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Is the COVID-19 vaccine safe and effective for immunocompromised people?

There's concern people with immune disorders may still be vulnerable to COVID-19 even after vaccination.
Illustration of woman's back with COVID-19 spores around her on a green background.
It’s estimated there are about 10 million immunocompromised people in the U.S.TODAY Illustration / Getty Images
/ Source: TODAY

Alan Sporn thought he was protected from COVID-19 after he received both doses of the Pfizer-BioNTech vaccine, with the second shot coming in February.

But the 75-year-old Illinois businessman died on March 29 after testing positive for the coronavirus and developing pneumonia, NBC Chicago reported. His family was stunned to find that the vaccination provided little protection for Sporn, likely because he was immunocompromised — diagnosed with chronic lymphocytic leukemia, a type of blood cancer, in 2019.

"He had eight antibodies," Bonnie Sporn, his daughter, told the station. "And you're supposed to have thousands of (antibodies). You know after you get your second vaccine, it should show up in your system."

The family said it was speaking out to alert other immunocompromised patients about their continued risk and the need to keep taking precautions and stay vigilant for symptoms even after they get the shot.

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Indeed, the Centers for Disease Control and Prevention advises people with weakened immune systems to “be aware of the potential for reduced immune responses to the vaccine, as well as the need to continue following current guidance to protect themselves against COVID-19.”

It’s estimated there are about 10 million immunocompromised people in the U.S. That entails a “large and diverse group” of Americans, said Dr. Paul Offit, an infectious disease physician and director of the Vaccine Education Center at Children's Hospital of Philadelphia. Some people are born unable to respond to infections because of defects in their T cells and B cells, disrupting antibody production.

Others have an acquired immune deficiency because they're undergoing chemotherapy or radiation for cancer, or receiving immune-suppressing treatments for their chronic diseases or autoimmune diseases. Transplant recipients must also take drugs to curb their immune system to keep it from rejecting the new organ.

People with compromised immune systems face two main questions when it comes to the COVID-19 vaccine: Is it safe and does it offer any protection?

Is the vaccine safe?

The first question is easier to answer, Offit said.

“It's safe even if you don't have an immune system,” he told TODAY. The Pfizer and Moderna vaccines use mRNA technology, which means the shots don’t contain a weakened live bug that could pose a threat in a vulnerable patient, and the Johnson & Johnson vaccine is replication defective, so the virus cannot reproduce itself in the vaccine recipient.

“Therefore it can't possibly, in that sense, do harm,” he noted.

The CDC says people who have weakened immune systems or autoimmune conditions may receive the COVID-19 vaccine, but should be aware the safety data is limited.

These patients were largely excluded from COVID-19 vaccine trials, so researchers at the National Institutes of Health are now recruiting participants for a clinical trial examining the immune response in people with different immune disorders or on immunosuppressive medications.

Is the vaccine effective?

There isn’t a one-size-fits-all answer because that depends on a person’s degree of immunosuppression and the nature of the underlying disease.

“There's a whole range of chemotherapies and biologicals that have different effects on your immune system, so it's a whole spectrum of suppression,” Offit said.

For example, three weeks after one dose of the Pfizer vaccine, only 39% of solid cancer patients and 13% of people with blood cancer showed an antibody response, compared to 97% of healthy people, a King’s College London study found in March.

“Some blood cancer patients may not get optimal protection from the vaccines and may be more susceptible to COVID-19 infections after vaccination compared to the general public,” the Leukemia & Lymphoma Society warned.

When it comes to organ transplant recipients, only half developed antibodies after two doses of a COVID-19 vaccine, researchers at Johns Hopkins University found.

In another study, only 3 in 13 patients with chronic lymphocytic leukemia — the blood cancer Sporn, the Illinois businessman, was diagnosed with — had measurable antibodies, even though 70% of them weren’t undergoing cancer therapy.

“This lack of response was strikingly low,” said Dr. Mounzer Agha, the study’s lead author and a hematologist at UPMC Hillman Cancer Center in Pittsburgh, Pennsylvania, in a statement. “It’s critically important for these patients to be aware of their continued risk.”

Advice to patients:

Since there’s no safety issue, there's no downside to getting the vaccine, Offit said: “It's certainly worth a try.”

Even though blood cancer patients may not respond fully to the vaccine, this does not mean vaccination is futile, the Leukemia & Lymphoma Society noted.

People with a fragile immune system are at risk for severe COVID-19, so getting even some protection from the vaccine is better than having none at all, the American Cancer Society noted.

Offit recommended people with compromised immune systems have their antibodies measured after they get the COVID-19 vaccine to gauge the amount of response.

Patients may want to ask their doctor whether it’s worth suspending their immune-suppressing medication or treatment for a while and then get vaccinated. Offit recently talked with a person with multiple sclerosis who was considering that step at the risk of having the disease flare up.

“In some cases… it is safe to hold the medication for a short period of time to allow a better response to a vaccine,” said Dr. Kathleen Mullane, an infectious disease physician at The University of Chicago Medical Center specializing in immunocompromised patients, in a statement.

“(But) many of these medications have a prolonged duration of action in the body, and delaying a dose may not have much effect on enhancing the immune response to a vaccine.”

People waiting for an organ transplant may want to get the vaccine before the surgery if possible, Offit said.

Patients who don’t have a robust response to the shot are not defenseless against COVID-19. They can mask, social distance and take other precautions to stay safe. While the CDC has announced that fully vaccinated people no longer need to wear masks or physically distance in most indoor and outdoor settings, the agency cautioned that people with compromised immune systems may need to continue taking all those precautions even after vaccination.

Monoclonal antibodies could be a vaccine alternative of sorts, but their protection fades after about three months, so people would have to repeat the infusions, Offit said.

Bottom line: Talk with your doctor about which precautions you still need to take after being fully vaccinated.