What is immunosuppression? Your questions on the latest Covid-19 trial answered

·4-min read
Some 40% of people who have impaired immune systems have a ‘low’ antibody response after being double-vaccinated (PA) (PA Archive)
Some 40% of people who have impaired immune systems have a ‘low’ antibody response after being double-vaccinated (PA) (PA Archive)

Some people have been found to have “low or undetectable” levels of antibodies, even after getting both Covid-19 jabs.

Here are your questions answered about what these findings mean for these groups and the potential autumn booster campaign.

– What has been found?

Some 40% people who have impaired immune systems have a “low” antibody response after being double-vaccinated.

– Is it all bad news?

If you flip the coin, this means that 60% of some of the most seriously-ill people in society have generated an antibody response which is similar to those of healthy adults. That is good considering that they could all have a poor antibody response to the vaccines in theory.

– What do you mean by immunosuppressed?

Apparently this is a term which is debated in the scientific community, so rather than getting into the middle of a row between academics, here is the definition given by one of the researchers in the Octave trial:

“If someone’s immune system is not functioning well, we could call that person immunosuppressed. The reason for their immunosuppression could be their underlying disease or it could be that the immune system is being supressed actively by a therapy that is given.”

Here is a list of some of the conditions of some people included in the trial: inflammatory arthritis; vasculitis; inflammatory bowel disease; solid tissue and blood cancers and liver or kidney disease.

-Did they all have the same response?

No, some appeared to have a much lower response than others.

PA Graphics (PA Graphics)
PA Graphics (PA Graphics)

The lowest response was found among patients with a condition called vasculitis who were receiving a type of treatment called a “B cell depleting therapy”. Almost all of the people who had undetectable antibodies after vaccination had this condition.

About half of people with inflammatory arthritis had an antibody response lower than desired while this was true for around a third (36%) of liver disease patients and 20% of those receiving dialysis for kidney disease.

-If someone does not show antibodies, does that mean they are not protected from Covid-19?

Not necessarily. Researchers performed immune tests on blood samples and examined not only antibody levels in the blood, but also the ability of a particular form of white blood cell, called a T cell, to respond to the vaccine.

Even though some people did not show antibody responses, the researchers found that across almost all patient groups, the T cell response was similar to healthy adults, indicating some form of immunological response had been mounted, even among those with undetectable antibody levels.

One of the researchers put it nicely: “The immune system is a wonderful system.

“Some people liken it to the airline industry: nobody designs an airline jet with a single vulnerable piece of engineering machinery, there are always back-up systems and evolution has required that the human immune system has numerous back-up systems so the different parts of the immune system activate and, if you like, kill viruses, it has many different ways of doing that.”

I feel a little bit forgotten that people aren’t taking this seriously and that there are numerous people who don't have any antibodies or any antibodies that are visible

Alice Scanlon

– Does this mean the vaccines are not effective in those who do not have an antibody response?

Not necessarily. There are more studies ongoing to assess vaccine efficacy among this group.

– How do people feel after finding out they do not have an antibody response?

Alice Scanlon, 69, suffers from chronic lymphocytic leukaemia, a form of blood cancer, which led to her being put on the shielded patients list.

Ms Scanlon, from Bridlington in Yorkshire said that she feels “forgotten” by other members of the public after tests revealed that she has not generated an antibody response to her two vaccine doses.

The 69-year-old, who has only recently started to venture to shops again, told the PA news agency: “I think they don’t really fully understand that I personally don’t have any immunity against Covid and I’m not prepared to take any risks.

“I feel a little bit forgotten that people aren’t taking this seriously and that there are numerous people who don’t have any antibodies or any antibodies that are visible.”

(PA Graphics) (PA Graphics)
(PA Graphics) (PA Graphics)

– Did this study look at all the vaccines?

No, people had their vaccines through the usual vaccination programme and the majority of people involved received either the AstraZeneca Covid-19 jab or the one developed by Pfizer.

– Does this mean people will get a booster?

That is not known yet. Vaccination experts on the Joint Committee on Vaccination and Immunisation have been ruminating on a booster campaign for some time now. They have been waiting for data on various studies to be published. This study will form part of their decision-making but it is not the whole picture.

– When will we find out about whether people will need a third jab?

September at the earliest, according to a throwaway line in one of the Department of Health’s latest press releases. This cuts it a bit fine with the NHS in England which is braced to start any potential booster campaign on September 6 alongside its flu jab offering.

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