This has been a stressful and disruptive year for all of us due to the COVID-19 pandemic. As the COVID-19 vaccinations begin, you may have many questions about the COVID-19 vaccine and wonder if you can and should receive the vaccine. We hope that the following information will address your questions and concerns.
The COVID-19 vaccines are messenger RNA (mRNA) vaccines. This is a new approach for vaccines that has been studied for over a decade. When you receive the vaccine, the mRNA provides instructions to cells at the injection site to make a piece of the “spike protein” that is unique to SARS-CoV-2 (the virus that causes COVID-19). Only a piece of the protein is made, and this protein does not do any harm to the individual vaccinated. These vaccines do not contain live virus, so there is no risk of developing COVID-19 infection from the vaccination.
The immune system detects the partial spike protein that is made by your cells and responds by producing antibodies against SARS-CoV-2. In that way, the immune system will then be ready to protect you against infection.
The approved vaccines were tested in large clinical trials and have met all safety standards. The safety of the vaccines will continue to be monitored closely. The FDA has said that people who have had severe allergic reactions to other vaccines or to the particular components of the COVID-19 vaccine, should avoid getting the vaccine.
The COVID-19 vaccine clinical trials excluded patients who recently received or were receiving immunosuppressive treatments for cancer therapy (this includes chemotherapy and some other anti-cancer treatments). Because of this, there are no specific data on the safety of the COVID-19 vaccine in this patient population. However, there is no obvious reason to suspect that the vaccines will be unsafe for patients with cancer.
In clinical trials, the vaccines have been shown to be over 90 percent effective in protecting against COVID-19 infection. Because patients with cancer were excluded from the clinical trials, it is not known whether patients who are immunosuppressed by cancer or by cancer treatment will mount the same immune response after receiving the COVID-19 vaccine. This will be studied in further trials.
Patients with certain cancers are at higher risk of COVID-19 infection and complications from the virus. If you have had cancer in the past, recently completed cancer treatment, or are on active cancer treatment, we feel that the potential benefit of vaccination outweighs the risk of COVID-19 infection and potential complications from the disease.
Vaccination requires two doses several weeks apart in order for optimal effectiveness. The most common side effects of the vaccine include pain and swelling on the arm where the vaccine is given, as well as fever, chills, fatigue, and headache. It is important to get the second shot even if you have side effects from the first shot unless your doctor instructs you otherwise.
The vaccines are available under an Emergency Use Authorization from the FDA. The priorities for who is vaccinated first are based on recommendations from the CDC. The goal is for everyone to have access to the COVID-19 vaccine. Currently, vaccines are available only to individuals in Category 1A, defined as those serving in healthcare settings who have the potential for exposure to patients and to long-term care residents. As more vaccine becomes available, vaccines will become available to people 75 years or older as well as essential workers (category 1B). The next category of individuals, Category 1C are adults of 65 and over and adults with underlying medical conditions. After these phases are complete, it is anticipated that vaccine will be available for the general population.
No, this is recommended as people with moderately to severely compromised immune systems may not build the same level of immunity to 2-dose vaccine series compared to people who are not immunocompromised.
The CDC recommends that everyone who has been receiving active cancer treatment for tumors or cancer of the blood get a third Moderna or Pfizer BioNTech COVID-19 vaccine shot at least 28 day after their second dose.
According to the CDC, cancer patients undergoing active treatment are considered immunocompromised, and therefore should get a third COVID-19 vaccine dose. If you have questions, you should plan to discuss this with your doctor at your next regularly scheduled clinic visit. As the CDC’s advisory committee on immunization practices continues to meet on this issue, guidance may change over time.
The CDC currently recommends a third vaccine shot only for people who are moderately to severely immunocompromised, including cancer patients in active treatment. However, the federal government has indicated that on September 20, a third vaccine shot may be available to everyone who previously received the Moderna or Pfizer BioNTech vaccines. The new plan calls for a third vaccine shot to be administered eight months after receiving the second vaccine dose.
Patients who are receiving radiation therapy only and have had not chemotherapy or other therapies in combination with radiation therapy, typically are not considered immunocompromised.
More research is needed to address this question. There is data that indicates the vaccines may be less effective in some immunocompromised people, including patients receiving chemotherapy for cancer, patients with blood cancers such as chronic lymphocytic leukemia (CLL), people receiving stem cells or organ transplants, and patients using certain medications, including some cancer medications that may reduce the immune response to vaccination.
To be clear, we strongly recommend that our patients and their close contacts get vaccinated against COVID-19. Further, in light of new FDA and CDC guidance, we recommend all cancer patients in active treatment get a vaccine booster shot, i.e., a third dose of Moderna or Pfizer BioNTech COVID-19 vaccine.
Please note that all cancer patients also should continue to take steps to reduce risk of exposure to COVID-19, including wearing a face mask around anyone outside your home, practicing social distancing, and avoiding crowds and poorly ventilated indoor spaces.
We hope this information is helpful. As we learn more about COVID-19 and about vaccination, our understanding and recommendations may evolve. The decision to be vaccinated is a personal one and should be made in discussion with your health care provider.
The pandemic is still here, so it is critically important to continue to mask, practice social distancing, and be diligent about hand-washing, whether or not you have been vaccinated. We want you to stay safe.
For further questions, please visit the CDC website.