People who live with inflammatory bowel disease (IBD) have had many questions regarding the COVID-19 pandemic and the vaccine rollout is no different. The good news is that prominent IBD physicians are advocating for people who live with Crohn’s disease or ulcerative colitis to get vaccinated against SARS-CoV-2 (the virus which causes COVID-19). As healthcare professionals, many of them have already received a vaccine themselves.
After speaking with Dr David Rubin, highly respected IBDologist, fierce advocate for patients, and consummate educator who graciously responds to my emails, on About IBD, I became better aware of the concerns of the IBD community in regards to vaccination. I’ve spent the better part of the last month working towards answering questions and reading research.
To that end, I have come up with 5 nuggets of information that address some of the chief concerns about COVID-19 vaccinations in people who live with IBD.
- The technology for the messenger RNA, which we also call mRNA, has been in development for 10 years. It’s not something that was created in the last year. The COVID-19 vaccines are created from the discoveries made during many years of hard work by researchers and scientists.(1)
- The US Food and Drug Administration still asked for all the same data for the COVID-19 vaccines as they would for any other vaccine. The difference was in the review process. The pandemic is obviously an urgent situation and vaccines are one factor that can help humankind beat back this virus. The FDA worked faster to grant emergency use for the vaccines but the process was still the same as it would be for any other vaccine product.(2)
- Vaccines do cause a response in our bodies. In fact, that’s the point. The body develops antigens after receiving a vaccine. The side effects reported so far in people who have received the vaccines in trials are what’s expected. Some people have reported more pronounced side effects and others report less. The best advice is to be aware that the side effects are a possibility and to plan for them by taking time off work/school if possible and using other self-care measures such as getting quality sleep. There haven’t been any major concerns over safety, which is why the emergency use authorizations have been granted.(3)
- The concern with some medications used in IBD and other immune-mediated conditions and the COVID-19 vaccines is not over having a bad reaction or safety. There is a question about if a vaccine will give the same level of protection as it does in people who don’t take immune suppressing drugs. For some vaccines, studies have shown that certain IBD medications may prevent a really good immune response. In other vaccines, the immune response is the same in a person who is receiving an IBD drug as it is for people who don’t have IBD and are not receiving any such drugs. But, we don’t know for sure yet about the COVID-19 vaccines because the mRNA vaccines are new technology. It’s entirely possible that immunity might be quite good but we have to see what the data shows. What’s important to remember, however, is that even some immunity is better than none.(4,5)
- There’s no evidence that receiving a vaccine will cause a flare-up of IBD. Studies on vaccinations in people with IBD as well as other immune-mediated conditions such as rheumatoid arthritis and lupus show no difference in the rate of flare-ups after vaccinations. The immune system is extraordinarily complicated. Part of why it’s so difficult to treat IBD is in finding out which parts of the immune system are involved and how to manage them. The immune system doesn’t have one switch that is either flipped to “on” or “off,” it’s far more nuanced than that. The body’s ability to produce antibodies against a virus after vaccination hasn’t been shown to have any affect on IBD inflammation. At this time, we have no reason to think that the COVID-19 vaccines will have any effect on IBD.(6)
Of course, with all of this, data is being collected and there will be more information as time goes on. Still, it’s recommended that for IBD patients, when our turn in line comes up, that we take the opportunity to get vaccinated.
Even having IBD, even having a j-pouch, even receiving medications: my place in line as an “otherwise healthy” adult under the age of 65 years who can work from home is going to be one of the last. But when my name is called: I’ll be ready and I will present my arm for the COVID-19 vaccine.
- Pardi N, Hogan MJ, Porter FW, Weissman D. mRNA vaccines – a new era in vaccinology. Nat Rev Drug Discov. 2018;17:261-279. doi:10.1038/nrd.2017.243.
- Hahn SM. COVID-19 Update: FDA’s Ongoing Commitment to Transparency for COVID-19 EUAs. U.S. Food & Drug Administration. 17 November 2020. Available at: https://www.fda.gov/news-events/press-announcements/covid-19-update-fdas-ongoing-commitment-transparency-covid-19-euas
- Nania R. What Are the Side Effects of COVID-19 Vaccines? 21 December 2020. AARP. Available at: https://www.aarp.org/health/conditions-treatments/info-2020/coronavirus-vaccine-side-effects/
- Kumar A, Quraishi MN, Segal JP, Raine T, Brookes MJ. COVID-19 vaccinations in patients with inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2020;5:965-966. doi:10.1016/S2468-1253(20)30295-8.
- Caldera F, Misch EA, Saha S, Wald A, Zhang Y, Hubers J, Megna B, Ley D, Reichelderfer M, Hayney MS. Immunosuppression Does Not Affect Antibody Concentrations to Measles, Mumps, and Rubella in Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2019;64:189-195. doi:10.1007/s10620-018-5321-z.
- Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105:1231-1238. doi:10.1038/ajg.2009.733.