It was late 2019 and over a year had passed since I had last visited the clinic for a blood draw related to the experimental vaccine I had taken four years earlier. I hadn’t given it a thought in nearly as long when I received the call: “Mr Harasta? We have bad news about the dengue vaccine trial.”
In these days of COVID-19, I have often thought back to the events of that vaccine trial, its failure, and the consequences that failure had for me while the politics of vaccine production have gone from fringe to front and center as we grapple with our global response to the pandemic.
Like everyone, socialists and the wider left have struggled to keep up with the constantly shifting science and its accompanying toxic politics. As socialists, however, we have a particular responsibility and power to take action in the defense of humanity. An opportunity to act on those commitments will soon emerge as we are confronted with a whole range of ethical issues related to human tests for the vaccine. Just as we organize our workplaces and communities, we must organize the trials to ensure those ethical issues aren’t decided in favor of for-profit medical companies rather than human need.
In the summer of 2015, I returned stateside after accompanying my wife on her doctoral research in her home country of Colombia. I was setting up our living arrangements in Syracuse, New York and looking for work. Like many in precarious economic situations, I encountered some posters around town soliciting healthy participants for medical trials.
One project, focused on dengue fever, caught my interest. I had just come from the city of Medellín where dengue is a scourge, and I had seen Colombia’s public health campaign there against dengue in action.
In the Medellín countryside, the rural poor know dengue all too well. Its nickname “breakbone fever” came from the signature mark of the disease’s severe manifestation: the excruciating pain in one’s joints that feels like the bones are being crushed. It is a plague that is expanding, with infections growing eightfold in the last two decades. The WHO estimates that there are one hundred to four hundred million yearly infections. Even with the best treatments (far too often unavailable), in its severe form dengue still has a death rate of 1 percent.
Like many viral infections for which we do not yet have vaccines, dengue primarily impacts people in the Global South. While people globally have benefitted immensely from the development of vaccines for a wide range of diseases, brutal inequalities continue to reproduce themselves in the list of those viruses for which there is no vaccine.
The trial sponsors in Syracuse were paying for individuals who were willing to take a vaccine candidate and then come in regularly over months for blood draws and observations. I am a firm believer in the importance of vaccines for the benefit of all, and human trials obviously need to be conducted before rollout. As in this case, often those trials need participants in the Global North countries who are not at risk of exposure to the virus and, therefore, false-positive antibody tests.
Participants were to engage in a multistep process: first baseline bloodwork and physical examination, followed a week later by several injections of the experimental vaccine over a number of days. This was followed by a tight schedule of clinic visits for more bloodwork and observation as well as self-observation of possible side effects, recorded in a home journal. These tests became less frequent over the course of the year that I participated. The pay, $50 for each visit, would help bridge the time before my new job would start up.
Still, I hesitated before eventually accepting, likely the same reasons that many socialists today may balk at the COVID-19 tests. Had the vaccine been vetted for safety to the extent possible before human trials? Was this truly a viable candidate for a workable vaccine, or was I unnecessarily putting myself at risk and prohibiting my participation in future tests? Finally, since the resulting vaccine would be the property of the for-profit Sanofi corporation, could I come to terms with the fact that I would be selling my health for someone else’s profit rather than solely for the public good?
I spent several days of thought and discussion with my partner as well as a virologist colleague before deciding that the benefits outweighed the costs. At the time, I thought myself fortunate to have knowledgeable people I could discuss these matters with. It would have been hard to make an informed decision otherwise. In that information vacuum, most participants are members of the precariat who disproportionately bear the burden of such tests on their bodies.
It doesn’t have to be this way. Participating in medical testing is essential for developing needed vaccines and disease treatments. And it is labor, a form of selling our bodies for capitalist profit — and is therefore amenable to labor organizing. It is in our power to not only sell, but also withhold, this labor. But we cannot meaningfully do so without planning and coordination. Socialists can step forward and join this fight, reshaping our world through collective action to organize the vaccine trials.
In the end, as I learned in that phone call, the dengue vaccine trial proved to be a spectacular failure. While it did give participants like myself some protection against infection, the immunity it provided was imperfect, and if a vaccinated individual did become infected, the chances were greatly increased that they would develop the severe form of the virus, requiring hospitalization. I was warned to avoid dengue-endemic regions and to take extra care in Colombia to prevent mosquito bites.
Although I felt frustrated and disappointed, such precautionary necessities hardly altered my life as they would for someone living in an endemic region. Thus, to my mild amusement, did I find myself in what I had always viewed as a dubious social category: the “vaccine-injured.”
This term, popular among anti-vaxxers, is used to describe people with various ailments — phantom or real — caused by vaccinations. Currently, there are campaigns for the federal government to compensate these individuals for their pseudoscientific maladies. For many anti-vaxxers, the mere potential for the existence of the “vaccine-injured” is justification for the complete dismantlement of our systems of vaccine-derived herd immunity.
I had been well aware of the possibility of such injury before participation — even in the best of circumstances, most vaccine candidates fail to live up to the hopes of their creators — and while I certainly wasn’t happy about the outcome, I was resigned to it. Today, I continue to hope, like so many millions, for a true dengue vaccine to protect myself.
All of this was simmering before the emergence of COVID-19 and the global push for a vaccine for this new pandemic. While it is common for different researchers to simultaneously pursue various vaccine candidates, the scope of this pandemic mixed with capitalist and nationalist greed means there are a bewildering number of vaccine candidates currently in the works: as this is written on August 13, the New York Times’s official vaccine tracker is following over 165 candidates, and investment capital is anticipating vast profits for the first to succeed.
Never one to overlook a potential for self-aggrandizement and glory, the Trump administration has developed “Operation Warp Speed,” a plan to roll out a COVID-19 vaccine as fast as humanly possible. In this frenzied context, many are concerned that a vaccine, perhaps with results akin to the one I took, will be prematurely distributed, and will “endanger millions of lives in the short term and will damage public confidence in vaccines and in science for a long time to come.”
On top of this, the ongoing question of class politics and vaccine ownership remains unresolved: Who will own and profit from a drug created through the efforts of tens of thousands of scientists working with the public support from tax revenues from billions of workers? Will the burden of testing the vaccine fall disproportionately upon those who are already oppressed in our society? Who will own the cure? Who will control its distribution? We cannot rely upon the emergence of another Jonas Salk, the creator of the polio vaccine, who famously responded to the question of who owned the patent: “There is no patent. Could you patent the sun?”
And yet the vaccine is clearly the best option. An ideal vaccine, such as polio, is cheap, easy to distribute, provides lifelong immunity with a single dose, and helps to build herd immunity in our communities to protect those who cannot be vaccinated. Unlike most for-profit medicine, which seeks to create expensive drugs that must be taken regularly for the rest of one’s life, therefore maximizing corporate profit, the vaccination aims to be an easy one-off that allows us to simply forget about the disease. This may very well be why we have the drug PrEP, which is remarkably effective in stopping HIV transmission but requires users to take it regularly, before we have a HIV vaccine.
The concept of herd immunity in particular coincides closely with our values of mutual care and support for the vulnerable. Herd immunity is the principle that when the large majority of society is vaccinated for a disease, it creates conditions so unfavorable to transmission that those who cannot be vaccinated (such as infants, people with certain health conditions, or those whose religions prohibit it) can still enjoy the protection from belonging to a collective. Our immunity protects not just ourselves, but those who cannot enjoy immunity themselves. Just as social distancing and quarantine is a form of care in COVID-19, vaccination serves an identical role.
However, the anti-vaxx movement, which encourages parents to argue for conscientious objection for their own children, has steadily decreased our societal rates of vaccination and weakened herd immunity.
Socialists, therefore, face a thorny conundrum with COVID-19: How do we promote vaccines — clearly a social good of the type that we should enthusiastically support — when they profit some of our most bitter enemies? How can we use what social and political power we have to protect as many people as possible as quickly as possible? How can we help to ensure that the brave individuals signing up for the trials are protected? How can, and should, we as individuals and organizations publicly support a vaccine that is owned by a for-profit corporation?
We shouldn’t have this problem: vaccines should be produced in publicly owned laboratories in a global consortium and be the common resource of all peoples (could you patent the sun?). But we simply do not have the time to produce such a network in the case of COVID-19. The capitalists will have created their tests and caused whatever damage they will cause before we could even meaningfully begin such a complex task. Already, the Russian state has announced a mysterious vaccine without late-stage human trials and without revealing any data about the outcomes of early-stage trials; and in India, Modi declared an Indian vaccine would be ready for independence day on August 15. So we are left with questions without easy answers.
For me, at least one answer in this laundry list of questions is clear: if they’ll take me, I am ready to roll up my sleeve for a properly vetted trial.
I’m well aware of the potential costs, both personal and societal. But I’m also aware of what the daily cost of this pandemic is, especially in the period of grotesque governmental negligence in which we in the United States are living. I also recognize that as an able-bodied, insured, professional white man, the potential personal costs are ones I can bear more easily than many others.
Because of the political and societal importance of vaccines, I believe many socialists will be lining up alongside me. However, this first opens up another set of questions: With so many vaccines emerging simultaneously, and being only able to participate in one per person, how do we choose? How can we, as socialists, maximize the impact of our participation and best protect each other? How can we use this moment to build socialism in America and beyond?
Our mass organizations around the globe — like the Democratic Socialists of America, of which I am a member — should take the lead in actively enabling this process. Left organizations should organize panels of experts aligned to our values to analyze the ongoing trials and rate them according to at least these three categories:
- Has the trial been rushed, and is there a disproportionate risk to participants? Have steps been taken by the vaccine creators to mitigate that risk?
- What is the likelihood of success in creating an effective vaccine?
- Who will own and/or control the end product? Are there any guarantees that this will not become a tool of exploitation?
It is likely that the answer to these questions will be messy, with multiple vaccine candidates having varying degrees of positive and negative categories. Moreover, it will likely be strategic for socialists to spread their participation around several different candidates. With so many current trials ongoing and each socialist only able to put their body on the line for one, our ability to collectively support one or more is the most potent tool in our box for affecting the best outcomes in this pandemic, but we cannot organize to do so without good information.
And once the COVID-19 crisis is over, it may be that this panel continues to do this work for other vaccines for other diseases. After all, dengue, malaria, AIDS, chikungunya, Zika, and so many others are still out there. It could be that, over time, the strength of our solidarity and sacrifices of our vaccine injuries will result in more effective, more just, and simply more vaccines.
We must remember that this pandemic is truly a global crisis, one where not only is there the potential for shock doctrine–inspired elite assaults on the working class but also the reality that hundreds of thousands of those same workers, so many of them in this country black and brown, are dying. This requires more than our admirable efforts at mutual aid — it requires at least some of us to step forward with those same bodies and risk injury.
This is not without precedent. I am reminded of a story told by the late, great historian Howard Zinn who described his own “conversion” to Marxism. He was on a bomber crew flying missions over Nazi Germany late in the war and began to have political conversations with his partner. It turns out that this man was a socialist whose party had advocated its young members to enlist in order to organize from within the military. He and Zinn discussed the imperialist powers and how the United States’s own bombs would be creating not freedom but a new form of empire, and yet how the fight against fascism was a fight that must be won.
We should take inspiration from that nameless airman and his comrades: the fight against COVID-19 (and dengue, and so on) will possibly create new empires of wealth, but it is a fight that must be won. It must be won on every front available, up to and including placing our own bodies on the line.
At the same time that we must face the viral enemy in front of us, we must weaken the class enemy that fights alongside us for its own profit. But we will win none of these fights if we are not present. We should organize in the trials the same way we organize our workplaces and communities. Our organizations must step forward to help give us direction, to help maximize the impact of our efforts — and minimize the threats to our own bodies in the process.