COVID-19: Vaccine Eligibility & Doses

Everyone aged 5 and older is currently eligible to receive a COVID-19 vaccine. Children must be at least 5 years old at the time of vaccination. For information about vaccinations for children and youth, please see COVID-19 Children and Vaccines.

For most people, mRNA (Pfizer and Moderna) COVID-19 vaccines are the best vaccine choice because of their strong immune protection they provide against severe illness and hospitalization, and their well-known safety profiles. The Pfizer vaccine is strongly recommended for 5-29 year olds, See Update on messenger RNA (mRNA) vaccines.

Children five to 17 years of age should talk about the benefits and risks of getting the vaccine with a parent or trusted adult. This includes understanding information about the vaccine, why it is being recommended and what will happen if they accept or refuse vaccination. Parents or legal guardians of younger children will usually have to provide consent on behalf of the child before or at the time of the appointment.

The Novavax vaccine is a new COVID-19 vaccine option for people 18 years of age and older, who have not been able, due to contraindications, or not willing to receive an mRNA COVID-19 vaccine.

Learn more about the vaccines, vaccine use by age and where to get vaccinated.

Everyone ages 5 and older are encouraged to receive their second dose as soon as they are eligible to ensure maximum protection against COVID-19.

The Pfizer-BioNTech (including the Pediatric vaccine), Moderna Spikevax, Novavax Nuvaxovid and AstraZeneca/COVISHIELD vaccines require two doses.

The Novavax vaccine is a new COVID-19 vaccine option for people 18 years of age and older, who have not been able, due to contraindications, or not willing to receive an mRNA COVID-19 vaccine. The Novavax vaccine can be used to complete a primary series that was started using a viral vector vaccine.

Interval between first and second doses

To further improve protection and effectiveness of the vaccine, the National Advisory on Immunization (NACI) and the Ministry of Ontario has recommended 8 weeks as the optimal interval between the first and second dose. Evidence will continue to be monitored and information will be updated as needed.

• An 8 week interval is recommended because it allows for a stronger immune response to the second dose, and it is associated with a lower rate of side effects.
• Data suggests that protection can be improved when the interval between the first and second doses are extended beyond the original manufacturer’s recommended interval (e.g., 21 days between 1st and 2nd dose of a Pfizer-BioNTech COVID-19 vaccine).
• This interval appears to provide optimal protection, while minimizing the time at risk of infection due to having protection from only one dose.
• Two doses at eight weeks apart, including any booster(s) when eligible, continues to protect adults and children from severe illness ensuring a strong immune response against variants, such as Omicron, and any future variants.
• Individuals may choose to speak with their primary care provider about what interval is best for them. The authorized interval may still be used.
• Interruption of a vaccine series resulting in a greater interval between doses than recommended does not require re-starting the series.

Learn more about the administration of the COVID-19 vaccine, about the vaccines, vaccine use by age, and where to get vaccinated.

Some people who have weakened immune systems may have a lower antibody response to the two-dose series due to their underlying condition(s). Getting three doses of the COVID-19 vaccine, as part of your first COVID-19 vaccine series, is recommended for people who are moderately to severely immunocompromised to help build antibodies and for better long-term protection.

It is important to speak with your doctor or specialist about the timing for you to have the best possible immune response from the vaccine and minimize delays in your treatment and advise the health care provider giving you the vaccination that you are immunocompromised.

A third dose can be given at a minimum of two months (56 days) after the second dose.

• For children ages 5-11, the pediatric PfizerBioNTech (10mcg) vaccine should be given.
• Ages 12-29 year olds, PfizerBioNTech (30 mcg) is recommended and preferred. With informed consent, adults 18-29 years may receive a full dose of Moderna (100mcg).
• Ages 30 and older, a full dose of Moderna (100 mcg) or PfizerBioNTech (30 mcg) should be given.

A COVID-19 booster is a vaccine dose given after you have completed the primary vaccine series. It helps improve protection against COVID-19 that may have decreased over time and boosts the immune response, including making more antibodies. Health Canada authorized mRNA vaccines (Pfizer-BioNTech and Moderna) to be provided for booster doses, regardless of which vaccine was used for your primary series.

The interval between the doses is dependent on the vaccine you receive, your age, your health status and if you recently had a COVID-19 infection. Public Health Agency of Canada and NACI continues to monitor evidence and information will be updated if subsequent doses are required.

According to NACI and the Ministry of Ontario, a booster dose of Novavax Nuvaxovid (0.5mL) may be offered with informed consent, to people without contraindications who are not able or willing to receive an mRNA vaccine.

First Booster Dose

A first booster dose vaccine provides an extra layer of protection against COVID-19.

• Youth ages 12-17 are eligible to receive a booster dose at least 6 months (≥168 days) after receiving your primary COVID-19 series. Youths must be 12 at the time of vaccination.
• Adults ages 18 and older (based on birth date at the time of vaccination) are eligible to receive a booster dose at least 3 months (≥84 days) after receiving your primary COVID-19 series
• Adults ages 18 and older who have proof of immunization AND have received three doses of any non-Health Canada authorized COVID-19 vaccine at the appropriate interval

Vaccine Type

• For 12-29 year olds: Pfizer (30mcg) is recommended and preferred. Moderna (50 mcg) may be given with informed consent to 18 to 29 year olds
• For 30-69 year olds: Any mRNA vaccine (Adult Pfizer or Moderna 50 mcg)
• For 70+ year olds: Any mRNA vaccine (Adult Pfizer or Moderna 100 mcg)

Second Booster Dose

A second booster dose is a dose given after the first booster. Currently the second booster dose is recommended for people who are at higher risk of getting very sick from COVID-19, including seniors. For most people, a second booster will be their fourth dose. For people who are moderately to severely immunocompromised, this will be their fifth dose.

A second booster dose of any mRNA vaccine is recommended for:

• People 60 years of age or older and received a booster dose at least 5 months (140 days) ago
• First Nation, Inuit and Métis adults and their non-Indigenous household members (18+) and received first booster dose at least 5 months (140 days) ago
• Residents of long-term care homes, retirement homes, Elder Care Lodges and older adults living in other congregate settings providing assisted-living and health services, who received first booster dose at least 3 months (84 days) ago

Either Pfizer or Moderna vaccine product can be given as a booster dose, although data suggests that Moderna Spikevax may provide a more robust immune response for those who are seniors or have a weakened immune system. The booster dose for Moderna is a full dose for people ages 70 and over and may be a half dose for other groups.

People who are moderately to severely immunocompromised will need to bring one of the following and optimal timing should be determined on a case-by-case basis in consultation with your clinical team:

• A referral form or letter from your physician, or their authorizing organization, confirming that you are eligible for a booster dose. The letter must include your full name and address (matching your ID), and your Ontario Health Card Number. Please ensure your form or letter has all the required information, including confirmation that you meet one or more of the criteria listed above.

OR

• If you are currently taking an eligible medication (see Table 1 of the COVID-19 Vaccine Recommendations for Third Doses):
  • It is highly recommended and preferred to bring proof of the prescription (e.g., pharmacy medication record). This is because some medications may be toxic to others and require special handling.
  • If you do not have a pharmacy medication record, call your pharmacy to request one.
  • If you must bring medications to the clinic, place them in a clean, see-through plastic bag and ensure the bag is closed. Medication bottles must include prescription date, your name, and contact info for the pharmacy.

It is strongly recommended that all people that come into close contact (e.g., healthcare workers and other support staff, family, friends, caregivers) with those who are immunocompromised complete a full two-dose vaccine series, including booster dose(s) when eligible (i.e., “ring vaccination”) and continue to follow public health measures.

More Information:

• City of Toronto: COVID-19: Where to Get Vaccinated
• Ministry of Health: COVID-19 Vaccine Third Dose and Booster Recommendations

* Moderate to severely immunocompromised populations (if 5 years of age and over) and residents (65+) of long-term care homes, retirement homes, elder care lodges and other senior congregate settings are eligible for a three dose primary series plus a booster (if 12 years of age and over) ** Referral is required from an allergist/immunologist or another specialist where a confirmed allergy exists to components of the mRNA vaccines or there are concerns in accessing an mRNA vaccine.

Re-vaccination is recommended with a new COVID-19 vaccine primary series (3 doses) and booster given the loss of immunity following:

• hematopoietic stem cell transplant (HSCT)
• hematopoietic cell transplants (HCT) (autologous or allogeneic)
• CAR-T-cell therapy

Optimal timing should be determined on a case-by-case basis in consultation with your clinical team.

Please bring your referral form/letter to EACH of your vaccination appointments, highlighting this is to restart your primary series.

Everyone aged 5 and older, without OHIP cards, may get vaccinated at any clinic or pharmacy clinic offering COVID-19 vaccines. Appointments for City immunization clinics must be made through the Provincial Vaccine Contact Centre at 1-833-943-3900.

Required Identification

For all clinics, bring an acceptable form of identification which may include non-Canadian and expired documents such as a driver’s licence or passport, a piece of mail with your name on it, a pay stub or a student card.

Vaccines Authorized by Health Canada

• If you received one dose of a two dose series outside Ontario, you should document this dose and you should get the second dose as soon as you are eligible. Do not wait for your previous dose to be documented before getting your final dose.
• If you have received all recommended doses or a combination of Health Canada authorized vaccines within the minimum recommended interval, after documenting the out of province dose(s) you will be considered to have a complete vaccine series and no additional doses are needed.

Vaccines approved for use in Canada are currently Comirnaty (Pfizer-BioNTech), SpikeVax (Moderna), Vaxzevria (AstraZeneca), and the single-dose Janssen (Johnson & Johnson).

Vaccines Not Authorized by Health Canada

• If you have received and documented one or two doses of a COVID-19 vaccine not authorized for use by Health Canada, you will be considered to have received a full vaccine series by getting one additional dose of an mRNA vaccine. Do not wait for your previous dose(s) to be documented before getting your final dose.
  • The interval between your previous dose and the additional dose should be at least 28 days
  • If you already received three doses of a non-Health Canada authorized COVID-19 vaccine at the minimum intervals, you should not receive any additional doses at this time

Unsure About Which Vaccine You Received

• If you received a previous dose and you do not have proof of vaccination, please contact the health care provider who gave you the COVID-19 vaccine(s) to receive a copy of your vaccination record.
• If the COVID-19 vaccine product used for your previous dose(s) remains unknown, or if written proof of vaccination is provided for a vaccine whose generic or trade name is not recognized, a new vaccine series should be started with a Health Canada authorized COVID-19 vaccine.
  • If you know the date of your previous COVID-19 immunization, wait at least 28 days before getting a new Health Canada authorized COVID-19 vaccine series.

If you are eligible for an additional dose(s), including an mRNA dose needed to complete your series or a booster dose, you can book an appointment at any City-run immunization clinic using your green photo Ontario Health Card (OHIP) number through the  provincial portal or by calling 1-833-943-3900 (TTY 1-866-797-0007). With an older red and white OHIP card number or with not OHIP number at all you can book an appointment by calling 1-833-943-3900 (TTY 1-866-797-0007). Walk-in appointments are also accepted. You do not need to wait until your out-of-province dose(s) is documented by Toronto Public Health.

No Prior COVID-19 Vaccination

If you have not received your first dose, it is still recommended even if you had a COVID-19 infection. Immunity from an infection may not last and you can get COVID-19 again.  To maximize the immune response after your confirmed COVID-19 infection, you can wait 8 weeks from when your symptoms started or you tested positive to get vaccinated. You can also get the vaccine as soon as your symptoms are resolved and you have finished your self-isolation. The vaccine is safe after a recent COVID-19 infection.

Second Dose Interval / Third Dose (as Part of a Three-Dose Primary Series) for Moderate to Severely Immunocompromised Individuals

It is still recommended you complete your vaccination series, even if you had a COVID-19 infection. Immunity from an infection may not last and you can get COVID-19 again.  To maximize the immune response after your confirmed COVID-19 infection, you can wait 8 weeks from when your symptoms started or you tested positive to get vaccinated. You can also get the vaccine as soon as your symptoms are resolved and you have finished your self-isolation. The vaccine is safe after a recent COVID-19 infection.

Booster Dose Interval

A booster dose is still recommended, even if you had a COVID-19 infection. Immunity from an infection may not last and you can get COVID-19 again. To maximize the immune response of the vaccine after your infection, you can wait 12 weeks from when your symptoms started or you tested positive. You can also get the vaccine as soon as your symptoms are resolved and you have finished your self-isolation.  The vaccine is safe after a recent COVID-19 infection.