You asked, we answer: Here's what you want to know about the COVID-19 vaccines

Recently we sent our patients a survey asking whether they had any questions about the COVID-19 vaccines produced by Pfizer and Moderna. Both vaccines have now been granted Emergency Authorization Use by the FDA.

More than 5,000 people responded to the survey. Here are answers to many of your questions, courtesy of Kelvin Lee, MD, Former Chair of Immunology and Senior Vice President of Basic Science, and Shirley Johnson, MBA, MS, RN, NEA-BC, Senior Vice President and Chief Clinical Operations Officer.

Stay tuned, because we’ll publish answers to more questions in future Cancer Talk articles. You’ll find answers to previous questions here.

ELIGIBILITY / PRIORITY

Q: Am I eligible for the vaccine?

A: Because the vaccines were not studied in cancer patients specifically, Roswell Park physicians have developed eligibility guidelines based on all available scientific and medical knowledge. They are using those guidelines, along with the New York State Department of Health guidelines, to recommend which patients should receive the vaccine based on their unique characteristics and the treatments they are receiving.

Your type of cancer, the kind of treatment you received or are receiving, or an immune-compromised condition will not automatically exclude you from receiving the vaccine.

If you have significant thrombocytopenia — not enough platelets (<50) — and are unable to receive an intramuscular injection or need to have a platelet transfusion before immunization, you should contact your Roswell Park physician or Advanced Practice Professional (APP) for approval before being immunized.

If you received a blood or marrow transplant or cellular therapy, see the question below for further information.

If and when you become eligible for vaccination at Roswell Park, you will be notified through the My Roswell patient portal, email, phone call, or text to your mobile phone and asked to schedule your appointment. You must respond immediately to let us know whether you want to receive the vaccine or if you want to decline it. We need to know your decision either way.

Q: What if I received a blood or marrow transplant or cellular therapy?

A: At this time, patients who received a transplant or cellular therapy will be offered the vaccine by the Transplant & Cellular Therapy Center based on when the transplant occurred or when the cellular therapy was given. You should contact your Roswell Park physician or Advanced Practice Professional (APP) before being immunized.

Q: When will I be able to get the vaccine?

Due to the large number of Roswell Park patients who are currently receiving treatment and the limited supply of vaccine worldwide, we must focus on patients who are most at risk. It is our goal to ensure that all our current patients receive both doses of vaccine over the next few months.

During the week of January 11, 2021, we will begin vaccinating patients 75 years and older who are on active therapy or who completed therapy (surgery, radiation or systemic therapy — for example, chemotherapy) within the past 12 months.

See important information in the question above concerning patients who received a blood or marrow transplant or cellular therapy.

This information will be updated on a regular basis.

If and when you become eligible for vaccination at Roswell Park, you will be notified through the My Roswell patient portal, email, phone call, or text to your mobile phone and asked to schedule your appointment. You must respond immediately to let us know whether you want to receive the vaccine or if you want to decline it. We need to know your decision either way.

Again, please do not contact your doctor at this time to schedule a vaccine appointment.

Q: Will patients who have cancer and other health conditions be prioritized over those who have just cancer?

A: Other health conditions are being factored into the prioritization list, as well as consideration of such factors such as age, whether a patient is on active chemotherapy treatment, the kind of cancer the patient has, etc.

Q: Can my family members also get the vaccine at Roswell Park? What if I’m the caregiver for a Roswell Park patient?

A: No. We do not expect to offer the vaccine to the general public.

SAFETY

Q: I’m concerned that the clinical trials did not include any cancer patients. Should l worry about getting the vaccine?

A: Our physician leaders at Roswell Park are reviewing every aspect of safety to determine which patients would benefit from the vaccine, which patients probably should not receive the vaccine at this time, and when it should be given to those who do get it. We expect to have those guidelines in place within a few weeks.

Q: What if I have to carry an EpiPen due to previous anaphylactic shock caused by shellfish or an allergy to wasp or bee stings? What if I am allergic to penicillin or other drugs? What if I have had an allergic reaction to flu shots?

A: Results of the clinical trials indicate that there were no significant side effects for people with general allergies.

Two people in the United Kingdom and two in Alaska did experience anaphylaxis, a serious allergic reaction, within 10 minutes of receiving the vaccine. One of the two in Alaska had no history of allergies. Both people in the U.K. had histories of allergic reactions and carried adrenaline auto-injectors as a result.

The Pfizer vaccine clinical trials enrolled 43,448 participants. Half received the vaccine and the other half received a placebo (which does nothing) in order to compare safety and effectiveness between the two groups. Data show that a few people in both groups experienced what were assumed to be allergic reactions, although the difference between the two groups was slight (.63% vs. .51%).

The phase 3 trial for the Moderna vaccine also had no instances of anaphylactic reactions in the 15,208 subjects who received the vaccine. There has been one incident with the Moderna vaccine being administered under the Emergency Use Authorization.

These anaphylactic reactions have been rare, and have been well managed using the same medical approaches used for other hypersensitivity reactions (for example, peanut allergies, etc.). The current recommendations from the CDC are that unless you are specifically allergic to an actual ingredient in the vaccine itself, you should get vaccinated.

Q: Will the vaccine be given in a location where I can get assistance if I develop a severe reaction?

A: Yes. You will receive the vaccine in the Research Studies Center at Roswell Park, an administrative building separate from our patient clinics — and certainly we are prepared to respond to an allergic reaction — or you may go to a local pharmacy that has been approved for vaccine distribution.

All vaccine sites are prepared to deal with anaphylactic responses. At Roswell Park, we are monitoring people for 15 minutes after vaccination, which is when an allergic reaction is most likely to occur.

Q: What ingredients are in the vaccines? Do they contain mercury or aluminum?

A: Here is the FDA's fact sheet about the Pfizer vaccine, and here's the one for the Moderna vaccine. Both include a complete list of ingredients. Mercury and aluminum are not on the lists.

Q: How concerned should I be about the side effects if I have diabetes, heart disease or other medical conditions? What if I have a history of blood clots?

A: Clinical trials leading up to the FDA’s Emergency Use Authorization of the Pfizer vaccine involved tens of thousands of people, half receiving the vaccine and half receiving a placebo (which does nothing). Significant side effects were very, very rare, and when they did occur, there was no clear evidence that they were caused by the vaccine. Most side effects occurred on the first day and included pain at the injection site, fatigue, headache, muscle aches and some joint pain.

The clinical trials included people who were HIV-positive or who had diabetes, heart disease, liver disease, chronic lung disease, obesity or hypertension (high blood pressure).

With the Moderna vaccine, the side effects were a little more frequent but not more severe.

Q: I saw a news report stating that the vaccine has not been tested on immunocompromised patients. What about bone marrow transplant patients and those receiving CAR T-cell therapy? Can I take the vaccine if I’m currently taking a biologic drug?

A: Please see the question above for specific information about patients who have received a transplant or cellular therapy.

Being immunocompromised will not automatically exclude you from being eligible for the vaccine. Both vaccines were tested in patients with HIV, which is associated with an immunocompromised state. Although the results in those patients were not available when the Emergency Use Authorization was granted, no serious safety concerns were noted.

Neither vaccine was tested in cancer patients in the clinical trials. However, Roswell Park’s experts have developed eligibility guidelines based on the latest available medical and scientific evidence.

Q: Is the vaccine safe for pregnant women? If I get the vaccine, will it be safe for my pregnant daughter to be around me?

The clinical trials excluded pregnant women, although some women became pregnant during the trials, and no adverse effects have been reported.

The American College of Obstetrics & Gynecology (ACOG) advises that women who are pregnant or breastfeeding should not be prevented from receiving the vaccine. ACOG also notes that pregnant women are at higher risk for becoming seriously ill if they become infected with COVID-19, and that “Black and Hispanic individuals who are pregnant appear to have disproportionately higher prevalence of COVID-19 infection and death.”

There should be no concern about being around pregnant women, infants or small children. The vaccine is not a live-virus vaccine; it is not infectious and cannot spread to others.

Q: Will the vaccine change my DNA?

A: No. The COVID-19 vaccines are not live-virus vaccines and cannot affect your DNA.

 

VACCINE AVAILABILITY

Q: When will the vaccine be available? Will Roswell Park get it before doctors’ offices and pharmacies?

A: On January 11, 2021, we began vaccinating patients 75 years and older who are in active treatment or who completed therapy (surgery, radiation or systemic therapy — for example, chemotherapy) within the past 12 months. This information will be updated on a regular basis.

Q: Will Roswell contact me when it’s available?

A: If and when you become eligible for vaccination at Roswell Park, you will be notified through the My Roswell patient portal, email, phone call, or text to your mobile phone and asked to schedule your appointment. You must respond immediately to let us know whether you want to receive the vaccine or if you want to decline it. We need to know your decision either way.

Again, please do not contact your doctor at this time to schedule a vaccine appointment.

Q: If I'm out of town when the vaccine becomes available for Roswell Park patients, will I miss out?

A: No. We anticipate receiving an ongoing supply of vaccine that will allow for vaccination in the future.

WHERE

Q: If transportation is a problem for me, can a visiting nurse come to my home to vaccinate me?

A: It is not yet clear whether home-based vaccination will become available. We will answer this question as soon as we have an answer.

COST

Q: Is the vaccine free or covered by insurance? If not, how much will it cost?

A: The vaccine is free, but an administration cost may be charged, and it is to be covered by insurance.

HOW THE VACCINE WORKS

Q: Do both vaccines require two doses? How far apart will they be? When I receive the first dose, will I be told when and where to get the second dose?

A: The Pfizer vaccine requires two doses, given three weeks apart. The Moderna vaccine also requires two doses, given four weeks apart.

At the time of your first dose, you will be advised when to return for the second dose, which will be given at the same location.

Q: Will we need to get the vaccine just once, or annually, like a flu shot?

A: Both the Pfizer vaccine and the Moderna vaccine require two initial shots for a person to develop immunity.

Right now we don’t know how long that immunity will last. We may need a shot once a year, twice a year or never again. We’ll find out as time goes on.

Q: Will I be protected after the first dose?

A: The vaccine produces a rising level of protection. You will get some protection from the first vaccination and more after the second shot. While we don’t know for certain, it looks as if it takes the immune system from two to four weeks to achieve the greatest level of protection.

Q: Will the vaccine fully prevent COVID-19 or just lessen the severity if I do get it?

A: The phase 3 clinical trials for both the Pfizer and Moderna vaccines were designed only to look at whether the vaccines prevented COVID-19 disease that was symptomatic (causing symptoms). Both vaccines very clearly reduced the chance of getting severe disease.

However, there is no data yet on whether the vaccines can prevent COVID-19 infection that has no or minimal symptoms, such as is often seen in young people. Therefore, it is possible that a vaccinated patient could still be infected with the virus — but without symptoms — and spread it to others.

So even if you get vaccinated, you still need to wear a mask, wash your hands and practice social distancing.

Q: How long will immunity last, or how long will it be until we have that information?

A: We don’t know right now.

Q: We’ve heard about the new type of COVID-19 breaking out in Europe. Will the vaccine protect against any new strains of the coronavirus?

A: This is still being studied for the new virus variant that was initially detected in the United Kingdom. We also don’t know whether new virus variants will evolve in response to the vaccine itself, which is being closely monitored.

LOOKING AHEAD

Q: Will there be enough vaccine?

A: Eventually, yes. Because these first vaccines are being offered under an Emergency Use Authorization by the FDA, at first they will be recommended for those at highest risk of getting infected with COVID-19 or from experiencing the most severe illness from COVID-19.

Q: What percentage of people will have to be vaccinated to reduce or eliminate spread of the disease?

A: According to the Centers for Disease Control and Prevention (CDC), “Experts do not know what percentage of people would need to get vaccinated to achieve herd immunity to COVID-19. Herd immunity is a term used to describe when enough people have protection — either from previous infection or vaccination — that it is unlikely a virus or bacteria can spread and cause disease.”

Q: How long will it be until everyone is vaccinated?

A: This will depend primarily on vaccine manufacture and distribution, which may be impacted by the current worsening of the pandemic itself, through disruption of supply chains and essential workforces. It is likely that full vaccination in the U.S. will not occur any sooner than summer 2021 – and possibly significantly later than that.

Q: Can I stop wearing a mask after I’m vaccinated?

A: No, not yet. You should continue to wear a mask, wash hands thoroughly and often, avoid group gatherings and maintain social distance until the pandemic is under control.