July 19th 2021 has been called ‘Freedom Day’ , the day when all covid restrictions ended and everyone resumed normal life. This is unfortunately not the case for the many people, like me, who have conditions that render them susceptible to Covid-19 and who may not respond as effectively to the vaccine. 

I have a lymphoma, a type of blood cancer that affects white cells called lymphocytes, cells that are part of the immune system and which have many functions to fight infection, including producing antibodies. There is scientific evidence that people with lymphoma are more likely to have a poor outcome if they contract Covid and so I, along with many other ‘clinically extremely vulnerable’ people, have been shielding for over a year now.

The big white hope was the Covid vaccine, and indeed the vaccine effort in the UK has been extremely successful by any standard. I have had both doses of the AZ vaccine  and did so before I started lymphoma treatment. But, there is now increasing evidence that people with blood cancers may not raise a good immune response to the vaccine.

 For example, a study by Sean Lim and colleagues showed that people with aggressive lymphomas who were within six months of treatment or people with indolent lymphomas, whether on treatment or not, did not raise a good antibody response to even 2 doses of a covid vaccine. I am one of those. The blogs on the blood cancer charity websites are filled with people who have raised no immune response at all and are now paradoxically more locked down, less free, than before July 19th.

Developing cancer is largely due to internal bodily factors, a series of unlucky throws of the dice controlling cell division. The likelihood of catching Covid depends on others’ actions as well as your own. Clearly there is a balance between a functioning society and individual safety. There are always trade offs. Yet there are simple things that could be done that haven’t.

All at risk patients should get an antibody test done, and if appropriate, be given a booster vaccination as soon as possible. If they have no immune response at all, perhaps their vaccination programme should start from scratch again. 

The Joint Committee on Vaccination and Immunisation (JCVI) and Public Health England lump all extremely vulnerable people into one group, even though they are clinically very diverse (includes people with many different types of cancer, diabetes, respiratory conditions, people taking immune suppressants etc) and forbids clinicians from making decisions according to individual patient circumstances. 

Whilst a command and control one size fits all approach may have been appropriate early on, we are overdue giving doctors some local autonomy on vaccine decisions, especially now that vaccine clinics are quiet and spare vaccines are available.

Second, lab produced antibodies could be given to people who cannot raise their own antibodies to a vaccine. One such is AZD7442, a long-acting antibody developed by AstraZeneca, being tested in the PROVENT trial.  NHS England should make use of the accelerated access to medicines provisions to make this available.

Lastly, what about mechanisms to decrease spread of viral particles to others?  The main one has been the wearing of masks, which has shifted from being mandatory in public places to being encouraged. People should be mindful of the cascade of spread, especially given that there are still many people who have been jabbed but remain unprotected, and these vulnerabilities are not visible. 

The other mechanism to reduce spread that has been suggested is the use of vaccine passports for travel and for access to public places. This should be encouraged to reduce transmission and also to encourage people to get fully vaccinated. Clearly people with blood cancers and others who may not have responded well to the vaccine can be ‘spreaders’ as well as being at extra risk. In practice, this is unlikely to be a huge problem as many such people are still shunning public places, but is an added argument for ensuring booster vaccination for such people.

In conclusion, it should be recognised that there are significant numbers of people like myself for whom Covid remains potentially a significant danger, and the opening up of society, whilst being an economic necessity, has made things worse for them. 

To mitigate their risk, there are some simple solutions: ensuring that there is flexibility to ensure that people who need booster vaccines get them as a priority; that antibodies are used if/when they become available, and that sensible precautions against spread should be encouraged like the using of masks and vaccine passports. 

The author has co-founded several drug discovery companies and advises many others in the area of CNS drug discovery.