“Nobody is safe until everyone is safe” has become a mantra that reminds us of the importance of equitable access to vaccines. It is estimated that between 70% to 80% of the population has to be vaccinated in order to achieve herd immunity and break the chain of transmission of Covid-19. However, since only limited doses of vaccines are currently available world-wide, the vaccination strategies devised have tended to prioritise key groups and the most vulnerable population groups, such as the elderly and those with co-morbid conditions such as cancer.
Patients with cancer as a group?are?at a higher risk?of severe infection caused by SARS-Cov-2 which may increase the risk of cancer-related morbidity and mortality. At the Shaukat Khanum Memorial Cancer Hospital and Research Centres (SKMCH&RC), in Lahore and in Peshawar, while disruptions in cancer management caused by the pandemic were kept to a minimum, some treatments had to be modified so as to protect these vulnerable patients as far as possible. The availability of Covid-19 vaccines for cancer patients and caregivers will allow specialised cancer hospitals such as SKMCH&RC to continue the fight against cancer in Pakistan while ensuring the safety of its patients and healthcare workers, free of the fear of future disruption caused by this pandemic.
Experts at the Shaukat Khanum Memorial Cancer Hospital and Research Centres, Pakistan’s only tertiary care cancer centres, recommend that cancer patients should receive the Covid-19 vaccine, so long as the vaccine used does not contain live virus. For patients on active therapy, COVID vaccine could be given at least two weeks prior to chemotherapy, or in between cycles. The optimal timing of vaccination should always be discussed with the treating oncologist prior to administration. This is also supported by many international expert medical groups including the American Association for Cancer Research, the American Society of Clinical Oncology, and Cancer Research UK. These organisations also recommend that those with cancer or a history of cancer should be offered priority access to Covid-19 vaccine. It is important to remember that each patient’s situation is unique and each patient undergoing cancer treatment must discuss the risks and benefits of Covid-19 vaccination with their cancer care team.
As of February 15, 2021, the Drug Regulatory Authority of Pakistan has approved the Sinopharm, Oxford Astra-Zeneca, CanSino and Sputnik V vaccines for emergency use in our country. None of these vaccines are based on live-attenuated virus and therefore, can all be given to cancer patients.
Caregivers play an essential role in the cancer journey of people fighting cancer. Experts at SKMCH&RC advise that caregivers of cancer patients should also be vaccinated against Covid-19, while again avoiding vaccines containing live viruses. Healthcare workers caring for patients with cancer with increased risk should also be prioritised in receiving vaccination?to minimise hospital-acquired transmission. For this reason, SKMCH&RC has already begun the process of vaccinating its front-line healthcare workers.
More information about the availability of these vaccines for cancer patients in Pakistan is expected in the next few days and weeks. It seems that the supply of vaccines in Pakistan may be limited for some time, but that this will be distributed via both public and private sectors. Through the Government’s free vaccination drive, citizens will be vaccinated in three main phases beginning with frontline healthcare workers, followed by the elderly and then the remaining population. Pakistan has also allowed sales of vaccines by the private sector and it is understood that rules and regulations governing this process have now been published. We are fortunate that the federal government has arranged for the supply of sufficient quantities of vaccine to ensure that a significant proportion of the population, including underprivileged patients, will be able to receive vaccination in the coming few months.
The Covid-19 pandemic continues, and we must continue to keep our guard up. Vaccination will not automatically obviate the need to continue to follow Covid-19 safety protocols. It is also important to remember that, although vaccination will prevent infection, we do not yet know if it also prevents an individual from carrying the infection and infecting others. For this reason, health experts recommend that those who get the vaccine still wear a mask and continue to follow safety measures, including physical distancing and practising hand hygiene.
Regardless of individual efficacy, all vaccines approved against Covid-19 are 100% effective in preventing severe disease and for this reason, vulnerable groups including cancer patients must be included in those given priority access to Covid-19 vaccination.
The writer is a Chief Medical Officer and Acting Chief Executive Officer Shaukat Khanum Memorial Trust
