Studies have found that cancer patients have worse outcomes than the general population when they contract COVID-19, and the pandemic has delayed cancer treatment, screening and research. With the advent of safe and effective COVID-19 vaccines, there is hope that the pandemic can be brought under control. “With the growing vaccination efforts, we’re starting to see the light at the end of this pandemic,” said medical oncologist Antoni Ribas during an April 14 session he co-moderated on building COVID-19 vaccine confidence at the American Association for Cancer Research (AACR) Annual Meeting 2021. (Ribas is Past President of the AACR, which publishes Cancer Today.) However, Ribas, who is director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center at UCLA in Los Angeles, also brought up the concern that not enough people will get vaccinated to prevent further outbreaks of COVID-19. The panel, he explained, was convened to “discuss how the cancer community can help build confidence in COVID-19 vaccines to end this pandemic and to return our full attention to preventing and curing all cancers.” “While demand for vaccines has thus far outweighed supply, we are now about to reach the point at which the vaccine supply at least nationally will start exceeding demand,” said physician-scientist Gilbert S. Omenn, director of the Center for Computational Medicine and Bioinformatics at the University of Michigan in Ann Arbor, who co-moderated the panel. Francis S. Collins, director of the National Institutes of Health, began by speaking about vaccine development, explaining that all the vaccines currently authorized by the U.S. Food and Drug Administration (FDA) were rigorously tested in phase III clinical trials with at least 30,000 people in each trial. And while it took only 11 months from when the genome sequence for SARS-CoV-2, the virus that causes COVID-19, was announced to when the first COVID-19 vaccines received emergency use authorization from the FDA, Collins said, “I want to assure you as a guy who’s been deeply engaged in vaccine development, kind of 24/7 here from my home office over the last 15 months, that in fact I have never seen an effort to develop a vaccine conducted with this kind of rigor.” It’s still too early to know whether the recommended pause in distribution of the Johnson & Johnson COVID-19 vaccine that was announced by federal authorities on April 13 will affect people’s attitudes toward getting vaccinated. But according to Collins, “the pause shows the level of care that is being taken to make sure this is safe.” Liz Hamel, vice president and director of public opinion and survey research for the Kaiser Family Foundation (KFF) in San Francisco, reported the results of the foundation’s latest survey released March 30. The KFF COVID-19 Vaccine Monitor: March 2021 revealed that the share of U.S. adults who report being vaccinated or intending to do so stood at 61%, up from about one in three adults in December. In the same timeframe, the percentage of adults adopting a “wait-and-see” attitude dropped to 17% from 39% in December. By contrast, the percentage of adults who said they will definitely not get the vaccine stayed roughly the same, between 13% and 15%. Panelists discussed strategies being used to get accurate and complete information about COVID-19 and the vaccines out to the public and to combat misinformation being spread on social media and other outlets. Mary M. Gullatte, an oncology nurse, patient advocate and corporate director of nursing innovation and research at Emory University in Atlanta, described an effort to encourage COVID-19 vaccinations in her African Methodist Episcopal church. For Gullatte, it was important to have “someone who looks like them” speak to the church congregation. She asked Zanthia Wiley, an African American physician in the Department of Infectious Diseases at Emory University School of Medicine, to speak. “She looked like the congregation members,” said Gullatte, and helped overcome doubts about the vaccine by providing honest responses to their questions. Eventually, the church became a site for vaccine distribution. “I got many calls and responses back saying, ‘Oh, my gosh. Thank you for doing this. This has been wonderful. I wasn’t planning on getting this vaccine, but now I feel confident that it’s safe,’” Gullatte said. Collins spoke of his outreach to white evangelical Christians, a segment of the population that polls show remains skeptical about the COVID-19 vaccines. Collins identifies as an evangelical Christian and has reached out to this population and met with church leaders, including appearing on the podcast of evangelical pastor Rick Warren. Grace Cordovano, a patient advocate and chief executive officer of Enlightening Results, a New Jersey-based company that provides patient advocacy and navigation services, said cancer patients and their caregivers are “heat-seeking missiles” when it comes to wanting accurate information. She emphasized that experts should not only listen to people’s questions about vaccines but also recognize that looking for information is a responsible thing to do. “It’s OK to ask questions,” Cordovano said. She criticized paywalls that prevent access to scientific information and praised the AACR for announcing they would start an open-access academic journal. Ribas pointed out that all COVID-19 journal articles in AACR publications are available for free at the AACR COVID-19 and Cancer Resource Center. ​

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​Read more coverage here​ from Ca​nc​er Today on the various impacts of the​ co​ronavirus o​​n people with​ cancer.
​Lee Greenberger, a patient advocate and chief scientific officer for the Leukemia & Lymphoma Society (LLS), pointed out that the trials that led to the authorizations of the vaccines largely excluded people with cancer. Nevertheless, he noted that the elevated death rate of people with blood cancer who get COVID-19 and the potential for these patients to develop chronic infections and viral variants means there’s good reason for blood cancer patients to get vaccinated when offered. He said that while 70% of U.S. blood cancer patients and survivors surveyed by the LLS in December 2020 said they were likely or very likely to get the COVID-19 vaccine, a little under one in five said they were unlikely or very unlikely. Greenberger said the survey would be repeated in the near future. In the meantime, LLS has established a national patient registry​​ to track responses of blood cancer patients who have been diagnosed with COVID-19 or have been vaccinated. Immunologist E. John Wherry, director of the Institute for Immunology at the University of Pennsylvania in Philadelphia, noted that that even if someone doesn’t have a full immune response to a vaccine, the vaccines generate multiple types of immune responses that could prove to be protective. “We have a lot of backup plans generated by these vaccines,” he said. He also distinguished between vaccine side effects, which are fairly common and a sign the immune system is working, and adverse events, which are extremely rare. For example, the blood clot issue that led to the recommended pause in the Johnson & Johnson vaccine has been reported so far in six people out of about 7.5 million vaccinated in the U.S. “Side effects are not something to be scared of,” he said of the muscle aches and headaches, fatigue and joint pain that are common side effects among vaccine recipients. According to Wherry, the vaccine provides a more consistent immune response across the population than natural infection by COVID-19. Panelists discussed structural racism in U.S. society and the health care system that has led to worse health outcomes and a disproportionate COVID-19 impact on minority populations. Lisa C. Richardson, director of the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC), said, “we better be sincere about dealing with structural racism.” “We need to be totally sincere about how hard the problem is, but not be afraid to tackle it,” she said. “People are dying because of a racist society.” Richardson cited a community health worker project at the CDC that is reaching out to all communities, including underserved populations, to provide health educa​tion and resources.​​​​ The session is available in its entiret​y on Vimeo.

Kevin McLaughlin is the executive editor of Cancer Today.