Acceleration of second doses for all cohorts


Classification: Official

Publication approval reference: C1342


ICS and STP leads
All CCG accountable officers
All NHS trust chief executives
All local authority chief executives


ICS and STP chairs
All CCG chairs
Chairs of NHS trusts and foundation trusts
All PCNs and GP practices
All community pharmacy
NHS regional directors
NHS regional directors of commissioning

6 July 2021

Dear Colleagues,

Acceleration of second doses for all cohorts

Yesterday, the government set out their latest guidance for appointments of a second dose of the COVID-19 vaccine to be brought forward from 12 to eight weeks for the remaining people in all cohorts who have yet to receive their second dose. This is to ensure everyone has the strongest possible protection from the Delta variant of the virus at the earliest opportunity possible.

This announcement builds on the previous advice that second doses for cohorts 1-9 should be brought forward from 12 weeks to eight weeks. All providers are asked to continue to vaccinate priority groups as soon as possible and not to hold on to vaccine supply.

In addition, the Green Book guidelines for COVID-19 vaccine dosing intervals have been updated (1 July) by Public Health England, in line with JCVI guidance.

The guidance states:

“For both adenovirus vector and mRNA vaccines, there is evidence of better immune response and/or protection where longer intervals between doses are used.

“Currently, JCVI is recommending an interval of eight to 12 weeks between doses of all the available COVID-19 vaccines. Operationally, this consistent interval should be used for all two dose vaccines to avoid confusion and simplify booking and will help to ensure a good balance between achieving rapid and long-lasting protection.

“The main exception to the eight-week lower interval would be those about to commence immunosuppressive treatment. In these individuals, the minimal intervals outlined below may be followed to ensure that the vaccine is given while their immune system is better able to respond.”

Actions now required

Accelerating second doses

With immediate effect, functionality on the National Booking Service (NBS) will change so that anyone who books their appointments through NBS will be offered their second dose appointment 56 to 84 days after their first dose appointment.

Work is expected to be completed shortly so that patients that wish to rebook are able to check the level of appointment availability on the NBS before cancelling and rescheduling their existing second dose appointment.

For those who have already received a first dose of a vaccination and have an appointment booked for a second dose in the next 10 days (up to and including 18 July) no action is required and appointments should continue as scheduled.

For those who have their second dose appointment scheduled on or after Monday 19 July:

  • Vaccination centres and community pharmacy-led local vaccination services (LVS): every effort needs to be made to ensure all additional capacity for first and second doses is uploaded to the National Booking System (NBS). Vaccination centres should open as many second dose slots as possible.
    From 7 July, we will start texting those with bookings more than 10 days out and more than nine weeks from their first dose, inviting them to rebook.
  • PCN-led LVS: all remaining second dose appointments scheduled on or after July (where that is more than eight weeks after their first dose) should be brought forward.
    Plans to do this should include working with your ICS to bring in additional workforce to run additional clinics.
    There is sufficient vaccine currently in the network to cater for changes to the second dose interval. We will review future delivery schedules to align to the new operational guidance and communicate them in the usual way.
  • Hospital Hubs: all second dose appointments scheduled on or after 19 July (where that is more than eight weeks after their first dose) should be brought forward. For those hospital hubs which are now utilising NBS, every effort needs to be made to ensure all additional capacity for first and second doses is uploaded.

Dosing interval

In line with the updated Green Book guidance second dose vaccinations should not be offered earlier than eight weeks. Any decision to vaccinate earlier than eight weeks should be made by the patient’s responsible clinician or vaccination site clinical lead on a case-by-case basis and must be based on clinical risks and benefits of giving the second dose earlier than eight weeks. There must be no blanket approach taken by vaccination sites to offer second doses sooner than advised.

Next steps

Finally, a webinar will be held for all key partners involved in COVID-19 vaccine deployment on 8 July at 6.15pm. This will provide an opportunity to discuss the latest developments, next steps from planning and ensure every system has what they need to deliver. Please register to attend before 4.30pm on the day of the event and the joining instructions can be found here.

Thank you for your continued leadership on this vital programme.

Keith Willett | SRO Vaccine Deployment | NHS England and NHS Improvement