Immunocompromised Folks May Not Produce COVID Antibodies, Even With A Vaccine

by Virginia Duan
Originally Published: 

For more than a year, many of us have been cooped up inside our homes, limiting our outside interactions, and being good little global citizens. We’ve been eagerly awaiting the day of being fully vaccinated so that we can go back to normal — or if not totally pre-pandemic normal, a close approximation thereof. And now that about half of U.S. adults have received at least one COVID shot, this new post-lockdown normal feels closer than ever.

However, for the approximately 3% of the U.S. adult population who are immunocompromised, they may still be infected with COVID-19 even after vaccination. They can’t risk easing up on their precautions. For these vulnerable individuals, the COVID vaccine won’t protect them — and their bodies may not even produce COVID antibodies — even after vaccination. Instead, they rely on all the people around them who can be protected by the vaccine to actually get the vaccine.

If only we lived in a perfect world where people — even the police — actually cared about the common good instead of their right to not wear a mask, not get vaccinated, and catch a highly contagious disease that has killed 567,000 people in the U.S.

Apparently there are still a lot of “let’s wait and see” folks out there. I’m not talking about the people who have vaccine accessibility issues and would benefit from mobile vaccinations. I’m talking about actual people who don’t think they “need” the vaccine — either because they’re anti-science or think they can benefit from herd immunity without doing any of the work.

Please, stop.

Folks, not only should you get vaccinated for yourself because unvaccinated people are 29 times more likely to die from COVID, you should get vaccinated to help people who either cannot get vaccinated or are immune compromised and thus, their bodies can’t or won’t be able to produce strong antibodies — even after a vaccine or illness. When these folks get infected, not only might they be sick for longer periods of time — they may die at rates up to 55%.

COVID vaccine might not be as effective in the immune-compromised


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While it’s unclear what percentage of the immunocompromised haven’t responded to the COVID vaccines, experts recommend that the following populations be extra cautious and check with their medical professional: organ transplant recipients; blood cancer survivors; anyone taking Rituxan or Remicade (a drug for treating inflammatory bowel disease), or the cancer drugs Gazyva or Imbruvica; or some folks more than 80 years old with fragile immune systems.

“We’re extremely concerned and interested in trying to see how we might be able to help those particular patients,” immunotherapy expert at the National Cancer Institute Dr. Elad Sharon told “The New York Times.”

For those of us who need a quick refresher course, the immune system is our body’s way of defending itself against pathogens (invaders) such as bacteria, viruses, fungi, or parasites. Our immune system kick starts when it encounters antigens — things that our body doesn’t recognize as its own — on the surface of these invaders.

When our immune system meets a “germ” for the first time, our bodies store identifying information (like the antigens) on this specific germ as well as how to fight it. Later, when our body encounters it again, we know exactly how to deal with them. Vaccines are like cheat sheets for our immune systems; teaching us how to recognize that germ without actually being infected.

However, for the immunocompromised, that’s not what happens.

Why the COVID vaccine doesn’t work as well for some

Some people have conditions like rheumatoid arthritis, multiple sclerosis, Crohn’s disease, psoriasis, or lupus — where their immune system mistakes their own body cells for pathogens and starts attacking. These conditions are treated with medications that suppress the immune system so that their body stops damaging itself.

Other folks may be organ transplant recipients who have to take anti-rejection medications (which again, prevents the body from attacking the new organ as something foreign — which it technically is), or cancer patients undergoing chemotherapy. (Traditional chemotherapy drugs can inhibit cell division and thus, one of the side effects is to damage non-cancerous cells that rapidly divide such as cells in the bone marrow — which leads to decreased production of blood cells and results in immunosuppression.)

Because their immune system is weakened, the immune compromised cannot make the appropriate antibodies at all or in the quantities necessary in response to the vaccine to defend against COVID-19. For vaccines like Hepatitis B, patients can be given a second series of the 3-dose vaccine to induce a response — but due to the limited availability of the COVID vaccine, this is not an option at the moment.

According to a recent national study published in the journal JAMA, only 17% of transplant recipients who received a first dose of either the Pfizer or Moderna vaccine showed detectable amounts of COVID antibodies after three weeks. This is in comparison to the 100% of immunocompetent people who produced detectable antibodies. The study also reported that people taking anti-metabolites such as mycophenolate or azathioprine were almost five times less likely to mount an antibody response.

For people who currently have or have survived blood cancers, the Leukemia and Lymphoma Society has established a registry for them to provide information and antibody tests. There are also other studies collecting and examining the response to the various COVID vaccines for cancer patients and other immunocompromised people.

Why it’s important for you to get the COVID vaccine


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This is where herd immunity comes in. You’ve likely seen the term bandied about. All that means is that enough of the general population is immune to a disease via vaccination or previous infection to indirectly protect people who aren’t immune. Because enough people are immune, the disease in question will be less likely to spread to the people who are not immune.

Remember that glimpse of normalcy? That pre-pandemic life will be even further out of reach if large portions of our population — including the immunocompromised — remain susceptible to COVID. For people who end up being sick with a virus for several months — which as mentioned before, those with weaker immune systems generally fight these illnesses for much longer periods of time — this allows a virus to mutate.

“This is how some variants emerged,” Washington University in St. Louis immunologist Ali Ellebedy told “The Atlantic.” Ellebedy, who is studying how immune compromised people respond to the vaccine, explained that it was a clear reason to make sure the needs of these patients are understood and met.

Honestly, aren’t you tired of reading the same words every week? I’m sure sick of writing them.

Get vaccinated — if not for yourself (although, you really should do it for yourself), then for everyone else. You are not the only person on this planet — and if you really want to go back to your old life, then act like it.

Information about COVID-19 is rapidly changing, and Scary Mommy is committed to providing the most recent data in our coverage. With news being updated so frequently, some of the information in this story may have changed after publication. For this reason, we are encouraging readers to use online resources from local public health departments, the Centers for Disease Control, and the World Health Organization to remain as informed as possible.

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