Coronavirus, Covid-19 and multiple sclerosis

The independent Medicines and Healthcare products Regulatory Agency (MHRA) has approved four Covid-19 vaccines for use in the UK. The first was developed by Pfizer-BioNTech, the second by Oxford-AstraZeneca and the third by Moderna. Although the three vaccines use different technology, they all work to induce an immune response to the spike protein of the coronavirus. These three vaccines are available through the NHS across the UK. The fourth vaccine developed by Janssen is currently not being used in the UK.

The Joint Committee on Vaccinations and Immunisations (JCVI) published advice for the priority in which people should receive the vaccine. The order of priority was based on individual risk, and aimed to protect the most vulnerable people and the health and social care systems. This means that the main criteria for the first phase of the vaccination programme was age, as the older you are, the more you are at risk of serious illness and death from Covid-19.

Everyone aged 12 and over is now entitled to a Covid-19 vaccination.

In England, if you've not received your vaccine already you can use the NHS website to book an appointment at a vaccination centre or hub. In Northern Ireland, where you can get your vaccine and how to book it, varies depending on your age. In Scotland you can register for a first dose through the online self-registration portal. In Wales you should have been invited for a vaccination and need to follow the instructions from your local health board for arrangements in your area if you've not yet taken up the offer.

Even if you think you've already had Covid-19, you should still consider being vaccinated, as the protection from the vaccine may be higher than from natural exposure, and last longer.

Are the vaccines safe?

The safety data checked by the MHRA indicates that all the vaccines are safe and effective for the majority of adults, including older adults. None of the vaccines are live, so they cannot cause Covid-19 itself.

Use of the Pfizer-BioNTech vaccine in people with a history of severe allergies was temporarily stopped in the UK after two healthcare workers experienced anaphylactic reactions in December 2020. However, this position was revised as the MHRA found no evidence of an increased risk of anaphylaxis to the Pfizer-BioNTech vaccine among people with serious but unrelated allergy histories. They now advise that only people who had an allergic reaction to the first dose of this vaccine, or who previously had reactions to any of its components, should not receive it. Anyone with a previous history of allergic reactions to the ingredients of the Moderna vaccine should not receive it, but again those with any other allergies such as a food allergy can have the vaccine.

The government's vaccine advisory committee have updated their advice for pregnant women, who should be offered the Pfizer-BioNTech or Moderna Covid-19 vaccines. No specific safety concerns had been identified relating to pregnancy, but there is now more safety evidence from the United States where more than 90,000 pregnant women have been vaccinated, mainly with the Pfizer or Moderna vaccines. This data hasn't raised any safety concerns and provides further confidence that the vaccines can be safely offered to pregnant women.

Pregnant women who are concerned are advised to discuss the risks and benefits of vaccination with their GP, midwife or a health professional at a vaccination centre. Those planning pregnancy, who have recently given birth, or are breastfeeding can be vaccinated with any vaccine appropriate for their age.

The Association of British Neurologists have advised that people taking Ocrevus or Lemtrada should discuss when to have their vaccine with their MS team. This is because these DMDs can affect how well a vaccine might work for you, so the timing of your infusions and vaccine will be important.

All the vaccines are given as an injection in the upper arm. In those aged 16 or over, two doses are required. The JCVI advises that the second vaccine dose should be with same vaccine as the first dose, except in rare exceptions - for example if the same vaccine is not available. Switching between vaccines, or missing the second dose, should be avoided if possible as this may affect the duration of protection. Most 12-15 year olds are only being offered one dose, but those who live with someone who is more likely to get infections or who are at high risk themselves are eligible for a second dose.

Timing of the second dose

When the Pfizer-BioNTech vaccine was first approved it was recommended that the second dose should be given 21 days after the first dose. However, due to the rapid increase in the spread of the virus in late 2020, this advice was changed so that delivery of the first dose to as many eligible individuals as possible was prioritised over receiving the second dose. The second dose of the Pfizer-BioNTech vaccine may be given between 3 to 12 weeks after the first dose. The second dose of the Oxford-AstraZeneca vaccine may be given between 4 to 12 weeks after the first dose. The second dose of the Moderna vaccine may be given between 4 to 12 weeks after the first dose. Data indicates that there's a high degree of protection from the first dose of all the vaccines which is why the dosing interval was allowed to be increased.

When will I be protected from Covid-19?

For most people, immunity is complete around 7 days after the second dose of the vaccine, but it can take up to 3 weeks. A very small minority of people may not be fully immune, even if they are vaccinated.

If you're severely immunocompromised, the vaccine might not give you full protection, so you may still need to avoid exposure to others for a while to reduce your risk. You might be considered severely immunocompromised if you've had your spleen removed, have had cancer, an organ or bone marrow transplant or if you're taking a medication which suppresses your immune system.

Third doses and booster jabs

There is currently a lot of confusion around the third doses and booster jabs which are currently being offered to some people. They are not the same thing. A third dose is an extra ‘top-up’ dose for those people who may not have generated a full immune response to their first two doses, and is classed as part of your primary course of vaccinations. In contrast, a booster dose is a later dose to extend the length of protection from your primary course of vaccinations - which may be two or three doses depending on your circumstances.

Third dose eligibility

The JCVI has advised that people with severely weakened immune systems should have a third vaccine dose as part of their primary course of vaccinations. It is only being offered to people with severe immunosuppression, or those who were severely immunosuppressed at the time of their first or second vaccination. Some people with MS, who are taking certain disease modifying drugs that work by depleting B cells and so might reduce your antibody response to the vaccine, may be eligible for a third dose. If you are eligible to have a third dose, your GP or specialist should contact you to let you know, and how you can access the third dose where you live. You may also get a letter from the NHS advising that you may be eligible and to discuss this with your doctor.

If you're on a disease modifying drug and are concerned that you may not have had a full immune response to the vaccination, you could contact your neurologist or MS nurse to discuss whether you should have the third dose.

The decision on the timing of the third dose should be made by your specialist. As a general guide, the third dose will usually be at least eight weeks after your second dose, but there is flexibility to adjust the timing so that, where possible, immunosuppression is at a minimum when the third dose is given. This will enable a better immune response to be generated. 

The JCVI advises that for adults aged 18 and older, either the Pfizer-BioNTech or  Moderna Covid-19 vaccines be administered for the third dose, as a number of studies have reported an increased immune response in some immunosuppressed people after a third dose of an mRNA vaccine. For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.

Booster dose eligibility

After a vaccination, your immune response gradually reduces over time, and you become less protected. With Covid-19 this is usually around six months after being fully vaccinated. Therefore, a booster vaccination is being offered to those people who are most at risk from Covid-19 to help improve your protection from your initial dose(s) of the vaccine. Currently frontline health and social care workers, the clinically vulnerable - including people with MS, and those aged 50 or over are eligible for a booster vaccination. The booster dose will be either with the Pfizer-BioNTech or the Moderna vaccine. In England and Scotland, those aged over 40 are also now being invited to book a booster dose when they become eligible. It is anticipated that the number of people eligible for a booster vaccination will expand further in the future.

You must have received your last primary dose of the vaccine at least six months ago to have a booster vaccination. For most people with MS, this means you'll become eligible six months after your second dose. If you receive a third primary dose of the vaccine, you'll become eligible for a booster vaccination six months after your third dose.

In England you can book an appointment for a booster dose if it's been five months since your second dose and you're in one of the eligible groups through the NHS website. In Scotland and Wales appointments are being offered in the same priority order as the first phase of the vaccination programme. NHS Scotland are sending invitation letters through the post. In Wales, you will be contacted by your local health board when it's your turn. In Northern Ireland, if you're eligible, you can book an appointment at a participating pharmacy or wait to be contacted by your GP.