Winter Is Coming and COVID-19 Vaccine Is Available! The Role of Gastroenterologist in Increasing COVID-19 Vaccine Acceptability Among IBD Patients.

Dear Editors:

We read with interest the inspiring and timely commentary by Melmed et al in which they explained the benefits and provided practical recommendations to get patients with inflammatory bowel disease (IBD) vaccinated for influenza and pneumococcus, particularly during the COVID-19 pandemic. Furthermore, the authors realistically described the future COVID-19 vaccination scenario for patients with IBD. The intrinsic immune-mediated nature of, as well as the need for, immunomodulating or biologic therapies in patients with IBD has raised several questions about the safety and efficacy of the COVID-19 vaccine.

In this context, we would like to dissect some specific points covered in this commentary, also considering the new available data coming from recently published phase III trials. First, we believe that, given the unprecedented development rapidity of COVID-19 vaccines, the answers on their performance in particular groups of patients (eg, patients with IBD) will be addressed over time. At the beginning of December 2020, the first COVID-19 vaccine (Pfizer-BioNTech vaccine) was approved in the United Kingdom, then in the United States, and finally in the European Union. The vaccination campaign started from the front-line health care personnel, home care staff, and residents. Subsequently, a second mRNA vaccine (Moderna) has also been approved in the United States. We are now waiting for the approval of a third vaccine with a different mechanism of action (Oxford-AstraZeneca vaccine), consisting of a replication-deficient chimpanzee adenoviral vector containing the gene for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein. On one hand, the efficacy data coming from phase III trials certainly have fueled the expectation of drastically reducing the spread of SARS-CoV-2 infection. On the other hand, no specific data for patients with IBD are yet available in these studies. We still need to extrapolate concepts of safety and efficacy from studies conducted in IBD populations with different vaccines. Undoubtedly new accumulating reports obtained from real-world data of vaccinated patients in appropriate post-marketing registers with eventual adverse reactions will clarify their safety both in the short-, and especially, long-term. In addition, the possibility of having different vaccines obtained from distinctive platforms will also allow their comparison and therefore the identification of the most effective and safe solution according to demographic characteristics and comorbidities, including IBD. Another crucial point is how to achieve the highest acceptance rate for the COVID-19 vaccine according to a predefined list of priorities, even in patients with immune-mediated inflammatory diseases (ie, IBD). This will not consider those with earlier access to the vaccine for reasons not connected to IBD, such as age, work activity, or presence of other comorbidities. Factors associated with the likelihood of accepting COVID-19 vaccination have been studied extensively in large population cohorts in order to drive public health information campaigns and to address vaccine hesitancy. The role of health care providers in recommending the vaccination results among the most significant factors in driving the compliance to vaccination. This means that an essential task in reducing IBD patients' hesitancy to get vaccinated against COVID-19 will be played by gastroenterologists who will have to educate and inform their patients on the usefulness of vaccination, as already reported in the past for other vaccine recommendations. Again, on this point, we believe that the open declaration of having been vaccinated (eg, through the use of “I’m vaccinated” pins or stickers or social media campaigns) would be an important motivator tool in orienting patients’ choice toward vaccination. Finally, as part of the exhaustive information, gastroenterologists will have to alert patients that the vaccine does not give 100% protection against COVID-19 and that we are not sure that it prevents the transmission of SARS-CoV-2. It will be essential to follow the preventive measures adopted so far until herd immunity will be achieved.