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COVID-19 and vaccination FAQs
The information below has been compiled by RCN advisers in public health, infection control, and employment relations. We'll be updating it as the situation develops - so please do check back often.
Looking for something different? Try ourCOVID-19 FAQs
The RCN actively encourages its members to take up the COVID-19 vaccine. TheNMC Code requires nurses to take measures to protect their patients and the public as well as to protect themselves against serious illness as a professional responsibility.
The vaccine reduces the individual's risk of severe illness, it will also reduce the chance of you contracting the infection and thereby passing infection to others who are more vulnerable to serious disease.
Alongside PPE and social distancing, vaccination is a measure to reduce the risk. Employers should take all reasonable steps to support the vaccination of at risk staff. The RCN believes that this includes employers allowing these staff reasonable paid time away from work to attend vaccination appointments.
Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers are required to assess the risk to staff of occupational exposure to hazardous substances (including biological agents and pathogens) and take measures to control and reduce the risk of exposure. Under regulation 3 of the COSHH Regulations employers have a duty to risk assess and put in place control measures to extend to those who may be affected by the work carried out by the employer, this includes taking all reasonable steps to ensure agency and bank staff are protected, vaccinated and provided with PPE.
The RCN recommends taking up vaccination as best practice. RCN members who are refusing vaccination should refer to the section on refusal below.
How do I get the vaccine (NHS, agency, students and those outside the NHS)?
Any staff who have not been offered the vaccine should contact their employer to find out how to go about getting it in the first instances.
In England, frontline staff who have not had the COVID-19 vaccine can call 119 or book online.
In Northern Ireland: NI Direct
In Scotland: NHS Inform
In Wales: NHS Wales
The groups in the population eligible for vaccination are all detailed in the Green Book chapter for COVID-19 vaccination and recommends that temporary staff such as bank or agency workers, including those working in the COVID-19 vaccination programme, students, trainees and volunteers who are working with patients in the NHS or in an independent or voluntary setting, must also be included.
The vaccine programme for health and care staff is being rolled out through organisations those staff at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable persons or other staff in a health care environment, are considered of higher priority for vaccination than those at lower risk. This prioritisation should be taken into account during vaccine deployment.
Heath and social care staff
Care home providers can now access new government funding to ensure staff are paid their usual wages for the time and travel costs of going to get their COVID-19 or flu vaccinations.
It is in provider's best interests regarding infection prevention and control, to support their staff with full pay when off sick to help stop the spread of infection and maintain standards of care.
You can also see our COVID-19 and time off guidance.
Can internationally recruited nurses get the vaccine?
Yes, internationally recruited nurses working in the NHS will be offered a COVID-19 vaccine and will not need a GP/NHS number.
What to expect after vaccination
The COVID-19 vaccines are safe and effective, but as with any medicine they can cause side effects. These are mostly mild and short lived and while not everyone will get them they are not uncommon. People should be advised that they may get side effects and reassured that these are to be expected. Anyone who becomes very unwell should call 111 or their GP.
The Resuscitation Council UK have recently updated their position statement regarding Covid-19 and vaccinations.
Please see 'What to expect after your COVID-19 vaccination' for more detailed information and printable leaflets in a range of languages. Contact us if your employer is taking any formal action against you due to sickness absence in relation to the vaccine. You can also see our COVID-19 and time off guidance.
It is really important that people return for the second dose of vaccine
Reporting and monitoring of adverse events after vaccination
All medicines adverse events are monitored by the Medicines and Health Care Products Regulatory Agency (MHRA) and there is a dedicated Coronavirus Yellow Card reporting site.
Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The MHRA also publish a Coronavirus COVID-19 vaccine adverse reactions report detailing the adverse events to date reported from the vaccine programme roll out.
Giving other vaccines alongside the COVID-19 vaccine
The guidance in theGreen Book chapter for COVID-19 vaccination recommends that COVID-19 vaccines can be co-administered alongside other vaccines. The exception to this is shingles vaccine where a seven day gap between administration of the shingles and the COVID-19 vaccine is recommended.
What if I am worried about an allergic reaction?
As with any vaccine there is a small risk of serious allergy and anaphylaxis but this is very rare, please see Contraindications and special considerations: the Green Book, chapter 6.
For the COVID-19 vaccines:
- As for any vaccine, anyone with a previous history of allergic reaction to the ingredients in the COVID-19 vaccines, should not receive it.
- Individuals with a history of immediate onset-anaphylaxis to multiple classes of drugs or an unexplained anaphylaxis should not be vaccinated with the Pfizer BioNTech vaccine. The AstraZeneca vaccine can be used as an alternative (if not otherwise contraindicated).
- Those with allergies to a specific drug or vaccine, food or insect stings can safely have the vaccine.
- All recipients of the Pfizer BioNTech or Moderna vaccines should be kept for observation and monitored for a minimum of 15 minutes as a precaution. This is due to severe adverse reactions seen in the initial roll out, not because of specific ongoing concerns.
- As with administration of any vaccine, facilities need to be available for the management of anaphylaxis and vaccinators need to be appropriately trained.
See this guidance for more information along with the Green Book, chapter 14a.
Reporting and monitoring of adverse events after vaccination
All medicines adverse events are monitored by the Medicines and Health Care Products Regulatory Agency (MHRA) and there is a dedicated Coronavirus Yellow Card reporting site.
Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The MHRA also publish a Coronavirus COVID-19 vaccine adverse reactions report detailing the adverse events to date reported from the vaccine programme roll out.
The Royal College of Nursing recommends that everyone accepts a COVID-19 vaccine when they are offered it. We know that Black, Asian and Minority Ethnic (BAME) communities are amongst the group that are at higher risk of becoming critically ill and dying as a result of contracting COVID-19, there are however some understandable concerns about vaccination from some communities. Vaccination is a vital step in protecting already vulnerable communities from further harm.
Tailored local implementation to promote good vaccine coverage in BAME communities is an important factor within a vaccine programme. Such programmes should aim to build trust and confidence in the vaccine as well as tackle misinformation.
Employer's duties
Employers are responsible for undertaking staff risk assessments to identify individuals at higher risk of contracting the virus and/or experiencing serious illness if they do. These risk assessments include factors such as ethnic background, and should be used as the basis for prioritising access to vaccines for staff. It is essential that all staff including those from BAME backgrounds have access to the vaccine as soon as they are offered it. Please see our individual risk assessment guidance for more information.
What is the evidence to show the vaccine is safe for BAME communities?
The Public Assessment Reports from the MHRA contain all the scientific information about the trials and information on trial participants.
- The Pfizer trial, participants included 9.6% black/African, 26.1% Hispanic/Latino and 3.4% Asian (Public Assessment Report for Pfizer/BioNTech COVID-19 vaccine)
- The Oxford/AstraZeneca vaccine 10.1% of trial recipients were Black and 3.5% Asian (Public Assessment Report for Oxford/AstraZeneca COVID-19 vaccine)
There is no evidence either of the vaccines will work differently in different ethnic groups.
Further Information
British Red Cross video encouraging everyone to join the conversation around vaccines.
Colleagues from University Hospitals Birmingham share their experiences of the COVID-19 vaccine, to encourage others to have the vaccine:
- Introductory video
- First video
- Second video
- Final video
Information from the British Islamic Medical Association on COVID-19 vaccines which addresses many of the myths.
Are there any resources to help with community languages?
Please see our section on leaflets and resources for help with accessing a range of materials, leaflets and videos in different languages.
As with any vaccine programme changes are inevitable as more information and evidence becomes available on the vaccines and as the nature of the epidemiology of the pandemic changes. Please see theRCN position statement on changes to the COVID-19 vaccination programme.
As a general principle, the RCN support the decisions of the Joint Committee on Vaccination and Immunisation (JCVI) as the independent expert group responsible for advising the UK vaccination and immunisation programme, wherever possible.
The decisions must be taken by independent experts and on the basis of all the available evidence and such decisions must be taken without pressure from government or other pressure groups. There must be detailed responses when concerns are raised and other solutions proposed.
General changes to the vaccine programme: how do I keep up to date?
Given the current epidemiology of the disease availability of new vaccines and constantly emerging information on the vaccines, it is inevitable that the programme will change. Vaccines need to be rolled out at speed as soon as they become available to help stop serious disease from COVID-19.
The rapid changes to the programme underline the necessity for all clinicians involved in the vaccination programme to keep track of the most up to date published guidance, to be found in the Green Book: Immunisation against infectious disease which provides the UK immunisation policy and is informed by JCVI.
The vaccines available in the UK for use against COVID-19, including the authorisation detail from the Department for Health and Social Care (DHSC) and the Medicines and Healthcare Products regulatory Agency (MHRA) are below:
- Pfizer BioNtech vaccine: Regulatory approval of Pfizer/BioNTech vaccine for COVID-19 currently being rolled out as part of the COVID-19 vaccine programme.
- AstraZeneca / Oxford Vaccine Group vaccine: Regulatory approval of COVID-19 AstraZeneca vaccine currently being rolled out as part of the COVID-19 vaccine programme.
- Moderna: Regulatory approval of COVID-19 Vaccine Moderna currently being rolled out as part of the COVID-19 vaccine programme.
- Janessen: Regulatory approval of COVID-19 Vaccine Janssen approved but awaiting further details and supplies for use in the COVID-19 vaccine programme.
Guidance from the RCOG on COVID-19 vaccines, pregnancy and breastfeeding and Coronavirus infection and pregnancy.
Conception and fertility
There is absolutely no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men. Everyone is advised to have the vaccine as soon as they are eligible. Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.
The British Fertility Society COVID-19 vaccines and fertility FAQs.
Pregnancy
Pregnant women are advised to be vaccinated.
The advice, in the Green Book, chapter 14a on COVID-19 is that pregnant women should discuss the risks and benefits of vaccination with their midwife or clinician.
There is good evidence of the safety of vaccines in pregnancy - please see the UK government COVID-19 vaccine weekly surveillance reports.
Breastfeeding
There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered any suitable COVID-19 vaccine.
Further information
Guidance from the RCOG on COVID-19 vaccines, pregnancy and breastfeeding and Coronavirus infection and pregnancy.
The RCM has also produced information on COVID-19 vaccines. Merged information sheet and decision aid tool (RCOG, RCM, MacDonald obstetric medicine society and UK teratology information service.
The British Society for Immunology video COVID-19 vaccine Q&A: fertility, pregnancy and breastfeeding
Short webinar Pregnancy and fertility Q&A
Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers are required to assess the risk to staff of occupational exposure to hazardous substances (including biological agents and pathogens) and take measures to control and reduce the risk of exposure.
Under regulation 3 of the COSHH Regulations employers have a duty to risk assess and put in place control measures to extend to those who may be affected by the work carried out by the employer. This includes taking all reasonable steps to ensure agency and bank staff are protected, vaccinated and provided with PPE.
The RCN recommends taking up vaccination as best practice and also recognise that there may be consequences for members at work if they have not been vaccinated. Staff need to be able to make this decision in a supportive environment with the right information, encouragement and clear explanation of the benefit and value of the vaccine.
In their guidance to the COSHH regulations, the Health and Safety Executive (HSE) point out that immunisation should be seen only as a useful supplement to reinforce physical and procedural control measures, not as the sole protective measure.
The HSE advise that employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. If so, employers should consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely. In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and where the risk of harm remains high, or potentially redeployment.
If you are considering refusing the vaccine, please see our section on refusal.
See 'Get involved in vaccine delivery' on our COVID-19 vaccination page.
I'm currently ill with COVID-19, can I get the vaccine?
People currently unwell and experiencing COVID-19 symptoms should not receive COVID-19 vaccine until they have recovered. This is to avoid wrongly attributing any new symptom or the progression of symptoms to the vaccine (and to prevent infecting anyone else in the vaccination centre).
As deterioration in some people with COVID-19 can occur up to two weeks after infection, ideally vaccination should be deferred until they have recovered and around four weeks after onset of symptoms or four weeks from the first positive test in those who are asymptomatic.
See COVID-19 vaccination: information for healthcare practitioners and the 'Green Book' chapter COVID-19: the green book, chapter 14a.
Do people who have already had COVID-19 get vaccinated?
Yes, they should get vaccinated.
There is no evidence of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody so people who have had COVID-19 disease (whether confirmed or suspected) can still receive COVID-19 vaccine.
It is not known how long antibodies made in response to natural infection persist. If individuals do have antibodies following natural infection, receiving COVID-19 vaccine would be expected to boost any pre-existing antibodies.
See COVID-19 vaccination: information for healthcare practitioners and the 'Green Book' chapter COVID-19: the green book, chapter 14a.
Vaccines and many medicines are routinely given outside the manufacturer licence. There are instances with the wider routine UK vaccine programme where the schedule and dose recommendations differ to those from the individual vaccine manufacturer's product information. This occurs as new evidence on disease epidemiology or vaccine effectiveness becomes available or on occasion for operational reasons.
Where there are differences to the manufacturer guidance and national policy, it is the Green Book guidance that takes precedence, as detailed as a basic vaccination principle. See Immunisation procedures: the Green Book, chapter 4.
The national Patient Group Direction (PGD) templates and national protocol templates are updated and available here. While these are developed for England, they are shared across the UK for authorisation in the devolved administrations.
Vaccine administration outside the existing PGD or protocol will need a Patient Specific Direction (PSD) or individual prescription.
Members with concerns about their registration can be reassured that the NMC will support those who follow the national protocol or the PGD even where the process diverges from manufacturers' instructions. If any patient brings a compensation claim, the state indemnity schemes will cover our members. Read more about indemnity in our guide COVID-19 and indemnity: what you need to know.
There is no evidence as to the interchangeability of the different COVID-19 vaccines, although studies are underway. Wherever possible the first and second dose should be the same vaccine.
Where an individual started the schedule and then attends for vaccination at a site where the same vaccine is not available, for example, if the individual received their first dose abroad, or where the first product received is unknown, it is reasonable, in these circumstances, to offer one dose of the locally available product to complete the schedule.
Advice on vaccine interchangeability and what to use where people have been vaccinated overseas see the PHE 'Guidance for health care practitioners' appendix 1.
What PPE is required for administering an immunisation including the COVID-19 vaccine?
Immunisers are advised on the infection prevention and control precautions and appropriate PPE for immunisation within the UK infection prevention and control guidance document (see page 17) i.e. wear an FRSM mask on a sessional basis, and risk assess the need for eye protection.
Gloves and aprons are not routinely required unless there is an additional risk of exposure to blood or body fluid contamination/broken skin. This risk is generally very low. If gloves and aprons are worn they are single use and must be removed and changed in between each patient. Hand hygiene must be rigorously applied between each vaccination episode and patient/person contact.You can see the RCN's poster 'Why you don't always need to wear gloves when giving vaccines'.
The WHO Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19: interim guidance, 22 May 2020 has similar guidance.
I have had the vaccine. Do I still need to wear PPE at work?
All vaccinated staff should still follow current COVID-19 guidelines on PPE and social distancing where appropriate.
Please also see our sections on returning to work, protection from future infection along with our PPE guide.
Will I be protected from infection after having the COVID-19 vaccine?
The aim of the COVID-19 vaccine programme is to protect people from severe disease as a result of infection with the SARS-CoV-2 virus. The initial aim of the programme based on the evidence from the vaccine trials was to protect the most vulnerable first therefore helping prevent severe disease in significant numbers of people with an impact on reducing mortality and pressure on hospital admissions.
As with most vaccines, it will generally take 2- 3 weeks for people to develop antibodies and build immunity to SARS-CoV-2 infection and COVID-19 disease. To achieve maximum effect It is essential that people have the full course, for most COVID vaccines this is two doses initially.
No vaccine will ever provide complete 100% protection.
- The RCN recommends that all members should continue to be tested in line with their organisation's expectations/policies.
- Members alongside the general public must continue to follow the advice on contacting their GP and or 111 if they feel unwell, are contacted by the NHS track and trace, or if they test positive.
- All must follow guidance and self isolate where necessary and follow advice from track and trace systems.
- The vaccine will not affect the accuracy of tests for COVID disease. For further information see COVID-19 vaccination: information for healthcare practitioners and Public Health Wales resources for health and social care professionals.
- All staff, regardless of their vaccination status need to follow the UK infection prevention and control measures and use the appropriate personal protective equipment.
- The RCN continue to campaign for the safety of all health care professionals as a priority. For more information, please see the RCN's PPE information.
There is increasing evidence that the COVID-19 vaccines are helping to stop severe infection and in transmitting the SARS-CoV2 virus.
We do not yet know how long the current vaccines will give protection. As relatively new vaccines there is limited data on this so far, although this is increasing all the time.
Assessment of immunity with or without antibodies is not a reliable predictor of immunity from infection. Other factors such as T cells are also important in the overall efficacy of vaccines.
All individuals respond differently to vaccines; people's age and any underlying conditions will affect their overall immune response. Having a high overall uptake across the population will help build community or herd immunity and help reduce transmission of infection.
Inevitably with a novel pathogen such as SARS-CoV-2, vaccine efficacy could be less effective against new variants of the virus, which the vaccines were not originally developed for and this is also being closely monitored by public health agencies and researchers. It is therefore imperative that people have 2 doses, if required, to offer the highest level of protection against variants.
Data are emerging all the time on the impact of the vaccine programme overall. The PHE vaccine surveillance reports show the overall monitoring and analysis of the vaccines against infections, hospitalisations and deaths as well as on transmission but obviously these data are still limited due to the relatively short time the programme has been running.
There is ongoing work looking at the impact of booster doses and potentially longer term for modified vaccines against different variants of the virus. See our section on booster doses.
The RCN aligns itself to JCVI guidance and is working closely with the NHS and public health agencies on both the vaccine efficacy data and the logistics of the roll out of the vaccine programme.
Please also see our section on returning to work after having the vaccine within this guide.
Can I return to work after having the vaccine?
Yes, you should be able to work as long as you feel well. If your arm is particularly sore, you may find heavy lifting difficult. If you feel unwell or very tired you should rest and avoid operating machinery or driving.
The vaccine cannot give you COVID-19 infection, and two doses will reduce your chance of becoming seriously ill.
All medicines, including vaccines, are highly regulated – and that is no different for the approved COVID-19 vaccine. There number of enablers have made this possible:
- The different phases of the clinical trial were delivered to overlap instead of running sequentially which sped up the clinical process.
- There was a rolling assessment of the vaccine trial data as soon as it became available so that experts at the MHRA and JCVI could review it as soon as possible, ask questions along the way and request extra information as needed – as opposed to the usual process which would mean getting all information at the end of a trial.
- Clinical trials managed to recruit people very quickly as a global effort meant thousands of people were willing to volunteer.
The trials and evidence show the vaccines to be safe and effective. These are being followed up with ongoing surveillance and monitoring to analyse the safety and ongoing effectiveness of the vaccines. The PHE COVID-19 vaccine surveillance strategy describes the process for how this will be implemented.
It is inevitable that the programme will adapt as more evidence becomes available. This will be analysed by the JCVI and MHRA and be published in the COVID-19: the green book, chapter 14a. Everyone should make sure they always look at the most up to date version and access it on line. For more information see the other sections on this page, particularly the one on 'Blood clots and COVID-19 vaccination' relating to the AstraZeneca vaccine and 'Allergies'.
Please also see the MHRA information on the process for vaccine authorisation and ongoing surveillance and the Oxford Vaccine Group useful information and resources for all COVID-19 vaccines.
You can also read our blog which helps to explain how vaccines have been tested.
I am extremely clinically vulnerable. What will having the vaccine mean?
COVID-19 vaccination will help to stop people from catching and therefore passing on the SARS-CoV2 virus but no vaccine will be 100% effective.
Studies have shown that those who are immunosuppressed do not have such a strong response to the vaccines and the JCVI have advised they be given a third dose of vaccine to help improve their level of protection from the vaccines.
Public Health England have updated theirguidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. People who are clinically vulnerable are now advised to follow the same advice as the rest of the population. See this guidance for individuals may wish to take extra precautions, but are no longer advised to shield.
Please also see our section on returning to work after having the vaccine above.
The COVID-19: the green book, chapter 14a gives detailed information.
The Pfizer BioNtech vaccine: Regulatory approval of Pfizer/BioNTech vaccine for COVID-19 and the Moderna: Regulatory approval of COVID-19 Vaccine Moderna vaccines are both authorised for children aged over 12 years.
Children and young people who have underlying health problems or are in a household with someone who is immune supressed should receive two doses of vaccine. Young people approaching 18 should also get two doses of vaccine. The CMO advice, considering the wider impact on children to education and mental health, is that having a significant proportion of young people vaccinated is likely to reduce infection and transmission of COVID-19 and as such will help reduce the likelihood of major disruption to education. Otherwise, healthy young people between 12 – 17 years and nine months and should receive one dose of vaccine.
COVID-19 generally causes less severe disease in children. The JCVI and CMOs acknowledge that the risks and benefits around COVID vaccination for healthy 12-15 year olds are more finely balanced than for older age groups.
Information provided about the vaccine should cover all the details needed to ensure a parents and young people are able to give informed consent.
More information is available from:
UK Government's updated COVID-19 vaccination: resources for children and young people
Advice and information from the RCPCH covid-19-vaccination-children-young-people
The primary objective of the COVID-19 vaccine programme is to protect people from severe disease. The COVID-19: the green book, chapter 14a provides the detail. Also see the COVID-19 vaccination: information for healthcare practitioners.
Primary COVID-19 vaccine schedule
The main COVID-19 vaccines used in the UK require a primary course of two doses of vaccine separated by a minimum eight week gap. The exception is the Janessen vaccine which requires just one dose.
Individuals who are immunosuppressed due to underlying health conditions or medical treatment may not mount a full immune response to COVID-19 vaccination. Immunosuppressed individuals aged 12 and over are recommended to have a third dose of COVID-19 vaccine, to be given at a minimum of eight weeks after the second dose. This will help to boost their overall immunity, please see the JCVI statement.
Additional third dose of vaccine
Individuals who are immunosuppressed due to underlying health conditions or medical treatment may not mount a full immune response to COVID-19 vaccination. Immunosuppressed individuals aged 12 and over are recommended to have a third dose of COVID-19 vaccine, to be given at a minimum of eight weeks after the second dose. This will help to boost their overall immunity, please see the JCVI statement.
Booster doses
The JCVI have advised that for those who are at greatest risk of COVID-19, a third dose COVID-19 booster vaccine should be given. See the COVID-19: the green book and JCVI statement regarding a COVID-19 booster vaccine programme for winter 2021 to 2022.
The advice is that the booster dose be given a minimum of 6 months after completion of the primary course as per the advice in the green book, this includes:
- those living in residential care homes for older adults
- all adults aged 50 years or over
- frontline health and social care workers
- all those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19 and adult carers
- adult household contacts (aged 16 or over) of immunosuppressed individuals.
JCVI will review data as they emerge and consider further advice at the appropriate time on booster vaccinations in younger adult age groups, children aged 12 to16 years with underlying health conditions, and women who are pregnant.
The advice on boosters applies to this year, there is no advice at the moment on the need for recurrent boosters.
Winter wellbeing
Protecting yourself and your patients is vitally important this winter
COVID-19 vaccination
Clinical information, guidance and relevant RCN positions on the UK COVID-19 vaccine programmes.
Our COVID FAQs
Find out how to protect yourself, what you should expect from your employer and what to do if you have concerns.
Page last updated - 21/10/2021
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Source: https://www.rcn.org.uk/get-help/rcn-advice/covid-19-and-vaccination
