Right now both in the UK and the USA where most of the readers of this site live the rate of COVID19 infection is very high. There are reports of some hospitals in areas of both countries running low on oxygen, and in the UK right now more people are in hospital with symptoms of COVID19 than at the previous high in March to April.

At the moment therefore it is crucial that dramatic action is taken to reduce the transmission and the seriousness of infections when they occur. Social distancing, mask wearing, opening windows when mixing indoors is unavoidable, and varying degrees of lock down are all happening. People with blood cancer are well advised to take additional precautions due to our additional risk.

Accelerating the roll out of the three COVID19 vaccines now available is also vital. The USA currently have emergency approvals for the Pfizer and Moderna vaccines. The UK currently has emergency approvals for the Pfizer and Oxford/Astra-Zeneca vaccines. India is rolling out the Astra-Zeneca/Oxford vaccine with a local manufacturer having been licensed to produce it for emerging economies. The EU is currently rolling out the Pfizer vaccine. Israel is also rapidly rolling out the Pfizer vaccine. More countries will follow soon. 

The three main international COVID19 vaccines have all published their data: Moderna and Pfizer were published in the New England Journal, and Oxford & Astra-Zeneca was published in the Lancet.

Over the next few articles, I will be answering questions about these vaccines based on their published clinical papers and other sources.

In this article I will answer a couple of quick easy to respond to questions. Other articles will focus on questions that require a bit more detail. In the meantime, you might want to refer to official UK advice and Blood Cancer UK charity advice, not sure if the US has a similar single helpful page like this:

• The UK NHS COVID19 vaccination information page 

• Blood Cancer UK Covid19 vaccination page

The purpose of vaccination is to stop this wretched virus dead in its tracks so 2021 can begin to return to normal. We face more pain whilst the vaccines are rolled out which is why it is so critical this is done quickly and politics, anti-vax and covid denial conspiracy theories must not be allowed to get in the way.

The UK committee has created a staggered approach which they believe in the first phase will cover the groups of people which have contributed to 99% of all COVID deaths. The USA has in theory does something similar but each state is allowed to adapt this and this is apparently causing some confusion.

What is Vaccine efficacy?

A vaccine’s efficacy is described as the reduction in the rate of cases of infection seen in vaccinated vs non vaccinated. As such it may be listed as around 90% in the case of the mRNA vaccines which i actually think is easier to understand if you turn it around. This means the rate in vaccinated people is only 10% of what you see In the control group. This rate is affected by exactly how you define an infection. The studies are slightly different on this but essentially mean infection with symptoms. If you instead look at severe COVID ie hospitalisations or deaths the effect is higher as —nobody— who was vaccinated for more than a few days in any of the studies got severe Covid whilst people in the Control group did. If you look at infection without symptoms it looks like the vaccines do reduce that but not by as much.

Will the vaccines work for blood cancer patients?

Elsewhere I have looked at the evidence for a reduced response to some vaccines in some patients with blood cancer. But these vaccines seem to be much more effective in healthy people than many other vaccines. Thus it is reasonable to expect many with blood cancer can be helped and so most experts are agreed most blood cancer patients should be vaccinated. Check with your own doctors if you need clarification about your own specific situation. But as I have already explained in a previous article in common with almost all vaccines the initial studies did not include people with impaired immune systems. This does not usually stop us from taking other vaccines.

How well do vaccines work in blood cancer patients? The evidence for Chronic Lymphocytic Leukemia (CLL)

Do some people get COVID19 even after vaccination?

Yes, when we see estimates that vaccines reducing the rate of infection with COVID19 by as much as 90% or more, that still means that some patients do still present with symptomatic COVID19. Crucially, however, it appears that the level of severity is significantly lower.

In the Moderna study 16% of COVID cases in the placebo group were counted as severe, none of the cases who were vaccinated per the protocol were counted as severe, with nobody getting COVID pneumonia in this group. (Table S13. Covid-19 Symptoms and Severity, Per-protocol Set Appendix page 32).

In the Pfizer study Thirty participants developed severe Covid-19; all 30 were in the placebo group and this also made up 16% of the infections. 

In the Astra-Zeneca study there were 2 serious cases of COVID19 in the vaccinated group leading to hospitalisation, one was detected on the same day as vaccination and the other was detected ten days later which is not long enough for the vaccine to take effect. 16 cases in the control group were hospitalised with severe COVID19. 

Clearly vaccines take time to work and we should not be surprised to read of people who catch the disease shortly after receiving the vaccine. There is NO mechanism whereby the vaccines can actually give you the disease. But if you are worried about infection and are vaccinated, you can of course already be carrying the virus at the time you are injected. 

It is worth noting therefore that in all three studies no one who was vaccinated with both doses was up admitted to hospital with COVID19. The trials did not enrol many patients in vulnerable groups, but some people who took the control injection did end up with severe COVID19. 

It is worth remembering of course that not many patients recruited in these studies were at higher risk of COVID complications so we cannot guarantee that vaccination will prevent every single case of severe COVID19 whilst it seems reasonable to hope that it it will dramatically reduce the rate of such complications, hospitalisations and deaths. If a vaccine can change COVID19 from potentially a viral pneumonia to more like a cold or flu like illness in most people that will be extremely worthwhile.

No vaccine works for everyone so we don’t know for sure that this dramatic benefit will be seen in every vulnerable group. In particular those of us with damaged immune systems may not respond well to the vaccines as we often do not respond well to other vaccines. Many patients with blood cancer patients likely will respond although some will not, and so the expect doctors are advising almost all of us to be vaccinated since some immunity is better than no immunity.

Since not everyone with blood cancer will respond to a vacicne it is essential that we do not immediately start taking risks. The advice will remain that until the population has a lower background rate we should still continue to take extra steps to protect ourselves.

How do I know if I will respond?

There is no way of knowing if any individual patient with blood cancer will respond to a vaccine. Indicators that might suggest patients are more likely to respond to vaccines in general could include being early in the disease, being in a period of watch and wait or remission. Indicators that you may be less likely to respond could include being recently post treatment, particularly if you still have a low lymphocyte count, or a low antibody level or are on IVIG.

But for the vast majority of people with blood cancer even if you are in a group less likely to respond to vaccines most experts are advising us to go ahead. If you are on active treatment, recently had a stem cell transplant, or if you have any questions about your personal suitability for vaccination please discuss this with your specialist team.

What about an antibody test?

There is a concept of a “test vaccine” that is done to help prove whether or not a patient will benefit from IVIG. Here an antibody test is done after vaccination to see if the vaccine has produced antibodies. Whilst we cannot be sure that if you have antibodies you cannot catch COVID19, the presence of antibodies after a vaccine would confirm that your body has reacted to the vaccine.

It seems therefore sensible to ask your doctor if it would be appropriate to check this level a few weeks after even the first dose so you know if there is at least some benefit. But even if you have antibodies the advice is going to remain that until we have a lower background rate we should still continue to take steps to protect ourselves, however. It is also important to ensure you use a test which l looks for antibodies to the spike protein. 

Are there any alternatives to vaccination?

The short answer to this is no. Although if you have blood cancer and are worried about that you may not respond to the vaccine, an alternative method to hopefully provide immunity is in clinical trials at the moment. This is a monoclonal antibody cocktail, and is accepting volunteers at sites across the USA and UK right now. When I completed the online enquiry form I received a phone call the next working day and was offered an injection slot a few days later and this will probably happen on the 8th January for me. I will still be able to take a vaccine later on if my doctors believe it will help me.

There are lots more questions to be answered please feel free to submit questions in the comments section or by email and I will aim to cover as many as possible in the coming days.