Conversely, immunological endpoints (eg, vaccine-induced antibody responses) could be added to clinical trials investigating iron interventions. Markers of inflammation should also be assessed, because inflammation suppresses serum iron, through induction of hepcidin, and increases ferritin. Key iron-associated parameters to measure should include transferrin saturation and serum iron, which reflect the circulating iron compartment (the source of iron for the responding immune system) ferritin, which reflects iron stores and soluble transferrin receptor, which indicates erythropoiesis. This framework includes retrospective analysis of newly available datasets derived from trials of COVID-19 and other vaccines, and prospective testing of whether nutritional iron interventions, commonly used worldwide to combat anaemia, improve vaccine performance.Ĭonsiderable progress in these areas could be made by retrospective analyses of samples from the many vaccine trials that take place in LMICs and high-income countries each year, to assess links between iron status and vaccine efficacy at individual and population level. We propose a framework for urgent detailed studies of iron–vaccine interactions to investigate and clarify the issue. In this Viewpoint, we highlight evidence showing that iron deficiency limits adaptive immunity and responses to vaccines, representing an under-appreciated additional disadvantage to iron deficient populations. Iron deficiency is the most common micronutrient deficiency worldwide, affecting more than 2 billion people, and its prevalence in LMICs could increase as food security is threatened by the COVID-19 pandemic. Identifying and correcting the specific causes of impaired vaccine efficacy is of substantial value to global health. Vaccine efficacy can also be decreased in adults in the context of some common comorbidities. Nevertheless, the efficacy of several paediatric vaccines is lower in low-income and middle-income countries (LMICs), where mortality from vaccine-preventable infections remains high. Vaccines are the most effective measure to prevent deaths and illness from infectious diseases. The Lancet Regional Health – Western Pacific.

The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.

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