Guidance on Covid-19 vaccination for the severely immunosuppressed

As the pandemic continues to develop and new variants emerge, we will be using this article to make sure everyone has access to important information regarding COVID-19 and what it means for people with rare autoimmune rheumatic diseases.

We’ll be updating this post regularly as new data and information emerges.

Background

People with a weakened immune system who are classified as severely immunosuppressed either due to underlying health conditions or medical treatment are being identified and offered a third primary dose of COVID-19 vaccination to help reduce their risk of getting seriously ill. 

It is recommended that the third dose be given at least eight weeks after the second, as part of the primary course of immunisation, but if your GP or consultant believes that a different 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.

The JCVI also recommends a booster dose for this group a minimum of three months (91 days) after the third primary dose.


Eligibility

Who is eligible for a third primary COVID-19 dose? 

Guidance from the Joint Committee on Vaccination and Immunisation (JCVI) recommends that a third dose be offered to individuals aged 12 years and over with severe immunosuppression. 

This includes people who 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 third dose

Further information about the eligibility criteria for a third dose has been published by the JCVI and is available here

Do I need a third primary dose or a booster dose?

RAIRDA has developed a vaccine flowchart below, in partnership with Versus Arthritis and The Arthritis and Musculoskeletal Alliance (ARMA) to help people work out if they are eligible for for a third dose, booster or neither which is available here.


Getting vaccinated

Included below is all the information someone needs to get vaccinated if they’re severely immunosuppressed.  

How to get your third dose of a COVID-19 vaccine

If you’re eligible for a third dose, your GP or hospital consultant should contact you to let you know. You may also have received a letter from the NHS advising that you may be eligible and to discuss this with your doctor. 

Your doctor will discuss with you how you can get your vaccine. You’ll usually get vaccinated at your local hospital or a local NHS service, such as a GP surgery.

If you are aged 18 or over and have a letter from a GP or hospital consultant confirming your eligibility for a third dose, you can also book your vaccination appointment online through the National Booking System or attend a walk-in vaccination site if you bring the letter with you to your appointment. 

If you are eligible and you do not have a referral letter from your GP or hospital consultant, you can still opt for a walk-in vaccination appointment, but you will need to present relevant medical documentation confirming your condition and have an assessment on site by a qualified healthcare professional. 

It’s important to be aware that not every walk-in site is able to offer vaccination for people who are severely immunosuppressed, so please use the NHS online walk-in site finder to make sure you choose the right site for you. 

Examples of medical evidence that can be used to confirm your eligibility includes, but is not limited to: 

  • A hospital letter describing your condition at the time of your 1st and/or 2nd dose
  • Evidence of prescribed medication at the time of your 1st/2nd dose – either in a hospital letter that describes the medication being prescribed, a prescription copy or a medication box with your name and the date on it

How to get your COVID-19 booster (fourth dose) 

If you are aged 18 and over and have already received a third dose of the vaccine, you should get a booster three months after your third vaccination. 

If you are eligible for a booster, your GP or hospital consultant should contact you to let you know and invite you to book your appointment. Your doctor will discuss with you how you can get your vaccine. You’ll usually get vaccinated at your local hospital or a local NHS service, such as a GP surgery.

If it has been three months since your third dose and you haven’t heard from your doctor yet, you should contact them to discuss your vaccination. 

Alternatively, if you already have a letter from a GP or hospital consultant confirming your eligibility for a third dose, you will be able to get a booster at a walk-in vaccination site if you take the letter with you, subject to assessment on site by a qualified healthcare professional. 

What adjustments are being made to support people who are severely immunosuppressed attending walk-in vaccination appointments?

Vaccination sites have been asked to ensure that appropriate arrangements and reasonable adjustments are in place such as priority lanes to support people who are less able to queue, including those in the severely immunosuppressed cohort.