COVID-19 vaccination guidance for people living with multiple sclerosis (MS)

05 February 2021

Professor William Carroll AM has provided the below advice for the MSWA community. Professor Carroll is an MSWA Board Member, leading national and global neurologist, former president of the Australian and New Zealand Association of Neurologists and current president of the World Federation of Neurology.

The current number one health priority around the world is the rapid and efficient roll out of an effective vaccine(s) for the COVID-19 pandemic. Based on known risk factors for complications and mortality from the virus several priority groups have been identified for the roll-out of vaccination programs, but this is also heavily influenced by service delivery factors (e.g. healthcare workers).

Evidence shows that people with MS (PwMS) are no more likely to develop COVID-19 or its complications, including those on treatment, (with the possible exception of those on ocrelizumab who may be at very slightly increased risk of complications but not death). Those with higher levels of disability (such as advanced progressive MS) may be at increased risk of complications from COVID-19.

The overall mortality from COVID-19 in Australia is consistent with other parts of the world at 3.2% (as at 8 January 2021). This means that on average three out of every 100 that might contract COVID-19 would not survive. Although infection rates in Australia and New Zealand remain very low, recent outbreaks (mostly related to quarantine breaches) have shown that further cases are inevitable.

Nine vaccines have now been formally tested in Phase III clinical trials in adults, have been approved in some parts of the world and have proven to be highly effective and very safe.

Of the three vaccines currently available in the US/EU/UK, two are being organised for distribution in Australia starting mid-February 2021. These are the Pfizer/BioNTech mRNA vaccine and the AstraZeneca or Oxford vaccine.

Frequently asked questions

As a PwMS should I have the COVID-19 vaccination?

It is currently recommended that everyone over the age of 18 years should be vaccinated against COVID-19. There is no specific data relating to the administration of any of the vaccines to PwMS, but studies in the US and EU are being conducted concurrently. However, there is no theoretical reason why any of the currently available vaccines destined for Australia will pose any particular risk to PwMS. The risks of COVID-19 are very real, are higher in PwMS with higher levels of disability, and far outweigh any conceivable risk from the vaccines.

Could the vaccine trigger a relapse of my MS?

There is currently no evidence to suggest that this might be the case. All of the vaccines can produce side effects that include fever and fatigue. Fever can on rare occasions cause a re-emergence of previous MS symptoms (a so-called “pseudo-relapse”) but it is widely thought that this only lasts as long as the fever is present (usually less than 24 hours) and does not imply any new inflammation or damage to the nervous system. Similarly, fatigue to vaccination can be similar to MS-related fatigue, but this should be only temporary.