COVID-19 update with Dr. Benjamin Marcum

Myth 17 – A Covid-19 Vaccine might be unethical. 

“And we know that in ALL THINGS God works for the good of those who love Him, who have been called according to His purpose.” Romans 8:28

This week I was asked an interesting question – one I have been asked before but now directly related to the coronavirus.  It is a question with an ethical dilemma and one I am happy to address in a public forum for the benefit of others who may have had this question before but not wanted to ask or may not have had the opportunity to ask.  The philosophical  implications of this issue are profound and stir deep emotions in many, including me.  I will do my best to explain my position which may or may not be your own, and whatever you determine, I respect the veracity of your belief and can understand if you disagree.  

First, some background. Medical research is a highly complex process that involves hours of painstaking work, creativity and money, and then a little more work.  The standards held by the FDA when it comes to developing medications, medical equipment for procedures and vaccines are more rigorous than any country in the world.  Applying the scientific method of experimentation for the purpose of proving a theory to human medical research raises ethical dilemmas in almost every single instance.  All medical research projects involving human subjects must now be evaluated by Institutional Review Boards before they are allowed to proceed in order to be sure that our collective ethical standards are upheld.  Arguably, the US has the most stringent ethical restrictions on medical research in the world – though that has not always been the case.  And, as we all know, ethical standards vary among each of our fellow citizens.  A society may determine a certain action is ethical, but your own personal ethic may say otherwise.  This is the crux of the question I am answering today.  

I have previously discussed herd immunity – developed through infection and hopefully soon, immunization.  Many companies are working on a vaccine for SARS CoV-2, the virus that causes Covid-19.  In fact, nearly 80 companies and academic institutions are working on the problem and, as you might expect, the creative juices are flowing.  Each project has a different approach to vaccine development and they all are using many different methods and materials.  One of the methods of evaluating efficacy of a vaccine and vaccine production, involves using cell cultures for that purpose.  You can imagine that before we try a vaccine in an actual live human, we would like to see what happens with the vaccine in a human cell.  We can also use human cells harvested and kept alive in a lab as factories for vaccine production.  So where do we get human cells to test the vaccine in?  From many places.

One of the most notorious stories of an immortal human cell line is the story of the cells of Henrietta Lacks.  Her story can be found in the book, The Immortal Life of Henrietta Lacks by Rebecca Skloot. She was an African American born in Roanoke, VA in 1920 who, unfortunately, developed cervical cancer.   In 1951 (69 years ago!), the Johns Hopkins physician who operated on her cancer saved the cancerous cells and (without Mrs. Lack’s knowledge or permission) forwarded them to a researcher who cultivated the cells into an immortal cell line that could be used for medical research.  They were named HeLa cells – derived from the first two letters of Mrs. Lacks’ first and last names.  Billions of dollars were generated by the research community that benefited countless companies and individuals without a penny going to Mrs. Lacks or her family.  This was the first immortal cell line developed for the purposes of medical research and, as you can see, was done in a very unethical way during a time that the human rights of a people group were blatantly ignored due to racism (and in her case, sexism).  A white male surgeon unceremoniously treated a poor black woman’s cancer without her having had the benefit of informed consent and took the tissue harvested from that procedure and parlayed it into something that generated profit for others.  This was before the era of Institutional Review Boards and would never pass muster today.  Likely the physician who did this would be incarcerated by today’s standards. 

I mentioned that billions of dollars of profit have been generated using the immortal HeLa cells and that is true.  But also, the medical advancements we as a society have enjoyed as a result of research with HeLa cells are without quantification.  Thousands of projects testing medications, vaccines, researching disease processes, have all used HeLa cells.  In fact, I did cancer research in medical school in Norfolk, Virginia, not far from the birthplace of Mrs. Lacks, trying to learn how a virus named HHV8 turned on cancer genes and might play a role in cause cancer in humans – using HeLa cells.  When I was doing this research I did not know the history of the cell line I was learning from.  I was simply happy to have a human cell culture to infect with the virus and measure whether a certain gene was turned on or off after exposure to the virus.  So much good (immeasurable, uncountable, unfathomable good) has come from the actions of one unscrupulous doctor that we could never understand what those cells have meant for the advancement of medical science.  Undoubtedly millions of lives have been affected in a positive way due to the HeLa cells.  And, I am happy to report, due to the efforts of the author, Rebecca Skloot, and many other well intentioned advocates, a foundation has been set up to benefit the descendants of Mrs. Lacks that is funded by some of the proceeds from research using her cell line, the first immortal human cells.

Mrs. Lacks is not the only person to have knowingly or unknowingly contributed human cells for the purposes of developing cell lines for medical research.  A cell line that has been used in many projects and, in fact, is being used by more than one company for researching a possible vaccine to prevent Covid-19, is named HEK293.  This cell line was born in 1973.  It is especially useful for transfecting the code for specific genes into the DNA of the cell and thus mass producing proteins of interest for scientific study.  HEK stands for human embryonic kidney.  These cells are an amalgamation of genetic material from multiple sources but the base cells were kidney cells harvested from a legally aborted Dutch fetus in the early 1970s.  The final product, HEK293, has undergone genetic engineering and transformation using adenovirus vectors, the science of which is beyond the scope of this discussion, but the fact remains that some genetic material in this now immortal cell line originated from an aborted fetus almost 50 years ago. 

Another commonly used cell line is named PER.C6.  This cell line was developed from human embryonic retinal cells from an 18 week aborted fetus in 1985.  This cell line was developed almost exclusively for producing medically active biologic compounds from vaccines to gene therapy products to antibodies etc.  Many vaccines are being currently researched and developed using this cell line including vaccines against HIV, malaria, tuberculosis, and, you guessed it, Covid-19.  

So… the question.  As a Christian, (or staunchly pro-life individual) is it ethical to use a vaccine that was developed using genetic material from an aborted fetus in its research?  

That’s a tough one.  

To be clear, I am pro-life.  I am the medical director for the Choices Crisis Pregnancy Centers across the Cross Timbers who’s main tenet is to promote life by supporting women in crisis, no matter what they choose to do with their pregnancies.  I believe life begins at conception and is precious.  Every hour, every minute, every second, every ounce of fleeting life is precious.  
For the same reason, I am pro-vaccine.  I believe that vaccination is one of the most powerful miracles of modern medicine that has preserved more ounces of life than any other medical advancement in our history.  In the case of vaccines built on the shoulders of aborted babies, it seems these two beliefs are at odds with one another.  I don’t think they are.  

I’ll try to illustrate why.  Imagine we were at war and your young son or daughter had just deployed against the enemy.  Imagine a general, face to face with the opposition, tasked with defending your loved one from the attack.  He has a new armor, one that is more effective than any other defense we have used to date.  “Deploy it at once!” you would plead.  “Protect my child at all costs!  Bring them home!”  “But,” replies the general, “this armor was got at a great price.  A general before me, much less ethical, slaughtered women and children of an innocent country to steal this technology so you would have protection for your child.”   Would you forgo the protection to honor those who were unjustly murdered? 

I would not.  I would use the armor to protect life.  And I would hold unscrupulous generals accountable.  I would advocate against merciless murder for the simple purpose of saving future lives.  I would learn from the past, remember and honor those who died, thank God that something good came from the horrible sacrifice and use the armor, while doing everything I can to stop future travesties from occurring.  Using the armor we have in hand to protect life IS NOT TANTAMOUNT to sanctioning a repeat offense.  It is simply protecting life.  It does not encourage further unscrupulous behavior if the behavior is dealt with directly.  No pro-choice advocate could justify abortion simply through the argument that we could harvest more human tissue for the purpose of medical research.  The mother making that choice is not remunerated for the fetal tissue.  It is simply not a valid incentive.  And, to be clear, I would advocate that we no longer develop new cell lines using aborted human tissue.  

I do not think that if we are truly pro-life, we can forgo protection and embrace sickness and death simply to honor a life that was unjustly taken.  If we are pro-life, we are pro-ALL-life.  Pro-unborn-life.  Pro-young-life.  Pro-old-life.  This is why we do not allow euthanasia (in most states).  This is why we admit hospice patients to the hospital when they have pneumonia or a urinary tract infection for life saving antibiotics.  This is why we vaccinate.  This is why we perform CPR on a dying patient after a trauma when there is little hope they will survive.  We cherish life.  Every ounce of it.  Choosing not to vaccinate against Covid-19 (or any other disease for that matter) simply because the vaccine was built on a platform of unjust death is an active choice to lean toward future death to prove a point – and that is absolutely NOT pro-life.  

This is not the first time I have been asked this question and it is one I have wrestled with for some time.  I absolutely believe we should advocate that fetal tissue from elective abortions not be used to develop new cell lines and new, more ethical sourcing of human cells for the purposes of research move forward.  (After all we DO need human tissue to further medical research – we should just source it ethically.  We source our coffee beans that way, after all.)  But I will not demonize the (albeit unwilling) sacrifice two unborn babies made that have produced so much good.  Out of their deaths have come life.  This is the basic truth of Christianity.  Through death – we have life.  I will not advocate that the cell lines we have already developed be destroyed and not used any more than I would advocate that a person give up their transplanted heart or kidney that was gotten from a drunk driving fatality.

Terrible things happen.  Sometimes on accident and sometimes because people make a choice.  When we can make good out of pain and suffering, so much the better!  It’s the example Jesus set.  If we invalidated every medical advancement that someone worked for good out after a unethical act was committed to make the advancement possible, we’d set our medical knowledge back decades.  We are imperfect people – all of us.  Everyone of us has made a mistake and often those mistakes have a way of turning out to be good.  This is not to minimize the death of unborn babies, rather to say that why would we sacrifice the main good that came from the tragedy?  That makes the death even more of a tragedy.  

Thankfully, philosophers wiser than me have thought about this problem as well.  The Catholic Church is one of the most staunchly pro-life organizations in the world.  They acknowledge that using aborted fetal genetic material in research is ethically problematic.  But they also acknowledge that ALL life is precious.  They have agreed that vaccination with vaccines built on the platforms of cell likes like HEK293 and PER.C6 is acceptable and recommended until an alternative is available.  Perhaps where I differ with them is the idea that we should stop using the cell lines already developed.  The main argument I see for that is that this question goes away and vaccination rates go up.  We already have more hurdles than we can jump, it seems at times, to convince patients to vaccinate – so if for no other reason than that, I concede that using these cell lines is problematic.  Though I still maintain that personally, I will use vaccines developed using the genetic material from those two babies in my family the minute they are appropriate – it is my way of honoring them.  I also honor them by continuing to fight for the life of all my patients, those unborn, newly born and grown – because all life is precious.  Every ounce.  

Praying for the almost 80 groups working on the vaccine.
BAM