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Controlled human infection with SARS-CoV-2 to study COVID-19 vaccines and treatments: bioethics in Utopia
  1. Søren Holm1,2
  1. 1 CSEP, Department of Law, School of Social Sciences, The University of Manchester, Manchester, UK
  2. 2 Center for Medical Ethics, HELSAM, Universitetet i Oslo, Oslo, Norway
  1. Correspondence to Professor Søren Holm, CSEP, Department of Law, School of Social Sciences, The University of Manchester, Manchester M13 9PL, UK; soren.holm{at}


A number of papers have appeared recently arguing for the conclusion that it is ethically acceptable to infect healthy volunteers with severe acute respiratory syndrome coronavirus 2 as part of research projects aimed at developing COVID-19 vaccines or treatments. This position has also been endorsed in a statement by a working group for the WHO. The papers generally argue that controlled human infection (CHI) is ethically acceptable if (1) the risks to participants are low and therefore acceptable, (2) the scientific quality of the research is high, (3) the research has high social value, (4) participants give full informed consent, and (5) there is fair selection of participants. All five conditions are necessary premises in the overall argument that such research is ethically acceptable. The arguments concerning risk and informed consent have already been critically discussed in the literature. This paper therefore looks specifically at the arguments relating to condition 3 ‘high social value’ and condition 5 ‘fair selection of participants’ and shows that whereas they may be valid, they are not sound. It is highly unlikely that the conditions that are necessary for ethical CHI trials to take place will be fulfilled. Most, if not all, CHI trials will thus be well intentioned but unethical.

  • research ethics
  • research on special populations

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  • Contributors SH is the sole author of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.