Information for people with a weakened immune system

Getting a 3^rd COVID-19 vaccine dose

People with a weakened immune system (severely immunosuppressed) are being offered a 3^rd dose of a coronavirus (COVID-19) vaccine to complete the primary course.  This is also known as a 3^rd primary dose. 

If you had a weakened immune system when you had your first 2 doses, the vaccine may not have given you as much protection as it can for people who do not have a weakened immune system.  A 3^rd primary dose may help give you better protection.  The 3rd primary dose for people with a weakened immune system is different to a COVID-19 vaccine booster dose. 

People over the age of 12 who believe they may be eligible for a 3^rd primary dose of the vaccine because they have a weakened immune system can now get it with or without a referral letter from their clinician on presentation of relevant medical evidence and clinical assessment.

Medical evidence confirming eligibility for a third primary dose includes:

• A letter from your GP or specialist confirming eligibility and timing of a third primary dose.
• A hospital letter that describes the person’s condition at the time of the first and/or second dose
• Evidence of prescribed medication at the time of the first or second dose, either in a hospital letter that describes the medication being prescribed, a prescription copy or a medication box with the patient’s name and a date on it.

Please take any letter from your GP or hospital specialist and/or information about your medication with you to your vaccination appointment. 

You can book your 3rd dose on the National Booking System or attend at a walk-in clinic. 

When should I have my 3rd primary dose?

JCVI has previously advised that, the decision on the timing of the third primary dose should be undertaken by the specialist involved in your care. Following the recognition of the Omicron variant, JCVI has now advised that those who have not yet received their third primary dose may be given their third dose 8 weeks after their second dose to avoid further delay.

Which vaccine will be offered as my 3rd primary dose?

The JCVI advises that for adults aged 18 and older, either the Moderna or Pfizer-BioNTech COVID-19 vaccines be administered for the third dose, as a number of studies have reported an increased immune response in some immunosuppressed people after a third dose of an mRNA vaccine.  

For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.

Getting a booster dose (4th dose)

If you were eligible for a 3^rd primary COVID-19 vaccine dose, you can also get a 4^th dose as a booster and a 5th dose as a spring booster. This may help to give you better protection against developing a serious illness from COVID-19.

A booster dose can be given no earlier than three months (91 days) after the 3^rd primary dose. 

There is no automatic recall for a 3-month booster built into the national digital system for patients who are severely immunosuppressed and would be receiving a fourth dose.

To receive the 4th dose, a GP or your hospital specialist will invite you for your booster (4th dose) when it’s due. Most people can also book their appointment online or go to a walk-in COVID-19 vaccination site.

The 4^th dose will be given at three months (91 days) after your 3^rd dose unless you have a letter from your specialist advising otherwise.

Getting a spring booster (5th dose)

If you were eligible for a 3^rd primary COVID-19 vaccine dose, you can also get a 5th dose as a spring booster.

Those eligible will be contacted by the NHS when they are due a spring booster. You will usually be offered an appointment around 6 months after your last dose of COVID-19 vaccine. For more information, visit the NHS website.