Advancing T-cell testing can help parents can make informed decisions on COVID vaccinations
There are increasing concerns over COVID-19 vaccines today — some are not based on misinformation but rather a lack of complete information. Parents have been voicing reservations on vaccinating their children due to increasing cases of myocarditis and pericarditis, and potentially other adverse outcomes yet to be identified. Given myocarditis is a life-threatening disease, I empathize with parents and the weight of their decision when considering the limited information we have.
As physicians, we determine a course of treatment for individual patients based on their clinical benefits versus risks. We employ evidence-based guidelines, standards of care, and our clinical experiences to ensure we are advising the best path forward. We know that children and young adults have statistically lower rates of hospitalization and typically experience mild symptoms, but could still spread the disease. While we have several vaccines only available under Emergency Use Authorization, we’re taking very educated guesses based on clues from other coronaviruses and emerging research. Nonetheless, we’re still flying a little blind here.
We need to prioritize vaccine-acquired and infection-acquired immune response research to understand the who, what, when, where, how, and why for future vaccination efforts, including clinical appropriateness. In doing so, federal agencies need to take a deeper dive into T-cells (and B-cells) as they play an essential role in reducing the severity of symptoms and help prevent infection. Here’s why T-cells matter for the long run:
In simplistic terms, when the human body is infected with a virus, it starts producing antibodies in a matter of days. They peak in a matter of weeks. Then, over the next months, as the body works to defeat the virus, the antibodies typically decrease to eventually immeasurable amounts. However, T-cells are designed to be much more resilient and help prevent reinfection in the long term when antibodies are low.
We can glean this from other coronaviruses. Studies show people infected with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have long-lasting immune responses. In fact, SARS T-cell responses played a role in cross-protection with MERS because they shared similar makeups, and have been found in patients more than a decade later. Our immune response is quite resilient considering people who survived the Spanish flue of 1918 had immune memory almost a century later.
Whether you had an asymptomatic or symptomatic infection from a year ago or longer — while you may not have measurable antibodies now — you most likely have a strong immune response that will protect you from death or significant illness thanks to your T-cells. Wouldn’t that be good to know for many reasons?
Physicians and parents need tools and information to have an accurate discussion on clinical benefit versus potential risk for their patients and families regarding vaccination and immunity. Suppose we prioritize diagnostics and research in immune response. In that case, we’ll better understand prior exposure of infection, the duration of vaccine-induced immunity, dosing and administration for specific populations, the medical necessity of boosters, and whether future vaccines will need to be made to combat variants.
Unfortunately, the U.S. is lagging behind in the practical application of this science. The UK’s health agency launched studies giving researchers this standardized tool in an effort to shed light on these unknowns. For example, they may be able to evaluate patients who had severe reactions to the vaccines and see if they already had natural immunity. The company behind this type of technology has its application pending before the FDA – unfortunately, they’re not prioritizing its review. This accessible technology could be utilized from your physician’s office to provide better clinical sensitivity of immunity by T-cells when antibodies have fallen below detectable levels. This sets the stage for parents to make a truly informed decision with your physician.
The clock is ticking as parents inch closer to the fall semester and return their children to the classroom. Every parent and physician I’ve talked to has told me if they knew their patient or child’s level of immune response, it would make sense to amend the standard on dosing and administration to meet clinical appropriateness. This would impact their benefits versus risk model. From what I’ve heard on how states and stakeholders are debating what to require and what not to require for its K-12 schools, we need real answers and the precision that comes from it.
We can go beyond our narrow understanding of COVID-19 immunity. HHS agencies need to better prioritize and collaborate efforts to develop what our next steps should really be for the short and long term, and natural immunity should be considered part of the equation. And thanks to Congress, they certainly have the resources to pull it off.
HHS’ unprecedented public-private partnerships like Operation Warp Speed delivered groundbreaking vaccines, therapeutics, and diagnostics in record time. The NIH’s “shark tank” initiative helped deliver over-the-counter testing to meet increasing demand.
When we’re bold, brave and lead, we can accomplish remarkable things.
Roger Marshall, M.D., is the junior senator from Kansas and is a member of the Health, Education, Labor and Pensions Committee.
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