COVID-19 Vaccines and People with Cancer

COVID-19 is now the leading cause of death in the United States, with more daily deaths than those caused by heart disease, typically the number one killer. Over 540,000 Americans have died from the coronavirus to date.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, continues to have a serious impact on many people, including cancer patients, their families, and caregivers.

Vaccines (also called immunizations or vaccinations) are used to help a person’s immune system recognize and protect the body against certain infections. Vaccines are now becoming available to help protect against COVID-19.

Currently, three COVID-19 vaccines have received emergency use authorization (EUA) from the US Food and Drug Administration (FDA):

• The Pfizer-BioNTech vaccine is authorized for people 16 years of age or older. It is given in two doses, three weeks apart.
• The Moderna vaccine is authorized for people 18 years of age or older. It is given in two doses, four weeks apart.
• The Johnson & Johnson/ Janssen vaccine is authorized for people 18 years of age or older. It is given as a single dose.

The Pfizer-BioNTech and Moderna vaccines have been found to be more than 90% effective at preventing COVID-19 infection in people who receive both doses, although they might not be as effective after only one dose. The Johnson & Johnson/ Janssen vaccine is about 66% effective at preventing COVID-19 infection but highly effective in preventing hospitalizations and death.

The Pfizer-BioNTech and Moderna vaccines contain messenger RNA (mRNA), which is genetic material. After a person receives the vaccine, the mRNA tells the cells in the body to make copies of the virus’s “spike” protein (the protein that normally helps the virus infect human cells). This doesn’t cause disease, but it does trigger the immune system to learn to act against the virus if the body is exposed to it in the future. The Johnson & Johnson vaccine, unlike Pfizer and Moderna, uses a human adenovirus that has been modified to express the virus’s “spike” protein. The modified adenovirus cannot replicate in humans and cannot cause disease.

Infectious disease experts have agreed that the vaccines have been shown to be safe and effective for the general population. There was no evidence that they would not be safe for most cancer patients, although it should be noted that patients receiving immunosuppressive and cytotoxic treatments were excluded from participation in the vaccine trials to date so there is little to no data on the safety and efficacy of the vaccines in cancer patients.

At this time, patients with cancer may be offered vaccination against COVID-19 as long as components of that vaccine are not contraindicated. The current CDC interim clinical guidance discusses immunocompromised individuals.

It states: “Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19.”

The expert panel noted that while some immunocompromised patients may experience a decreased response to the vaccine, it may still confer some benefit and is important to reduce the risk or severity of COVID-19 to cancer patients, especially given recent evidence of higher rates of severe infection.

At this time, patients undergoing treatment may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated.  Oncologists have experience providing other types of vaccines to patients receiving treatment for cancer, including chemotherapy, immunotherapy, radiation therapy or stem cell transplantation. Strategies such as providing the vaccine in between cycles of therapy and after appropriate waiting periods for patients receiving stem cell transplants and immune globulin treatment can be used to reduce the risks while maintaining the efficacy of vaccination.

Cancer survivors may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated.

At this time, only those with contraindications to a specific vaccine component should not be offered vaccination with that specific product. These contraindications are described in detail in CDC interim clinical guidance.

As there is still uncertainty around the extent to which immunocompromised patients with cancer will develop immunity in response to vaccination, vaccinated patients should continue to follow current guidance to protect themselves from exposure to COVID-19. The expert panel underscored the message that while providing the vaccine to cancer patients and their caregivers will reduce risk for infection or clinical COVID-19 disease, they emphasized the importance of continuing practices of wearing masks, social distancing, and maintaining good hand hygiene even after vaccination.

The physicians, physician assistants, and nurse practitioners of Southeast Radiation Oncology Group support the use of COVID-19 vaccinations and encourage patients to discuss this further with their providers.

***This content was adapted from the American Society of Clinical Oncology: COVID-19  Patient Care Information and the American Cancer Society***