Experts say vaccination benefits outweigh risks
Joanne Troutman always knew she was going to get vaccinated against COVID-19. She’s a strong supporter of vaccines and runs a United Way in rural Pennsylvania that offers services to people who are in need.
But she admitted some apprehension about what would happen after the needle plunged into her shoulder.
Troutman has struggled with autoimmune disease for years. Would the immune trigger send her disease into overdrive again?
None of the large-scale vaccine trials included people who are immunocompromised, though every indication is that vaccines are safe in this group. Organizations representing experts in cancer, organ transplantation and autoimmune diseases all support vaccination for their patients.
Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said Wednesday that there are still questions about vaccines and the immunocompromised.
It’s remains unclear, he said at a news conference, whether people who are immunocompromised make a comparable immune response to those without these conditions, whether the protection from vaccines will last as long in them and whether they will be able to transmit the disease after vaccination.
There’s no question people who are immunocompromised are at higher risk
for bad outcomes if they do get COVID-19, he said.
People with compromised immune systems are also more likely to spread the virus to others, several experts said, and may be more likely to foster the variants that threaten to make the disease more dangerous and vaccines less effective.
“We have an amazing opportunity to prevent people from getting ill,” said Lewis Teperman, director of transplantation at Northwell Health, a large care provider in New York.
Some people who are immunocompromised are hesitant, mostly out of fear of flare-ups and lack of long-term data. In a survey by the Leukemia & Lymphoma Society, 70% of the 6,516 patients and survivors who participated said they were “likely” or “very likely” to be vaccinated – no more than the general population, although people with blood cancer are three times more likely to die from COVID-19.
“These are people at high risk of contracting this illness, but more importantly, if they become sick, the downside consequences of morbidity and mortality are just so enormous,” said Reni Conti, who helped conduct the research at Boston University.
Some hesitancy in this group is natural, said David Pugliese, division chief of rheumatology at Geisinger Health System in Pennsylvania: “If I was in their shoes, if I was on immunosuppressing medications and had an autoimmune disease, I would want to talk to someone about it before I rushed over and got a shot.”
For Troutman, president and CEO of the Greater Susquehanna Valley United Way, it was never a question of whether she’d get vaccinated. In addition to her work, she’s a primary caregiver for her father, who was diagnosed with lung and jaw cancer last year. Her mother-inlaw is battling colon cancer.
Her own health issues – fibromyalgia, small-fiber neuropathy, an autoimmune disorder – might make her more vulnerable to a bad case of COVID-19.
Since her mother is a COVID-19 nurse, Troutman heard horror stories over the past year about how bad the disease could be.
“If there’s any way I could prevent having my family have to go through that, of course I’m going to do that,” Troutman said.
Everyone in her support group for people with autoimmune issues has gotten vaccinated, she said. “I’m definitely feeling it was the right decision.”
At the American Cancer Society, there are far more cancer patients and survivors clamoring for a vaccine than worrying about its risks, said Laura Makaroff, the society’s senior vice president for prevention and early detection.
Active cancer patients are definitely at higher risk for complications, Makaroff said, “which makes them very good candidates for the vaccine.” She reiterated the importance of providing vaccines to caregivers, as well.
The bigger worry for blood cancer patients is that they might not get great protection from the vaccines, said Gwen Nichols, chief medical officer of the Leukemia & Lymphoma Society. There are studies in the United Kingdom to examine the response of blood cancer patients to vaccine, she said.
People caring for immune-impaired loved ones should get vaccinated, too, she said, to provide added protection.
The initial fear among transplant recipients was that a shot might cause their immune system to reject their organ – but that hasn’t happened, Teperman said. “Unequivocally, that has not been the case.”
Up to 20% of organ recipients will die if they require hospitalization for COVID-19. The death rate climbs to 80%90% among those who end up in intensive care, he said.
“When they do get sick, they really get ill, and the mortality can be significant, especially in renal transplant patients,” Teperman said.
“We have an amazing opportunity to prevent people from getting ill.” Lewis Teperman Director of transplantation at Northwell Health, a large care provider in New York
The virus is likely to replicate more inside a transplant patient who takes immunosuppressive medication than in a healthy person whose immune system can quickly rein in the virus.
This provides more chances for the virus to develop mutations, Teperman said, and makes transplant recipients likely to shed more virus and for a longer time, potentially infecting more people than is typical.
During the outbreak of the first SARS in 2003, a liver transplant recipient developed the disease and exposed more than 60 others. Analysis showed that another infected transplant patient had 1,000-fold more virus in their tissue than others who had been infected.
“We definitely can say from SARS1 that superspreader events can occur and people will have a higher viral burden if they are immunosuppressed,” said Deepali Kumar, a transplant infectious disease specialist at the University of Toronto and secretary of the American Society of Transplantation.
Living donors should be vaccinated against COVID-19 to make sure they do not pass on the disease to their recipient, Teperman said.
People waiting for a transplant should also be vaccinated, he said, though those who have received a new organ within the past month should delay vaccination until they are switched to a lower dose of immunosuppressant medication to ensure the vaccine will protect them.
Pugliese said people with rheumatoid arthritis should get vaccinated.
The American College of Rheumatology recommends vaccination as does the National Multiple Sclerosis Society.
Vaccination could trigger a flare-up of autoimmune disease, Pugliese said, but among the patients he sees, “I’ve only had minor flare-ups. Nothing really major or traumatic coming from getting the vaccine.”
The main concern Pugliese has about vaccinating people with autoimmune disease is they won’t get the same 95% protection seen with healthy people.
“We worry that maybe they don’t get the full benefit,” he said, “but we still expect they’re getting benefit.”
A small number of people with stable HIV have been included in some of the trials, Fauci noted. People with HIV should receive COVID-19 vaccine because the potential benefits outweigh the risks, according to the Department of Health and Human Services.
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