The corona vaccine does not work well in half a million people with weakened immunity

Two in three people who have undergone a kidney transplant are insufficiently protected against the virus after a corona vaccination. That is one of the results of a research program into the effect of corona vaccines in people with a disturbed immune system. Research financier ZonMw and various research centers presented the first conclusions of this program on Tuesday.

In more than half a million Dutch people, the immune system does not work properly. This concerns, for example, people with a congenital abnormality of the immune system, with certain autoimmune diseases, blood-related disorders, Down syndrome or HIV, cancer patients who receive chemotherapy, or people who have had an organ transplant and are taking immunosuppressive drugs for this. These people are at greater risk of a severe course of Covid-19.

The effectiveness of corona vaccines had not been studied before in these groups: the manufacturers mainly conduct their drug studies on healthy adults. But it is expected that people in these groups will benefit little or no from corona vaccination. This week emphasized RIVM boss Jaap van Dissel the problem of these so-called ‘non-responders’, saying, “We can’t do anything specific for this group.”

In the meantime, this is being worked on. ZonMw is financing eight research projects on behalf of the Ministry of Health, Welfare and Sport, aimed at eight different patient groups. A total of 15.5 million euros is involved. “The projects started last January,” says Daniël Warmerdam, program coordinator at ZonMw. “The studies are still ongoing, but we think it is important to announce the first results now. We are working closely with RIVM, VWS and the Health Council to be able to put it into practice as soon as possible.”

Unique approach

Similar studies are underway in other countries. “But what is unique about our approach is that we use the same research methods in all these projects,” says Warmerdam. “This makes it possible to compare the results of the projects with each other, also with the studies in healthy people. In this way, you actually have larger research groups at your disposal.”

Not only the kidney project showed that many people are poorly protected after two corona vaccinations. “After lung transplantation, the protection is also poor,” Warmerdam summarizes. “People with severe congenital immune disorders are also hardly protected. The picture was diverse in blood diseases. And we are still waiting for the first results of the studies in cancer patients and people with autoimmune diseases, Down syndrome and HIV.”

Mortality from Covid-19 is three to five times higher among kidney patients

Jan-Stephan Sanders, internist-nephrologist (kidney specialist) at the University Medical Center Groningen, is leading the study among kidney patients. “In the Netherlands there are 60,000 people with kidney failure,” he says. “These are people whose kidneys do less than 30 percent of their work. Of these, 6,000 are on regular kidney dialysis, and 12,000 have had a kidney transplant. In these groups, the mortality from Covid-19 is three to five times higher than in healthy people. That is precisely why it is so important that these patients receive a well-functioning vaccine.”

The renal examination consists of four parts. First, the researchers follow vaccinated kidney dialysis and transplant patients over a longer period of time to see whether or not they get Covid-19, and if so, to what extent. Another component is a so-called immune response study. The researchers also look at how the immune system reacts to the vaccine, in this case that of manufacturer Moderna. Doctors from Groningen, Rotterdam, Nijmegen and Amsterdam examined how many antibodies and immune cells they had in their blood four weeks after their second vaccination in several hundred people with kidney failure, kidney dialysis or a kidney transplant. “In the control group and in the renal failure group, everyone had an antibody response,” says Sanders. “In the dialysis group, 98 percent showed an immune response. In the transplant group, that was only 57 percent.”

In a further test, the doctors examined whether the amount of antibodies in the subjects’ blood was sufficient to actually neutralize the coronavirus. “We do this with a lab test in which we see how well the antibodies attach to the virus particles,” says Sanders. “In people with renal failure and renal dialysis, the neutralizing effect was generally good. So if these people showed an immune response, it was effective. But of all kidney transplant patients, only 33 percent had a good response.”

Third vaccination

So what are possible solutions for these patients? „We can give these people a booster give: a third vaccination,” Sanders answers. “In the New England Journal of Medicine A recent study showed that a third dose in kidney patients caused an increase in the number of antibodies. But after that, 45 percent were still insufficiently protected. We therefore also want to explore other options.”

For example, patients taking a certain immunosuppressive drug could temporarily interrupt that treatment. “But we first want to investigate that very carefully, because it has to be safe,” says the Groningen kidney expert. After all, these patients take these drugs to prevent them from rejecting the new organ. Sanders: “And we want to see what happens if you give these people a combination of vaccines.” There are more and more clues that a combination of vaccines is more effective than administering the same vaccine twice. Sanders: “In the meantime, we continue to inform people: do get vaccinated, and stay careful.”

The ZonMw program has now been running for six months. Many of the measurements are repeated after twelve months. The study into the effectiveness of the vaccines in kidney transplant patients will continue for at least another 2.5 years. “Covid-19 will not be gone by then, and there will certainly be new questions,” says Sanders. “But I think we’re a lot further than that.”

Also read: Emergency medicine for people with weak defenses against corona

Warmerdam of ZonMw also believes that new questions will continue to arise. “For example, how long do the antibodies stay in the blood?” he notes. “We don’t know that yet for the healthy population. And in addition to extra vaccinations, we are also investigating other options, not only in kidney patients but also in the other groups. For example, you can give people antibodies that you have purified from the blood of cured Covid-19 patients.”

ZonMw also emphasizes the importance of information. “We hope that as many Dutch people as possible will be vaccinated,” says Warmerdam. “Yes, vaccinated people can still carry the virus, but much less. The more people are vaccinated, the less virus is circulating and the better these vulnerable groups are protected.”

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