COVID-19: Vaccine Eligibility & Doses

Getting every eligible resident their first and second dose of the COVID-19 vaccine is a high priority. It is more important than ever to get vaccinated and follow public health guidance. Getting the COVID-19 vaccine lowers the risk of serious illness, hospitalization and death, while protecting individuals and the wider community from getting sick.

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 means the young person must understand 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.

Search the table below to find out where you can access your vaccine and when you can get your second, third or booster dose:

If you have a fever or COVID-19 symptoms, please get your vaccine at a later date, when your isolation is completed and you no longer have any COVID-19 symptoms.

Learn more about vaccine use by age. Consult with your health care provider before getting vaccinated, if you:

• are on medications that weaken your immune system – you may want to time your vaccination with your medications
• had an allergic reaction within four hours after receiving your first COVID-19 vaccine dose
• have severe allergies to any of the vaccine ingredients

Your health care provider will review the benefits and risks for your unique situation.

Second Doses

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

All residents are encouraged to get vaccinated as soon as they can, and to receive their second dose as soon as they are eligible to ensure maximum protection against COVID-19.

How to Get Your Second Dose

As of November 6, 2021, second doses are available at all five City-run clinics by appointment only. Residents can book their appointment online or call the provincial booking system at 1-833-943-3900. Pharmacies, some hospital clinics, some select primary clinics, and community immunization clinics also offer second dose vaccinations either by appointment or walk-in may be available.

If You Received an mRNA Vaccine (Pfizer or Moderna) for Your First Dose

City clinics offer mRNA vaccines and staff will ensure that residents are aware of which vaccine brand they will receive at the time of their appointment. The Moderna and Pfizer vaccines are incredibly similar with near identical efficacy rates. A “mixed mRNA model” – mixing Pfizer and Moderna for first and second dose – is approved by both the federal and provincial governments. Both vaccines have similar side effects and are safe, effective and interchangeable.

As of September 29, 2021, Ontario’s Chief Medical Officer of Health recommends the Pfizer-BioNTech vaccine for individuals aged 18-24 years old, based on the current available data from Ontario’s adverse events following immunization (AEFI) surveillance system. Individuals 18-24 years old can still receive the Moderna vaccine with informed consent. Ontario will continue using the Pfizer-BioNTech vaccine for youth ages 12-17 (including those turning 12 in 2021).

As of November 19, 2021, the pediatric Pfizer-BioNTech vaccine is the only COVID-19 vaccine approved by Health Canada for children aged 5 (or turning 5 in 2021) to 11. See: Second Dose details for this age group.

For more information:

• COVID-10 Vaccine Information Sheet: For Children (age 5-11)
• COVID-19 Vaccine Information Sheet For Youth
• COVID-19 Vaccine Recommendations Special Population

If You Received AstraZeneca for Your First Dose

As of June 17, 2021, the National Advisory Committee on Immunization (NACI) recommends that an mRNA (Pfizer or Moderna) COVID-19 vaccine is now preferred as the second dose for people who received a first dose of the AstraZeneca vaccine.

A third or booster dose vaccine provides an extra layer of protection against COVID-19. Health Canada authorized mRNA vaccines (Pfizer-BioNTech and Moderna) to be provided for third/booster doses. Ontario has also expanded eligibility for a third/booster dose of COVID-19 vaccine. A booster dose is an additional dose of vaccine that helps to increase protection that may have decreased over time.

The following groups are now eligible:

• Adults 18+ (based on birth date – must be 18 years old at time of vaccination)
• People who are immunocompromised (see details below)
• First Nations, Inuit and Métis Adults (16+)
• Health Care Workers (Ages 16+ years old – see eligibility list)
• Designated Essential Caregivers in congregate settings

For those eligible, either mRNA COVID-19 vaccine (Pfizer-BioNTech Comirnaty or Moderna Spikevax) may be used as a third dose or booster dose, regardless of which vaccine was used for the first two doses.

• For the Pfizer-BioNTech Comirnaty mRNA vaccine, a full dose (30 mcg) is recommended.
  • This includes 18-29 year olds who are currently eligible to receive a third/booster dose.
• For the Moderna Spikevax mRNA vaccine:
  • A full dose (100 mcg) is recommended for adults 70 years of age and older, residents of long-term care homes, retirement homes or seniors in other congregate settings, and all eligible immunocompromised people.
  • A half dose (50 mcg) is recommended for other adults less than 70 years old.
• A booster dose is not approved by Health Canada for 12 to 17 year olds.

Three-Dose Primary Series

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 advise the health care provider giving you the vaccination that you are immunocompromised. Ages 12 and older should be offered the full dose of either Moderna (100 mcg) or PfizerBioNTech (30 mcg) as a third dose. For children ages 5-11, the pediatric PfizerBioNTech (10mcg) vaccine should be given.

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

• People receiving dialysis (hemodialysis or peritoneal dialysis)
• Transplant recipients of a solid-organ transplant or hematopoietic stem cell transplant (within two years of transplantation or taking immunosuppression therapy)
• People undergoing active treatment* for solid tumors and hematologic cancers
• Recipients of chimeric antigen receptor (CAR)-T-cell
• People with moderate or severe primary immunodeficiency (e.g. DiGeorge syndrome, Wiskott-Aldrich syndrome)
• People with stage 3 or advanced untreated HIV infection and those with acquired immunodeficiency syndrome
• People undergoing active treatment** with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the Immunization of Immunocompromised Persons – Canadian Immunization Guide for suggested definition of high dose steroids), alkylating agents, antimetabolites, tumour-necrosis factor (TNF) inhibitors, and other biologic agents that are significantly immunosuppressive (see Table 1 of the COVID-19 Vaccine Recommendations for Third Doses***)

*Active treatment includes people who have completed treatment within 3 months. Active treatment is defined as chemotherapy, targeted therapies, immunotherapy, and excludes people receiving therapy that does not suppress the immune system (e.g. solely hormonal therapy or radiation therapy).**Active treatment for people receiving B-cell depleting therapy including people who have completed treatment within 12 months.***People taking medications listed in Table 1 of the COVID-19 Vaccine Recommendations for Third Doses or those taking other medications identified by their health care providers as significantly immunosuppressive.

Booster Dose (4th dose)

For adults (aged 18+), a booster dose (i.e. 4^th dose) can be given at least 3 months (84 days) after you have completed your three-dose primary series.

Individuals who are moderately to severely immunocompromised will need to bring one of the following:

• 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 (i.e., “ring vaccination”) and continue to follow public health measures.

For post-transplantation recipients:

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

Re-vaccination is recommended with a new COVID-19 vaccine primary series (3 doses) given the loss of immunity following CAR-T-cell therapy or transplant. Optimal timing should be discussed with your physician/specialist.

More Information:

• City of Toronto: COVID-19: Where to Get Vaccinated
• Ministry of Health: COVID-19 Vaccination Recommendations for Special Populations
• Ministry of Health: COVID-19 Vaccine Third Dose Recommendations

Everyone aged 5 and older, without OHIP cards, may get vaccinated at any city-run clinic, hospital or pharmacy clinic offering a first, second and, if eligible, third/booster dose.

City Immunization Clinics

COVID-19 vaccinations are available at city-run clinics by appointment only. Residents without an OHIP card must provide a COVID ID number when making an appointment. To obtain a COVID ID number, please contact Toronto Public Health at 416-338-7600, seven days a week from 8:30 a.m. to 4:30 p.m. Callers will be invited to leave their contact information so a representative can return their call.

Once a COVID ID number is received, appointments can be made through the Provincial Vaccine Contact Centre at 1-833-943-3900.

Children ages 5 to 11

Children between the ages of 5 to 11 who do not have an OHIP card do not need a COVID ID to book a first dose appointment at a City-run clinic. They may call the Provincial Booking Centre at 1-833-943-3900 and the agent will assist in booking their first dose appointment. At the City-run clinic, a COVID ID will be provided and can be used to book second and subsequent dose appointments.

Required Identification

For all clinics, residents must bring an acceptable form of identification with them which may include government-issued ID (including 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 Ontario Health Card (OHIP) number by calling 1-833-943-3900 (TTY 1-866-797-0007). You do not need to wait until your out-of-province dose(s) is documented by Toronto Public Health.

Without an OHIP number, you first need to obtain a COVID ID, which can be requested by contacting the Toronto Public Health at 416-338-7600, seven days a week from 8:30 a.m. to 4:30 p.m. Callers will be invited to leave their contact information so a representative can return their call.