NCCN Issues Statement, Insists on Mandatory COVID-19 Immunization for Health Care Workers

The National Comprehensive Cancer Center Network (NCCN) has released a statement imploring health care employers to mandate COVID-19 vaccinations among their employees. ^1,2

Because patients with cancer are known to be more susceptible to experiencing complications from COVID-19, and certain populations may not mount an effective immune response to vaccination, the NCCN COVID-19 Vaccination Advisory Committee stated that it was “incumbent on healthcare workers” to be vaccinated against the virus.

“Cancer care providers have a responsibility to their patients and colleagues to do everything they can to reduce the spread of COVID-19; that includes getting vaccinated,” Robert W. Carlson, MD, chief executive officer of the NCCN, stated in a press release. “We know [patients with cancer] already face a higher risk from COVID-19 and must be protected during their many interactions with healthcare workers. According to the science, vaccines are our best option to safely protect ourselves and the people around us from this potentially deadly disease.”

Although the vaccination of healthcare workers will not serve to prevent all exposure to SARS-CoV-2, it confirms that the community is doing everything possible to protect more patients from infection. Moreover, many institutions have been reported to have experienced transmission clusters among healthcare workers during the pandemic, despite mitigation efforts.

For example, 3 clusters of COVID-19 infections among healthcare workers that were not associated with patient exposure were identified at The University of Texas MD Anderson Cancer Center.³ Investigators defined a “cluster” as 2 or more cases of SARS-CoV-2 in healthcare workers who worked in the same unit at the same time.

The initial cluster involved works from an ancillary services unit, with contacts traced back to a gathering in a break room in which 1 employee was symptomatic but not yet diagnosed with the virus. Subsequently, 7 employees were infected with COVID-19. The second cluster was comprised of 4 employees and was determined to be community related. The third cluster involved 2 employees with possible transmission while working in the same office at the same time.

The institution implemented a step-up approach to control infection spread among employees. This included universal masking, stronger cleaning practices, increased awareness, and the implementation of surveillance testing.

According to the committee, these kinds of events can have a significantly negative impact on healthcare systems.

On August 23, 2021, the FDA approved the Pfizer-BioNTech COVID-19 vaccine (previously referred to as BNT152b2; Comirnaty) for use in the prevention of COVID-19 disease in individuals aged 16 years or older.4 The vaccine has been available for emergency use in this population since December 11, 2020,5 and the authorization had been expanded to include individuals between the ages of 12 years and 15 years, as of May 10, 2021.6

On December 18, 2020, the FDA granted emergency use authorization (EUA) to the Moderna COVID-19 vaccine to prevent COVID-19 infection in individuals aged 18 years or older.7 The Johnson & Johnson single-dose vaccine also received EUA from the regulatory agency in February 27, 2021, for the same indication.8

In January 2021, the NCCN issued guidance that stated that all patients with active cancer, or with active, recent, or planned cancer treatment, should be considered highest priority to receive 1 of the COVID-19 vaccines granted for emergency use.9

In the event of limited vaccine supply, the NCCN specified that patients with active cancer who were on treatment including those on hematopoietic and cellular therapy; those planning to initiate treatment; and those who received treatment less than 6 months ago, be among the first to receive vaccination. Patients who were receiving hormonal therapy were the only exception to this recommendation.

Data from a recent study have demonstrated that COVID-19 vaccination induced high rates of seroconversion in patients with cancer, although those with hematologic malignancies have showcased lower immunogenicity and those who received prior immunosuppressive therapies appear to be less responsive.10

These data indicate that most patients with a cancer diagnosis have a high chance of responding to vaccination, even those who were receiving active treatment with chemotherapy, targeted therapy, or immunotherapy. As such, investigators concluded that the findings underscore the continued need to vaccinate patients with cancer urgently and broadly.

“We’re deeply committed to doing everything to protect our patients from COVID-19,” Brahm Segal, MD, Roswell Park Comprehensive Cancer Center, co-leader of the NCCN COVID-19 Vaccination Advisory Committee, stated in a press release. “Our patients come to our centers for high-quality and cutting-edge cancer care. We must insist they are protected as much as possible from COVID-19 during medical visits, and this requires that our workforce be immunized.”

References

1. Cancer guidelines organization supports mandatory COVID-19 vaccination for health workers. News release. National Comprehensive Cancer Network. August 19, 2021. Accessed August 23, 2021. https://bit.ly/3B7CVkO
2. National Comprehensive Cancer Network vaccine statement. August 19, 2021. Accessed August 23, 2021. https://bit.ly/3sHLD6D
3. Ariza-Heredia EJ, Frenzel E, Cantu S, et al. Surveillance and identification of clusters of healthcare workers with coronavirus disease 2019 (COVID-19): multidimensional interventions at a comprehensive cancer center. Infect Control Hosp Epidemiol. 2021;42(7):797-802. doi:10.1017/ice.2020.1315
4. FDA approves first COVID-19 vaccine. News release. August 23, 2021. Accessed August 23, 2021. https://bit.ly/3870L3K
5. FDA takes key action in fight against COVID-19 by issuing emergency use authorization for first COVID-19 vaccine. News release. FDA. December 11, 2020. Accessed August 23, 2021. https://bit.ly/3gWWfsE
6. Coronavirus (COVID-19) update: FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in adolescents in another important action in fight against pandemic. News release. FDA. May 10, 2021. Accessed August 23, 2021. https://bit.ly/2XKtTff
7. FDA takes additional action in fight against COVID-19 by issuing emergency use authorization for second COVID-19 vaccine. News release. FDA. December 18, 2020. Accessed August 23, 2021. http://bit.ly/34IwcjR
8. Johnson & Johnson COVID-19 vaccine authorized by US FDA for emergency use – first single-shot vaccine in fight against global pandemic. News release. Johnson & Johnson. February 27, 2021. Accessed August 23, 2021. https://bit.ly/3j8niDK
9. NCCN shares new guidance principles for vaccinating people with cancer against COVID-19. News release. National Comprehensive Cancer Network. January 22, 2021. Accessed August 23, 2021. https://bit.ly/3ycjlCn
10. Thakkar A, Gonzalez-Lugo JD, Goradia N, et al. Seroconversion rates following COVID-19 vaccination among patients with cancer. Cancer Cell. 2021;39(8):1081-1090.e2. doi:10.1016/j.ccell.2021.06.002