3rd dose of vaccine announced for people who are vulnerable to Covid-19

The JCVI has recommended a roll out of a 3rd dose of vaccine to immunocompromised people. This is not the same as the possible booster dose which may be offered to a wider group in future. This 3rd dose is for a group of people, including those who have kidney transplants or are immunosuppressed because they have certain kidney diseases. In response to our query, Public Health England have explained that it is the immunosuppressive therapy that is the important point and so the guidance refers to people who have received immunosuppressive therapy in the past six months, regardless of when the transplant occurred.

Many studies have shown that immunosuppressed people do not have an effective response to vaccination. The JCVI say that they are encouraged that some people have made a response (even if not yet adequate) to vaccination as this gives them confidence that a further dose will be effective for a large minority. Data from the US and Israel supports this conclusion. The announcement a couple of weeks ago that a special monoclonal antibody treatment has been authorised in the UK for those who do not make any antibodies, is also encouraging.

Fiona Loud, Policy Director at Kidney Care UK, said: “For months we have heard from immunosuppressed kidney patients that they are worried they don’t have the same protection from Covid-19 vaccines as others. Some of them have continued to shield or are going back into shielding because they see infection rates going up in their area. This third dose will increase their chances of protection, so we welcome today’s announcement that it will be offered to people who are vulnerable to Covid-19. We need to see this clearly communicated and enacted by medical teams as soon as possible.”

This advice applies to adults and children over 12. The advice is that there should be an eight week gap between 2nd and 3rd dose, unless for example someone was imminently going to have a transplant and be immunosuppressed. A 3rd dose will be an mRNA vaccine, such as Pfizer or Moderna by preference but Astra Zeneca can be offered if either of the other two are not available. The main route for vaccination is through the primary care network and more detail will be with us shortly but we have been informed that it should start in the first half of September.

It is not yet known whether the flu jab will be given out at the same or a similar time and we await more information on that too. There is no information to say that reaction to a 3rd vaccine dose will be worse than that to a previous dose, with a mild indication from Israeli data that it may be slightly less.

However, with our medical colleagues we remain concerned that data on those who are on dialysis or at a late stage of CKD remain at risk as studies have shown that they also have a suboptimal response to two doses of COVID vaccine. In particular, response may be suboptimal against the delta variant.

The JCVI says that those with less serious immunosuppression are not included in this advice but are likely to become eligible for another dose as part of a potential booster programme, pending further advice from the JCVI. In the event of a booster programme, it is expected that severely immunosuppressed people will also be offered a booster dose, at a suitable interval after their third dose.