We have routinely advised all our patients undergoing vaccination to take a pure melatonin supplement preferably one to two weeks before the jab, and for the next three to four weeks after. This is repeated when they get their second shot.

The rationale for this is that it may help prevent the excessive reaction and other side effects of the vaccine, and it may also help enhance the immune response, in terms of antibody production and immune memory following vaccination.

Enhancement of response to vaccination is particularly important in the elderly because it’s an established fact that vaccines, in general, may not be as effective in the elderly, compared to younger adults.

They have what is termed as immune senescence, meaning that their immune system is relatively weaker and the desired immune response to vaccination is relatively less.

There is, therefore, a need to try to enhance their immune response involving the two parts of immunity, called the innate and cellular immunity. This is where adjuvant treatment with natural immune system-boosting agents like melatonin comes in.

Our groups at the Manila Doctors Hospital and Fame Leaders Academy have been privileged to have closely worked with an eminent group of global scientists including professors Russel Reiter and Dun-Xian Tan of the University of Texas, Gregory Brown of the University of Toronto, and Harold Pupko in Ontario, Canada, on some research projects evaluating the usefulness of melatonin in the prevention and treatment of COVID-19.

Natural supplement

We are convinced of the benefit the natural supplement can offer because of its potent anti-inflammatory, antioxidant and immunomodulatory effects, which also account for its benefits in those undergoing vaccination.

Our published preliminary report was acknowledged as the first report on the use of high-dose melatonin in actual COVID-19 patients. Several other reports followed, and there are now several large multicenter trials being conducted here and abroad to confirm its efficacy.

Dr. Camilo Roa Jr. now heads the local group which is midway through its clinical trial involving several COVID-19 hospitals nationwide. Since it’s a double-blind trial comparing melatonin with placebo (dummy capsules), we don’t know yet the results until the last patient is enrolled and the results analyzed.

The research is funded by the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD). We’re optimistic that the results will be positive, and that can be our country’s contribution in the global fight against this killer virus.

Brown’s own group in Canada, together with Daniel Cardinali from the Pontifical Catholic University of Argentina, made a strong recommendation for those getting vaccinated to take melatonin supplements.

In their scholarly article published in Melatonin Research early this year, they explained that based on prior experience with the influenza vaccine, up to 50 percent of vaccinated adults showed suboptimal or inadequate response, resulting in lack of effectiveness of the vaccine. They cited growing evidence that “insufficient sleep may potentially be a pervasive and prominent factor accounting for this variability.”

They further explained that those experiencing total or partial sleep loss would have markedly reduced antigen-specific antibodies as compared to healthy sleepers. This was the reason, in our previous columns, we discouraged healthcare workers from getting their inoculation shots immediately after their duty day. This could possibly explain why a lot of our health-care workers are getting infected despite being fully vaccinated.

Cardinali and Brown also stressed that prevaccination sleep quality is an important factor that may help determine resulting efficacy of the vaccine, and the unfavorable side effects that may be experienced.

They said that melatonin enhances the immune response to vaccines by increasing the blood cells that produce the antibodies and the natural killer cells that engulf the virus, like in the Pacman game.

They concluded: “Administration of exogenous melatonin could increase the potency of the immune response and the duration of the immunity induced by the vaccine. Besides, melatonin could also prevent adverse effects of the vaccination due to its antioxidant and immunomodulatory properties. Therefore, the administration of melatonin from two weeks to at least four weeks after vaccination may constitute an effective means to enhance the efficacy of vaccination against SARS-CoV-2.”

Landmark study

Reiter and Tan, who both belong to the elite group of most-cited scientists in the world, also affirm the comprehensive benefit melatonin can offer, both in the prevention and treatment of mild to severe cases of COVID-19.

The two were instrumental in making us decide to undertake the ambitious local multicenter clinical trial, which is expected to be a global landmark study in the use of melatonin for COVID-19.

They also agree that melatonin supplementation can enhance the immune system response following vaccination.

There is no disagreement that a good night’s sleep—seven to eight hours every night— enhances immunity. Many are now experiencing sleeping problems because of too much anxiety caused by COVID-phobia, and this definitely weakens the immune system.

“As COVID-19 vaccines are being distributed, it is of utmost importance that patients continue to prioritize their sleep to maintain optimal health,” said Dr. Kannan Ramar, president of the American Academy of Sleep Medicine, in a statement. “Getting sufficient, high-quality sleep on a regular basis strengthens your body’s immune system and optimizes your response to a vaccine.”

Based on several studies, there is also a strong association between sleep and vaccination response.

In a 2020 study published in the International Journal of Behavioral Medicine, immune system response to flu vaccines was observed to be more effective in those who had adequate sleep during the two nights prior to the vaccination.

Similar findings were also noted in patients’ response to vaccination for hepatitis A and hepatitis B.

A similar piece of advice on getting sufficient amount of sleep prior to vaccination was also given by Dr. Khurshid Khurshid, director of the Center for Neuromodulation at the University of Massachusetts Medical School in the United States.

He explained: “The role of sleep in boosting innate and acquired immune response is significant. All people, particularly health workers, should be aware of the immunity-boosting effects of sleep. Studies have shown that normal sleep after vaccination strengthens the immune response against an invading antigen, and this immunity-boosting effect of sleep is clinically significant.”

Various experts abroad recommend taking melatonin to improve sleep starting two weeks prior to vaccination to ensure that “the vaccine is taken in the midst of optimal sleep conditions—when your immune system is at its best.”

They recommend that the supplement be taken for at least four weeks after receiving the vaccine to enhance the body’s immune response.

They believe this could even increase the length of time a person has immunity to COVID-19 after being vaccinated. This can be a pragmatic solution to the rapidly waning efficacy of the vaccines after six months, especially with the Delta variant.

Improving immunity

There’s also a concern in young people less than 40 years of age getting vaccinated due to the cases of rare deadly reactions, like blood clots in women and myocarditis or heart swelling in young males.

We have maintained our stand that healthy young adults are better off just boosting their natural immunity rather than taking the risk of serious vaccine side effects, but for those who really want to get vaccinated, we advise them also to take melatonin, so as to modulate their immune system response to the vaccine.

Their strong immune system response is the one causing the potentially serious reaction, and melatonin can help modulate or temper this.

Dr. Victoria Sharma, medical director of the Sharp Grossmont Hospital Sleep Disorder Center in the United States, affirms that melatonin may help fight COVID-19 by suppressing an overactive immune response.

She also emphasizes that getting good sleep does wonders to improve immunity, “which can help the vaccine be more effective.”

Sharma offers the following recommendations to improve one’s sleep:

• Keep a regular schedule—try to eat, sleep and perform daily activities at the same time every day.
• Find ways to reduce anxiety and stress, such as exercise and meditation, and avoid potentially stressful activities, such as watching the news, before bedtime.
• Maintain a healthy diet and reduce or eliminate caffeine and alcohol intake, especially before bedtime.

So, the bottom line, according to global experts, is that a good night’s sleep before and after vaccination can help bolster your chances of beating the virus.