Vaccines for COVID-19 – your questions answered

Last updated: October 2022

The JCVI has recommended a booster dose to help boost immunity over the winter of 2022-23 in people who are most at risk from COVID-19.

The following groups will be offered a booster dose during the autumn of 2022:

• residents and staff of care homes for older adults
• frontline health and social care workers
• all adults aged 50 and over
• people aged 5–49 who are in a clinical risk group
• people aged 5–49 who are household contacts of people with weakened immune systems
• people aged 16–49 who are carers.

The autumn booster doses should be given a minimum of 3 months after your previous dose of COVID-19 vaccine.

If you’re in one of the other groups listed above, you will be contacted when booking is open for you.

Most people in these groups will be offered one of the newer vaccines which target the Omicron BA.1 variant of COVID-19 as well as the original virus (these are called ‘bivalent’ vaccines). However, the JCVI have advised that in the event of shortages, one of the original Moderna or Pfizer BioNTech vaccines may be given instead. This is because prompt delivery of the booster doses before the winter is considered more important than the type of vaccine given.

You may be able to have a flu vaccine at the same time as your COVID-19 booster, but it’s not recommended that you delay having either vaccine if it isn’t possible to have the two together.

Last updated: June 2022

There are some types of arthritis which are caused by the body’s immune system, which usually protects us from infection. When the immune system is affected by arthritis or drugs to treat the condition, the risk from COVID-19 is increased.

People who catch COVID-19 can become very unwell. Many people will need hospital treatment even if they don’t have a health condition.

Vaccines are a good way for people with rheumatology conditions to stay safe. Vaccines teach the immune system to recognise infections, stopping people becoming unwell.

When vaccines for COVID-19 first became available, the Joint Committee on Vaccination and Immunisation (JCVI) issued guidance on priority groups to receive the vaccines.

The JCVI continues to advise the four governments of the UK on who should receive the vaccines, including booster doses, and when.

Read the NHS open letter to people with a weakened immune system (PDF, 771 KB) which explains why it's important to have the COVID-19 vaccination and to keep up to date with your booster doses.

The vaccine is currently available to everyone over 5. People aged over 16 will be contacted by the NHS when it’s their turn to get the vaccine.

Those aged 12 to 15 are able to have two adult doses of the Pfizer-BioNTech COVID-19 vaccine. For most people in this age group, the second dose will be given 12 weeks after the first dose. However, those who are at higher risk from COVID-19 or who live with someone who has a weakened immune system may have the two doses 8 weeks apart.

Children aged between 5 and 11 can also have two doses of the Pfizer/BioNTech vaccine, but these will be lower doses than for adults. For most children in this age group the two doses will be given at least 12 weeks apart3. However, those who are at higher risk from COVID-19 or who live with someone who has a weakened immune system may have the two doses 8 weeks apart.

In September 2021, the JCVI announced that people who had severely suppressed immune systems at the time of their first and second doses of the vaccine should be offered a third dose. This is not a booster dose, but an additional dose to increase your protection from COVID-19. People with suppressed immune systems will then be eligible for their booster three months after they have had their third primary dose.

You can find out who is able to get a third dose of the vaccine, and a booster dose, in the sections below.

In England, you can access the online national booking system to make an appointment or call 119 free of change between 7am and 11pm.

In Scotland, you can visit the NHS Inform website to find out how to book for primary or booster doses.

In Wales, you can check your local health board’s vaccination webpages for information about clinics and appointments. Find you local NHS health board.

In Northern Ireland, you may be eligible to book your appointment online for a Trust location. Or you can go to the nidirect website to find out more about how to book.

We know that some people who might be at an increased risk from COVID-19 may still have concerns about visiting their GP practice or local vaccine site to get vaccinated.

There are things you can do to reduce your risk of COVID-19 outside the home, such as wearing a mask, washing your hands regularly, and keeping a distance from other people as much as possible. 

If you are offered the vaccine and delay taking it, you leave yourself at risk of COVID-19.

People over 12 who had severely suppressed immune systems at the time of their first and second doses of the vaccine can get a third dose.

This is not a booster dose, but an additional ‘top-up’ dose to increase protection from COVID-19 for people who may not have not had a good response from the first two doses. People who have a third dose will be offered their booster after three months. Your GP or rheumatology team will invite you for your booster dose when it's due. 

Based on the guidance put out by the JCVI, the British Society of Rheumatology (BSR) has recommended that that most people who were taking the following treatments during the time of their first two doses, be offered a third dose of the vaccine:

• Conventional DMARDs, such as methotrexate, azathioprine, mycophenolate mofetil.
• Anti-TNF biologics, such as infliximab, adalimumab, etanercept, golimumab, certolizumab pegol.
• Other biologics, such as rituximab, tocilizumab, abatacept, ustekinumab, secukinumab, belimumab.
• JAK inhibitors, such as baricitinib, tofacitinib, upadacitinib, filgotinib.
• Prednisolone (steroid tablets) at doses of at least 10mg per day.

This does not include the DMARDs sulfasalazine or hydroxychloroquine.

A third dose is recommended at least 8 weeks after the second dose of the vaccine.

Not all people who have or are currently taking these treatments need to receive a third dose. Your doctor should be able to tell you whether you should receive a third dose based on your medical history.

Rheumatology teams and GPs have been asked to review their patient records and invite people with severely suppressed immune systems to get their third dose of the COVID-19 vaccine. Everyone who is eligible for a third dose of the vaccine should have been contacted by either their rheumatology team or GP by 11 October.

If you have not been invited to receive a third dose, but you think you should have been, you should contact your GP or rheumatology team.

If the medications you take have changed over time or if you get your prescriptions from different doctors, it might be harder for doctors to correctly identify you as eligible for a third dose. It may be helpful to confirm your status as a severely immunosuppressed person with your GP in order to arrange getting a third COVID-19 vaccine.

You can download this letter template to help you register with your GP as severely immunosuppressed. (PDF, 116KB)

Third primary doses of the COVID-19 vaccine are being offered to people who have a severely suppressed immune system, either because of a health condition or treatment.

This is because research has found that people in this group are less likely to have received a good level of protection from their first two doses of the vaccine. A third primary dose is being offered to this group to try to increase their initial levels of protection.

Booster doses are offered from time to time after completion of a primary course of vaccinations. This is because the effectiveness of the vaccines in preventing COVID-19 infection has been shown to tail off after a time.

The information provided in this flowchart is based on recommendations from the British Society for Rheumatology.

The first three COVID-19 vaccines available for use in the UK were – the Pfizer/BioNTech vaccine (brand name: Comirnaty) , the Oxford AstraZeneca vaccine (band name: Vaxzevria) and the Moderna vaccine (band name: Spikevax).

The Pfizer/BioNTech and Moderna vaccines use bits of genetic code to cause an immune response, and are known as mRNA vaccines. The Oxford AstraZeneca vaccine uses a real virus that has been inactivated to cause an immune response.

These are safe ways to show the body what COVID-19 looks like, so that the immune system is better prepared to fight a COVID-19 infection.

More recently, some vaccines have been adapted with the aim of providing greater protection against COVID-19 variants, especially the Omicron BA.1 variant, while still offering protection against the original strain of the virus. These are known as ‘bivalent’ vaccines. Pfizer BioNTech and Moderna bivalent vaccines have both been approved for use in the UK for the Autumn 2022 booster doses.

People with some types of arthritis take medicines to suppress the immune system. In general people on these treatments need to avoid live vaccines. You can find out more about live vaccines and how they can affect people taking drugs to suppress the immune system on our vaccinations webpage.

All of the COVID-19 vaccines available in the UK are safe for people with arthritis and people taking drugs that suppress the immune system, even if your condition is active.

The Pfizer/BioNTech and Moderna vaccines are not made from a real virus, and people who take medicines to suppress the immune system can have these vaccines.

Although the Oxford AstraZeneca vaccine is made of a real virus, it has been inactivated so it can’t cause a serious infection, even in someone whose immune system has been suppressed. This means that it’s safe for people who are on medicines to suppress the immune system.

People on drugs that suppress the immune system are on the priority list for vaccination that has been produced by the Joint Committee on Vaccination and Immunisation (JCVI).

There is no good evidence that one vaccine is more suitable than another for people who are on drugs that suppress the immune system. It may take many months of further research to determine this.

People with suppressed immune systems who need a third dose of the vaccine will usually be offered the Pfizer/BioNTech or Moderna vaccine if they’re over 18, regardless of what initial vaccine they received for their first and second doses. However, JCVI guidance does allow for Oxford AstraZeneca to also be used for third doses if it is available. The Pfizer/BioNTech vaccine is preferred for third doses in people aged 12 to 17.

Recent trials have shown that mixing vaccine types is safe and does not lower the level of protection from COVID-19.

If you’re offered the vaccine and delay taking it, then you leave yourself at risk from COVID-19.

Some people who are taking drugs that suppress the immune system may be given advice to continue avoiding exposure to COVID-19 after they have had the vaccination. This is because their medications could mean their immune system doesn't respond as strongly to the vaccine as people who don't take these drugs.

People with severely suppressed immune systems, either because of their condition or the medication they take, generally receive a much lower level of protection after just one dose of the vaccine, so it is very important for this group to get all recommended doses of the vaccine in order to be as protected as possible.

The OCTAVE study is exploring the effectiveness of the vaccine after two doses in people with autoimmune conditions. Read more about the OCTAVE study and its initial results.

A third dose of the vaccine is recommended for people who have severely suppressed immune systems. This is being given as a ‘top-up’ for people who may not have had a full response to their first two doses, to maximise the level of protection this group has.

If you’re offered the vaccine and delay taking it, then you leave yourself at risk from COVID-19.

The VROOM study , published in June 2022, showed that stopping methotrexate for two weeks after a COVID-19 vaccination doubled people’s antibody response for at least three months without causing major flare-ups of arthritis. While pausing methotrexate after vaccination may be a good idea for many people, we don’t recommend pausing any of your treatments without checking first with your healthcare team.

If you haven’t yet started treatment with medicines that suppress the immune system, or if you’re about to have a repeat course of treatment to suppress the immune system, it might be a good idea to delay this for a period after you have had a dose of the vaccine. But you should only think about doing this if your rheumatology team say that it is safe to delay your treatment.

Everyone in the UK will need to follow government advice on reducing the spread of COVID-19, even after they have had the vaccine. People who are clinically extremely vulnerable will need to follow the local advice for this group, even if they have been vaccinated against COVID-19.

It’s fine for you to have the vaccine while you’re taking steroids. There’s no reason to delay the vaccine if you’re taking steroids, or have recently had a steroid injection or finished a course of steroid treatment.

Taking steroids as tablets, liquids, injections or drips might mean that your immune system doesn’t respond as well to the vaccine as someone who isn’t taking these drugs. This means that you may be advised to follow advice on shielding and social distancing guidance after you have had it and if you may need a third dose of the vaccine as part of your initial course. Steroid creams or eye drops should not affect your immune system or response to the vaccine.  

Your healthcare team might want to discuss delaying a dose of steroids or a steroid injection with you, especially if there is a high risk of getting COVID-19. It’s important that you don’t stop taking your steroid medication without speaking to a healthcare professional, as this can leave you at risk of having a flare-up, which can increase your risk of COVID-19.

It’s known that children and young people are at a very low risk of severe illness from COVID-19, including those with arthritis and related conditions.

The government has said that children aged between 5 and 15 can receive two doses of the Pfizer/BioNTech vaccine. Children aged 12-15 who are severely immunosuppressed are able to have a third primary dose of the vaccine.

Children aged between 12 and 15 who are at higher risk of COVID-19, or who live with someone who is more likely to get infections (such as someone who has rheumatoid arthritis or lupus) are also able to get a booster dose of the vaccine. Children in this age group who have had three primary doses of the vaccine will also be able to have a booster dose three months after their last primary dose.

See the above sections ‘Who will receive a third dose of the vaccine?’ and ‘Who can have a booster dose of the vaccine?’ for more information on these doses.

Children aged between 5 and 11 are now able to have two doses of the Pfizer/BioNTech vaccine. These will be lower doses than the vaccines for adults. It is not yet known if or when 5-11 year-olds will be able to have booster doses.

It’s recommended that pregnant women are offered either the Moderna or Pfizer/BioNTech vaccine at the same time as the rest of their age group, or if they are at an increased risk of COVID-19 due to a medical condition or treatment.

If you have already received a dose of the Oxford AstraZeneca vaccine and are pregnant, it’s still fine for you to have a second dose of this vaccine.

It’s recommended that breastfeeding women can receive any of the available COVID-19 vaccines, as long as it’s suitable for them. Trials on using the vaccines during pregnancy and breastfeeding are still in the early stages, but there is nothing to suggest that they are harmful during pregnancy or breastfeeding.

If you are pregnant or breastfeeding, your doctor or midwife will be able to give you more advice and discuss with you the benefits and risks of vaccination based on the evidence we have so far.

Guidelines recommend people do not have major surgery and vaccines within one week of each other. This is because both surgery and the vaccine can cause a fever.

The person giving you the vaccine will be able to let you know about any side effects that you can expect, and these may differ depending on which of the vaccines you have. It’s common to have some pain at the injection site following a vaccination.

As well as pain at the site of the injection, you may other side effects that include feeling tired, achy, feverish or sick, or have a headache. If you do have side effects, they usually come on shortly after the vaccination and are not linked with more serious or lasting illness.

If you have any adverse reactions to the vaccine, it’s important to tell a healthcare professional so they can report it to the Yellow Card Scheme. Anyone is free to use the scheme to report adverse reactions, but it’s still important to tell a healthcare professional if this happens to you.

All three of the vaccines are thought to offer short-term protection after the first dose. The second dose is important for longer-term protection from COVID-19.

Research has shown that the Oxford AstraZeneca vaccine prevented COVID-19 in about 7 in every 10 people, with no severe cases from 14 days after the first injection. The Pfizer/BioNTech vaccine prevented COVID-19 in more than 9 in every 10 patients (95%) and starts to work around 10 days after the first dose. The Moderna vaccine was found to prevent COVID-19 in more than 9 in every 10 people (92%) after the first dose in trials.

A third dose of the vaccine is recommended for people who have severely suppressed immune systems. This is being given as a ‘top-up’ to increase protection levels for people who may not have had a full response to their first two doses, rather than as a booster to stop high immunity levels from lowering.

It’s possible for people who have already had COVID-19 to have the vaccine for it. It’s not known yet how long the antibodies made by your body in response to COVID-19 last, so a vaccine could offer more protection or boost any antibodies your body has already made.

If you’re looking for support, especially during these uncertain times, we’re here for you. Read our dedicated coronavirus information with signposting to the latest official government advice and guidance.

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