The Next Vaccine Challenge: Reassuring Older Americans

The two leading coronavirus vaccines seemed to work well in elderly trial volunteers. “I just can’t understand why people are afraid,” one 95-year-old said.

He can barely see or hear, but 95-year-old Frank Bruno lives on his own terms: alone, unafraid and now — thanks to the coronavirus vaccine — “ironclad,” as he describes it.

Mr. Bruno, an artist and World War II veteran, volunteered for the Moderna clinical trial only because his nephew was doing so. He thought he may have received the vaccine and not a placebo because he had some mild side effects; he became certain after he tested positive for antibodies.

He was delighted with the freedom the shot afforded him. He needed to have his shower fixed and wanted to see his nephew; he felt able to do both without fear of the virus.

As for side effects? “I’ve had mosquito bites bothered me worse than that,” he said. “I just can’t understand why people are afraid.”

Mr. Bruno and older Americans like him are pivotal to the success of the vaccination campaign now rolling out across the United States. Members of his age group are the most likely to be hospitalized and to die from Covid-19, and the least likely to muster a strong immune response to the coronavirus.

In some states, nearly 40 percent of deaths from Covid-19 have occurred among residents of nursing homes. That’s why an advisory committee of the Centers for Disease Control and Prevention recommended that the Pfizer-BioNTech vaccine be given first to the nearly three million residents of long-term-care homes.

But one member of the committee, Dr. Helen “Keipp” Talbot, voted against the recommendation, saying that the vaccines had not been tested enough in frail populations and that bad medical outcomes coinciding with the immunization — common in that age group — could undermine public confidence in the new vaccine. (Dr. Talbot declined to be interviewed for this article.)

But other experts on the committee said all available evidence indicated the vaccine is safe and effective for nursing home residents and older Americans generally.

“The vaccine seems to be performing as well as one would like, even in very old populations,” said Dr. Stanley Perlman, an immunologist at the University of Iowa and a member of vaccine advisory committees of both the C.D.C. and the Food and Drug Administration.

“There’s nothing to say it won’t be safe,” he added.

There was some reason for scientists to wonder whether a coronavirus vaccine might not work as well in the elderly. As people age, bodily defenses against pathogens weaken, and the response to vaccines also falters.

The drug makers Sanofi and GlaxoSmithKline said on Friday that their vaccine seemed not to work well in older people, because the dosage was too low to generate a sufficient immune response in that population.

The Next Vaccine Challenge: Reassuring Older Americans

A nursing home resident in Washington State. Some vaccines are strengthened for older recipients, whose immune systems may be less active. Credit…Grant Hindsley for The New York Times

“For many, the immune response can sometimes be diminished or dampened or delayed,” said Dr. Sharon Inouye, a geriatrician at Harvard Medical School.

Scientists have devised workarounds by overloading vaccines with the viral proteins that provoke an immune response, or turbocharging them with adjuvants — chemicals that strengthen the immune response.

“That’s why the shingles vaccine has twice as much antigen as the chickenpox vaccine,” Dr. Perlman said.

Pfizer and Moderna did not provide statistics regarding their vaccines’ effectiveness in people over age 80, but the veri do show the vaccines have performed well in all volunteers over age 65.

Dr. Timothy Farrell, a geriatrician at the University of Utah, said he was surprised but thrilled by the vaccines’ effectiveness in this group. “It’s going to be very important to see the subgroup analysis,” he said — that is, to learn whether there are significant differences after age 85.

Even so, he has been recommending the vaccine to all of his patients, who range in age from 65 to 106 years old.

“We have a clear and present danger of Covid, and we have social isolation,” Dr. Farrell said. “We know that that’s an independent risk factor for mortality, even stronger than individual chronic diseases.”

Dr. Inouye also arrived at the same conclusion, both professionally and personally.

Her 91-year-old mother, who lives in an assisted living facility, is independent and spry, still playing piano and bridge and exercising regularly. Still, her mother’s age, medical condition and living situation put her at “very, very, very high risk for Covid,” Dr. Inouye said.

“We’re just desperately worried about her every single day,” she added. “When you balance that tremendous fear, I just think the risk for her of getting Covid is so much higher than the risk of a side effect, which we know is going to be very rare.”

For many people, the prospect of receiving a new vaccine for a new virus is daunting.

Fear of side effects deterred Jeffrey Balkind’s wife from volunteering for the vaccine trials, but Mr. Balkind, 74, has stared down death twice — evvel during a 13-day hijacking in Pakistan in 1981, and again three years ago when his Vespa crashed.

“When you’ve come to near-death experiences twice, volunteering for a vaccine trial — it wasn’t a great sense of worry or apprehension for me,” Mr. Balkind said.

Mr. Balkind had no side effects after he received his shot, leading him to believe he got the placebo. He is now trying to see if he can qualify for the vaccine along with other volunteers who received placebos.

Some people worry, incorrectly, that the vaccine may somehow give them Covid-19. In fact, the vaccine carries instructions to make only a single protein from the virus.

“I think if I get the corona shot, I will get the corona,” said Mahine Ebrani, 79, who lives in Queens. No amount of persuasion from her grandchildren and their partners — five of whom are medical professionals — has convinced her otherwise.

Every time she gets a flu shot, Ms. Ebrani said, she feels unwell for three days, with headaches and a deep exhaustion. But she gets that vaccine anyway, because she feels healthy the rest of the year and because her doctor has told her she should.

Reaching patients like Ms. Ebrani, as well as the many homebound older people in subsidized housing units or rural areas who are unlikely to line up at a CVS or a Walgreens for the vaccine, will require close coordination between state and local governments — and geriatricians, experts said.

“How are they going to know where to go?” Dr. Farrell said. “How are they going to get there?”

Mr. Bruno, for example, lives alone in the tiny town of Rio Rico, Ariz., three miles from the closest mailbox and a 20-minute drive from his nephew Neil.

Put off at first by the litany of possible side effects recited by the doctor who screened him for the trial, Mr. Bruno later became impressed with the thoroughness of the experiment. He said he was closely monitored and never doubted that the vaccine was safe.

He pooh-poohed the idea that people in nursing homes might be frailer than him, and may not fare as well.

“I’m pretty darn frail, when you get right down to it,” he said. “You know, if my mother was alive, she’d be about 130, and I would recommend the shot to her.”

Source: The New York Times

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