Confusion over booster and third Covid vaccine could be putting patients in ‘harm’s way’

NHS doctors explain the Winter Vaccines

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Vulnerable patients could be missing out on a life-saving COVID-19 vaccine as confusion grows over the difference between the third dose and a booster, blood cancer charity Myeloma UK has warned. As the charity reports, the terms “third dose” and “booster” are being used interchangeably, leading to uncertainty among GPs and clinicians about which should be given first, if any at all. This means that thousands of patients could be missed off vaccination lists or denied a booster going forward.

While there is no difference in the ingredients of the vaccine and booster, and therefore no medical risk to receiving a booster instead of a third dose, it is key for medical staff to administer them in the correct order and make sure immunocompromised patients get as much protection from the virus as possible.

Suzanne Renwick, Head of Clinical Practice Services at Myeloma UK, said: “We’re very concerned to hear that some GPs and clinical specialist teams don’t quite understand that a third primary vaccine is part of patients’ standard vaccination schedule and that people with severely weakened immune systems, such as myeloma and other blood cancer patients, will need a booster after they’ve received their third dose.

“The two are not interchangeable. They are both necessary and must be offered to patients in the right order. It’s all in the timing. We’re already seeing patients being offered a booster instead of a third dose. This means that they may be missed off the list of people eligible for a booster further down the line – which is absolutely crucial to maintaining their protection against COVID-19.

“The onus will then be on patients to advocate for themselves, explain that they were given a booster instead of a third dose and to ultimately try to convince their GPs that they are entitled to receive a much-needed booster.”

On September 1, the Joint Committee on Vaccination and Immunisation (JCVI) announced that people with severely weakened immune systems at the time of their first and/or second vaccination would receive a third dose of a COVID-19 vaccine as part of the standard vaccination schedule to improve response rates and increase their level of protection against the virus.

This third dose, the JCVI said, should be followed by a booster around six months later.

Boosters are given to help maintain and extend the length of protection received from the initial vaccination schedule.

Since the JCVI’s announcement, the Myeloma UK Infoline and Ask the Nurse email services have been inundated with queries from concerned patients who have received conflicting information from their GPs or been told they only need a booster.

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Ellen Watters, Myeloma Information Nurse Specialist, said: “We’re receiving call after call from patients whose GPs are only offering a booster but not the third vaccine. We’re doing our best to keep up with the latest government advice and are guided by the limited amount of data provided by recent studies. Unfortunately, this is becoming a growing problem and we want to clear up any confusion that could potentially place at-risk patients in harm’s way.”

Further confusion about who is responsible for identifying patients in need of a third jab and/or booster has complicated matters.

In theory, the decision of who is eligible for a third dose of the vaccine and when they should receive it is ultimately up to patients’ clinical specialist team, i.e. hospitals.

Clinicians should then contact patients’ GPs and advise them on who should be offered a third “top-up” dose – that is people who may not have achieved a sufficient immune response to the first two doses.

But when it comes to identifying who should be receiving a booster, the decision falls to GPs and vaccination centres.

Professor Alex Richter, Director of the Clinical Immunology Service at the University of Birmingham and Consultant Clinical Immunologist at University Hospitals Birmingham, said:“There are two different rollouts happening simultaneously – one for the third primary dose and one for the booster – with different teams responsible for them, which is causing unnecessary confusion.

“There needs to be clarification on how the rollouts should be implemented and where these lists identifying patients should be coming from and who should be instigating and administering the vaccines.

“At the moment there’s huge inconsistency: in some areas GPs are taking the lead and in others it is the hospitals. Identification for the first, second and booster vaccine doses is done from primary care lists, whereas it appears that hospital specialists are expected to identify individuals for a third primary dose by writing to GPs – introducing duplication of effort in many cases. We seem to be reinventing a system that worked pretty well the first time round. Patients are confused and they’re really anxious. We need the infrastructure to ensure that NHS Trusts across the country are fully aware of the guidance and how to implement it, so their patients get the right protection from the virus. Patients shouldn’t be the ones wading through red tape to know what they’re eligible for.”

Who can get a COVID-19 booster vaccine?

Booster vaccine doses will be available on the NHS for people most at risk from COVID-19 who have had a second dose of a vaccine at least six months ago.

This includes:

• 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
• People aged 16 and over who are a main carer for someone at high risk from COVID-19
• People aged 16 and over who live with someone who is more likely to get infections (such as someone who has HIV, has had a transplant or is having certain treatments for cancer, lupus or rheumatoid arthritis).
• People who are pregnant and in one of the eligible groups can also get a booster dose.

You can book your COVID-19 booster vaccine dose online if you are a frontline health or social care worker.

You can also book your booster dose online if you have been contacted by the NHS and you are either:

• Aged 50 and over
• Aged 16 and over with a health condition that puts you at high risk from COVID-19.

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