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How well do COVID-19 vaccines work in people with cancer, inherited and medication-related immune deficiencies, and other vulnerable populations like long haulers?
No one’s certain, but four studies led by researchers at The Ottawa Hospital and the University of Ottawa are aiming to find the answers to those questions.
On Thursday, the federal government announced $8 million in funding for the studies through its COVID-19 Immunity Task Force (CITF) and Vaccine Surveillance Reference Group (VSRG). One study will investigate vaccine efficacy in cancer patients, and another will look at blood cancer patients specifically.
“More than two million Canadians are currently living with cancer and many have weakened immune systems … This makes patients more susceptible to viruses like SARS-CoV-2,” noted a media release issued by the CITF on Thursday.
“It is important for these patients to have protection through vaccination, but a weak immune system can mean a weaker response to vaccines. However, very little research has been done on COVID-19 vaccines in people with cancer.”
The third study will look at how immune cells (T cells) respond to COVID-19 as well as antibodies. That study will also “help illuminate the science” around those struggling with post-COVID-19 conditions (long haulers with ongoing symptoms after contracting the virus).
Recruiting in Halifax
The fourth study will recruit patients in Halifax and is focused on examining COVID-19 vaccine efficacy in people with inherited and medication-related immune deficiencies.
In its Thursday media release, researchers said those with inherited immune deficiencies are at greater risk of developing severe COVID-19 and may also be less likely to respond to vaccines.
In addition, people with conditions like multiple sclerosis, arthritis, and other immune-mediated diseases could be at risk because medications used to treat them often suppress their immune system.
The CITF said the study, COVID-19 Vaccine Immunogenicity and Safety in ImmunoDeficient patients, will provide “crucial data” that will help protect patients with an immune deficiency against COVID-19 and uncover “which component of the immune system is essential in the COVID-19 vaccine response so that tailored vaccines can be developed in future.”
Dr. Gina Lacuesta, a clinical immunologist at Halifax Allergy and Asthma Associates and a professor at Dalhousie University’s Faculty of Medicine, is one of the study’s Halifax collaborators.
She said there’s currently not much data on this population of patients and their response to the vaccines.
“Thus it’s important to get as much data as possible and study it, especially with the newer platform, the messenger RNA vaccines … We really want to study how everybody’s going to respond to this vaccine,” Lacuesta said in an interview Thursday afternoon.
“We’re trying to narrow this study, looking mostly at those who have a B cell dysfunction, which means the inability to produce antibodies … We’re looking at all aspects of the type of immune response that these patients will have so it’s really exciting.”
‘We just don’t know at this point’
Lacuesta said there are only a handful of immunologists in the Atlantic provinces. They’ve been discussing the upcoming study with their patients, many of whom have expressed a desire to participate. While she expects participants will primarily be from the Halifax area, Lacuesta also knows patients in rural Nova Scotia who will drive to Halifax “at the drop of a hat” to be included.
Every day patients ask if the study has launched yet, eager for the opportunity to glean in-depth information about their immune response to the vaccine.
“They want to know what their response is to this vaccine, because at this point, it’s kind of this grey area where we hope and we think they’re going to have some response,” Lacuesta said.
“It’ll be great if we can see that they have a robust response compared to the general population, but we just don’t know at this point.”
Lacuesta said if they’re able to determine there’s a good immune response, it will give a vulnerable population the confidence to move forward knowing the vaccines work for them.
“These poor immunodeficiency patients, a lot of them have been so scared, isolating at home. They are vulnerable. Even if restrictions lift, they’re all still nervous and some of them don’t have a choice,” Lacuesta said.
“I have front line workers and retail workers who have immunodeficiency and we’ve had conversations throughout this entire pandemic of what are the risks and benefits of them being out in the world. So if we can give them some confidence that it’s helpful, that’s great.”
There’s also the possibility that this group of patients get a robust response, but it drops off sooner than it would in the general population.
“So are these individuals people who we may think about boostering again, or more often than the general population,” Lacuesta asked. “We just don’t know … But it’s exciting that Halifax gets to participate in this really collaborative study for rare conditions.”
The research team led by Dr. Juthaporn Cowan is recruiting 460 participants with inherited or medication-related immune deficiencies from 12 sites across Canada — Halifax, Montreal, Ottawa, Toronto, Winnipeg, Edmonton, Calgary, and Vancouver.
“Our study will provide crucial data to help us protect people with immune deficiencies against COVID-19,” Cowan, infectious disease physician and associate scientist at The Ottawa Hospital and assistant professor at the University of Ottawa, said in a media release.
“It will also help us learn more about which compartment of the immune system is essential in the COVID-19 vaccine response, so that better vaccines can be developed in future.”
Study participants must be at least 12 years old and be either planning to get vaccinated or have already been vaccinated (up to 24 weeks post-second dose).
Researchers also hope to recruit a control group of healthy people over the age of 12 who have not yet been vaccinated but plan to be.
Anyone interested in enrolling in the study (immune deficiency patient or control group) can check their eligibility and sign up here.
More information on all four studies can be found on The Ottawa Hospital website.
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