Statement on third primary COVID-19 vaccine doses for people with rare autoimmune rheumatic diseases

Over the past few weeks, RAIRDA’s member charities have had hundreds of calls from patients reporting problems arranging the third primary COVID-19 vaccination dose they are eligible for.

There are tens of thousands of people in the UK with rare autoimmune rheumatic diseases. Whilst individually uncommon, people with these diseases therefore represent a significant proportion of those deemed clinically extremely vulnerable to the virus. Research has shown people with these diseases were significantly more likely to be infected with, and die from, COVID-19 during the first few months of the pandemic in the UK.

Given many of these people are on strong immunosuppressive treatment, they may not mount a strong immune response after two doses of COVID-19 vaccine.

Whilst we understand that the first two doses of vaccines should have given some degree of protection to patients, there is a clear need for a third primary doses for this group to give them the best protection, ideally timed to minimise the impact of their immunosuppressive treatments.

For England, full guidance on who is eligible for a third primary vaccination can be read here in Annex A. Guidance from the British Society for Rheumatology is that all rheumatology patients, aside from those solely on hydroxychloroquine and/or sulfasalazine, should receive a third dose to enhance primary vaccination.

We passed on the patient concerns we had heard in England to the Department of Health and Social Care who have given us the following guidance:

  • If you have received a letter from your consultant or GP advising on when you should have your third dose, you can take the letter to a walk-in vaccination site. Vaccinators will not be able to administer the vaccine without this letter.
  • The NHS in England has sent texts to those eligible last week and letters should be arriving this week.
  • In the meantime, any patient who has not yet been contacted but thinks they may be eligible for a third dose can contact their consultant for an update.

However, we know that some patients find it difficult to contact their consultant or get a timely response to queries, and that many consultants, hospital departments, and GPs are currently over capacity.

The above guidance applies in England. However, we understand there are issues, to a lesser or greater extent, across the UK and are working to relay the concerns of patients, and to obtain similar guidance from health departments, in the other nations of the UK.

In some areas, we have heard positive feedback from patients about hospital departments who seem to have been able to contact all their patients. To us, this is just another example of the importance and the advantages of well-resourced, well-organised, and well-coordinated care for these conditions.

Due to the ongoing issues we hope the health service will explore a self-referral mechanism for people who need a third primary dose which could keep the need for GP and consultant involvement to a minimum.