COVID Vaccines OK for Immunocompromised

As distribution of the COVID-19 vaccines sputters along, this question will be asked: Should people who are immunocompromised get vaccinated?

Mostly, the answer is yes, according to the FDA and CDC. They both weighed in when the Pfizer-BioNTech and Moderna vaccines received emergency use authorizations (EUAs) from the FDA in December. Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases and now the chief medical adviser in the Biden administration, offered this caveat while speaking to a group of hematologists just before the approval of the Pfizer-BioNTech vaccine: Taking immunosuppressants might mean a less robust response from the vaccine, but “some degree of immunity is better than no degree of immunity. So, for me, it would be recommended that these people do get vaccinated.”

The American College of Rheumatology echoed Fauci’s endorsement, saying that for those taking drugs such as prednisone, “even partial protection will be of benefit both to patients and the general public.”

The American Association of Cancer Research (AACR) went further, saying that not only should patients with active cancer get vaccinated, but they also should be among the first in line. The American Society of Clinical Oncology has taken a similar position.

As the AACR noted, neither of the vaccines with EUAs nor the ones in phase 3 trials use live virus, which could, theoretically, overwhelm a compromised immune system and result in infection.

Here is the full text of the CDC's advice on vaccination of people whose immune systems are compromised as of this morning:

Persons with HIV infection or other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in mRNA COVID-19 vaccine clinical trials, though data remain limited. Immunocompromised individuals can receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, and the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19 (see below). Antibody testing is not recommended to assess for immunity to COVID-19 following mRNA COVID-19 vaccination.

At this time, re-vaccination is not recommended after immune competence is regained in persons who received mRNA COVID-19 vaccines during chemotherapy or treatment with other immunosuppressive drugs. Recommendations on re-vaccination or additional doses of mRNA COVID-19 vaccines may be updated when additional information is available.