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Why Some Immunocompromised People May Not Be Eligible for a COVID-19 Vaccine

  • People with weakened immune systems can benefit from the coronavirus vaccine even if they have to wait longer to get it.
  • Two vaccines — Pfizer/BioNTech’s and Moderna’s — are likely to receive emergency approval this month from the Food and Drug Administration (FDA).
  • People with compromised immune systems can still benefit from widespread vaccination through what’s known as community immunity, or herd immunity.

Many people with a weakened immune system have a higher riskTrusted Source of severe COVID-19.

This includes people with cancer or HIV or those who have organ transplants. Also included are bone marrow recipients, and people taking corticosteroids or other medicines that suppress the immune system.

Public health experts have recommended that people who are immunocompromised take steps to avoid being exposedTrusted Source to SARS-CoV-2, the coronavirus that causes COVID-19.

This includes staying home as much as possible, practicing physical or social distancing, and wearing a cloth mask when around others.

But what about the coronavirus vaccines? Will these offer another level of protection for people who are immunocompromised?

Two vaccines — Pfizer/BioNTech’s and Moderna’s — are likely to receive emergency approval this month from the Food and Drug Administration (FDA). Preliminary data suggests the vaccines can protect against symptomatic coronavirus infection.

However, these vaccines won’t be approved initially for use in people who are immunocompromised. This group, though, could still benefit from widespread coronavirus vaccination.

“We will eventually be able to offer protection to [immunosuppressed people], either through direct vaccination or by indirectly protecting them through herd immunity,” said Dr. Edward Jones-Lopez, assistant professor and infectious diseases specialist at Keck Medicine of University Southern California.

Immunocompromised not included in initial vaccine trials

All vaccines have to go through clinical trials before they can be approved for use by the FDA. The initial coronavirus vaccine trials have been done in the “general” population.

This includes healthy, younger adults, as well as older adults and some people with well-controlled health conditions such as diabetes or heart disease.

But these trials have excluded particularly high-risk or vulnerable populations such as children, pregnant women, and the immunocompromised.

Studies involving these higher-risk groups are generally done only after the initial vaccine studies have finished.

“Once the vaccine is deemed safe and effective within the general population,” said Jones-Lopez, “other studies are done that target these specific high-risk populations.”

Though most immunocompromised people were excluded from the initial coronavirus vaccine trials, one group was included — people 65 and older.

In general, older adults have less effective immune responses, including poor responses to vaccines. That’s why this group gets a higher-dose flu vaccine each year.

Jones-Lopez said that for the other groups — especially those who are severely immunocompromised — there isn’t enough data to know if the coronavirus vaccines will be appropriate for them.

“I would say we are one or two studies away from finding this out,” he said.

Another issue with vaccinating people who are immunocompromised is that some vaccines contain live, weakened virus or bacteria. This, however, is not the case with the two vaccines most likely to be approved first.

These types of vaccines don’t generally cause illness in healthy people but can be riskier for those with a weakened immune system.

For example, the chickenpox and herpes (zoster) vaccines aren’t recommended for people with severely compromised immune systems.

Of the more than 100 vaccines being developed to protect against COVID-19, only a few use a live, attenuated coronavirus virus. These vaccines, though, are all still in the very early stages of development.

Community immunity protects the most vulnerable

If the FDA issues an emergency approval for a coronavirus vaccine, it will specify which groups of people can receive it.

Given the lack of clinical trial data on the use of these vaccines in people who are severely immunocompromised, Jones-Lopez thinks the vaccines will not be approved initially for this group.

However, the immunocompromised can still benefit from widespread vaccination through what’s known as community immunity, or herd immunity.

Community immunity occurs when enough people have been vaccinated in a population to slow the spread of a virus.

“If we hit 70 to 75 percent [coronavirus vaccination],” said Jones-Lopez, “then we could reasonably assume that everybody else is going to be protected.”

Of course, if some communities have lower coronavirus vaccination rates, the virus can more easily spread in those areas, which increases the risk to people who are immunocompromised.

Dr. Anthony FauciTrusted Source, director of the National Institute of Allergy and Infectious Diseases, thinks certain people with weakened immune systems should plan to get the coronavirus vaccine when it is available to them.

“It is clear that if you are on immunosuppressant agents, history tells us that you are not going to have as robust a response as if you had an intact immune system that was not being compromised,” Fauci said last week at the 62nd American Society of Hematology Annual .

“But some degree of immunity is better than no degree of immunity,” he said. “So for me, it would be recommended that these people do get vaccinated.”

Still, if you’re immunocompromised, it’s a good idea to check with your doctor before getting the coronavirus vaccine to make sure it’s the best option for protecting your health.

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