With the Covid-19 vaccine rollout in full swing across provinces, many have advocated for prioritizing cancer patients and other immunocompromised individuals during the next phase.
The clinical trials for these vaccines excluded people with compromised immune systems, such as cancer patients, and thus many are skeptical about whether the vaccine is safe for this population or not.
Below are some Q&A’s prepared by The Lung Health Foundation, outlining some common concerns for those living with lung disease as well a summary of the vaccine rollout plans for each province.
COVID-19 Vaccines and those Living with Lung Disease
Should individuals who are immunocompromised, including those with lung disease, be concerned about getting a COVID-19 vaccine?
No. There is no issue with safety for immunocompromised individuals.
Currently, the National Advisory Committee on Immunization (NACI) has not made any clear national recommendation to vaccinate populations with underlying medical conditions. This is because there isn’t any certainty that the vaccines will be as effective with immunocompromised persons.
However, while immunocompromised people may not respond as well to the vaccines, they may also be more likely to have a severe reaction to COVID-19. As such, even a lesser degree of protection is important.
Has the vaccine been tested in people with lung disease including lung cancer, chronic obstructive pulmonary disease, or severe asthma?
To-date, there have not been any specific vaccine trials for people with lung disease. However, this is not unusual, and is the case for most vaccines that have been approved historically. There are currently, however, a number of studies running on vaccine response in immunocompromised people.
Between Israel, the United Kingdom, and the United States, more than 3 million people have now been vaccinated (in addition to the more than 30,000 in clinical trials). In Canada, more than 350,000 people have received at least the first dose of an approved COVID-19 vaccine. Many individuals with underlying conditions have now been vaccinated worldwide. The only adverse events to-date have been allergic reactions, which are rare, but not unexpected.
Should people undergoing active treatment for cancer including immunotherapies be concerned about getting vaccinated against COVID-19?
No. These vaccines are very safe.
There is no question that vaccination is much safer than leaving yourself exposed to COVID-19. From what we currently know, immunotherapies should not have a huge impact on the effect of the vaccine, so, while individuals on immunotherapies may not be quite as well protected as others who receive the vaccine, there will still be some level of protection provided to them.
Can I become sick with COVID-19 due to getting the vaccine?
No. None of the Health Canada-authorized vaccines contain the live virus that causes COVID-19. The vaccines use inactive or killed infectious agents, which means they cannot reproduce or multiply, making it impossible to get COVID-19 from the vaccines.
How has the government decided who will get the vaccines first?
COVID-19 is a unique infectious disease. The biggest risk factors for disease, severity and death are age (people over 50 are 20 times more likely to die than those under 50) and congregate living (nursing homes, shelters, migrant worker dormitories). Next on the list are socioeconomic variables and things associated with them.
NACI has provided preliminary guidance on key populations for early COVID-19 immunization, which provides recommendations to the provinces and territories on key populations that should be prioritized. These recommendations were informed by: the evidence available at the time of the deliberations; an expert stakeholder survey; and the assessment of an ethical framework.
The Canadian Agency for Drugs and Technology has also released reports to support healthcare providers and policymakers in determining prioritization schemes. In their report ‘COVID-19 mRNA Vaccines for People with Cancer’, they note that there are significant data gaps on the safety and efficacy of the vaccines for individuals with cancer which is deterring governments from including cancer patients as a priority until more evidence becomes available.
While the federal government has provided these guidance documents, it is ultimately up to the provinces and territories to decide who they will include within their priority groups.
What do we know about vaccine rollout across Canada?
Ontario has released a three-phased vaccine rollout plan. Phase 1, occurring from December 2020 to March 2021, will vaccinate:
- residents, staff, essential caregivers (including family caregivers) and other employees who work in congregate living settings providing care for seniors
- healthcare workers, including hospital employees, other staff who work or study in hospitals, and other healthcare personnel
- adults in First Nations, Métis and Inuit populations
- adult recipients of chronic home healthcare
Phase 2 will occur from March to July 2021, and will vaccinate:
- older adults, beginning with those 80 and older and decreasing in five-year increments over the course of the vaccine rollout
- people who live and work in high-risk congregate settings (for example, shelters, community living)
- frontline essential workers, including first responders, teachers and other education staff and the food processing industry
- individuals with high-risk chronic conditions and their caregivers
- Other populations and communities facing barriers related to the determinants of health across Ontario who are at greater COVID-19 risk (e.g. Black and other racialized populations)
Note that what is considered a ‘high-risk chronic condition’ has yet to be released. Phase 3 (August 2021 and beyond) will vaccinate remaining Ontarians. For more information visit: Government of Ontario
Here’s what we know about vaccine rollout across the other provinces and territories:
|Province||Priority Populations||Are adults with chronic conditions included in priority populations?|
|British Columbia||The first groups to get vaccinated between December and February are: long-term care residents, staff, essential visitors, people in hospices, health-care workers, and people in remote and isolated First Nations communities. For more information visit: Government of British Columbia||Not at this time.|
|Alberta||Phase 1 groups include: respiratory therapists, ICU/health-care workers, LTC, ER staff, home-care workers and residents of LTC homes. For more information visit: Government of Alberta||Not at this time.|
|Saskatchewan||Long-term care residents and staff as well as health-care workers, COVID testing staff, residents aged 80 and over, residents over the age of 50 in the north. For more information visit: Government of Saskatchewan||Not at this time.|
|Manitoba||ICU workers, LTC, acute-care workers born on or before Dec. 31, 1975; workers in COVID-19 immunization clinic, testing sites, and labs handling COVID-19 specimens; workers from designated COVID-19 hospital wards; provincial and federal correctional facility workers; and home-care workers employed by regional health authorities. For more information visit: Government of Manitoba||Not at this time.|
|Quebec||People who are vulnerable or people of significantly decreased independence who live in residential or LTC homes; workers in the health-care network and social services in contact with patients; people living in private seniors’ residences; and residents in isolated and remote communities.
People aged 60 and older (prioritized by age); adults under 60 years of age who have a chronic illness or a health problem that increases their risk of complications from COVID-19; adults less than 60 years of age without chronic illnesses or health problems but who provide essential services. For more information visit: Government of Quebec
|New Brunswick||LTC residents and staff, health-care workers with direct patient contact, adults in First Nations communities, older New Brunswickers.
Starting in the spring, vaccination will expand to residents and staff of communal settings (homeless shelters, correctional centres, etc.), other health workers including pharmacists, first responders and critical infrastructure workers. For more information visit: Government of New Brunswick
|Not at this time.|
|Nova Scotia||Front-line health workers, LTC residents and staff, adults over the age of 75, staff involved in the COVID-19 response, family physicians, paramedics, and home-care workers. For more information visit: Government of Nova Scotia||Not at this time.|
|NFL and Labrador||Seniors in congregate living settings, health-care workers at risk of exposure, people of advanced age and adults in remote or isolated Indigenous communities. Phase 2 will include other healthcare workers, residents and staff of congregate living settings, and other essential workers. For more information visit: Government of Newfoundland||Not at this time.|
|PEI||Residents/staff of LTC homes, health-care workers, seniors aged 80 or older, and adults living in Indigenous communities. In phase 2 the program will expand to seniors in their 70s, remaining health-care workers, residents of shared-living facilities, and essential workers. For more information visit: Government of PEI||Not at this time.|
|Yukon||Residents and staff of group living settings like long-term care homes, group homes, and shelters; health-care workers working in health-care settings, PSWs working directly with patients and clients; people over 80 who do not live in LTC homes; and Yukoners living in rural and remote communities, including First Nations people. For more information visit: Government of Yukon||Not at this time.|
|NWT||People of advanced age; people with existing chronic disease/multiple medical conditions; people who travel outside NWT regularly for medical care; health-care workers and those who provide care to high-risk vulnerable populations; those who live in NWT but work regularly outside or at work camps with out-of-territory workers; and those who live in a remote community, including Indigenous communities. For more information visit: Government of Northwest Territories||Yes.|
|Nunavut||Nunavummiut who are most at risk of either contracting COVID-19 or developing serious complications due to COVID-19, communities where health services are minimal, long-term care homes, and crowded facilities like homeless shelters and correctional facilities. For more information visit: Government of Nunavut||Yes.|
While the information provided is current as of the date of publication, please refer to your provincial health authority for the most up-to-date information.
The Lung Health Foundation will be advocating that NACI change its recommendations to the provinces and territories to include individuals with high-risk chronic conditions (specifically lung disease) in their priority populations.
This document has been developed in consultation with medical experts in the area of infectious respiratory disease and is relevant as of January 14tt 2021. If you have any additional concerns about the safety or efficacy of the COVID-19 vaccines then we encourage you to speak to your healthcare provider.