What implications are there for different types of COVID-19 vaccines, for people with MS?

Vaccines for COVID-19

In the midst of the chaos created by the global COVID-19 pandemic, I am sure it has not escaped your notice that there are now around 10 approved COVID vaccines, with many more in the earlier stages of development. The initial evidence suggests that they are extremely effective at preventing a person from developing coronavirus, and there are very high hopes that the end of this terrible infection might now be in sight. But of course, some key questions remain. Not least amongst these, is the safety of any potential vaccine.

Are the vaccines safe?

It is crucial to point out that just because a treatment has been produced quickly, it does not mean that any shortcuts have been taken. Given the vital importance of these projects, the timeline has been shortened by conducting some of the many research steps simultaneously, rather than waiting to complete phase one before moving to stage two etc., and also by starting the lengthy regulatory processes at the beginning of the development process, not the end. This does not mean that key steps are being omitted or that risks are being taken with our health, and this innovative process may even help to fast-track treatments for other conditions in the future, perhaps even MS. Where previously it took 10 years or more to develop a treatment and get it to market, this could now be achieved in as little as one to two years.

Who decides the vaccine is safe?

It is also important to realize that the decision on the safety of any potential vaccine does not lie in the hands of the pharmaceutical companies that make them, but rather in the independent pharmaceutical regulatory bodies, such as the FDA in the United States, or the MHRA in the U.K. Safety is their primary concern, especially when proposing to vaccinate large proportions of the population. 

So far, all three vaccines report very good safety data, with no significant complications or major side effects.  The Oxford vaccine trial was paused twice, but on both occasions was restarted after investigation – a relatively common event in trials, and no cause for concern at this stage.

So what does it mean for people living with MS?

Having MS does not mean that you shouldn’t take the COVID-19 vaccine, and there is nothing to suggest that a vaccine will cause MS, trigger relapses or worsen symptoms. There are some potential issues for people taking certain disease modifying drugs (DMDs) however, and these may make some vaccines either unsafe or ineffective.

Can I have the vaccine while receiving MS treatment?

If a vaccine is “live”, then it contains small amounts of active virus particles, and there is the potential that you might develop the infection if the immune system has been suppressed, as is the case with some MS treatments. For example, the polio, yellow fever and MMR vaccines are all live, and many people with MS are advised to avoid these whilst taking certain DMDs (please speak to your MS team if you are unsure). But at this stage it appears unlikely that the COVID-19 vaccine will be live, in which case it should be safe, regardless of which DMD you might take.

The second issue is whether the vaccine will still be effective if you are taking DMDs. For a vaccine to work, it must trick the immune system into launching an attack, as if it were fighting off the real infection, thereby hopefully providing long-term immunity. Some of the DMDs will blunt the reaction of this immune response, for example in the first weeks and months after an immune reconstitution treatment such as alemtuzumab (Lemtrada) or a stem cell transplant. 

The anti-CD20 drugs, such as Ocrelizumab (Ocrevus) or Ofatumumab (Kesimpta), deplete the immune system’s B cells, which are responsible for making the antibodies that provide much of the long-term immunity of vaccines. So there is the possibility that a COVID-19 vaccine will not be as effective for some people.

What if I am not able to have the vaccine? 

But even if there are reasons why you personally are not able to take the vaccine, this is still very positive news. If there is a widespread population vaccination program, this will control the spread of the pandemic and significantly reduce your chances of becoming infected with COVID-19.  At the present moment, it is the very best hope we have of returning our lives to “a new normal”. 

We eagerly await the next developments, and will of course keep you updated. In the meantime, if you wish to read more on the topic of vaccines and MS, here is a link to a 2019 review (https://www.frontiersin.org/articles/10.3389/fimmu.2019.01883/full).

Stay safe


    References:


    Vaccine & MS information

    More information is shared regularly, which differs by country. We will endeavour to share links and information with you as and when it becomes available. 

    Worldwide

    Australia 

    https://www.msaustralia.org.au/about-ms/covid-19-information-people-ms14 Jan 

    US

    COVID-19 Vaccine Guidance for People Living with MS 13 Jan, National Multiple Sclerosis Society

    UK 

    The UK MS register is asking 'What do you think about the COVID-19 vaccine?'

    If you live in the UK and have MS, please join/log in to the UK MS Register 

    COVID-19
    Hide commentsShow comments

    Marie Malloy (not verified)

    I am wondering now that the Pfizer vaccine is reported to be an MRNA vaccine, if you have any updates on the safety of it for people with MS?

    Lucy-OMS

    Hi Marie, OMS have no more information than is available publicly. The main consideration with vaccines for people with MS is if you are taking a DMD that affects your immune system, when 'live' vaccines are not necessarily recommended. As the vaccine you've referenced is an mRNA vaccine that would not be considered a live vaccine. If you are taking a DMD, please speak to your Neurologist if you are concerned. If not taking a DMD it is not thought that you will have any different reaction to a member of the general population

    Julie Greenhalgh (not verified)

    What about if you are following OMS and taking low dose naltrexone. Is it safe to take the vaccine?

    Lucy-OMS

    Hi Julie, I cannot say for sure whether it is safe or not, there is no particular signal coming from the available data that would preclude people with MS from getting one of the vaccines.

    Lucy (not verified)

    mRNA vaccines are famous because they create a strong t-cell inmune response (not just antibodies). Exactly what a person with MS doesn't want.

    The article is based on live and dead vaccines. We know how those work. Please explain mRNA vaccines and how is the inmune response with those.

    Mostly because it's the first mRNA vaccine ever.

    Lucy-OMS

    Hi Lucy, please be reassured that there are many neurologists who are specialist in these t cell responses looking at this - please find detail here https://neurologyacademy.org/articles/webinar-anti-cd20-therapies-and-c… https://mstrust.org.uk/news/covid-19-vaccines-what-they-mean-people-ms. There is no particular signal coming from the available data that would preclude people with MS from getting one of the vaccines. ON an individual level, if offered a particular vaccine (as it is not certain that everyone will be offered one or which they will be offered) side effect needs to be weighed carefully against the deaths and serious morbidity prevented with the vaccine. Decisions about your own healthcare is ultimately down to you.

    Lucy-OMS

    Hi Effie, it would be worth speaking to your MS team but I believe you would follow the same guidance as other people with MS / taking other DMTs or no DMTs

    Bernard (not verified)

    I have PP MS is the vaccine ok for me as I’m not on any medication

    Lucy-OMS

    Hi Bernard the indications are that it should be okay to take. Follow the general advice given to those with MS

    Frances Robson (not verified)

    Why do we even need a vaccine for a "virus" that over 99% of people survive? There are many dangerous side effects possible with the vaccines, including death, autoimmune conditions (already have one, thanks), heart attacks, infertility, cancer, etc. My immune system suits me just fine. No need for toxic chemicals to be injected into me!
    Doctors from around the world have spoken out against the vaccines. Do some research of your own.

    JennyN

    Hi Jonny, thanks for this - really interesting. The one thing that concerns me is that I know that one trial was stopped a couple of times because of cases of transverse myelitis - which has obvious links to MS. Has anyone looked into the possible risks from this perspective to those of us who already have MS? I've seen nothing written about this anywhere, which I find odd.

    I might well still take the vaccination, even if there is an increased risk of TM, because for me that might outweigh the risks of catching the full virus and watching it run amok in this MS-y body, but I'd like to know that the issue has been looked into and addressed by someone!

    Thanks and take care, J

    Lucy-OMS

    As mentioned, the Oxford trial was paused due the development of transverse myelitis in a participant, there were about 18,000 people in each of the treatment and placebo arms. As you know, transverse myelitis is often a precursor to MS (clinically isolated syndrome). We know that some of the available vaccines for other conditions can cause transverse myelitis. However, given the numbers in this trial, it is to be expected that various diseases will occur randomly throughout a trial depending on their natural incidence in a population, without necessarily being caused by the treatment, but rather just the expected background occurrence rate of those diseases. At the end of a trial, the investigators weigh up whether the incidence in the trial is higher than would be expected naturally. For example, in the parts of the world where the study was running, we would expect probably around 1 in 500 people to develop MS at some point. That might equate to a case of two out of 18,000 over the time period of the trial. In this case, the investigators appear satisfied that the incidence in the treatment arm isn't higher than what might occur naturally without treatment and hence there are no particular safety concerns.

    Once approved by the regulator, of course much larger numbers of people get the vaccine and so it becomes clearer over time whether this was a random occurrence or if there is a more causal issue with the vaccine. Depending on numbers, if there is a higher than expected rate over time, then the regulator might do a number of things. Of course, that side effect needs to be weighed carefully against the deaths and serious morbidity prevented with the vaccine. So, depending on numbers, the regulator might just issue a 'black box' warning on the container but continue its approval for us. Over time it might become clearer whether one particular vaccine of those approved was more likely than others to cause MS for example, and then people with MS might be advised to avoid that one and take one of the others. We are not near that point yet though, so there is still a lot of what is called 'post-marketing surveillance' to be done once approval is granted.

    Our take overall at the moment is that there is no particular signal coming from the available data that would preclude people with MS from getting one of the vaccines. Please do contact your medical team for specific queries. It is still early days and we will share more information as it becomes available.

    Delphina (not verified)

    As far as I'm aware & according to the MS society no information has been released regarding Pfzer vaccine & MS. We (the public) are still waiting to hear how many if any ms'ers were part of the trial. I have read that it isn't a live vaccine. Other than that alot of questions have no answers ie how long does the vaccines effect last for. I'm keeping my ears & eyes open

    junferth

    My neurologist held a patient briefing this week and recommended against taking the AstraZenica vaccine (because of the incidences of transverse myelitis). She recommended the Pfizer and Moderna vaccines, based on what we know at this stage. She also mentioned that some people with MS who have had COVID-19 have failed to develop antibodies afterwards, which obviously begs the question of what is efficacious protection for our population.

    Lucy-OMS

    Thank you for sharing, that's really interesting and glad your Neurologist is having such a proactive approach with her patients. We definitely recommend listening to your medical team as a priority.

    Ozer (not verified)

    some other countrys will use inactive vaccine..have any idea this inactive vaccine?

    Susan- ms mom (not verified)

    My daughter has MS. She's a 28-year old RN. Got the vaccine just after Christmas. Two weeks ago she relapsed with vestibular symptoms and a worsening of her usual issues--leg pain, etc. She is missing work, taking steroids (horrible) and had an MRI yesterday. We'll see what's up. I find the timing a little suspicious.

    Lisa - au (not verified)

    So sorry to hear this Susan. How is she doing now? Was your daughter on Medication or just following the oms diet ?