Recently, several readers asked me if older relatives with these conditions should be immunized. This is a matter for medical experts and I have sought the advice of several. All strongly suggested that people with doubts contact their doctors and discuss their individual medical circumstances.
P: My 80-year-old mother has chronic lymphocytic leukemia. For weeks, your oncologist did not tell you “yes” or “no” about the vaccine. After a lot of pressure, he finally replied, “It won’t work for you, your immune system is too compromised to make antibodies.” She asked if she can get the vaccine anyway, just in case it offers some protection, and he told her that he didn’t discuss it with her.
First, some basic principles. Older adults, in general, responded extremely well to the two Covid-19 vaccines that received special authorization from the Food and Drug Administration. In large clinical trials sponsored by pharmaceutical companies Pfizer and Moderna, vaccines have achieved substantial protection against significant illnesses, with efficacy for the elderly ranging from 87% to 94%.
But people 65 and older undergoing cancer treatment were not included in these studies. As a result, it is not known what degree of protection they can derive.
With regard to safety, there is currently no evidence that cancer patients are more likely to experience side effects from the Pfizer-BioNTech and Moderna vaccines than other people. Generally, “we are confident that these vaccines are safe for (cancer) patients”, including older patients, said Dr. Armin Shahrokni, geriatrician and oncologist at Memorial Sloan Kettering.
The exception, which applies to everyone, not just cancer patients: people who are allergic to the components of the Covid-19 vaccine or who experience severe allergic reactions after the first injection should not take the Covid-19 vaccines.
Efficacy is a consideration for patients whose cancer or underlying treatment suppresses their immune systems. Notably, patients with blood cancer and lymph nodes may have a blunt response to vaccines, along with patients undergoing chemotherapy or radiation therapy.
Even in this case, “we have every reason to believe that if their immune system is working, they will respond to the vaccine to some extent”, and that will likely be beneficial, said Dr. William Dale, chief of supportive medicine and director from the Center for Cancer Aging Research at the City of Hope, a comprehensive cancer center in Los Angeles County.
Balancing the timing of cancer treatment and immunization can be a consideration in some cases. For those with serious illnesses who “need therapy as soon as possible, we should not delay treatment (for cancer) because we want to preserve immune function and vaccinate them” against Covid, said Hohl of Memorial Sloan Kettering.
One approach may be to try to synchronize Covid’s vaccination “between cycles of chemotherapy, if possible,” said Dr. Catherine Liu, a professor in the vaccines and infectious diseases division at Fred Hutchinson Cancer Research Center in Seattle.
The American Cancer Society’s medical and scientific director, Dr. William Cance, said his organization is “strongly in favor of vaccinating cancer patients and survivors, especially older adults”. Given the scarcity of vaccines, he also recommended that cancer patients who contracted Covid-19 should receive antibody therapies as soon as possible if their oncologists believe they are good candidates. These infusion therapies, by Eli Lilly and Co. and Regeneron Pharmaceuticals, rely on synthetic immune cells to help fight infections.
Q: Should my 97-year-old mother, in a nursing home with dementia, get the Covid vaccine?
The Alzheimer’s Association also strongly encourages immunization against Covid-19, “both for people (with dementia) who live in long-term care and for those who live in the community, said Beth Kallmyer, vice president of care and support.
“What I think this question is trying to do is ‘Will my loved one live long enough to see the benefits of being vaccinated?'” Said Dr. Joshua Uy, medical director of a Philadelphia nursing home and grant director of geriatric studies at the University of Perelman School of Medicine of Pennsylvania.
Potential benefits include not getting sick or dying from Covid-19, receiving visits from family or friends, interacting with other residents and participating in activities, Uy suggested. (This is a partial list.) Since these benefits can begin to accumulate a few weeks after residents of an institution are fully immunized, “I would recommend the vaccine to a 97-year-old with significant dementia,” said Uy.
Minimizing suffering is an important consideration, said Dr. Michael Rafii, an associate professor of clinical neurology at the University of Southern California’s Keck School of Medicine. “Even if a person has end-stage dementia, you want to do everything you can to reduce the risk of suffering. And this vaccine provides individuals with good protection against Covid’s severe suffering,” he said.
“My advice is that everyone should be vaccinated, regardless of the stage of dementia they are in,” said Rafii. This includes patients with dementia at the end of their lives in palliative care, he noted.
If possible, a loved one should be at hand to reassure you, as being approached by someone wearing a mask and carrying a needle can evoke anxiety in dementia patients. “Have the person who gives the vaccine explain who they are, what they are doing and why they are wearing a mask in plain and simple language,” suggested Rafii.
P: I am 80 years old and I have type 2 diabetes and an autoimmune disease. Should I get the vaccine?
This question has two parts. The first has to do with “comorbidities” – having more than one medical condition. Should older adults with comorbidities receive vaccines from Covid?
Certainly, because they are at a greater risk of becoming seriously ill because of Covid, said Dr. Abinash Virk, an infectious disease specialist and co-chairman of the Mayo Clinic’s Covid-19 vaccine launch.
“The Pfizer and Moderna studies looked specifically at older people with comorbidities, and showed that the response to the vaccine was similar to (from) younger people,” she noted.
The second part has to do with autoimmune diseases, like lupus or rheumatoid arthritis, which also put people at greater risk. The concern here is that a vaccine can trigger inflammatory responses that can exacerbate these conditions.
Philippa Marrack, chairman of the department of immunology and genomic medicine at National Jewish Health in Denver, said there is no scientifically accurate data on how patients with autoimmune diseases respond to Pfizer and Moderna vaccines.
So far, there has been no cause for concern. “More than 100,000 people have now received these vaccines, including some that probably had autoimmune diseases, and there have been no systematic reports of problems,” said Marrack. If patients with autoimmune diseases are really concerned, they should talk to their doctors about delaying immunization until other Covid vaccines with different formulations are available, she suggested.
Last week, the National Multiple Sclerosis Society recommended that most patients with multiple sclerosis – another serious autoimmune disease – receive Pfizer or Moderna Covid vaccines.
KHN (Kaiser Health News) is a non-profit news service that covers health issues. It is an independent KFF (Kaiser Family Foundation) editorial program that is not affiliated with Kaiser Permanente.