As the world moves forward in the effort to vaccinate the population against COVID-19, the recommendation to get vaccinated definitively includes people with multiple sclerosis, according to guidance just released by the National Multiple Sclerosis Society.
‘Comparing to not getting the vaccine and getting a disease that can kill you if you have increased risk, it’s better to have an attenuated response than no response at all.’
Dr. Jaime Imitola, director of UConn Health’s Division of Multiple Sclerosis and Translational Neuroimmunology, is one of the experts the MS Society invited to its task force to come up with the guidelines, which seek to dispel notions that the vaccine is too risky for people with MS.
The guidance states, “Most people with relapsing and progressive forms of MS should be vaccinated. The risks of COVID-19 disease outweigh any potential risks from the vaccine. In addition, members of the same household and close contacts should also get a COVID-19 vaccine when available to decrease the spread of the virus.”
While clinical trials of the messenger RNA vaccines approved for emergency use by the Food and Drug Administration (available from Pfizer and Moderna so far) did not yield conclusive data on their effectiveness in MS patients, the experts considered the general population data and data from studies of other mRNA vaccines.
“We have good data from multiple studies about how a population with MS will respond to a vaccine,” Imitola says. “There are very important trials done in MS patients that suggest there is no worsening. You don’t get worse disease, you don’t get a worse reaction to a vaccine. In terms of your immune response, you still get immunity with an attenuated response produced by B cells if your MS medication targets B cells, that’s true, but the responses to the vaccines not only depends on B cells but three different kinds of T cells, which are intact even if you are on MS medications. Therefore, comparing to not getting the vaccine and getting a disease that can kill you if you have increased risk, it’s better to have an attenuated response than no response at all.”
Communicating the recommendations to people with MS, as well as the medical professionals who care for them, is critical because it is a population that is diverse, not only in race and socio-economic status, but also in the spectrum of beliefs about the vaccine, some of which may not be accurate.
“I think that in MS we are dealing with a very engaged population of patients,” Imitola says. “I don’t feel that there are too many denialists in this. MS patients are well engaged and always learning and choosing what is best for them, they are curious. Of course some patients are apprehensive and many are still at home and are scared, but they need the expert recommendations rather than getting this from the internet or Facebook. The only way that we are going back to some normality is that everyone gets the COVID-19 vaccines, masking and social distancing.”
The MS Society says its guidelines, which apply specifically to the Pfizer and Moderna vaccines, are subject to change and may become more detailed as more is learned from continued scientific study. Other conclusions include:
- Those considered at higher risk for severe COVID-19 include those with progressive MS, who are older, who have a higher level of physical disability, who are Black or Hispanic, or who have certain medical conditions (diabetes, high blood pressure, obesity, heart and lung disease, pregnancy). They should get the vaccine as soon as it’s available to them.
- The risk of getting COVID-19 far outweighs that of a vaccine-induced MS relapse or worsening of MS symptoms.
- The vaccines are safe to use with MS medications. Patients should continue their disease-modifying therapies unless advised otherwise by their MS health care provider.
Health agencies and charitable organizations around the world have endorsed and are adopting the recommendations. Imitola says being selected to the MS Society’s task force and represent his patients’ needs is an honor.
“We have an excellent MS team here,” Imitola says. “This is just a reassurance of our expertise and the kind of work that we’re doing for the state’ most vulnerable patients. We have a unique spectrum of MS patients: older population, Black and Hispanic patients, who tend to be higher risk patients than Caucasians. We have patients with great numbers of comorbidities. And also we have the progressive MS patients. In a way, our job is tougher than at a typical MS center. So you need to match the disease complexity with competent, comprehensive and compassionate care, and that’s where we come in, our entire comprehensive group.”