During the last year and a half, immunocompromised people have been at extremely high risk for the virus. And for many, the COVID vaccine didn't change that.
That's why a group of independent Centers for Disease Control and Prevention experts at a Thursday meeting largely voiced support for allowing immunocompromised people to talk to their doctors about getting a third shot, a booster, that could increase their antibody response to vaccines.
But the advisory committee didn't make a formal recommendation, saying more data was needed and, ultimately, regulatory allowance from the Food and Drug Administration.
About 2.7% of U.S. adults are considered immunocompromised, an umbrella category that includes cancer patients, transplant recipients, people with HIV and patients on high-dose steroids.
"We long for a fuller life," said Phil Canuto, a kidney transplant recipient from Akron, Ohio, who told the CDC advisory committee on Thursday that he had no antibody response after two Pfizer shots.
"I can't wait to see my stepdaughter's new Colorado home," he said, choking up. "I want to eat a medium rare steak at the Diamond Grill."
Canuto, who spoke before the CDC advisory panel during the public comment period, said he'd been told he still must behave as if he's not vaccinated.
"I urge you, beg you even, to recommend that we be able to receive a third vaccine dose," he said. "The benefit could open up the world to us again."
At the same time, pressure is mounting as other countries, including France and Israel, already have approved boosters for those who are immunosuppressed. In the U.S., debate over booster shots for the general public has ratcheted up as the delta variant wreaks havoc.
Data presented at the meeting said a booster shot could increase antibodies in an immunocompromised person by up to 50%.
Dr. Sara Oliver, an epidemiologist with the CDC who presented the findings, also explained how immunocompromised people are a priority group for booster research because they're at greater risk of serious COVID-related consequences.
For example, in one U.S. study, 44% of hospitalized breakthrough cases were immunocompromised people. An Israeli study found it was around 40%. Breakthrough cases, which are expected, refer to people who test positive for COVID-19 while fully vaccinated. The vaccines are highly effective against severe disease and hospitalization, but it's possible for people to develop mild or asymptomatic illness even when vaccinated.
"We want to vaccinate. During this entire conference, we've been saying, vaccinate, vaccinate, vaccinate," said Dr. Pablo Sanchez, a member of the panel. "These people want to be vaccinated, they're not vaccine hesitant. And it seems to me that we should promote that."
He argued that the FDA should "at least allow it while we obtain more data" because "we really need to help this population out more." Patients, Sanchez argued, could end up taking matters into their own hands.
Canuto, of Akron, said he planned to do just that.
"Hundreds of us lie to pharmacies and immunization sites about our previous vaccinations, trying to get an extra unauthorized dose," he told the committee. "I know that's what I'll be doing if additional doses are not sanctioned."
Another ACIP member, Dr. Sandra Fryhofer, a liaison of the American Medical Association, pointed out that there are millions of excess vaccine doses right now that aren't being taken advantage of in the U.S.
At the same time, there are immunocompromised patients doing "all they can" and still not getting protection.
"I really do share the concerns that have been expressed by our ACIP members about, you know, our patients, right now, they're immunocompromised, that are doing all they can do by getting vaccinated, by having their close contacts vaccinated, and it's not enough that they're still not protected," Fryhofer said.
The work to assess additional studies is ongoing, and the next step would be for the FDA to issue regulatory guidance.