For millions of Americans who are immunocompromised, protection against COVID-19 is far from guaranteed, even after vaccination.
Fifteen months into the COVID-19 pandemic, a sense of normalcy is returning to American cities. With more than half of adults fully vaccinated, masks, in many cases, are coming off.
But for millions of immunocompromised Americans, vaccine protection is far from guaranteed.
Are the COVID-19 vaccines as effective for immunocompromised people?
- Lana Duran, organ transplant recipient with an autoimmune disease
- Dr. Victoria Shanmugam, director of rheumatology at George Washington University
- Dr. William Schaffner, infectious disease expert at Vanderbilt University
- Dr. Mounzer Agha, director of Mario Lemieux Center for Blood Cancers at University of Pittsburgh Medical Center
- Dr. Brian Boyarsky, research fellow at Johns Hopkins Medicine
- Study on vaccine antibody response in blood cancer patients
- Study on vaccine antibody response in organ transplant recipients
No, research suggests the COVID-19 vaccines are not as effective for immunocompromised people.
WHAT WE FOUND
As Lana Duran watches her Washington, D.C. neighborhood reopen, her mask is staying on.
“It’s been stressful,” Duran said. “I wish I could feel that sense of freedom.”
The 31-year-old suffers from lupus, an autoimmune disease causing her body to attack her heart and kidney. She received a kidney transplant five years ago.
“I am more at risk of catching COVID-19 and more likely to die from it,” she said.
Duran got vaccinated in March, hoping for protection. But it may not have worked. Antibody tests performed by her doctor show no response to the vaccine.
“So, I don’t have any protection,” she explained.
An estimated 12 million Americans, around 4% of the country, are immunocompromised, meaning their immune system doesn’t work as well. That includes some cancer patients, organ transplant recipients, those with autoimmune diseases and others.
Most of those groups were excluded from last year’s COVID-19 vaccine trials. Now, their responses to the vaccines are being studied, and the early data is concerning.
For the vast majority of people, the vaccines will stimulate their immune system and create antibodies to protect against COVID-19, according to experts.
But in a study of organ transplant recipients, 46% had no antibody response to the Pfizer or Moderna COVID-19 vaccines. And those who did often showed low levels of antibodies. Dr. Brian Boyarsky authored the study.
“This was in stark contrast to the 100% of healthy people in the original trials, who developed antibodies,” Dr. Boyarsky said. “This was surprising and concerning for us because we believe that a lack of antibody response to the vaccine could mean that someone is at a higher risk for developing the infection, or a severe form of the infection, after vaccination.”
Another study of blood cancer patients showed similar results, with 46% producing no antibodies after their shots.
“This is preliminary data,” said Dr. Mounzer Agha, who authored the study. “You cannot rely on the antibody response solely to say whether the vaccine has worked or not. But when some patients do not have any evidence of antibodies, it is a fair statement to assume that those patients are not protected by the vaccine.”
For some patients, their illness itself can compromise their immune system. But experts think most aren’t producing antibodies because of immunosuppressive medications they’re either actively taking or have taken at some point in their lives.
“There are patients where we’ll specifically recommend that they adjust the timing of their regular medications around the time of their vaccine,” said Dr. Victoria Shanmugam, director of rheumatology at George Washington University. Shanmugam treats patients with a range of autoimmune diseases and is one of many doctors now testing immunocompromised patients for antibodies to see if they’ve responded to the vaccine.
“We don’t have data that really tells us at what antibody number are you protected against the virus,” Dr. Shanmugam said. “I’ve had patients who have zero antibody response after being vaccinated. I would have to assume that those patients are still as vulnerable as a non-vaccinated individual.”
Dr. Shanmugam is recommending those patients remain vigilant, and continue practicing COVID-19 safety measures like wearing masks and distancing.
In May, the U.S. hit a massive milestone, with more than half of American adults fully vaccinated against COVID-19. But a Gallup poll published in early May found 25% of the country is still unwilling to get their shots.
“Vaccine hesitancy is going to continue to have this virus smolder,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.
“The more of us that are vaccinated, the more difficult it is for the virus to get through us to the immunocompromised person… If people really accept vaccination and we get vaccination rates up to 80+% or higher, then immunocompromised people will feel more comfortable going out and having a near-normal life,” he explained.
Lana Duran is living as if she didn’t get the vaccine. She quit her job as a pastry cook last year over COVID-19 safety concerns. She’s now working from home. Her Washington, D.C. apartment building just lifted its mask requirement for common areas.
“I reached out like, listen, I live in this building, I’m immunocompromised, can we change it?” Duran recalled. “They’re like, no, I’m sorry. We’re following the CDC guidelines.”
Duran just got her first dose of the Pfizer vaccine two months after getting the Johnson & Johnson vaccine.
“I just hope something works,” she said.
She hasn’t seen her family since the pandemic started. She lost her grandmother to the virus last September.
Now, she’s hoping more hesitant Americans get their shots. Otherwise, she fears her return to normalcy may take many more months.
“I totally get it, but what about us?” Duran asked. “I feel like a big group of us are left behind.”
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