We believe at this stage that cancer patients will be offered a COVID-19 vaccine in the Stage 1b phase as ‘younger adults with an underlying medical condition’.

It is anticipated that the 1a group will be given the Pfizer vaccine, with the balance of the population being given the Oxford/Astra Zeneca vaccine. TGA approval is only active for the Pfizer vaccine at present, but the Oxford vaccine is expected to receive approval in the near future. However, the situation is fluid with increased orders now in place for the Pfizer vaccine and other vaccines coming on line. Mutations in the virus may also change the profile and nature of the chosen vaccines throughout 2021.

We are seeing a variety of figures regarding the effectiveness of these vaccines in the press, which can be misleading as they often measure different things. The two most important indicators are whether a vaccine reduces spread and whether it greatly reduces death or serious disease needing hospital care. At present the only vaccine that may reduce spread is the Oxford/AZ vaccine, while all approved vaccines appear to be very effective in reducing death and serious disease. On that basis both the Pfizer and Oxford vaccines have been widely approved overseas. Any overall advantage of one over another is unclear with immediate effectiveness, ease of administration and distribution, and the length of the effect all under consideration.

Present evidence dictates that availability and logistics will determine which vaccine individuals and specific groups will receive. Public health considerations make it essential that those decisions are made by the Australian Government at this critical time. With improved availability, broader evidence and greater experience choice may be possible but that will be well down the track. Ultimately any vaccine that goes through the rigorous TGA process will be both safe and effective. Knowing what we do today, we would have the first approved COVID-19 vaccine that we are offered.

No live coronaviruses are used as vaccines. A variety of technologies are being employed in COVID-19 vaccine development including very traditional approaches alongside cutting-edge genetic technologies. Some non-functioning ‘carrier viruses’ are used in certain vaccines, notably the Oxford/AZ vaccine, but this is a tried and true technique applied in a variety of other vaccine types. Because COVID-19 vaccines are not live attenuated vaccines, they are considered safe in cancer patients and immunosuppressed persons.

We are living through an international medical emergency on a scale not seen for over 100 years and there has been a rush to develop and implement new vaccines. However the process of approval has remained strict, particularly in countries such as Australia where public health measures have been successful at controlling viral spread. We have the luxury of watching new vaccines be trialled in countries with much higher COVID-19 rates. The new vaccines have very similar safety profiles to all widely used vaccines. We are particularly protected in Australia by our effective public measures and the rigorous assessment processes of the TGA.

The COVID-19 vaccines are safe in immunosuppressed patients, such as cancer patients, as the vaccine does not contain living active virus. The Norway experience appears to have resulted from the choice of vaccinating a very vulnerable population either approaching the end of their life for other reasons or with early COVID-19 at the time of vaccination. Analysis of these reports has been very reassuring regarding safety in the wider population.

Yes, these vaccines appear very effective in quite large trials. However, the durability of the effect over time, the effect on new strains and the need for boosters of the same or modified vaccines are all unanswered questions today. What is very clear is that we will have answers to these questions quickly.

The side effects of the COVID-19 vaccines are very similar to many other vaccines, with local tenderness and redness, slight fever and fatigue quite common. Occasional allergic reactions have occurred in susceptible people, emphasising the need for qualified supervision of the vaccination programme. Long term side effects are, of course, a critical question to which there cannot be a clear present answer. However, the technology behind the vaccines is well established and we are reassured by the experience of similar vaccines including the new mRNA vaccines (gene therapy-based vaccines) which have been extensively trialled as cancer therapies. Overall, it is clear that the side effects of these vaccines are predictably consistent with other vaccines.

At present we know that symptomatic COVID-19 is greatly reduced through COVID-19 vaccination, as are deaths and severe disease needing hospital care. However, reports are now suggesting that the logical follow-on from the effectiveness against disease and death from COVID-19 will be a reduced risk of spreading and catching infection.

This is a very important question, particularly for people with cancer where vaccine effectiveness may be reduced (e.g. after bone marrow transplant). Ideally the more of our close contacts that are vaccinated, then the less our own risk is (i.e. ‘local herd immunity’). It all contributes to ‘community herd immunity’. Vaccination relies on the interdependence we all have on each other’s actions and wellbeing. ‘No human is an island’ to modernise an old saying! At present the guidelines in Australia have not recommended this as routine. We do sense however that it will become more common around the world as more vaccines become available.

In almost all circumstances the answer is yes. If you are concerned you need to seek qualified advice. People currently undergoing anti-cancer therapy or on immunosuppressive medications are special cases and you should seek advice from your treating doctor. In the rare circumstance that you can’t be vaccinated, it is important to surround yourself with those who have been vaccinated and keep practicing good hygiene and social distancing.

The answer is the same as above, with the qualification that some patients receiving bone marrow transplants or other complex therapies may be advised to defer their vaccine and remain both in protective isolation and surrounded only by vaccinated individuals as far as possible.

It is recommended that vaccinations for different conditions such as influenza are separated by at least three days to space out any reactions.

While the knowledge around COVID-19 vaccines is in its early stages and the penetration of vaccines into communities around the world remains relatively low, it is essential that we maintain the social hygiene and public health measures that have served us so well in Australia. We hope and expect that as 2021 moves towards the final quarter, we will see a high level of community immunity and present restrictions will begin to be lifted. It is however far too early to consider ‘COVID-19 passports’ for vaccinated people or to open international borders. This is a project that we all share in – the more that we all participate, the more effective the vaccination programme will be and the sooner we can return to a safer world.