Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study


People with cancer are at increased risk of hospitalisation and death following infection with SARS-CoV-2. Therefore, we aimed to conduct one of the first evaluations of vaccine effectiveness against breakthrough SARS-CoV-2 infections in patients with cancer at a population level.


In this population-based test-negative case-control study of the UK Coronavirus Cancer Evaluation Project (UKCCEP), we extracted data from the UKCCEP registry on all SARS-CoV-2 PCR test results (from the Second Generation Surveillance System), vaccination records (from the National Immunisation Management Service), patient demographics, and cancer records from England, UK, from Dec 8, 2020, to Oct 15, 2021. Adults (aged ≥18 years) with cancer in the UKCCEP registry were identified via Public Health England's Rapid Cancer Registration Dataset between Jan 1, 2018, and April 30, 2021, and comprised the cancer cohort. We constructed a control population cohort from adults with PCR tests in the UKCCEP registry who were not contained within the Rapid Cancer Registration Dataset. The coprimary endpoints were overall vaccine effectiveness against breakthrough infections after the second dose (positive PCR COVID-19 test) and vaccine effectiveness against breakthrough infections at 3–6 months after the second dose in the cancer cohort and control population.


The cancer cohort comprised 377 194 individuals, of whom 42 882 had breakthrough SARS-CoV-2 infections. The control population consisted of 28 010 955 individuals, of whom 5 748 708 had SARS-CoV-2 breakthrough infections. Overall vaccine effectiveness was 69·8% (95% CI 69·8–69·9) in the control population and 65·5% (65·1–65·9) in the cancer cohort. Vaccine effectiveness at 3–6 months was lower in the cancer cohort (47·0%, 46·3–47·6) than in the control population (61·4%, 61·4–61·5).


COVID-19 vaccination is effective for individuals with cancer, conferring varying levels of protection against breakthrough infections. However, vaccine effectiveness is lower in patients with cancer than in the general population. COVID-19 vaccination for patients with cancer should be used in conjunction with non-pharmacological strategies and community-based antiviral treatment programmes to reduce the risk that COVID-19 poses to patients with cancer.


University of Oxford, University of Southampton, University of Birmingham, Department of Health and Social Care, and Blood Cancer UK.

Author list



  1. Department of Oncology, University of Oxford, Oxford, UK 
  2. Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK 
  3. Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK 
  4. Birmingham Medical School, University of Birmingham, Birmingham, UK
  5. UK Health Security Agency, London, UK 
  6. Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK 
  7. Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. Oncology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  9. NHS England, London, UK
  10. NHS Improvement, London, UK 
  11. Department ofCancer, Taunton and Somerset NHS Foundation Trust, Taunton, UK
  12. National Disease Registration Service, NHS Digital, London, UK
  13. Department of Surgery and Cancer, Imperial College London, London, UK
  14. Leicester Cancer Research Centre, University of Leicester, Leicester, UK
  15. Kent Oncology Centre, University of Kent and Kent and Medway Medical School, Maidstone, UK
  16. Department of Oncology, Torbay Hospital NHS Foundation Trust, Torquay, UK
  17. UCL Cancer Institute University College London Hospitals NHS Trust and University College London, London, UK
  18. CRUK Lung Cancer Centre of Excellence, University College London Hospitals NHS Trust and University College London, London, UK
  19. Cancer Services, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
  20. Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
  21. Department of Health and Social Care, London, UK
  22. Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK
  23. Royal College of Physicians, London, UK
  24. Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  25. Population Health Sciences, University of Bristol, Bristol, UK
  26. Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  27. Department of Academic Oncology, Royal Free Hospital, London, UK
  28. Cancer Sciences, University of Southampton, Southampton, UK;
  29. Cancer Services, The Royal Marsden NHS Foundation Trust, London, UK


Lennard Y W Lee1,2,17*, Thomas Starkey2*, Maria C Ionescu5*, Martin Little6*, Michael Tilby7*, Arvind R Tripathy7*, Hayley S Mckenzie8*, Youssra Al-Hajji4, Matthew Barnard5, Liza Benny5, Alexander Burnett9,10, Emma L Cattell11, Jackie Charman12, James J Clark13, Sam Khan14, Qamar Ghafoor7, George Illsley5, Catherine Harper-Wynne15, Rosie J Hattersley16, Alvin J X Lee, Pauline C Leonard19, Justin K H Liu20, NCRI Consumer Forum, Matthew Pang21, Jennifer S Pascoe7, James R Platt20, Vanessa A Potter22, Amelia Randle23, Anne S Rigg24, Tim M Robinson25, Tom W Roques26, René L Roux6, Stefan Rozmanowski21, Mark H Tuthill6, Isabella Watts27, Sarah Williams7, Tim Iveson, Siow Ming Lee17,18, Gary Middleton1,3,7, Mark Middleton, Andrew Protheroe6, Matthew W Fittall29†, Tom Fowler5†, Peter Johnson9,28

Novel Coronavirus SARS-CoV-2


The Lancet - Oncology