Vaccine Hesitancy in Cancer Patients

“If I accept the vaccine,” one cancer patient says, “it will be with a strong feeling of guilt that at best I will be prolonging my life for a few months or years.”

Do the vaccines against the coronavirus offer cancer patients the same hope that they hold out to healthy people? The women in my cancer support group expressed hesitancy as the vaccines started to be administered to health care workers.

Lucy Cherbas, in chemotherapy for recurrent ovarian cancer and in the over-70 population slated to receive the vaccine next, described the moral impediment that some healthy people also confront in a different variant.

“If I accept the vaccine,” she said, “it will be with a strong feeling of guilt that at best I will be prolonging my life for a few months or years, while others behind me in line still have full lives to live if they don’t succumb to Covid-19.”

Lucy’s altruism reminds us how many people have responded to the pandemic with grace and grit. I talked about her guilt with Dr. Timothy Lahey, a medical ethicist and infectious disease specialist at the University of Vermont Medical Center. He pointed out that at a personal level, “Lucy has no duty to endanger herself for others.” As long as she meets vaccine eligibility criteria, he said, “she should feel no compunction about claiming her vaccine.”

According to Dr. Lahey, “altruism is admirable because it is not compulsory.”

Even at a population level, with vaccine prioritization designed to minimize death and suffering, Lucy has “every right to trust the system and receive the vaccine when her number is called.” Of course, she can give up her place, but, Dr. Lahey said, “such a decision would do little to improve the efficiency of the overall distribution system.”

Lucy was also concerned about the physical issues that play a more prominent role in medical conversations. Because she is on a chemo drug that kills dividing cells, Lucy worried that the vaccine would be ineffective. “The development of an immune response involves a lot of cell division, and that seems unlikely to happen in the presence of anti-mitotic chemo agents,” she said. (Before she retired, Lucy was a molecular geneticist.) Since her oncologist continued to advise her to take the vaccine, Lucy has overcome her misgivings and has made an appointment.

Like Lucy, cancer patients need to discuss their unique cases with their physicians. According to Dr. Otis Brawley, past medical and scientific officer of the American Cancer Society and currently a professor of oncology at Johns Hopkins University, “no guidance has come out from the usual nongovernmental groups.”

Katherine Cherbas

He added that authorities like the Food and Drug Administration, the Centers for Disease Control and Prevention and the Medical Research Council of Britain “leave it up to individual doctors, but suggest that it should be safe.”

Ideally, those cancer patients who want the shot could get it at their cancer centers rather than in a mass distribution site. But a bumpy rollout and age restrictions have frustrated many people with cancer. Still, if the shot is offered, Dr. Brawley recommends it to his patients in active therapy and to those in follow-up. Certainly, they may not have as strong a response as someone who has an intact immune system; however, they will get some protection and will not be harmed because the current vaccines from Moderna and Pfizer are not produced from live virus (as measles, rubella, mumps and smallpox had been). Live virus vaccines must be avoided by the highly immunocompromised.

The Moderna and Pfizer coronavirus vaccines, Dr. Brawley explains, are made from messenger ribonucleic acid, or mRNA, by means of a new technology. Its genetic material causes the vaccinated person to create the same proteins that are found in the spikes of the novel coronavirus.

“The vaccinated person’s immune system then recognizes these proteins as foreign and produces antibodies against them,” Dr. Brawley said. “Another immune cell called a dendritic cell also records the proteins as foreign.”

Dr. William Nelson, director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, agreed that “the worst that could happen” to cancer patients inoculated with the coronavirus vaccine “is a poor response.” The poorest responses will probably occur with people in treatment for B-cell lymphomas and multiple myeloma, he explained, because regimens for these diseases often involve agents targeting antibody-producing cells in the body. “For folks undergoing bone marrow transplants,” Dr. Nelson advised, vaccinations should probably be timed at three to six months after the transplant to ensure that immune recovery has occurred.

As important as the vaccines are, Dr. Nelson urged people with cancer as well as their families and friends to “remain vigilant about mask-wearing, social distancing, hand washing, etc.” Because cancer patients often experience low white-blood cell counts, their symptoms — fever, muscle aches, headache, dry cough — can be indistinguishable from those of Covid-19. “Now these patients will also need to be rapidly tested for the coronavirus and isolated in a suitable facility to get their intravenous antibiotics infused.”

When the health authorities in my state, Indiana, announced they would inoculate people over 70, I had no problem signing up online for an appointment. When I went for my first shot at a small medical facility, it was abuzz with people buoyed by high hopes for widespread, so-called herd immunity. My own optimism was shadowed by periodic news stories this winter about mask-less receptions, rallies, protests, parties and raves, and by personal conversations with people scared of inoculation in general.

As Eula Biss explained in her brilliant pre-pandemic book “On Immunity,” fear of the government, of the medical establishment, and of public intrusions into the private body can inhibit the collective trust that achieving immunity requires. Because fearfulness often afflicts cancer patients, they might be especially susceptible to these sorts of trepidations.

In a period of rampant disinformation, anti-vaccine campaigners have emerged to decry what they call a “scamdemic.” They will feed and fuel vaccine anxiety unless they are vigilantly countered by scientific authorities in the media.

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