Общият брой: 57,3 милиона случая и 1,36 милиона смъртни случая.

Общият брой: 57,3 милиона случая и 1,36 милиона смъртни случая.

Етично ли е да се дава на хората плацебо, когато има животоспасяваща ваксина? Трябва ли тези, които са получили плацебо в първите две изпитвания, да получат преференциален достъп до активна ваксина, за да им се отблагодари за тяхната жертва?

Няма консенсус между етиците и служителите в общественото здравеопазване по нито една точка.

Монсеф Слауи, главен научен съветник на Operation Warp Speed, програмата на администрацията на Тръмп, която ръководи усилията за разработване на ваксина, каза, че участниците в изпитването трябва да бъдат първи на опашката за ваксиниране. Те не бяха споменати във вторник на среща на борда на Центъра за контрол и превенция на заболяванията на САЩ, който препоръчва кой трябва да получи ваксината пръв.

Кандидат ваксините срещу COVID-19, едната произведена от Pfizer/BioNTech, а другата от Moderna, изглежда са готови да получат разрешение за спешна употреба от FDA в рамките на седмици, след като покажат, че са безопасни и имат повече от 94% ефективност. Компаниите проведоха големи опити съответно с 44 000 и 30 000 души, в които половината от доброволците получиха плацебо. Участниците не знаят какво са получили.

Типичните изпитвания на ваксини продължават две години. И двете групи се следват, за да се гарантира безопасността и да се посочи колко дълго ще продължи защитата на ваксината. По време на пандемия, при която всяка минута един американец умира от COVID-19, официалните лица определиха двегодишно забавяне като неприемливо.

Ранното прекратяване на плацебо групата си има цена.

Намерете отговори на вашите въпроси, свързани с болката, и решения на официалния уебсайт на Hondrostrong .

„Нямаме пълния профил на тези ваксини“, каза Норман Бейлър, президент и главен изпълнителен директор на Biologics Consulting и бивш директор на Службата за изследване и преглед на ваксини към Администрацията по храните и лекарствата.

Продължаването на сравняването на плацебо групите и групите с активна ваксина може да помогне на изследователите да разберат по-добре как различните демографски групи, като възрастните хора, реагират на ваксината и да идентифицират всякакви неочаквани дългосрочни здравословни проблеми.

„Загрижен съм за етиката, ако не мога да го получа, докато всеки друг с моите характеристики може да го получи“, каза Оренщайн, който седи в Научния консултативен съвет на Moderna. „Когато стане достъпен за хората в моята категория, би трябвало да мога да бъда разкрит и да го получа.“

Участниците в изпитването не трябва да бъдат премествани начело, каза Франклин Милър, професор по медицинска етика в Медицинския колеж Weill Cornell в Ню Йорк.

Ако повече от 35 000 души в плацебо групите от двете изпитвания бяха приоритизирани, това би отложило ваксинациите за 35 000 здравни работници, рискуващи живота си всеки ден, за да лекуват пациенти с COVID-19, каза той.

Разбира се, ако участник в изпитването е и здравен работник, този човек трябва да получи ваксината заедно със своите връстници, каза Милър.

Артър Каплан, професор и основател на отдела по медицинска етика в Медицинския факултет на Нюйоркския университет в Ню Йорк, каза, че смята, че единственото етично нещо, което трябва да се направи, е да се идентифицират хората в плацебо групата и да им се позволи да се ваксинират, напускайки проучването ако е необходимо.

„Това наистина ще навреди на изпитанията ви“, каза Каплан, защото няма да е възможно да се сравнят двете групи за по-дълъг период от време.

Тъй като някой в ​​плацебо групата от изпитването на Moderna е починал, който вероятно би оцелял, ако е бил ваксиниран, „нямате друг избор, освен да разкриете“ опитите и да предложите на хората в плацебо групата ваксина, когато стане налична, каза той.

Каплан се надява, че хората и в двете групи ще бъдат проследени, дори след ваксинация, за да се намали вредата за изследванията, но не е ясно дали компаниите – разтегнати, опитващи се да произведат ваксините – ще имат необходимите средства да проследят участниците, каза той.

Комитет на Световната здравна организация стигна до различно заключение от Каплан. В сряда в New England Journal of Medicine се твърди, че трябва да започнат по-мащабни проучвания, включващи стотици хиляди хора, за да се търсят редки ефекти, които не са били наблюдавани при първите 35 000 участници. Тези в плацебо групата могат да бъдат ваксинирани два месеца по-късно, свеждайки до минимум етичните опасения.

„Такова изпитване може да се проведе или по време на период на спешна употреба, или веднага след лицензирането и може да се разглежда като справедлив начин за разпределяне на първоначално ограничени доставки на ваксина“, според международната група от 20 души, включваща статистици, експерти по инфекциозни болести , епидемиолози и други учени.

Друга възможност: Помолете хората в изпитването, включително получателите на плацебо, да останат по алтруистични причини, забавяйки ваксинацията в името на научното разбиране.

Това би било етично, стига хората да са напълно информирани за наличието на ефективна ваксина, каза Милдред Соломон, член на факултета на Центъра по биоетика към Харвардското медицинско училище и президент на Hastings Center, безпартиен мозъчен тръст по биоетика.

„Основният принцип в изследванията върху хора е, че трябва да има доброволно и информирано съгласие“, каза тя.

Как да тестваме занапред?

Учените са разделени относно това как да тестват други ваксини срещу COVID-19, след като първите две се оказаха толкова ефективни. През следващите няколко месеца, докато станат широко достъпни, няма проблем, казаха Слауи и други.

След като всеки може да влезе в аптека или лекарски кабинет и да получи ваксина с две дози, която вероятно ще бъде много ефективна срещу COVID-19, ще бъде по-трудно да се оправдае даването на плацебо на някого.

Това е „трънлив въпрос“, съгласи се д-р Мери Басет, директор на Центъра за здравеопазване и права на човека FXB в Харвардския университет и бивш здравен комисар за Ню Йорк. „Би било най-добре за обществото, ако хората продължат в изпитанията, както са били записани.“

Тийнейджъри са участвали в проучванията на Pfizer/BioNTech и Moderna, рандомизирани да получат или плацебо, или активната ваксина. Тези опити не са напреднали достатъчно, за да разкрият ефективността, така че няма етични затруднения в продължаването на плацебо-контролирани изследвания в тази група.

На по-малките деца не е разрешено да участват в проучвания за ваксина, защото не е ясно каква доза ще им е необходима или как ще реагират на ваксината. По същия начин няма информация за бременни жени, тъй като те не са били проучени, така че етичните опасения, наблюдавани при възрастни, не са уместни.

Да се ​​надяваме, че хората ще участват в изпитания на други кандидат-ваксини, каза Соломон, дори ако имат шанс да получат плацебо и никаква лична полза.

„Има още много неща, които трябва да научим, че би било наистина жалко да не продължим рандомизирани проучвания за допълнителни ваксини. Имаме нужда от повече ваксини“, каза тя. "Но изследователите трябва да го направят по отговорен начин, който гарантира напълно информирано доброволно съгласие."

Дори ако една по-късна ваксина е по-малко от 94% ефективна, тя може да е за предпочитане пред двете водещи в някои ситуации, каза Милър. Може да изисква само една доза, като кандидат, тестван от Johnson & Johnson, или е по-евтин и по-лесен за разпространение в селски райони с по-ниски доходи, като ваксина, произведена от AstraZeneca и Оксфордския университет.

„Още по-важно е тези изпитания да продължат, защото това може да е ваксина, която ще достигне много повече хора“ от тези на Moderna или Pfizer/BioNTech, каза той.

В бъдещите изпитвания ваксините трябва да се сравняват с двете, за които е известно, че действат, а не с плацебо, каза д-р Питър Бах, директор на Центъра за здравна политика и резултати в Memorial Sloan Kettering Cancer Center в Ню Йорк.

По този начин всеки ще получи или високоефективна ваксина, или друга активна ваксина, която, надяваме се, ще осигури подобни ползи – и никой няма да остане незащитен.

Фармацевтичните компании не харесват подобни опити за директно сравнение, каза той, защото тяхната ваксина може да не изглежда толкова добра, колкото тази на някой друг, но е в интерес на обществото да знае дали някои ваксини са по-ефективни от други.

„Това са изкуствени ограничения поради тази идея, че частната индустрия трябва да произвежда свои собствени продукти, защото те са тези, от които могат да уловят приходите“, каза Бах. „Ако отговорът е, че ваксините на Pfizer и Moderna спасяват повече животи, трябва да произвеждаме повече от тези продукти.“

Свържете се с Weintraub на kweintraub@usatoday.com.

Покритието за здраве и безопасност на пациентите в USA TODAY е възможно отчасти чрез безвъзмездна помощ от Фондация Масимо за етика, иновации и конкуренция в здравеопазването. Фондация Масимо не предоставя редакционна информация.

Pfizer и BioNTech обявиха сделка за 1,95 милиарда долара с федералното правителство за предварително закупуване на 100 милиона дози от техния кандидат за експериментална ваксина.

Компаниите планират да започнат окончателно тестване от фаза 2 и клинични изпитвания от фаза 3 до края на месеца, според съобщение за новини в сряда.

Те казаха, че се надяват да започнат процеса на регулаторно одобрение, за да получат ваксина, лицензирана от Администрацията по храните и лекарствата още през октомври.

В съобщението се казва, че правителството на САЩ ще плати на компаниите при получаване на първите 100 милиона дози след разрешение или одобрение от FDA. Не беше ясно дали плащането ще бъде извършено, ако ваксината не бъде одобрена от FDA. Pfizer не отговори веднага на искане за разяснение.

Споразумението дава на САЩ опция за закупуване на допълнителни 500 милиона дози.

Американците ще получат ваксината безплатно, „в съответствие с ангажимента на правителството на САЩ за безплатен достъп до ваксини срещу COVID-19“, се казва в съобщението.

Pfizer, базирана в САЩ компания, и нейният сътрудник BioNTech, немска компания, очакват да произведат до 100 милиона дози в световен мащаб до края на 2020 г. и потенциално повече от 1,3 милиарда дози до края на 2021 г.

Споразумението е между компаниите и Operation Warp Speed, ръководена от Белия дом работна група, която работи за ускоряване на разработването на ваксини и терапии срещу COVID-19.

Pfizer реши да не търси федерално финансиране за разработване на своите изследвания за ваксина срещу COVID-19 и това е първата финансова сделка между Съединените щати и компаниите за ваксина срещу COVID-19.

Operation Warp Speed ​​също сключи сделка за 1,2 милиарда долара с AstraZeneca, британско-шведска компания, за 300 милиона дози от нейната кандидат-ваксина, ако се окаже ефективна и бъде лицензирана.

Още: Поне две фармацевтични компании обещават достъпни ваксини срещу COVID-19 по време на пандемията

И при двете сделки всички ваксини, които не преминат проверката, ще бъдат унищожени.

Чрез предварително закупуване на възможна ваксина правителството се опитва да подреди огромен брой дози, които могат да бъдат дадени веднага щом премине през процеса на регулаторно одобрение на FDA.

„Разширяването на разнообразното портфолио на Operation Warp Speed ​​чрез добавяне на ваксина от Pfizer и BioNTech увеличава шансовете, че ще имаме безопасна, ефективна ваксина веднага след края на тази година“, каза министърът на здравеопазването и човешките услуги Алекс Азар.

Pfizer и неговият партньор BioNTech подадоха в петък спешно разрешение от Администрацията по храните и лекарствата, два дни след като обявиха, че ваксината срещу COVID-19 е 95% ефективна.

„Нашата работа за доставяне на безопасна и ефективна ваксина никога не е била по-спешна, тъй като продължаваме да наблюдаваме тревожно нарастване на броя на случаите на COVID-19 в световен мащаб“, каза в изявление д-р Алберт Бурла, председател и главен изпълнителен директор на Pfizer .

Беше обнадеждаваща седмица за кандидатите за ваксина. В понеделник данните, публикувани от фармацевтичната компания Moderna, показаха, че нейната ваксина има висока степен на ефикасност. И във вторник главният учен на Johnson & Johnson каза, че производителят на лекарства очаква да поиска разрешение за своя кандидат за еднократна ваксина до февруари или по-рано.

Новината за ваксината идва, докато коронавирусът продължава да опустошава САЩ преди празника на Деня на благодарността. В четвъртък нацията съобщи за близо 188 000 нови случая на ден – най-много регистрирани от началото на пандемията. Броят на смъртните случаи надхвърли 252 000, включително повече от 2000, отчетени само в четвъртък. Хоспитализациите в цялата нация експлодираха, като почти 80 000 американци сега получават стационарно лечение.

📈 Днешните числа: САЩ са докладвали повече от 11,8 милиона случая и повече от 253 300 смъртни случая, според данни на университета Джон Хопкинс . Общо в световен мащаб: 57,3 милиона случая и 1,36 милиона смъртни случая.

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