Israelis With Weak Immune Systems Are More Hesitant to Be Vaccinated for COVID-19

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A coronavirus vaccination at Clalit Health Services in Jerusalem last week.
A coronavirus vaccination at Clalit Health Services in Jerusalem last week.Credit: Ohad Zwigenberg

People with weak immune systems, at a high risk for serious illness and death from the coronavirus, have received a high priority for vaccination but are hesitating as they cope with their already complicated medical conditions.

Under 80 percent of Israelis with weak immune systems have been vaccinated, compared with 86 percent of everyone 50 and over – and this latter number rises with age and increases to 90 percent when including people who have recovered from COVID-19.

A study by Maccabi Health Services shows that the vaccine may be a bit less effective for people suffering from immunosuppression, but it still significantly reduces the risk of being infected with the disease.

“You can understand the indecision among patients suffering from suppressed immune systems, who every day face a complicated medical condition and so might be concerned about being vaccinated,” said Maccabi’s chief physician, Dr. Daniel Landsberger. “But the numbers prove beyond doubt that the vaccine can clearly protect them from serious illness and even death.”

Maccabi, one of Israel’s four health maintenance organizations, has around 36,300 members with weak immune systems. A full 76.5 percent of them have been vaccinated so far, compared with 80 percent of Maccabi members all told, including young people with a low risk of illness.

The 76.5-percent number compares with 78 percent at the Meuhedet HMO and a strong 85 percent at Leumit.

Maccabi says the coronavirus infection rate for people with weak immune systems who have not been vaccinated is 10 times higher than for those who have been: 3 percent, compared with 0.3 percent for immunosuppression patients at least a week after their second dose.

“These are patients with very complex medical backgrounds who have undergone complex operations, bone marrow transplants, chemotherapy and radiotherapy treatments, or treatment with a range of drugs including biological medicines and immunosuppressant drugs,” said Dr. Arnon Shahar, who heads Maccabi’s coronavirus task force.

“Anything that can change their medical condition causes fear and distress. Still, patients with immunosuppression, as well as fragile chronically ill patients, are the groups with the highest mortality rate, so the vaccination is meant for them first and foremost.”

The coronavirus ward at Shaare Zedek Medical Center in Jerusalem last week.Credit: Ohad Zwigenberg

Israel has over 150,000 people with weakened immune systems. One subgroup is patients with autoimmune diseases – people with overactive immune systems. These patients are usually treated with drugs that suppress – and thus compromise – the immune system.

Another group is people receiving immunosuppressing drugs to prevent a transplanted organ from being rejected. Other groups include people receiving treatments that seriously suppress their immune systems, such as cancer patients who need bone marrow transplants or chemotherapy.

The immunosuppressed population may be small compared to that for common risk factors such as high blood pressure, diabetes and heart and lung disease. But about 3 percent of people who have died from COVID-19 had a history of poor immune function.

Still, the decision to vaccinate people with weak immune systems and give them high priority was not a simple one. Pfizer’s clinical trials did not include patients with poor immune function – not for safety reasons but amid fears that the vaccine would be less effective for them and skew the results of the trials.

Even before the pandemic, patients with compromised immune systems were treated with vaccines developed from killed viruses, and in some cases also from weakened live viruses, and there were no extraordinary side effects.

When the Pfizer-BioNTech vaccine was approved, the Health Ministry launched discussions among experts on whether to approve vaccinating people with suppressed immune function. In December, the coronavirus monitoring committee recommended that these patients be vaccinated – along with all members of their households, including children.

“Immunosuppressed patients, whether following oncological or hematological treatment or following a transplant, are at higher risk of complications and mortality from the coronavirus, so those patients should be especially sure to be vaccinated,” the committee said.

One reason for the decision: The mRNA coronavirus vaccines of Pfizer-BioNTech and Moderna do not contain adjuvant substances that enhance the immune reaction, as vaccines based on killed viruses do.

The committee also recommended that these patients be vaccinated during a period of treatment when the suppression of their immune systems was at a low; for example, weeks before a scheduled transplant. Still, when the recommendations were issued, the level of the vaccines’ effectiveness with such patients was unknown.

And this cohort remained indecisive when Israel launched its vaccination campaign in the second half of December, even after 10 months of shutting themselves at home.

Citing Maccabi’s data for the general population, Landsberger, Maccabi’s chief physician, noted that a week or more after the second dose, the COVID-19 infection rate is just 0.1 percent. That compares with 0.3 percent for those with suppressed immune systems.

“It’s critical that they get vaccinated, particularly due to their medically complex situation, which endangers their lives if they become infected,” Landberger said.

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