Vaccines and the Immunosuppressed

October 28, 2021

This article has not been updated recently

In our latest expert webinar, Professor Tim Spector, lead scientist at the ZOE COVID Study, was joined by Professor Ellie Barnes, Professor of Hepatology and Experimental Medicine at the University of Oxford, and Professor Gavin Giovannoni, an academic neurologist and multiple sclerosis expert based in the Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. 

They answered all your questions about immunosuppression and how a compromised immune system can alter the effectiveness of your COVID vaccine. 

What does immunosuppression and being immunocompromised mean?

“Being immunocompromised or immunosuppressed means that your immune system doesn’t respond to various stimuli as well as it should do,” says Gavin. “This includes people with reduced white cell counts, people who are more at risk of opportunistic infections, and those have blunted vaccine responses.” 

People can be born with immune deficiency, or it can be caused by a range of medicines that suppress the immune system, known as immunosuppressants. These are used to treat diseases such as cancer or autoimmune disorders including arthritis, colitis and multiple sclerosis. Chronic conditions such as diabetes, liver, lung, and renal disease can also cause immunosuppression.   

More than half a million people in the UK have a compromised or suppressed immune system. However, when you include people with chronic diseases that can affect the immune system, the number is much higher, affecting a significant proportion of the population.

Immunosuppression gives people a greater risk of catching infections and viruses, including COVID-19. 

People with immunosuppression are also more likely to go to the hospital with COVID-19, more likely to be admitted to ICU and at an increased risk of dying as a result of the virus. As a result, people who were immunosuppressed were prioritised for vaccination during the initial vaccine rollout. 

Are COVID vaccines safe and effective for people who are immunosuppressed?

Although COVID vaccines were prioritised for immunosuppressed people, some people have been hesitant to accept them because they aren’t sure if the vaccine is safe.

People with compromised immune systems are advised to avoid certain types of vaccines known as live vaccines. These contain weakened versions of viruses that are safe for people with healthy immune responses, but can still cause illness in people whose immune systems are not fully functional. 

“The COVID vaccines we are using in the UK are not live vaccines, so they can’t replicate or cause infection themselves. While we might advise patients on immunosuppressants not to take some vaccines, the COVID vaccines are safe for them,” says Ellie.

However, although COVID vaccines are safe for people who are immunosuppressed, we still don’t know how effective they are.

“We don’t have enough data to know how effective the vaccines are in people with immunosuppression. But based on immunology, we would expect that the vaccines won’t work as well in this population,” says Gavin.

So if the vaccines might not work for you, should you still accept one? Our experts say yes.

“The advice at the moment is that people who are on immunosuppressant drugs or who have immunosuppressive diseases should be vaccinated against COVID,” says Ellie. 

Results from her national study, Octave, showed that 60% of people with immunosuppression did respond to the COVID vaccine. The Octave study also showed that 40% of immune-suppressed patients had a low response to two primary vaccines, and 10% had no response at all. 

In response to this data, the government advised that people in this group should get an additional third dose of the COVID vaccine. However, there has been some confusion about whether this additional dose is different to the booster doses that are now being rolled out to higher risk groups who were vaccinated early on, including over-50s and healthcare workers.  

“Patients who are immune-suppressed, or who have chronic diseases that can cause immune suppression, should have three primary vaccines and then subsequently they can have boosters,” explains Ellie. She says that the third dose should be given as soon as possible after the first two, rather than waiting six months as with boosters.

But is there any point in having a third dose if you didn’t respond to the third dose? Ellie says yes. 

“There’s emerging data now that in patients who didn’t respond to two vaccines, some do respond to a third,” she points out. 

How to stay safe from COVID if you’re immunocompromised

People with suppressed immune systems can protect themselves by making sure they get vaccinated against COVID, as well as having an annual flu jab. 

But if you aren’t sure how much protection the vaccine is giving you, it can be challenging to know how you should act in the face of the high COVID infection rates we have in the UK right now.

Gavin advises understanding your risk from the virus by using the QCovid risk calculator. You can also request an antibody test to determine if your immune system has responded to the vaccines. This can help you understand your risk and inform your behaviour, such as social distancing, avoiding gatherings and other infection control measures like handwashing and mask wearing.

Our experts agree that taking additional measures to avoid COVID must be carefully balanced with maintaining your quality of life. 

“We’ve seen enormous mental health problems in our patients, and we don’t want to perpetuate that,” says Gavin. “ We need to be sensible in terms of social distancing, wearing masks in enclosed spaces, and general hygiene. But we also need to be able to live with the virus because it’s not going away in a hurry, and people can’t stay locked up forever.” 

We’re continuing our research on the effects of vaccination on people who are immunocompromised. You can help us by downloading the ZOE COVID Study app, logging your vaccines and sharing your daily health reports. It only takes a minute, but you’ll be contributing to life-saving research. 

Stay safe and keep logging.

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