April 2024


May 6, 2021

Christine A. Peschken MD MSc FRCPC
Head, Section of Rheumatology
Acting Head, Section of Allergy and Immunology
Professor of Medicine and Community Health Sciences
Max Rady College of Medicine, Rady Faculty of Health Sciences
University of Manitoba
Chair, Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus

The intervals in the clinical trials for the different vaccines: 3 weeks for Pfizer, 4 weeks for Moderna and 4-12 weeks for AstraZeneca’s. However, after studying immune response after the first dose of vaccinations the National Advisory Committee on Immunization (NACI) recommended delaying the second dose for up to four months.  The rationale was to allow as many as people as possible to receive at least a single dose, thereby providing greater overall protection to the population, and hopefully ending or at least dampening down the third wave sooner.

Several studies have shown that the mRNA vaccines are at least 90% effective following the first dose (although it is not known how long this will last) and there are also studies showing that the AstraZeneca vaccine is more effective if the second dose is delayed to 12 weeks versus four.

All provinces have followed NACI’s recommendations, but all are watching carefully to see if there is a resurgence in COVID-19 infection in people where the second dose is delayed. This is all in the setting of a vaccine shortage, ideally of course all provinces would like to offer both doses to all adults as soon as possible.

There is growing concern that people with lupus or other autoimmune disease, or those taking immunosuppressive medications will not mount the same response to the vaccine, therefore will have less protection, and greater need for an urgent second dose, as well as even possibly “booster” doses in the future.

Each province, as well as NACI, is currently trying to figure out how best to manage the vaccine rollout with all of the competing priorities.  Each province has done things a little bit differently in terms of which population groups are prioritized.  One of the current subjects for discussion is prioritizing second doses for high risk groups.

Apparently vaccine supply and shipment are expected to steadily increase in May. We are therefore hopeful that this will allow people with lupus to get a timely first and second dose for maximal protection.  It needs to be stated though that even after the second dose protection may not be optimal for some immune compromised people.  For that reason, following all of the public health restrictions currently in place is more important than ever in the next few weeks as we hopefully begin to see light at the end of this very long tunnel.

We look to our health care professionals to help advocate for priority first dose and priority second doses for people with lupus and other high risk conditions.

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