Opinion: Even fully vaccinated, people with organ transplants aren’t fully protected until more Americans get their shots

“When can we go back to Starbucks?”

My brother, Anmol, asks me that question every time I’m home for a visit.

It’s our tradition. When I’m home, the two of us go to a nearby Starbucks. Anmol doesn’t know a venti from a grande or a mocha from a hot chocolate, so I order whatever I think he’ll like and something for me. As we sit inside the cozy cafe, he nurses his drink and tells me what time the recycling truck came by the house, how many paper bags he’s added to his collection, what random person’s birthday is coming up, and much, more more.

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Anmol really looks forward to this ritual. He doesn’t get out of the house much, and only sees me every few months.

He doesn’t actually see me. Anmol has been blind since he had a stroke before he was 2 years old, a complication of the congenital kidney disease that caused his intellectual disability and necessitated a kidney transplant at age 3. He’s been on drugs to suppress his immune system for the past 33 years.

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The pandemic has interrupted our ritual. Anmol lives with our parents, both in their 70s, and I live more than 400 miles away, working as a doctor on inpatient medical wards taking care of patients with Covid-19 at the hospital in New England that has treated the most Covid-19 patients. I come home for a visit only when I feel comfortable I won’t be bringing the virus with me.

As a physician, I was in the first wave of people to be vaccinated. My family got their shots a few months later. Now that we are all vaccinated, Anmol wants to go to Starbucks.

I’m not sure we’re ready to do that.

The Centers for Disease Control and Prevention recently decreed that fully vaccinated people no longer need to wear masks outdoors or indoors. If the CDC, led by someone I personally trust — the former head of infectious diseases at my hospital — says that going maskless is okay as long as you’re fully vaccinated, I’m on board with that.

But as I see businesses — including Starbucks — start dropping masking requirements for customers, I’m pretty sure people aren’t hearing the “as long as you’re fully vaccinated” part.

As people start celebrating the so-called return to normalcy, vaccination rates have dropped. I worry that Americans are going to stop getting vaccinated, thinking that with falling case numbers and death rates, and the new guidelines, the CDC has sounded the “all-clear.”

A friend said to me, “People who don’t get the vaccine now only have themselves to blame if they get Covid-19.” It’s a common refrain, though one I don’t believe. My bigger concern is for those who can’t get the vaccine for medical reasons and those for whom vaccines probably won’t work — like Anmol.

A week before the CDC mask announcement, a major study showed that almost half of people living with organ transplants produce zero antibodies after two doses of vaccine, including nearly 60% of people on the drugs that Anmol takes. The very drugs keeping his body from rejecting his kidney make him vulnerable to infection from SARS-CoV-2 and other pathogens.

There are a lot of Americans like my brother. There have been more than 850,000 organ transplants in the U.S. since 1988, including 39,000 during 2020. An estimated 2.7% of all Americans are immunocompromised, many of them because they are taking the same drugs as transplant recipients for Crohn’s disease, psoriasis, and other autoimmune diseases.

President Biden said, “If you’re fully vaccinated and can take your mask off, you’ve earned the right to do something that Americans are known for all around the world: greeting others with a smile.” Anmol is vaccinated, and always greets people with a smile. But he can’t show it in public. Not yet.

Instead, his doctors say he should keep wearing a mask and social distancing when he is outside of the house, and to follow the guidelines for people who aren’t vaccinated. I ask them if Anmol should be tested for antibodies. They say no: we don’t know at what level of antibodies he’s truly protected. The antibody test will only give a “false sense of security.”

The disappearance of Covid-19 from the community will slow as people stop wearing mask, stop social distancing, and stop getting vaccinated. In March 2020, when vaccines were just a glimmer in pharmaceutical companies’ eyes, we worried that Covid would blaze through the population like a wildfire. Today, with about half of Americans vaccinated, we’ve got the fire contained, but if we stop fighting now it will burn steadily for a long time. To put it out, unvaccinated Americans need to get their shots.

The sooner they do, the sooner I can take Anmol to Starbucks. America, please help me fulfill his simple wish.

Hemal N. Sampat is an internist and pediatrician at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School.

Source: STAT