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Information about COVID-19 fourth doses

The Ministry of Health recently announced that some people with immunocompromising conditions can get a fourth dose of the COVID-19 vaccine.

If you are a person with cancer, you can find out more about fourth doses below to see if you are eligible. You can also speak to a member of your health care team.

Fourth doses for people who are immunocompromised

If you are an Odette Cancer patient who might be eligible for a fourth dose of COVID-19 vaccine, see below.

People with solid tumours or hematological cancer who are in active treatment are eligible for a fourth dose of the COVID-19 vaccine.

Active cancer treatments reduce your immune system.

You are in active treatment if you have had immunosuppressive therapy for:

  • solid tumour in the last 3 months, or
  • hematological cancer in the last 6 months or
  • taken an anti-C20 drug in the last 12 months

Research has shown that people on certain treatments or with certain medical history are at greatest risk of poor outcomes from COVID-19, and that a fourth dose of vaccine provides better immunity against COVID-19.

You are still well-protected by three doses. The fourth dose will provide even more protection.

Who should get a fourth dose?

You should get a fourth dose if you are in active treatment for a solid tumour or malignant hematological condition. This means that you are on stable, active treatment that can cause moderate to severe immunosuppression.

Toronto Public Health defines this as:

  • Patients on chemotherapy, targeted therapy, or immunotherapy right now.
  • All malignant hematology patients who are on treatment or are within 6 months post-treatment (including all CML patients)
  • Patients who have completed treatment within 3 months, or within 12 months for patients receiving B-cell depleting therapy.
  • All patients who received an allogenic transplant within the last 2 years or who are on chronic post-transplant immune-suppressive
  • All patients who received an autologous transplant within the last two years
  • Patients who are on active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22, e.g. rituximab, obinutuzumab), high-dose systemic corticosteroids (prednisone equivalent of ≥ 20 mg/day), alkylating agents (e.g. bendamustine, cyclophosphamide), antimetabolites (e.g. 5-fluorouracil, methotrexate), or tumour-necrosis factor (TNF) inhibitors (e.g. infliximab) and other biologic agents that are significantly immunosuppressive

You are also eligible for a fourth dose if:

  • you got your first or second vaccine during or within 12 months after treatment with anti-CD20 agents
  • you got chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy).

How to book a fourth dose of the COVID-19 vaccine

Please visit the Ministry of Health's website.

Frequently asked questions

Who should get a fourth dose?

People with cancer who are on active treatments like chemotherapy, targeted therapy and immunotherapy should get a fourth dose of the COVID-19 vaccine. It must be at least 84 days since your second dose. People who have had a stem cell transplant or CAR-T cell therapy should also get a fourth dose. People who’ve recently had these treatments should also review the list above to see if they are eligible. For the full list of who should get a fourth dose, see above.

Learn more about COVID-19 and the vaccine in a Sunnybrook-hosted webinar

Why do I need a fourth dose?

Research has shown that people on certain treatments or with certain medical history are at greatest risk of poor outcomes from COVID-19, and that a fourth dose of vaccine provides better immunity against COVID-19.

When should I get a fourth dose?

Immunocompromised people or people on any of the treatments above can get the fourth dose at least 84 days after their third dose. It can also be later than that too. You remain well-protected by three doses.

How do I get a fourth dose?

You can go to select pharmacies or a vaccine clinic. Visit the Ministry of Health's website for more information. You will need proof of your medication, like the medication slip.

I didn’t get a third dose yet!

That’s OK. You can still get a third dose. You can book a third dose using the provincial website or speak to a member of your healthcare team.

Should my family get a third dose of the COVID-19 vaccine?

Your family member might now be eligible for a third dose. Visit the Ministry of Health's website for more information.

I didn’t get my first or second dose yet. What do I do?

The COVID-19 vaccine is a safe and effective way to protect yourself from COVID-19. If you haven’t got the vaccine yet, please speak to your care team or visit The Ministry of Health's website.

What else can I do to protect myself against COVID-19?

Please continue to follow public health guidelines for masking and distancing. Encourage people in your family who were born in 2009 or earlier to also get vaccinated with two doses of COVID-19 vaccine. Children age 5 to 11 are now also eligible for vaccines. Learn more.