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Drugs are controlled against the alternative treatment often enough. The study needs to be designed differently, but statistics can do this.

You pick a high risk group that either doesn’t have access to prep

For the HIV vaccine trials, all participants are educated about and are offered free PrEP. There will be participants who choose not to take the PrEP anyway, and there will be people who are not compliant with PrEP's dosing schedule, which will reduce its efficacy against HIV acquisition.

That's only a problem for the studies. I'm talking about after the studies. I can see a lot of at-risk people saying "Yeah, I'll do both."

I was joking to my doctor that when I get access to the COVID vaccines, I plan on Moderna in one arm and Pfizer in the other.

The comment you replied to was specifically asking how the trial would work given PrEP though.