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Do immunosuppressants affect the COVID vaccine?

Learn how being immunosuppressed impacts the efficacy of vaccines
Katy Anderson writer headshot
By | Aug. 23, 2021 Medically reviewed by Jesse P. Houghton, MD, FACG
COVID vaccine for immunocompromised

CORONAVIRUS UPDATE: As experts learn more about the novel coronavirus, news and information changes. For the latest on the COVID-19 pandemic, please visit the Centers for Disease Control and Prevention.

The new, highly contagious COVID-19 variants, such as the Delta variant, mean that coronavirus infections are on the rise in the U.S. once again—and it’s even more essential to get a COVID vaccine. But what about those with autoimmune conditions? Are the COVID-19 vaccines still recommended for those who are taking immunosuppressant medications?

One recent study found that nearly 3% of U.S. adults under age 65 take medications that weaken their immune systems and may limit COVID-19 vaccine response. Here’s what you need to know about the COVID vaccine for immunocompromised people.

What does it mean to be immunocompromised?

If you’re immunocompromised it means that your immune system is not working as well as it should. You may be more vulnerable to infections, including infectious diseases such as COVID-19. Being immunocompromised has several different causes:

  • Chronic diseases such as cancer, heart disease, diabetes, HIV, and lung disease
  • Autoimmune conditions such as lupus, rheumatoid arthritis, and multiple sclerosis
  • Transplants such as bone marrow or organ
  • Medications such as certain biologics (mainly used for autoimmune diseases)
  • Treatments such as radiation or chemotherapy for cancer
  • Advanced age
  • Pregnancy

The severity falls on a spectrum. If you’re only slightly immunocompromised, you might catch the flu a little more easily. If it’s severe, viruses like the common cold can be life-threatening, and you will be at risk for more rare infections that don’t usually affect people with normal immune systems. Certain causes are temporary, like pregnancy or cancer treatment, and the immune system will usually bounce back to normal functioning after a period of time. Being immunocompromised has effects on daily life. You may need to take extra precautions to avoid getting sick, and there’s the potential that it might reduce your body’s response to the COVID-19 vaccine.

RELATED: Are people with chronic diseases more vulnerable to coronavirus?

Can immunocompromised people get the COVID vaccine?

“By and large, because of the heightened risk of developing severe disease from COVID-19 among immunocompromised people, it is recommended that immunosuppressed people receive the vaccine,” says Beth Beatriz, Ph.D., an epidemiologist and public health expert at parentingpod.com. People with autoimmune conditions, immunocompromising conditions, or people who take immunosuppressive medication or therapies may get any of the COVID-19 vaccines, according to the U.S. Centers for Disease Control and Prevention (CDC). There are just a few special considerations to keep in mind.

1. Lack of definitive data on safety

There is not enough research to establish the safety and efficacy of the vaccine in immunocompromised people. “Unfortunately, at this time we do not have definitive data on the vaccine efficacy or specific vaccine safety data for individuals with autoimmune diseases,” says Javeed Siddiqui, MD, MPH, the chief medical officer at TeleMed2U. Studies are forthcoming, but in the meantime “it is critical for individuals with autoimmune diseases to discuss vaccination efficacy and safety with their medical providers,” Dr. Siddiqui advises.

2. The vaccine may be less effective

In order for an immunization to work, it has to elicit a response from your immune system. For people who are immunocompromised, that response may be reduced—resulting in reduced immunity against COVID-19.

New research is in progress, including one study that showed that immunocompromised people had a wide range of antibody responses. For example, only 1 in 5 lung transplant patients had a robust antibody response, but people with well-controlled HIV had a nearly complete antibody response. In other words, the cause of immunosuppression may affect the vaccine’s effectiveness. 

It’s now recommended that immunocompromised people who are already vaccinated receive a booster shot (at least four weeks after their second dose) to help trigger more of an immune response and increase immunity.

Do any medicines interact with the COVID vaccine?

“If an individual is taking immunosuppressive medication, that could blunt the response to the vaccinations,” Dr. Siddiqi says. To prevent this effect, the CDC recommends following the same guidance for COVID vaccines as for other vaccinations in immunosuppressed patients: Get the COVID vaccine at least two weeks before starting immunosuppressant medication.

“It may also be wise to discuss with your medical provider the possibility of changing the timing of your immunosuppressants around your vaccination to try to increase the efficacy of the vaccine,” Beatriz says. Certain medications—like those that treat autoimmune conditions—may not be able to be delayed. Others, like a cortisone injection, could possibly be scheduled around a COVID vaccine appointment.

Medications that suppress the immune system

There are many different types of drugs that affect the immune system. For people with autoimmune conditions, your own immune system attacks your body as if it were fighting a bacteria or virus. Medications can help to suppress that reaction. For transplant patients, an immunosuppressant prescription can make it less likely that your body rejects the new organ. Additionally, other, more common medications like corticosteroids reduce immune response while reducing inflammation in the body.

If you take any of the following types of medications, have a conversation with your healthcare provider about the COVID-19 vaccine:

However, preliminary studies suggest that the type of immunosuppressant medication matters when it comes to its effect on COVID-19 vaccines. “Initial results suggest that the antibody responses to the vaccine—which may impact effectiveness of the vaccine—may vary by the type of immunosuppressant,” Beatriz says. “In particular, immunosuppressants that work by impacting B-cell function appear to have a lesser antibody response to the vaccine while tumor necrosis factor-α inhibitors do not seem to impact antibody response to the vaccine.” 

Additionally, according to a recent study, there’s no evidence to suggest that corticosteroid injections decrease the efficacy of an mRNA COVID-19 vaccine. 

Who should not get the COVID vaccine?

The CDC recommends that everyone aged 12 years and older should get a COVID-19 vaccine as soon as possible. “There are very few contraindications to COVID vaccination,” Dr. Siddiqui says. It’s really only individuals with a history of severe allergic reaction such as anaphylaxis after a previous dose, or to a component of an mRNA COVID-19 vaccine.  

“You may have heard that those taking immunosuppressants are not recommended to take certain vaccines, including the MMR (measles, mumps, rubella) vaccine,” Beatriz says. “It is important to note that the reason for that is that these types of vaccines have live virus. None of the COVID-19 vaccines currently approved for use in the United States (Johnson & Johnson, Moderna, Pfizer) contain live virus.”

The official recommendation from the CDC is that the COVID vaccine is safe for immunocompromised people, including people with HIV infection or other immunocompromising conditions, or people who take immunosuppressive medications or therapies. Even though the efficacy is unknown, because immunocompromised people are at higher risk of severe COVID-19, even a blunted response to the vaccine is better than no vaccine.

There is much that we are still learning about COVID-19, but we do know that COVID-19 vaccines are safe and effective and help to protect the most vulnerable among us—including those who are immunocompromised.