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Coronavirus (COVID-19) vaccine and cancer

There has been a lot of interest in the coronavirus vaccines, and it is understandable for you and your loved ones to have questions about it.

Specialists say that it is important for people with cancer to have the vaccine and it is safe. Your cancer treatment can also go ahead if you've had the vaccine. 

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that a booster programme begins in September 2021. This means that people most at risk of COVID-19 have an extra injection of the vaccine.

Four vaccines have been approved for use in the UK. They are made by:

  • Pfizer-BioNTech
  • AstraZeneca-Oxford
  • Moderna
  • Jansen (Johnson and Johnson)

The single-dose Johnson and Johnson vaccine will be available later in the year. 

What is a vaccine?

A vaccine is a type of medicine that trains the body's immune system Open a glossary item to fight a disease it has not come into contact with before. For infectious illnesses, vaccines try to prevent people from becoming ill with a disease, rather than treating it.

COVID-19 vaccines

The Medicines and Healthcare products Regulatory Agency (MHRA) approved 4 vaccines for use in the UK:

  • Pfizer-BioNTech
  • AstraZeneca-Oxford
  • Moderna
  • Johnson and Johnson
VaccineHow it worksDosesStorage
Pfizer-BioNTechThis vaccine is an mRNA vaccine and doesn't contain a live virus. mRNA vaccines work by carrying a 'genetic message' to your cells and instructing them to make antigens. This prepares the immune system to make antibodies to fight the virus.2 doses at least 8 weeks apart-70°C
AstraZeneca-OxfordThis vaccine is made from a harmless virus that usually causes the common cold in chimpanzees. It doesn't cause a cold in humans. Scientists have changed this virus to include the gene for the coronavirus spike protein. Injecting this vaccine prepares the immune system to attack the virus without exposing the body to the full virus.2 doses at least 8 weeks apart2 to 8°C
ModernaThis vaccine is also an mRNA vaccine.2 doses at least 8 weeks apart-20°C
Johnson and JohnsonThis vaccine is made from another virus called Adenovirus 26 that usually causes colds or flu-like symptoms. Scientists have changed this virus to include the gene for the coronavirus spike protein. Injecting this vaccine prepares the immune system to attack the virus without exposing the body to the full virus.a single dose2 to 8°C

Do I need a third vaccine?

The Joint Committee on Vaccination and Immunisation (JCVI) published new recommendations on the 1st September 2021. These recommendations are for anyone over the age of 12 years whose immune system was severely weakened when they had the first or second vaccine. The JCVI recommends these people should be offered a third vaccine.

For people who have cancer or have had cancer this includes those:

  • who had a blood cancer and were having treatment at the time they had their vaccines, or who had treatment to cure their cancer in the previous 12 months
  • people with blood cancer such as myeloma, chronic lymphoid leukaemia (CLL), low grade lymphoma
  • have had a stem cell transplant more than 2 years ago but continue to have a weakened immune system or have graft versus host disease (GVHD)
  • who were having chemotherapy or radiotherapy that weakened their immune system or had this treatment in the previous 6 months

Talk to your specialist if you are not sure whether you need to have a third vaccine, they will be able to advise you. This is separate from the booster vaccine programme. 

They say that you should have this third vaccine 8 or more weeks after your second one. Exactly how this will happen is still being planned. It is likely that you will receive a letter from your GP or local vaccine centre inviting you for the third vaccine. If you are having cancer treatment your specialist will advise about when is the best time to have this jab. They may arrange it for you or write to your GP recommending when is best. 

This is not a booster jab so you may still need a booster. This is in that same way the general population may need it after their first two doses. 

Booster vaccines

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that a booster programme begins in September 2021. This means that people most at risk of COVID-19 have an extra injection of the vaccine. This will help to continue protection against COVID-19 during the winter months.

The JCVI advises the booster jab because of concerns that immunity against the virus might become less over time.

The people most at risk include priority groups 1 to 9. These groups had their vaccine during the first phase of the vaccine programme last year.

JCVI has expanded the list. It also includes adult household contacts of immunosuppressed individuals.

The booster programme will happen in 2 stages and include the following groups:

Stage 1

  • adults aged 16 and over who are immunosuppressed
  • people living in residential care homes for older adults
  • all adults aged 70 and over
  • adults aged 16 and over who are clinically extremely vulnerable
  • frontline health and social care workers

Stage 2

As soon as practicable after stage 1, the following groups will be called:

  • all adults aged 50 and over
  • all adults 16 - 49 years with underlying health conditions that put them at higher risk of severe COVID-19
  • adult household contacts of immunosuppressed people

The JCVI advises that people most at risk have the booster injection no earlier than 6 months after the second jab of their last course.

People who had their vaccine during phase 1 of the vaccination programme would have received their second dose approximately 6 months ago. So, it would be appropriate for them to have their booster jab starting in September.

JCVI advises the Pfizer vaccine as the booster jab of choice. This is because research has shown that this vaccine works well as a booster jab.

Or, you may have a half dose of the Moderna vaccine. If you can’t have the Pfizer or Moderna vaccines due to allergies, you can have the Astra Zeneca vaccine if you had it before.

Speak to your GP or healthcare team if you have questions about your individual situation.

Vaccine side effects

Talk to your healthcare team or GP if you are worried about the side effects of the vaccines. They will be able to give you advice about your situation. It is best to do this before going for the vaccine.

The vaccinator at the vaccination centre will also talk to you about the general side effects of the COVID-19 vaccines.

How well do the vaccines work for people with cancer?

The original studies on the vaccines did not include people having systemic anti cancer therapy (SACT). But specialists agree that the vaccines are safe for most people having SACT (see questions further down on this page). Systemic anti cancer therapy includes treatments such as chemotherapy and can cause a weakened immune system.

A weakened immune system means it might not work as normal and so it can't protect the body against infections.

So, having the vaccines with a weakened immune system may cause the body to not have a full antibody response. As a result, it might not create enough antibodies Open a glossary item to give protection against the virus.

This means that people with a weakened immune system (clinically extremely vulnerable) who had the vaccine, should continue to follow advice on protecting themselves. This way they can reduce their risk of infection.

Severe allergic reaction (anaphylaxis)

People with a history of a severe allergic reaction (anaphylaxis) to a vaccine, medicine or food should not have these vaccines.

Swollen lymph nodes

A side effect of the Moderna and Pfizer-BioNTech vaccines is lymph node swelling. You might have swollen lymph nodes in the armpit of the arm that had the vaccine for up to 2 weeks. Talk to your doctor if it doesn't get better. 

Public Health England (PHE) study on how well the vaccines work

Earlier in July 2021, Public Health England (PHE) published results from a study on how well the COVID-19 vaccines work. The study says that the vaccines give the same protection to most people with underlying health problems as they do to the rest of the population.

The study included about 1 million people with underlying health problems. The study found that vaccines worked less well in people who had a weakened immune system. But they still gave protection to 74 out of every 100 people (74%). This level of protection is still high. This is when compared to about 85 out of every 100 people (85%) with normal immune systems.

For people with weakened immune systems, the level of protection increased a lot after the second dose. This was from 4 out of every 100 people (4%) after a single dose to 74 out of every 100 people (74%) after the second dose. It shows the importance of a second jab.

How well the vaccines work will differ between people. It will depend on your individual circumstances. The results from this study are encouraging.  But we need more research. It will help us to understand how well vaccines work for people with certain health conditions.

Pfizer-BioNTech vaccine results from the SOAP study

The SOAP study has been looking at COVID-19 in people with and without cancer. It has also been looking at how their immune systems deal with it.

Early (interim) results for the SOAP trial were published in January 2021. Those results showed that:

  • most people with a solid cancer will be able to fight COVID-19 in the same way as people without cancer. This is because they develop antibodies to COVID-19
  • people with certain types of blood cancer varied in how well they were able to respond to the virus. Many of these people took much longer to get rid of it

The SOAP study has also been looking at how having a COVID-19 vaccination affects the immune system. In particular, they were looking at people with cancer. It looked at people having the Pfizer-BioNTech vaccine.

The SOAP study involved 205 volunteers – 54 without cancer and 151 with cancer who were having treatment that causes a weakened immune system (95 with solid cancers, such as breast or lung cancer, and 56 with blood cancers). 

On 10th March 2021, the researchers released some further information. These results have not been peer reviewed. Peer review means that other experts look at the research. These experts are looking for any errors as well as any limitations in the research. This helps to make sure the conclusions from it are accurate.

The results showed that after 3 weeks of having the first dose, antibodies were found in:

  • 38 out of every 100 (38%) of people with solid cancers
  • 18 out of every 100 (18%) of people with blood cancers

This is compared to 94 out of every 100 (94%) of people without cancer. 

The study also showed that having the second dose of the vaccine 3 weeks after the first dose helps the vaccine work better. The number of people having antibodies 2 weeks later (5 weeks after the first dose) was 95 out of every 100 (95%) for people with solid cancers. Not enough people with blood cancer received a second dose to know if this improved their response.

In people who did not get a vaccine boost at 3 weeks, and who researchers tested after 5 weeks, antibodies were found in:

  • 30 out of every 100 (30%) of people with solid cancers
  • 11 out of every 100 (11%) of people with blood cancers
  • 86 out of every 100 (86%) of people without cancer

Understandably, the results of this study might worry you. And it is likely to raise a number of questions about the vaccine and what you should do.

At this stage, we don’t have any more information. We also don’t know what it means for the AstraZeneca-Oxford vaccine. You should still have the vaccine and follow the advice on how to protect yourself from the virus.

Talk to your healthcare team if you have any questions. They know your circumstances best.

OCTAVE study

The OCTAVE study has been looking at how the COVID-19 vaccines affect the immune system Open a glossary item of people with cancer and chronic illnesses.

Early results were published on 24th August 2021. The trial was for people with conditions that affect the immune system. This included only a small number of people who had cancer. They included people with:

  • solid cancers – either breast or lung cancer
  • blood cancer – either myeloma or acute myeloid leukaemia

They also included people having a stem cell transplant.  

The team looked at how many antibodies Open a glossary itemthere were in the blood after 2 doses of the vaccine. They compared these to healthy people. The results show that some people had produced a lower number of antibodies when compared to the healthy volunteers. This was:

  • just under 1 in 5 people with a solid cancer (17%)
  • just over a third of those with blood cancers (39%)
  • a third of those who had a stem cell transplant (33%)

The study didn't look at how well protected people are from developing COVID-19. It was only looking at the number of antibodies there were in the blood.

This study only included a small number of people with cancer and with only a few cancer types. There is still a lot to learn about how the vaccines work in people who have weakened immune systems. The researchers are now looking into booster vaccines. They want to find out if that might provide more protection.

Importantly, like other studies this has shown that most people had a response to the vaccine. If you have any concerns about what this means for you speak to the team caring for you.

These are early results we will update them when more information becomes available. 

Coronavirus (COVID-19) vaccine and cancer treatment

Talk to your doctor or specialist nurse for specific advice for your circumstances. 

The information below is about the Pfizer-BioNTech, AstraZeneca-Oxford and Moderna vaccines. It is only a guide.

Specialists say that everyone having SACT should be considered for the vaccine. Your cancer treatment can also go ahead if you've had the vaccine, and there is no need for your treatment to be delayed because of it.

Can I have the vaccine when I’m having immunotherapy?

Immunotherapy can trigger an increased immune response causing side effects. But there is not enough evidence that it might happen with these vaccines. Specialists say that the benefit of having the vaccine should be weighed against the risk of not having it and becoming ill with COVID-19.

People having immunotherapy can have the vaccine at any time in their treatment cycle.

Can I have the vaccine when I’m taking part in a clinical trial?

You can have the vaccine when on a clinical trial for SACT unless the trial criteria say you may not have a vaccine or exclude people who have had the vaccine.

When is the best time to have the vaccine when I’m having treatment?

Whenever possible you will have the vaccine before you start treatment. Ideally, you should have the vaccine 2 weeks before you start your first cycle of SACT.

If you are already having treatment, your doctor will discuss with you when it is best to have the vaccine.

Can I have the vaccine if I have low levels of white blood cells (neutropenia)?

Ideally, you should not have an injection if you are unwell with neutropenia and until your level of white blood cells is back to normal.

People who have chronic neutropenia should have the vaccine.

Can I have the vaccine if I have low platelets or a bleeding disorder?

Your healthcare team will decide when it is safe for you to have the injection. It will depend on your level of platelets and the risk of bleeding.

Can I have the vaccine if I've recently had an autologous (your own) or allogeneic (donor) stem cell transplant?

People who've had a stem cell transplant can have any of the 3 vaccines. Specialists say that if you’ve had an autologous stem cell transplant, you can have the vaccine 2 months after the transplant. If you’ve had an allogeneic stem cell transplant, you can have the vaccine 3 to 6 months after your transplant.

People with Graft versus Host Disease (GvHD) or those receiving high dose steroids protection might have to wait a little longer before having the vaccine. This is because they still have weakened immune systems.

Talk to your healthcare team to find out when would be the best time for you to have the vaccine.

Can I have the vaccine if I've had CAR-T therapy?

Talk to your healthcare team to find out whether you can have the vaccine if you've had CAR-T therapy.

I am having radiotherapy, can I have the vaccine?

The vaccine is recommended for people having radiotherapy and you can have it during treatment. This is because it doesn't affect your immune system like chemotherapy and other cancer drug treatment does. 

I am going to have surgery, can I have the vaccine? 

Having surgery in itself is not a reason not to have the vaccine. Wherever possible people having surgery should have the vaccine at least 1 week before surgery.

I had cancer treatment to my lymph nodes, can I have the vaccine?

People who had surgery to remove their lymph nodes, or who had radiotherapy to their lymph nodes, are at risk of lymphoedema. Injections in an arm on the side of lymph node treatment can trigger lymphoedema. You should ask to have the vaccine on the opposite arm of your cancer treatment. If you had treatment on both sides, you should have the vaccine in your thigh.

More information

You can read more about what the COVID-19 vaccine means for people with cancer on the Cancer Research UK science blog.