Now that the Covid-19 vaccination programme has begun here in the UK, our members have raised many questions about the approved vaccine and how it affects CLL patients. The following may answer many of the most common questions You may also like to see our webinar on vaccines, where these questions were discussed. You can find it here.
This information is based on the first three vaccines which either are already available or are likely to become available shortly.
How do the vaccines work?
Vaccines work by preventing people from becoming severely ill and by stopping the spread of illness to others.
The advice from the Joint Committee for Vaccine and Immunisation (JCVI), the group which advises the government on vaccines, is that everyone who is offered a vaccine should have it. Our clinical advisers have also confirmed that this is the case.
However, it is not yet known whether any of these vaccines can prevent people from passing on the virus to other people who have not yet been vaccinated.
For this reason, if you do receive a vaccine, it is important you continue to observe social distancing and other actions to make sure that you do not spread COVID-19 unknowingly to non-vaccinated people. The vaccine will also take up to five weeks from the initial jab until it has become fully effective.
Is the vaccine safe?
Although the vaccines which will be available soon have been developed very quickly, they have to pass through a very stringent test and approval procedure. They must all be approved by the Medicines and Healthcare products Regulatory Agency (MHRA) following a thorough review of all the clinical data.
The advice from the Joint Committee for Vaccine and Immunisation (JCVI), the group which advises the government on vaccines, is that everyone who is offered the Pfizer-BioNTech vaccine should have it. Our clinical advisers have also confirmed that this is the case.
None of the first three vaccines which will become available, the Pfizer-BioNTech, the Oxford – Astra Zeneca vaccine or the Moderna vaccine is a live vaccine. They are therefore suitable for CLL patients, who must not receive live vaccines.
Other vaccines are awaiting approval, and we will provide further information when approval is granted, should this be different from other vaccines in development.
If you have any concerns about receiving the vaccine, we advise that you speak to your medical team about it once you have received your invitation.
Will it work?
It is still not clear what degree of immunity CLL patients will receive from the vaccine. It is known that CLL patients do not respond as well to the flu vaccine, for example, as people with normal immune systems.
However, this does not mean that you will get no response at all, and some response, however small, would provide at least some protection. Our advice is, therefore, that you should have the vaccine if invited, provided there are no contra-indications, such as allergic response or pregnancy. Under 16s are also advised not to have it. Please check with your medical team if in any doubt.
It is also important that you receive both doses of the vaccine. Whilst some protection is acquired from the first dose, the second dose is needed for full protection, which is likely to be particularly important to those affected by CLL.
Has the vaccine been tested on CLL patients?
We understand that neither the Pfizer vaccine nor the Oxford vaccine was tested in immunocompromised patients. However, our current advice is that those affected by CLL should have the vaccination when invited to do so. About 40% of the people vaccinated in the Pfizer trial were over 55, and it is thought that it works well in this population.
However, it’s important to understand that your immune system worsens with age and is even more damaged in CLL patients. Any vaccine will not work as well as in the general population but may give at least some protection. Further research is required to establish what degree of protection.
Can I have more than one vaccine?
Both the Pfizer-BioNTech and Oxford vaccines have been approved for a specific dosing schedule only. Although this has been modified to increase the gap between the first and second doses, It is not possible for individual clinicians or others giving the vaccine to decide to give extra doses, as this has not been tested in trials.
I’ve had Covid – should I still be vaccinated?
It is not yet certain how much immune response will be generated by natural infection, and it’s also not clear how long this response will remain in the body.
Some studies have suggested that antibodies are short-lived after infection, and there have been cases of reinfection reported, although rare. Therefore, it is recommended that you still have the vaccination, as this has been designed to give lasting protection.
I am currently on chemo treatment – can I have the vaccine?
This is a group in which the Pfizer-BioNTech vaccine has not been specifically tested. We do not yet know who was tested in the trials for other vaccines in development. With other vaccines, such as childhood vaccinations or flu, there are specific times when these should be had whilst you are on chemotherapy, to give the vaccines the best chance of working. If you are invited for the vaccine during a course of chemotherapy, please speak to your team if you are unsure when is the most appropriate time to have it.
When can I have the vaccine?
The government has published a list of priorities for receiving the vaccine. You can find the full list here: Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 2 December 2020 – GOV.UK (www.gov.uk)
The highest priority is currently health and social care workers and those over the age of 80. This will then be followed by other age groups, down to priority level 4, where any person who is considered clinically extremely vulnerable to COVID-19 (including CLL patients) will be invited at the same time as those aged 70-74. It’s known that age is the biggest risk factor for serious illness from COVID-19, and it is anticipated that many CLL patients will fall into the over 75 categories. Additionally, you may meet the criteria because of your work.
NOTE: the exception to this advice is those who are pregnant or planning to become so within three months of vaccination, and children under 16, both of whom are currently advised not to have the vaccine.
As each group is invited to start having a vaccine, you will receive a letter to inform you of this. Please do not contact your GP to request an earlier vaccination, as this will not be possible. We will look to update our advice as each new group is invited.
It may be some time before all groups are vaccinated. This is the largest mass vaccination programme ever undertaken by the NHS. Additionally, there are just two vaccines currently approved. The Pfizer-BioNTech vaccine and the Oxford Astra Zeneca vaccine. A total of about 140 million doses have been ordered but extra doses and other vaccines will be needed to cover the whole population of vulnerable and elderly people, and more still if the vaccine was to be rolled out to the wider population. Therefore, we need to use the doses already available to cover as many people as possible, which is why the second vaccination is being delayed.
Please continue to follow all guidance on reducing COVID-19, including after you have had the full vaccine.
If I have had the vaccine, can I stop social distancing?
No, we advise you to continue to follow all guidelines to reduce the spread of COVID-19 until the government advises otherwise. As mentioned in previous questions, we do not know how effective the vaccine will be in those affected by CLL and we also do not know if the vaccine will prevent you from passing COVID-19 to other people who are not yet vaccinated. This applies to everyone, regardless of whether you have completed your full course of vaccination or whether your family has also received the vaccine.
I have an allergy – is the vaccine right for me?
It has been reported that two of the first recipients of the Pfizer-BioNTech vaccine had experienced an anaphylactoid reaction after receiving the vaccine. This kind of reaction is where the person develops a range of symptoms including a rash, breathlessness, and a drop in blood pressure. It is important to note that this is not the same as an anaphylaxis reaction, which can be fatal. The two people affected had severe allergies, which meant that had to carry an epi-pen at all times. The NHS is no longer giving jabs to people with “significant” allergies; this is defined as “any person with a history of immediate-onset anaphylaxis to a vaccine, medicine or food”.
If you are unsure if this applies to you, please check with your GP or medical team before having the vaccine.