COVID-19 Vaccines and Cancer: A Conversation with Cancer Expert Otis Brawley, MD
The National Coalition for Cancer Survivorship (NCCS) hosted a conversation on February 23 about COVID-19 vaccines with cancer control expert and Bloomberg Distinguished Professor at Johns Hopkins University, Otis Brawley, MD.
Two COVID-19 vaccines have been approved, with more vaccine candidates on the horizon. What do the vaccines mean for people with a history of cancer? NCCS CEO Shelley Fuld Nasso sat down with Dr. Brawley to ask questions from survivors and advocates, and to learn what we know about the COVID-19 vaccines.
Most importantly, Dr. Brawley said those with a history of cancer should get the first vaccine they can:
We don’t yet have data to show that any vaccine is biologically better for cancer patients versus another… My advice is get the vaccine that you can get. I would advise if you get Moderna as a first shot, try to get Moderna as your second shot. If you get Pfizer’s as a first shot, try to get Pfizer’s second shot. However, the CDC has said, if you’re in a pinch and you’ve got Moderna and there’s no Moderna available for the second shot, it’s okay to get the Pfizer or vice versa, but all of us would prefer people stick with the same vaccine.
Dr. Brawley cautioned, however, that everyone should talk to their doctor: “Every person’s going to have to talk to their doctor about their specific circumstance. There are some instances where there’s some people who are under therapy and they should not get the vaccine right now.”
We’ve highlighted some of the most important parts of the conversation below. Or watch the full video at the bottom of the post.
- Should cancer patients take whichever vaccine they are offered, or are any of the vaccines better?
- What is it that makes cancer patients at higher risk for COVID-19?
- What do you say to those hesitant to take the vaccine and concerned that they were approved so quickly?
- After being vaccinated, what is safe and what precautions still need to be taken?
- When you look at the data, do you see any encouraging trends about getting Black Americans vaccinated?
- When will the vaccine be available for kids? Should we prioritize childhood cancer survivors over other kids?
Watch the Full Conversation
Should cancer patients take whichever vaccine they are offered, or are any of the vaccines better for cancer patients?
At this juncture, we don’t have data to show that any vaccine is biologically better for cancer patients versus another. I personally think that the J and J vaccine, if approved, might be better because it’s only one shot. It’s not better biologically, it’s just easier to administer in a treatment regimen. But we don’t have evidence that one is better than the other. My advice is get the vaccine that you can get. I would advise if you get Moderna as a first shot, try to get Moderna as your second shot. If you get Pfizer’s as a first shot, try to get Pfizer’s second shot. However, the CDC has said, if you’re in a pinch and you’ve got Moderna and there’s no Moderna available for the second shot, it’s okay to get the Pfizer or vice versa, but all of us would prefer people stick with the same vaccine.
What is it that makes cancer patients at higher risk? Is it the cancer itself or is it treatments for cancer? And if it’s the treatments, which treatments make patients more vulnerable?
The people who are at risk for contracting the disease are people who have a lowered immune system. Now that lowered immune system can sometimes come about because of cancer treatment. Say people who have solid tumors, colorectal cancer, or breast cancer, their immune system is relatively intact. When we start giving them chemotherapy, their immune system is damaged. One of the side effects of treating the cancer. People have lymphoma and leukemia on the other hand, that’s a cancer of the immune system. Their immune system has a problem to begin with. So the approach to coronavirus should be different between the two. We have a lot of data to show that people who have leukemia, especially who get coronavirus are more likely to have bad outcomes. Most people do well, but they’re more likely to have bad outcomes compared to the people who have solid tumor disease. People who have solid tumor disease who are cured are at essentially the same risk as people who are of the same age and basic health. And the people who have treatment. Now, people who are getting treated with drugs that specifically target B cells that make immunoglobulin are at especially higher risk for Coronavirus. B cell treatments are common in leukemia and lymphoma.
What do you say to people who are hesitant to take the vaccine and concerned that they were approved so quickly?
Yeah, well, the education, I think is the most important part and folks who are hesitant to get the vaccine while I respect their hesitancy, I’ll tell them, everyone that I talked to who’s gotten the vaccine is of the belief that getting COVID is far worse. They haven’t talked to people who’ve gotten COVID. Getting COVID is far worse than getting the vaccine. Now that being said, there’s a lot of people say, how is it that this vaccine was the virus was discovered last December of 2019, we had a vaccine candidate by May of 2020, and now we’re giving it, you said 19 million people have gotten both vaccinations complete? Well, let me explain. It didn’t take six months to develop that vaccine. It took 50 years. Those of us who work in the world of cancer and oncology should be able to understand much of the science that went into developing the vaccine and understanding this disease were things that were developed in the war on cancer.
And it’s very much related to Richard Nixon signing the National Cancer Act in 1971. You know, the fact that we had a problem and, a problem in China, within 45 days and realizing that problem in China, they published for the world on the internet, the RNA sequence. The fact that we use these messenger RNA viruses, those were developed 20 years ago in cancer work. Some of the drugs, the recombinant DNA, the Remdesivir, I’m sorry, recombinant antibodies, the remdesivir to block replication. These were all things that were all developed out of cancer work. And so one could really say it took a long time to develop the vaccine. A lot of the work was done well before we actually knew there was a virus out there. And I’ve looked at the studies, the studies have been done very, very well. There’s an argument that the Moderna and Pfizer vaccines have been researched better than most that are FDA approved.
After being vaccinated, what is safe and what precautions still need to be taken?
I believe that people who are aware and the CDC currently recommends that people who have been vaccinated still wear masks, social distancing, and hand washing. Keep in mind. The vaccine is not 100, never was 100% effective. And with the British and South African variants now in the United States, it’s probably less than 95% effective for Moderna and for Pfizer. So I recommend that people who had been vaccinated first feel a little bit more relief, but don’t let your guard down. And there are some people who said, if you’re in a group of folks who all have been vaccinated, you can let your guard down a little bit more. I’m a little worried about that because early in this conversation, I admitted to you. There’s some people who get vaccinated and the vaccine just doesn’t take. Doesn’t work for them, especially I worry, especially about people that have B cell disorders. And so I think that those of us who are vaccinated still should do the socially responsible thing, wear a mask, do as much social distancing as possible and wash your hands. Now seeing the grandkids from a distance, let’s do it from a distance.
We talked about disparities in outcomes and higher drop in life expectancy for Black Americans. When you look at the data, do you see any encouraging trends about getting Black Americans vaccinated?
The drop in life expectancy in Blacks and Hispanics is primarily because Blacks and Hispanics have high rates of COVID, and they have high rates of COVID because they disproportionately work jobs that don’t allow for social distancing. The data that I have, it varies around the country. I personally think that we shouldn’t worry too much about Black hesitancy to take the vaccine, that as more and more people take the vaccine and do well after taking the vaccine, Blacks and others who are hesitant to take the vaccine will start getting in line. They just don’t want to be first. And I totally understand their concerns. I totally understand their suspicions. I’ve been outspoken that we in medicine have worked long and hard to deserve some of those suspicions. But I, along with 49 other black members of the National Academy of Medicine, recently filmed an advertisement encouraging people to get vaccinated when their turn comes. So I’m very pro-vaccine, but I think we should be patient with the folks who are hesitant to get the vaccine. Most of them, I think will eventually come around to, “I want to get the vaccine.”
When will the vaccine be available for kids and is there a reason to prioritize childhood cancer survivors over other kids?
We are doing the bridging studies right now, bridging studies are when you do approve something, or prove something works in adults, you then start doing studies to figure out if they work in kids. We want to make sure that the vaccine is safe and effective in adults before we start looking to see if it’s safe and effective in children. My gut feeling, and this is an opinion, this is not based on any science fact, is that childhood cancer survivors in childhood should be prioritized ahead of other kids. However, one of the most common cancers in childhood are those leukemias and lymphomas that affect the immune system. So we need to be very cautious there. Now, childhood cancer survivors who are adults should definitely get this vaccine right now. That’s a group of people that is growing in size, by the way. And unfortunately the average childhood cancer survivor, who is in their twenties or thirties has five different comorbid diseases related to the treatment that cured them or the disease that they were cured. And so this is a population that has a lot of comorbid problems. They, in my mind, definitely should be prioritized early amongst adults to get this vaccine.