Issue 35, 1 December 2021

The newsletter on COVID-19 vaccination is an RIVM publication with up-to-date information for professionals involved in COVID-19 vaccination.

Progress report on the COVID-19 vaccination campaign

Booster vaccination invitations for care workers

Hospitals are already working hard to vaccinate their own care workers. From 3 December on, general practitioners, their support staff (including triage staff for GP and out-of-hours medical centres) who have contact with patients, and ambulance crews who have contact with patients (including ambulance dispatchers) will be invited for the booster vaccination. They will receive the invitation from their employer and be vaccinated in hospitals. Other care workers will receive an invitation through their employers in December. They can go to the Municipal Public Health Services (GGDs) for their vaccination. 
RIVM is contacting as many relevant sector associations as possible, so they can inform their members and affiliated care organisations about how to invite their care workers. For employers who are not affiliated with a sector association, more information will soon be available on the RIVM website. Freelancers working in healthcare can be invited by the employer they are currently working for. They can contact SoloPartners for more information.

People born in 1939 or before invited for COVID-19 booster vaccination

People born in 1939 or before can contact the GGD to schedule an appointment for a COVID-19 booster vaccination. It is not necessary to wait for the invitation letter. The best way to make an appointment is online, at If that does not work, they can also call 0800-7070 to make an appointment by phone.

European Medicines Agency (EMA)

Pfizer/BioNTech vaccine approved for children aged 5 years and over

On 25 November 2021, EMA recommended approval of the COVID-19 vaccine made by Pfizer/BioNTech (Comirnaty) for use in children aged 5 years and over. This vaccine was previously approved for conditional use in people aged 12 years and older. More information is available on the website of the Dutch Medicines Agency.

Advisory report of the Health Council of the Netherlands

COVID-19 booster vaccination for people with Down syndrome 

The Health Council of the Netherlands considers optimal protection through vaccination to be important for adults with Down syndrome. This is warranted in view of their higher risk of serious illness and death due to COVID-19, even after vaccination. For that reason, the Health Council has advised offering this group a booster vaccination.

COVID-19 booster vaccination for people aged 18-60 years

The Health Council emphasises that it remains important to give the first booster vaccinations to older people and people living in residential care institutions. After that, there may be health benefits in giving a booster vaccination to people between the ages of 18 and 60, in order from old to young. Read more in the advisory report (in Dutch).

Ministerial decree on vaccination strategy

Booster vaccinations have started

As of 19 November 2021, people aged 80 years and older are invited to get the booster vaccination. The aim is to be able to offer a booster vaccination to as many older people as possible before the end of the year. A booster vaccination has also been provided to the first people aged 18 years and older living in a residential care institution and to people aged 18 years and older working in healthcare and WMO-based support provided under the Social Support Act who have contact with patients and clients. People with Down syndrome will receive an invitation from 3 December 2021 on. After these groups have had an opportunity, everyone under 60 will be able to receive a booster vaccination. Invitations will be sent in order from old to young (until 18 years). See the Parliamentary letter of 26 November 2021 on the current situation regarding COVID-19 (from page 25).

Frequently asked questions

Q: Why is heterologous vaccination used in the booster campaign? 

A: The Health Council of the Netherlands recommends using an mRNA vaccination for the booster jab, regardless of the vaccine used in the primary course of vaccinations. The COVID-19 vaccines made by Pfizer/BioNTech and (half-dose) Moderna are EMA-approved for homologous booster vaccination. The Health Council has stated that there is no longer a preference for homologous vaccination in the context of the booster vaccination. Although heterologous use of the Moderna and Pfizer vaccines has not been officially reviewed by the EMA, a booster dose of these mRNA vaccines induces high titres of neutralising antibodies, regardless of which vaccine was given in the primary vaccination series (Atmar 2021). For the time being, both mRNA vaccines are being used for the booster vaccination programme in the Netherlands. Both mRNA vaccines can be used after a primary vaccination series of all 4 COVID-19 vaccines used in the Netherlands. The Mix and Match study by Atmar showed that a heterologous booster dose of all 3 vaccines used in the US (Janssen, Comirnaty, and Spikevax) produced a good booster response. An mRNA vaccine induces the highest antibody titres and optimal neutralising antibodies. Results are still expected for the UK-based COV-boost study that also included Vaxzevria (AstraZeneca) as a basic series.
Based on preliminary data, the Joint Committee on Vaccination and Immunisation (JCVI) recommends using an mRNA vaccine for the booster vaccination. PRAC is currently reviewing whether there is a clearly elevated risk of myocarditis or pericarditis in adolescents and young adults after Spikevax (Moderna). In the Netherlands, it has therefore been decided for the time being to reserve Spikevax (Moderna) for people aged 60 years or older, for whom it is an excellent booster. People living in residential care institutions and care workers also include people under 60 years old, which is why these groups will receive Comirnaty (Pfizer/BioNTech) in the booster campaign. See the implementation guidelines for COVID-19 vaccination 2021 for further information. 

Q: What interval is required between administration of an influenza vaccination and a COVID-19 vaccination? 

A: Because the COVID-19 vaccines have received conditional marketing authorisation for the Netherlands, the aim is to monitor the adverse reactions as well as possible. The following intervals are recommended:

  • An interval of at least 1 week when an influenza and/or pneumococcal vaccination is administered prior to a COVID-19 vaccination.
  • An interval of at least 2 weeks when an influenza and/or pneumococcal vaccination is administered after a COVID-19 vaccination. 

In exceptional cases, it can be considered to administer an influenza vaccination at the same time (on the same day) as a COVID-19 vaccination. The FluComCov study demonstrated safety and effectiveness of simultaneous administration of influenza vaccination and COVID-19 vaccination (Comirnaty or Vaxzevria) (Lazarus 2021, BMJ 2021). However, simultaneous administration does make it more difficult to identify any adverse reactions. All other intervals shorter than those recommended have not been investigated and cannot therefore be recommended. It is not possible for GGD GHOR Nederland to make a distinction between different vaccines when making an appointment for the COVID-19 vaccination. Therefore, a 2-week interval is maintained for all vaccines, before and after the COVID-19 vaccination.

Updated implementation guidelines for COVID-19 vaccination

The implementation guidelines for COVID-19 vaccination 2021 have been updated. The latest version of the implementation guidelines is always available online (in Dutch). Section 1.3 outlines all major changes compared to the previous version; more minor interim changes are listed under Version Management (at the end of the document).

Recent changes have covered the following topics:

Interval between influenza vaccination and COVID-19 vaccination.

Adverse reactions

Pharmacovigilance Centre Lareb has posted a new update about reports of possible adverse events following immunisation with COVID-19 vaccines which were reviewed by experts up to and including 21 November 2021.

Public communication

RIVM has developed an animated video about what a booster vaccination is. It can be found on the web page with background information and frequently asked questions about the booster vaccination.

The Ministry of Health, Welfare and Sport (VWS) has developed a new infographic about the booster vaccination. Care providers and support staff can use this document to explain the booster vaccination to people with an intellectual disability.

Upcoming events

On 17 November 2021, the webinar on youth in the pandemic (among other topics) had about 10,000 viewers. It was another great success in the recent series of Webinars for Professionals. Did you miss the livestream of the Webinar? You can watch it via this link. The webinar is accredited until 1 December at 18:00 hrs.


Editors: Vaccination implementation, National Coordination Centre for Communicable Diseases Control (LCI).

The newsletter is also available in Dutch.

For questions and/or comments about this newsletter, healthcare professionals can send a message to

Private citizens can call the public information number 0800 - 1351 with their questions.