Can Immunocompromised People Safely Receive the COVID-19 Vaccine?

Woman receiving a vaccine while wearing a face mask.

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Key Takeaways

  • Doctors recommend immunocompromised people receive the COVID-19 vaccine. 
  • The Pfizer and Moderna COVID-19 vaccines do not contain live traces of COVID-19. 
  • Depending on the person's immunocompromised level, some may receive lower levels of immunity from the vaccine.

The highly anticipated COVID-19 vaccine rollout is here with Pfizer-BioNTech and Moderna leading the charge. It was made clear by the government that healthcare workers and residents of long-term care facilities would be the first in line to receive the vaccines, and as of Feb. 19, almost 60 million doses have been given in the United States.

But as more people get vaccinated, what will getting vaccinated mean for immunocompromised people, and how does immunocompromised status potentially impact COVID-19 vaccine immunity?

People who are immunocompromised have weakened immune systems. According to the Centers for Disease Control and Prevention (CDC), this includes people living with HIV/AIDs, those who have undergone radiation or transplants, and people who have diseases that affect their immune system.

What This Means For You

Once your turn to receive the vaccine arrives, consult with your healthcare provider about your immunocompromised status and how the vaccine may impact you. Ask them what kind of vaccine you'd be receiving and what their recommendations are.

The Type of Vaccine You Get Matters

For immunocompromised people, the type of vaccine they receive matters. “There are different types of vaccines," Peter Gulick, MD, associate professor of medicine at Michigan State University, tells Verywell. "There’s a live vaccine and attenuated where it doesn’t have any kind of live virus."

What Gulick is referring to are inactivated vaccines, a type of vaccine that uses the killed version of the germ that causes a disease. Examples of inactivated vaccines include hepatitis A, flu, polio, and rabies. Because inactivated vaccines do not provide as much strength as live vaccines, they are usually administered in doses.

On the other hand, activated vaccines are vaccines that use a weakened version of the germ to build a strong and lasting immune system. These vaccines include measles, mumps, rubella (MMR), smallpox, chickenpox, and yellow fever. Activated vaccines can be dangerous for immunocompromised people because the active virus present in the vaccine runs the risk of causing illness.

The COVID-19 Pfizer and Moderna vaccines are neither live vaccines nor inactivated vaccines. They use a new method that relies on teaching cells to make a protein or piece of a protein that triggers an immune response.

The Pfizer and Moderna vaccines lead to the production of antibodies. These antibodies then work to keep us healthy and protect us from getting COVID-19. “A vaccine that’s not live is usually a component that triggers your body to create a memory for that specific virus and then create antibodies versus a live vaccine which has a low concentration of the actual virus itself,” Navya Mysore, MDCM, CCFP, a New York-based family physician and medical director for the Tribeca office of One Medical, tells Verywell. 

“These COVID vaccines are not live vaccines," Gulik says. "And so, a patient that is immunocompromised—no matter what degree of compromise—could take the vaccine."

The Johnson & Johnson COVID-19 vaccine developed by its pharmaceutical company Janssen is a viral vector vaccine that uses an inactivated common cold virus (adenovirus) as the delivery method (vector) for transporting a recombinant vaccine for COVID-19. Recombinant vaccines use a small piece of genetic material from the virus to trigger an immune response and are typically safe in people who are immunocompromised. Janssen applied for emergency use authorization from the FDA on February 4.

In some cases, one dose of a live-attenuated vaccine can give a lifetime of protection. The Pfizer and Moderna COVID-19 vaccines require two doses; and it's still unknown if additional booster doses will be needed. If authorized, the Johnson & Johnson vaccine may be given in one dose and it's still unknown when or if additional booster doses will be needed.

Weaker Immune Response

People with HIV were included in mRNA COVID-19 vaccine clinical trials, but the number of these participants was small in the trials so the data is still limited. According to the CDC, immunocompromised individuals, including those with HIV and those on immunosuppressive medications and therapies, can get vaccinated with mRNA vaccines but should discuss it with a physician. There is still the potential for reduced immune responses and a lack of safety and efficacy data.

The Johnson & Johnson COVID-19 trials also included immunocompromised participants, including those with HIV, but the CDC and FDA have not yet made any statements or recommendations. The FDA is scheduled to meet on Feb. 26 about the company's request for emergency use authorization.

Although the mRNA COVID-19 vaccines have a roughly 94% to 95% efficacy rate, immunocompromised people might be less likely to respond to the vaccine. “They [immunocompromised people] may only get a 20% or 30% response depending on how immunosuppressed they are,” Gulick explains.

Timing of the vaccine matters in order to optimize its efficacy. “I want to not delay it, but try to optimize their immune systems so they can get a good response,” Gulick says.

Gulick waits for his patients who are HIV positive to have above 200 T cells before recommending they get the vaccine. “With my HIV patients, I try to get their T cells up to at least above 200 and as high as I can before I give them any vaccines,” Gulick says. “If their T cells are low, they may not get the response I want them to get.” 

This is one of the reasons social distancing and mask-wearing should be standard procedure even after vaccination. “Because such patients have the potential for reduced immune responses, they must continue to follow all current guidance to protect themselves against COVID-19, even after vaccination,” Sri Banerjee, MD, PhD, MPH, epidemiologist and core faculty in Walden University’s School of Health Sciences, tells Verywell. 

Next Steps 

If you are immunocompromised, Mysore recommends speaking with your provider about your immunocompromised status and the COVID-19 vaccines. “What I’ve been telling my patients is when the time comes for them to be vaccinated, to individually touch base with your primary care doctor to figure out what those considerations are and whether or not you should be or should not be getting vaccinated,” Mysore says. 

Some questions you may consider asking your healthcare provider include:

  • What kind of vaccine am I getting? 
  • Should I get the vaccine? 
  • If the answer is no, why am I not recommended to get the vaccine?

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.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. COVID-19 vaccine data. Updated February 19, 2021.

  2. Center for Disease Control and Prevention. General Information for Immunocompromised Persons. Updated February 8, 2021. 

  3. U.S. Department of Health & Human Services. Vaccine types. Updated March 2020.

  4. Center for Disease Control and Prevention. Understanding mRNA COVID-19 vaccines. Updated December 18, 2020.

  5. Food and Drug Administration. Coronavirus (COVID-19) update: FDA announces advisory committee meeting to discuss Janssen Biotech Inc.'s COVID-19 vaccine candidate. Updated February 4, 2021.

  6. Johnson & Johnson. Johnson & Johnson announces single-shot Janssen COVID-19 vaccine candidate met primary endpoints in interim analysis of its Phase 3 ENSEMBLE trial. Updated January 29, 2021.

  7. Centers for Disease Control and Prevention. Interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States. Updated February 10, 2021.