Patients could be missing out on COVID-19 vaccines as confusion grows over the difference between the third jab and booster

Other News // 12th October 2021

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, Myeloma UK has warned.

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 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.

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 administrating 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 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.”

We have created a letter to help patients experiencing difficulties explaining eligibility for a third COVID-19 vaccine to a healthcare professional. Give this letter to your GP and/or haematology team to inform them about your need to receive a third vaccine and not a booster.

For more information about the COVID-19 vaccine, including the third vaccine and the booster, visit our COVID-19 Information Hub Vaccine FAQs.