From the rapid vaccine development to heart risks and delaying immunization, we spoke with an infectious disease expert on common worries people have about getting the COVID-19 vaccine.
Patients with cancer – and their household members and loved ones – should get the COVID-19 vaccine as soon as it’s available and their health team determines that they are eligible, according to Dr. Brahm Segal.
Segal is the chair of internal medicine and chief of infectious diseases at the Roswell Park Comprehensive Cancer Center. He said that while he knows people may feel apprehensive about the vaccine, the benefits far outweigh the minimal risks.
“If you haven’t been vaccinated yet and you have cancer, you certainly should be [vaccinated],” Segal said in an interview with CURE®.
His advice aligns with the National Comprehensive Cancer Network’s latest recommendations.
Segal explained that researchers already knew a lot about SARS coronaviruses, the type of virus that causes COVID-19, because there was a SARS outbreak nearly 20 years ago. Experts already had an understanding on what kind of proteins coronaviruses make and how they attach to cell surfaces.
“At the very onset of the outbreak, with the virus sequence that was available in public databases, we knew quite a bit of what we were dealing with from the get-go,” Segal said.
He mentioned that when the COVID-19 outbreak started, people were already exploring mRNA vaccine technology for various other uses – including the treatment of cancer. According to Segal, researchers just had to apply the mRNA vaccine mechanism to cover the spike protein of COVID-19, which is the protein that the virus attaches to in cells, leading to infection.
One of the vaccines – the Johnson & Johnson shot – is not mRNA-based, but DNA-based. Still, the same principles apply.
“What we’re trying to do with these vaccines is to have the person develop antibodies against the spike protein that the virus makes to attach to cells, and in that way, try to avoid infection from happening,” Segal said.
The COVID-19 vaccines were developed and granted Emergency Use Authorization (EUA) by the Food and Drug Administration quicker than drugs usually are – a timeline that typically takes years. The EUA was based on large clinical trials that proved the vaccines worked in preventing infection or severe COVID-19.
Early-phase trials started by testing out the safety and immunogenicity, and then expanded to major, randomized trials.
“So even though it was accomplished quickly, there was a huge amount of research that went into it,” Segal said. “All the safeguards were in place – it’s just that you had sites from all over the world that were enrolling people, and enrollment proceeded pretty rapidly.”
News headlines lately have been highlighting the potential for cardiac side effects – such as myocarditis, which is inflammation of part of the heart – from the COVID-19 vaccines. However, when it comes to whether or not people get the shots based on that, Segal said, “I don’t think it’s a close call at all.”
Since cancer drugs can also cause heart complications, patients with cancer may be especially weary of the vaccine, but Segal said that the risk of cardiotoxicity as a result of the vaccine is extremely low, and there is also a risk for heart complications for patients who contract COVID-19.
“So far, there’s no obvious safety concern for patients with cancer that would argue that the vaccine is less safe among them compared to the general public,” he said.
Segal said that there are rare exceptions of when people should delay getting their COVID-19 vaccine. He said that the vast majority of patients with cancer should get immunized, and if they are unsure, he urges them to speak with their oncologist and health care team.
However, patients undergoing cellular therapy or stem cell transplants – or who are in the immediate- or early-transplant period – should wait to get the vaccine, Segal said, explaining that it is “extremely unlikely that there’ll be any lasting response.”
“But the vast majority of patients with cancer should get immunized – there’s no reason to wait,” Segal said.
Household members and loved ones should not wait, either.
“Family members, household members, people they work with and their friends should all be immunized, because in patients with cancer, some of the cancers and some of the therapies for cancer can disable the vaccine from being fully effective,” Segal said. “So even though they’re vaccinated, they may not get the same protection that people with normal immune systems have. So, the way to address that is for patients to be immunized, but also for the people around them as much as possible to be vaccinated, too.”
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