The most common question being asked of Dr. Karina Top is “whether people in priority groups ([such as] health care workers) who have weakened immune systems or are pregnant should get the COVID-19 vaccine,” says the pediatric infectious disease physician and associate professor at Dalhousie University in Halifax, whose research focus is vaccine safety, including for immune-compromised patients.
“Whether they should get the vaccine comes down to the balance of their risk of exposure to COVID-19, [their] risk of severe COVID-19 if they are exposed and the potential risks of the vaccine. It’s an individual decision that people need to discuss with their health care provider.”
When the Pfizer and Moderna vaccines were initially approved for use at the end of 2020, many jurisdictions restricted access to the populations who had been in the companies’ large phase 3 clinical trials, thus excluding pregnant and immunocompromised people. In recent weeks, as experts around the world pour over new data and studies—including from the continued monitoring of trial participants—some of those same jurisdictions are easing their initial criteria for who can get the vaccines.
One example of that change can be seen in Ontario, which updated its eligibility criteria in January. Its COVID-19 Vaccine Recommendations for Special Populations now states that pregnant and breastfeeding women, those with autoimmune conditions as well as immunocompromised persons are eligible to receive the vaccines, though with “informed counselling and consent.” Dr. Isaac Bogoch, an infectious diseases physician who is on Ontario’s COVID-19 Vaccine Distribution Task Force, called the province’s move an “important (and very welcome) change.” Like Ontario, Alberta also permits those who are immunocompromised, pregnant or breastfeeding to get the vaccines, though some of those who have immune issues need to consult their family doctor or specialist first.
“In general, we know that COVID-19 can be more severe in people who are pregnant or have certain types of immune system problems, especially if they have other risk factors like older age, obesity, and diabetes,” explains Top in an email to Maclean’s, Chatelaine’s sister publication. “We also know that the vaccines currently being used in Canada can’t cause COVID-19 because they don’t contain live virus. However, the safety of COVID-19 vaccines in people who are pregnant or have weakened immune systems aren’t fully known because they were not included in the clinical trials.”
There’s also the severity of a person’s disease to consider: “Individuals who are on treatment to suppress their immune system are likely to have a better response to the vaccine when they are on the lowest doses of immune suppression that they can tolerate and their underlying disease is under control,” explains Top.
Complicating the discussions that people are having with their health care providers is the fact that no one is sure about potential side effects for those with immunity issues who get the Pfizer and Moderna COVID-19 vaccines. “The two COVID-19 vaccines are using a new technology—mRNA—to train your immune system to recognize the virus that causes COVID-19,” says Top. “There are concerns that these vaccines could also activate the immune system in a way that is unhelpful, such as a [flare-up] of the autoimmune disease.”
“Generally the recommendations have moved toward considering COVID-19 vaccination if the benefits outweigh the risks after a discussion with a health care provider about that lack of information on the safety or effectiveness of COVID-19 vaccines in people with immune system issues,” explains Top.
In addition to governmental recommendations, disease-specific organizations are offering basic guidance. Lupus Canada’s website, for example, states that, as “people with lupus may be at higher risk of severe illness from COVID-19…current recommendations are for adults with lupus to be immunized against COVID-19 when it becomes available.” And on Jan. 11, the Society of Obstetricians and Gynaecologists of Canada reiterated its support for pregnant and breastfeeding women being eligible for the COVID-19 vaccines in a consensus statement: “Women who are pregnant or breastfeeding should be offered vaccination at any time if they are eligible and no contraindications exist.”