Millions of Americans may have been caught up in “pickles” and did not respond adequately to the Covid-19 vaccine

It was a beautiful March afternoon. In June, she was flying high in the sky as Tatelman walked her dog in the neighborhood of Boston.

Tatelman recently received a second dose of Pfizer’s Covid-19 vaccine, finally seeing the end of the pandemic. Perhaps soon she will be able to play with her grandchildren and return to volunteering to help their children in foster care. A few months after her husband turns 75, she will be able to celebrate at the restaurant.

As she walked, she came across her doctor. My doctor immediately stopped talking about her.

To treat inflamed blood vessels in the lungs, Tatelman, 73, is taking drugs that suppress the immune system. Her doctor was reading a recent medical study, suggesting that the vaccine may not work for some people taking medications like her.

He asked her to have a blood test to see if the vaccine worked, that is, if she had antibodies to the virus.

She tested and found no detectable antibody against Covid-19.

“It was a complete shock,” she said.

Tatelman was now full of questions to his doctor. Does her low antibody level mean that the vaccine didn’t work? Should she get a third vaccination? Reduce the drugs that suppress the immune system and increase the chances of the vaccine working Is there anything else she could try to get the Covid-19 vaccine to work for her?

Little data is available to help Tatelman and her doctor answer these questions. Millions of other Americans are also taking immunosuppressive drugs that may diminish the effectiveness of the Covid-19 vaccine, they are in an unknown area, and vaccination may not have worked. I’m afraid.

If vaccination is unsuccessful, they rely on having the rest of the people vaccinated.

This should encourage unvaccinated people to roll up their sleeves, Francis Collins, director of the National Institutes of Health, told CNN Thursday.

“Think of this as your own well-meaning donation to the more vulnerable, even if you don’t think it’s necessary,” Collins said. “That’s their greatest hope.”

The vaccine has never been tested in people with immunodeficiency

The number of Americans taking drugs that could be challenging for the Covid-19 vaccine is unclear, but new Research Helps you get a quote. In a treatise published last month, Dr. Beth Wallace, a rheumatologist at the University of Michigan, and her team looked at a database of more than 3 million Americans to find out how many people are taking immunosuppressive drugs. I did.

Based on that data, Wallace estimates that about 6 million Americans are taking immunosuppressive drugs that can interfere with the vaccine.

She said this was conservative because her database does not include anyone who is taking Medicare and is likely to take such medications. Her estimates did not include anyone taking oral corticosteroids. This can be a vaccine problem in large quantities over a long period of time.

When a drug company tested the Covid-19 vaccine in a clinical trial last year, it specifically excluded people taking immunosuppressive drugs.

Dr. Catherine Stephenson, an infectious disease expert and assistant professor at Harvard Medical School, said that as a result, those patients remained “trapped in pickles” without knowing if the vaccine would work.

After the vaccine was released to the public, researchers began investigating how effective or ineffective it was in people with immunodeficiency.

There was some good news.

One small Research A study from the Icahn School of Medicine in Mount Sinai, New York, found that patients taking certain medications to treat ulcerative colitis and Crohn’s disease were “strong” against Pfizer and the Moderna Covid-19 vaccine. It showed an antibody response. The study is published on a preprint server.

Ah Research Researchers at Johns Hopkins University School of Medicine have shown that organ transplant patients are not in very good condition. In a study of more than 650 organ transplanters (who are taking medication to suppress the immune system and not reject new organs), 46% responded to antibodies after two doses of Pfizer or Moderna. Did not show.

another ResearchThe University of Washington School of Medicine examined patients with symptoms such as lupus, psoriasis, and inflammatory bowel disease, and the two drugs they were taking (glucocorticoids and B-cell depleting agents) were the Pfizer and Modana vaccines. I found that I was “substantially” impairing my ability. Induces an immune response.

“No one expected the vaccine response to look so bad,” said Stephenson, director of the clinical trials unit at the Virology and Vaccine Research Center at the Beth Israel Deacones Medical Center.

She said that patients with weakened immunity flooded her office every day with phone calls and emails asking what to do.

“It was a very frequent question for patients, and last week three different meetings, conferences and seminars were held, all trying to address this issue and find a strategy for what to convey,” said Stevenson. I am.

For now, she and her colleagues have told patients that it is not worth testing for antibodies after vaccination. At this time, it is difficult to know exactly what antibody levels provide protection against Covid-19.

Is US Food and Drug Administration And that US Centers for Disease Control and Prevention We also recommend that you do not check for antibodies. Various medical societies are held. American College of Rheumatology, American Transplant Society, And that International organization for the study of inflammatory bowel diseaseIn essence, antibody testing does not completely answer the patient’s question as to whether vaccination worked.

“For patients who do not have antibodies or do not show a strong antibody response, it is not yet known if you will be protected.” Leukemia / Lymphoma Society“There are other types of immunity that may provide protection. Immune cells, known as T cells, can play a role in our immune system’s ability to protect us from COVID-19. There is. “

Is CDC Continues to advise people with immunodeficiency not to take additional vaccines.

However, some patients are not listening.

Patients getting extra dose on their own

Dr. Robert Montgomery is one of them.

Montgomery is the director of the NYU Langone Transplant Institute. received Heart transplant in 2018.

After tests showed that two doses of Pfizer’s Covid-19 vaccine were “almost unresponsive,” Montgomery was “extremely disappointed” and vaccinated with Johnson & Johnson. Told.

He said receiving a third dose was an “unknown area”, but he did so because he was exposed to a patient with Covid-19.

He says it worked. His antibodies rose after receiving the third vaccination.

Things didn’t go well for Boston’s grandmother, Tatelman.

Like Montgomery, she was vaccinated with J & J to supplement Pfizer’s two doses.

A few days ago, she learned that there was still no detectable antibody against Covid-19 on the third dose.

“My doctor sent me a note that’you would be disappointed’and said that’disappointed’ wouldn’t even get close to my feelings,” said Tatterman. “It was incredibly depressing.”

Looking to the future

The National Institutes of Health is trying to determine which approach works best for people with weakened immunity who are failing to get the vaccine.

“[We’re] If you want to properly protect these people, you need to understand what you need to do, “Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases at NIH, told CNN.

According to Dr. Daniel Rotrosen, director of allergy, immunology and transplantation at NIAID, researchers hope to bring about 200 vaccinated kidney transplant patients to the study this summer.

If the test shows that the Covid-19 vaccine did not work well, the study participants will be offered an additional vaccine to see if it helps, Rotrosen added. ..

Some doctors are skeptical of that possibility. They have greater hope for immunosuppressed patients to receive regular doses of the antibody drugs currently used to treat Covid-19.

Regeneron, a biotechnology company that manufactures Covid-19 monoclonal antibody drugs, is considering research proposals to test prophylactic drugs in immunosuppressed patients, a spokeswoman for the company said.

“I strongly agree that patients in this group may benefit from REGEN-COV,” Alexandria Bowie wrote in an email to CNN, referring to the company’s drug.

While these studies are underway, Tatterman feels like he has never been vaccinated and needs to rely on other people for whom the vaccine has worked.

She knows that she shouldn’t hug her younger grandchildren who haven’t been vaccinated. She has not returned to foster parent volunteering. Wednesday was her husband’s 75th birthday and they didn’t go to the restaurant to celebrate.

“Even close friends don’t understand why I don’t go to restaurants with them. They say,” Of course you can go to restaurants, “but I say,” Absolutely, no, I can’t. ” She said. “Where am I safe? Where isn’t it? I don’t know too much.”

correction: This article has been updated with a modified number by Dr. Beth Wallace.