Not forcefully. He said paid volunteers. Why does the idea of challenge trials cause a furious reaction? Let's compare it to the space shuttle: 135 missions with 2 missions in which everyone died. That's a case fatality rate of 1.5% -- in the neighborhood of the Covid CFR. And I'd expect a challenge trial on young healthy volunteers to have a much lower CFR. Why is risking people for the shuttle OK, but risking people for a vaccine that benefits all of humanity not OK?

There's two big issues with this approach:

1) death is but only the worst outcome. Being on the space shuttle does bring risk, yes, but not a 50/50 chance of a significant impact to your general health.

2) you'll end up testing the vaccines largely on marginalized population and people with heavy financial problems, misrepresenting the population at large and showing biased result.

For this age range, the survival rate for everyone is 99.98%. It'd be even higher if your screened aggressively for comorbidities / general health and provided everyone with top notch healthcare knowing in advance they have been exposed.

I would sign up for this in a heartbeat. Not only for the cash payment -- but you'd be a local hero and you could feel good for the rest of your life about taking a small risk to save the lives of many ill or elderly people.

So 2 person out of 10 000 dies. You would be a local hero and you would probably feel good for the rest of your life which is 2 weeks time. Also, let’s talk about long COVID. Nobody knows how long is it stay with you or if you even recover from it. You are a hero but you cannot climb the stairs anymore. And you will be forgotten in months.

Except the point is people were willing to sign up knowing that is exactly the risk they're undertaking.

The alternative that we chose was hundreds of thousands of more deaths and millions of more cases. From people who didn't sign up for it.

Would it be immoral if they were offered a million dollars?Honest question, because it feels like the philosophy might not match up with common experience. It feels like an interesting question. People voluntarily risk worse for less pay in other fields, e.g. the military.

And if it wasn't immoral, what is the dollar limit?

Money is worth different amounts to different people.

Bill Gates or Jeff Bezos will never risk their life for "only" a million bucks. Find a depressed + suicidal dude somewhere else, and they may be personally willing to risk their life for just $100.

Making an industry of people who are willing to harm themselves for money is... probably not the business we should be encouraging. And that's assuming everyone is "playing nice". At a minimum, it means that we'll be inclined to start experimenting upon the poor and depressed (and then shedding away moral qualms because they signed a piece of paper).

Historically speaking in the USA, we have legacies like the Tuskegee Syphilis Study, where African Americans were chosen as the control group and lied to about getting a Syphilis treatment: leading to a generation+ long distrust in science.

Yeah yeah, we can't "assume" scientists will be racist jackasses today. But... we still have to account for what happened in our history and why certain testing methodologies have become taboo.

Good points. It's obvious that the potential for ethical problems in such a situation is huge.

I've thought for similar questions that a required baseline would be to at least have a society that provides a viable minimum social safety net, as well as free healthcare. When external conditions compel people to risk their health for survival, it is impossible to ensure sound ethics.

The point about ensuring that science and scientists can be trusted in the future is also an excellent point.

Why wouldn't they be willing volunteers?

It would be quite possible for it to clearly be informed consent also, at least to the extent the disease was characterized at that point in time.

The reason people keep bringing it up is that the consequences of the pandemic have been much worse than the consequences of allowing a few thousand people to intentionally expose themselves to an infection in a controlled setting¹. It's not guaranteed that challenge trials would have mitigated the pandemic, but it's weird to just outright circumscribe the possibility when the ongoing downside is huge.

1. I use the odd phrasing here because lots of people pretty much choose to expose themselves to the infection anyway; maybe not explicitly, but close enough.

[1 Day Sooner](https://www.1daysooner.org/) is an organisation pushing for these trials, that's found 38,000 informed volunteers who would be willing to do these trials. Force is completely unnecessary, there are enough altruistic people who are willing to do trials like this

Remember that in, say, a cancer treatment trial, patients are signing up to potentially not receive the treatment depending on the run-in and randomization phases. I'm not suggesting these patients are forced into that decision; rather, I'm just pointing that controlled, randomized trials have some ethical fuzziness around them.

But they already have cancer, and the treatment may (or may not) help them.

What's being proposed here is for people to sign up and then inject a potentially deadly disease into them.

But until treatments/vaccines were developed, everyone on Earth had the disease-equivalent, sometimes-fatal status of "no prior immunity to COVID".

Sure, the scale is massively different for a young healthy person: "susceptible to COVID" would mean a moderate chance of catching the disease (growing over time), and then a small chance of death or previous complications. But the "susceptibility" is also a "health condition" with nonzero risk-of-death.

And for society as a whole, COVID passed cancer as a cause of death last year, and in January 2021 has been killing about twice as many people as all cancers combined.

So "diagnosed-with-cancer" versus "susceptible-to-COVID" shouldn't be that different in terms of the kinds of risks we'd let informed people take to address that danger.