If you are aged 12 or over and had a severely weakened immune system when you had your first 2 doses of the coronavirus (COVID-19) vaccine, you will be offered a 3rd dose and a booster (4th dose).

The first 2 doses may not have given you as much protection as they can for people who do not have a severely weakened immune system. A 3rd dose may help give you better protection.

A booster (4th dose) helps improve the protection you have from your first 3 doses of the vaccine. It helps give you longer-term protection against getting seriously ill from COVID-19.

You will also be offered a spring booster of the COVID-19 vaccine if you are aged 12 and over and have a weakened immune system.

Who can get a 3rd dose and a booster (4th dose)

You will be offered a 3rd dose and a booster (4th dose) if you have a severely weakened immune system. This includes if you had or have:

• a blood cancer (such as leukaemia or lymphoma)
• a weakened immune system due to a treatment (such as steroid medicine, biological therapy, chemotherapy or radiotherapy)
• an organ or bone marrow transplant
• a condition that means you have a very high risk of getting infections
• a condition or treatment your specialist advises makes you eligible for a 3rd dose and a booster (4th dose)

You'll usually be offered a 3rd dose at least 8 weeks after you had your 2nd dose.You can get a booster (4th dose) from 3 months (91 days) after your 3rd dose.

How to get your 3rd dose and a booster (4th dose)

If you're eligible, a GP or your hospital specialist should contact you to let you know you can get a 3rd dose or booster (4th dose).

Spring boosters

Eligibility for a spring booster is now 91 days (3 months) after your previous vaccination and we will be offering either Pfizer or Moderna. Please do not wait to be contacted by the NHS book an appointment or walk-in to a local vaccination clinic.

Book or walk-in to get your vaccination:

• Appointments can be booked via the National Booking System or by calling 119.
• Walk-in to a vaccination clinics (no appointment required, limited vaccine availability). 

Positive COVID-19 test result?

People aged 18 and over need to wait 4 weeks. Most young people aged 5 to 17 years old need to wait 12 weeks. If you or your child are aged 5 to 17 years old and at high risk from COVID-19, or live with someone who has a weakened immune system, need to wait 4 weeks.

If you or your child has symptoms of COVID-19, but have not had a test, you should wait until your symptoms are better before you get the vaccine. You can talk to a healthcare professional at the vaccination site about this.

Frequently Asked Questions on third doses

 What is a 3^rd dose of the primary course?

The Joint Committee on Vaccinations and Immunisation (JCVI)  issued guidance on the 3^rd September recommending a 3^rd dose of the COVID-19 vaccine as part of the primary course of vaccination. This is being  offered as a routine part of vaccination to people who are severely immunosuppressed (as defined within the JCVI guidance) due to treatment for conditions such as cancer or for those with long-term chronic conditions where their immunity is affected by medication.

Why is it recommended?

People who have a severely weakened immune system as a result of treatment, may not have the same immune response to the vaccine, and therefore, the JCVI recommends that a 3^rd dose will help reduce the risk of getting seriously ill or dying from COVID-19, and from spreading COVID-19 (Coronavirus (COVID-19) vaccines www.nhs.uk)

Who is eligible for it?

JCVI guidance recommends that a 3^rd dose is  offered to individuals aged 12 years and over with severe immunosuppression, including those who are being treated for conditions such as cancer or for those with long-term chronic conditions where their immunity is significantly affected by regular medication. Severe immunosuppression is defined within the advice section of the JCVI guidance.

Guidance for household contacts of those who are immunosuppressed has not changed. They are recommended to be vaccinated with their first and second doses, in line with current JCVI guidance.  Details are available here.

 Is there a list of conditions and treatments available which identifies people who are considered severely immunosuppressed?

The list has been published by the JCVI and is available here.

How will patients know if they are eligible?

Consultants and GPs have been asked to identify patients eligible for a 3^rd dose. Patients will be contacted by their consultant / hospital doctor or GP team who will discuss the timing of the 3^rd dose, in light of the current or planned immunosuppressive therapies the patient is undergoing. 

If the hospital consultant works at a hospital hub, with available vaccine supply, they should invite eligible individuals to be vaccinated on site.  If the patient cannot be vaccinated at the hospital site, the consultant will write to the patient’s GP with clear advice on timing of a 3^rd dose and identifying any interaction with their current treatment. Patients should then be invited to be vaccinated at a PCN-led vaccination site.

GP teams should also identify patients on their list and liaise with hospital doctors to invite eligible individuals via their consultant. Patients will be given a clinical authorisation letter which they will need to take with them to receive their vaccination.

Can patients be vaccinated at a walk-in vaccination site?

A clinical authorisation letter will be given to eligible patients and this will act as authorisation to a COVID vaccination site that the patient requires a 3rd dose of the COVID-19 vaccine. Individuals can go to a centre which their clinician has highlighted or, if not specified, to any COVID vaccine centre offering walk-in vaccinations. Patients can find a walk-in COVID vaccine centre here: Search - Find a walk-in coronavirus (COVID-19) vaccination site (www.nhs.uk). They do not need to call their GP surgery or contact the hospital about this.

Can patients self-identify as severely immunosuppressed?

If individuals think they are eligible for a 3^rd dose and have not been contacted as yet, they are advised to speak to their GP or Consultant.

Is the 3^rd dose the same as the booster vaccine?

No.  The 3^rd dose is not the booster vaccine.  It is recommended that the 3^rd dose should be given at least 8 weeks after the 2^nd dose and is part of the primary course of immunisation.  A booster jab is also expected be offered 6 months after the 3^rd dose but we are currently awaiting JCVI guidance on this.

Which vaccine will be offered as a 3^rd dose?

JCVI have advised a preference for mRNA vaccines (full dose Pfizer-BioNTech or Moderna) for the third dose, with the option of the AstraZeneca Vaxzevria vaccine for individuals who have received this vaccine previously where this would facilitate delivery. For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.

When will a 3^rd dose be offered? What interval will there be between 2^nd and 3^rd dose?

The JCVI recommends that the 3^rd dose should be offered at least 8 weeks after the 2^nd dose.

Research shows that, as with the interval between the 1^st and 2^nd dose, 8 weeks has been observed as providing the individual with the most benefits in terms of an immune response. If, however, the patient’s GP or Consultant believes that an alternative interval should be offered, because of ongoing treatment or starting treatment which will suppress the individual’s immune system, then this timing may be altered. Intervals will be considered, in light of the individual’s specific health circumstances and an assessment made by their clinician.

Where possible, JCVI recommends that the 3^rd primary dose should be delayed until two weeks after the period of immunosuppression, in addition to the time period for clearance of the therapeutic agent.

Will a booster vaccine also be given?

It is expected that, in line with interim JCVI guidance, individuals will be eligible for a booster vaccine, as part of the routine booster programme, from around 6 months after their 3^rd dose. We are currently awaiting final advice from the JCVI.

If a severely immunosuppressed individual has had a good immune response to the first two doses, will they still be offered a third dose?

Some people who are immunosuppressed may not generate a good immune response regardless of the number of vaccine doses administrated. However, data is not currently available to reliably identify who might, or might not, benefit from a third primary dose of a COVID-19 vaccine.

The JCVI guidance highlights published studies describing the effect of a third dose of mRNA vaccine in persons who are immunosuppressed reporting increased immune responses in varying proportions.

JCVI guidance recommends that a 3^rd dose will be offered to individuals aged 12 years and over with severe immunosuppression (as defined within the JCVI guidance).

 What are the side-effects of a third dose?

Find out more about COVID-19 vaccines side effects and safety.

 When can people expect to be invited for, and to receive, these 3rd doses?

Hospital doctors and GP teams are already identifying and consulting with severely immunosuppressed patients.  The precise timing of an individual’s 3^rd dose vaccination will be determined following consultation with their consultant / GP in line with JCVI advice.

Are people in this group also eligible for the flu vaccine?

Some patients who are immunosuppressed are also eligible for the flu vaccine and we would strongly encourage them to get vaccinated to protect themselves against flu, which can have very serious complications for some immunosuppressed patients. Local GP teams and pharmacy services are offering flu vaccines in line with local available supply.

Close contacts of immunocompromised individuals are also eligible for the national influenza vaccination programme, specifically individuals who expect to share living accommodation on most days over the winter and, therefore, for whom continuing close contact is unavoidable.

Will the 3^rd dose be given alongside the flu vaccine?

Flu vaccine is not currently included in this advice. Advice on co-administration within this context will be issued in due course.

What do I do if I am contacted to have my third dose, after I've received my booster?

If a patient, who is immunosuppressed has already received their booster dose, this dose will be re-categorised on NHS systems as their third primary dose through a nationally coordinated process in due course. The patient can therefore ignore this letter if they have already received their booster dose as this will count as their third dose. As with other eligible patients, you will be able to access your booster dose after at least 182 days have passed since your last dose.

Reference documents

On 1 September 2021 the JCVI issued advice on third dose COVID-19 vaccinations as part of primary course vaccination schedule for those severely immunosuppressed.

JCVI issues advice on third dose vaccination for severely immunosuppressed - GOV.UK (www.gov.uk)

Third primary COVID-19 vaccine dose for people who are immunosuppressed: JCVI advice - GOV.UK (www.gov.uk)

The JCVI stated that the specialist involved should advise on whether the patient fulfils the eligibility criteria and on the timing of any third primary dose.

On 2 September 2021 NHSE/I wrote to all GP practices, NHS trust chief executives, CCGs and ICS/STP leads, among others, setting out actions for all systems to take to vaccinate immunosuppressed group identified by JCVI as requiring a third primary course dose.

C1399-Updated-JCVI-guidance-for-vaccinating-immunosuppressed-individuals-with-third-primary-dose.pdf (england.nhs.uk)

On 30 September 2021 NHSE/I outlined the assurance process for GPs https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/09/C1427-covid-19-vacc-assuring-implementation-of-jcvi-guidance-vaccinating-severely-immunosuppressed-individuals.pdf and Trusts https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/09/C1428-covid-19-vacc-assuring-implementation-of-jcvi-guidance-vaccinating-immunosuppressed-individuals-third-pr.pdf .

NHS England and NHS Improvement continue to emphasise the roles of clinicians and are working alongside patient charities and clinician networks to ensure eligible patients are identified and advised on the criteria of the third primary dose in line with JCVI guidance. Information for patients is available on the NHS website: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine-3rd-dose/

This information is correct as at: 29/11/2021