Vaccines for COVID-19 – your questions answered

Why is it important for me to have the vaccine?

Last updated: 21 September 2021

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.

You can find out more about vaccines on our Vaccinations webpage.

Making a decision about the COVID-19 vaccine

To help you make a decision about having the COVID-19 vaccination, we have worked with other organisations to develop a decision support tool.

Decision support tool for the COVID-19 vaccine (PDF, 468 KB)

This is designed to support conversations about the vaccine between you and your healthcare professional. You can use this to prepare for appointments, during appointments, or both.

What vaccines are available?

There are many vaccines in development for COVID-19, but we don’t know exactly when each of these will be available. So far, three COVID-19 vaccines are available for use in the UK – the Pfizer/BioNTech vaccine, the Oxford AstraZeneca vaccine and the Moderna vaccine.

It’s recommended that people between 18 and 39 without underlying health conditions are offered an alternative to the Oxford AstraZeneca vaccine if one is available. This doesn’t apply to people aged between 18 and 39 who are in vaccine priority group 4 or 6. Find out more about which of the JCVI’s priority groups include people with arthritis.

If you’ve already had the first dose of your Oxford AstraZeneca vaccine, you should still get your second dose. If you have a condition that causes problems with how your blood clots, speak to your healthcare professional for advice. 

This page covers the three vaccines currently available in the UK.

What types of vaccines are being developed?

There are many different types of vaccinations for COVID-19 in development around the world, which act in slightly different ways to cause the immune system to respond.

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.

When will people with arthritis receive the vaccine?

The Joint Committee on Vaccination and Immunisation has produced some advice on the COVID-19 vaccine and priority groups to decide the order in which people should receive the vaccine.

The JCVI advice applies to all four nations of the UK.

Who can get the vaccine currently?

The vaccine is currently available to everyone over 16. People aged 16 and 17 will be contacted by the NHS when it’s their turn to get the vaccine, but some walk-in vaccination sites are offering the vaccine to this age group.

Those aged 12 to 15 with suppressed immune systems are also able to have the Pfizer-BioNTech COVID-19 vaccine. You can find out more on our COVID-19 information for children and young people webpage. All 12 to 15 year olds in England will be offered one dose of the Pfizer/BioNTech vaccine, and it’s expected that this will be organised through schools

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.

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 and Wales, people aged over 12 who live with someone who is at an increased risk of COVID-19 due to their immune system being suppressed (for example, due to their medications or an existing health condition) are also able to receive their vaccine as part of group 6.

If you are eligible to have the COVID-19 vaccine because your condition or treatment suppresses your immune system, you should be contacted by your healthcare team to arrange for any people over 12 who live with you to have their vaccine too. Once they have booked their vaccine, they will need to take the letter you receive from your healthcare team as well as proof that they live with you, along to their vaccine appointment.

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, if you're in the priority groups, you should already have been invited for the vaccine. If you haven't, contact your GP or visit the NHS Inform website. You can book your appointment online, if you are eligible for the vaccine.

In Wales, some NHS local health boards are asking people in the priority groups to get in touch if they haven’t been invited for the vaccine yet. Find your local NHS health board.

In Northern Ireland, if you’re 18 or older, you can book your appointment online.

We know that some people who might be at an increased risk from COVID 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. All healthcare settings delivering the vaccine, including GP practices, still require patients to wear a mask and maintain social distance to lower the COVID-19 risk.

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

Fraud awareness

There's been some reports of people receiving fraudulent calls, emails and text messages offering the COVID-19 vaccination. The vaccine is not available privately and a genuine contact from the NHS won’t ask for payment as the vaccine is free.

Who will receive a third dose of the vaccine?

In September 2021, the JCVI announced that people who have severely suppressed immune systems at the time of their first and second doses of the vaccine would be able to 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. It is expected that the JCVI will publish more guidance on a COVID-19 booster vaccination programme this autumn.

Based on the guidance put out by the JCVI, the British Society of Rheumatology (BSR) has recommended that that all people taking the following treatments be offered a third dose of the vaccine:

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. Speak to your doctor about when you should get your third dose of the vaccine, as they will be able to time this around your treatment in order to give you the highest possible level of protection from COVID-19.

Who can have a booster dose of the vaccine?

This autumn and winter, the people at most risk of COVID-19 will be able to have a booster dose of either the Pfizer/BioNTech or Moderna vaccine, though some people may be offered the Oxford/AstraZeneca vaccine instead. It’s fine if the vaccine you get at your booster dose is different to the one you had earlier in the year.

Booster doses will be available for the following people:

  • people aged 50 and over
  • people who live and work in care homes
  • frontline health and social care workers
  • people aged 16 and over with a health condition that puts them at high risk of getting seriously ill from COVID-19 but do not have a severely suppressed immune system (this group are being offered third initial dose of the vaccine instead)
  • carers aged 16 and over
  • people aged 16 and over who live with someone who is more likely to get infections (such as someone who has lupus or rheumatoid arthritis).

The NHS will contact you when it’s your turn to have the booster dose, which will be at least 6 months after your second dose.

Some people with arthritis who have a severely suppressed immune system will be able to have a third dose of the vaccine instead, which is different to a booster dose. You can find out more about who is able to have a third dose in the section above.

What is the difference between a third dose and a booster dose of the vaccine?

Third 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 dose is being offered to this group to try to increase their initial levels of protection.

Booster jabs are being offered to people who are likely to have received a high level of protection from their first two doses of the COVID-19 vaccine, but who would be at an increased risk of COVID-19 if their protection levels decreased. The booster dose will be offered to boost this group’s level of protection, at least 6 months after getting the first two doses, to maintain their high levels of protection in the long term.   

Could my medication or condition mean I can’t have the COVID-19 vaccine?

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).

Is one vaccine more suitable than another for people who are on drugs that suppress the immune system?

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.

Should I delay or stop my treatment, and will my treatment affect how the vaccine works?

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.

If you’re already taking medicines that suppress the immune system, you shouldn’t stop or delay these to have the vaccine, as doing this could cause you to have a flare-up, which can increase your risk from COVID-19.

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 until a couple of weeks after you have had the last 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.

Can I have the vaccine if I am taking steroids?

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. 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.

Do children need to have the vaccine?

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

The government has recently announced that children aged between 12 and 15 can receive the Pfizer/BioNTech vaccine if they have certain conditions. This includes children who have arthritis and related conditions that mean they need to take drugs to suppress the immune system. 

The full list of drugs that will be included hasn’t been released yet, but we will keep this page updated as we find out more.

See our dedicated webpage for more information about coronavirus in children and young people with arthritis.

All 12 to 15 year olds in England will be offered the Pfizer/BioNTech through a schools-based vaccination programme

Can I have the vaccine if I am pregnant?

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.

Can I have the vaccine if I am waiting for surgery?

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.

How is the vaccine given?

Vaccines are usually given as an injection into the upper arm.

The Pfizer/BioNTech vaccine is given in two doses, between 3 and 12 weeks apart. The Oxford AstraZenenca vaccine and Moderna vaccine are given in two doses, between 4 and 12 weeks apart.

If you’re in one of the priority vaccine groups 1-9, you may be contacted to have your second dose 8 weeks after your first.

It’s recommended that people who can have a third dose of the vaccine receive this at least 8 weeks after their second dose. People who are taking treatments that suppress their immune system should talk to their doctor about when they should get their third COVID vaccine dose in relation to the timings of their treatment in order to get the highest level of protection possible.

Are there any side effects?

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.

How long will the vaccine take to work?

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 is expected that the JCVI will publish more guidance on a COVID-19 booster vaccination programme this autumn.

Do you still need the vaccine if you have had COVID-19?

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.

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