The Third Vaccine

02 December 2021

Patients who are eligible

Based on the Joint Committee on Vaccination and Immunisation (JCVI) recommendations, nearly all rheumatology patients (aside from those solely on hydroxychloroquine or sulfasalazine), should receive a third dose of the vaccine. Patients on a dose of Methotrexate lower than 20mg are also not eligible.

Read the full independent report by the JCVI here.

Who will contact Patients

A letter was sent by JVCI on 2nd September 2021 to:

• All GP practices.
• All community pharmacy-led vaccination sites.
• Vaccination centres.
• All CCGs.
• All directors of public health.
• All directors of children’s services.
• All NHS trust chief executives.
• All ICS and STP leads.

It contains updated information regarding the third primary dose of the COVID vaccine.

Rheumatology departments have been asked to flag all patients that are eligible for the third primary dose, and this should be picked up by the Gps. Patients should wait to be contacted either by their Healthcare team directly or they may receive an official letter with advice.

See the letter here.

Where do patients receive the third vaccine

If you are contacted directly, the GPs/ consultant should be able to advice the next steps. Some practices will be rolling out the vaccine themselves so may be able to ask patients to come straight in. For those who are not able to go to their GP surgery the current advice is to take proof of eligibility to a vaccination centre.

The difference between the third Vaccine and the booster

The main difference between the third vaccine and the booster is the timing. The booster vaccine should be administered to patients 6 months after their second dose. The third primary dose should be received before the end of the 6-month gap.

Protection from the Vaccine

Some people who are immunosuppressed, for example because of an underlying health condition or the medicines they are taking, may not have responded as well to their primary vaccines as those who are not immunosuppressed. The real take home message is that ‘some’ protection is certainly better than no protection and there is higher risk of serious consequences of COVID19 if disease is not well controlled. If you have any concerns, you should speak to your treating clinician. It is extremely difficult to know who will respond well to the vaccine, therefore the 3rd dose is being recommended to all people who are on medications for their RA (other than those on sulfasalazine and Hydroxychloroquine).

Some people are asking whether taking an antibodies blood test can tell them whether they have protection from COVID-19. We still don’t know how exactly how serology result (B cell response) correlates with protection from severe infection. Some recent experience is that most of the patients and the general population recently/currently infected despite double vaccinated had very mild disease. Virtually all OCTAVE participants had robust T cell response (even those with no/low B cell response) so while it is still unclear the significance of this response it is very encouraging. The most common form of antibody tests available only test for B cell response. Thus, having one may only cause unnecessary concern and expense.

Vaccines available

Vaccine nameLive or not live 
(MHRA classification?)
Date approved by MHRAApproved forDose 
Pfizer/BioNTech COVID-19 mRNA Vaccine BNT162b2Not live03/12/202012 years and older2 doses up to 12 weeks apart
Oxford/Astra Zeneca (ChAdOx1 nCoV-2019) vaccineNot live*30/12/202018 years and older**2 doses up to 12 weeks apart
ModernaNot live08/01/202118 years and older2 doses
COVID-19 Vaccine JanssenNot Live*28/5/202118 years and older1 dose