Lessons Learned About CHI Research Ethics

Abstract This final chapter summarizes the lessons learned throughout the manuscript. The history of controlled human infection (CHI) research reveals its potential for scientific breakthroughs and ethical challenges. Ethically troubling challenge studies of the past still color beliefs about research today and may also contribute to a “yuck” reaction to this research—an intuitive reaction that it is unethical. CHI research does present a collection of ethical issues that are not fully resolved, particularly when a new model is being created. Accordingly, this book provides ethical framework tailored for CHI research. This framework helpfully clarifies that extra scrutiny is not always needed for CHI research, but that new CHI models infecting humans for the first time generally require it. Applying this framework to recent experiences with Zika virus and COVID-19 reveals that CHI research should be thought of as a longer-term investment rather than a shortcut to scientific advances. Furthermore, misconceptions that all CHI research involves high ethical concern have led to blanket exclusion of some groups, but CHI studies can be useful and ethical even in low- and middle-income countries and in so-called vulnerable populations. Finally, CHI research reveals several lessons for research ethics more generally, including the importance of elevating research participants in society. Perhaps the most important and enduring lesson of this book is that scientific advances depend on people who are willing to take on risk for the benefit of others in society, a sacrifice that warrants respect.