Amid the news explosion that followed President Trumps COVID-19 diagnosis and brief convalescence earlier this month, there was a nugget you might have missed: The antibody treatment from biotech company Regeneron the president tookseemingly to great effecthad been developed in part by means of cells derived from fetal tissue.

Most of the discussion around this revelation concerned whether it showed the president to be a hypocriteeither personally because of his stated pro-life beliefs, or as a matter of policy because his administration has suspended federal funding for scientific research involving fetal tissue. (Both claims were dubious: There was no reason to believe the president knew the provenance of the Regeneron cocktail when he was treated with it, and the kind of fetal-derived cells used to develop the drug were not included in the administrations funding freeze.)

But the news portended a larger problem that may prove important in months to come: the ethical objections other pro-life people may have to new COVID treatmentsincluding vaccineswith similar issues in their development history.

I think its going to test our convictions about these things, said Dr. C. Ben Mitchell, a professor of moral philosophy at evangelical Union University and senior fellow at the Center for Bioethics & Human Dignity. Whether or not we are going to be consistent with our convictions.

Beyond the central aim of ending legal abortion, no issue has so united the pro-life movement over the last few decades as the push to prevent fetal and embryonic remains from being used in medical research. In the 2000s, the battle involved embryonic stem cell research: President Bush prohibited federal funding for research involving new embryonic stem cell lines in 2001, a policy President Obama reversed in 2009. More recently, the issue has been researchers use of fresh tissue from recent abortions, following activist David Daleidens 2015 expos on Planned Parenthoods practice of selling organs from aborted fetuses to medical research companies.

But while pushing for public policy changes and supply chain reforms to make researchers less reliant on ongoing abortions, pro-lifers have also struggled with a parallel issue on a more personal level: whether its permissible to make use of treatments developed via the use of fetal tissue that already exist. If abortion is evil, they ask themselves, then can I in good conscience allow myself to benefit from medicines that rely on the practice?

Such questions are complicated by the fact that, unlike the tissue research that has dominated pro-life policy space in recent years, many medical products in current use, including a number of childhood vaccines, have a connection to abortion that is distant and tenuous. The cell cultures used in developing such medicines are most accurately described not as fetal cells themselves, but as cells that are fetal-derived: Cells originally taken from an aborted fetus that have been cultivated to multiply freely ever since.

The most widely used of these cell lines date back to just a handful of abortions in Europe in the 1960s. The WI-38 cell line, which has been used to develop vaccines for rubella, rabies, measles, mumps, and various other diseases, is derived from the lung tissue of a fetus aborted in Sweden in 1962; The MRC-5 line, used to produce vaccines for Hepatitis A and polio, dates back to 1966. Other lines are used for other purposes: HEK293 cells, which are derived from fetal kidney cells isolated in the Netherlands in the early 1970s, can be used to create virus-like cells that arent able to infect humans. Researchers use these pseudoviruses to test new therapeutics without having to handle live virus themselves, reducing the need for extreme biosafety precautions in laboratory settings. (The aforementioned Regeneron made use of HEK293 cells in this way.)

These cell cultures wont reproduce infinitely, but saying so almost feels like a technicality: Descendants of the WI-38 and MRC-5 lines have been used to create hundreds of millions of doses of vaccines over the past half-century.

Going by any sort of costbenefit analysis, the use of these cell lines has been a force for good in the world. By making use of the remains of a bare handful of elective abortionsabortions that would have taken place whether or not researchers decided to use thema staggering number of people around the world have been spared the miseries of a whole host of wretched and deadly diseases.

But for those who advocate for decoupling from such practices, simply to use the language of cost and benefit in the first place is to give away the game. If thats the measure, they argue, its hard to see how you could oppose any promising medical research, even the most depraved: How can you weigh the suffering of a few unfortunates against the ongoing benefits to all humanity of curing a deadly disease?

These sorts of ethical questions arent the exclusive domain of the pro-life movement. What posture we ought to take toward ill-gotten medical research is a question that has long occupied bioethicists, given how much of the science underpinning our current understanding and practice of medicine was conducted in unethical waysoften even by the standards of their own time, and even more so by the more exacting standards of the present.

The classic example, of course, is the gruesome human experimentation carried out by Nazi doctors in concentration camps, but there are examples closer to home, too: black men in Alabama whose untreated syphilis was allowed to fester for decades so government researchers could observe the progress of the disease, all the while assuring the subjects they were being treated; developmentally disabled children in New York given chocolate milk laced with feces to deliberately infect them with hepatitis as part of an effort to develop a vaccine.

Other ethical issues involve the origin of immortalized cell cultures in particular. The longevity of these cell lines is such that many of them predate modern medical standards on ethical human research, which werent truly codified until the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research, established by Congress for the purpose in 1974, published its Belmont Report in 1979. The oldest such cell line in existence is a culture of cervical cancer cells taken from a woman named Henrietta Lacks in 1951, who died of the disease that same year. Lacks never consented to having her cells cultured; nor did the women who obtained the abortions that resulted in the WI-38 or MRC-5 cells.

These fraught ethical issues are not a thing of the past. After decades of lobbying, the Lacks family finally won a partial concession from the National Institutes of Health in 2013 to place some restrictions on medical access to information about their relatives cells. Pro-life organizations continually push for researchers to divest from and seek alternatives to fetal cell cultures as well.

For some pro-life bioethicists, the vast distance between the harm of the original abortion and the use of the modern treatment in which it resulted means that, while policymakers and biotech firms still have a moral obligation to work toward developing ethically unproblematic alternatives, individuals dont necessarily have a moral duty to abstain from such treatments themselves. Medical ethics are complicated and a matter of conscience, said Tiffany Manor, who directs the Life Ministry of the conservative Lutheran ChurchMissouri Synod. Some modern medical procedures result from past research that was conducted unethically. That doesnt mean that we ought to throw out all of the beneficial procedures.

But others argue that individuals retain a moral duty to keep pressure on the medical research industry by declining the use of such treatments when possible without creating grave risks to public health. The Catholic Churchs Pontifical Academy for Life tried to strike such a balance when it considered the question in 2005:

On a cultural level, the use of such vaccines contributes in the creation of a generalized social consensus to the operation of the pharmaceutical industries which produce them in an immoral way. Therefore, doctors and fathers of families have a duty to take recourse to alternative vaccines (if they exist), putting pressure on the political authorities and health systems so that other vaccines without moral problems become available. They should take recourse, if necessary, to the use of conscientious objection with regard to the use of vaccines produced by means of cell lines of aborted human foetal origin.

The document goes on:

As regards the diseases against which there are no alternative vaccines which are available and ethically acceptable, it is right to abstain from using these vaccines if it can be done without causing children, and indirectly the population as a whole, to undergo significant risks to their health.

You can see the precarious moral tightrope here: It is good, in the mind of pro-life ethicists, to attempt as much as possible not to participate, however indirectly, in the evil act of a long-ago abortion. But one ought not strain so hard to avoid that participation that one thoughtlessly commits another evil act: allowing oneself or ones children to become vectors of otherwise preventable disease, spreading suffering and even death to those around them.

All this, remember, is just the moral calculus that surrounds such vaccine under normal medical circumstances. Throw in a global pandemic and an unprecedented race to treat and cure it, and you begin to get a sense of the scale of the ethical headaches involved.

Take the issue of Regeneron. Since his own positive experience with the companys antibody cocktail, REGN-COV2, President Trump has become its biggest cheerleader; pushing for it to play a major role in COVID treatment going forward. We have hundreds of thousands of doses that are just about ready. I have emergency use authorization all set, he said on October 7. Youre gonna get better, and youre gonna get better really fast.

But both Regenerons drug and a similar antibody treatment currently being developed by Eli Lilly made use of fetal tissue in their developmentnot in the actual manufacture of the drug, as mentioned above, but in creating neutered pseudoviruses to test its effectiveness.

Imagine a person whose doctor has recommended such a drug trying to make a decision in the light of the moral principles suggested by the Pontifical Academy for Life. On the one hand, the drug is a product of fetal tissue research in only the most remote possible way. But the possibility of endangering others by abstaining does not bear considering here, as the cocktail is a treatment, not a vaccine. Further, it is unclear how a person recommended such a treatment by a doctor ought to think about the question of whether there are ethically acceptable alternatives. Other drugs can help manage COVID, of course, but generally speaking their effect is cumulative: Dexamethasone and remdesivir are not replacements for antibody therapy.

To cap the dilemma off, it isnt as though a pro-life person could start off with unproblematic treatments and work up to REGN-COV2 as a matter of last resort: Patients arent prescribed antivirals or steroids for COVID unless theyre already seriously sick, while antibody treatments like Regenerons have been shown to be helpful only if theyre given very early in the course of the disease, before the bodys own immune response has had a chance to kick in.

COVID vaccines in development present further difficulties. First, we dont actually know which of the many vaccines currently being developed will end up the first to pass muster as a safe, effective, and mass-producible weapon against the pandemic. Many of the candidates do not make use of fetal-derived cells in any capacity. Others use such cells only in confirmatory tests, as with Regeneron. Still others use them in the production of the vaccines themselves.

Of the four vaccines seemingly closest to release in America, twothose being developed by Pfizer and Modernawere merely tested on fetal-derived cells. Two others, from Johnson & Johnson and AstraZeneca, are made with them. The latter vaccines Phase III clinical trials were placed on hold earlier this month, but were resumed last week.

Under ordinary circumstances, this would be a no-brainer: Many pro-life people would simply wait for one of the less objectionable vaccines to become available. But during the coronavirus pandemic, where every day that goes by without a vaccine is critical, what happens if Johnson & Johnson or AstraZenecas product is first past the post, and the federal government invests heavily in its development and distribution?

Its unclear whether such a situation would provoke a legal clash. The federal government doesnt have the constitutional authority to mandate vaccines, but states and cities can; all 50 states require children to receive a battery of vaccines before attending public school, although all offer various exemptions for religious, philosophical, and/or other reasons. Whether citizens have a right to such exemptions, however, is less clear: the Supreme Court has upheld mandatory vaccination programs in the past and has separately ruled that the right to practice religion freely does not include liberty to expose the community or the child to communicable disease.

Theres no reason to believe yet that states will choose to go that route. New York Gov. Andrew Cuomo, whose state was racked by the coronavirus this spring and who last year signed a state law ending religious exemptions for childhood vaccines, is thus far messaging that an eventual COVID vaccine will be available to all New York residents who want one.

The likelier scenario may be that such a clash will instead simply play out in the court of public opinion.

One of the nightmare scenarios Ive been thinking about is, say we get a safe and effective vaccine, and it comes from what many would regard as tainted sources, said Mitchell. And so pro-lifers decide not to use the vaccinethey wont be vaccinated. My guess is that there would be a huge uprising in the society saying, Well, youre posing now a public health risk. We now have a vaccine, but youre choosing not to use it. Youre exposing others to it by not taking the vaccine, or youre going to cost our health care system huge amounts of money in treating you when we have a vaccine that could prevent getting COVID-19, but you choose not to. So I think those are going to be an important test of our convictions.

Photograph by Paul Hennessy/NurPhoto/Getty Images.

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Is the Pro-Life Movement on a Collision Course with the Coronavirus? - The Dispatch