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Explainer: What you should know about COVID-19 antivirals and vaccines

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April 24, 2020

What just happened?

Earlier this week, the University of Oxford announced that patients have been enrolled in clinical trials for a coronavirus vaccine, and the U.K.’s health secretary said the country would be “throwing everything” behind the project. Medical researchers at Oxford are among the thousands across the globe who are working on potential treatments and vaccines for the novel coronavirus disease known as COVID-19.

Two weeks ago, the World Health Organization (WHO) said there were three vaccine candidates in the clinical testing phase while 67 potential vaccines are in the preclinical phase. There are also more than 150 different drugs—such as antivirals—being researched and tested as possible treatments for COVID-19

What are vaccines, and how do they work?

A vaccine is created from the same infectious agent that causes a disease, using extremely small amounts of weak or dead microbes such as viruses, bacteria, or toxins. A vaccine stimulates your immune system to produce antibodies, exactly as it would if you were exposed to the disease. After getting vaccinated, you develop immunity to that disease, without having to actually get the disease.

Vaccination is the act of getting a vaccine, usually as a shot, while immunization is the process of becoming immune to (i.e., protected against) a disease. The purpose of vaccination is immunization.

Why is it so important to develop a vaccine for COVID-19?

The human body has an immune system equipped with several tools to fight infection from germs such as bacteria or viruses. The first time the body encounters a germ, it can take several days to make and use all the germ-fighting tools needed to overcome the infection. After the infection, though, the immune system remembers what it learned about how to protect the body against that infectious disease. Vaccines serve a similar function by helping to develop immunity by imitating an infection. 

People who are immune can’t pass the disease to others. For example, if 80% of a population is immune to a virus, 4 out of every 5 people who encounter someone with the disease won’t get sick and won’t spread the disease. When a high enough percentage of a community has become immune to a disease because of vaccination and/or prior illness, they have developed herd immunity. Because it limits the spread of the infection, herd immunity protects those who aren’t able to be vaccinated (e.g., infants, pregnant women, or immunocompromised individuals) or who would be at higher risk of injury or death from the disease.

Based on early estimates of this virus’s infectiousness, it is believed that we will need at least 70% of the population to be immune to the novel coronavirus to achieve herd immunity. Because the death rate for COVID-19 is unknown, but believed to be up to 10 times higher than for the flu, developing herd immunity solely through infection would lead to extraordinary levels of mortality from the disease. The development and widespread distribution of a vaccine would make it possible to achieve herd immunity with a lower rate of fatality and serious injury.

Even when herd immunity is reached, though, our communities will still suffer deaths from COVID-19. “Herd immunity is not this magical number where once you reach that point nobody else gets infected,” says Shane Crotty, an immunologist at the La Jolla Institute for Immunology in California. “It would no longer be a full-blown epidemic once you get to herd immunity, [but] the virus would still spread, it would still infect people, it would still kill people. It would just be a less common event.”

What are antivirals, and how do they work?

Antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that help your body fight against viruses by killing or preventing the growth of viruses.  Such drugs are most helpful when they are able to impede multiplication of the virus before it causes significant damage to the body. (They are different from antibiotics, which fight against bacterial infections.) Antivirals are most commonly used to treat influenza (e.g., Tamiflu is an antiviral commonly used to treat flu).

Currently, several companies are developing or testing antivirals against the virus that causes COVID-19. Antivirals in current use that are being considered or tested for treatment of COVID-19 include: Chloroquine (used for malaria), Favipiravir (used for influenza), Kaletra (used for HIV), and Remdesivir (used for Ebola and MERS).

According to the Centers for Disease Control (CDC), antivirals are a “second line of defense” (with vaccines being the first line of protection). But most researchers believe antivirals to treat COVID-19 are likely to be developed and approved before a vaccine becomes available.

What are clinical trials and observational studies?

Before vaccines and antivirals can be approved for use on humans, they must undergo  rigorous study. The two types of medical research involving people are observational studies and clinical trials.

In an observational study, medical researchers assess health outcomes in groups of participants according to a specific research plan. Participants in such studies may receive interventions (e.g., drugs, medical devices) or procedures as part of their routine medical care, but participants are not assigned to specific interventions by the investigator (as in a clinical trial). As applied to COVID-19, an observational study might perform such functions as collecting data on symptoms in a group that has recently been diagnosed with or exposed to someone with the virus.

Clinical trials are research studies that evaluate the effectiveness of a medical, surgical, or behavioral intervention. They are the primary way researchers find out if a new treatment, such as an antiviral drug, is safe and effective for use on people. 

Before the U.S. Food and Drug Administration (FDA) approves a clinical trial to begin, researchers perform laboratory tests and studies in animals to test a potential therapy’s safety and efficacy. If these studies show favorable results, the FDA gives approval for the intervention to be tested in humans.

Clinical trials advance through four phases to test a treatment, find the appropriate dosage, and look for side effects:

Phase I. The drug is given to a small number of healthy people and people with a disease to look for side effects and figure out the best dose.

Phase II. The drug is given to several hundred people who have the disease, looking to see whether it works and if there are any side effects that weren’t caught during the initial testing.

Phase III. In this large-scale trial, the drug is given to several hundred or even up to 3,000 people. A similar group of people take a placebo, or inactive compound. The trial is usually randomized and can take 1 to 4 years. This stage provides the best evidence of how the drug works and the most common side effects.

Phase IV. Drugs that are approved for use undergo continued monitoring to make sure there are no other side effects, especially serious or long-term ones.

The FDA has issued guidance on the conduct of clinical trials of medical products during the COVID-19 public health emergency.

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24