If you are wondering why some people die from complications from COVID-19 although they had been fully vaccinated, it is probably because they are immunocompromised. Immunocompromised individuals may not mount strong immune responses to COVID-19 vaccines, says Medical expert.
Since the Food and Drugs Authority of America authorized the first COVID-19 vaccine, people with compromised immune systems have lived in limbo, waiting to find out whether, or how much, vaccination might protect them. The vaccine clinical trials excluded nearly all immune-compromised people because including them might interfere with determining vaccine effectiveness for the general population. But that’s left this group with little data on what vaccination means for them.
This explainer will attempt to answer all such related questions.
First, who are immunocompromised people?
Medical experts say Immunocompromised individuals may be categorized into two broad categories: those who have a genetic mutation or an illness, such as HIV, that impairs immune function; and those who take certain drugs, including immunotherapy, to treat certain diseases. Immunotherapy is a method of suppressing or dampening immune responses when the immune system is “overactive,” as in autoimmune diseases, in which immune cells target healthy tissue, or following organ transplantation.
Rheumatoid arthritis, type 1 diabetes, multiple sclerosis (MS), and inflammatory bowel disease (Crohn’s and ulcerative colitis) are all autoimmune illnesses that trigger this hyperactive reaction. Simply, MD, a blood cancer specialist from Smilow Cancer Hospital in the US Dr Stuart Seropian in a media interview said that “In general, the more immunocompromised someone is, the less effective vaccines will be for them.”
“The immune system has two basic functions: to identify foreign tissue and to provide defence against infection,” he explained.
Dr Seropian said people are said to be immunocompromised primarily “when they are more vulnerable to infection than healthy individuals, because of issues with at least one of those two functions.”
Currently, no data exist on the vaccines’ effectiveness in immunocompromised patients because, as is true with the development of all vaccines, they weren’t included in the initial clinical trials. Medical experts say such persons need to speak with their doctors before taking the jab.
“That’s why it’s really important for people who have these immune-suppressed conditions to talk to an expert about their specific situation because there is such a great amount of variability,” says an infectious disease fellow at the University of Pennsylvania Perelman School of Medicine Aaron Richterman.
In Ghana, however, the Federation of disabled organizations said with the hope of being inoculated, members of the Share-care Ghana group who are living with auto-immune and neurological conditions have had to suspend their medications before the inoculations.
Sadly, they are still yet to be given the jab 7 months after vaccination had begun in Ghana.
The World Health Organisation said this could be fatal as Persons with disabilities may be at greater risk of severe disease and death if they become infected with COVID-19 due to: health conditions that underline their disability; and barriers to accessing appropriate and timely health care, which arise from the difficulty in communicating symptoms; inaccessibility of transportation, health facilities and telehealth services; gaps in support and assistant services; and discriminatory triage procedures.
What do studies say about this group?
Early research seems to suggest it will be a mixed bag — that although some immunocompromised individuals may make antibodies, others may not. And for those who do, it is not known whether the antibodies will be effective at neutralizing SARS-CoV-2, what level of antibody will be needed to protect against infection or how long the antibodies will last.
An infectious diseases physician at the University of Pittsburgh Medical Center who specializes in organ transplant recipients, Ghady Haidar said he and his team studied immune responses in blood-cancer patients who received both doses of one of the mRNA vaccines and discovered that 46 per cent of them did not produce any antibodies against covid-19. Haidar has since led a subsequent study showing that the vaccine-induced antibodies varied depending on the type of underlying immune system issue.
“These were expected results, as disappointing as it is,” Haidar said of the findings.
Similarly, a news report published by the Washinton Post said a research letter that was published in JAMA found that 46 per cent of 658 transplant patients did not mount an antibody response after completing either the Pfizer or Moderna vaccine series. And some research suggests that some treatments may impact immune responses.
Why covid vaccines don’t work well on immunocompromised people.
The objective of the vaccinations is to elicit a strong immune response against a harmless variant of a virus. Then, when the actual infection arrives, the body is prepared to defend itself. However, if a person’s immune system is impaired, that reaction may be weakened—or even disappear entirely.
“In general, the more immunocompromised someone is, the less effective vaccines will be for them,” says Dr Seropian.
Previous research on vaccinations against other viruses, including influenza, indicates that immunocompromised individuals do not mount the same response to vaccines as healthy individuals. The same has been proven to be true with COVID-19 vaccines.
Health experts say it is a common practice to give immunocompromised patients additional doses or higher doses of a vaccine to try to generate a stronger immune response, and research has shown that such patients can develop increased antibodies after a third shot of the coronavirus vaccines. A Washinton Post report said a paper published in the New England Journal of Medicine found that organ transplant recipients who took both doses of the Moderna vaccine had “substantially higher immunogenicity” — meaning an effective immune response — after a third shot.
As with most vaccines, it is hard to say exactly how much more protection the extra coronavirus shot will provide as it will vary from patient to patient. An infectious disease expert who works with HIV patients at the University of California in San Francisco Monica Gandhi said the third dose is likely to give many a boost.
What more can I do to protect myself against the virus?
Health experts agree that most immunocompromised people should still get vaccinated, because, to recap, many may make protective antibodies, though some may need a third shot. And others may still achieve protection from the cellular side of the immune system as it is revved up by the vaccine.
It may also be necessary to work with treating physicians to balance the timing of the shots with any immune-suppressing treatments such as chemotherapy or other medications for underlying illnesses.
Aside from this, health experts said, those with immune system deficiencies should still be cautious — continuing with frequent hand-washing, mask-wearing, social distancing and also choosing the types of gatherings that are the safest for them even after vaccination.
This story is supported by Journalists for Human Rights under the Mobilizing Media to Fighting Covid-19 project.
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