A distinction is made between medical risk groups that are also eligible for seasonal flu vaccination, and medical high-risk groups as designated by the Health Council. The medical high-risk groups were vaccinated first; the other medical risk groups had their turn later.
A. Medical high-risk groups
There are groups of patients who have a particularly high risk of severe illness or death due to COVID-19. These people run a risk comparable to people around 70 years old. Therefore, the Health Council recommends that these groups be vaccinated as a priority. The following groups have been selected on the basis of this advisory report:
People who are very severely immunocompromised (i.e. their immune system is impaired):
- Patients with a haematological malignancy/disease resulting in very severe immunosuppression and who have been monitored for this condition by a haematologist in the previous year;
- Patients with severe renal failure (dialysis or in preparation for dialysis);
- Patients who have received a transplant (organ, stem cell or bone marrow) and are severely immunocompromised + patients who are on the waiting list for a transplant;
- Patients with a severe congenital immune disorder (primary immune deficiency).
People who are not severely immunosuppressed and who are at high risk of complications for other reasons:
- Patients with neurological disorders accompanied by respiratory compromise;
- People with Down’s syndrome;
- People with morbid obesity (BMI > 40).
For an explanation on the selection process see the information letter on vaccination of medical risk groups (in Dutch). More information about the process and vaccination schedule is available in this flowchart (in Dutch).
Young people aged 16 and 17 years old (born in 2003, 2004 and 2005) who are in the high-risk groups are also being vaccinated. The Health Council published an advisory report to that effect. From 18 May on, they received an invitation through the medical specialist, which provides access to vaccination by the Municipal Public Health Service (GGD). Young people with neurological disorders who cannot travel to the GGD will be vaccinated at home via a mobile vaccination team. Young people with Down’s syndrome or morbid obesity were previously invited via their GP for vaccination by the GGD.
For an explanation of the vaccination route and the selection process, see the information letter on vaccination of young people in medical risk groups (in Dutch).
B. Medical risk groups
In addition to the high-risk groups, there are other medical risk groups. These are the same people who are invited for a seasonal flu jab from their GP every year due to their medical indication. They have a higher risk of becoming seriously ill from COVID-19 that is approximately comparable to the age group of 50-59 years. This involves people with:
- abnormalities and functional disorders of the respiratory tract and lungs;
- chronic heart disease;
- diabetes mellitus;
- chronic renal insufficiency; (dialysis and kidney transplant patients);
- an immune deficiency or treatment with medicines that affect the immune system (immunosuppressants) leading to reduced resistance to respiratory tract infections.
People between the ages of 18 and 60 years old (born between 1961 and 2003) who are in one of the medical risk groups listed above were invited for vaccination from the beginning of May on. Some of the people in this group are also in a medical high-risk group (such as the dialysis and kidney transplant patients), and were therefore already invited for vaccination. The GPs selected patients based on the General Practitioners Information System (HIS). This group are vaccinated at a vaccination site operated by the Municipal Public Health Services (GGDs).
It is possible (although very unlikely) that there may be people who have not been selected for COVID-19 vaccination, but do have (or believe that they have) an elevated risk of a severe course of illness from COVID-19. Unfortunately, it is not possible to arrange exceptions to the vaccination strategy or the selection process on an individual basis. They will be eligible for vaccination based on their age.
Hugo de Jonge, outgoing Minister of Health, Welfare and Sport, decided on 9 June 2021 that young people with a medical indication could also be vaccinated, as advised by the Health Council of the Netherlands. This involves children and adolescents born between 1 January 2004 and 30 June 2009. This group will receive the Pfizer/BioNTech vaccine from the GGD.
The following young people are eligible:
1. Young people with health problems who can easily be selected by the GP, or for example by the institutional physician. This applies to:
- Young people who are invited annually for the seasonal flu jab;
- Young people with Down’s syndrome.
From 23 June on, they received an invitation from their GP for vaccination by the GGD (or via a route for people who are not mobile enough to travel).
2. Young people who cannot be selected by their GP via the flu jab procedure, for whom an alternative route must be found. This applies to:
- Young people with obesity ≥ Class 2 according to the NHG standard;
- Individual cases involving substantial direct or indirect health effects, in which the treating physician or GP may also provide an indication for vaccination;
- Healthy young people in the context of ring vaccination. This applies to children and adolescents living with a vulnerable household member. In these cases, the household includes someone in a medical risk group who cannot be vaccinated themselves for medical reasons, or who has an immune disorder and may not be sufficiently protected after vaccination. The vulnerable household member could be a child (sibling) or an adult (parent or guardian).
Selection of these groups proved to be time-consuming. Moreover, it was decided on 30 June 2021 to invite all young people aged 12-17 years for vaccination. Young people from the groups listed above can therefore make an appointment from early July on when their birth year is eligible for vaccination. More information is available at Government.nl.
3. Young people with cancer who are currently being treated for the disease. They will receive an invitation from the Prinses Máxima Centrum in Utrecht, and will also be vaccinated at that location from mid-July on.
Considerations regarding vaccination
The Health Council of the Netherlands has stated that the benefits of vaccination with the Pfizer vaccine outweigh the drawbacks of possible side-effects for children aged 12-17 years who are in medical risk groups.
Vaccination can protect children and adolescents against COVID-19 and its consequences:
- Children with chronic health conditions have a higher risk of severe illness from COVID-19, compared to healthy children.
- In addition, children and adolescents can also develop long-term symptoms after a SARS-CoV-2 infection. This is also known as Long COVID.
- Moreover, children can sometimes develop a severe inflammatory reaction in multiple organs as a result of COVID-19. This reaction is referred to as Multisystem Inflammatory Syndrome – Children (MIS-C). Although MIS-C is rare, it can be life-threatening.
- Besides the medical impact of COVID-19, the Health Council has also taken into consideration the possible social consequences of staying home, only seeing friends from a distance, and not attending in-person classes at school.
Safety and effectiveness of vaccines
All vaccines registered by the European Medicines Agency (EMA) are safe to administer. This also applies to all risk groups and high-risk groups, including people who have impaired immunity or are taking medication that reduces immunity. There are only a few contraindications for vaccination, which can be found in the vaccination guidelines (in Dutch). All the vaccines provide very good protection against severe COVID-19.
The effectiveness of COVID-19 vaccination in (severely) immunocompromised patients is still unclear. The Health Council has recommended preferably using mRNA vaccines for people who have health problems that effect their immunity. Even so, the advice is always to make use of the first vaccine that is offered, and not to wait for a different vaccine, since every type of vaccine provides protection against (severe) COVID-19.
Pfizer and Moderna for medical risk groups
People who are in a medical risk group are advised to use the invitation for an mRNA vaccine (Pfizer or Moderna) administered by the GGD. These vaccines are given in two doses and offer slightly more protection than a single Janssen vaccination against COVID-19. Janssen is not an mRNA vaccine.
This advice is primarily important for people with impaired immunity (less resistance due to immune disorders) or whose immune system does not work properly due to an underlying disease or medication (e.g. chemotherapy for cancer treatment). For other medical conditions, such as heart or lung problems, mRNA vaccines are also the preferred choice. Two mRNA vaccinations offer the best possible protection for these people.
People with Down’s syndrome or morbid obesity born in 1946 through 1960 receive their vaccination from their GP. People with Down’s syndrome or morbid obesity born in 1961 through 2005 are vaccinated by the GGD. If they are unable to travel, they will receive their vaccination at home.
Patients aged 18 years and older who are in the medical high-risk groups will receive their COVID-19 vaccination in hospital. Young people aged 16 and 17 years old (born in 2003, 2004 and 2005) will be vaccinated by the GGD.
People with neurological disorders accompanied by respiratory compromise will receive an invitation from a university medical centre (UMC). Those who are not mobile enough to travel to the hospital will be vaccinated at home.
Other vulnerable patients
The COVID-19 vaccination programme is a large-scale vaccination programme. The aim is to vaccinate as many people as possible as quickly as possible in order to reduce severe illness and death. For that reason, it has been decided to select the groups who receive the seasonal flu vaccination every year, since existing processes can be used that will accelerate vaccination. We are following the advisory reports from the Health Council of the Netherlands in this regard.
It is possible that there may be people who have not been selected, but do have (or believe that they have) an elevated risk. They will be eligible for vaccination based on their age. Unfortunately, it is not possible to arrange exceptions to the vaccination strategy on an individual basis, also because of the limited availability of vaccines.
- General information on COVID-19 vaccination and vaccines can be found in the implementation guidelines (in Dutch): COVID-19 vaccination | LCI guidelines (rivm.nl)
- Information about COVID-19 vaccination of immunocompromised patients is available in the LCI guidelines (in Dutch): COVID-19 vaccination of immunocompromised patients | LCI guidelines (rivm.nl)
- More information for patients and the public: https://www.government.nl/topics/coronavirus-covid-19/dutch-vaccination-programme, thuisarts.nl (in Dutch)
Overview of vaccination for medical high-risk groups
The schedule may still change, for example due to delays in vaccine supply in the Netherlands or if there are other problems with a vaccine.
|Medical high-risk groups and risk groups||Vaccine||Vaccinated where?||Starting when?|
|1||Patients with a haematological malignancy/disease||Moderna or Pfizer||Hospital||End of March|
|2||Patients with severe renal failure||Moderna or Pfizer||Hospital||End of March|
|3||Patients who have received an organ, stem cell or bone marrow transplant (including patients who are on the transplant waiting list)||Moderna of Pfizer||Hospital||End of March|
|4||Patients with severe congenital immune deficiency||Moderna or Pfizer||Hospital||End of March|
|5||Patients with neurological disorders accompanied by respiratory compromise*||
Moderna, Pfizer, AstraZeneca or another vaccine**
|UMC or at home||End of March|
|6||People with Down’s syndrome who do not live in a residential care institution||AstraZeneca, or Pfizer||
GP or GGD
|7||People with morbid obesity (BMI >40).||AstraZeneca or Pfizer||
GP or GGD
|Vaccine||Vaccinated where?||Starting when?|
|Other medical risk groups||Pfizer or Moderna||GGD||May|
Frequently asked questions
Both groups have an increased risk of becoming seriously ill from COVID-19, or dying from the disease. They are therefore more likely to end up in hospital or die than other people in the same age groups. The people in the medical high-risk groups are even more at risk: about the same as people aged around 70. Therefore, they will be vaccinated sooner than the other medical risk groups.
At what age does vaccination start?
The minimum age limit for the Dutch COVID-19 vaccination campaign was 18 years old. Specifically for high-risk groups, the Health Council of the Netherlands advised adjusting the minimum age limit for these people to 16 years from April 2021 on. On 9 June 2021, it was decided that young people aged 12-17 years who have a medical indication could also be vaccinated. Finally, on 30 June 2021, it was decided that all young people aged 12-17 years would be invited for vaccination.
What should I do if I receive two invitations?
You may be invited twice: by your GP, and by the hospital where you are being treated. This can happen if you are in one of the high-risk groups, or one of the medical risk groups. The advice is always to make use of the first vaccine that is offered, so you can be vaccinated as quickly as possible. All COVID-19 vaccines provide effective protection against severe COVID-19 (serious enough to require hospitalisation).
If you receive an invitation from two different hospitals, please notify the hospital where you will not be vaccinated that you will not be using that invitation.
Can I choose which vaccine I get?
No, that is not possible. The aim is to always to make use of the first vaccine that is offered. Always accept the first invitation.
What should I do if I get side-effects after vaccination that can affect my treatment, such as a fever?
Many people develop side-effects after vaccination, such as fever, headache or tiredness. These side-effects usually go away on their own within 1 to 3 days. In principle, they will not affect your treatment or disease. If pain or fever becomes severe, you can take a paracetamol. In rare cases, serious side-effects can occur after vaccination. In that case, always contact your GP or treating physician. See the information provided on thuisarts.nl (in Dutch) for more details.
I do not receive an annual invitation for the seasonal flu jab, but I do have a higher risk of serious illness from COVID-19. When will I be vaccinated?
The GP selects the people who receive a seasonal flu jab every year. It is possible that there may be people who have not been selected, but do have (or believe that they have) an elevated risk. They will be eligible for vaccination based on their age. Unfortunately, it is not possible to arrange exceptions to the vaccination strategy on an individual basis. If you are not in that group, then you will receive an invitation later when you are eligible based on your age. There is no reason to call your treating physician in the hospital or your GP about this.
I am not in a risk group, but my treating physician in the hospital and/or my GP believes that I do have a higher risk of serious illness. Can I receive priority vaccination based on that advice?
Unfortunately, it is not possible to arrange exceptions to the vaccination strategy or the selection process on an individual basis. If you are not selected as part of a risk group, then you will receive an invitation as soon as possible when you are eligible based on your age. There is no reason to call your treating physician in the hospital, your GP or the GGD about this.
I have never received an invitation for a seasonal flu jab, but I am in a medical risk group at this point in time. Will I be invited for COVID-19 vaccination?
Yes. Everyone who has a medical indication and is in the risk groups based on their medical health condition at this time will be invited for COVID-19 vaccination.
I am in the high-risk groups, have a GP in the Netherlands, but am being treated abroad. When will I be vaccinated?
You will receive an invitation from your GP for vaccination by the GGD. You will receive the invitation in the same period as the (‘regular’) medical risk groups, between 6 and 20 May 2021.
I am in the medical risk groups, but live abroad. My GP is based in the Netherlands. When will I be vaccinated?
You will receive an invitation from your GP for vaccination by the GGD. You will receive the invitation in the same period as the (‘regular’) medical risk groups (between 6 and 20 May).
I am in the medical risk groups, but my GP is based in a different country. I am currently living in the Netherlands. When will I be vaccinated?
In that case, you will be invited when you are eligible based on your age. No separate exceptions are made for this.
I am pregnant and am in a medical risk group or high-risk group. Can I be vaccinated?
Yes, pregnant women may be vaccinated. See also the recommendations on vaccination of pregnant women.