Even as the world moved past emergency pandemic footing, a quieter crisis persisted for those whose own treatments left them unable to fully benefit from the vaccines meant to protect them. Research drawn from nearly 12 million people in England reveals that individuals living with multiple sclerosis faced seven times the hospitalization risk and four times the mortality risk from COVID-19 during 2022 compared to the general population — a disparity that held even among those who had received three or more vaccine doses. The culprit is not the disease itself but the medications used to manage
MS patients face 7x higher COVID-19 hospitalization risk despite vaccination
MS patients experienced disproportionately higher COVID-19 hospitalizations and deaths despite vaccination, indicating inadequate protection for this vulnerable population.
Vaccination alone cannot adequately shield this group from severe outcomes.
Mark
So the headline says MS patients are seven times more likely to be hospitalized with COVID. That's a big number. But I want to understand what's actually driving it—is it the disease itself, or something else?
Mimi
It's not the disease itself. That's the crucial part. Having MS doesn't inherently weaken your immune system in a way that makes you more vulnerable to infection. What does is the medication. Many MS patients take drugs that deplete B cells—immune cells that produce antibodies. Those drugs work well for controlling MS, but they also mean your body can't mount as strong a response to a vaccine.
Luke
But wait—the study looked at people during 2022, the Omicron wave. By then, most people had some prior exposure to COVID, either from infection or vaccination or both. The researchers say they didn't measure prior infection. So we don't actually know how much of that seven-fold difference is about vaccine failure versus other factors like disability level or comorbidities.
Mimi
That's fair. The study does acknowledge those limitations. But the raw numbers are still stark. Over three-quarters of the MS patients had three or more vaccine doses. And they still had 1.28 hospitalizations per 100 person-years versus 0.24 in the general population. That's not a small gap.
Mark
So if vaccination isn't protecting them adequately, what would? What are these "additional preventive measures" they're calling for?
Mimi
The paper doesn't specify. That's part of the problem—we know the vulnerability exists, but the solutions aren't laid out. It could mean antivirals, it could mean different vaccine strategies, it could mean social measures. The researchers are essentially saying the current approach isn't working and something needs to change.
Luke
And that's where I'd push back a little. They're presenting one year of data from England during Omicron. That's valuable, but it's not a complete picture of what works or doesn't work. They didn't look at disease-modifying therapy types, didn't measure time since vaccination, didn't account for prior infection. Those are big variables.
Mark
So the headline is accurate—MS patients do face higher risk—but the explanation for why, and what to do about it, is still incomplete.
Mimi
Exactly. The finding is solid. The mechanism is partially understood. The solution is still being figured out.
O Pulso
- Despite receiving three or more COVID-19 vaccine doses, MS patients in England were hospitalized at more than five times the rate of vaccinated people in the general population during the 2022 Omicron wave.
- The medications that make life with MS manageable — particularly B-cell depletion therapies — actively undermine the immune response that vaccines are designed to trigger, creating a cruel paradox for patients who follow every medical recommendation.
- Among 16,350 MS patients studied, 215 were hospitalized and 25 died from COVID-19, translating to mortality rates more than double those seen in the broader vaccinated population.
- Researchers cannot yet isolate which specific therapies, vaccine formulations, or individual health factors drive the elevated risk, leaving the full picture incomplete even as the danger itself is unmistakable.
- Scientists are calling for layered, tailored public health protections beyond boosters for immunocompromised patients, warning that a uniform vaccination strategy is leaving some of the most at-risk people without adequate defense as new variants continue to emerge.
Even as the world moved past emergency pandemic footing, a quieter crisis persisted for those whose own treatments left them unable to fully benefit from the vaccines meant to protect them. Research drawn from nearly 12 million people in England reveals that individuals living with multiple sclerosis faced seven times the hospitalization risk and four times the mortality risk from COVID-19 during 2022 compared to the general population — a disparity that held even among those who had received three or more vaccine doses. The culprit is not the disease itself but the medications used to manage it, which suppress the very immune cells vaccines depend upon to build protection. This finding asks a deeper question that extends beyond MS: how do we honor the social contract of public health when standard tools fail the most vulnerable among us?
A large-scale study of nearly 12 million people in England has delivered an unsettling finding: people with multiple sclerosis remain profoundly vulnerable to severe COVID-19 illness and death even after repeated vaccination. Presented at the European Congress of Clinical Microbiology and Infectious Diseases in Barcelona, the research identified 215 hospitalizations and 25 deaths among 16,350 MS patients during 2022 — rates that translate to seven times the hospitalization risk and four times the mortality risk of the general population, even after adjusting for age and sex.
The numbers are stark. MS patients were hospitalized at a rate of 1.28 per 100 person-years, compared to 0.24 in the vaccinated general population. More than three-quarters of those MS patients had already received at least three vaccine doses. The protection that vaccination reliably offers most people simply does not reach this group in the same way.
The reason lies in the treatments themselves. Professor Jennifer Quint of Imperial College London, who led the analysis, explains that disease-modifying therapies — especially those that deplete B cells — suppress the precise immune machinery that vaccines rely on to generate protective antibodies. Some patients carry additional burdens: complicating health conditions or significant disability that further compound their risk. The result is that even a fully vaccinated MS patient may be left exposed in ways that standard public health messaging does not adequately convey.
The study draws on routinely collected NHS data — real hospital admissions and death records, not surveys — lending its conclusions considerable weight. Researchers acknowledge they could not account for specific drug regimens, time since last dose, or prior infection, leaving some mechanistic questions open. But the pattern is consistent and clear.
Quint and her colleagues are calling for a fundamental rethinking of how health systems protect immunocompromised populations. Boosters alone, they argue, are not enough. As new COVID-19 variants continue to emerge, the evidence now demands layered, individualized protections — and the harder question is whether health systems will move quickly enough to provide them.
A study of nearly 12 million people in England during 2022 has found that individuals with multiple sclerosis face a starkly elevated risk of severe COVID-19 illness and death, even when they have received three or more vaccine doses. Researchers presenting the work at the European Congress of Clinical Microbiology and Infectious Diseases in Barcelona this April identified 215 hospitalizations and 25 deaths from COVID-19 among 16,350 people with MS in their dataset—rates that, after accounting for age and sex differences, translate to seven times the hospitalization risk and four times the mortality risk seen in the general population.
The disparity persists despite widespread vaccination. More than three-quarters of the MS patients in the study had received at least three doses of a COVID-19 vaccine by the start of 2022. Yet their incidence of hospitalization reached 1.28 per 100 person-years, compared to 0.24 per 100 person-years in the vaccinated general population. Deaths occurred at a rate of 0.14 per 100 person-years among people with MS versus 0.06 per 100 person-years in the broader population. The findings suggest that vaccination alone cannot adequately shield this group from severe outcomes.
The vulnerability stems not from MS itself but from the medications used to treat it. Professor Jennifer Quint of Imperial College London, who led the analysis, explains that certain disease-modifying therapies—particularly B-cell depletion drugs—interfere with the immune system's ability to mount a strong response to vaccines. These medications suppress the very immune cells responsible for generating protective antibodies. Some MS patients also carry additional risk factors: underlying health conditions or higher levels of disability that compound their susceptibility to poor COVID-19 outcomes. The combination leaves even repeatedly vaccinated individuals exposed.
The research emerges from the INFORM study, a broader investigation into COVID-19's impact on immunocompromised populations across England. Researchers analyzed routinely collected health data from a random 25 percent sample of all NHS-registered individuals aged 12 and older during the calendar year 2022, which coincided with the Omicron wave. The dataset encompassed nearly 12 million people, of whom 16,350 had a recorded diagnosis of MS. The scale and real-world nature of the data—drawn from actual hospital admissions and death certificates rather than surveys or estimates—lend the findings substantial weight.
Quint and her colleagues acknowledge important limitations. They could not measure the effect of specific disease-modifying therapies, the time elapsed since a person's last vaccine dose, which vaccine formulations individuals received, or prior COVID-19 infection. Other unmeasured factors related to MS severity or underlying conditions may have influenced the results. These gaps mean the true mechanisms driving the elevated risk remain incompletely understood, though the pattern itself is clear and consistent.
The researchers call for a fundamental shift in how public health systems approach COVID-19 protection for people with MS. Vaccine boosters, they argue, are insufficient. Instead, they advocate for additional preventive measures and layered protections tailored to this vulnerable population—a recognition that as new COVID-19 variants continue to emerge, a one-size-fits-all vaccination strategy leaves some of the most at-risk people inadequately defended. The question now is whether health systems will act on that evidence.
Citações Notáveis
Having multiple sclerosis in itself doesn't increase the risk of getting COVID-19, rather it's the taking of immune modifying medicine such as B-cell depletion therapies that can reduce the effectiveness of vaccines.— Professor Jennifer Quint, Imperial College London
Vaccine boosters are inadequate to protect this clinically vulnerable group. People living with MS should be considered an important high-risk group for which additional preventive measures and multi-layered public health protections are urgently needed.— Professor Jennifer Quint
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