Who are the people who don’t respond to the vaccine? How can they protect themselves from COVID-19?

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Vaccinations are the best defense against the coronavirus. However, there are people who do not respond to vaccines and do not produce adequate protection. This includes cancer patients, people undergoing chemotherapy, hemodialysis, organ transplant recipients and those taking immunosuppressants. For them, pre-exposure prophylaxis, i.e. administration of antibodies, can be a salvation. – This type of therapy, which is administration of immunoglobulins, is not the proverbial drops. It will cost a bit, so in order to be able to provide something like this, certain conditions will have to be met – says Dr. Tomasz Dzieśćtkowski, a virologist.

1. It is estimated that up to 2 percent. the vaccinated population may be at risk of serious consequences of COVID-19 as it has not developed an adequate immune response to the vaccine
2. About 40 percent. vaccinated and hospitalized people are people with impaired immune system
3. Such people need additional protection against COVID-19. They may be supported by the administration of antibodies
4. A cocktail of such antibodies has been developed by one of the suppliers of vaccines against COVID-19. Soon it is to be issued compliant with its use
5. More information can be found on the Onet homepage

Administering antibodies as a rescue for many people

Adrian Dąbek, Meodnet.pl: What is pre-exposure prophylaxis?

Dr hab. Tomasz Dzieiątkowski: This is the administration of antibodies. In the near future, the FDA and most likely EMA will give the appropriate approval for use, a cocktail of two antibodies produced by one of the vaccine manufacturers, administered deeply intramuscularly. These are two antibodies isolated from the plasma of convalescents, which is important, especially in the context of messages about the failure of this method of therapy. These antibodies, according to the recommendations, will be administered to patients after transplantation, after chemotherapy and potentially, but this is not fully known yet, because the SmPC is not yet known (Summary of Product Characteristics – editorial note), they will also be dialysis patients and treated with immunosuppressants for rheumatic diseases.

Therapy will follow specific rules. The patient must be vaccinated, the patient must be diagnosed with the absence of antibodies, i.e. the absence of a normal immune response, and only then this cocktail of two antibodies – ixagevimab and cilgavimab – can be administered. The manufacturer is currently trying to use this cocktail for a therapeutic purpose. Then such antibodies would be administered twice rather than once.

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Is this the same group of people recommended for an additional dose of the vaccine?

Yes. However, even in this group where an additional dose of the vaccine was used, we have about 20-30 percent. non-responders. This is not much, but of course you have to be aware that these are people at particular risk of severe COVID-19.

What if someone is not in this immunocompromised group and is concerned that they have not developed immunity after vaccination?

No, this is not a rationale for using this therapy.

The response to the vaccine reflects the level of your immune response.

Basically, you could say that this reaction is 1 to 1. But this type of therapy like immunoglobulins is not the proverbial drops. It will cost a bit, so in order to be able to give something like this, all the provisions contained in the Summary of Product Characteristics will have to be met. The average Kowalski, who thinks he has not responded to the vaccine, will not be able to go into the pharmacy and get the drug on request.

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And if someone checks the level of antibodies …

Certainly, no one will test antibodies on their own, because there are no such recommendations. This can only be done by an accredited laboratory at the unit that will be serving the cocktail. All this so that there is no doubt that we have different results, from Sas to Las. Because we still do not have a uniform consensus as to what antibody level has a protective value. This is the basic problem. So far, only the French government, quite arbitrarily, has stated that this level is more than 260 international units, but relevant research is still needed.

It should be clearly emphasized once again: at the moment there is still no recommendation for antibody testing either before or after vaccination.

How do we protect ourselves against viruses?

Then I will ask about the basics. We have two lines of defense against viruses?

You could even say three. Because we also have non-specific defense. So NK cells (Natural Killer), i.e. the continuity of the mucous membranes and skin. And then we have cellular and humoral defenses. Both humoral and cellular defend against infection, that is, specific, specific immunity against a given pathogen. Vaccines induce this immunity. A humoral response is more readily detectable, but not that vaccine administration does not produce a cellular response. It also induces.

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So people who do not have a reaction to the vaccine should not worry that it has not worked?

Usually the vaccine works. If it does not work, it is most common in people with impaired immune systems. Because if someone takes antibodies against B lymphocytes, required in the course of therapy, and you don’t have these B lymphocytes, because we killed them with specific antibodies, it is difficult – in most cases – to expect such a person to produce antibodies that are produced by these B lymphocytes. And for such people, treated with immunosuppressants, a new drug, which is a mixture of antibodies, is to be administered prophylactically – at least in theory.

And will antibody cocktails also undergo modifications, as is the case with vaccines?

Probably yes. But now it can be said that the manufacturer has done research for the Delta variant, they also have preliminary tests for the Omicron. And it looks like it still works.

1. Who is the most resistant to the Omikron variant?

Because there are studies that say that Omikron eludes both the current vaccines and the antibodies used.

This is a very big simplification. It’s not that vaccines don’t work. This is one of the many myths. They work, they are only less effective. And that is why it is important to administer booster doses, i.e. the third dose, if only because if we cannot defeat the virus with the quality of antibodies, i.e. those produced in such a way that they very accurately neutralize a specific variant of SARS-CoV-2, we can try to defeat the virus with their amount. To put it simply: the more antibodies there are, the easier it will be to inactivate it.

So it looks like we are going to have a seasonal vaccination.

Maybe not seasonal, but more reminiscent of. But it was known from the very beginning. There are very few vaccines that do not require booster doses. The only question is in what time interval we will accept them. We get flu every year, and we should have whooping cough or diphtheria vaccines every 8-10 years.

Also read:

1. This is where the fifth wave will start? Doctor: hit the east wall
2. Delmicron – the number of infections with the combination of Delta and Omicron is increasing
3. Infection records could lead to the end of a pandemic. How it’s possible?
4. Doctors for COVID-19 patients: don’t wait until you start dying
5. Who is the most resistant to the Omikron variant?

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