Immunocompromised Individuals Need More Guidance About COVID Vaccine Timelines

As of last month, two groups are eligible for another round of bivalent COVID vaccines: people aged 65 and older and immunocompromised individuals. But guidance is lacking for the latter group. 

For older adults, recommendations from the Centers for Disease Control and Prevention (CDC) is straightforward: Anyone aged 64 and older can get one additional dose of the updated (bivalent) booster shot from Pfizer or Moderna if they received their first dose at least four months ago. 

For immunocompromised individuals—such as people living with autoimmune diseases, people undergoing chemotherapy, or people taking medications that suppress the immune system—that timeline is shortened to two months after their first dose of a bivalent shot. But from there, whether or not they receive additional doses—and when—is up to their provider. 

“We know that initial antibody responses to and the effectiveness of the COVID-19 vaccines are generally less predictable and robust among [people who are immunocompromised] and that these rates generally improve with repeat doses,” Brian Koffman, MD, chief medical officer of the CLL Society, which advocates for people with chronic lymphocytic leukemia, a cancer of the immune system, told Verywell. “We know that immunocompromised patients who have been vaccinated are less likely to be hospitalized and to die of COVID-19. But we currently we have limited published data on vaccine response levels or efficacy to guide us on the best timing and numbers of extra bivalent boosters in this community.”

While Koffman said more “more research is needed to understand how to protect the most vulnerable,” he emphasized the CLL Society recommends that anyone with moderately or severely impaired immunity follow the recent CDC guidelines on a second bivalent COVID-19 vaccine in consultation with their healthcare provider.

According to Jeremy Faust, MD, an emergency room doctor at Brigham and Women’s Hospital in Boston, the open-ended CDC guidance is a step in the right direction, and the best public health officials can offer at the moment.

“To me, the biggest piece of news here is that there’s a liberalization of what the immunocompromised patients in our community will have access to,” Faust, who is conducting research on immunocompromised people and booster doses, told Verywell. “We’re in uncharted territory.”

For now, the vaccination guidance doctors give to their immunocompromised patients will be largely educated guesses. William Schaffner, MD, the medical director of the National Foundation for Infectious Diseases and a professor of infectious diseases at the Vanderbilt University School of Medicine told Verywell that he fully expects that the upcoming June meeting of the Food and Drug Administration’s advisory committee on vaccines to include a discussion on what is known about the optimal booster schedule for people who are immunocompromised. 

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.