Publication approval reference: C1531
- Trust medical directors (to cascade to clinicians/clinical teams who manage immunosuppressed patients)
- Regional directors
- Regional directors of commissioning
- Regional medical directors
- Regional directors of public health
25 January 2022
We previously wrote (on 2 September and 30 September) to ask for your support to ensure eligible severely immunosuppressed patients aged 12 and over receive a third primary dose of the COVID-19 vaccine, following JCVI advice in September, and we wrote to cancer alliances in November about the same subject.
We are writing now to ask for your support to ensure that patients who are severely immunosuppressed receive their booster dose as well as continuing to offer third primary doses to those who are eligible.
The further JCVI advice on 29 November stated:
Severely immunosuppressed individuals who have completed their primary course (3 doses) should be offered a booster dose with a minimum of 3 months between the third primary and booster dose. Those who have not yet received their third dose may be given the third dose now to avoid further delay. A further booster dose can be given in 3 months, in line with the clinical advice on optimal timing.
To ensure that all severely immunosuppressed individuals are offered an opportunity to receive the COVID-19 vaccinations for which they are eligible, please contact the lead specialist in each of the trusts in your area and:
- ask them to write to all patients who are eligible for a booster dose, inviting them to receive that dose, in line with November’s JCVI advice, as soon as possible – using the referral letter template in Appendix A and the FAQs in Appendix C.
- ask them to write to all eligible patients who have not yet received a third primary dose, inviting them to receive that dose, in line with September’s JCVI advice, as soon as possible – using the referral letter template in Appendix B, and the FAQs in Appendix C.
Trusts should vaccinate severely immunosuppressed patients eligible for a booster dose (a minimum of three months since their third primary dose), and any remaining third primary doses, within their hospital hub. If the local hospital hub is not available, trusts should put collaborative arrangements in place with a local vaccination service, such as a vaccination centre, to book the patient a vaccination at that site.
All opportunities should be explored to ensure that eligible individuals are receiving the COVID-19 vaccination for which they are eligible, and this should be a key part of any in-person or remote consultation undertaken relating to the individual’s condition.
Severely immunosuppressed people with a referral letter can attend walk-in clinics to receive their third primary or booster dose. Further details for patients on receiving a third primary dose are available here and for a booster here.
Owing to the complexity of this cohort, the need for optimal timing, and change in severely immunosuppressed status, specialists have a key ongoing role to play to ensure their eligible severely immunosuppressed patients are receiving the COVID-19 vaccination for which they are entitled (whether first, second, third or booster dose).
At the same time, while the cohorts are slightly different, they should continue to make eligible highest risk patients aware of their eligibility for COVID-19 treatments (see recent correspondence).
If you have any questions, please contact your regional vaccination operations centre.
Many thanks in advance for your support with this important matter.
Professor Stephen Powis | National Medical Director | NHS England and NHS Improvement
Dr Nikita Kanani | Deputy Senior Responsible Officer, NHS Vaccine Deployment and Medical Director for Primary Care | NHS England and NHS Improvement
Appendix A: Template referral letter inviting patients who require a booster dose following severe immunosuppression, for consultants to adapt and send along with Appendix C Frequently Asked Questions
Referral for your booster dose of the COVID-19 vaccine
We are writing to let you know that you are now eligible for a booster dose of the COVID-19 vaccine, following advice from the Joint Committee on Vaccination and Immunisation (JCVI) in November.
The advice recommends that a booster dose is given to individuals aged 12 and over who were immunosuppressed at the time of the administration of their first two doses, from 91 days after their third primary dose. This is being advised as a precautionary measure to increase immunity levels and provide a better vaccine response, based on studies and experience with other vaccines.
You are eligible for a booster dose given [diagnosis and/or treatment, delete as appropriate] and your receipt of a third primary dose on [date].
[Note: For a few people, the timing of their booster may need to be determined considering the therapy they are receiving. [GP/consultant] to advise here about optimal timing, and to please select the relevant option below]:
I am recommending that you receive your COVID-19 booster dose
- between [dates] to ensure optimal interaction with your treatment.
- xxx days prior to/after [delete as applicable] your therapy is administered.
- at any time and you should get vaccinated at the earliest opportunity.
You can receive your vaccination [select as applicable] by:
- booking an appointment at a local vaccination service using this link [add link to local booking system]
- attending your local hospital hub/ hospital hub+ [signpost as appropriate]
- presenting this referral letter at a walk-in clinic offered by your local vaccination centre, community pharmacy or hospital hub/hospital hub+.
This letter confirms your eligibility for a further vaccination. Please take this letter with you to receive your booster dose of the vaccine.
Answers to some common questions are included with this letter. Please read these, particularly if you are in active treatment, as they contain important information about the timing of your third primary dose and booster dose.
[Signatory on behalf of NHS trust]
Appendix B – Template referral letter inviting patients who require a third primary COVID-19 vaccine dose following severe immunosuppression, for consultants to adapt and send along with Appendix C
Dear [insert name of patient]
Referral for your third primary dose of the COVID-19 vaccine
We are writing to you because you are eligible for additional doses of the COVID-19 vaccine.
This includes a third dose as part of your primary course of the vaccine, to be followed by a booster no sooner than 91 days after this third primary dose, following advice from the Joint Committee on Vaccination and Immunisation (JCVI) in September and November.
The advice recommends that a third primary dose and booster dose is given to individuals aged 12 and over with severe immunosuppression in proximity to their first or second dose of COVID-19 vaccine. This is being delivered as a precautionary measure to increase levels of immunity and provide a better vaccination response based on studies and previous experience of other vaccines.
You are eligible for the third primary dose given your [diagnosis and/or treatment, delete as appropriate].
This letter confirms your eligibility for a further vaccination. Further details on options to access your vaccination are available on the NHS website. Please take this letter with you to receive your third primary dose of the vaccine. You can also use it to access your follow up booster three months later.
Answers to some common questions are included with this letter. Please read these, particularly if you are in active treatment, as they contain important information about the timing of your third primary and booster dose.
[Signatory on behalf of NHS Trust]
Where can I find JCVI guidance about those who have been immunosuppressed and their families?
The JCVI regularly updates their recommendations. Please see the links below to relevant recent guidance:
- JCVI advice on third primary doses for those who have been severely immunosuppressed (1 September)
- JCVI advice on booster doses for those who have been severely immunosuppressed (29 November)
- JCVI advice on vaccination of children and young people (including 5- to 15-year-olds who are household contacts of those who have been immunosuppressed) (22 December)
What is the third primary dose?
This dose should form part of your main COVID-19 vaccination course. You may hear this referred to as the third primary dose of the vaccine. This is advised to help boost your immunity to COVID-19 and ensure the best possible vaccine response. This is based on research and experience with other vaccines. The third dose should be delivered a minimum of eight weeks following your second COVID-19 vaccination.
Is the third primary dose the same as a ‘booster’ dose?
No, the third primary dose is not the same as a booster vaccination. Based on current recommendations, you will also be offered a booster vaccination no sooner than 91 days after your third dose.
How do I get my vaccination?
Your referral letter will let a COVID-19 vaccination site know that you require a third primary dose of the COVID-19 vaccine. If you have already had your third dose, the letter explains that you are also eligible for your booster three months later.
You can take your referral letter with you to the vaccination centre which your clinician has highlighted. If they have not specified one, you can book via the National Booking Service for your third primary dose, or visit a COVID-19 vaccination centre offering walk-in vaccinations that specify they have ‘third dose availability’. You do not need to call your GP surgery or contact the hospital about this.
It is not yet possible to book your booster on the National Booking Service.
Walk-in vaccinations for people who have been severely immunosuppressed are available for you to receive your third primary dose and/or your booster. Please use the online walk-in vaccination site finder to find your nearest available walk-in clinic.
Ideally you will need a referral letter from your GP or specialist. If you don’t have a specific letter directing you to receive a third primary dose or booster, you may still be able to receive these following a clinical conversation and if you are able to provide evidence of your condition or therapy.
If I don’t have a specific referral letter from my GP or hospital, what evidence should I provide the vaccination site with to prove I am eligible for a third primary dose?
If you don’t have a specific referral letter that describes your condition, you can present evidence such as:
- a hospital letter that describes your condition, or the medication you were prescribed with, at the time of your first and/or second dose
- a prescription copy or a medication box with your name and a date on it.
Will I still need a booster of the COVID-19 vaccine?
Yes, severely immunosuppressed individuals who have completed their primary course of three doses should be offered a booster dose with a minimum of three months between the third primary dose and the booster.
Are 5-11 year olds who are household contacts of someone who is severely immunosuppressed now eligible for a primary vaccination course?
Yes, they are now eligible for a primary vaccination, joining children in older age groups. For further details please see this statement from JCVI.
How can I access antibody testing to assess response to vaccination?
The NHS has launched a national COVID cancer antibody survey for individuals who are on cancer treatment or have been diagnosed in the last year. The survey will enable you to find out your COVID antibody responses following vaccination or infection. If you choose to participate in this survey, a finger prick blood kit will be sent to you at home and testing will be done through the gov.uk antibody testing program. You can self-enrol at https://covidcancersurvey.uk.