I had a liver transplant in 2006. For the rest of my life, my body's immune system will consider my transplanted liver to be "foreign tissue" and will turn its weaponry against it as it would against an invading virus or bacteria. Of course, as opposed to a virus, I actually want to keep my new liver and so I must take immunosuppressants. I owe my life to these medications.
I've had a pretty challenging health history. Along with that transplant, I've dealt with a number of other diseases, surgeries, and hospitalizations. When COVID-19 came along, I didn't need to be told twice to be careful. Although I am only 57, it's unlikely I would fare well if I became infected with the virus. Social distancing and mask wearing became the order of my days. My house, my wife, my two cats, curbside shopping, and Zoom have comprised most of my world for the past year.
But about 9 months ago, hope began to appear on the horizon: The coming vaccine. My wife Tamara and I had theoretical conversations echoed in households throughout the world: "Let's hold tight for a while longer. We can do it. The vaccine is coming!" The vaccine equaled the possibility of our world opening up again, not to mention the vanquishing of dread that came with every dry cough or slight fever.
The vaccines finally came. By December they were being administered in my home state of Oregon, and the data indicated good efficacy. That's all I needed to hear. Medical science had already saved my life on more than one occasion. I was ready, willing, and eager, with no hesitation whatsoever.
Well, okay, I'm leaving out one part of the story. I did wonder about the immunosuppressant medications that I take every day: If the vaccine works by provoking an immune response that produces immunity to COVID-19 ... would the immunosuppressant drugs somehow prevent that immune response from happening?
Well, since the trials to develop the vaccines did not study folks like me or the almost 11 million other people in the U.S. who take immunosuppressant medications, I decided I would just have to get the vaccine to find out.
I got my first Moderna vaccine in late winter. I waited, content with my wife, my cats, and Zoom as my second vaccine appointment approached. As I waited, the hammer fell: A team of doctors at Johns Hopkins Medical School released a study of transplant recipients who had received their first COVID-19 vaccine. The transplant recipients were, of course, all taking immunosuppressants.
Through a blood test, the study examined the level of detectable antibodies found in the transplant patients after the first vaccine. It had already been established for the much larger immunosuppressant-free population that, after the first vaccine, 100% possessed the antibodies. However, disturbingly, the Hopkins study found that only 17% of the subjects possessed COVID-19 antibodies.
"Uh-oh." A dread-filled, big-time "uh-oh." I contacted the Hopkins team, enrolled in the study and got an antibody blood test after my first dose that, sure enough, reported back: "No detectable antibodies."
The latest study results investigating the response in immunosuppressed transplant patients after their second vaccine doses found that 54% produced antibodies. While better than with a single dose, the results are not altogether encouraging.
After a recent infusion of rituximab, which has also been linked to poor antibody responses, I'm holding off on my second dose for now, but plan to take another run at the vaccine.
What does this all mean? The picture is not entirely clear. More studies are needed, more data must be accumulated. But, the bottom line is this: The COVID-19 vaccines may not work -- or may work quite imperfectly -- for people who take immunosuppressant drugs. This includes people being treated for so many autoimmune diseases.
For me -- and possibly millions of others -- it means our worlds may not open up as soon as we thought they might. It also means something potentially much more serious: After being vaccinated, we might imagine ourselves to possess immunity to COVID-19 when we may possess little or no immunity at all. The consequences of such a situation are obvious.
So far, I am not aware that the CDC or other major health organizations have issued alerts to folks like me on immunosuppressants. This needs to happen as soon as possible. Lives are at stake. This is science in action. New evidence is rolling in and the responsible agencies should be responsive. It is bad enough to have to remain in my burrow when I had so hoped to be able to escape. It would be far worse to contract COVID-19 due to a simple lack of information.
David Goldstein is a former SAT instructor and a transplant patient now on disability.