Proof of the condition is required at the clinic (i.e. referral form, letter from a specialist or primary care provider). All clients should consult their doctor before receiving their third, fourth, or fifth dose. Please verify any treatment or timing considerations.

On this page

Those who are medically eligible based on the provincial guidance below are permitted to receive a three-dose primary series. 

Ministry of Health COVID-19 Vaccine Booster Recommendations

The above document lists immunosuppressive medications Table:1 (pg 11-13). Prescriptions or medication bottles for immunosuppressants listed in the table may be presented at the clinic as proof of condition. If the immunosuppressive medication is not listed, a referral form/ letter from a health care provider is required.

Referrals must be completed by a health care provider and a copy brought to the clinic.

High Risk Health Condition:

A 3-dose primary series of mRNA COVID-19 vaccines are recommended for the following populations eligible for vaccination with the vaccine product authorized for their age group (these recommendations also apply to children aged 6 months and older who fall within any of the categories below):

  • Individuals receiving dialysis (hemodialysis or peritoneal dialysis)
  • Recipients of solid-organ transplant and taking immunosuppressive therapy
  • Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Individuals with HIV with prior AIDS-defining illness or prior CD4 count ≤ 200/mm3 or prior CD4 fraction ≤ 15% or (in children 5-11 years) perinatally acquired HIV infection
  • Individuals receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies3 (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the Canadian Immunization Guide for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumour-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive (See Table 1).
  • Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) for a solid tumour or hematologic malignancies. *Active treatment includes patients who have completed treatment within 3 months. Active treatment is defined as chemotherapy, targeted therapies, immunotherapy, and excludes individuals receiving therapy that does not suppress the immune system (e.g., solely hormonal therapy or radiation therapy).

Primary Series (First, Second & Third Dose):

Moderate to severe immune-compromised individuals 5+ are eligible for a three-dose primary series. Proof of condition is required at the clinic.

Recommended Dose Spacing 

  • 1st dose
  • 2nd dose, 8 weeks after 1st dose
  • 3rd dose, 8 weeks after 2nd Dose

*Exact timing should be decided with the treating provider in order to optimize the immune response from the vaccine series and minimize delays in the management of the individual’s underlying condition. Additionally, the interval should consider risk factors for exposure

Fourth & Fifth Dose (First and Second Booster):

All individuals in Ontario 12 years of age and older are recommended to receive a 1st booster dose after completion of a primary COVID-19 vaccine series. The 1st booster for those who received a 3-dose primary series corresponds to a 4th dose among eligible immunocompromised individuals. 

Moderate to severe immune-compromised individuals 12 years of age and older are eligible for a second booster dose (5th dose).

Recommended Booster Dose Spacing for Immunocompromised:

  • First booster dose (4th dose) 
    • If 11 and under, not eligible
    • If 12-17, 6 months (168 days) after 3rd dose
    • If 18+, 5 months (140 days) after 3rd dose
  •  Second booster dose (5th dose)
    • If 11 and under, not eligible
    • If 12-17, 6 months (168 days) after 4th dose
    • If 18+, 5 months (140 days) after 4th dose