Covid-19 vaccines: what they mean for people with MS

Q: What would a Covid-19 vaccine mean for people with MS? 

We’ve recently heard the fantastic news about the first positive result from one of the Covid-19 vaccine trials. It’s particularly good news because this vaccine was targetted against one of the parts of the Covid-19 virus – known as the S protein or the spike protein – which nearly every other vaccine is targetted against. So even if this particular vaccine doesn’t end up working, it’s shown that this is a good strategy that all the other vaccines, more or less, are adopting so we can be more confident now than we ever have been that a useful vaccine will come along shortly. 

There'll be two clear effects of finding a successful vaccine for people with MS. One is that the more people who take this vaccine, the more it will reduce the number of people who can be infected by Covid-19. Therefore the overall infection rate will decrease, reducing the chance of someone with MS being exposed to someone who has Covid-19. Secondly, people with MS will be offered the vaccine at some point in the future and, if it’s effective for these people, then they will have direct immunity against Covid-19. 

Q: What time scales are we looking at for a vaccine? 

One positive thing which has come out of the coronavirus pandemic has been the determination to shorten the development time for drugs. The normal development time for a vaccine is nearly 10 years and it's been shortened to between one and two years through a really concerted effort between funders and regulators. 

We anticipate that healthcare workers in the NHS will be the first group to be vaccinated, potentially in December. This will shortly be followed by people who are especially vulnerable – that would include elderly people, those with diabetes, hypertension, combined comorbidities and people with MS on immunosuppressant drugs. I imagine people with MS, particularly those on immunosuppressant drugs and those with significant disability, will be in the second wave. When will that be? I’m guessing, but potentially before Easter next year. This is unprecedented that we've gone from first discovering this new virus to having not one, but many potential vaccines available.  

Q: Would a Covid-19 vaccine be safe for all people with MS? Are there any risks? 

Having MS by itself does not mean that you shouldn't take the vaccine. There's no concern that a vaccine will cause MS, trigger a relapse or make your symptoms worse. I would really encourage everyone with MS to look forward to taking this vaccine, unless they're told that they shouldn't have it because of the drugs they're on. There are some disease modifying drugs (DMD) that are used to treat MS which would make some vaccines either unsafe or ineffective.  

Q: For people with MS who are taking a DMD, how will they know whether a Covid-19 vaccine would be safe and effective for them? 

The first key thing we need to discover is whether or not the vaccine that we're offered is a live virus or not. Many people who are on DMDs at the moment will have been told whether or not they can have a live vaccination. Polio, yellow fever and the measles, mumps and rubella (MMR) vaccines are all live. There are some DMDs that it’s just not safe to have a live vaccine on. 

I think it’s quite unlikely that we’re going to get a live vaccine. Most of the vaccines we’re looking at are inactivated so they should be safe. So that’s the first thing – is the vaccine live or not? If the vaccine isn’t live then it should be safe for everyone to take, regardless of the DMD you’re on. 

The other issue is whether the vaccine would be effective if you’re on a DMD. The whole point of a vaccine is that it triggers an immune response. It’s that immune response which is going to protect you against Covid-19. There are some DMDs which suppress the immune system to a level that means a vaccine may not be effective. 

An example of this is the drug Lemtrada. This drug has a profound effect on your immune system for a few weeks. If you have a vaccine four weeks after Lemtrada, it will not make any difference to your immune system. But if you wait a year or two after Lemtrada, your immune system will recover enough to respond to a vaccine.  

The other drug which causes some concern in this respect is Ocrevus. This is given every six months to deplete a particular part of the immune system – B cells. It's these B cells that produce antibodies that provide some, if not all, of the immunity against some vaccines. People who are on Ocrevus have a reduced ability to respond to vaccines all the time they’re on the drug, not just the first few months after taking it. We don’t yet know for sure, but it may well be that being on this DMD may mean that a Covid-19 vaccine will not be as effective as it could be for that particular person. 

Q: Will the vaccine be free on the NHS? 

Absolutely, no question. There’s a big effort to push this through the NHS and there’s been no discussion of paying for the vaccine that I’m aware of. 

Q: Would different versions of the vaccine be offered to different people? 

It may well be the case that different vaccines suit different sorts of people. We already have different vaccines for children. It may well be that older people need a slightly different Covid-19 vaccine to younger people because of the way their immune system works.  

Q: Would children with MS be offered the vaccine? 

Children with MS wouldn’t be at high risk of severe Covid-19 disease. I think children with MS who are on a DMD should be offered it if it's suitable.  

Q: What about people who are really worried about side effects of vaccines?  

We know there's a significant population who are against vaccines. We’re never going to get to the point where people are forced to have vaccines because that would be quite wrong. I think provided that the proportion of the population who choose not to have a vaccine is relatively small, we will still get the benefit of the wider proportion taking the vaccine and reducing the chance of transmission.  

We've heard a little bit about trials stopping because of side effects. A vaccine would not be pushed through if it was potentially dangerous. The Oxford vaccine trial has been paused twice, to my knowledge, but it has also restarted on each occasion and I really wouldn't draw too many conclusions from that. That's quite a common practice particularly in vaccine trials that if you get any hint of concern that you pause, consider what you've seen and then restart if it appears to be safe. I think we can be confident that the regulatory authorities in the UK, Europe and the US will have safety very much on their mind. 

Q: Any final thoughts? 

It's exciting news that a Covid-19 vaccine, which I hope will be the first of many, has proven to be successful. I think people with MS will naturally want to focus on the potentially negative side of what I've said, about the group of people on certain DMDs in whom a Covid-19 vaccine may not be effective. But on a positive note, even if you’re not able to have the vaccine – because it's not safe or won't be effective – the fact that the vaccine is available more widely through the population is good news for you as well. That will control the pandemic and reduce the chance of you getting infected, so this really is good news for everyone.

 

Read Professor Alasdair Coles' Q&A on Covid-19 vaccines: part two