Experts recommend new bivalent booster for cancer patients
An expert panel from the National Comprehensive Cancer Network (NCCN) recommends the new bivalent booster, which also protects against the Omicron variant, for cancer patients.
Roswell Park patients should speak to their treating physician about whether they will benefit from an additional booster.
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COVID-19 vaccines FAQs
For cancer patients
YES. All people with cancer should be fully vaccinated against COVID-19.
The National Comprehensive Cancer Network (NCCN) guidelines, co-authored by Brahm Segal, MD, recommends that people with cancer get all their COVID-19 shots, including 3 primary doses of an mRNA vaccine (Pfizer/BioNTech or Moderna) and any recommended boosters, for a total of at least 4 shots.
Those living in the same household as a person with cancer should get fully vaccinated and boosted as soon as they can, too. Any caregiver or other close contact of a person with cancer also should get all their vaccines and boosters.
The NCCN notes that specific patients should wait to be vaccinated. People in the process of receiving the following therapies should wait at least 3 months after they finish therapy to get vaccinated:
- Stem cell transplant, either allogeneic or autologous stem cell transplant. People getting a stem cell transplant should delay vaccination.
- Cellular therapy, such as CAR T-cell therapy or NK cell therapy. People who receive cellular therapy have a much less effective immune system for weeks or even months after this therapy.
People with cancer who undergo major surgery should also wait a few days to up to 2 weeks to get vaccinated.
Roswell Park can provide all necessary vaccine doses to our patients who prefer to be vaccinated at Roswell Park. Please reach out to your care team to inquire about scheduling. Commercial pharmacies throughout our region also have vaccines available, and you can schedule an appointment online or by phone.
The most important thing is that you receive all recommended doses of the vaccine for maximum and sustained protection from COVID-19 — do not wait for an appointment at Roswell Park if you have an earlier opportunity to get the vaccine.
Additional resources for scheduling a third COVID-19 vaccine dose:
- Erie County, NY, Department of Public Health vaccination sites
- New York State-run vaccination sites
The authorized COVID-19 vaccines have been shown to be safe for cancer patients, including those in active treatment for cancer. Vaccines are safe for those undergoing immunotherapy and vaccine status should not impact participation in clinical trials. No white cell counts or other testing are needed to determine your eligibility for the third dose or booster.
It is not yet clear whether home-based vaccination will become available. We will answer this question as soon as we have an answer.
The vaccine is free, but an administration cost may be charged, and it is to be covered by insurance.
If you received a blood or marrow transplant or cellular therapy (TCT) recently, you should wait at least 3 months after finishing therapy to get vaccinated.
Your Roswell Park physician or Advanced Practice Professional (APP) will determine your eligibility and recommend the most appropriate timing for vaccination.
If you’re immunocompromised and prefer to get your fourth dose (i.e., the booster that follows your three-part vaccination series) at a commercial pharmacy, you are encouraged to let the pharmacy know in advance of your immunocompromised status. Although state and federal officials have directed that no prescriptions, authorization letters or antibody testing are required to qualify for an additional dose, you will likely be asked to attest to the fact that you are eligible and may need to present your insurance card. Some pharmacies are not yet fully updated on the latest CDC recommendation that immunocompromised patients require 4 doses in total to be considered “boosted.”
IMPORTANT: Wherever you are vaccinated, you will need to present your COVID-19 Vaccination Record Card/Excelsior Pass.
While the terms are sometimes used interchangeably, they are intended for distinct recipients and purposes.
Third or additional COVID-19 vaccine doses for immunocompromised individuals are given to vaccinated people whose immune systems are severely weakened by particular health conditions or medical treatment, to help them develop immunity to COVID-19.
Boosters are given to extend protection against COVID-19 in vaccinated individuals. A booster shot is needed because the effectiveness of the initial dose(s) diminishes over time.
Where possible, we advise that you get the same vaccine for your third dose that you had for your first two doses. But if your first vaccine type (Moderna or Pfizer) is not available, it is safe for you to get the other vaccine.
For patients who initially received the Johnson & Johnson/Janssen vaccine, an mRNA booster is recommended 8 weeks after the initial vaccine administration due to the risk of developing thrombocytopenia and thrombosis syndrome (TTS). In most situations, Pfizer-BioNTech or Moderna COVID-19 vaccines are preferred for cancer patients over the Johnson & Johnson/Janssen COVID-19 vaccine for primary and booster vaccination due to risk of this potential serious adverse effect.
Immunosuppressed people who have previously received a three-dose primary series and boosting through prior recommendations are now eligible to receive one of the bivalent boosters if they are 12 years old or older for Pfizer, or at least 18-years-old for Moderna. This has been shown to improve immune response against Omicron strains in people with full immune system capacity. The committee supports this recent approval but cautions they are still awaiting data on bivalent booster effectiveness in immunocompromised people.
Vaccine science & safety
Thousands of people were vaccinated in the phase 1, 2 and 3 studies of the COVID-19 vaccines, and so far, data from those studies indicate that the vaccines are safe. The Food & Drug Administration (FDA) conducts stringent reviews of the vaccines by some of the brightest, most accomplished scientists and health professionals. We can be confident that any vaccine authorized by the FDA is safe and effective.
In addition, a separate COVID-19 Clinical Advisory Task Force has been created in New York State to independently evaluate the safety and effectiveness of the vaccines. Their recommendation will be considered before any vaccine is made available in New York State.
No, you cannot get COVID from being vaccinated.
The vaccines are not live viruses. They are all either just one or two molecules out of the entire virus or they are a piece of the virus — one or two genes that have been put into another virus that just causes the common cold and that has been inactivated.
No. The COVID-19 vaccines are not live-virus vaccines and cannot affect your DNA.
The side effects recorded during the COVID-19 clinical trials look very much like those associated with other vaccines, such as vaccines for the flu, measles and mumps. It is normal to experience some arm soreness, and some people will experience mild side effects that are a sign that the immune system is working, such as low-grade fever, fatigue, muscle aches or headache.
All vaccines — from the COVID-19 vaccine to the childhood vaccines you received as a kid — have very rare side effects that happen to between one in 100,000 to one in a million patients. Less than 2% of the people who took part in the clinical trials experienced severe side effects, and none were out of the ordinary. There were no autoimmune side effects, for example.
The phase 3 clinical trials included people with high blood pressure, diabetes, emphysema, cardiovascular disease, HIV and other conditions, and in those people the vaccine was shown to be safe and effective. While the data are still being analyzed, there were no clear differences in safety or efficacy for those people.
Here is the FDA's fact sheet about the Pfizer vaccine, Moderna vaccine and the J&J vaccine. Both include a complete list of ingredients. Mercury and aluminum are not on the lists.
Both are about 95% effective. What does that mean? In the clinical trials, half the patients were given the vaccine and the other half received a placebo (which doesn’t do anything). It is unethical to deliberately expose people to the coronavirus, so researchers just followed up to see which people later became infected.
In the Pfizer/BioNTech trial, of the 43,448 participants (who were 16 years and older), 21,720 received the vaccine and 21,728 received a placebo.
Twenty-eight days after the first dose was given, 170 cases of COVID-19 were observed among those who participated. Of those 170 COVID-19 cases, 162 — or 95% — were observed in the placebo group, versus 8 cases in the vaccination group.
In terms of protection from any kind of infection, the straightforward numbers would suggest that the J&J vaccine is less effective when we look at all COVID infections. Both the Pfizer and the Moderna vaccines led to protection of greater than 90%, in the 95% range. With the J&J vaccine, it's closer to 70%.
But the more important thing in terms of public health and personal health is that the J&J vaccine was extremely effective, as effective as Pfizer and Moderna, in terms of preventing hospitalizations and there were no deaths in vaccine recipients who developed COVID.
It usually takes from two to three years to develop a vaccine. The COVID-19 vaccines were developed in six months.
The Pfizer and Moderna vaccines were developed quickly because they used brand-new mRNA technology, which uses instructions for building proteins that can be used to prevent or treat a disease. The same technology was used to develop at least one of the vaccines for the Ebola virus.
The traditional way of making a vaccine was to inoculate chicken eggs with a virus, grow the virus, purify the virus, inactivate the virus, and then make a vaccine out of it. That process is extraordinarily complicated, and that’s why vaccine development took as long as it did.
If the situation weren’t as urgent as it is, the companies who have developed vaccines probably would have taken the standard route. But the advantage of this technology is that it’s incredibly fast — faster by magnitudes than any previous technology we used for developing vaccines.
With Johnson & Johnson, it's a little bit different. It’s not an RNA-based vaccine, but it’s based on virus DNA. The DNA is packaged in an unrelated virus that poses no risk to us, but it's basically housed in this other virus called adenovirus. The DNA that encodes for the spike protein has been engineered, so it's inside the adenovirus. With this vaccine, we don't need to worry about the adenovirus creating infection because it's engineered to not create a problem, but it enables delivery of the spike DNA. And then from the DNA, we go to RNA, from RNA we go to protein and the end result is you're making spike protein.
The regulatory scientists at the Food & Drug Administration are some of the finest scientists and professionals around. They’ve been doing this a very long time. Their interest is in the health of our citizens. Their review of the safety and efficacy of the vaccines is going to be as high-quality as we can possibly get in these rapidly changing times.
The Food and Drug Administration on August 23, 2021, granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, making it the first to move beyond emergency use status in the United States.
Our physician leaders at Roswell Park have reviewed 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. In addition, as a member of the National Comprehensive Cancer Network (NCCN) — an alliance of 30 of the nation's top cancer centers — Roswell Park is following the recommendations of the NCCN COVID-19 Vaccination Advisory Committee for vaccinating cancer patients. These guidelines are based on the latest medical and scientific evidence.
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 vaccinated people 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.
New York State has put out a guide about what to know regarding the COVID-19 vaccines:
- Protect Yourself, Your Family, and Your Baby: Get the COVID-19 Vaccine (English)
- Korean/한국어 번역,
- Russian/русский язык
- Bengali/বাংলা অনুবাদ,
- Haitian Creole/Kreyòl Ayisyen
COVID-19 has hit the Black and Hispanic/Latinx communities especially hard. Americans who identify as Black or Hispanic/Latinx represent 33% of all COVID-19 illnesses and 28% of all deaths from COVID-19.
Although the coronavirus vaccines offer protection from COVID-19, their release has raised many questions, especially for individuals from communities of color. Our COVID-19 Vaccine and Communities of Color fact sheet has the answers you need.
Yes. All vaccine sites are prepared to deal with anaphylactic responses, and the CDC advises sites to monitor people for 15 minutes after vaccination, which is when an allergic reaction is most likely to occur.
Again, if you believe you are eligible to receive the vaccine at this time and have not yet been scheduled for vaccination at Roswell Park, you are encouraged to schedule an appointment at a community vaccination site outside of Roswell Park if you have the opportunity to do so.
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.
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.
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 is a member of the National Comprehensive Cancer Network — an alliance of 30 of the nation's top cancer centers — and we are following recommendations of the NCCN COVID-19 Vaccination Advisory Committee for vaccinating cancer patients.
Efficacy and administration
Yes. A booster can prolong your immunity to the virus after your primary vaccination series. For cancer patients, the NCCN recommends 3 primary doses and plus any recommended boosters, for a total of at least 4 shots, as soon as possible. The bivalent booster prevents infection form both the original SARS-CoV-2 virus and the Omicron variant and in recommended for cancer patients.
You will be scheduled for your booster shot at the time of your first shot. It is important that you receive this second dose for maximum protection. There is no evidence to show that protection from the first dose will last if you do not get the second dose.
More information about the second dose
The second dose of the Pfizer vaccine is given 21 days (three weeks) after the first dose. The second dose of the Moderna vaccine is given 28 days (four weeks) after the first dose. You should receive the second dose of vaccine as close to the recommended date as possible. The Johnson & Johnson vaccine is only one dose.
- It is permissible to receive the second dose up to four days earlier than the recommended date.
- If you are unable to receive the second dose by the recommended date (you're late in getting it), you should still get it. You do not need to start over again with another first dose.
Note that COVID-19 vaccine products are not interchangeable. Your second dose must be the same vaccine product. If for some reason you receive a different vaccine for the second dose, you do not need to get another second dose of the original vaccine.
Yes, in some cases. NCCN experts suggest that people with cancer receive vaccinations and boosters from either Pfizer or Moderna. These two are preferred in people with weakened immune systems.
Adults with weakened immune systems who had the J&J vaccine as their primary vaccination, should also get one Pfizer or Moderna vaccine dose and then one bivalent booster.
Moderna is the preferred mRNA vaccine for pediatric immunosuppressed patients age 6 months to 17 years.
The vaccines produce 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.
Yes. The vaccines are not 100% effective, and in the first clinical studies, 5% of people who got vaccinated later became infected with COVID-19. If you do get infected and have symptoms, you can spread COVID-19 to others.
Also, in the clinical trials, only the people who developed symptoms of COVID-19 were tested for the virus. We know that some people — especially younger people — can be infected with the virus but don’t develop any symptoms — the so-called “asymptomatic infections.” We do not yet know if the vaccines protect people from asymptomatic infections, which is important because asymptomatic patients can still spread the virus to others.
The guidance below is provided by the CDC. More information can be found here.
Data from clinical trials indicate that the COVID-19 vaccines can safely be given to people who show evidence of having previously been infected with COVID-19. Vaccination should be offered whether you had symptomatic or asymptomatic infection (with or without symptoms). COVID-19 testing to determine whether you are infected now or were infected in the past is not recommended as part of the process for deciding whether or not you should be vaccinated.
If you are currently infected with COVID-19, you should not get vaccinated until you have recovered and have met the criteria for discontinuing isolation. This recommendation applies to people who develop COVID-19 infection before receiving any vaccine doses as well as those who become infected after the first dose but before receiving the second dose.
Masking is now optional in most areas of Roswell Park, including the lobbies, cafeteria, elevators and most waiting and reception areas. Masks continue to be required in the following healthcare spaces:
- Operating Room, Ambulatory Surgery Center, Post-anesthesia Care Unit; masks are optional in the common waiting areas outside these units
- Assessment and Treatment Center (ATC)
- Chemo/Infusion clinic
- All hematology oncology clinics – leukemia, lymphoma, myeloma, TCT Clinic
- Inpatient units
Masks will remain available for those who choose to wear them in the mask-optional spaces. In areas where masks are no longer required, patients and visitors may request staff to wear one. Your decision to wear a mask will be respected.
For more information about the COVID vaccines, please visit:
Nobody is claiming that the vaccines are 100% effective. In some of the people who have tested positive after being vaccinated, they may have developed COVID during an early window period, like after the first shot but before the second. They may have already had asymptomatic COVID at the time that they got the first vaccine or the second. Recall, the incubation period can be as long as two weeks. Then there are people who simply got COVID. They got the full vaccine, proper period elapsed, and they got COVID.
There's no question that you're going to reduce the likelihood of getting COVID, and even more important, you will dramatically reduce the likelihood of severe COVID that will lead to hospitalization and death. Just because a vaccine is not 100% effective, it's not an all-or-none situation. It may be partially effective, it may be that you get COVID but not as severe as you otherwise would have had it had you not been immunized.
The expectation is that the vaccines are effective against the variants, but there's variability and geographic diversity in the variants. The virus can rapidly mutate and there can be a shift in the prevalence between garden variety SARS coronavirus-2 and the variants. There are some data that some of the variants may actually be more aggressive than the original virus. For what we know right now, the vaccine should be effective against variants, but that is not a sure thing and things can change.
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. Vaccine hesitancy in the general population impedes the development of herd immunity, which leaves people with cancer at higher risk. Reducing community spread will help people with cancer who are at higher risk of COVID-19 complications and may have less protection from available vaccines. After vaccination, patients continue to wear masks, maintain social distancing, avoid crowds and follow other non-pharmacologic recommendations for COVID-19 prevention.