- COVID vaccines were not tested in subjects such as MS and other autoimmune diseases
- MS patients treated with immunosuppressive therapies react poorly to the vaccines
- Standard prevention measures for COVID-19 are of paramount importance
The rapid development of COVID vaccines in a matter of months was a scientific tour de force; and the result of accumulated knowledge over a 20yr period of time. The vaccines were tested in healthy individuals given the pressure to produce vaccines quickly for the vast numbers of people who needed to be immunized. However, people with a variety of ailments were not included in the roll out clinical trials of the vaccines. In particular, testing was not done on the 3-5% of individuals with compromised immune systems such as autoimmune disease (MS on certain treatments in particular), various forms of cancer (particularly Lymphoma and Leukemia) and individuals with transplants or HIV.
The mRNA vaccines have an excellent safety profile and do not worsen autoimmune conditions such as MS.
Most patients with MS on different therapies do make antibodies in response the COVID vaccination. However, patients on Ocrevus, Kesimpta, Lemtrada and post bone marrow transplant make antibodies to new challenges poorly, including COVID vaccination. In our experience with Ocrevus we have not seen antibody production even after 3-4 booster shots. A recent study, however, reported that Ocrevus patients had cellular immune responses (there are two arms of the immune system – antibodies and cellular responses and both are protective). In other conditions a range of 15-80% of individuals do not make antibodies. Neither the makers of the vaccines nor the Federal Government have performed clinical trials of the vaccines in these at risk groups as yet. There is also no consensus about using booster vaccines to try to get a heightened immune response in at risk individuals; though there have been discussions about the possibility of testing this approach.
Not having antibodies against the Corona virus increases the risk for developing COVID-19 infection. If someone in these groups were unfortunate enough to get infected they can be treated with Remdesivir and Monoclonal Antibodies, which offer hope of preventing progression to more severe forms of the infection .
This leaves continued use of the preventive methods we have become accustomed to such as social distancing and crowd avoidance, masks and good ventilation. These precautions make a lot of sense for at risk individuals in spite of the CDC loosening of protective requirements for the general public.