How older adults with chronic illnesses can assess whether to get the Covid-19 vaccine

Some older adults with chronic illnesses like dementia have safety concerns about taking the Covid-19 vaccine.

(KHN)As public demand grows for limited supplies of Covid-19 vaccines, questions remain about the vaccines' appropriateness for older adults with various illnesses. Among them are cancer patients receiving active treatment, dementia patients near the end of their lives and people with autoimmune conditions.

Recently, a number of readers have asked me whether older relatives with these conditions should be immunized. This is a matter for medical experts, and I solicited advice from several. All strongly suggested that people with questions contact their doctors and discuss their individual medical circumstances.
Experts' advice may be helpful since states are beginning to offer vaccines to adults over age 65, 70 or 75, including those with serious underlying medical conditions. Twenty-eight states are doing so, according to the latest survey by The New York Times.
      Q: My 80-year-old mother has chronic lymphocytic leukemia. For weeks, her oncologist would not tell her "yes" or "no" about the vaccine. After much pressure, he finally responded: "It won't work for you, your immune system is too compromised to make antibodies." She asked if she can take the vaccine anyway, just in case it might offer a little protection, and he told her he was done discussing it with her.
        First, some basics. Older adults, in general, responded extremely well to the two Covid-19 vaccines that have received special authorization from the Food and Drug Administration. In large clinical trials sponsored by drugmakers Pfizer and Moderna, the vaccines achieved substantial protection against significant illness, with efficacy for older adults ranging from 87% to 94%.
          But people 65 and older undergoing cancer treatment were not included in these studies. As a result, it's not known what degree of protection they might derive.
          Dr. Tobias Hohl, chief of the infectious diseases service at Memorial Sloan Kettering Cancer Center in New York City, suggested that three factors should influence patients' decisions: Are vaccines safe, will they be effective, and what is my risk of becoming severely ill from Covid-19? Regarding risk, he noted that older adults are the people most likely to become severely ill and perish from Covid, accounting for about 80% of deaths to date — a compelling argument for vaccination.
          Regarding safety, there is no evidence at this time 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, a Memorial Sloan Kettering geriatrician and oncologist.
          The exception, which applies to everyone, not just cancer patients: people who are allergic to Covid-19 vaccine components or who experience severe allergic responses after getting a first shot shouldn't get Covid-19 vaccines.
          Efficacy is a consideration for patients whose underlying cancer or treatment suppresses their immune systems. Notably, patients with blood and lymph node cancers may experience a blunted 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 functioning at all, they will respond to the vaccine to some extent," and that's likely to be beneficial, said Dr. William Dale, chair of supportive care medicine and director of the Center for Cancer Aging Research at City of Hope, a comprehensive cancer center in Los Angeles County.
          Balancing the timing of cancer treatment and immunization may be a consideration in some cases. For those with serious disease who "need therapy as quickly as possible, we should not delay (cancer) treatment because we want to preserve immune function and vaccinate them" against Covid, said Hohl of Memorial Sloan Kettering.
          One approach might be trying to time Covid vaccination "in between cycles of chemotherapy, if possible," said Dr. Catherine Liu, a professor in the vaccine and infectious disease division at Fred Hutchinson Cancer Research Center in Seattle.
          In new guidelines published late last week, the National Comprehensive Cancer Network, an alliance of cancer centers, urged that patients undergoing active treatment be prioritized for vaccines as soon as possible. A notable exception: Patients who've received stem cell transplants or bone marrow transplants should wait at least three months before getting vaccines, the group recommended.
          The American Cancer Society's chief medical and scientific officer, Dr. William Cance, said his organization is "strongly in favor of cancer patients and cancer survivors getting vaccinated, particularly older adults." Given vaccine shortages, he also recommended that cancer patients who contract Covid-19 get antibody therapies as soon as possible, if their oncologists believe they're good candidates. Th