Nutritional adequacy may yet be able to enhance vaccine efficacy
PremiumWe need clinical research to see if micronutrient supplements could help fortify immunity and the effectiveness of covid jabs
Nutrition, vaccine efficacy, sleep deprivation, immune system, micronutrients, Global Nutrition Report
A number of silent factors, such as stress or sleep deprivation, have a direct influence on our immune system. One such important factor is micronutrient deficiency, a special focus area of our work at Sight and Life (SAL) Foundation. The food we consume plays a key role in laying down the foundations of our immune system. Our bodies only need small amounts of micronutrients, but maintaining an optimum level is essential for our immunity. Micronutrient deficiencies occur when either the food you eat does not provide the body with sufficient vitamins and minerals, or demand for the same increases during specific stages in life, such as during pregnancy and lactation.
In an ideal world, we can all adopt a healthy diet and correct specific nutrient deficiencies to safeguard ourselves better. However, it is not possible to reach 3 billion people with affordable healthy diets quickly and urgently. In the wake of this, a comparatively quicker, short-term solution could lie in multi-micronutrient supplements, which can reach the last household on the back of good programme implementation. A single micro- nutrient supplement a day could help correct this deficiency.
Across the world, hunger is has been rising. The number of people who did not receive adequate nutrition was up 10 million from 2018 to 2019, and then rose sharply by 161 million in 2020, which, of course, was due to pandemic-related crises. According to the 2021 Global Nutrition Report, 149 million children under 5 are stunted and 45 million are ‘wasted’, while 30% women of child-bearing age suffer from anaemia. The Standing Together for Nutrition consortium estimated that over the next 3 years, the covid crisis would cause an additional 3.5 million children to suffer stunting, 13.6 million children to suffer ‘wasting’ and an additional 283,000 deaths related to malnutrition among under-5s in low- and middle-income countries.
The large burden of world hunger is borne by countries like India. Hidden hunger or micronutrient deficiency is an even larger malaise, as it lurks silently among seemingly well-fed urban populations that may be consuming nutrient-empty calories, thus weakening their immune system despite their not feeling ‘hungry’.
Since the pandemic, the optimal-micronutrient status of individuals has become even more important. Existing evidence (bit.ly/35uQaSe) indicates that supplementation with high-dose vitamin C, D and zinc may alleviate the health complications caused by covid, including inflammatory markers, oxygen dependence, length of hospitalization and mortality.
However, achieving a good nutritional status goes beyond warding off infections.
As we wait for covid vaccines and the supposed security of ‘herd immunity’ to end this pandemic, what if we are overlooking an important factor?
There’s compelling scientific evidence that micronutrient deficiencies reduce vaccine efficacy, as gauged by a robust immune response and measured by antibody levels. “When the immune system isn’t properly fuelled and is impaired, it can lead to poor vaccine responses," concluded Margaret Rayman, professor of nutritional medicine, University of Surrey, and Philip Calder, head of human development and health and professor of nutritional immunology, University of Southampton, in their paper, ‘How to make COVID vaccines more effective: Give people vitamin and mineral supplements’.
A significant body of findings suggest that to achieve the levels of micronutrients necessary to support optimal functioning of the immune system, micronutrient supplementation, in addition to good nutrition knowledge and behaviour, is a must. This is also one of the reasons we launched IMPAct4Nutrition with Unicef India and 13 other partners such as Tata Trusts and CSR Box, to name a few. The platform engages the private sector to act with government initiatives such as the Poshan Abhiyaan to address malnutrition.
The effect of micronutrient adequacy on an effective vaccine response has been demonstrated before. A clinical trial conducted by Rajiv Bahl et al in 2002 studied the effect of vitamin A on antibody response to the oral polio vaccine (OPV). They noted that “Vitamin A supplementation to mothers in the post-partum period and to their infants with OPV at 6, 10, and 14 weeks, improved antibody response to poliovirus type 1". A more recent study, in 2020, by Stoffel and colleagues from ETH Zurich, Switzerland, showed that iron deficiency in infants resulted in a reduced response to the diphtheria, pertussis and pneumococcal vaccines. Infants with iron deficiency anaemia saw an improved response to the measles vaccine when supplementary iron was given at vaccination time.
Current research addressing the effects of malnutrition and the effectiveness of the covid vaccine is largely focused on elderly demographic groups in high-income countries. There is a need for more clinical research on the impact of supplementation to make vaccines more effective for various age brackets in various other geographies.
SAL proposes a call to action for clinical trials to further uncover whether micronutrient supplementation prior to and after vaccination increases covid vaccine efficacy.
We hypothesize that such an approach would increase vaccine efficacy and malnourished populations in low- and middle-income countries would benefit the most. The intervention would likely also encourage people to keep up their intake of supplements upon seeing its benefits. There is mounting evidence on how micronutrients help cope with covid. The effect of good nutrition and adequate micronutrients on an effective vaccine response deserves high-priority attention.
Klaus Kraemer & Neha Bainsla are, respectively, managing director, and India country manager, Sight and Life Foundation
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