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By Dorry Segev and William Werbel
Dr. Segev and Dr. Werbel are researchers who treat transplant recipients at Johns Hopkins University School of Medicine. They are studying Covid-19 vaccine responses in immunocompromised people.
From the beginning of the Covid-19 pandemic, the risk of getting infected with the coronavirus and developing severe disease from it was substantially higher for the millions of Americans with weakened immune systems because of treatment for cancer, autoimmune disorders, transplants and many other conditions.
Vaccines promised a respite. But physicians like us who care for immunocompromised people quickly learned that our patients’ immune responses from vaccines were often weak. For example, in one study we showed that transplant recipients who were vaccinated with two doses of mRNA vaccines made by Moderna and Pfizer had an 82-fold higher risk of infection and 485-fold higher risk of hospitalization or dying compared with the vaccinated general population overall.
These revelations were frightening, and without clear guidance from health officials on how to proceed, many immunocompromised people took it upon themselves to find solutions. Some figured out how to get additional vaccine doses by finding pharmacies that didn’t ask about prior doses or by persuading doctors and pharmacists to help them.
In an effort to increase immunity in this group, the Food and Drug Administration eventually authorized an additional third vaccine dose of the Pfizer and Moderna vaccines in August. Omicron has since added to the urgency for the immunocompromised. Some people have sought fourth and fifth doses though the safety and effectiveness has not been fully studied. In an encouraging step, the Centers for Disease Control and Prevention will now allow some people with weak immune systems to get a fourth dose this year, but only as a booster taken five months from their last shot.
High-risk people should not be made to feel that they are on their own to protect themselves. Public health officials and other providers must realize that Omicron is especially scary for the immunocompromised because it is so contagious and widespread and can infect people even with robust immune systems.
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