Coronavirus Disease 19 (COVID-19)
vaccine platforms are becoming available and are the most promising strategy to curb the spread of
SARS-CoV-2 infections. However, numerous uncertainties exist regarding the pros and cons of vaccination, especially in patients with (immune-mediated)
kidney diseases on immunosuppressive drugs. Here, members of the Immunonephrology Working Group (IWG) of the European Renal Association-European Dialysis and Transplant Association (ERA-
EDTA) discuss thirteen frequently-asked questions regarding safety and efficacy of the most promising
vaccine candidates. Post-marketing surveillance should be performed to estimate the rate of
vaccine response (humoral and cellular) of different
vaccine platforms, and surveillance of disease activity following administration of
COVID-19 vaccines. Some of the candidates induce signaling pathways which also promote autoimmune
kidney diseases, e.g.
type I interferons in
systemic lupus erythematosus. Efficacy estimates would thus far favor the use of selected
COVID-19 vaccines, such as
BNT162b2,
mRNA-1273 or Gam-COVID-Vac. Humoral immune response after vaccination should be monitored using appropriate assays. Even in the absence of
neutralizing antibodies patients might be protected by a sufficient cellular immune response capable to reduce severity of
COVID-19. A reduced
vaccine response after the use of CD20-depleting agents is anticipated, and it is particularly important to discuss strategies to improve
vaccine response with these patients. Distancing and shielding measures remain important as not all
vaccines fully protect from
coronavirus infection. In-depth information about the most pressing
vaccine questions is essential to reduce vaccine hesitancy of patients.