The Covid-19 pandemic has disproportionately affected liver patients – patients with chronic liver disease have around 5-times increased mortality from Covid-19 than individuals without liver disease. Therefore, the development of vaccines is a welcome step, but we don’t yet know if they are fully protected in liver patients. Early data from the US demonstrates that two-thirds of liver transplant patients don’t have detectable antibodies to the coronavirus after one dose of mRNA vaccine (Boyarsky et al 2021).


There is, therefore, an urgent need to determine how effective these vaccines are in liver patients, to determine if extra protection is needed – such as extra vaccine doses, additional medications, or continued shielding. The COBALT study is taking place across Europe to urgently address this question by measuring responses to vaccination in liver patients. It is designed to report back quickly to inform patients and policy-makers, although further support is needed to accelerate this process and allow policy decisions to be made rapidly.