Publication approval reference: C1200
COVID-19 vaccination programme: FAQs on second doses
Version 1 – 19 March 2021
LOCATION OF SECOND DOSE
Does second dose vaccination need to happen at the same place as the first
dose?
• People using the National Booking Service (booking into a vaccination centre or
designated community pharmacy) are given their closest available appointment
locations. While we expect most people will book both appointments at the same
location, there is an option for the second dose appointment to be booked at a
different location. This applies to the COVID-19 AstraZeneca vaccine only.
• People who had their first dose through a GP service should be invited for their
second dose through the same GP service.
• People who had their first dose at a Hospital Hub site should be invited or be able
to book their second dose at the same location.
• There are other circumstances in which it may be appropriate for a patient to
receive their second dose in a different location to their first dose, for example,
discharged outpatients, students, doctors in training on rotation to hospitals, people
who have become housebound or moved into a care home since their first dose, or
patients who have moved to a new house to somewhere a long way away from
where they had their first dose.
• Local systems should take a common-sense approach to these cases, eg trying to
reduce extensive travel for elderly patients where possible.
SECOND DOSE INTERVAL PERIOD
What is the second dose interval period?
• The agreed dose interval period is set at 77-84 days as outlined in the Chief
Medical Officer’s letter. Vaccine will be supplied for second dose clinics to take
place 11 weeks post first dose clinics, so that the 12-week time period between
doses is achieved.
Can clinics be scheduled early to vaccinate outside of the interval period?
• Clinics should not schedule second dose appointments earlier than 77 days post
the first dose, unless there are exceptional circumstances, as this is not in line with
the agreed dose interval.
Are there any circumstances when individual patients can receive their second
dose outside of the standard interval period?
• The Green Book states that second dose should in almost all cases be given
between 77 and 84 days after the first dose. However, there are a small number of
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circumstances when the second dose can be given at a different time interval, for
example:
Some patients with planned immunosuppressive therapy
• There are a small number of patients who are about to receive planned
immunosuppressive therapy and, where clinically appropriate, should be
considered for vaccination prior to commencing therapy (ideally at least two
weeks before), when their immune system is better able to make a response.
• Where possible, it would also be preferable for the two-dose-schedule to be
completed prior to commencing immunosuppression.
• This would entail offering the second dose at the recommended minimum for
that vaccine (three or four weeks from the first dose) to provide maximum
benefit that may not be received if the second dose was given during the period
of immunosuppression.
Homeless people and rough sleepers
• Given the vulnerabilities of homeless people and rough sleepers, local teams
should exercise operational judgement and consider a universal offer, where
those experiencing homelessness or rough sleeping are vaccinated alongside
priority group 6 (as far as local teams consider appropriate).
• To maximise coverage in this group, JCVI also advise a first vaccine dose
should be given, even if follow up for a second dose is likely to be uncertain,
and that the dosing schedule can be compressed if that makes delivery of a
second dose more certain.
• If an interval longer than the recommended interval is left between doses, the
second dose should still be given. The course does not need to be restarted.
Can patients be vaccinated sooner than 77-84 days if it is operationally
convenient?
• Second doses should be offered within 77-84 days. The clinical evidence for the
COVID-19 AstraZeneca vaccine shows better efficacy following a 12-week gap,
which is the basis of the JCVI recommendation.
• However local areas should agree a pragmatic approach to giving doses earlier
than this following a clinical assessment and weighing up risks and benefits.
SCHEDULING AND ADMINISTERING SECOND DOSES
Can different vaccines be used for first and second doses?
• The Green Book states that the same vaccine used for the first dose must be
used for the second, except in very exceptional circumstances. These
exceptional circumstances are:
o If the first product received is unknown or if they received a brand that is
not available in the UK. In these circumstances every effort should be
made to determine which vaccine the individual received for their first
dose and to complete the two-dose course with the same vaccine.
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o If the patient initially had the Pfizer Vaccine in an LVC or HH clinic and
has since become housebound. In these circumstances as the COVID-
19 vaccine AstraZeneca can be transported, a second dose with this
vaccine can be given.
• Those who experienced anaphylaxis reactions with the first dose of one brand
of vaccine may be offered another vaccine if advised by an allergy specialist.
CONSENT
Does consent need to be obtained for the second dose, in particular in the case
of care home residents?
• The Standard Operating Procedure for Covid vaccination in community settings
states that “the giving and obtaining of consent is viewed as a process, not a
one-off event. Consent should still be sought on the occasion of each
immunisation visit. Consent must be given voluntarily and freely”. It is not
necessary for care home staff to obtain a second consent form. The original
consent forms include the second dose, as they describe consent for the full
course. However, patients should have the opportunity to refuse the second
dose – this may occur in the rare case of a side effect. Further details are
available on NHS Futures web platform issued by the clinical workstream.
• If care home residents do not have capacity and the decision to vaccinate has
been made on best interests or through an attorney, this would have been for
the full course, so would not necessarily require a second process. However, at
the time of the vaccination, there should be the opportunity for an individual or
advocate to refuse consent. We expect this to be unlikely in most cases.
DATA AND RECORDING
How are first and second dose vaccination events recorded?
• First and second dose vaccinations are to be recorded in the points of care system
in an accurate and timely manner in order to start the allocation calculations. This is
important for Pfizer in particular, as its supply is finite.
• Outcomes4Health differentiates between first and second doses.
• Once a first dose event has been recorded on the system this will trigger a second
dose allocation requirement 11 weeks later.
• It is important that doses are recorded onto the points of care system at the point of
vaccination to ensure clinical safety, eg ensuring that a patient receives the correct
second dose.
VACCINE ALLOCATIONS AND SUPPLY
How do we manage any surplus doses?
• Where there is surplus vaccine following second dose clinics, this should be
used for first doses in the prevailing priority cohorts, for those patients who have
been vaccinated prior to starting immunosuppression and who need a shorter
interval between doses.
• For LVS in particular, every effort is being made to right-size Pfizer supply with
the use of pack down in order to minimise surplus.
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How will we separate first and second dose vaccines on site?
• Vaccine deliveries will not be separated into first and second doses. This will
need to be done on site on arrival, informed by the allocation planning process.
Sites will receive their regular weekly allocation information which will include
first and second dose summaries in order to do this.
• Care must be taken to ensure that volume allocated for second dose activity is
appropriately identified and directed to second dose clinics.
• HHs’ and VCs’ Immform accounts will show total allocation per site – there is no
differentiation between first and second dose on Immform.
When will second dose allocations be available?
We are trying to provide visibility of four weeks’ worth of allocations ahead of time, to
be finalised about two weeks in advance of delivery to Local Vaccination Services, or
availability to order in the case of Vaccination Centres or Hospital Hubs. Exact
timelines will be communicated shortly through the usual cascade routes. For Local
Vaccination Services and Pfizer vaccine we are making efforts to extend to more than
four weeks’ worth of allocations ahead of time.
What if we don’t have sufficient supplies to cover patients who didn’t have their
first dose at that site?
In the unlikely event that supply is insufficient please urgently escalate through the
normal routes.
Who do I contact if I have a query around final second dose allocations?
• If your query is related to final dose allocation, it should follow the standard comms
route, ie from SVOC, to RVOC, to NVOC which is then shared with the central
team.
• Please do not bypass this process, to ensure your queries and requests are
actioned as soon as possible.
• The role of Customer Services remains unchanged, same routes apply for second
dose as those for first dose.

2022-2023

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