COVID-19 Vaccinations For People With Autoimmune Conditions

Update: As of August 13, 2021, the Center for Disease Control and Prevention (CDC) now recommends an additional dose of the mRNA COVID-19 vaccine for people who are moderately to severely immunocompromised. Read more here: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the US.

The creation and approval of new COVID-19 vaccines is an exciting development. However, there are still many questions to be answered. One important question: How will the COVID-19 vaccines impact those with autoimmune conditions?

Many people with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and other autoimmune conditions are wondering how the vaccines will work for them. This is especially true for those taking drugs that affect the immune system.

We answer some of the most common questions below. However, it is important to remember that information on COVID-19 and its vaccines changes regularly, and what we know today may be different in the near future.

mRNA vaccines safety

Due to the extreme situation the world has been in, the United States Food and Drug Administration (US FDA) was able to quickly approve 2 COVID-19 vaccines under their emergency use authorization (EUA) program. These vaccines are made by Pfizer (in combination with another company, BioNTech) and Moderna.1-3

An emergency use authorization allows a product to make it to the market faster than usual. This does not mean that the product is unsafe or untested. It just allows certain hurdles in the approval process to be bypassed.

Both vaccines went through rigorous safety and effectiveness studies. Based on the results from these studies, the FDA decided that any potential risks of the vaccine were greatly outweighed by the benefits. Both vaccines use mRNA technology. Although these are new to the market, mRNA vaccines have been studied for years.

How do mRNA vaccines work?

Oftentimes, vaccines contain a weakened, live version of a virus, a dead version of a virus, or a part of a virus so that the body can recognize and react. When the body sees these parts of vaccines, it makes antibodies against them. These antibodies can then be used as protection in the future if a person is ever exposed to that particular virus. This is what can potentially give a person immunity.

An mRNA (messenger RNA) vaccine is different from past vaccines in that it only carries instructions (specific genetic material for our body to “read”). These instructions, the mRNA, go into our body’s cells and tell the cell to start making a specific protein. In the case of the COVID-19 vaccine, cells are told to make a protein on the COVID-19 virus particle called the spike protein. The spike protein helps COVID-19 get into the body and start infecting cells.

When we start making this foreign protein, our bodies react and make antibodies, just like they would in other vaccines. The difference is, the mRNA vaccines only deliver the instructions and not any part of the actual virus. This makes it impossible to develop COVID-19 from the vaccine or for parts of the mRNA to get into our cells permanently. If a person who is vaccinated is exposed to COVID-19 later on, these antibodies can reactivate and protect them from the virus before getting sick. Even if a person does still get COVID-19, the antibodies may help prevent severe illness from developing.3-7

For people with autoimmune diseases or taking immunosuppressants

The clinical trials studying these new vaccines did not include people with significant medical issues, such as autoimmune conditions. This is a common approach for most new drug research since the main goal is to find out how the vaccine would be tolerated by people without these conditions. It does not mean that people with autoimmune conditions should not get vaccinated.

Some people have also wondered whether being on immunosuppressing drugs will impact how well a person responds to the vaccine. There has been concern that if a person’s immune system is weakened because of immunosuppressants, they will not be able to produce a strong antibody response to the vaccine. The theory is that these people may not be as protected as someone with a regularly functioning immune system.

At this time, COVID-19 and its vaccines are so new that we do not know what puts a person at higher risk for severe illness or what might impact a person’s vaccine response. However, many major organizations, including the American College of Rheumatology, have suggested that the benefits of getting the vaccine and avoiding severe COVID-19 may greatly outweigh the potential risk for those with rheumatic conditions or who are taking immunosuppressants.1,2,5-8 The Center for Disease Control (CDC) has also stated that people with autoimmune conditions may get the vaccine.9

Future vaccine research

People with rheumatologic conditions or who are taking drugs that impact the immune system were not included in the original clinical trials. This means our knowledge of the vaccine’s effects on this group is limited. However, more research is ongoing and we will gradually learn more about the vaccine, how it works in many groups of people, and we will be able to make more concrete recommendations.

Ultimately, the decision to get vaccinated is a personal one and may be unique based on each person’s situation. Talk with your doctor about the risks and benefits in your specific case before making a decision.

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