The first HIV vaccine efficacy trials will probably be proposed sometime before the end of the millennium, and will probably take place somewhere in the developing world rather than in any of the Western industrialized nations. These trials will doubtless be surrounded by controversy, and well they should be.
Two hundred years ago, when Edward Jenner proposed his first smallpox
vaccine efficacy experiment, it too was rightly surrounded by
much controversy. Doubts about the scientific as well as ethical
propriety of Jenner's experiment arose from within the medical
community, from within the popular media, and from the populace
of his time, and the same will doubtless be the case for our century's
HIV vaccine efficacy experiments.
Some of the similarities between the two cases - Jenner's smallpox
vaccine experiment in 1796, and today's proposed HIV vaccine efficacy
experiments - are quite striking. Some of the differences also
are ethically quite significant. Both the similarities and differences
will be detailed in the following pages.
This study is an examination of some of the key ethical dilemmas
entailed by Jenner's proposed experiment, the first (I believe)
scientifically designed biomedical experiment in the history of
modern scientific medicine.
The ethical quandaries entailed by HIV vaccine efficacy trials
are far more complex than those entailed by Jenner's experiment.
Yet I believe that much can learned about the problems associated
with today's vaccine efficacy trials - whether they be trials
for HIV vaccines, for malaria vaccines, for tuberculosis vaccines,
or for any number of other potential experimental vaccines - by
a close examination of Jenner's much earlier experiment based
on much simpler data and covering a much shorter period of time.
Sometimes highly complex problems can be most effectively approached
by an examination of problems that are simpler and more fundamental,
then extrapolating some of what is learned in the simpler case
to what is still unclear in the more complex case.
I believe that an examination of some of the ethical issues in
Jenner's work will be illuminating for analogous issues raised
by today's proposed vaccine efficacy trials.
Jenner homepage | Jenner Table of contents
preface | Introduction | chp 1 | chp 2 | chp 3 | chp 4
chp 5 | chp 6 | chp 7 | chp 8 | App I | App II
Introduction to Philosophy | Ethical Issues in HIV Vaccine Trials
Curriculum Vita | TK homepage | Public lectures