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Covid vaccine and blood cancer

We're here for you if you want to talk

0808 2080 888

[email protected]

How to book a covid vaccine if you have blood cancer, or live with someone who does

Find out how many covid vaccinations you should have, and how to get them.

Page updated 23 May 2022

Problems getting your fifth dose? Use our letter for GPs...

If you're having problems getting your fifth vaccine dose, we've created this letter to explain to GPs and healthcare professionals how many doses you should have:

Who can get the covid vaccine and how many doses?

As of 21 February 2022, the JCVI recommends that:

  • Children aged 5 to 11 who have blood cancer should have two vaccine doses (at a reduced dose).
  • Children aged 5 to 11 who live with someone who is immunosuppressed should have two vaccine doses (at a reduced dose).
  • People aged 12 and above who have blood cancer should have five vaccine doses (three primary doses and two boosters).
  • People aged 12 and above who live with someone who is immunosuppressed should have three vaccine doses (two primary doses and one booster).

Most people who are living with blood cancer and many who are in remission from blood cancer have a weakened immune system, which makes it harder to fight off viruses and other bugs. This is called immunosuppression. Immunosuppressed people are at higher risk of getting seriously ill from covid.

That's why, when covid vaccines first become available, people were prioritised for vaccination if they:

  • had any type of blood cancer (leukaemia, lymphoma, myeloma, MDS, MPN), whether they were on treatment or not
  • were immunosuppressed as a result of blood cancer in the past
  • had had a stem cell or bone marrow transplant in the past
  • had any other underlying condition that meant they were classed as "clinically vulnerable" or "clinically extremely vulnerable".

Because immunosuppressed people are at higher risk from covid, household contacts (people who live most of the time with someone who is immunosuppressed) and unpaid carers were also prioritised for vaccination.

Going forward, people who are immunosuppressed, including most people with blood cancer, are being offered extra vaccinations. While covid vaccinations may not work as well for immunosuppressed people, there's evidence that repeated doses can offer better protection. People who are severely immunosuppressed may also be eligible for new antiviral treatments if they get covid.

We have more information about research into how effective covid vaccinations are for people with blood cancer.

Adults and young people aged 12 and over with blood cancer

As someone who has a weakened immune system because of blood cancer, you should have another booster dose of the vaccine in Spring 2022. This should be your fifth vaccine dose.

Spring boosters for people with blood cancer or immunosuppression

Following advice from the Joint Committee on Vaccination and Immunisation (JCVI), the government has announced that people over 75 and people aged 12 or over who are immunosuppressed will be offered another booster of the vaccine, as part of a Spring booster campaign. This is to be given 3 to 6 months after your last dose. You can see the government’s information about the Spring booster campaign here.

Once the roll-out starts, if it has been at least 3 months since your last dose, you can have your Spring booster. Adults over 18 could have either a full dose of the Pfizer vaccine, or a half dose of the Moderna vaccine. Young people aged 12 to 17 years old will be offered a full dose of the Pfizer vaccine.

General guidance for the public suggests the Spring booster is ‘around 6 months’ after your last dose. But some people with blood cancer only had their last dose quite recently. The Green Book (page 28) states that in this case, you should still have your next booster as part of the Spring campaign, as long as it’s been at least 3 months since your last dose.

The roll-out of Spring boosters is expected to start around the end of March/early April:

  • In England, you can book your 5th dose (second booster) online or call 119.
  • In Scotland, the NHS will contact you to arrange your appointment.
  • In Wales, your Health Board GP will contact you to arrange your appointment.
  • In Northern Ireland, further details about how to book are expected soon.

If you still haven’t had your first booster by March 2022, you should have this as part of the Spring campaign. We have more information about Spring boosters for people with blood cancer.

How to book your fourth dose (first booster) if you're 16 or over

If you have not yet booked your fourth (booster) dose of the covid vaccine, follow the guidance for the UK country you live in:

You can get your fourth dose (booster) at a vaccination centre if it’s been 3 months since your third dose, and you have a letter from a doctor. You can book an appointment online or go to a walk-in vaccination site.

If you had a letter from your doctor confirming your eligibility for the THIRD primary dose, you can use this letter at a vaccination centre to get your FOURTH booster dose too.

If you think you're eligible for a fourth dose but you do not have a suitable letter, contact your GP or hospital specialist to ask for one. Show them this letter from NHS England which explains that they need to provide you with some written evidence for your fourth dose.

Although this is not NHS advice, if you don't have this letter, we suggest you contact your vaccination centre and ask if they will accept other evidence of your eligibility such as:

  • a doctor's letter showing that you had blood cancer at the time of your 1st or 2nd dose
  • evidence of the medication you were taking at the time of your 1st or 2nd dose - a hospital letter that describes the medication you were prescribed, a copy of your prescription or a medication box with your name and the date on it.

Not all centres can offer fourth doses. Use the online search to check for centres that say "3rd dose for people with a weakened immune system" as they should be able to provide fourth doses.

If your third primary dose was recorded as a booster, this doesn’t matter, you are still eligible for a fourth dose, and this will be recorded as a second booster.

You could download this FAQ document from NHS England about this, to help with any conversations with your doctor or vaccination centre.

If you had your third primary dose at least 3 months (12 weeks) ago, your health board should invite you for a fourth (booster) dose.

You can also book online or phone the free Scottish Covid Vaccination Helpline on 0800 030 8013 (8am to 8pm). For more information, see this web page from the NHS in Scotland.

If you had your third primary dose at least 3 months ago, your health board should invite you for a fourth dose. See this web page for Wales about third doses and boosters.

If you haven't been invited for your fourth dose and it's more than 3 months since your third dose, contact your health board.

In Northern Ireland, people will be identified by their Trust clinician or GP for a fourth dose. If you have a letter from your GP or another clinician confirming that you need a booster, you should be able to book online. See this web page from NI Direct about third doses and boosters.

How to book your third primary dose if you're 16 or over

Wherever you live in the UK, show your doctor the guidance from the JCVI and this joint statement from us and the British Society for Haematology, which explains who should be getting a third primary dose.

Here's what we know about how people aged 16 and over should book their third primary doses in each country of the UK.

At a vaccination centre

In England, people who are immunosuppressed can get their third primary dose from a mass vaccination centre, if they present a letter from their GP or consultant stating that they meet the criteria. You can go to a vaccination centre without an appointment, or you can book an appointment on the NHS website.

How to get a letter:

  1. Download this letter from NHS England from 25 Jan 2022. Show your GP or consultant the template letter on page 4 (Appendix B).
  2. Ask your GP or consultant to write and sign a letter based on this template, stating that you should have a third primary dose of the vaccine.
  3. Show the signed letter at a mass vaccination centre and say you are there for your third primary dose (a full dose of Pfizer or Moderna).

If you do not have a letter:

If you do not have a letter from your GP or hospital specialist inviting you for a 3rd dose, you can bring either:

  • a hospital letter that describes the condition or treatment that caused you to have a severely weakened immune system at the time of your first or second vaccine dose
  • a prescription or a medicine box with your name and the date showing when the medicine was prescribed - this must show that you had a severely weakened immune system at the time of your 1st or 2nd dose.

A clinician at the site will check to make sure that you’re eligible for a 3rd dose.

If you think you’re eligible for a 3rd dose but you do not have a suitable letter, prescription or medicine box, please contact your GP or hospital specialist.

To find your nearest vaccination centre that is offering third doses, use this NHS postcode checker.

If you are currently having treatment, make sure you check with your hospital team about the timing of your vaccine, because there might be certain points in your treatment cycle when the vaccine is most likely to work.

If you continue to have trouble getting your third vaccine, please email [email protected] to let us know.

Through your GP or hospital team

You may be contacted by your GP or hospital team offering you a third dose. Your hospital might ask your GP to arrange it for you. On September 30, NHS England sent a letter to all GPs and treating teams setting a deadline of October 11 for people who are immunocompromised to be offered a third vaccine dose. You could show these letters to your GP or treating team if you are having problems getting a third dose: Letter sent to GPs about third vaccine doses; Letter sent to treating teams about third vaccine doses. Some people have had success by going to their haematology team first, who then contacted their GP.

In Scotland, you should get an invitation from the NHS or your Health Board. See this web page about third doses and also this web page about third and fourth doses. If you haven't been invited yet in Scotland, speak to your specialist doctor or GP and show them the web pages linked above. If you still have problems, you could contact your area's Health Board. Several Health Boards have information about third primary doses on their website, for example: NHS Western Isles and NHS Highland.

In Wales, those who are eligible are being identified and contacted by their Health Board, which will offer an appointment at a mass vaccination centre. See this web page from Public Health Wales explaining about third doses. If you need to contact your Health Board, you can find contact details on this list of Health Boards in Wales.

In Northern Ireland, people will be identified by their Trust clinician or GP and invited in to receive a third primary dose. See this web page from NI Direct explaining about third doses. If you need to contact your Trust, use this list of Health Trusts in Northern Ireland.

A diagram to explain the timeline of Covid-19 vaccines doses  from first dose to booster.

In addition, immunosuppressed people aged 12 and over will be offered a fifth dose (a second booster) to be given 6 months after their fourth dose (first booster).

How to book your third and fourth doses if you're aged 12 to 15

Young people aged 12 to 15 who are immunosuppressed should have three primary doses of the vaccine. On 22 December 2021, the JCVI recommended that young people aged 12 to 15 should also have a fourth vaccine dose (booster) if they are immunosuppressed and it's been 3 months since their third primary dose.

All young people aged 12 and 15 are eligible for their first and second primary vaccinations and you can get these in the same way as the rest of your age group.

Here's what we know about booking your third and fourth doses if you are immunosuppressed:

If you're aged 12 or over, you should be invited for third and fourth vaccination by your GP or hospital. You can also go to a walk-in vaccination site to get vaccinated without an appointment. You’ll need to bring a letter from a GP or your hospital specialist confirming you're eligible for a third dose - you can use your third dose letter to get your fourth dose. If you do not have a letter, contact your GP surgery or hospital specialist. Check that the vaccination site is offering vaccines for 12- to 15-year-olds.

Young people aged 12 to 15 should be contacted by NHS Scotland. If you don't hear from the NHS and think you've been missed, contact your hospital team or GP. For help booking an appointment, you can phone the free national vaccination helpline on 0800 030 8013 (8am to 8pm, 7 days a week).

You should receive a letter from your local Health Board. Contact your local Health Board if you don't hear from them

You can book appointments online if you have received a letter from your doctor or clinician advising that you need a third or fourth dose.

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Children aged 5 to 11 who have blood cancer, or live with someone who does

On 22 December 2021, the JCVI recommended that children aged 5 to 11 who are in a clinical risk group, or who live with someone who is immunosuppressed, should be offered a primary course of vaccination. The course would be two 10-microgram doses of the Pfizer vaccine (a third of the adult dose), with a gap of 8 weeks between the first and second doses. The MHRA (which approves medical treatments in the UK) has approved this reduced dose after finding that it is safe and effective in children.

The JCVI has now advised that all children aged 5 to 11 should be offered two reduced doses of the vaccine, at least 3 months apart. This may mean other ways to get your child vaccinated will be available soon.

How to book vaccinations for children aged 5 to 11

Follow the guidance for your country - it's often same booking process whether your child is the one who is immunosuppressed, or someone else in your household.

Parents and guardians should get an invitation from their GP surgery or hospital specialist to make an appointment for their child. A few walk-in vaccinations sites are offering vaccines to children aged 5 to 11. You'll need to show a letter, text or email inviting your child for their vaccine to show they are eligible.

Using this online NHS tool, answer the questions in relation to your 5- to 11-year-old, and it will tell you how to book their vaccine.

You can also ring the free national vaccination helpline on 0800 030 8013 (8am to 8pm, 7 days a week) to find out how to book your child’s vaccine.

If the child is in a clinical risk group themselves, they should be invited for vaccination by their local health board. If the child is a household contact of someone who is immunosuppressed, you can request their vaccine online.

Your GP will write to you to offer an appointment at a Trust vaccination site. Children in special schools may be able to get the vaccination from the school nursing team on site.

If you are booking for a child because they live with someone who is immunosuppressed, you can book via the vaccination booking platform, but children in this group must have a letter from their GP or other clinician stating that they are a household member of someone who is immunosuppressed.

From the week commencing 28 February, the vaccination booking platform should be amended to allow all children aged 5 to 11 years to book a vaccination appointment.

People who live with someone with blood cancer (household contacts)

People who live with someone who is immunosuppressed are a priority group for vaccinations. This is to protect the vulnerable person they live with from catching covid and becoming seriously ill.

  • Adults who live most of the time with someone who is immunosuppressed because of blood cancer or another health condition can have three doses of the vaccine - two primary doses and one booster. This is the same as for the rest of the population aged 16 and over.
  • Children aged 5 to 11 who live with someone who is immunosuppressed should have two primary doses of the vaccine. In fact the JCVI recently advised that all children aged 5 to 11 can have two primary doses. See above for details of how to book vaccination appointments for children aged 5 to 11 in your part of the UK.
  • Young people aged 12 to 15 in the general population can have two primary doses of the vaccine. On 22 December 2021, the JCVI recommended that young people aged 12 to 15 should have a third dose of the vaccine (a booster) if they live with someone who is immunosuppressed and it's been 3 months since their second primary dose.

Here's what we know about how to get a third (booster) dose if you are aged 12 to 15 and live with someone with blood cancer:

  • In England: Eligible young people can go to a walk-in vaccination site with a letter, text or email inviting them to get a booster dose. If you do not have an invitation, bring a letter from the GP or hospital specialist of the person you live with confirming that members of their household should get a booster.
  • In Scotland: NHS Scotland are asking people to wait to be contacted.
  • In Wales: You should be contacted automatically by your local health board. If you don't receive an appointment, contact your local health board.
  • In Northern Ireland: Boosters will be offered at Trust vaccination hubs. You can book appointments online if you have a letter stating that you are eligible for a COVID-19 booster because you live in a household with somebody who is immunosuppressed.

If you're worried you or someone you live with has covid

Read our information about new treatments for people with blood cancer who test positive for covid.

We also have information about ways to protect yourself if someone in your household tests positive.

Why should people with blood cancer have extra doses?

People with blood cancer do not respond as well to vaccinations as the rest of the population. This is because for a vaccination to work, your immune system needs to react, and the immune systems of people with blood cancer often don't work fully.

But studies have shown that even if people don't generate covid antibodies after two covid vaccine doses, they can go on to develop antibodies after a third dose. We also believe that a fourth and fifth booster dose will improve vaccine response even more.

Having multiple covid vaccine doses if you have blood cancer gives you the best chance of protecting yourself from covid, which we know is a serious risk to people with blood cancer..

I've had a third primary dose - but it was recorded as a booster

If your third dose was recorded on the system as a booster, this does not stop you getting a fourth dose. You will still be able to have a booster (fourth dose). This may be recorded as a 'second booster'.

I couldn't get/didn't know about the third primary dose - so I booked a booster as part of the national booster programme instead

Some people with blood cancer took up the offer to have a booster as part of the national booster programme, because of the difficulty or lack of awareness of getting a third primary dose instead. This is something we are actively feeding back to the NHS, as it represents a failure of communication with doctors and patients.

If you had a Pfizer booster, you would have been given exactly the same dose as if you'd had a third primary dose. In practice, the vaccine jabs are the same, even if they are recorded differently on your record.

If you had a Moderna booster, you would have been given a half dose (0.25ml), rather than a full dose (0.5ml). Although this is disappointing, considering it is down to a failure of communication in the healthcare system, a half dose of Moderna is used in all other clinically extremely vulnerable groups (who aren't immunosuppressed) because it has been shown to be very effective and the side effects from a half dose are reduced. The reason for offering people with blood cancer a full dose instead was to give them as much vaccine as possible, even if it meant having more side effects from the vaccine. Your Moderna booster should still give you some extra protection while you wait for your next booster (fourth dose). But if you are worried about this, contact our support service.

Whichever booster you had as your third dose, you will still be eligible for another booster (fourth dose) in 3 months' time - see the answer to the question above (I've had a third primary dose - but it was recorded as a booster).

Ask the Experts

Watch our ‘Ask the Experts’ session about additional vaccine doses, ongoing research and upcoming treatments. Featuring Professor Emma Morris (leading a vaccine effectiveness study), Dr Alison Uriel (working on a trial for alternative methods of protection from covid), Dr Maggie Wearmouth (from the Joint Committee for Vaccination and Immunisation), Claire Amaladoss (Deputy Director of the Vaccine Deployment Strategy at NHS England) and Rachel Kahn (Research Communications Manager at Blood Cancer UK).

We're aware that many people haven't been invited for their third primary dose yet. So, if you're struggling to get your third dose but are invited for a booster vaccination as part of the national booster programme which is already underway, this is what we recommend:

  • If you are offered a booster vaccination using the Pfizer-BioNTech vaccine, have it. This is because the Pfizer booster vaccination for the general population and the Pfizer third primary dose for people with blood cancer are both full doses and therefore exactly the same.
  • If you are offered a booster vaccination with the Moderna vaccine, make sure you get a full dose. This is because the Moderna booster vaccination for the general population is a half dose. If you have blood cancer, you should have a full dose of Moderna as your third primary dose.

If you are invited for a booster AND and third primary dose of the covid vaccine, do not have both. It's better to book a third dose, as that's what you should be having if you have blood cancer.

Three months after your third jab, you should be invited for another booster (a fourth dose). See above for how to book in your UK country.

Who should have the third primary dose?

The third primary dose is for people who had weakened immune systems at the time of their first or second vaccination, who might not have produced enough antibodies from the vaccine. This includes anyone with blood cancer or ongoing immunosuppression. The third primary dose aims to increase the level of protection gained from the vaccine.

People who get a third primary dose of the vaccine will also be offered a booster (fourth dose) 3 months after their third dose.

The group offered a third primary dose includes people who:

  • were having treatment for blood cancer, or were in remission after having treatment in the previous 12 months
  • had either an allogeneic or autologous stem cell transplant in the previous 24 months
  • had a stem cell transplant more than 24 months before, but had ongoing immunity issues
  • were on watch and wait (active monitoring) for any type of blood cancer.

We've been assured that there is room for clinical judgement on who gets the third primary dose. So groups that aren't specifically mentioned in the guidance but are considered to be at high risk can get a third dose. This means people who were in remission for longer than 12 months when they had their previous vaccinations will be eligible if their GP or hospital team recommend it.

If you're currently having treatment, your treating team should advise you about the best timing for your third dose.

How will the effectiveness of the third primary dose be monitored in people with blood cancer?

The efficacy of the third dose will be monitored by the OCTAVE DUO study, explained on our vaccine efficacy research page.

Research is also going on to find other ways to prevent and treat coronavirus for people who don't get full protection from covid vaccines.

Flu vaccines and covid vaccines

We've had some calls from people asking whether they need to leave a gap between their flu jab and their covid vaccine. This isn't necessary, and it's really important you get your flu jab, so please take it as soon as you're offered it.

When covid vaccines were first rolled out in early 2021, the guidance said not to have a flu jab within 7 days of the covid vaccine. However, this advice has now changed, as we have the data to show it's safe to have them together. You might want to show this web page to your GP.

The MHRA have confirmed that data from the ComFluCOV trial shows that having both jabs on the same day is safe and doesn't reduce the effectiveness of either vaccine. The NHS also confirms this, saying 'Some people may be eligible for both the flu and the covid-19 booster vaccines. If you are offered both vaccines, it's safe to have them at the same time.'

Getting protected against flu and covid is really important for people with blood cancer, so if you're offered either vaccine, do take them. If they are close together or even on the same day, this is fine.

Flu vaccines for adults and children

If you currently have any type of blood cancer, whether you are having treatment or not, you should get a free priority flu jab. If you had blood cancer in the past, but you still have a compromised immune system, then you should also get a free priority flu jab.

You might be offered the flu jab at the same time as your third covid vaccine dose.

For 2021, the JCVI have recommended that countries in the UK offer free flu jabs to all of the following groups:

  • all children aged 2 to 15 by 31 August 2021 (but not 16 years or older) (nasal spray version)
  • those aged 6 months to under 50 years in clinical risk groups
  • pregnant women
  • those aged 50 years and over
  • those in long-stay residential care homes
  • carers
  • close contacts of immunocompromised individuals
  • frontline health and social care staff

For a child aged 16 or under who has blood cancer or a compromised immune system, they should not get the nasal spray version of the vaccine, as this is a live vaccine. They should have the jab version instead, which is not live.

Unpaid carers and household contacts (people who live with a clinically extremely vulnerable person) can now get vaccinated in group 6 of the roll-out. See our information below on 'Getting a covid vaccine if you are in priority group 6'.

Getting a covid vaccine if you have blood cancer (priority group 4) (clinically extremely vulnerable)

Updated 6 April 2021

People who currently have any type of blood cancer are clinically extremely vulnerable and should be on the shielding list. This means you are in priority group 4 for the vaccine. You should have been invited for your vaccine by 15 February, in all countries of the UK.

If you haven't been contacted yet, you should now contact your GP urgently to make sure you're on the shielding list, and use the links/numbers above to book yourself a vaccine.

Being on the shielding list is important not just for getting your vaccine now, but in case the same priority list is used for future covid vaccines.

If you have received letters about shielding during the pandemic, then you are on the shielding list and should have been invited for the vaccine.

If you are not on the shielding list but think you should be, tell your hospital team and your GP, as either of these can add you to the list. Send them this web page, which explains why you should be on the list and how to add you.

If you have an MPN and are having trouble getting on the shielding list, share this document with your GP. It explains why you should be on the list and how to add you:

Getting a covid vaccine if you are in priority group 6 (clinically vulnerable, unpaid carers and household contacts)

Updated 27 April 2021

People in priority group 6 are now being invited for their vaccines. You will be contacted by either the NHS or your GP to invite you to book your vaccine appointment. You may also be able to use the links given at the top of this page to book your own vaccine.

Group 6 are the over-16s who are clinically vulnerable (have an underlying health condition, but aren't clinically extremely vulnerable), unpaid carers, and household contacts of immunosuppressed people.

People aged 16 to 64 years with underlying health conditions

If you are under 65, and you're not already included in priority group 4 (clinically extremely vulnerable), then you are in group 6 if you have had a stem cell or bone marrow transplant in the past, if you have immunosuppression due to disease or treatment, or if you have any other underlying conditions listed in the government's guidance under 'Persons with underlying health conditions'.

The government refers to The Green Book for a definition of 'immunosuppression' and The Green Book defines "anyone with a history of haematological malignancy" as immunosuppressed - see Chapter 14a page 11 of The Green Book. So if you have a history of blood cancer, you could be in priority group 6.

Although the government guidance automatically puts people whose stem cell transplant was over 6 months ago in priority group 6, it also highlights that clinicians will use their judgement to add other people to priority group 4 if they feel that's best. If you've had a transplant in the past, we have more information and sources to help you talk to your doctor about which group you are in.

If you are in priority group 6, your GP will need to know this in order to invite you for a vaccine or allow you to book it online. Try the links and numbers at the top of this page to book your vaccine, and if this doesn't work, contact your GP.

Unpaid carers (if you look after someone with blood cancer)

Unpaid carers are people who are the main carer of an elderly or disabled person (adult or child – and cancer counts as a disability) whose welfare may be at risk if the carer falls ill, or anyone who is eligible for Carer’s Allowance.

If you think you may be an unpaid carer but aren't on Carer's Allowance, read this information from Carer's UK, and contact your GP to register as a carer.

Ideally, you should be registered as a carer to get the vaccine in group 6. You can tell your GP you are a carer, even if you don't qualify for or get Carer's Allowance.

In Scotland, you should still let your GP and/or local carer centre know you are an unpaid carer, but in terms of getting the vaccine, you will also need to self-refer for the vaccine.

We are aware that people who live with someone with blood cancer have been able to get a vaccine by various methods:

  • First try the links and numbers for your country at the top of this page.
  • Call or email your GP to tell them you're looking after someone with blood cancer.
  • Call 119 and tell them you're looking after someone with blood cancer.
  • Contact your local vaccination centre and tell them you're looking after someone with blood cancer.

Household contacts of immunosuppressed people (if you live with someone with blood cancer)

On 29 March 2021, the JCVI recommended that household contacts of people who are severely immunosuppressed get a covid vaccine in priority group 6, along with unpaid carers and people with underlying health conditions.

As of 27 April 2021, we are aware that the NHS in England, Scotland and Wales are following this advice. We are awaiting confirmation from Northern Ireland as to whether they will also follow it.

Anyone who is a household contact of someone with a history of blood cancer should now be offered a covid vaccine in England, Scotland and Wales.

If you need help talking to your GP about getting the vaccine as a household contact of someone with blood cancer, share the below document with them. This document currently refers to England, but it may be helpful for people in Scotland and Wales too. We will update it for Scotland and Wales as soon as the NHS in those countries releases guidance on how they will implement the vaccines for household contacts.

Household contacts are adults who expect to share living accommodation on most days with someone severely immunosuppressed, where continuing close contact is unavoidable. Both the immunosuppressed person and the household contact need to be 16 or over. Members of support bubbles who do not share living space with the person for the majority of the week are excluded from the definition, but they may be eligible for vaccination in group 6 as registered or unpaid carers (see above).

'Severely immunosuppressed' is defined by the JCVI (and The Green Book on page 11) as:

  • anyone with a history of haematological malignancy - this means anyone with a history of blood cancer
  • people who require long-term immunosuppressive treatments
  • people who are receiving immunosuppressive or immunomodulating biological therapy, or steroid sparing agents
  • people treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.

You can see the letter sent to GPs in England, the update from the government in Wales, the web page from the NHS in Scotland which mentions household contacts, and also the letter from the JCVI, and the letter from Matt Hancock.

Guidance in England:

GPs will write to any patients they have who are immunosuppressed to tell them about this.

If you are a household contact of someone with a history of blood cancer, you should contact your GP to book a vaccine.

You will need to take your own proof of address to your vaccination, which matches the address of the immunosuppressed person, although GPs have been asked to be flexible if in some situations you are a close contact that does not live at the same address.

If you are registered at a different GP to the immunosuppressed person, you can use the letter they receive with your own GP to book your vaccine.

If household contacts have trouble booking their vaccination

We’re hearing that a few GPs in England aren't aware that household contacts are now eligible for vaccination, or aren't aware that appointments should be booked through them. If you're a household contact and this happens to you, show your GP the letter we've prepared above. The guidance from NHS England states very clearly that household contacts are eligible and that vaccinations should be arranged through the GP surgery.

If you need to take things further, you can ask to speak to the Practice Manager at your surgery and if necessary, make a complaint. Or contact the customer contact centre for NHS England.

We're aware that some household contacts aged 16 to 18 are finding it difficult to get vaccinated because of low supplies of the Pfizer vaccine - the only one approved for this age group. If this happens, follow the advice above under "If your second vaccination appointment is cancelled".

For Scotland and Wales, we don't yet know what the process for booking household members' vaccinations will be - we will update this page when the guidance is published.

Which people with blood cancer are on the Shielded Patients List?

Blood cancer affects the immune system, and so do its treatments.

Adults with blood cancer may have a compromised immune system and therefore be at high risk of serious illness from coronavirus.

Even people who are not on treatment (for example, those on ‘watch and wait’) may have compromised immune systems due to the cancer itself.

Since the start of the pandemic, we have learned more about how coronavirus affects different people, and it is clear that people with blood cancer have a higher chance of getting seriously ill from coronavirus and of dying with it. A recent meta-analysis of studies found that 34% of people with blood cancer in hospital with coronavirus died.

It is crucial that people with blood cancer who are clinically extremely vulnerable are on the Shielded Patients List so they are invited for their vaccine at the appropriate time.

Being on the Shielded Patients List also means people will receive relevant letters from the Department of Health & Social Care. In some areas where the risk is very high, the government are advising this group not to go out to work, and these letters provide evidence to people’s employers and enable them to access sick pay and other government support.

The government automatically includes adults with blood cancer in the clinically extremely vulnerable group if they:

*If your transplant was more than 6 months ago, the government automatically classes you as vulnerable (not extremely vulnerable). But – your doctor can choose to move you to the extremely vulnerable group. We have more information and sources to help you talk to your doctor about which group you are in.

In England, the Clinical Director for Cancer (Peter Johnson) sent a letter to all cancer teams, with added clarification that the high-risk criteria includes blood cancer patients:

  • before, during or after treatment, including those being managed expectantly (on watch and wait)

How to add patients to the Shielded Patients List

GPs and hospital teams can and should add patients to the Shielded Patients List. There is guidance on how to do this across the UK here:

England

Scotland

Wales

  • You can find a list of patients who are on the shielding list through the Primary Care Portal.
  • To add a patient to the shielding list, add the code ‘65Z.. Infectious disease prevention/control NOS’ to their patient record.
  • For hospitals – tell your Health Board’s Information Department, who have access to the shielding list and who regularly submit new additions for the shielding list to the NHS Wales Informatics Service.

Northern Ireland

  • Use the Primary Care intranet site for guidance and searches you can run on EMIS and Vision to manage high-risk patients.

If GP’s are unsure about a patient’s condition, they should speak with their specialist treating team (eg haematology).

The RCGP has guidance on how to flag patients as clinically extremely vulnerable.

In England, the Medical Director for Primary Care (Dr Nikita Kanani) sent a letter to all GP practices on 2 November, requesting them to continue flagging high-risk patients and adding them to the Shielded Patients List.

During the first period of shielding in the UK, many blood cancer patients did not receive their shielding letters for weeks, some not for months. It is crucial this does not happen again, as these letters provide evidence to employers that people should be off work as per government advice.

Being on the Shielded Patients List is now crucial for blood cancer patients, to ensure they are invited for their covid vaccine.

Chronic myeloid leukaemia (CML) and Myeloproliferative neoplasms (polycythaemia vera, essential thrombocythaemia, myelofibrosis)

There has been some uncertainty about how high-risk CML and MPN patients are. The NHS at a national level does include all CML and MPN patients in the clinically extremely vulnerable category.

Now that we know how high-risk blood cancer patients are from coronavirus, it is crucial that all blood cancer patients, including CML and MPN patients, are added to the Shielded Patients List (listed as clinically extremely vulnerable) and invited for their covid vaccine as part of priority group 4.

A recent meta-analysis of studies found that 34% of people with MPNs and CML in hospital with coronavirus died.

GPs can and should add their CML and MPN patients to the Shielded Patients List. This could be important for the future, for example for future covid vaccine roll-outs, or government support for those shielding.

MPN Voice has this statement on its website, clarifying that MPN patients should be offered the vaccine.

The International Chronic Myeloid Leukaemia Foundation (iCMLf) has this statement on its website, clarifying that CML patients should be offered the vaccine.

If you have an MPN and are having trouble getting on the shielding list, share this document with your GP. It explains why you should be on the list and how to add you:

Are people in remission from blood cancer clinically extremely vulnerable?

Patients in remission from myeloma could still have a compromised immune system and are included in the criteria as someone who "currently has any type of blood cancer”. They should be on the Shielded Patient List.

Patients in remission with a chronic blood cancer could still have a compromised immune system and are included in the criteria above as someone who "currently has any type of blood cancer”. They should be on the Shielded Patient List unless their specialist doctor advises otherwise.

Patients in remission from any other blood cancer: The length of time it takes for the immune system to recover after cancer and its treatment varies depending on the type of cancer, the treatment given and the person as an individual. There is no specific time frame. Generally, it takes a few months to a year to recover. Many people’s immune systems recover to a normal level after treatment. However, some patients experience ongoing issues with being more prone to infections and getting more severe infections. It’s important to discuss this with patients and their specialist blood cancer teams, to agree whether they would benefit from being on the Shielded Patients List. Even if they are not on the shielding list, they may still be 'clinically vulnerable' (rather than clinically extremely vulnerable) and should therefore be included in priority group 6 for the covid vaccine - see above under 'People aged 16 to 64 years with underlying health conditions'.

Patients who finished chemotherapy in the last 3 months: These patients may still have a compromised immune system. This should be discussed with the patient’s specialist blood cancer team.

Patients who've had a stem cell transplant: If the transplant was in the last 6 months, they are automatically classed as clinically extremely vulnerable and should be on the Shielded Patient List. If the transplant was over 6 months ago, the government guidance automatically classes them as vulnerable (not extremely vulnerable). But – their doctor can choose to move them to the extremely vulnerable group if they feel this is best. We have more information and sources about how long people may be extremely vulnerable for after a transplant.

Support for GPs

If you have any patients affected by blood cancer, you can signpost them to Blood Cancer UK for support and information.

We are also very happy to speak to GPs and other healthcare professionals if helpful - contact us for information about blood cancer and coronavirus.

Our support line offers emotional and practical support. It is free to call on 0808 2080 888 or email [email protected]

Our website has up-to-date information about blood cancer, coronavirus, and living with blood cancer.

Where can I have the covid vaccine safely?

The covid vaccine will be rolled out at hospital hubs, local community services (like GP surgeries), and vaccination centres (like conference centres and sports stadiums).

Any setting administering the vaccine will follow strict guidelines to ensure this is a COVID-safe environment for clinically extremely vulnerable people to visit.

GPs and any other settings delivering coronavirus vaccines have been given strict guidelines and instructions on things like:

  • storage and handling of the vaccine
  • training of healthcare providers who will administer the vaccine
  • ensuring a COVID-safe environment
  • managing side effects and any reactions
  • monitoring patients when they have the vaccine and for 15 minutes afterwards.

They have also had their site inspected to ensure they are ready for the roll-out.

What are the side effects of the covid vaccine?

Like all vaccines, the Pfizer, AstraZeneca/Oxford and Moderna covid vaccines can cause side effects, although not everybody gets them.

Pfizer vaccine side effects

Most side effects are mild or moderate and go away within a few days.

Common side effects include pain, swelling or redness at the injection site, tiredness, headache, muscle pain, chills, joint pain, fever and nausea (feeling sick).

Here is the full list of reported side effects, including less common ones: Pfizer vaccine side effects.

AstraZeneca/Oxford vaccine side effects

Most side effects are mild or moderate and go away within a few days, with some still present a week after vaccination.

Common side effects include tenderness, pain, warmth, redness, itching, swelling, bruising or a lump where the injection is given, generally feeling unwell, feeling tired (fatigue), chills or feeling feverish, fever, headache, feeling sick (nausea), being sick (vomiting), joint pain or muscle ache, and flu-like symptoms, such as high temperature, sore throat, runny nose, cough and chills.

Here is the full list of reported side effects, including less common ones: AstraZeneca/Oxford vaccine side effects.

Moderna vaccine side effects

Most side effects go away within a few days of appearing.

Common side effects include tenderness and swelling of the underarm glands on the same side as the injection site, pain or swelling at the injection site, headache, nausea (feeling sick), vomiting, muscle ache, joint aches, stiffness, feeling very tired, chills and fever.

Here is the full list of reported side effects, including less common ones: Moderna vaccine side effects.

Healthcare workers who administer the vaccine can tell you about any side effects and are trained in what to watch out for. You will also be asked to wait for 15 minutes after your injection to make sure you are OK before you leave.

Keep updated about coronavirus and blood cancer

Join our mailing list for key updates about coronavirus for people with blood cancer, what we're doing to help, and ways you can help, including campaigns you may be interested in.

Support for you

Call our free and confidential support line on 0808 2080 888. We are currently receiving a very high volume of calls related to coronavirus, so if you're not able to get through straight away, please leave a message and we'll get back to you as soon as we can.

You can also email us if you prefer to get in contact that way. We'll usually get back to you within two working days, but due to the current rate of calls and emails we are currently receiving it may take us longer.

Talk to other people with blood cancer on our Online Community Forum – there is a group for coronavirus questions and support.

You can also find out what's helping other people affected by blood cancer through coronavirus and beyond in our pages on living well with or after blood cancer.

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