Survey shows nearly a quarter of people with rheumatic conditions are struggling to get access to a vital third primary jab

RAIRDA and its member charities are calling for urgent government action to address concerns about the roll-out of third primary doses for the COVID-19 vaccine. Our recent survey suggests that nearly one quarter (22%) in England with a rheumatic disease, whose treatment affects their immune system, are still unable to access a third primary COVID-19 vaccine dose. This is despite a national commitment to offer a third primary dose to immunosuppressed people by 11 October [1]. 

Two in five (41%) respondents, in England, also said they believed they received a booster jab instead of a primary dose. This raises concerns that some primary doses are being misclassified as boosters, which could prevent patients from accessing a recommended booster dose six months later.

Additional findings 

Supported by the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis Society (NRAS) and Arthritis and Musculoskeletal Alliance (ARMA) the survey findings in England found that:

  • More than one in three (38%) reported no proactive contact from the NHS to inform them of their eligibility for a third primary dose
  • Of those who had received their third primary dose, nearly half (45%) said it was much more difficult to access than their first or second.
  • 17% of patients taking rituximab, a treatment for those with very serious illness that is proven to have a major impact on vaccine protection, have still not received their third primary dose. 
  • Two in five (42%) people who completed the survey found it difficult to get an acknowledgement, or evidence from a healthcare professional to confirm eligibility in order to secure a third primary dose. 


The Joint Committee on Vaccination and Immunisation (JCVI) had issued guidance earlier this year recommending three primary COVID-19 vaccine doses for people who are immunosuppressed [2].  A booster jab would normally follow six months later. 

Risk from COVID-19 and vaccine protection

We know from previous research that people with rheumatic conditions are considerably less likely to generate antibodies after two doses of a COVID-19 vaccine [3]. Moreover, people with rare autoimmune rheumatic conditions are at greater risk, being twice as likely to die from COVID-19 or a complication related to the virus compared to the general population [4]. 

Our asks

The lack of clarity and communication means that many continue to remain inadequately protected as we approach Winter. As a result, we are calling for the government to go further in its commitment to protect vulnerable people from COVID-19 and work with NHS England and NHS Improvement to increase uptake of third primary doses. This includes:

  • clearer information for healthcare professionals and patients on third primary dose eligibility.
  • the accurate recording of third primary doses to ensure people have access to COVID-19 booster vaccinations.
  • the development of a self-referral mechanism for third primary doses on the national vaccine booking system, which will allow appointments to be booked more easily.

Advice and support

We urge those who think they are eligible for a third primary dose, and have not yet been contacted by the NHS, to contact their consultant for advice. Our member charities are also able to offer support and information. 


  1. NHS England, COVID-19 vaccinations – Assuring implementation of JCVI guidance for vaccinating severely immunosuppressed individuals with a third primary dose
  2. Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination, 1st September 2021
  3. Megan Rutter, Peter C Lanyon, Matthew J Grainge, Richard Hubbard, Emily Peach, Mary Bythell, Peter Stilwell, Jeanette Aston, Sarah Stevens, Fiona A Pearce, COVID-19 infection, admission and death among people with rare autoimmune rheumatic disease in England: results from the RECORDER project, Rheumatology, 2021;, keab794,
  4. National Institute for Health Research (NIHR): OCTAVE trial: Initial data on vaccine responses in patients with impaired immune system