Monday, August 10, 2020

Obesity Epidemic Threatens Covid Vaccine Effectiveness

This post is a reprint of an article published in Kaiser Health News.  Sarah Varney is the author.

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

 Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

“Will we have a COVID vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

“Will it still work in the obese? Our prediction is no.”

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more — known as morbid obesity or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the body’s immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue — or fat — in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

“Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored,” pleaded researchers from the Mayo Clinic’s Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.
By contrast, the diminished protection of the obese population — both adults and children — has been largely ignored.

“I’m not entirely sure why vaccine efficacy in this population hasn’t been more well reported,” said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. “It’s a missed opportunity for greater public health intervention.”

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

“That was the mystery,” said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. “It’s not insurmountable,” said Petit, who is researching COVID-19 in obese patients. “We can design better vaccines that might overcome this discrepancy.”

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.
“The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.”


32 comments:

Anonymous said...

But alas, since we now live in a world where a small yet vocal minority of hipsters will scream “But Kingfish, that’s fatphobic” and then thousands of corporate entities and media will scream “Yes! They are right! That’s fatphobic,” nothing will help

FLM in a press conference said...

FAT LIVES MATTER!

Anonymous said...

So I guess COVID vaccination will be accompanied by a prescription for Fen-Phen?

Anonymous said...

Where's Oprah on this, being a MS native and all. Folks need to get on WW, GOLO, Jenny Craig, Nutrisystem or as I learned to do, just shut my mouth at times. May not actually do a thing to stop Covid, but it will help somebody.

Anonymous said...

Lets face it, from time to time you have to thin the herd.

Anonymous said...

I'm hoping for at least some protection that will reduce the severity of the disease. Combine that with the reduced transmission levels from widespread vaccinations and it should make it pretty effective overall versus the uncontrolled mess we are living in now.

Release the vaccine as soon as it shows effectiveness in testing. There should be enough data by sometime in October to justify an emergency authorization for targeted populations.

Anonymous said...

@3:47, how could you possibly know that?

Anonymous said...

A vaccine won't do much good if people won't take it. About 1/3 of the country will not get vaccinated and about 25% more are on the fence.

https://www.marketwatch.com/story/will-the-public-be-ready-for-a-vaccine-many-americans-say-they-wont-get-the-coronavirus-vaccine-if-one-is-developed-2020-08-06

Anonymous said...

Only six comments by now? Must be a lot of old fat JJ readers with hurt feelings.

Anonymous said...

Until there is an abundant supply of whatever vaccine we wind up with, obese people should not be given the vaccine. It should be given to others on whom it has a higher efficacy rate. Obese people can continue to shelter at home and mask up until they lose weight.

Anonymous said...

3:43 - I see what you did there...

Anonymous said...

The never-vaxers are about to be exterminated. Its all part of big pharma's plan

Anonymous said...

4:45 There are two vaccines in phase 3 testing already. One started toward the first of July in Brazil with U.S. testing starting at the end of July. If they are effective there should be a noticeable decline in the infection rate of the vaccinated group after four weeks. Even if a booster is given after a month results would be seen in six weeks. That would be by the middle of September at the latest for initial results. If the results continue to be positive then an October emergency authorization is not unreasonable.

Obviously I don't know what is going to happen. But the timeline does work, and with Trump's statement that he thinks a vaccine will be available before the election it would be most likely the FDA grants emergency authorization to specific groups based on positive initial results.

Anonymous said...

@3:47, you already have that. It’s called your immune system and it works for 98.8something% of people exposed to ComplianceTest19

Calm Down said...

Joe Biden called me fat.

Anonymous said...

Bill Maher says it best. We need to bring fat shaming back because it works.

https://youtu.be/Dm4TAdiEFn0

Anonymous said...

4:45. Walmart had a run on crystal balls weeks ago.

Anonymous said...

Vaccine, sign my fat ass right now. I have nothing to lose, except weight that is. Signed I don't give a shit about something I know is out there, death.

Anonymous said...

And no matter what I do to stay healthy and fit, my health insurance premiums keep going through the roof thanks to you lazy fat asses. Talk about socialism with a capitalist price to pay.

Anonymous said...

My pleasure 8:10. Glad to be of service. Problem is I'm not what anyone would call lazy.

Anonymous said...

There's a fat chance that people will lose weight because of this report, or is it a slim chance?

Anonymous said...

Keep your mits off my fried chicken. Oh....please pass the gravy.

Green Acres said...

@3:37 - Oprah???!!! She's fat, single, and super rich but gives advice about weight loss, marriage, and income inequality.

@6:28 - Putin claims Russia has developed a vaccine and that his daughter took the shot, so I guess Trump is right that there will be a vaccine before the election. Yeah, something made in Russia. Trump needs to take that vaccination so we all can see his bravery.

Anonymous said...

@8:09 AM (8/11) - Amen and amen!

Anonymous said...

I look forward to the day a Fat Tax is implemented a la Japan.

Anonymous said...

@9:03am - You’ll never take my freedumbs to be fat! MURICA

Anonymous said...

Obesity is largely a byproduct of poverty.

Anonymous said...

@12:46
Noooo, "obesity is largely a byproduct of" eating too much, too frequently and getting little-to-no exercise. Slovenliness and laziness abound in wealthy people too. Look around you.
It's called taking personal responsibility for your situation and not blaming others.

Anonymous said...

Now I'm hungry for some fried chicken.


It'll be whatever's left at KFC or Popeyes.
(and the drive through length).

Anonymous said...

12:46, please give it a rest..

Everything that is wrong in the world can't be connected to Poverty.

Everywhere else I've been to in the world, those in "poverty" definitely weren't "fat"!

Only here with the "free" guv-mit subsidies, food banks, church food pantries.

I work with a guy and "fat" isn't the word for him. He'll come in with a dozen asst'd donuts, large ice coffee drink. By 9 AM, its gone and he has been to the snack area and come back with a honey bun, chips and a Snickers with a 20 oz coke to wash it down. Then its lunch and same routine in the afternoon. I tallied what he spends on snacks everyday and it is usually between $6.50 to $8.00 a day and that is just work...

Poverty, I don't buy it.

Anonymous said...

7:30PM

It doesn't sound like your guy is in poverty, but a fat ass sugar/salt addict.

SSanders,MA said...

As a sociologist who has researched weight stigma, this article is so irresponsible! It is an attempt by Pharma to scapegoat obesity in advance for the vaccine not working. Pharma knew that some vaccines are not as effective in larger people for decades. Instead of fixing the problem, they used it as even more reason larger folk should take their poison diet pills. Obesity is correlated with poverty in this country, so lets blame the poor and essential workers who held us together during the pandemic instead of the predatory execs at Pharma who only care about making a buck. Furthermore, the author of this garbage, Sara Varney, is also trying to exploit weight stigma. She has a ridiculous book out about how obesity is ruining the sex lives in America. Pure rubbish. So many of these journalist suck up to Pharma, knowing that is the only way they will get anywhere. Shame!



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