-draft) soldiers, and firefighters, many of whom may be putting themselves at greater danger. Practicing medicine also poses huge risk to those who do it during the pandemic—does that mean we should stop compensating them? I think clearly not.

I’m not volunteering for the money—I’m not getting paid and don’t expect that I ever will. But if I am able to participate in a trial, it will be a valuable service rendered to the vaccine manufacturers and society at large, at significant personal expense (in terms of risk, time, and opportunity cost). I feel volunteers should be compensated for that.

I think a kind of similar topic to this that I’d be interested to hear people talk about (I’m sure Abie’s perspective would be cool to hear!) is the idea of paying non-directed living kidney donors. There’s a huge amount of people who need kidney donations, and a new kidney could make huge life expectancy and quality of life improvements. Then, on the other hand, many young healthy people have an extra kidney they could donate at what is likely a relatively low risk. The private and public cost of treating kidney disease without donations is enormous—so much so, that you could feasibly have some kind of legislation where (informed, healthy, consenting) kidney donors are payed like $50,000. This could potentially find an equilibrium in the high supply and high demand of kidneys, where people who need a kidney can get better and people who have a kidney they are willing to donate can get compensation. It could be a lifesaving technocratic solution—depending on how we think of that same dilemma of if compensating kidney donors creates economic coercion.

On a personal level, while I have more thinking to do for sure, I feel pretty confident that I want to try to donate a kidney. I think I want to donate in next three years or so—but one thing that makes me consider waiting is if the long-shot idea of paying kidney donors might come to fruition in the next few decades. If I knew for sure the payment legislation will never come, I would very likely be willing to do the donation on account of the humanitarian risk vs. reward. However, compensation for something like that could really change my finances, so if it might be on the horizon maybe it’s better to wait until it comes. - Wilson

On another level, one of the concerns I have about paid vaccine trials in comparison to the other Professions you mentioned is the skill ceiling associated with it. While there are certainly risks and costs associated with what you do, trial volunteers by the nature of the job are passive participants in the research.

The other jobs therefore are unlikely to attract desperate individuals unless they believe they can at least fake competence. Likely, such individuals would be caught quickly. On the other hand, here the concern would be with regards to hiding aspects of their health that might get them disqualified, such as smoking, drinking or drug use in an attempt to gain legitimate income. While a few such individuals are not the end of the world, enough of them could taint the study and if undetected can lead to pernicious results on vaccine development.

That said, I completely understand the logic in rewarding such services to society, if only in the interest of fairness. This is a more complex question than can be solved on a Reddit thread, but interesting to think about nonetheless

Thanks for the response!

While a few such individuals are not the end of the world, enough of them could taint the study and if undetected can lead to pernicious results on vaccine development.

Would you be willing to explain what you mean by that? -Wilson

How do I sign up to be a vaccine volunteer?

Head to 1daysooner.org and click on the big "Volunteer" button on the main page! -Gavriel Edit: the direct link is https://1daysooner.org/volunteer

Hey JazinAdams! Great question! Although there are not currently any challenge trials taking place (where volunteers are intentionally exposed to the virus itself to test a vaccine candidate), signing up at the link above puts you in touch with vaccine manufacturers when a challenge trial becomes available. On our website, you can also find other ways to advocate for challenge volunteers and the preparation of trials--we need more help in volunteer organizing, communications (like this!), research, and governmental advocacy.

There are also multiple current non-challenge vaccine trials going on--I'm not aware of any central sign-up for volunteers for that, however. To participate, you would likely need to chance upon somehow seeing some type of communication seeking volunteers when the organization is looking. -Wilson

Do you like purple or blue?

I like a vivid purple best! -Wilson

Blue is my signature color. :) -Gavriel

How do studies like these (https://www.cidrap.umn.edu/news-perspective/2020/06/chinese-study-antibodies-covid-19-patients-fade-quickly) regarding the rate at which antibodies fade in COVID-19 patients affect your mentality during the study?

The antibody research hasn't really affected my own mentality--it is always worth remembering how incredibly dangerous this virus is, but that makes vaccine development and accessibility all the more important. Also, there are different components of our bodies' immune reactions with other mechanisms of "remembering" the virus. Plus, it seems like even a low level of antibodies is useful. NYT article with more explanatory links: https://www.nytimes.com/2020/06/18/health/coronavirus-antibodies.html

-Gavriel

Do you think it will be boring having to be in a medical facility to 4-8 weeks during the trial?

Hello nomminnate! Interesting question.

I don't think it will be very boring; but we will see! I think the knowledge that we are participating in something that could potentially help resolve a global crisis will make it really memorable. Also, confinement to a small space won't be dramatically different from isolating in my dorm room. I'm not sure how much time every day will be spent doing medical tests or something--if its multiple hours a day, that could get dull after the novelty wears off. I do hope I'm able to keep doing my studies though to keep myself occupied--many of my classes involve playing violin, and I'm worried that might not work very well. --Wilson

Like Wilson, I certainly hope that a sense of purpose would make it more bearable. However, I think it will be difficult for me. I live in a house with a yard right now and have the chance to go outdoors often. (Still physically distancing myself from others, of course! Lots of spacious public land in my area.) What would really help me in the event that I'm confined to a medical facility for a long time is being able to video-chat often with friends and family. -Gavriel

I am also signed up as a volunteer with 1 day sooner and I feel like I have no idea what to picture the experience being like. I definitely agree it would be memorable. My best guess is that it's like being an in patient at a hospital, which was kind of boring in my prior experience.

That's awesome to hear that you want to be a challenge volunteer! I think a hospital is a good comparison. A trial volunteer will be in a much more controlled environment than most hospital patients. -Wilson

The facility will probably be more like a dorm setting than a hospital facility! For reference, check out this ominously-named article, "Welcome to Hotel Influenza," that profiles a challenge trial facility where volunteers were deliberately exposed to influenza: https://www.slu.edu/news/2018/june/hotel-influenza.php - Abie

Hey guys, I think this is a great and noble thing to do. I would have done it myself if it was an option, though I'm convinced I've already had Covid. In any case, my question is:

Do you think there is any realistic probability of something like this happening? If so, who would run it?

It seems to me like, despite the fact that Covid doesn't seem to be as severe as was once feared, it's still feared enough that the ethical considerations and red tape in the way of something like this happening is too much to bring it to fruition.

One other thing I see you mention in the comments is that you wouldn't expect to get paid for such a trial. This seems very odd to me. My sister got paid a considerable amount in the UK for trialing a nicotine patch. A vaccine challenge trial obviously carries much more risk, so why not get paid?

As I'm writing this more things are coming into my head so I'm going to write one more thing. Be wary of volunteering in any study where long term follow-ups are not included. I mentioned earlier I think I've already had it. Back when all this was kicking off in the UK (early March) I had a nasty dry cough and a bit of a fever. The cough took weeks to subside and I thought that was the end of it. But ever since I've had the feeling that it might have had a long term impact on my lungs. I'm a fit 25 year old (cycle 6+ times per week for at least an hour, do squash and taekwondo) and had no problems before, but now when I cycle and sometimes at rest I feel a shortness of breath that I don't recall feeling before. It's quite possibly in my head and a result of reading so many articles about long term effects, but I do wonder. I'm going to mention it to my doc when things begin opening up a bit more, thankfully I can here without worrying about money/insurance. If I were to do this in the US and didn't have insurance then long term care would be a must.

Anyway, sorry for the long message! Good luck and thanks for sharing here!

Hey cobmaster! Thanks for your questions. I agree with what u/nomminnate has already said, and I'd like to add on.

I do believe challenge trials are likely to happen, and we've seen positive movement recently. In addition to challenge doses being prepared as u/nomminnate said, we've also seen the WHO come out with a report from a panel of experts on COVID-19 challenge trials. Nearly all of the experts recommended preparations begin now, and most believed trials should go forward even if there is no rescue therapy. We've also seen Belgium [invest $22 million in building facilities for challenge trials](https://www.bioworld.com/articles/435677-european-commission-working-on-procurement-plan-as-covid-19-vaccine-race-accelerates).

I'm sorry to hear that your lungs don't seem to be doing as well. I think your point on the importance of long-term follow-ups is a great one! That's part of the reason why I think its important to have an organization like 1Day Sooner explicitly for advocating on behalf of volunteers, so that volunteers interests are part of the conversation throughout the process. -Wilson

is the last person's name actually wilson wilson?

It sure is! -Wilson

Oh! cool! Never met someone with the same last name and first name.

There are a whole bunch!

In fact, Wilson Wilson is also the name of Wilson from Home Improvement.

If its helpful, u/thelegend90210, here's a good reference guide for telling us apart. -Wilson

As relatively young adults, your risks are relatively low; however, if you do get infected through a challenge, you run the risk of exposing others (even if isolated in a positive-pressure ward, health care workers will still be around you). How do you weigh the ethical concerns of a challenge in light of the potential exposure to workers that do not have a choice about participating in your care?

That's a great point. I view it as everyone taking on what they believe is an acceptable level of risk in order to develop a vaccine sooner. I'm volunteering to take on the risk of being a vaccine tester because I think it's worth it, but that's impossible without the rest of the health care system set up to handle a challenge trial. Part of that system is the health care workers, who are going to take on the risk of caring for/examining volunteers. I believe that health care workers DO make a choice, just much earlier than we did: they choose to enter a profession where they know there's a risk of them being exposed to infected patients. In that sense, they have much more of an active choice than most people. We all might be exposed to infected strangers on a regular basis, or we might be infected ourselves, not know it, and infect others at the grocery store. So in my view, that ethical concern is greater, and needs to be addressed as quickly as possible with a vaccine. Something that's come up in 1Day Sooner meetings is that it's the right of volunteers to choose to take on this risk. Similarly, it's the right of health care workers to choose that profession in the first place, and to choose to stay in the profession during a pandemic. Like us, health care workers are probably often motivated to take on those risks out of a sense that it will make the world a better place. Health care has always been a heroic path, but I think that's even clearer right now. -Gavriel

Hey SeahawksBandwagoner! In addition to Gavriel's great response, I'd like to say this: A COVID challenge trial would likely take place under a rigorous safety procedure called Biosafety Level 3, and in a facility designed for that level of security. Personal Protective Equipment, and likely a respirator, would be required, and there are self-closing and locking doors as well as hands-free sinks and eyewashes. I believe these are safer than many of the circumstances in which medical staff are currently treating COVID patients, but there would still be risk. In this pandemic, I've admired many healthcare professionals' bravery to continue to work at great personal sacrifice, and I think that it speaks highly of the profession that many would be willing to work in a challenge trial if it meant saving many lives through an earlier vaccine. -Wilson

Hello! First of all, I appreciate everything you're doing. I would just like to know: is there a compensation for taking part in the research? Do you they just pay you, or do they have other benefits?

Hey Rachel! Thanks for the kind words! That's a good question. It will depend on what the specific vaccine manufacture decides, but I think the answer is there will likely not be any payment, althoug volunteers will likely have most expenses covered: travel, food, medical costs, long-term medical compensation if necessary, etc..

EDIT: As I've learned more about this, it looks like some form of payment to compensate the time/service that volunteers are learning is more likely to happen than I thought. -Wilson

How do you personally feel at the moment? And how do your family and friends feel about your decision?

Much respect for what you're doing! Thanks!

Hi!

I'm somewhat anxious for my safety about the possible long-term damage this virus can cause, even for those who survive it, but I know that whatever I'm feeling about it applies to everyone else as well and the impact my volunteering might have is more important than my fear. I'm also really touched and impressed by the number of people who have signed up--we're past 30k by now! I think that says something really beautiful about people wanting to do whatever they can to solve this. My friends and family have been extremely supportive and proud of me (although my parents added that they're worried for me, of course!). Their love and kind words are really sustaining me right now. -Gavriel

Hey thecaptaintrout! I feel weary, and hopeful, I think. Although I definitely have many things going easier for me in this crisis, its hard to see so much suffering and apathy right now, at the same time as day-to-day life is more stressful. I'm also increasingly hopeful that challenge trials will happen, and that on a personal level I will leave the pandemic a stronger person than I entered it.

The friends and family I've talked to so far have been supportive. Some of them are surprised that I would be willing to potentially postpone my education for a semester, as school is a big part of my life--but when I point out that crises of similar scope have called for people to delay their life plans, my family seems to understand. -Wilson

One thing I'd add is that I think there's a decent chance (that is difficult to quantify) of getting COVID-19 over the coming months anyway, so the marginal risk of being exposed to COVID-19 in a lab setting with excellent healthcare does not stress me out immensely! - Abie

What if adverse effects only show up 5 years down the road?

Adverse effects from the vaccine or the virus? Side effects of vaccines usually show up within a couple of weeks and are related to the disease itself--the amount of virus in the vaccine was too high or the virus wasn't completely dead or something like that. It's definitely possible that there are side effects of the disease itself that are only going to show up on a longer timeline. However, that only makes it more important to develop a vaccine. I don't believe that any of us are guaranteed to avoid the virus permanently. I am scared of the virus, but all my reasons for signing up remain the same or even more important if there are more adverse effects we don't know about yet. -Gavriel

Hello GliTHC! That's a great question--its probably my biggest personal concern as a young healthy volunteer. I think its a real possibility. Because the COVID-19 is so new, there are many unknown about if/what the long-term effects could look like, and what the risk is. Unknown long-term effects are scary, but it also highlights the urgency of creating a vaccine--if more people are in danger of health issues than we thought, than the potential upside of challenge trials also raises. -Wilson

Isn't that crazy dangerous? I've been hearing about the side-effects of Covid-19. They're pretty bad. You could be facing a lifetime of diabetes.

Hey capilot! Thanks for your question. I think there is absolutely danger to volunteering in a challenge trial.

TLDR: It is dangerous, but I think the risks are outweighed by the rewards.

It’s possible we could die in the short-term from COVID, although it’s unlikely—perhaps as low as 1 in 10,000 for a healthy 20-year-old. It’s possible that we could sustain serious non-fatal illness in the short-term. However, one advantage to contracting COVID in a trial is that the medical staff will know and be able to help—most ethicists believe challenge trial volunteers should have priority access to ventilators and other resources. Volunteers in a control group would also, by definition, be given a leading vaccine candidate early—which could raise or lower risks, depending on the safety and effectiveness of the vaccine. There also may be a rescue therapy by the time a trial were to take place. I also share concerns about serious chronic illnesses from COVID-19, whether that be diabetes or something we do not know. There is reason to believe COVID-19 can cause diabetes, and we don’t know how prevalent that is. Are there dangers? Absolutely. But, as a young health person, getting a vaccine out earlier would be worth the risk in my opinion.

I also think that even if we assumed the dangers were much greater than they were, if the reward outweighs the risk volunteers should be able to do it.

At the age of 17, my great great grandfather, Frank Underhill, lied about his age to military recruiters to enter service with his brother in WWI. He drove a military ambulance. Now, I’ve never met him, but I think he was likely motivated by some sense of altruism. Although he survived, he ended up with chronic respiratory illness due to chemical weapons that likely ended his life early. I don’t know how informed he was of the risks, but he risked great personal danger for others, and I think our country is used to letting people take the kinds of risks that a soldier takes. (Due to misrepresenting his age, he also wasn’t able to start Social Security until 66, Ha!). Its hard to know for sure, but I feel the reward to personal risk ratio for me is much greater for a challenge trial than for WWI. —Wilson

I agree with everything in Wilson's stellar response and would only add that there's no guarantee of avoiding the virus permanently even if we don't sign up for a trial! If I locked myself in the house and only got groceries every other month, I could contract the virus that one time in the grocery store, or when my housemates went. As Wilson says, this way, we'll get a calculated viral dose and excellent medical care. And if I were living in isolation like that for a year, I know my mental health/quality of life would be really bad. If I feel that way, millions of people who don't live in such nice places as I do would be even worse off. Millions of people are out of work. Millions of people are suffering. I'm extremely worried about the state of the country and the world. This is something I can do to help alleviate the suffering. I'm willing to take on the risks as well. -Gavriel