Analysis

Let's talk about immunocompromised people and the COVID-19 vaccine

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Everyone has heard politicians and public health leaders pleading with Americans to get one of the three available vaccines for SARS-COV-2 — the virus that causes the disease COVID-19.

And vaccination rates are increasing to a point where pandemic restrictions are beginning to loosen and promises of “hope” for a “return to normalcy” continue to be dangled before us. 

Two of the vaccines have efficacy rates in the mid-90% range, the Moderna and Pfizer vaccines. Both require two doses, separated by weeks, to be effective. A third vaccine, made by Johnson & Johnson, is a single-dose shot, with a lower efficacy in preventing infection, but the same record in stopping people from becoming sick enough to require hospitalization.

The vaccines work and at incredibly high levels of efficacy. In fact, public health officials say the high efficacy would be a dream for standard influenza vaccines, which are considered very good at just 60% efficacy.

Despite all the hoopla and PR, one group of Americans continues to get a confusing message about when and whether to take the vaccine: the immunocompromised community. But federal guidance on vaccination for this group is complicated. The U.S. Centers for Disease Control and Prevention (CDC) website recommends vaccination, but then refers individuals to their primary care doctors to discuss their specific case.

Why?

“The principle is that you can take the vaccines,” said Dr. Natasha Bagdasarian, an epidemiologist who consults with the Michigan Department of Health and Human Services (DHHS). “But there is always a potential for extenuating circumstances where that doesn’t apply.”

Clear as mud, right?

Actually, it is. Not all immunocompromised people have the same level of problems with their immune system. So the real question becomes: Will the body have enough of an immune system to have an immune response — to create antibodies against coronavirus — or not? And that is a very personal exploration requiring consultation with a doctor.

How many Americans are immunocompromised is unknown. But a 2013 study published in the Journal of the American Medical Association found that 2.7% of Americans had such a condition.

Being immunocompromised can be the result of disease, like HIV; autoimmune diseases, where the body attacks itself; medications to prevent rejecting an organ transplant; or actively receiving specific types of chemotherapy to treat cancers.

To better understand this conundrum, I reached out to my personal physician, Dr. Erik Wert. He has an autoimmune condition requiring regular infusion treatments to suppress his immune system. But he got a vaccine — the J&J version. He said he spoke with his own physician about this choice and the two landed on the J&J option because it was a more traditional vaccine and more likely to trigger an immune response in his body.

But in my case, as someone living with HIV, the decision he and I arrived at by looking at my labs was that I should not take any of the vaccines at this time. My current immune function is quite suppressed and likely would not allow a response to occur.

In fact, we think when I had COVID in February 2020, that’s exactly what happened. I had the disease, but because I had such a poor immune system, it may actually have prevented me from dying because I was unable to mount the overwhelming immune response tied to so many deaths by COVID. Unfortunately, that also means we don’t know if I have immunity from that infection.

So no COVID vaccine for me right now.

And Bagdasarian said that’s why other people getting the vaccine becomes so important. The creation of “herd immunity” which scientists believe will happen when 70% or more of the community is vaccinated, ultimately protects a person like me. The virus essentially has nowhere to go because so many people already have an immune system primed to destroy the virus if it enters the body. If the virus can’t replicate, it can’t be transmitted to another person — you know, like me.

How many Americans will ultimately be advised to reject the vaccine because of their immune function remains unclear. Bagdasarian said that while clinical trials didn’t necessarily focus on immunocompromised persons, the “real life” application of the COVID vaccines shows that it is working for at least some in the immunocompromised category.

But folks like me? We have to rely on folks like you to get vaccinated to help us avoid death.

This column was originally published online for Michigan Advance. 

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