Vaccine Hesitancy in Cancer Patients

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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.