COVID-19 vaccine trial testing on prisoner

Step 1
The case we have selected for analysis covers the ethical dilemma of whether vaccine makers in the USA should be able to conduct COVID-19 vaccine trial testing on prisoners. The article was done by ScienceInsider (Appendix 1); in this article, they speak with two people who have published about health and ethics in holding facilities during the pandemic. These two people are George Annas and Lauren Brinkley-Rubinstein. Mr. Annas is a lawyer and bioethicist at Boston University, whose research addresses ethics and human rights in clinical trials, while Ms. Brinkley-Rubinstein is a sociologist and epidemiologist at the University of North Carolina, Chapel Hill, who studies infectious disease management and substance abuse in incarcerated people. This was a well-thought-out idea by Science Insider to interview both individuals as Annas has recently written in the New England Journal on inhumane medical practices in immigrant detention centers. In contrast, Brinkley-Rubinstein has taken part in an article advocating for COVID vaccine trial testing on prisoners. So as a reader, you can get an informed look at both sides of the argument.
The article then goes on to ask the two experts on whether any of the 38 leading vaccine trial research teams have come forward and avidly advocated for prisoner testing. Although no specific company has been singled out as coming forward, there were some rumblings at the federal level in the United States of America on whether they should give the “okay” approval on the matter. For our research purposes, we have decided to use a vaccine research entity by the name of Altimmune as our decision-maker in this scenario and if they should consider campaigning for being able to do prisoner testing. Given that Altimmune plans to put their vaccine candidate into phase one trials very soon (Appendix 2), the option of prisoner testing is much more viable for them as they are ahead in the process of vaccine trials compared to other companies within the United States. This, in combination with the fact that they are one of the leading companies in North America when it comes to COVID-19 vaccine efforts, makes them a great hypothetical “decision-maker” in this scenario.
The article also mentions prior instances of prisoner trial testing in the past and how almost none of these cases included an instance where prisoner trial was voluntary or done ethically.  Although not mentioned by name in the article, a real example of unethical testing on prisoners took place in 1952 when Doctor Chester Southam obtained funding from the government and injected live cancer cells into 14 patients with advanced cancer and into 14 healthy convicts at the Ohio State Prison. The study in prisoners was designed to examine “the natural killing off process of the human body.” (Appendix 3). The problem with this testing was the prisoners were lied to; the healthy prisoners were told that the cancer cells could be injected out of them if cancer started to matriculate, which is entirely untrue and deemed to be extremely unethical across the board. Another famous experience mentioned in the article was John Charles Cutler’s 1940s experiments in Guatemalan prisons. In those experiments, prisoners were deliberately infected with gonorrhea, syphilis, and chancroid. The article also mentions the positives of being able to do tests on prisoners if it was done with the correct safeguards ethically in place. As more than 125,000 U.S. prisoners have been infected with the virus (and over 1,000 have died), and in combination with the fact that prisons are inherently built against the idea of social distancing. One could argue that prisons would be a great place to test the vaccines as the inmates are frequently at such high-risk levels of catching the virus, and this would put the immunity of your vaccine trial to the test, so to speak.

Step 2
The case of Coronavirus treatment can be seen to have multiple ethical issues. First, the drugs under research and development, aiming to help those infected with the virus. This is an ethical issue as it involves the well-being of people. Creating a solution for the pandemic will be among one of the most crucial discoveries of this year, let alone decade. This can be attributed to the fact that many people have succumbed to the disease, and millions are infected (Lee, 2020). Production of a vaccine would be better for society.
On another angle, the case shows a significant consideration of benevolence. This aspect is closely related to the first one. It indicates a high possibility of the decision having the ability to help others. The vaccines under development will be of great value to everyone globally, and more importantly, it will be help those already infected with the virus (Lee, 2020). In this case, the needy represent the more significant population as the pandemic has spanned the entire world. Any decisions related to this affect many people and must be made with the utmost consideration.
Another aspect of ethics in business is related to prior commitments. The idea of producing vaccines was initiated early this year. For instance, one vaccine name AdCOVID, set to be produced by the University of Alabama at Birmingham had already begun by the 30th of March this year. It was to be a single intranasal dose that would help prevent coronavirus infection (Lee, 2020). However, up to now, the institute has not yet provided the vaccine, and the world is still dependent on antibiotics for treatment. It shows the aspect of interference with prior commitments as the world was hopeful in readiness for the solution.
The final ethical aspect is product quality. The institutes working on the coronavirus vaccine and the different medicines to treat those already infected (Lee, 2020) must be viewed at a higher standard. Considering that this is a matter of life and death, which affects many people scattered all over the world, it is paramount that the organization produce high quality and well-tested drugs. Quality in drugs is essential as they should focus on cure and not causing harm to those who seek medical attention.

Step 3
As previously mentioned, the decision that is being analyzed is whether the companies working on creating vaccines for COVID-19 should be allowed to conduct test trials on prisoners. Several potential ethical issues are associated with making this decision:
Issues of Consent
There is an issue of consent present with administrating vaccine trials on prisoners as the individuals being tested are in a submissive state compared to the administrator. Historically, there have been issues regarding consent; as mentioned in the article, there have been tests done on prisoners without permission being given, such as John Charles Cutler’s 1940s experiments in Guatemalan prisons. There will be a need to address these historical issues and provide a viable way for prisoners to provide consent without prison system’s influence.
Transparency issues
There is also the potential for this decision to be made with a lack of transparency. Companies, such as Altimmune, may claim to be conducting these test trials a safe way; however, no one other than the test subjects and the company truly knows how these tests are being conducted. An example of this happening in the past was during the Holocaust when the public was told that “research” was being performed on prisoners when this was, in fact, not the case. A lack of transparency in this decision is concerning because although testing is being done to benefit all of society, it should still be conducted through ethical means.
Deception
Potential for deception is present as there is a significant outcome on the line, and both sides are adamant. As there is a possibility of producing a vaccine that could save thousands, it is not unreasonable to say there is a sufficient motive for test trials to be pushed forward while only supplying minimal information to the public and the prisoners. This will need to be addressed as all communication with the prison system, or the general public can sway opinions to one side or the other.
Self-interest manipulation
There is a possibility for Altimmune to partake in self-interested manipulation to have a decision made in their favour. The article mentions that the potential to test within these detention centres presents benefits to the prisoners, as these environments are considered as significantly high-risk, and a successful trial would prevent any future outbreaks. However, Altimmune could only make the benefits known to the prisoner population and the public to get more people on board with the decision to move forward with testing, thereby acting in a certain way in order to get the decision they want.
Discrimination
Prisoners are some of the most disenfranchised citizens within our community; the proposal to test vaccines on them has almost the same ring as saying that tests will be done on the homeless. The decision to test on prisoners must be viewed from all perspectives, and it will have to be determined if the decision to test would be the same regardless of the participant being tested.
Abuse of power or authority
The prisoners in question are considered to be at the bottom of a hierarchal system, allowing those above them to take advantage of them easily. Many of the testing conducted on prisoners in previous years have been done without their consent, which is a blatant abuse of power by those above them. This past precedent allows those in power (Altimmune) to abuse their control over the prisoners in this current situation. This can be manifested in two ways: conducting the testing without consent from prisoners and/or conducting a different testing type than that made aware to the prisoners.
Exploitation
Prisoners are being used to improve society while bearing the brunt of the costs, such as any adverse effects from the vaccine trails. The prisoner population would not even benefit from many of the impacts that a fully functional vaccine would provide, such as re-opening businesses and the economy. This situation of increased risk with little benefit compared to the ones administrating tests who receive little risk, and all the benefits must be analyzed as this is the basic formula for exploitation.
Step 4
Do not conduct any testing in prisons at all and focus on testing solely on the general public
Give prisoners the option to take part in the test trials