# An Ethical Analysis of Public Attitudes towards Controlled Human Infection Studies in Singapore: Acceptability and Payment

## TL;DR

This study explores public attitudes in Singapore towards controlled human infection studies involving SARS-CoV-2 and examines ethical concerns, including participant payment.

## Contribution

The study reveals Singaporeans' support for higher payment models in CHI studies and suggests that acceptability may not depend solely on institutional trust.

## Key findings

- Most Singaporeans support CHI studies despite limited prior knowledge about them.
- Participants favor higher payment rates, such as SGD$30 per hour.
- Support for CHI studies in Singapore is comparable to the UK despite differing levels of public trust.

## Abstract

Singapore is conducting its first controlled human infection (CHI) study, and is administering SARS-CoV-2 as the challenge agent. Ahead of this study, we conducted a survey to assess public perceptions in Singapore of CHI studies in general and with SARS-CoV-2, and the ethical issues they raise, including those around payments to research participants. Overall, there was large support for challenge studies in Singapore, suggesting they could obtain a social license. However, a minority strongly disagreed, and most respondents reported limited pre-survey knowledge about CHI studies. Importantly, Singaporeans support a higher incentive model of payment than is usually employed in challenge study research. They support either a Market Model or a Payment for Risk Model. There was most support for paying participants the highest rate offered—in our study, it was $SGD30 per hour. These results were broadly in line with a similar study in the UK, despite the latter having notably lower reported levels of public trust and, most recently, a highly criticized response to COVID-19. As such, general support for CHI studies may not be a direct function of background confidence in public or biomedical institutions but reflect other factors such as their intrinsic value and importance. More direct cross-cultural research in different contexts concerning attitudes towards CHI studies could help shed light on the extent that localized factors such as culture, history, and infrastructure affect both their acceptability and attitudes towards participant payment.

The online version contains supplementary material available at 10.1007/s41649-024-00335-z.