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Pandemic Vaccine Research Continues: Scientists Seek to Find Answers for Society’s Most Vulnerable

Much of the world has eased pandemic restrictions. However, as society finds its new “normal,” scientists continue to work hard, behind the scenes, to answer questions about COVID-19 and vaccines for vulnerable people.

Arthritis Research Canada’s Quebec team recently launched a study to evaluate the safety of a 4th dose of COVID-19 vaccine in individuals living with autoimmune rheumatic diseases who are treated with rituximab.

“Few people living with these diseases and taking rituximab develop immunity after being vaccinated” said Dr. Paul Fortin, a senior scientist at Arthritis Research Canada. “Only 19 per cent of people in this category who participated in our ongoing COVID-19 vaccine study developed SARS-CoV-2 antibodies after receiving two doses of the Moderna mRNA vaccine.”

Still Many Questions

The goal of this study is to evaluate the safety (i.e. side effects) of a 4th dose of COVID-19 vaccine in people with autoimmune rheumatic diseases and to determine the immune response after a 4th dose.

The research team will specifically evaluate the effect of the immunosuppressive treatment, rituximab, on COVID-19 vaccine responses, examine rates of disease flares and assess the persistence of immune responses against COVID at six and 11 months and offer a  4th dose of vaccine.

This study will give people the option to choose between a subunit protein vaccine (which contains purified proteins of the virus that stimulate immune cells) and an mRNA vaccine (Moderna) for their 4th dose. Both of these types of vaccines are considered to be very safe. This study will also tell us about patient preferences.

 “The end goal is to inform public health authorities on the advantage of a fourth dose, as well as the advantage of using specific vaccine types to optimize responses in this vulnerable group,” Fortin said.

However, this research is not without challenges. The pandemic environment is constantly changing, and new variants continue to emerge. This could lead to revisions of current public health recommendations on how to manage immunosuppressed patients, which would impact the study.

Individuals living with systemic autoimmune rheumatic diseases are at higher risk for worse COVID-19 infection, yet vaccination could re-activate their autoimmune disease.

Documenting the development of antibodies, as well as cellular immunity (cells that can react against the virus), of those most at risk for COVID-19 complications is essential to further our understanding of the best strategies to protect this vulnerable group.

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