Individuals aged 12 and over with immunosuppression are now recommended to receive a third primary dose of the COVID-19 vaccine

Dear Patient

We are writing to let you know that according to our records you may now be eligible for an extra dose of the COVID-19 vaccine given your current health condition or treatment you are receiving. This is based on the latest advice from the Joint Committee on Vaccination and Immunisation (JCVI) Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination – GOV.UK (

The advice recommends that a third dose is given to individuals aged 12 and over who were immunosuppressed around the time of receiving their first or second Covid-19 vaccine dose. This is being advised as a precautionary measure to increase your immunity level and provide a better vaccine response. It is part of your primary course of vaccination and is separate to a booster vaccination, which you will likely become eligible for in six months’ time, pending further advice from the JCVI.

The JCVI advises a preference for either of the mRNA vaccines Pfizer or Moderna, irrespective of which vaccine you received for your first and second doses. In Cornwall, the main mRNA vaccine used is Pfizer and therefore this is the vaccine you will likely receive. If you are unable to have Pfizer or Moderna for medical reasons (e.g. allergy) then the Astrazeneca vaccine can be used following a discussion with a health professional on a case-by-case, individualised basis.

The third dose must be at least 8 weeks after your second dose and scheduled, where possible, to coincide with periods of minimum immunosuppression. Our records indicate that you are on a long-term medicine that can cause immunosuppression (please see Annex A for further information) and as such, the timing of your third dose is less crucial, provided the 8 weeks has elapsed since your second dose.

If you have already had a third dose as part of the recently launched ‘booster’ dose programme at 6 months after your second vaccine, then please treat that dose as a ‘third primary vaccination’ and you will likely become eligible for a further booster dose in the future, pending further advice from the JCVI.

To access the third dose of vaccine please use the following link to book your appointment through either the Royal Cornwall Showground Vaccination Centre, the Health & Well-Being Vaccination clinic at Treliske or your local community pharmacy via the link. The app works best in Google Chrome.

Please ensure you bring this letter with you to your vaccination clinic appointment as proof of eligibility for a third primary dose of covid vaccine.

If you are unable to use the link or require further guidance then please phone the covid helpline on 01872 252205 or email

For more information about the coronavirus vaccine visit

If you have already organised your third primary dose then please disregard this letter.

Yours sincerely,
North Cornwall Coast PCN

Annex A – JCVI list of eligible individuals

1. Individuals with primary or acquired immunodeficiency states at the time of vaccination due to conditions including:

  • acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure
  • individuals under follow up for chronic lymphoproliferative disorders including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma, Waldenstrom’s macroglobulinemia and other plasma cell dyscrasias (note: this list is not exhaustive)
  • immunosuppression due to HIV/AIDS with a current CD4 count of <200 cells/μl for adults or children
  • primary or acquired cellular and combined immune deficiencies – those with lymphopaenia (<1,000 lymphocytes/ul) or with a functional lymphocyte disorder
  • those who had received an allogeneic (cells from a donor) or an autologous (using their own cells) stem cell transplant in the previous 24 months
  • those who had received a stem cell transplant more than 24 months ago but had ongoing immunosuppression or graft versus host disease (GVHD)
  • persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (for example, common variable immunodeficiency) or secondary to disease/therapy

2. Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including:

  • those who were receiving or had received immunosuppressive therapy for a solid organ transplant in the previous 6 months
  • those who were receiving or had received in the previous 3 months targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators including B-cell targeted therapies (including rituximab but in this case the recipient would be considered immunosuppressed for a 6-month period), T-cell co-stimulation modulators, monoclonal tumour necrosis factor inhibitors (TNFi), soluble TNF receptors, interleukin (IL)-6 receptor inhibitors, IL17 inhibitors, IL 12/23 inhibitors, IL 23 inhibitors (note: this list is not exhaustive)
  • those who were receiving or had received in the previous 6 months immunosuppressive chemotherapy or radiotherapy for any indication

3. Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including:

  • high-dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the previous month
  • long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months
  • non-biological oral immune modulating drugs, such as methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day, 6 mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day in the previous 3 months
  • certain combination therapies at individual doses lower than above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine)

4. Individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination.

Individuals who had received brief immunosuppression (≤40mg prednisolone per day) for an acute episode (for example, asthma / COPD / COVID-19) and individuals on replacement corticosteroids for adrenal insufficiency are not considered severely immunosuppressed sufficient to have prevented response to the primary vaccination.