How can stress affect COVID-19 vaccine immune response?

Female healthcare worker receives COVID-19 vaccine 
I can’t help but think of the song “Don’t Worry Be Happy” as we’re getting ready to be vaccinated against SARS-CoV-2, the coronavirus that causes COVID-19. 
That little ditty pretty much sums up what my research team at The Ohio State University found when we reviewed 49 vaccine studies in humans dating back 30 years. Our own mind-body research over the years has shown how stress impairs physical health in a variety of ways, primarily by hampering the human immune response. 
Our review of scientific literature has been accepted for publication in the journal Perspectives on Psychological Science.
One of my colleagues, Annelise Madison, first author of the paper and a graduate student in clinical psychology at Ohio State, had the idea to look at these previous studies. 
She wanted to see what factors, such as stress, depression and inactivity, we could modify to help make our response to the vaccine quicker, more robust and lasting.
What did we find?
The studies we examined document how stress, depression and poor health behaviors can negatively affect the body’s immune response to vaccination. They also offer insights into how improving health factors can enhance that response. 
The studies found that the impaired immune responses tended to fall into three categories: 
  • interference with the development of antibodies against the pathogen
  • more rapid erosion of antibody protection that does develop
  • intensification of vaccination’s side effects 
The studies in our review investigated the effects of psychological factors and behaviors on the immune response to a range of vaccine types, such as influenza, hepatitis B, typhoid and pneumonia.
Because many findings have been consistent across responses to different vaccines, we considered them likely to be relevant to the SARS-CoV-2 vaccine for COVID-19.
We didn’t have to look far to find studies to support this theory. A few of my past studies conducted at The Ohio State University Wexner Medical Center illustrate the varying effects of different types of stress on human responses to vaccination.
For example, a study of medical students’ immune response to a highly effective hepatitis B vaccine found that all students eventually developed antibodies. But the students who were more stressed or anxious about exams coinciding with the inoculations took significantly longer to develop protective antibodies.
My lab’s past research has also shown that older adults—who are considered at higher risk for severe COVID-19 symptoms—sometimes don’t respond well to flu vaccines. In one study, only 20% of stressed adults who were age 71 or older developed antibodies after a flu shot.
Additional studies in my lab showed that people who were depressed experienced post-vaccination side effects of lethargy, malaise and irritability for a longer period of time than people who weren’t depressed. 
What does this mean?

These findings suggest that with the COVID-19 vaccine, when you’re more stressed and more anxious, it may take a little longer to develop antibodies. So you should allow more time before assuming you’re protected. 

Unfortunately, the steady stress of navigating our disrupted routines and social lives during the pandemic may have set us back when it comes to maintaining healthy behaviors.
For example, we found recent data from across the world documenting higher depressive and anxiety symptoms and more insomnia during lockdown, increased alcohol sales and overeating, and fewer average step counts recorded by Fitbits.
But the good news is that the power to make improvements that give us the best chance for a healthy response to the coronavirus vaccine is almost completely in our control.

How can we get ready for the COVID-19 vaccine? 

So while we wait our turn to get the COVID-19 vaccine, what are some ways to we can prepare emotionally and physically to improve our immune response?

Here are five tips that may help:

  • Manage stress through exercise and mindfulness meditation
  • Get enough sleep
  • Quit or curb tobacco use
  • Improve our diets
  • Seek professional help for depression
According to previous research, a range of interventions may help us all get the most out of the COVID-19 vaccine: Massage and expressive writing for stress management; short- and long-term physical activity, including 25 minutes of arm exercises before injection; and nutritional supplementation all helped increase antibody response or reduce side effects in past studies. 
The evidence suggests that making these changes—even in the short term, right around the time of vaccination—could influence how our bodies respond. The time to act is now, before most of us have received COVID-19 vaccines, to help make the vaccine as effective as possible and its protection last as long as possible.  
Janice Kiecolt-Glaser is director of The Ohio State University’s Institute for Behavioral Medicine Research and a professor of psychiatry and psychology in the Ohio State College of Medicine.