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For the third time, when it comes to the coronavirus vaccine, Esther Jones, a dialysis nurse in rural Oregon, has been tempted. After two doses of the Pfizer-BioNTech vaccine failed to shake the immune system to produce antibodies, he sought a third vaccine, this time the Moderna vaccine.

It worked. Blood tests revealed a reasonable antibody response, although lower than that detected in healthy people. He took a fourth dose last month in hopes of boosting levels even more.

Ms. Jones, 45, underwent a kidney transplant in 2010. To prevent organ rejection, he has since taken drugs that suppress the immune response. She was expected to have trouble responding to a coronavirus vaccine and enrolled in one of the few studies ever done to test the benefit of a third dose in people with weakened immune systems.

Since April, healthcare providers in France have routinely third dose given A two-dose vaccine to people with certain immune conditions. The number of organ transplant recipients with antibodies increased from 40 percent after the second dose to 68 percent four weeks after the third dose, a French team found. researchers recently reported.

Study involving Ms. Jones revealed similar results in 30 transplant recipients who received third doses on their own.

Be vulnerable to infection D., an organ transplant surgeon at Johns Hopkins University, who led the study. Dorry Segev said it was “very scary and frustrating” for people who are immunocompromised, even after vaccination. “They have to keep going unvaccinated until we find a way to give them better immunity,” he said.

But in the United States, there has been no concerted effort by federal agencies or vaccine manufacturers to test this approach, leaving people with low immunity with more questions than answers. In fact, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health suggest even against the test To find out who is protected. And academic scientists are hampered by rules limiting access to vaccines.

D., an oncologist at Montefiore Medical Center in the Bronx, who led a study showing that some cancer patients do not respond to treatment. “There should already be a national study looking at booster vaccinations in post-transplant patients,” said Balazs Halmos. vaccines. “We shouldn’t have our little team here in the Bronx trying to figure this out.”

An estimated 5 percent of the population is thought to be immunocompromised. The list of reasons is long: some cancers, organ transplants, chronic liver disease, kidney failure and dialysisand drugs like Rituxan, steroids and methotrexateroughly taken 5 million people for ailments ranging from rheumatoid arthritis and psoriasis to some types of cancer.

A rheumatologist at NYU Langone Health, Dr. “These are the people who are left behind,” said Jose U. Scher. methotrexateeffect on vaccines.

Not everyone who has one of these risk factors is affected. But without further research, it’s impossible to know who might need extra doses of the vaccine and how much. Besides the risk of Covid-19, there is also evidence that: low immunity can allow virus keep repeating potentially in the body for a long time new variants.

Infusion of monoclonal antibodies may help some people who don’t produce antibodies on their own — but again, this idea is not fully explored, said John Moore, a virologist at Weill Cornell Medicine in New York City.

Using monoclonal antibodies “makes a lot of sense for this group of people, so I’d like to see companies become more active in this area,” he said. “Government support or pressure will also help.”

The third dose approach enjoys widespread support among researchers because it has a clear precedent. For example, people who are immunocompromised are given booster doses for hepatitis B and flu. And discontinuation of methotrexate Known after getting the flu shot develop a vaccine potency – compelling evidence of the American College of Rheumatology we recommend that you pause the use of methotrexate for one week before being vaccinated against coronavirus.

There are several studies stated a third dose of coronavirus vaccine can be successful in patients without detectable antibodies after the first or second dose. But the research was delayed.

modern gears up Pfizer, which manufactures some immunosuppressant drugs, to test a third dose in 120 transplant recipients planning a study 180 adults and 180 children with immunodeficiency.

The companies turned down at least two independent teams hoping to study the effects of the third dose.

NIH Recruit 400 immunocompromised people It’s for a trial that will monitor levels of antibodies and immune cells for up to 24 months – but has no trials looking at a third dose.

“Unfortunately, it takes time, especially as a government agency,” said epidemiologist Emily Ricotta of the National Institute of Allergy and Infectious Diseases. “We have to go through a lot of regulation and approval processes to make these types of projects.”

However, this explanation does not satisfy some researchers. Dr. Scher noted that many medical centers have groups of patients who do not respond to vaccines, so federal agencies can organize a clinical trial without too much difficulty. “This is a very simple study,” he said. “No rocket science here.”

Earlier studies had suggested that many people with cancer would not respond to vaccines, but these analyzes were done after patients received a vaccine. single dose. Of Montefiore Medical Center, Dr. A new study published this month by Halmos and colleagues has allayed some of those fears. Vaccines seem to work well in patients with a wide variety of solid and liquid tumors. big analysis.

But 15 percent of those with blood cancer and 30 percent of those taking immunosuppressant drugs did not have detectable antibodies after the second dose. Halmos said he and his colleagues are keen to test whether a third dose could benefit these people, but they don’t yet have access to vaccines.

Dr. In a previous study, Segev’s team had less than half of 658 transplant recipients. had measurable antibodies After both doses of an mRNA vaccine made by Pfizer-BioNTech or Moderna. But to follow up on the finding, they had to recruit volunteers like Ms. Jones, who took the third doses on their own.

Scientists say that a third dose elevated antibody levels In all 30 transplant recipients with low or undetectable antibody levels.

Ms Jones said she felt many people like her had been abandoned by the federal government, especially with the threat of more infectious variants circulating in the United States.

Some members of a Facebook group for immunocompromised people, desperate for protection, received a third dose at mass vaccination sites where providers didn’t check records or even crossed state lines. Despite this, many continue to wear masks to protect themselves and have sometimes had to endure harassment as a result.

“It really upsets me that so many people in this world should never have been masquerading as this super political thing,” he said. “It makes it harder for us to take care of ourselves.”