Which COVID-19 vaccine is best for cancer patients?

With three COVID-19 vaccines now authorized for emergency use by the Food and Drug Administration (FDA), you might be wondering which vaccine is best for current and former cancer patients. After reviewing all available data, MD Anderson medical experts agree that all three vaccines are safe and recommended for cancer patients.

So, should you take Johnson & Johnson’s Janssen COVID-19 vaccine (J&J), which requires only one dose, if that’s what’s available? Or should you wait for one of the Pfizer or Moderna vaccines, which both require two doses, spaced 21 and 28 days apart, respectively?

According to our experts, the answer is clear: “Don’t pass up an opportunity to get the vaccine, no matter which one it is,” says Anita Ying, M.D., vice president of Ambulatory Medical Operations. “The best COVID-19 vaccine to get is the first one available to you.”

Timing matters for cancer patients getting a COVID-19 vaccine

Ying’s advice is particularly true for cancer patients, since some may be immunocompromised, making them both more vulnerable to severe infections and more likely to need hospitalization should they contract COVID-19.

“The sooner you can start building resistance to the novel coronavirus, the sooner you’ll have at least some protection against it,” notes infectious diseases specialist David Tweardy, M.D. “And that benefits everyone.”

For patients in active treatment, a COVID-19 vaccine will likely be more effective when coordinated with their treatment schedules. Those who have recently had surgery should wait two weeks before receiving one. And those enrolled in clinical trials, or who are receiving chemotherapy, CAR T cell therapy, immunotherapy or stem cell transplants should consult their care teams for additional guidance on timing.

Other timing considerations apply for those who’ve received a different vaccine recently, who’ve received monoclonal antibody therapy or convalescent plasma to treat a COVID-19 infection.

Everyone else can receive a COVID-19 vaccine as soon as one becomes available to them.

Benefits of all three vaccines outweigh risks of COVID-19

No matter which COVID-19 vaccine you get, you can rest assured that it is both safe and effective in protecting against severe infections. Vaccines must be at least 50% effective at preventing symptomatic infection in order to be authorized by the Food and Drug Administration.

“The Pfizer and Moderna vaccines are 95% and 94% effective, respectively, at preventing symptomatic infection,” says Tweardy. “The Johnson & Johnson vaccine is 67% effective overall.”

At first glance, that may make the J&J vaccine look slightly less desirable. But both the J&J and the Pfizer vaccines were 100% effective at preventing hospitalizations and death due to COVID-19, and the Moderna vaccine was 89% effective. The J&J vaccine also had the second-highest rates of efficacy at preventing severe infections: 77% after 14 days and 85% after 28 days.

“The overall numbers are different,” notes Tweardy. “There’s no getting around that. But when you consider the fact that different strains of the virus were circulating at the time the Johnson & Johnson one was being tested, it’s really not a fair comparison. What we’re looking for is a vaccine that prevents death and allows patients to survive the infection, and that’s exactly what the Johnson & Johnson one does, just as effectively as the other two.”

One dose or two: choosing the COVID-19 vaccine that’s right for you

Though their methods of accomplishing it differ slightly, all of the current COVID-19 vaccines work by inducing people’s bodies to produce a spike protein dotting the novel coronavirus’ surface. Recipients’ immune systems then recognize the protein as an invader and start generating antibodies against it.  

This immune response is what makes vaccine recipients much less likely to develop a COVID-19 infection, should they ever be exposed to it. And that’s why it’s best to be vaccinated as quickly as possible.

Still, there may be some situations in which it makes more sense to opt for the Johnson & Johnson vaccine. For one thing, the J&J vaccine requires only one dose to be effective, while the Pfizer and the Moderna vaccines require two, spaced several weeks apart. That means you could achieve the maximum protection afforded by the J&J vaccine in a much shorter time period.

“The goal is to start building up resistance as quickly as possible,” says Tweardy. “So, the sooner you can launch that process, the better. But if you’re really afraid of needles or unable to commit to receiving a second dose at the recommended time, Johnson & Johnson might be a better option for you, if it’s available.”

When a vaccine opportunity knocks, don’t hesitate

One of the most important things to keep in mind is that supplies of the COVID-19 vaccine are still limited across the country. So, if an opportunity arises to get a COVID-19 vaccine, think very hard before letting it pass you by — especially if the only reason you’d be doing so because it’s not the vaccine you’d prefer most.

“It might be several weeks or months before you get another opportunity,” adds Ying. “And it may or may not be the one you want. So, in my opinion, it’s not worth missing the chance to be vaccinated.”

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