b'I ncclluussiioonnMMaakkeessInaaDDiieerreenncceef orrEEvveerryyoonneefoAlan R. SegaloExecutive DirectorIn a recent statement about the COVID-19 vaccine, our senior medical advisor, Dr. Ben Throwermade the point that while it is likely safe and eective for people with MS, that conclusion is based onwhat is known about the vaccine in the general public combined with what is known about MS, noton study results. Why? Because people with MS, as a group, were not included in the vaccine trials.*This is not unusual, of course. Medications you take for things other than MSfrom headachemedications to heart disease treatmentswere not tested specically on people with MS. Once theirsafety is established in people without MS, the science behind the medications is considered,including how they are metabolized and what their mechanism of action is. If there is no indicationthat they may interact negatively with the MS disease process or its treatments, a medication canbe used by someone with MS.However, in the case of the vaccine, there is an open question. Will those on certain immuno-suppressive treatments have a weakened response to the vaccine? We will not know until peoplewith MS, or people with other conditions who take similar immunosuppressive drugs, are includedin further study. (Most doctors agree that a weakened response is better than no response andencourage use of the vaccine. We encourage you to discuss it with your healthcare provider.)This issue highlights the importance of inclusion. The broader the group that can be included inany study, the more is learned. Conversely, leaving groups out of research can limit our knowledge.For example, women tend to be under-represented in clinical research, and researchers sometimesfail to look at study results by gender. The outcome? Of the 10 prescription drugs taken o themarket by the U.S. Food and Drug Administration between 1997 and 2000 because of severeadverse eects, eight caused greater health risks in women.A chronic issue in research is the under-representation of people of color. The MS communityhas not been unaected by this problem. Drugs have come to market and later been found to be lesseective in people of color than in Caucasians. In this issue, Drs. Annette Okai and Tirisham Gyangexplain how people of color may experience MS dierently than their Caucasian counterparts,and why inclusion in research is vital. (See their articles on pages 12 and 16, respectively.)However, the idea of inclusion extends beyond clinical research. Feeling includedin society,in the family, in the MS communityis important for everyone. When we asked what makes peoplefeel left out for our Facebook Feedback question, we got some surprising answers, which you willnd throughout this issue. We also got an interesting story about feeling included again from NeeleyGentry that we are happy to share with you. (See page 26) Neeleys story highlights the point thatwhat makes a person feel included can be dierent for each of us.At MS Focus, we strive to make each member of the MS community feel welcome. That beginsin our oces with our diverse sta and commitment to inclusion, and extends to our services,which are made available fairly to all, and even to the pages of this magazine, where we hope youfeel included and represented. * It is unknown whether some individuals with MS were included in the trials as part of the general public,but the trial did not gather data about the reactions of people with MS as a group.7 msfocusmagazine.org'