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March 29, 2023

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COVID vaccines fall short for transplant recipients

Anti-rejection drugs drastically reduce their efficiency

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Vancouver resident Laura Ellsworth sits on a park bench for a portrait July 29 at Esther Short Park. Ellsworth is a fully vaccinated kidney transplant recipient but doesn't have full protection from COVID-19. She was part of a study on COVID-19 vaccines in immunocompromised patients.
Vancouver resident Laura Ellsworth sits on a park bench for a portrait July 29 at Esther Short Park. Ellsworth is a fully vaccinated kidney transplant recipient but doesn't have full protection from COVID-19. She was part of a study on COVID-19 vaccines in immunocompromised patients. (Joshua Hart/The Columbian) Photo Gallery

In spite of being fully vaccinated, Laura Ellsworth lives in fear of catching COVID-19.

That’s because she’s had a kidney transplant and her anti-rejection drugs drastically reduce the efficiency of the vaccine.

Ellsworth found out she was not protected only when she took part in an antibody testing study by Johns Hopkins University of people like her who were vaccinated but immunocompromised. That’s when she learned that while she was fully vaccinated, she was not fully protected.

“It was a surprise even to the doctors involved in the study,” Ellsworth said. “They weren’t anticipating it would be such a low response.”

Ellsworth worries that others who are also immunocompromised may not be aware that their vaccines are not effective, so she got in touch with Clark County Public Health to spread the word that people taking immunosuppressant drugs need to be cautious.

But it’s not been easy. Although she takes every precaution she can, she worries because the COVID delta variant is even more deadly, as it spreads faster through the air, she said.

“We live in a community, and if there’s anything that this virus has shown is that literally, that is the air we all share,” she said. “There is no other illustration of how we are all connected when you look at the way something like a virus spreads through a community. That just shows how interconnected we are and how much we need to take care of one another.”

The rapid development of vaccines to fight COVID-19 has been miraculous, Ellsworth said, but they don’t do her or people like her much good — something scientists didn’t realize at first. Clinical trials by the three major vaccine manufacturers — Pfizer, Moderna, and Johnson & Johnson — did not include people like her, Ellsworth said, who must take anti-rejection drugs for life.

She received a kidney transplant when she was a teenager, and Ellsworth, 45, has had to take drugs ever since to avoid rejection — drugs that inhibit the efficiency of the COVID-19 vaccines.

Ellsworth estimates there are about 14 million Americans who are immunocompromised; that includes not only transplant recipients but also people taking immunosuppressant medication for other reasons, people in chemotherapy, and people being treated for things such as rheumatoid arthritis and Crohn’s disease.

“There are all kinds of diseases where people are taking immunosuppressants,” she said.

As a result of the antibody study, Ellsworth’s doctor advises that she live as if she weren’t vaccinated at all, which is extremely frustrating.

Having mask requirements lifted by the Centers for Disease Control and Prevention has also made her life more difficult and put her and others like her at higher risk.

“We knew unvaccinated people were going to take off their masks, so that made the world more dangerous for us,” she said. “I know they wanted to incentivize people to get vaccinated and it was a fine line, but when the CDC did that, myself and my friends who are immunocompromised were scared.”

Ellsworth, who is strategic partnerships and advocacy manager at Vancouver’s Council for the Homeless, said her employer understands that, for the foreseeable future, she has to keep working from home.

‘We don’t have a vaccine’

The long-term answer, of course, is for everyone to get vaccinated, and Ellsworth understands some people’s hesitancy — because all of the vaccines on the market are administered on an emergency basis and haven’t yet received full approval by the Federal Drug Administration.

“I have a lot of hope that when the FDA fully authorizes it, then a lot of people will go get (the vaccine),” she said. “They’ll trust it more.”

Another thing the FDA could do is approve the Novavax vaccine, which has been shown to have better results in immunocompromised people but which the FDA hasn’t fast-tracked, Ellsworth said, because there was already ample supply on the market.

“They were completely overlooking immunosuppressed people, because right now, we don’t have a vaccine,” she said.

A recent article in The Atlantic magazine by scientist and writer Hilda Bastien said that the Novavax vaccine has “a substantially lower rate of side effects than the authorized mRNA vaccines.” The side effects are a “big barrier” to COVID vaccine acceptance, especially among people who might be penalized for missing work because of them.

The article, which does not mention immunosuppressed people, also concludes that the Novavax vaccine is not on the market because the current national supply exceeds demand. But the Novavax vaccine is easier to produce and uses more traditional methods, similar to the vaccines for whooping cough (pertussis) or hepatitis B.

Another move that federal authorities could make would be to authorize a third dose of any of the vaccines to people who are immunocompromised, which Ellsworth said is being done in some other countries and seems to help, and which she and her other transplant friends are pushing for.

“We’re advocating for the CDC or the FDA to give authorization so that our doctors can start prescribing a third dose for us,” she said. “But what we’re hearing is that doses are not recommended at this time, and we are to continue living as if we were unvaccinated.”