En español | The COVID-19 vaccines have been hailed as miracles, but for some people with conditions that weaken their immune systems the shots may not be a panacea. That's because the vaccines may not provide them with enough antibodies to fight off the novel coronavirus.
A healthy immune system is often compared to a giant army attacking infections and other health conditions. But at least 10 million Americans have compromised immune systems, many because they have a condition that requires them to take anti-inflammatory drugs or similar medications. They include organ transplant patients who are prescribed an array of drugs to prevent the rejection of the transplanted organs, cancer patients and people with lupus, multiple sclerosis, rheumatoid arthritis and HIV/AIDS.
For them, that vulnerability could undercut the promise that the vaccines now being injected into the arms of millions nationally will bring immunity and liberation from COVID-19 for everyone.
In general, doctors treating patients with these conditions recommend they get a COVID vaccine because some protection is better than none. But experts and the Centers for Disease Control and Prevention (CDC) suggest that people with these conditions consult with their health care providers before getting vaccinated.
The CDC also recommends that even after getting vaccinated, those with compromised immune systems should consider still taking precautions against COVID-19, including wearing a mask and staying six feet apart from people who don't live with them. Doctors also recommend that people with these conditions ask their relatives and friends to get vaccinated.
Doctors performed 39,000 organ transplants in 2020, with kidney transplants leading the way.
Those receiving new organs typically take medications that prevent the immune system from going to war against the donated organ. “If the immune system is too active, it attacks the new organ,” says Peter Chin-Hong, a professor of medicine at UC San Francisco who directs its immunocompromised host infectious diseases program.
Those same drugs appear to undercut the vaccine's antibodies. In fact, a May 2021 study of 658 transplant recipients found that 46 percent had no antibodies after they received two COVID-19 vaccine shots.
The study, from the Johns Hopkins University School of Medicine in Baltimore, has received widespread attention among transplant recipients, experts said. They said they were not surprised by the results.
That's why transplant doctors often try to plan ahead and have patients get vaccinated before surgery, said Joseph G. Timpone, M.D., section leader for transplant and immunocompromised services at MedStar Georgetown University Hospital in Washington, D.C.
Organ recipients should be vaccinated, and so should their household members and caregivers, says a June 2 letter from 24 groups representing professionals in transplant medicine.
A new Johns Hopkins study signals that transplant patients may benefit from so-called “booster dosing,” getting an extra dose of the COVID-19 vaccine. The study of 30 transplant recipients with low antibody levels found that a third dose boosted antibody responses in 14 of the recipients.
People with cancer can be more susceptible to infections.
"Both the underlying medical condition and immunosuppressive regimens may affect the immune response", says Meghan Baker, M.D., a hospital epidemiologist who works with immunocompromised patients at Dana Farber Cancer Institute and Brigham and Women's Hospital in Boston.
Those with blood cancers may be more at risk of long-term infection and death than those with solid tumors. That's because they frequently have lower levels of immune cells that produce antibodies, says the National Cancer Institute.
Certain cancer treatments can suppress the immune system, including chemotherapy or stem cell or bone marrow transplants.
Most immunocompromised cancer patients will get some protection from the COVID-19 vaccines, but they should take precautions to minimize their exposure to the novel coronavirus, Baker says. Meanwhile, she adds, “There are active studies to determine if and when a booster vaccine may be appropriate."
An estimated 1.2 million people in the United States have HIV, or human immunodeficiency virus. If untreated, HIV can advance to AIDS, known as acquired immunodeficiency syndrome. But new infections are down more than two-thirds since the epidemic's harshest years in the mid-1980s. New drugs are stabilizing existing cases.
"Between 50 percent and 70 percent of people with HIV/AIDS are on medications that have made their immune systems intact,” says Carole Treston, executive director of the Association of Nurses in AIDS Care, in Uniontown, Ohio, and Washington, D.C.
Treston supports federal guidelines that all people 12 and older — except those with previous vaccine allergy reactions — be vaccinated. She points to federal guidance that says people with HIV “should receive COVID-19 vaccines, regardless of their CD4 or viral load, because the potential benefits outweigh the potential risks.”
Lupus is an autoimmune disease, meaning that the body's immune system attacks its own organs and tissue. It affects 1.5 million people in the United States, mostly women of child-bearing age.
It is characterized by mild or no symptoms interrupted by “flares” or flare-ups, periods when symptoms worsen. Lupus can also lead to serious problems such as kidney failure, blood clotting and heart attacks.
The lupus immune system is less capable of fighting infections, says Ashira D. Blazer, M.D., a rheumatologist at NYU Langone Health in New York City. And when a lupus patient has an active flare, the immune system is less effective in combatting such infections, she said.
The medical center recommends that lupus patients get the COVID-19 vaccines, and those who have are not getting more flares than those who have not. But those experiencing moderate to severe flares should confer with their rheumatologists about the vaccines’ risks and benefits, she said.
"Some medications that are required to treat more serious lupus features may decrease the vaccine's efficacy,” Blazer adds.
5. Multiple Sclerosis
Like lupus, Multiple Sclerosis (MS) is an autoimmune disease. A patient's immune system attacks the protective coating on nerve fibers, which can be damaged or even destroyed. Symptoms include muscle spasms, loss of balance and the inability to walk.
Nearly 1 million people in the United States age 18 and over have MS. Some treatments can rein in the immune system's ability to fight infection, says Julie Fiol, associate vice president of health care access for the National MS Society.
For instance, people taking certain medications “will have a reduced and possibly indetectable antibody response to the COVID-19 vaccines,” Fiol says. But even then, other parts of the immune system may kick in and offer protection.
Clinical trials have been launched to probe how those with multiple sclerosis respond to the vaccine.
"These studies are critical for people with MS,” Fiol says, “So they can understand their level of protection and feel comfortable returning to their ‘normal’ as many others already are.”
Deborah Schoch is a contributing writer who covers health and science. A longtime journalist, she has most recently done work for AARP, The New York Times and KNBC-TV Los Angeles.