Question Time: Covid-19 and vaccination webinar report

Thank you to everyone who attended and contributed to the webinar, the fourth in our series on Covid-19. The specific focus of this session was on vaccinations and it covered the different vaccines available, their effectiveness against the new variants of Covid-19, dosing arrangements, safety issues and rollout prioritisation. It was emphasised that this advice is relevant to everyone in the renal community, regardless of kidney function or treatment.

The webinar was chaired by Fiona Loud, Kidney Care UK Policy Director. We were joined by five kidney doctors, Dr Rebecca Suckling and Dr Fiona Harris from Epsom and St Helier University hospitals, Dr Joyce Popoola from St George’s University Hospital, Dr Andrew Frankel from Imperial College Healthcare Trust and Professor Richard Haynes from the Oxford Kidney Unit. Thank you to them all for their advice and answering your questions.

Introduction

Dr Frankel began by giving a short update on the current situation. Since the last webinar in December, new variants of the virus have been identified which has led to a rapid increase in cases and we are now in a third national lockdown. The need to continue following government guidelines in regards to social distancing and, if applicable, shielding was emphasised. The vaccine roll out is now reaching kidney patients but there is a lot of inaccurate and misleading information available, especially on social media. The webinar will aim to reassure you that the vaccine is safe and effective by answering your questions based on fact and knowledge.

Update

During the webinar we discussed some new guidance about the interval between 1st and 2nd doses of vaccines which had only just been announced. We would like to clarify this, as it does not apply to people already on immunosuppressants for whom there is no change to your schedule for getting your 2nd vaccination. It only applies to those about to start immunosuppressants and only then as part of an individual decision with your medical team.

Which vaccine is best for me?

Professor Haynes explained that there are currently two main types of vaccine - mRNA (Pfizer and Moderna) and viral vector (Oxford). Although they work slightly differently, both types aim to get your own body to produce a small part of the virus – the spike protein – which is how the virus normally gets into and infects your cells. Your body can then produce an immune response against the protein so that if you come into contact with the real virus in the future, you have the antibodies ready to fight it.

Extensive trials have been conducted on all of the vaccines. The Pfizer and Moderna vaccines are around 90-95% effective. This means that if 100 people are exposed to the virus, only 5-10 will actually get it. The Oxford vaccine is around 70% effective, however this doesn’t mean that it is not as good as the Pfizer or Moderna vaccines. Although it may not be quite as effective at preventing infection, no one who was given the Oxford vaccine became seriously ill or needed hospital treatment. The best vaccine to take is the one you are offered first as this will ensure you are protected as soon as possible.

The Joint Committee on Vaccination and Immunisation (JCVI) do not make any specific recommendations in regards to the vaccine for people on immunosuppressants. They are all considered equally effective for kidney patients.

How well do the vaccines work?

Dr Popoola explained that all of the vaccines available in the UK have been approved and declared effective. There is a lot of misinformation out there but it is important to trust the medical team that have been looking after you, and to ask them if you have any questions or concerns.

The Covid-19 vaccine is given in two doses. You will have some protection against the virus within 2-3 weeks of the first dose, but the second dose is needed to give more prolonged protection.

We know that other vaccines, such as those given each year for flu, are effective in immunosuppressed people so there is no reason to believe that the Covid-19 vaccines won’t also work.

Just because you have had the vaccine, it doesn’t mean that you won’t get the virus. Covid-19 presents on a spectrum from no symptoms, mild symptoms, severe, those needing hospital treatment, intensive care or even death. The vaccine shifts the curve to the very mild end of the spectrum. Even once you have had the vaccine you should still follow the guidelines regarding social distancing and shielding until enough people have been vaccinated and community prevalence has fallen sufficiently.

Are the vaccines effective against the new variants?

The evidence so far shows that all of the current vaccines are effective against the new variants of Covid-19. This is because the vaccines focus on the spike protein which only changes ever so slightly in each new variant. This means that the immune response the vaccine produces in your body is still effective if it encounters a new variant. Vaccine research is still ongoing and new vaccines will be developed including potentially for any new variants if necessary, in the same way that the flu vaccine is slightly different each year.

What about the antibody trial?

There are currently two trials which are investigating antibody injections, similar to the convalescent plasma trials which looked into giving plasma from people who have recovered from Covid-19 to those who are currently ill with it. These trials are still in the early stages and it will take a few months before the results come out. The best way forward at the moment is therefore the vaccine.

How does the vaccine dosing schedule work?

Dr Frankel explained that the government made the decision to extend the initial dosing schedule from between 3 and 4 weeks to between 4 and 12 weeks. The decision was made for very strong public health reasons but has led to a lot of confusion and misinformation. The vaccines were given in a particular way during their trials so the effectiveness conclusions are based on those precise arrangements. However a longer gap between doses may not reduce the effectiveness and may even improve it as lots of other vaccines are given with a three-six month gap from the initial dose to a booster. We know that the first dose gives a very good level of protection after three weeks until at least the second dose. Studies are now taking place to examine different dose intervals and more information will become available in time.

New guidance about dosage intervals for those about to start immunosuppressants

Public Health England have published guidance on the vaccination of people who are about to start taking immunosuppressants which may affect a small group of kidney patients. It advises that ideally both doses should be given before the immunosuppressant treatment starts. The first vaccination should be considered at least two weeks before the immunosuppressant treatment starts and the second vaccine should be given within the minimum recommended time (3 or 4 weeks after the first). This is because the immune system may respond better to a vaccine given before immunosuppressant treatment starts. This may affect some kidney patients, including those with are due to start immunosuppressants for specific conditions. Any decision about timing of vaccinations will be a clinical decision taken by your doctor in discussion with you, and will take into account your individual condition and the reason for starting immunosuppressants. Your doctor will advise you if the date of any scheduled vaccination appointment needs to change.

This does not affect those who are already taking immunosuppressants, such as people with a transplant. If you are already taking immunosuppressants the timing of your second dose will normally be the same as for the general population (between 4 and 12 weeks after the first dose).

The vaccine may need to be given annually like the current flu jab in order to maintain full protection.

Could I be offered different vaccines for each dose?

The recommendation is that you will receive the same vaccine brand for each dose so you will not mix between two different brands of vaccine

Can children receive the vaccine?

Dr Popoola noted that very few children are seriously affected by Covid-19 so they are not currently the focus of the vaccine effort. All of the vaccine trials were conducted on adults and did not include anyone under the age of 16. The Pfizer and Moderna vaccines are licensed for use in those aged 16 and over and the Oxford vaccine for those aged 18 and over. Some young people who are considered at increased risk such as those waiting for a transplant will be offered the vaccine in the initial stages, but only if they are aged 16 or older. A very small number of children aged over 12, who have severe neuro-disabilities and live in an institutional setting, may be considered for vaccines. This would be considered an unlicensed use if under 16.

Can I receive the vaccine if I am pregnant?

When it was first approved, the Pfizer vaccine was not recommended for anyone who was, or was trying to become, pregnant. This advice has now changed and pregnant women are receiving the vaccine without any reported complications. The risk of catching Covid-19 is far greater than the mild side effects that are sometimes reported after receiving the vaccine. There is no evidence that any of the UK vaccines can affect fertility, so they can be given to women planning to become pregnant.

Can I catch Covid-19 from the vaccine?

Professor Haynes explained that none of the UK vaccines contain ‘live’ virus so they cannot give you an infection, even if you are immunosuppressed.

Should I have the vaccine if I am waiting for a transplant?

Yes all of the vaccines are safe if you are waiting for a transplant.

How long should I wait after a transplant before receiving the vaccine?

It is recommended to wait until your immunosuppressant is at maintenance level. This may be up to twelve weeks after your transplant when your medicines are at a baseline. Different people may be vaccinated at different times depending on their clinical circumstances and it best to discuss with your doctor. There is no evidence that the vaccines will lead to a loss of transplant.

Do I need to change any of my medications when I receive the vaccine?

No. You should not change or stop any of your medications without consultation from your healthcare team.

Are there any side effects to the vaccines?

As with other vaccines, there may be mild side effects to the Covid-19 vaccine such as having a sore arm or feeling tired for a day or two. These can be treated with paracetamol and should wear off quickly. There is no evidence that side effects are worse for people with underlying conditions such as kidney disease or based on any medication they are taking.

No serious side effects have been reported for any of the vaccines. They are considered as safe as the annual flu jab. No long-term side effects have been reported but Covid-19 can have long-term effects so it is very important to get vaccinated.

Can the vaccine cause an allergic reaction?

Dr Frankel commented that, when you go for your vaccine, you will be assessed by the healthcare team to make sure you are able to receive it safely. Unless you have had a previous allergic reaction to one of the components of the vaccine – which is very unlikely –it is safe to receive it. You will be asked if you are on any blood thinning medication so that the healthcare team can monitor you after the injection. This is to do with the injection rather than the vaccine itself.

There is no evidence that the vaccine will interfere with any medication that you may be taking.

Should I have the vaccine if I have had already had Covid-19?

Yes. If you are a transplant patient or are on immunosuppressants, you should tell your renal unit if you develop Covid-19 so that they can provide advice and treatment specifically to your circumstances.

You should wait at least 28 days after testing positive for Covid-19 before receiving your vaccination.

What happens after vaccination?

Professor Haynes emphasised that, if you were shielding before you received your vaccination, then you should continue to shield afterwards. This includes working from home and the Kidney Care UK Advocacy Officers can help with this if there are any issues with your employer. The government will lift the shielding advice when vaccination and other measures have had a significant impact on the prevalence of the virus throughout the population. The vaccine is a vital step but it is not an immediate way out of the restrictions.

It is very important that everyone continues to follow all government advice in regards to washing hands, wearing a face mask and maintaining social distancing.

Can I travel/see family?

It is not recommended that people who are shielding travel, especially internationally. Visiting family is currently restricted by the government to those in your support bubble.

How is the vaccine being rolled out?

Dr Popoola explained that the vaccine is being offered first to those who are most at risk of becoming seriously ill with Covid-19.

Kidney patients with CKD 5, who are on dialysis, immunosuppressants or have a transplant are in group 4. Those with earlier stages of CKD are in group 6. The majority of people in groups 1 and 2 have already been offered the vaccine and those in groups 3 and 4 are now being contacted. However this does vary across the country.

It is strongly recommended that you get your vaccine as soon as you are offered it. This may need to be delayed if you have recently had a transplant or tested positive for Covid-19, in which case you should ask your healthcare team for advice.

Where will I receive the vaccination?

You may get the vaccine at your GP surgery, a local community centre or at a central ‘hub’ such as a hospital or conference centre. You will be given a set appointment time and the vaccination centre will be set up to ensure that social distancing is maintained and that you are kept safe.

If you are on dialysis you may receive the vaccine on the unit or through your local vaccine centre. It is safe to receive the vaccine while you are actively receiving dialysis.

You may be contacted by post, phone or email.

It is possible to receive the vaccine at home if you are frail and this is the only option.

Will my family members be vaccinated at the same time?

In most cases family members will need to wait their turn in the priority groups, unless they are also in an at-risk group or are the main carer. We are still looking into how this will be rolled out across the kidney community.

How will Covid-19 affect me if I was born with one kidney/have been/intend to be a living kidney donor?

Dr Frankel commented that if you have one kidney and have stable kidney function then you are classed as part of the general population and are at no higher risk of Covid-19. This includes living donors who have already donated. You will therefore be vaccinated with your age group. If you are planning to become a living donor and you live with your intended recipient you may be offered the vaccine at the same time as they receive theirs.

How do I know if I am classed as clinically extremely vulnerable?

Dr Suckling noted that these are people who are currently being advised to shield and have received a letter to explain this. If you think that you are in this category but have not been advised to shield, talk to your healthcare team. Your kidney function may have deteriorated from March 2020 when shielding was first advised and your records may not have been updated nationally. The vaccine invites are sent nationally and your GP cannot control who is invited at each stage but they can update your record if you now fall into a higher priority group. The Kidney Care UK website clarifies which groups are classified as clinically extremely vulnerable.

There are geographical variations in how quickly the vaccinations are rolled out to the different groups. The aim is to offer the vaccination to everyone in the top four priority groups by the middle of February. Please wait and watch for your invite. They are coming through and it may be quite short notice when you do receive your vaccine slot.

Summary

Dr Frankel concluded the webinar with a reminder that there is so much information out there, and it is not all based on facts. We are also still learning about Covid-19 so it is important to know where to get the right information and to use trusted sources.

Fiona Loud acknowledged the bravery of the kidney community through these very hard times and how vaccination is the best way to get us back to near normal.

• Please keep checking the Kidney Care UK Covid-19 guidance for updates and further webinars
• Please get in touch for general support, advocacy, counselling or grants