The current situation is a bit confusing – lots of information and recommendations coming from different directions regarding the Corona vaccination, high incidences, alarmism on one side, demand for relaxation on the other. Especially for patients with multiple sclerosis who have very specific questions about their disease, this is certainly not an easy time. Therefore, I want to try and clarify the situation for them: At the moment, we are seeing a high level of infection activity with the Omicron variant in Germany. Fortunately, it is slightly less pathogenic (disease-causing), but on the other hand, it is capable of bypassing the vaccine protection in quite a few people (this is referred to as immune escape). They then become infected despite being vaccinated.
Nevertheless, it is beyond question that people with complete vaccination protection – and for me this means 3x vaccinated (2x basic immunization + one booster vaccination) – are perfectly protected against an infection with older variants like Delta and still relatively well protected against an infection with Omicron. It is also clear that in fully vaccinated people, serious or even life-threatening infections are effectively prevented – i.e. although the vaccine does not currently prevent virus transmission, it does provide very good individual protection. This statement also applies to patients with multiple sclerosis, whether they are undergoing immunotherapy or not. With complete vaccination, there is no longer any need to fear ending up in intensive care or even dying from the disease.
Omicron as a preview
The Omicron variant is probably already giving us a taste of the future when SARS-CoV2 becomes endemic. We will inevitably be infected with the virus in the future and will contract a cold caused by SARS-CoV2. However, these infections will contribute to building up population immunity and thus help to contain the transmission of the virus in the medium term. To further boost population immunity, it is important that large parts of the population receive a vaccine adapted to the Omicron variant once again. It will definitely be useful for next winter. I would already recommend this vaccine update to all those affected by MS. And from what we hear, such a vaccine could be available in April/May 2022.
Given this background, we could actually relax a bit and think about loosening measures and contact restrictions, as other European countries are currently doing. Unfortunately, however, compared to other European countries, Germany still has a very large vaccination gap, especially among older people. So we still have plenty of unvaccinated fellow citizens who can become seriously ill from an infection – even with Omicron. And the often-heard idea of now infecting oneself with the milder Omicron variant and thus no longer needing a vaccination is not a good idea either. Because the immune protection only lasts a short time after the Omicron infection and does not protect against older variants like Delta. If the lack of willingness to get vaccinated among many millions of fellow citizens remains at this level – and nothing indicates that this will change – we will have to accept restrictions again next winter and I think no one can endure that anymore.
Close the vaccination gap
Therefore, all efforts should currently be primarily focused on closing the vaccination gap. And I personally think that this will not work without a political solution in the form of a general vaccination requirement.
So, closing the vaccination gap should be the focus, but Germany is currently rather discussing the STIKO recommendation for the so-called 2nd booster vaccination (4th vaccination against SARS-CoV2). In my view, this is rather a secondary problem, but certainly of some interest for vulnerable groups, which also include patients with multiple sclerosis. The recommendation is based on observations from Israel: Here it could indeed be shown that the 4th vaccination is also not a way to prevent transmission and infection with Omicron. On the other hand, it is reported that in older patients (> 60 years), whose booster was already more than 4 months ago, a 4th vaccination significantly reduces the risk of symptomatic courses and hospitalization.
As far as MS is concerned, it therefore makes sense (analogously to the recently given recommendations for treatment with antiviral drugs), to vaccinate MS patients undergoing immunotherapies that impair the vaccine response (S1P modulators, anti-CD20 antibodies) and with further risk factors such as higher age (> 60), significant disability due to MS (EDSS > 6) and/or severe comorbidities a 4th time with the currently available vaccines, if the booster vaccination is already several months ago (> 4 months). This group of MS patients can feel addressed by the current STIKO recommendation and should make a decision for a 4th vaccination (even before a vaccine update is available) together with their doctors.
I hope this summary brings some clarity to the current discussion. But before I finish, a comment on another STIKO recommendation this week, namely the recommendation of the Novavax vaccine (Nuvaxovid) for people aged 18 and over. Nuvaxovid is a protein-based vaccine that has shown good efficacy in its Phase III trials, which were conducted before the Omicron variant appeared. Personally, I see no advantage of this vaccine over the available and already millions of times administered mRNA vaccines. Also the argument that we now finally have a “dead vaccine” is no differentiation against the already existing vaccines, which are also not capable of replication and can thus also be referred to as “dead vaccines”. However, if the availability of this protein-based vaccine convinces some skeptics to get vaccinated, then so be it.
