Oncology patients eligible for COVID-19 vaccine from 22 March: but which one?

Patients with cancer will be the next priority for COVID-19 vaccine when phase 1b of the rollout commences on 22 March.

With phase 1a having targeted frontline COVID-19 workers to receive Pfizer’s vaccine (‘Comirnaty’) through clinic hubs, the next phase, 1b,  is planned to deliver up to 15 million doses of the Oxford/AstraZeneca vaccine via GPs to groups including the elderly, Indigenous Australians, other frontline workers and people with specific medical conditions that put them at risk of COVID-19

In its advice on priority groups for COVID-19 vaccination in Australia, the Department of Health states that the medical conditions conferring highest risk include people who have blood cancer “eg leukaemia, lymphoma or myelodysplastic syndrome (diagnosed within the last 5 years)”; those having chemotherapy or radiotherapy, and those who have had a bone marrow transplant in the last 24 months. The priority list also includes people who are on immune suppressive therapy for graft versus host disease.

The document “Preliminary advice on general principles to guide the prioritisation of target populations in a COVID-19 vaccination program in Australia”  states that moderate risk conditions include a non-haematological cancer (diagnosed in the last 12 months); some neurological conditions (stroke, dementia, other) and other other primary or acquired immunodeficiency.

People with underlying conditions will need to provide proof of them to demonstrate their eligibility for vaccination via My health record, a health professional referral if required or a declaration form.

In phase 1b, the Oxford/AstraZeneca vaccine will be made available through GPs and Aboriginal Community Controlled Health Services. The government’s COVID-19 information site says that patients will not be able to choose which vaccine they receive and that “specific vaccines will be administered based on availability and subject to any determination made by the TGA. “

However some immunisation experts have suggested that people with medical conditions such as haematological cancers should be targeted for the Pfizer vaccine because of its higher efficacy over the AstraZeneca vaccine.

Speaking at a Senate public hearing on the rollout of the COVID-19 vaccine on 2 March, Professor Raina MacIntyre of the University of NSW Global Biosecurity Program said she thought that people in group 1b should be getting Pfizer as well, because there was a high proportion of immunosuppressed people in this category.

“I know the oncology society, the haematologists, the clinicians and the specialist societies that look after immunosuppressed patients are concerned because their patients are more at risk of infection and more at risk of severe complications.

Professor Robert Booy, a paediatrician and former Head of Clinical Research at the National Centre for Immunisation Research and Surveillance (NCIRS) at Westmead, NSW, said he agreed, and there should be no logistical problem with delivering Pfizer vaccine via GP practices.

“I also think 1b people could benefit greatly,” he said.

“I’ve had people writing to me from that group, and I’ve said, ‘Well, I don’t know.’ But I think it also needs to be understood that the Pfizer vaccine, although coming in freezers at minus 17, can, once it’s defrosted, sit for five days in a fridge which is monitored before it’s reconstituted at two degrees. So GPs could manage that and they could be very involved in the rollout of Pfizer vaccines.

In the US, oncologists have raised concern that people with cancer are not getting access to COVID-19 vaccination depite recommendations that they be prioritised. The American Society of Clinical Oncology (ASCO) has written to the Centers for Disease Control and Prevention (CDC) urging them to allow cancer care providers to give the vaccine to their patients.

The letter notes that the CDC has identified cancer as one of several serious conditions that place adults of any age at increased risk of serious illness from the virus that causes COVID-19.

“This identification is consistent with the evidence regarding the increased risk of serious COVID-19 illness among cancer patients, with growing evidence of an especially significant risk for hematological cancer patients and lung cancer patients,” it said.

“We recommend that states be encouraged to distribute vaccines to cancer care providers for those providers to vaccinate their patients in situations where the practices are willing and able. Engaging cancer care providers would address the challenge of how patients demonstrate that they have a serious underlying health condition qualifying them for vaccination in states that require it. In addition, it will ensure that cancer patients have a discussion with their care team about whether they should receive a COVID-19 vaccine.”

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