Instruction on timing of second dose of COVID-19 vaccinations



Classification: Official

Publication approval reference: C1039


  • All CCG Accountable Officers
  • All CCG Chairs
  • All PCNs and all GP practices
  • All NHS Trust Chief Executives

Copy to:

  • All Local Authority Chief Executives
  • NHS Regional Directors
  • NHS Regional Directors of Commissioning
  • Chairs of ICSs and STPs
  • Chairs of NHS trusts and foundation trusts
  • All Medical Directors, Chief Nurses and Chief Pharmacists

11 January 2021

Dear Colleague,

Further to our letter dated 30 December, we are now writing to set out clear instructions on offering second dose vaccinations to ensure maximum optimisation of the COVID-19 vaccination programme.

There has been a rapid increase in COVID-19 cases in December and January, resulting in a large increase in hospitalisations. Together with the emergence of a new variant, we must now do everything we can to maintain and step up the pace of vaccination, including extending vaccinations to frontline health and care workers.

Updated guidance from the independent JCVI and the UK chief medical officers was published on 30 December. It clearly sets out the need to increase spacing of second vaccine doses for both the Oxford/AstraZeneca vaccine and Pfizer/BioNTech vaccine.

The statement from the four UK Chief Medical Officers clearly sets out the rationale for prioritising first dose vaccination: vaccinating twice the number of people in the next 2-3 months is preferable in public health terms to vaccinating half the number with only slightly greater individual protection.

This public health approach is centred on doing as much good for as many people as possible in the shortest possible time and can be found in full here.

Vaccine efficacy

The two vaccines that have been approved by the MHRA that are in use in the UK, have impressive efficacy rates, offering protection to those most at risk.

The short-term vaccine efficacy from the first dose of the Pfizer-BioNTech vaccine is calculated at around 90% and around 70% for Oxford AstraZeneca, with high protection against severe disease. More information can be found in the PHE report to JCVI.

Given the high level of protection afforded by the first dose, expert clinical modelling produced by the Joint Committee for Vaccination and Immunisation shows vaccinating a greater number of people with a single dose will prevent more deaths and hospitalisations than vaccinating a smaller number of people with two doses.

A full copy of the report can be found here.

For immediate action

To help us deliver our public health duties identified above, we need to vaccinate as many people as quickly as possible, including our frontline health and care workforce. All vaccination sites must with immediate effect, ensure all second dose appointments that have not already been rescheduled must be rearranged.

This means all appointments to receive the second dose must be rescheduled, with recipients to be booked in for a second dose in the 12th week.

This includes second dose arrangements for both patients and health and care staff, and will enable us to protect double the number of frontline staff in half the time. A standard operating procedure to support vaccination rollout to staff was published on 7 January and can be found here.

Communications material for hospital hubs and local vaccination services to support the rescheduling of appointments will be reissued to your communications leads.

For all PCN and practice led local vaccination services

We ask all local COVID vaccination services to prioritise care home residents and care home staff to ensure this priority group is vaccinated against COVID-19 as quickly as possible. Both the Oxford/ AstraZeneca and packed down Pfizer vaccine should be prioritised towards immediately vaccinating care home residents and staff, and housebound over 80s.

An additional supplement of £10 per dose on top of the item of service fee for all vaccines delivered in a care home setting has been set up, and rescheduling support has been provided and made available to PCN-led local vaccination services.

Thank you for your continued efforts. We recognise the additional work this could generate at our busiest time of the year. However, we know that one life is saved for every 180 vaccinations of those aged 80 years or older and we must now take immediate action to ensure maximum short-term impact and lives saved.

Emily Lawson | SRO Vaccine Deployment and Chief Commercial Officer | NHS England and NHS Improvement

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

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