Covid vaccine and blood cancer

Page updated 31 January 2024

If you have blood cancer and test positive for covid, you may be eligible for antibody and antiviral treatments. These treatments can reduce the risk of getting seriously ill from covid.

On this page we explain:

• How to access covid treatment in England
• How to access covid treatment in Scotland
• How to access covid treatment in Wales
• How to access covid treatment in Northern Ireland
• Free covid tests in the UK
• Tips for getting fast treatment for covid
• More about the treatments
• Who is eligible to be assessed for treatment
• Evusheld - for preventing covid in people with blood cancer

In England, if you test positive for covid-19 you will no longer automatically be contacted by the NHS to discuss treatment. The way you access assessment for covid treatments varies depending where you live.

Use the drop-down menu below to find out what you should do in your area as soon as you test positive for covid. You should follow the instructions for your local Integrated Care Board (ICB) ­­– the area where you are registered with a GP. Find your local Integrated Care Board on the NHS website.

If you are travelling within the UK and test positive for covid, contact NHS 111.

In some areas, you can refer yourself for treatment. If this applies to you, make sure you have the following information to hand when you make contact with a Covid-19 Medicines Delivery Unit (CMDU) or a similar service:

• date you tested positive
• date your symptoms started
• current address (including where you’re staying if you’re away from home)
• contactable phone number
• your current medical conditions
• your current medications

Although you do not have to register your positive test (online or by 119) to access treatments, we still recommend you do this because it will mean your test result is visible to the NHS against your NHS number.

Normal prescription costs apply for covid treatment in England. However, if you have blood cancer, you can get a Medical Exemption Certificate, which entitles you to free prescriptions. Find out more about free prescriptions.

If you get symptoms of covid, you should take a lateral flow test as soon as possible. If it’s positive, you’ll need to log your positive test online or by calling 119.

You should then report your positive covid result to your Health Board. You can find contact numbers for each Health Board here.

Whoever you speak to, tell them you are immunosuppressed, with a positive covid test, and that you think you are eligible for treatment. You could also get advice by calling 111, your hospital team or your GP.

If you get symptoms of covid, you should take a lateral flow test as soon as possible. If it’s positive, you will need to complete this form to access treatment: Covid-19 Antiviral Self-Referral Form (NHS111 Wales).

You should then be contacted by your Local Health Board within 48 hours. You may be contacted by telephone or text message. If you are eligible for treatment, they will tell you how to get it. This will depend on which treatment is suitable for you.

If you can't complete the online form, or you are not contacted within 48 hours of reporting your test result, call NHS111. Tell them you have covid symptoms, have tested positive, believe you are in the highest risk group and are eligible for treatment.

For more information, read the Welsh Government's information about covid treatments. The Welsh Medicines Advice Service also has information about covid treatments and how to access them.

You can find contact numbers for each Local Health Board in Wales here.

If you get symptoms of covid, you should take a lateral flow test as soon as possible. If it’s positive, you’ll need to log your positive test online. You should receive a text message advising that your local HSC Trust will be told and that medical staff will review information in your medical records.

If you cannot use the online service to report your test result, or you have used the service but not received a text message within 24 hours, contact your GP or GP out of hours service. They can contact your local Trust for you.

Make sure you keep a box of rapid lateral flow tests at home. Free testing is no longer available to the general public, but if you are eligible for covid treatments, you can still get free tests.

You can also use tests you buy from a pharmacy. The results of these will be accepted.

If you get covid symptoms, take a rapid lateral flow test as soon as possible. If it’s positive, follow the instructions for your country, or your local area if you live in England. If the test is negative, but you have covid symptoms, continue to take lateral flow tests daily.

From 6 November 2023, you should be able to pick up free rapid lateral flow tests from a local pharmacy. Tests now come in boxes of 5.

When you visit your pharmacy, take a copy of a letter or email that shows you're eligible for covid treatments - this is not essential but will help confirm that you should have free tests. You can also show the pharmacist this fact sheet from Community Pharmacy England which explains who is at high risk from covid and therefore eligible for free lateral flow tests.

A friend, relative or carer can collect tests for you, or you may be able to book a volunteer responder by calling 0808 196 3646. Anyone collecting free tests for you should take a letter or email confirming your eligibility for covid treatments, plus these personal details:

• your condition or conditions
• your NHS number
• your full name
• your date of birth
• your address

Some people have told us they are having difficulty getting free tests from a pharmacy. To see if your local pharmacy provides free tests you can use the Find a Pharmacy page on the NHS website to find pharmacies near you. Each pharmacy should have a 'Treatments and Services' section where you can check to see if COVID-19 testing is listed.

You can order free covid tests from the NHS Scotland portal.

In Wales, from 1 February 2024 you will be able to collect free tests from participating pharmacies. You will not be able to order tests online or by phone from this date.

Use the NHS Wales online search to find a pharmacy near you providing free tests.

In Northern Ireland, you should be able to collect free lateral flow tests from your local pharmacy. It may help to take a letter or email showing that you are eligible for covid treatments. See the advice for England above.

• Make sure you have contact details for your hospital team's out of hours service, in case you test positive at the weekend or any time outside their normal working hours.
• Keep a list of your medical conditions and all your medications handy - this will help you during any telephone assessments for covid treatment.
• If you are having medical care for any other health condition in addition to blood cancer, speak to both your blood cancer specialist and your other specialist now. Make sure they both know that you might need their input quickly if you get covid and need antiviral or antibody treatments.
• If you have problems asking for covid treatment, contact your Integrated Health Board in England, your Health Board in Scotland, your Health Board in Wales or your Trust in Northern Ireland.

Across the UK, people with blood cancer aged 12 and above who test positive for covid may be eligible for:

• Paxlovid (nirmatrelvir/ritonavir) (antiviral, tablets)
• sotrovimab (antibody, intravenous drip), if Paxlovid is unsuitable.

These medicines aim to stop covid becoming severe and to prevent hospitalisation or serious illness in those most at risk.

After your positive test, you would need to have a telephone consultation with a healthcare professional, to find out whether you can have one of the treatments.

These treatments are available across the UK, although the process for how to access them varies in the different countries - we explain the process for how to access them above.

These treatments have been found to be safe and effective at reducing the risk of hospitalisation and death in people with blood cancer with covid. Which treatment you have (if any) will be based on a personal assessment with a qualified healthcare professional about the different benefits and risks.

Paxlovid (nirmatrelvir and ritonavir)

• antiviral treatment (made up of nirmatrelvir and ritonavir)
• taken as tablets at home
• can be used in people aged 18+
• 88-89% relative risk reduction of hospitalisation or death
• should be given within 5 days of covid symptoms starting, but this can be extended to 7 days if needed
• more about Paxlovid

There are lots of health conditions and other medicines that can interact with Paxlovid. With some, you shouldn’t take Paxlovid at all, with others, your doctor should consider this with you before making a decision. The drugs include some cancer drugs, immunosuppressants, painkillers, drugs for infections, blood clot prevention drugs, hormonal contraceptives, and other medicines. So any decision about starting Paxlovid would need to follow a discussion about your type of blood cancer, any other health issues and what other medication you are on.

Sotrovimab (Xevudy)

• to use if Paxlovid is unsuitable
• antibody treatment
• given into a vein (intravenously), so you’d need to attend a medical clinic to have treatment
• can be used in people aged 12+ who weigh at least 40kg
• 79% relative risk reduction of hospitalisation or death
• should be given within 5 days of covid symptoms starting
• more about sotrovimab

If you are told you are not eligible for treatment

Not everyone with blood cancer will be eligible for the treatment, even after a telephone consultation. In this case, you could think about joining the PANORAMIC trial. This trial gives you a 1 in 2 chance of getting Paxlovid (half the people on the trial get Paxlovid and half don’t).

You can sign up to the PANORAMIC trial yourself if you have covid symptoms, a positive covid test, and you are aged 50 or over, or 18 to 49 with an underlying condition.

If you are thinking of travelling away from home, do discuss this with your healthcare team or doctor first. Ask them:

• What do I need to think about before travelling?
• What should I do if I test positive for covid while I'm away?

Not everyone with blood cancer needs antivirals or antibody treatments for covid, but some do. For many people, covid can seem mild at first but then get worse.

Before you go away, make sure you:

• Have all of your covid vaccinations, including the spring booster
• Ask your healthcare team what you should do if you get covid while you are away
• Have contact numbers for your healthcare team, including numbers for evenings and weekends
• Take a recent clinic letter and any medication paperwork with you
• Take lateral flow tests away with you, and test if you get symptoms
• Get travel insurance if you can - Blood Cancer UK have teamed up with Staysure to provide travel insurance for people with blood cancer.
• Ask your healthcare team for a letter to take with you, detailing your current diagnosis, treatment and condition overview, medication list, fitness to travel, and eligibility for covid treatment.

If you get covid while you are away, tell your healthcare team straight away and get their advice.

You can also check the policy for covid treatments in the country you are visiting by contacting their health authority. If you have a UK European Health Insurance Card (UK EHIC) that hasn’t expired yet, or a UK Global Health Insurance Card (UK GHIC), you can access the same medical treatments as residents of the country you are in. So if covid treatments like Paxlovid are available in the country you are in, and you would be eligible for it according to that country’s guidance, you might be able to access it there.

From 13 June 2022 (updated March 2023), written guidance explains that the following people with blood cancer might be eligible for a telephone assessment for covid treatment following a positive covid test. People who:

• have any type of blood cancer (including chronic blood cancers, MPN and MDS) and have had cancer treatment within the last 12 months (aspirin is not a cancer treatment) - including people with CML who are in chronic phase molecular response, or on first or second line TKI treatment) (previously, these CML patients were excluded)
• had a stem cell transplant in the last 12 months - either allogeneic (donor) or autologous (using your own stem cells)
• have active graft vs host disease (GvHD) regardless of how long ago the transplant was
• had CAR-T therapy in the last 24 months
• anyone else with CMML, myelofibrosis (CMML and myelofibrosis were previously excluded), MDS, myeloma (not including MGUS), or a chronic B-cell lymphoproliferative disorder (eg CLL, hairy cell leukaemia, follicular lymphoma, SLL, marginal zone lymphomas, MALT lymphoma, Waldenström macroglobulinaemia), regardless of treatment
• anyone who has been diagnosed with a mature T-cell malignancy (eg peripheral T-cell lymphomas, cutaneous T-cell lymphomas, T-cell prolymphocytic leukaemia, T-cell large granular lymphocytic leukaemia). This category was added in March 2023.

People with other conditions like other cancers, kidney disease, liver disease and other underlying conditions are also eligible. We have explained the breakdown for blood cancer above, but you can see the latest guidance here.

If you are told you are not eligible for an assessment, but you think you should be, contact your hospital team straight away. Your specialist doctor (haematologist) may be able to refer you.

Always let your hospital team and GP know if you have blood cancer and test positive for covid.

We've produced this document with the British Society for Haematology to aid understanding of the eligibility criteria at covid medicine delivery units around the UK. It was up to date as of July 2023:

There are some people that might not be eligible for the covid treatment, according to the list above. This includes:

• people who have CML, ET, PV AND who have not had any anti-cancer treatment in the last 12 months (aspirin doesn't count as a cancer treatment), no CAR-T therapy in the last 24 months, and no active graft vs host disease (GvHD).

The full guidance on eligibility is available here.

For people with these conditions, we think you might not be eligible for covid treatment. However, as this eligibility criteria has changed several times, it might still be worth contacting 111, your GP or your hospital team, to ask whether you should have a telephone assessment for the treatment.

Whether you have been sent a letter about this or not, if you get covid symptoms, take a covid test as soon as possible. If you get a positive result, follow the instructions for your country above, to find out whether you should access covid treatment.

The eligibility criteria is based on advice from experts about different levels of risk in different conditions. It is under constant review with experts (we are also influencing this by sharing our vaccine research) so it's possible the list could be expanded again, as it already has been changed more than once. If you are worried about your risk and access to the treatment, talk to your doctor or medical team, or contact us.

Evusheld is a preventative antibody treatment. It's designed to prevent covid in people who may not get effective protection from the covid vaccines.

Evusheld is a long-acting antibody treatment, which was found to prevent covid in people who took it during trials in 2021. It's made by AstraZeneca and is made of two monoclonal antibodies called tixagevimab and cilgavimab. It's given by injection.

When Evusheld was first licenced in March 2022, it was seen as an important option for people with blood cancer who may not respond well to the covid vaccines. Evusheld was licenced by the MHRA (the body that regulates medicines in the UK) - this means that legally, Evusheld is allowed to be used in the UK. Whether it is made available routinely on the NHS is a separate decision though, made by NICE (the body that reviews which medicines should be given on the NHS).

In early 2023, NICE issued guidance that Evusheld cannot be recommended on the NHS for vulnerable adults to protect against covid-19, because there is no evidence of its clinical effectiveness against current variants (and those likely to be circulating in the next 6 months) in the UK.

Evusheld had already been made available privately in the UK, and this remains the case. We have more information about accessing Evusheld privately, and things to consider.

Outside of private access, Evusheld is not available on the NHS, and NICE does not currently recommend its use for preventing covid. NICE has made this decision because the latest evidence shows that Evusheld is unlikely to prevent infection with most of the variants circulating in the UK now and in the near future.

An antibody treatment can give your body the covid antibodies it needs to fight the illness. The antibodies are injected straight into the bloodstream. They will stick to the surface of coronavirus and stop it getting inside our cells and making us ill. They also act as a distress signal, telling other cells to come and help destroy the virus.

This is particularly important for people with blood cancer, whose immune systems may not be able to develop its own covid antibodies after vaccination.

Sotrovimab (Xevudy) is an antibody treatment.

Antivirals work slightly differently from antibodies. They interfere with the way the coronavirus replicates and reproduces in our body.

On their own, viruses can’t make more versions of themselves. What makes them effective, is their ability to enter our own cells and hijack a toolbox in our cells that allows them to increase their numbers. Antivirals stop this from happening, and the less virus there is in our body, the lower the risk of more severe illness.

Paxlovid (nirmatrelvir and ritonavir) is an antiviral treatment.

Blood Cancer UK are funding and coordinating research into how covid is affecting people with blood cancer, and how well the covid vaccines are working. Together with other charities, we are investing £800k in vaccine efficacy research.

We report on our own research findings, and findings from other key studies. Find out what we know so far about covid vaccine efficacy for people with different blood cancers.

Coping with the risk of covid is understandably difficult if you have blood cancer. We have more information about coping with risk and uncertainty.

Talking to other people with blood cancer is helpful. You can do this on our Online Community Forum.

We are also here to answer your questions or just to talk about how you're coping. Contact our free and confidential helpline on 0808 2080 888 or send us a message.

The following companies have provided funding for our coronavirus support, but have had no further input: AbbVie, AstraZeneca, Celgene, Gilead, Incyte, Kyowa Kirin, Novartis, Pfizer, Sanofi, Takeda.