This webinar has been brought to you by MSNZ and the Ministry of Health to mark World MS Day.
For those of you that didn’t manage to watch the webinar live on the 2nd June or would like to watch it again, the recording is available here.
About the webinar
The New Zealand Covid Vaccine Programme is currently being rolled out and will soon be available for those with disabilities and high-risk health concerns.
We acknowledge the high level of interest within the Multiple Sclerosis (MS) Community for information about how the vaccines are impacting people with MS globally, and when they will be available.
Professor David Tscharke is a person with MS, an MS Researcher and Head of the Department of Immunology and Infectious Diseases at the John Curtin School of Medical Research, Australian National University. David has helped inform the Multiple Sclerosis International Federation and our friends at MS Research Australia on COVID-19 vaccines, as well as providing short courses on vaccines for the Australian Government.
David’s talk will cover several key questions the MS Community are raising, such as:
- what does the Pfizer vaccine do to your immune system?
- How the vaccine will work with MS medications available in NZ?
- Are there any key concerns around timings to be aware of for other vaccines or Disease Modifying Therapies (DMTs)?
- What is the research telling us?
Our second speaker, Ray Finch has been seconded to the Ministry of Health, tasked with designing the vaccine rollout plan specifically for the disability community. Ray is working to ensure the issues and concerns of the sector are considered as the vaccination programme is implemented. Ray will discuss the key information you need to know.
When can I get the vaccine?
The Ministry of Health have confirmed that people diagnosed with Multiple Sclerosis are considered under Group 3 for access to the Pfizer COVID Vaccine (Comirnaty). Roll out of Group 3 has begun in most DHBs but access is dependent on availability. The Ministry has advised that people in Group 3 should wait to be contacted by your DHB.
Eligibility is due to people with MS having a health condition that means you’re eligible for a free publicly-funded flu vaccination: Eligibility criteria | Influenza – Immunisation & Vaccination Info, NSIG New Zealand
For more information see: COVID-19: Vaccine advice for specific groups and health conditions | Ministry of Health NZ
Disabled persons living in long-term residential settings/communal care, people with complex care needs who have multiple carers supporting their daily life, or who live in the Counties Manukau DHB area, should have been able to already access the vaccine in Group 2 now. If you haven’t been contacted by health authorities, we recommend enquiring with your DHB.
Please note the dates are based on the information provided by the Ministry of Health and dependent on vaccine availability and may differ across DHBs.
COVID-19 Vaccination and DMTs
The current data and what we know of the mechanism of actions of Tysabri, Aubagio, Tecfidera, Betaferon, Avonex or Copaxone do not present any indication that the immune response received from the Covid mRNA vaccine will be impacted as they are not immunosuppressive.
Patients on ocrelizumab (Ocrevus) or fingolimod (Gilenya) should be aware that these are immunosuppressives and may affect your body’s ability to generate an immune response. However, it is unknown how much of an immune response is required.
Gilenya works by blocking B and T cells in your lymphnodes which can increase susceptibility to some infections. Global data is not currently showing an increased risk of severity of Covid-19 for those on Gilenya and vaccination is still recommended.
Ocrelizumab depletes the B-cells in your body. However, B-cell memory in your bone marrow should remain unaffected and these will continue to make antibodies to maintain any immunity received prior to beginning treatment. There is a much lower ability to produce new B-cell responses and therefore antibodies following treatment initiation. Therefore, patients who are looking to begin treatment with Ocrelizumab are required to complete their immunizations at least 6 weeks prior to initiation of Ocrelizumab (Medsafe Datasheet: https://www.medsafe.govt.nz/profs/Datasheet/o/Ocrevusinf.pdf).
The optimal time for a vaccination in the interval between two doses of Ocrelizumab is not known and might depend on the individual’s risk of SARS-CoV-2.
Various studies are ongoing in this area with varied results:
- Vaccination study results in the VELOCE trial show that patients treated with ocrelizumab were able to mount an attenuated immune response to non-live vaccines and new antigens at week 12 after ocrelizumab infusion compared to placebo. However, no data is currently available to show if the same applies also to the SARS-CoV-2 vaccines but theoretically this is expected to be the same.
- In the Israeli study reviewing the immune response to the vaccine in patients with ocrelizumab, fingolimod and cladribine, only 22.7% of patients treated with ocrelizumab developed an antibody response likely to be fully effective. Most patients treated with fingolimod have a low lymphocyte count and failed to develop antibodies against SARS-COV-2.
As the mRNA vaccine is not “live”, meaning you are not receiving a dose of the virus itself, for those people with MS who are already on Ocrelizumab or Fingolimod, vaccination is still recommended however your body’s ability to generate an optimal immune response will be limited. For Ocrelizumab (but not Fingolimod), while the antibody response will be affected, it is expected theoretically that your body will be able to make T-cells against SARS-CoV-2, which should provide a layer of protection.
Patients who are either on or due to begin treatment with Ocrelizumab are highly recommended to contact their Neurology Team, Nurse or Neurologist, to discuss their immunisation schedule based on their treatment regime. Treatment decisions should be made between a patient and their treating neurologist or other medical professional based on a benefit/risk assessment specific to the individual patient, and vaccines must be given in accordance with the approved label for the vaccine.
It is well known that viral infections can cause relapses and trigger exacerbations of multiple sclerosis. The most up to date evidence shows that the risks of relapses outweigh any potential vaccine side-effects therefore people with MS are strongly recommended to get the flu and measles vaccines.
An MS diagnosis entitles you to a free and early access for the flu vaccine. It is also recommended that you receive your flu vaccine no less than 2 weeks prior or 2 weeks following your COVID vaccine.
With Group 3 access beginning, we recommend contacting your primary health provider as soon as possible to make a booking for your flu vaccine so as not to delay you being able to receive the COVID vaccine when this becomes available.