Friend or Foe?
After months of pandemic devastation, the approval and rollout of two Covid-19 vaccines in the UK has been widely celebrated – and rightly so. But for people with multiple sclerosis – especially those on immunosuppressant drugs – it has led to much confusion.
How safe are the vaccines? When is the optimum time to get it? Will it be effective?
Knowing this, four MS experts sat down for a Zoom meeting last week and answered questions from a dozen of us with MS.
The panel included – Prof Klaus Schmierer, Clinical Academic Neurologist, Queen Mary University London, Prof David Baker, expert in Neuroimmunology, QMUL, Joela Mathews, Lead Neuroscience Pharmacist, Barts Health NHS Trust and Dr Helen Ford – Consultant Neurologist and MS Clinical Lead, Leeds Teaching Hospitals. Dr Ford also has been regularly providing guidance to the MS Society on the Covid vaccines.
Click here to see a short video of the session: “MS and the Covid-19 vaccines – Friend or Foe?”
For those who prefer to read, this is a summary of the questions and answers.
Some caveats: this is a fast-moving story and new information is appearing all the time. For example, the University of Oxford/AstraZeneca vaccine has just been approved by the UK regulator with rollout expected within days.
That said, the answers below pertain to the Pfizer-BioNTech vaccine as it is the only vaccine being used in the UK so far. Next week that will change.
Is the Covid-19 vaccine safe for people with MS?
Prof Baker: “The ultimate take-home message is that there is no evidence to show that these vaccines – the Pfizer-BioNTech, the Moderna and the Oxford University/AstraZeneca – aren’t safe for anybody.”
Prof Schmierer: “Bar a minute minority, everybody should have the vaccine.”
Is the vaccine live?
Prof Baker: “The way they make the Oxford/AstraZeneca vaccine, it’s a crippled vaccine so theoretically it is not dead, but it’s not live. So essentially it can infect a cell once and that’s it. It can’t go anywhere after that. The Pfizer-BioNTech and Moderna vaccines are not live.”
Will getting the vaccine make my MS worse?
Prof Schmierer: “There is very little evidence that the vaccines – or any vaccination – triggers MS relapses or reactivation. So I would be pretty reassured.”
I’m confused about what group I’m in to get the vaccine: Group 4 “clinically extremely vulnerable individuals” or Group 6 – “everyone aged 16 years to 64 years with underlying health conditions”?
Mathews: “If you, at any point, were asked to shield or got the letter from the NHS or your GP, you are definitely clinically extremely vulnerable and then you will be in the higher tiers. If you were not asked to shield, but you used the normal precautions that everybody else was using, then you are likely to be in Group 6.”
I’ve had the coronavirus. Should I still get vaccinated?
Prof Baker: “The plan would be for everyone to have the vaccine irrespective of whether you’ve had Covid or not. What they are hoping with the vaccine is that you get a much longer and higher level of sustained antibody response, because that will be your first line of defence – that stops you getting reinfected.”
Does it matter which vaccine I get – the Pfizer or the Oxford vaccine?
Prof Baker: “No.”
How long does it take before the vaccine starts to work?
Dr Ford: “Certainly with the Pfizer vaccine you have your first dose then the second dose (booster) usually follows after 21 days. You don’t get full immunity until 7 days after that second dose.
However, there are plans in the UK to delay the second dose for up to 12 weeks to allow more people to be vaccinated. It is thought the first dose will give you enough protection, even if not optimal, against the Covid virus.
With the Oxford/AstraZeneca vaccine, you have your first dose then the second dose is usually at 28 days. You don’t get full immunity until 7 days.”
(Again there is now a plan to delay the second dose for up to 12 weeks. It is thought the first dose will give you enough protection, even if not optimal, against the Covid virus. It has been shown by delaying the second dose of this vaccine you can get a bigger protective response)
After getting the vaccine, will I still need to socially distance?
Dr Ford: “When you get your appointment you will get the date for the first vaccine and the second vaccine. You have to commit to those two doses. You need to keep on being careful. You need to keep on with social distancing – not relax just because you’ve had the first dose.”
I’m on a disease-modifying therapy (DMT). I’ve heard I might not develop an effective immune response – and the vaccine won’t work. Is this right?
Prof Schmierer: “From studies looking at the responses to other vaccines on people with MS treated with immunotherapies, we expect that the build-up of immunity against Covid-19 following vaccination may be reduced. However, this does not mean vaccination will not be effective. Some immunity is better than no immunity.”
I’m on dimethyl fumarate (Tecfidera), the beta-interferons (Avonex, Betaferon, Extavia, Plegridy, Rebif), teriflunomide (Aubagio), glatiramer acetate (Copaxone) and natalizumab (Tysabri) – when should I get the vaccine?
Prof Schmierer: “You can get the vaccine at any time if you are on one of these. Also we have no evidence suggesting these DMT’s will reduce the efficacy of the vaccine.”
I’m on fingolimod (Gilenya). Will it be as effective?
Prof Schmierer: “You may see a reduced response to the vaccine. However we don’t recommend you take a break off that – simply because the disease activity can come back with a vengeance.”
I’m on alemtuzumab (Lemtrada). When is best to get the vaccine?
Dr Ford: “What we suggested in the MS Society Advisors guidance was to wait 3 months/90 days until after your last infusion.”
I’m on cladribine (Mavenclad). When is it best to get the vaccine?
Dr Ford: “Again, as we suggested in the MS guidance, I would wait 3 months/90 days until after your last course of tablets. If it is only after two months and the vaccination is offered, I would probably say take it; the same with Ocrevus (ocrelizumab).
However we would recommend being less flexible with alemtuzumab – and would stick to waiting for 3 months.”
I’m on ocrelizumab (Ocrevus). When is it best to get the vaccine?
Prof Schmierer: “We recommend the gap between the last Ocrevus infusion and first Covid vaccination to be as long as possible.
If you adhere to the routine Ocrevus schedule (infusions every 6 months), this means a gap of about 4 months after your last infusion leaving about 8 weeks to give the first and second dose of the vaccine. For the gap between the second dose of the vaccine and your next Ocrevus infusion, we recommend aiming for 3 weeks, provided logistics allow this. Pending new guidance from the Department of Health, we may have to review this.”
Mathews: “To reiterate, we do not expect it to be harmful to get it at a different time point, but it is just about maximising your immune response.”
I am about to start on: Ocrevus, Gilenya, Lemtrada or cladribine. Should I delay treatment?
Prof Schmierer: “You should discuss this with your MS team. It might be preferable to wait after you are vaccinated – which may mean initiating therapy about 3-4 weeks after the second injection of the Covid vaccine shot (booster). The risks of this strategy will depend on your individual disease activity and on vaccine availability.“
Should we push for the vaccine with our GP’s?
Mathews: “GP’s are asking people not to contact them about the vaccine as they are trying to do their day jobs as well as the vaccines on top. We are trying to get information out. It is very difficult. It is a logistical nightmare.”
I’m due to get my next Ocrevus infusion soon. Say I get offered the vaccine just before, what should I do?
Prof Schmierer: “If you are due a vaccine – say in February – and you are just a little too close to your infusion, I would much rather you contact your MS team and push your infusion down by four or six weeks, or even longer, which will have no harm, but give you that extra time to mount an immune response against the vaccine.”
I’ve had HSCT (Haematopoietic Stem Cell Transplantation). When should I get the vaccine?
Prof Schmierer: “It is a bit more complex there. You are looking at a delay of the vaccine until you have seen some recovery has occurred. I would probably wait until there is actually an immune system rebuilt.”
More information sources: Green Book – Immunisation Against Infectious Disease. This is constantly being updated so bear this is mind.