Thread by @DrMattMcCarthy

Vaccine Dilemma: When should volunteers who received placebo get the real thing? If vaccines are highly effective, it seems unethical to withhold inoculation from people who bravely volunteered for a study. But that’s what some researchers want. 1/

mRNA vaccines are reportedly 95% effective, but it’s possible that number will degrade over time. Allowing volunteers to cross over from placebo to vaccine unblinds these trial and ends the collection of randomized data.
That prevents us from learning crucial information... 2/

...about the degradation of vaccine efficacy, durability of protection, and long-term safety data. Some argue that volunteers who received placebo should be among the LAST to get vaccinated.
This preserves the integrity of ongoing trials. 3/
nejm.org/doi/full/10.10…

But some who received placebo believe that they now deserve priority. Vaccination could reasonably be seen as a reward for their heroism. Results of a clinical trial are not their concern. They're not wrong.
So, how do we reconcile this? 4/
nytimes.com/2020/12/02/hea…

Here's a suggestion: Pay them. Providing financial incentives for study subjects used to be uncommon. That's not longer the case. (I explore this in 'Superbugs'). We're asking thousands of people to do something very difficult to benefit society. Give them a reason to do it.