COVID-19 Vaccines: Position Statement

The Crohn’s & Colitis Foundation advocates on behalf of millions of Americans who are affected by Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD).

The Foundation supports the principles below as they relate to the safety, efficacy, and delivery of COVID-19 vaccines:

  • The Foundation supports access to safe and effective vaccinations for COVID-19.

  • The Foundation recognizes that vaccine supplies may be initially limited and supports an equitable delivery system of COVID-19 vaccines that prioritizes access to communities of highest impact and risk. The Foundation encourages patients and caregivers to review and follow their state guidelines for COVID-19 vaccination.

  • The decision to receive a vaccine should not be based on the Foundation’s advice or reporting. The Foundation encourages effective partnering between patients and their healthcare providers to address concerns regarding vaccination and to make shared decisions on whether a patient should receive a COVID-19 vaccine.

  • The Foundation remains committed to monitoring information as it is made available regarding the status of COVID-19 vaccines and their impact on IBD patients.

  • The Foundation continues to support and encourage social distancing, mask wearing, and other strategies designed to mitigate the spread of the coronavirus while awaiting vaccinations in the IBD community and general population.

COVID-19 Vaccine Safety and Effectiveness

All vaccines are developed and approved through a rigorous method, similar to the phases that are used to develop, test, and approve medications. The Food and Drug Administration (FDA) provides guidance and oversight of all drugs, vaccines, and devices used in the United States. Recognizing the urgency and need for a COVID-19 vaccine, the FDA implemented an expedited process of reviewing and approving a vaccine under an Emergency Use Authorization (EUA).1

In the development phase, COVID-19 vaccines must go through the three phases of vaccine clinical trials during which time tens of thousands of individuals receive the vaccines. For an EUA to be issued for a vaccine, the FDA performs a comprehensive evaluation of all available information related to each vaccine and determines that the known and potential benefits outweigh the known and potential risks of the vaccine. This EUA evaluation is performed by a team of career scientists and physicians within the FDA, and includes a review from external scientists and public health experts not affiliated with the FDA. Importantly, no steps in FDA’s review process were skipped for the COVID-19 vaccines currently under the EUA.

The currently approved vaccines, as well as the others known to be in Phase III testing, do not contain live virus particles. There is no concern of contracting COVID-19 from the vaccine, even among patients on immunosuppressive medications.

Non-live vaccines are considered safe for IBD patients regardless of the type of IBD therapy the patient is receiving. Those on specific types of immune-modifying treatments may have a reduced vaccine immune response, however, vaccination should not be deferred solely because they are receiving those treatments. IBD patients receiving systemic corticosteroids should be advised by their healthcare team on potential decreased vaccine efficacy.2 

The currently approved vaccines are also considered safe for women with IBD that are planning pregnancy, are pregnant, or are currently lactating.2 

COVID-19 Vaccine Delivery

Due to an initially limited supply of COVID-19 vaccines, vaccines are expected to be administered in a phased approach. As of January 1, 2021, the Centers for Disease Control and Prevention (CDC) recommended jurisdictions administer vaccines as follows:3

  • Phase 1a began in December 2020 and includes offering vaccinations first to healthcare workers and those in long-term care facilities.
  • Phase 1b should occur second and include essential workers (examples: Education Sector, Emergency Responders, Food & Agriculture, Transportation) and persons age ≥75 years.
  • Phase 1c should occur third and include persons aged 65-74 years, persons aged 16-64 years with certain underlying medical conditions that place them at increased risk for severe illness,4 and essential workers not recommended for vaccination in Phase 1b.
  • Phase 2 should occur when more vaccines are available and include all persons aged ≥16 years not previously recommended for vaccination.

It is important to note that CDC's vaccine administration recommendations are not mandated, and their recommendations are subject to change based on current events. Most states are following the CDC’s recommendations, however, some states are prioritizing vaccine distribution differently. 

Patients should monitor their state’s health department guidance for specific information on individual states’ distribution plans.

Considerations for Receiving a Vaccine

Current data shows that IBD patients are not inherently at increased risk for severe illness from the coronavirus.2,5,6,7,8 The Foundation encourages patients with IBD to continue to follow practices that mitigate the spread of the coronavirus while awaiting vaccines to become more broadly available in Phase 2. However, if a patient with IBD is on steroids, has other qualifying medical conditions that are considered high-risk, or is otherwise included in Phase 1a-1c, patients should partner with their healthcare team to discuss receiving a vaccine.

There is increasing evidence that COVID-19 disproportionately impacts Black, LatinX, and Native American communities in the U.S., and that these communities are experiencing higher rates of infection, hospitalizations, and deaths due to COVID-19.9,10 Socioeconomic factors, lack of access, systemic inequities, biases, and racism play a role in exacerbating the impact of the pandemic in these communities as well as other groups across the country. More studies are needed to further understand this impact, particularly among patients with Crohn's disease and ulcerative colitis.

Once COVID-19 vaccinations are widely available, the Foundation supports an effective partnership between a patient with IBD and their healthcare team to address any concerns and make an informed decision on receiving a vaccine. The Foundation seeks to inform the community with the best available information, however, decisions on vaccinations must be made on an individual basis between a patient and their provider. The Foundation continues to monitor the status of current and future COVID-19 vaccines, including their impact on the IBD community.

Patients and providers may find the latest COVID-19 vaccine information by visiting the Foundation’s vaccine resources webpage. Inquiries can be addressed to the Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center), Monday through Friday, 9:00 a.m. to 5:00 p.m. ET at 888-MY-GUT-PAIN (888-694-8872)

 

References

1United States, Food and Drug Administration. (2020, November 20). Emergency Use Authorization for Vaccines Explained. Retrieved from https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

2Siegel CA, Melmed GY, McGovern DPB, et al. Gut Epub January 27, 2021 doi:10.1136/gutjnl-2020-324000: https://gut.bmj.com/content/gutjnl/early/2021/01/20/gutjnl-2020-324000.full.pdf 

3Dooling K, Marin M, Wallace M, et al. The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep 2021;69:1657-1660. DOI: http://dx.doi.org/10.15585/mmwr.mm695152e2external icon.

4United States, Centers for Disease Control and Prevention. (2020, December 1). Certain Medical Conditions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html 

5Allocca, M., Chaparro, M., Gonzalez, H. A., Bosca-Watts, M. M., Palmela, C., D’Amico, F., . . . Fiorino, G. (2020). Patients with Inflammatory Bowel Disease Are Not at Increased Risk of COVID-19: A Large Multinational Cohort Study. Journal of Clinical Medicine, 9(11), 3533. doi:10.3390/jcm9113533

6Brenner, E. J., Ungaro, R. C., Gearry, R. B., Kaplan, G. G., Kissous-Hunt, M., Lewis, J. D., . . . Kappelman, M. D. (2020). Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology, 159(2). doi:10.1053/j.gastro.2020.05.032

7Derikx, L. A., Lantinga, M. A., Jong, D. J., Dop, W. A., Creemers, R. H., Römkens, T. E., . . . Hoentjen, F. (2020). Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study. Journal of Crohn's and Colitis. doi:10.1093/ecco-jcc/jjaa215

8Papa, A., Gasbarrini, A., & Tursi, A. (2020). Epidemiology and the Impact of Therapies on the Outcome of COVID-19 in Patients With Inflammatory Bowel Disease. American Journal of Gastroenterology, 115(10), 1722-1724. doi:10.14309/ajg.0000000000000830

9United States, Centers for Disease Control and Prevention. (2020, November 30). COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved December 16, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html 

10Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., . . . Sullivan, P. S. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, 47, 37-44. doi:10.1016/j.annepidem.2020.05.003

 

View and download the position statement as a PDF

Last updated January, 2021