64 Scientific American, February 2022
Franklin is one of many people who belong to this
vulnerable club. Former secretary of state Colin Pow-
ell, who died in October 2021 from COVID complica-
tions, was among them. He had been vaccinated but
suffered from multiple myeloma, a blood cancer that
attacks infection-fighting white blood cells and is
often treated with drugs that suppress the immune
system even further.
The pandemic has forced everyone to adjust to re -
stric tions on normal life. But for those who belong to
a broad category known as immunocompromised, even
ordinary activities come with extraordinary risks. This
umbrella term includes people whose immune systems
have been weakened by diseases such as cancer, HIV
infection or autoimmune disorders or by immunosup-
pressant treatments such as steroids, chemotherapy or
drugs that prevent rejection of transplanted organs.
Studies have shown that immunocompromised peo-
ple are more vulnerable to being hospitalized or dying
from COVID and less likely to develop strong protec-
tion from vaccination. There have been hopeful signs.
Additional doses of some COVID vaccines, strategic
timing of immunosuppressant treatments and prophy-
lactic COVID treatments may boost protection among
a subset of these people and restore at least some
of the freedoms they have lost during the pandemic.
But tempering that hope is the emergence of new
variants—such as Omicron—that might erode some
of the vaccines’ immunity. As of press time, the Omi-
cron variant appeared likely to evade at least some of
that protection, although researchers were urgently
working to determine just how much.
With Omicron, “I worry a lot for our immunocom-
promised folks,” says Dawn Bodish, an immunologist
at McMaster University and a Canada Research Chair
in Aging and Immunity. “A few months ago I said con-
fidently, ‘Ah, fourth doses, nobody’s thinking about that.’
Now we all are—and mixing and matching the vaccine
types and really optimizing the dosing regime, so these
people can be protected as best as we’re able.”
INCOMPLETE PROTECTION
There is sTill much we don’t know about how well the
COVID vaccines work in people with immunosup-
pressing diseases or treatments, because the clinical
trials that preceded their approval excluded this
group for safety reasons. But scientists have begun to
study this question. A recent report from the U.S. Cen-
ters for Disease Control and Prevention that exam-
ined immunocompromised people who received
Tanya Lewis is a senior editor covering health
and medicine for Scientific American.
G
eorge Franklin iii is one oF The longesT-surviving kidney TransplanT
recipients in the U.S. Now 67, he received his lifesaving surgery 46
years ago, which has enabled him to lead a healthy and active life—
swimming, bowling, visiting friends and even competing in a sport-
ing tournament known as the International Transplant Games. But
since the beginning of the COVID pandemic, he hasn’t been able to
do any of these things. Like most transplant recipients, Franklin, who
lives in western Maryland, has to take medication to suppress his
immune system and prevent his body from rejecting the donor organ.
Last March he received the Johnson & Johnson COVID vaccine but did not develop detectable
levels of antibodies. “Those of us that have no antibodies,” he says, “it’s as if we’ve never taken a
shot.” (Last November he got the Moderna vaccine and finally developed antibodies.)
