Information on the Government’s additional COVID-19 advice for people whose immune system means they are at higher risk



Classification: Official

Publication approval reference: C1511


  • All GP practices


  • NHS regional directors
  • NHS regional directors of commissioning
  • Directors of public health
  • Foundation trust medical directors

4 January 2022

Dear colleagues

We are writing to let you know that the Government has provided new guidance for people whose immune system means they are at higher risk of serious illness if they become infected with COVID-19.

This letter is for information only. You do not need to take any action.

Who the advice applies to

This advice applies to those with weakened immune systems who are:

  • eligible for a third primary dose of the COVID-19 vaccine; or
  • eligible for new COVID-19 treatments.

A list of the people who meet these criteria is included in the following links:

Nature of advice

The Government advises these people to take additional precautions. The list of additional precautions is included at Annex A and the full guidance can be accessed here.

The guidance also draws attention to the importance of vaccination and access to new treatments for these groups of patients.

As you are aware, the Shielding Programme was closed in September 2021. The Government advises those formerly identified as Clinically Extremely Vulnerable (a larger cohort of people than only those who are immunosuppressed) to follow the same guidance as the rest of the population. The Government also notes that this group may still wish to consider if additional precautions are right for them and may receive specific advice from their clinician on staying safe. This advice is available here.

What does this mean for you?

Patients whose immune system means they are at higher risk are likely to be alerted to the additional guidance through the media, charities and other communications. It is helpful for you to be aware of the advice as part of your general care.

We would like you, in particular, to be aware of the advice to this cohort to work from home where possible. If they are unable to work from home, they are advised to speak to their employer about what temporary arrangements can be made to reduce their risk. If they are too ill to work, they may be eligible for Statutory Sick Pay. There is currently a time limited change in how Statutory Sick Pay can be accessed, which is set out in the following guidance: Children and young people should attend education settings unless their clinician has advised otherwise.

The guidance may also heighten interest in new treatments and vaccination for those who are immunosuppressed:

As you will be aware, people with a weakened immune system who have had a third primary dose of the vaccine can get a booster dose from at least 3 months after their third dose. GPs and hospital specialists have been asked to identify and invite patients for their booster dose when it’s due. More information about booster doses:

Thank you again for everything you are doing to support this phase of the COVID-19 response.

Yours sincerely

Professor Stephen Powis | National Medical Director | NHS England and NHS Improvement

Dr Nikita Kanani | Medical Director for Primary Care | NHS England and NHS Improvement

Annex A: Government guidance for people whose immune system means they are at higher risk

If you are in one of the two groups with weakened immune systems (eligible for a third primary dose of the COVID-19 vaccine or eligible for new treatments for COVID-19) the Government advises you to:

  • ensure you have had all of the vaccines you are eligible to receive, including your booster
  • continue to follow any condition-specific advice you may have been given by your specialist
  • work from home if you can. If you cannot work from home, speak to your employer about what temporary arrangements they can make to reduce your risk
  • wait until 14 days after another person’s most recent dose of a COVID-19 vaccine before being in close contact with them
  • avoid enclosed crowded spaces
  • practice social distancing if that feels right for you and your friends
  • ventilate your home by opening windows and doors to let fresh air in
  • ask friends and family to take a rapid lateral flow antigen test before visiting you
  • ask home visitors to wear face coverings
  • wash your hands regularly and avoid touching your face.