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When payment is offered for controlled human infection model (CHIM) research, ethical concerns may be heightened due to unfamiliarity with this study design as well as perceptions—and misperceptions—regarding risk. Against this backdrop, we commend Grimwade et al 1 for their careful handling of the relevant issues, coupling empirical and conceptual approaches. We agree with foundational elements of the authors’ analysis, including the acceptability of payment for research risk.1 However, in our view, it is preferable to treat payment for risk as a discretionary incentive to achieve adequate recruitment and retention, rather than compensation owed as a matter of fairness.
Where we agree
Grimwade et al 1 note that although their ‘Payment for Risk Model’ was ‘created specifically in the context of CHIM research, it has the potential to inform payment in other areas of medical research.’ We agree and would go further: we do not need a special payment framework for CHIMs because there is nothing so novel about them compared with other types of research as to demand a distinct approach. Any successful payment framework must address the following ethical issues: preserving informed consent (avoiding coercion and undue inducement); treating participants fairly (avoiding exploitation); encouraging adequate recruitment and retention; avoiding deception by participants; and preserving public trust.2 Some of these issues may have particular salience in the context of CHIMs, but this study design does not demand consideration of entirely distinct ethical factors when evaluating offers of payment.2
We also agree with Grimwade et al 1 about several other key points.2 Given the burdens involved and …
Contributors HFL wrote the first draft. Both authors contributed to conceptual analysis, substantive editing, and final approval of the manuscript.
Funding This authors receive funding from the Greenwall Foundation as Faculty Scholars (no award number).
Competing interests Both authors received an honorarium from 1Day Sooner for producing an independent report on the ethics of payment for participation in human infection challenge studies: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3674548.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.