COVID-19 vaccine programme next steps for leukaemia patients: third doses and boosters

There has been much discussion in the media of both a third dose of COVID-19 vaccine and booster programmes. This has caused some confusion; this article aims to explain who is eligible for each programme and how they differ from each other. Note: to the best of our knowledge, this advice applies across the UK.

Third dose of vaccine for the immunocompromised:

On the 1st of September, the governments of the UK have accepted advice from the JCVI to offer a third dose of the vaccine to the immunocompromised. This is separate from booster vaccines, and is considered part of their primary course. This is with the hope of further building the immunity of those with suppressed immune systems. While it is possible that some immunocompromised people will not generate any antibody response regardless of the number of vaccine doses, recent studies report cases of increased immune responses in the immunocompromised after a third vaccine.

What is the evidence for needing a third dose of the vaccine if you are immunocompromised?

As many of you will know, blood cancer patients were prioritised for the COVID-19 vaccine earlier this year, due to many patients being clinically extremely vulnerable to COVID-19. Unfortunately, further research has shown that those blood cancer patients who are also immunosuppressed due to their condition and/or treatments are less likely to have responded to the vaccine than other blood cancer patients with working immune systems. More work is needed to know which blood cancer patients are most likely to benefit from this news; the studies on the impact of the third vaccine dose focused on people who have had transplants. However, some protection is better than none, so it is recommended that you get the third dose you are offered in the hope you will see some benefits. You can read some studies published so far here and here.

Should I bother with a third vaccine if I have not made antibodies to the vaccines so far? Do I need to find out my antibody levels before I have the third vaccine?

We would encourage everyone who is eligible to take up the offer of the third vaccine. There is some evidence that it increases an immune response, including in people who did not make many antibodies. Some protection is better than none. 

You do not need to test for antibodies before you have the third vaccine. Even if you have responded to the first two vaccines, we would encourage you to take up the third. Antibodies are only part of the immune system and the role of other parts of the immune system isn’t yet fully understood. It is possible that the third vaccine may yet boost your immune response further.

Is the third dose the same as the booster vaccine?

No. The third dose for the immunocompromised is an addition to the primary course (first two doses of the vaccine) to try and raise the level of immunity among the immunocompromised to match the immunity of the rest of the population. Booster vaccines are likely to then be given on top of this in the New Year, approximately 6 months after the immunocompromised have received their third dose. 

If you are not eligible for a third dose as per the criteria outlined in the next section, please go to the section about booster vaccines further down this article. Please contact your specialist consultant or nurse if you are not sure which group you fall into, as they are responsible for identifying people who need the third dose.

Who is eligible for the third vaccination?

The third dose can be given to anyone aged 12 and over who is considered clinically immunocompromised at the time they were first vaccinated. The third dose must be 8 weeks or more after the second dose of the vaccine. The JCVI advice says this should include people with acute and chronic leukaemias who are undergoing treatment or who will not achieve a cure within 12 months. Also included is anyone who has had a stem cell transplant in the last 2 years and those who received immunosuppressive chemotherapy or radiotherapy in the 6 months prior to vaccination. Please check with your consultant or specialist nurse if you are unsure if this applies to you.

When and where will I receive my third vaccine?

The third dose will be delivered at any time from the 13th of September. You will be contacted by letter to confirm your eligibility. Specialist consultants and nurses are primarily responsible for identifying people who are eligible for this third dose, so they are the best port of call if you do not receive this letter soon and you believe you count as someone who is immunosuppressed. GPs may also be able to help, but this will depend on their level of knowledge about your condition. The third dose is expected to be arranged by the GP practices where they have been delivering COVID-19 vaccines. However, we are aware not all GP practices are delivering vaccines themselves – they have been asked to highlight their eligible patients to wider authorities so you should receive further information on where to go.

Important: if you are eligible for a third vaccine, do not book a “booster” dose by calling 119 or using the online system. You should be sent a letter directly with official instructions, please follow these instead.

The vaccine given will most likely be Pfizer or Moderna. This is because most people who are immunocompromised received AstraZeneca as their first vaccine, and evidence suggests that a different vaccine for the third dose makes for a better immune response. Under 18’s will only receive Pfizer.

Will I get a booster vaccine later too?

Yes. This third vaccine is considered part of your first course of vaccination, so you will have 3 doses instead of the usual 2 doses. You will then be recommended to have a booster in approximately 6 months time too. 

Important: anyone who lives in the same household as you is now eligible for a booster dose, if it has been more than 6 months since they had their second dose. See next section for details. 

Booster vaccine programme for all other leukaemia patients:

If you are not considered immunocompromised as a result of your diagnosis and/or treatment, you will also shortly be offered another COVID-19 vaccination too. This is a “booster” dose, similar to how you will have a booster jab of tetanus if you cut yourself and have not had the jab in a long time. 

What is the evidence for this?
Recent studies have indicated that, even in those who have responded well to the vaccine, immunity has declined over time slightly. This is fairly normal and happens with other vaccines too (e.g. tetanus). Therefore, to try to avoid another spike of infection, the governments have decided that the most vulnerable to COVID-19 should have a boost of their immunity at 6 months after vaccination, to try to restore their immunity to its original level.

Who is eligible for the booster dose?
The booster programme covers many people. Here are the criteria as set out by the JCVI:

  • those living in residential care homes for older adults
  • all adults aged 50 years or over 
  • frontline health and social care workers 
  • all those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19 (as set out in the green book), and adult carers
  • adult household contacts of immunosuppressed individuals

You may fall into more than one of these categories, but we understand that all leukaemia patients will qualify under the “underlying health conditions” criteria. Please check with your consultant or specialist nurse if you are at all unsure.

You can only have a booster dose if you are more than 6 months after your second vaccine.

When and where will I receive my booster dose?
The booster doses are planned to begin from the week of 20th of September. You will be contacted by the NHS to confirm your eligibility. The booster doses are expected to be delivered in all COVID-19 vaccine centres and instructions should be in the communications to you. Do not call to book via your GP.

The vaccine given will most likely be Pfizer or Moderna.

If you have questions, you can contact the Advocacy team by calling 08088 010 444, or emailing advocacy@leukaemiacare.org.uk.

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