A new study that colleagues from the University of Limerick and University of Stirling, UK, and I recently published in Brain, Behavior, and Immunity has found that lower social cohesion was associated with antibody response to the COVID-19 vaccine. Lower social cohesion also made people feel lonelier, and this was an additional factor in reducing antibody responses to the vaccine.
This study is a classic case of mind-body medicine, whereby our emotions generated by interacting with our social worlds can influence our immune systems.
Why is this important?
Antibodies are a core component of our adaptive immune system’s ability to fight off infections including COVID-19. As we have learned during the current pandemic, COVID-19 vaccines were part of the global strategy to combat the virus. Having the vaccine was important, as the antibodies produced following a vaccination offered protection against hospitalization and death. However, when people do not make enough antibodies following this and other vaccines, they are often vulnerable to infection or re-infection, hence the addition of getting booster shots.
Stress, immunity, and the pandemic
The influence of factors such as stress on our immunity, including antibody response to vaccination, is well-established. Research has found that chronic stress has a negative impact on our immune system, which can increase our vulnerability to infections, increasing our levels of inflammation and related diseases but also lowering our ability to make antibodies following vaccinations.
In contrast, research has also found that better quality social relationships and higher social support have been found to boost immunity (eg, low levels of inflammation) and increase antibody levels following vaccination Thus, these psychosocial factors activate parts of our brain where we think about and process the information about them and this, in turn, triggers a biological cascade that has a knock-on effect on our ability to make antibodies.
Given the negative impact of stress on people’s immune systems, in particular its damaging effect on antibody responses to vaccinations, we decided to see if these types of social stressors seen during the pandemic would also have a negative effect on the COVID-19 antibody responses.
As we have all noticed, during the COVID-19 pandemic, stress was ubiquitous, from managing multiple lockdowns, job losses, increased social restrictions, and lower social engagement as well as issues of misinformation and public trust coming to the fore all leading to increased social stress. We focused on social cohesion as a key predictor of antibody responses.
Social cohesion is a concept that captures our sense of trust in others in our neighborhood, connections, and sense of belonging with others, as well as helping and talking to each other. For example, during the initial lockdowns in Europe a sense of “being in it together” ‘was an oft-used mantra to increase social cohesion and public adherence to public measures, as this was seen as a way of working together to fight the virus . In fact, this was evident from the “clap for carers” in the UK, Italians singing from balconies, and Dubliners playing bingo in the flats, all of which increased social cohesion and public trust.
However, the author noticed that these feelings of social cohesion and trust were short-lived; something UK researchers now call the “Dominic Cummings effect” whereby public health guidance was broken and disregarded by the political elite, leading to outrage from the general public who were seen as largely compliant with these measures. Similarly, diminishing levels of trust were also seen in the US during these periods, as levels of mistrust of science and governments began to emerge again, having a negative impact on adherence to public health guidance. Alongside this, lockdowns were associated with less social interaction and an increased risk of loneliness. Thus, given their prominence, it made sense to examine if social cohesion and loneliness were having an effect on COVID-19 antibody responsiveness.
How did we conduct this research?
We used data from over 600 people who took part in the UK’s Understanding Society COVID-19 antibody study in March 2021.
Participants were sent out a blood sampling kit and asked to provide a blood sample. They had to confirm if they had the COVID-19 vaccine, how many doses, whether they had the infection, and complete a survey that captured their ratings of social cohesion and loneliness.
The blood samples were then sent to a laboratory for antibody titer analyzes and these were then pooled with the survey social cohesion and loneliness data.
What did we find?
We found that those participants who reported lower levels of social cohesion had a poorer antibody response to the COVID-19 vaccine. For example, those who felt less connected to their neighborhood and who had lower trust in their neighbors made fewer antibodies compared to those who reported higher levels of these. In addition, those who reported lower social cohesion also tended to report that they felt lonelier, and this, in turn, reduced their antibody response.
What does this all mean?
Well, given that the pandemic is still ongoing and vaccination is a core strategy for dealing with COVID-19, this study highlights that external factors such as trust, connections, and loneliness, which are not part of our immune system, are actually important for it. Moreover, social cohesion and loneliness are malleable and can be harnessed for improving vaccine responsiveness. In addition, these results highlight once again the relevance of public trust and social cohesion to the success of our pandemic response.