Covid-19 vaccine and MS: Your questions answered

Bringing a vaccine or medical drug from start to finish normally takes years. Drug companies need to complete extensive clinical trials to ensure that their drug or vaccine is safe to use in a wider variety of people, and that it is effective at controlling the disease for which it is designed. The independent Medicines and Health products Regulatory Agency (MHRA) evaluates the data from the trials to come to a conclusion.

The Covid-19 vaccines have taken less than one year to come to the point where they are being given to the public. However, the researchers have taken all the same steps as normal. They have saved time in a number of ways:

• Researchers did not have to wait for funding to be allocated before starting each phase of the clinical trial. Governments and commercial organisations prioritised the Covid-19 vaccine studies, and made money and resources available immediately.
• Clinical trials move through several distinct phases. To speed up the process, the Covid-19 vaccine trial phases ran concurrently, instead of one after another.
• Processes for creating vaccines for new diseases had already been developed. As soon as researchers had access to the genetic code of the new coronavirus, they could begin these processes. Successful vaccines have been developed in this way for other diseases, and the Covid-19 vaccine did not have to be created 'from scratch'.

Common side effects from all three licenced vaccine are soreness at the injection site, a headache, feeling tired or achey. You can take painkillers such as paracetamol if you need to.

The full list of side effects can be read on the patient information leaflet for the Pfizer/BioNTech vaccine, the patient information leaflet for the Oxford/AstraZeneca vaccine, and the patient information leaflet for the Moderna vaccine. 

All three licenced vaccines were tested in clinical trials where there were people with stable long-term disease in both the active and placebo groups. We do not know whether any people with MS were in those groups. 

The Pfizer/BioNTech vaccine does not contain egg or animal products.

The Oxford/AstraZeneca vaccine does not contain egg. It was created using human kidney cells.

The Moderna vaccine does not contain egg or animal products.

Age is thought to be a more significant risk factor for severe disease with Covid-19 than underlying health issues. This is reflected in the priority categories. 

As we understand it, priority category 4 includes people of any age who are clinically extremely vulnerable. People with MS do not automatically fall into this category, but some people with MS, with other health conditions and on some medications (including some disease modifying drugs and steroids) may be called at this stage. If you were advised by your consultant to shield throughout the year, you may be called at this time. 

Otherwise, we expect that people with MS will be vaccinated with their age group, or in priority category 6, whichever is first. Priority category 6 includes people with underlying health conditions, and is largely the same group of people who are eligible for a free annual flu vaccine.

There may be local interpretations of the priorities, based on practical logistics. The Pfizer/BioNTech vaccine needs to be kept extremely cold, and used quickly once defrosted. To avoid wasting doses, health and care workers or people at a lower priority may get vaccinated earlier than expected in some places.

You can read more about your risk of infection and serious disease in our A-Z of coronavirus and covid-19 webpage.

In general, people who are not clinically extremely vulnerable and have no underlying health conditions will be vaccinated at the same time as other people the same age. The government guidance does allow for flexibility in order to reach people effectively and avoid wastage, but you are more likely to find that your partner/carer is vaccinated at the appropriate time for them, and not at the same time as you.

The exception is if you are an unpaid carer for a clinically extremely vulnerable person. Guidance was amended on 5 January to allow for the vaccination of people who are the main carer for an elderly or disabled person whose welfare would be at risk if the carer fell ill.

In practice, this means that unpaid carers would be added to the priority category 6.

People with MS are advised to have vaccines where they are offered. The evidence suggests that having a vaccine will not make your MS symptoms worse, and will not trigger an MS relapse. 

You may have been told to avoid live vaccines if you are taking a drug that strongly affects your immune system. None of the first three Covid-19 vaccines (Pfizer/BioNTech, Oxford/AstraZeneca, Moderna) are live vaccines, and they cannot cause the disease.

So, even if you are taking a drug which suppresses your immune system, such as mitoxantrone, azathioprine, methotrexate, cyclophosphamide or steroids, you can take one of these Covid-19 vaccines if it is offered.

Disease modifying drugs (DMDs) can affect the immune system. This does not affect the safety of the vaccine, but in some cases your DMD may affect whether the vaccine will stimulate enough of a response to protect you from Covid-19.

There is no concern for people taking a beta interferon (Rebif, Avonex, Plegridy, Betaferon or Extavia), glatiramer acetate (Copaxone and Brabio), teriflunomide (Aubagio), dimethyl fumarate (Tecfidera), and natalizumab (Tysabri).

If you are taking ocrelizumab (Ocrevus), fingolimod (Gilenya), alemtuzumab (Lemtrada) or cladribine (Mavenclad) your immune system may not make as strong a response to the vaccine. The MS Society Medical Advisors have recommended that if you are already taking Ocrevus or Gilenya, you should be aware of this, but not alter your treatment plan.

If you are taking Lemtrada or Mavenclad, the recommendation is to wait 3 months after your last course or infusion. If you need a second course of Mavenclad or Lemtrada, it is safe to delay it until after your vaccination.

Talk to your MS team about the best strategy for you. If you are planning to take Ocrevus, Gilenya, Lemtrada or Mavenclad you may be advised to be vaccinated before starting your DMD. 

It takes some months for your immune system to recover from haematopoietic stem cell transplantation (HSCT). If you have the vaccine too soon after transplantation, you may not make enough antibodies to protect you from Covid-19. The MS Society Medical Advisors recommend that you should wait at least six months after treatment before getting vaccinated.

You should leave seven days between getting your flu vaccine and your Covid-19 vaccine.

The current vaccines all require two doses and it takes time for your body to build up a strong immune response. For the Pfizer/BioNTech vaccine, you need to have a second dose 21 days after your first dose, and then wait a further 7 days until you are protected.

No vaccine gives 100% protection from illness, so you should still take care to avoid infection, particularly if you are clinically extremely vulnerable. Researchers are not yet sure whether people who have been vaccinated are still able to carry and transmit Covid-19, even if they are themselves protected. To protect others, you should adhere to the guidelines for your area.