Denmark to offer booster jab for mixed Covid-19 vaccination

Residents of Denmark who are vaccinated against Covid-19 with a mixture of vaccinations from two different companies are to be offered a booster jab against the virus.

A pop-up vaccination centre in a Danish supermarket in September 2021. Denmark is to offer a third vaccine dose for people with mixed vaccine doses in an effort to meet all international travel rules.
A pop-up vaccination centre in a Danish supermarket in September 2021. Photo: Claus Bech/Ritzau Scanpix

The decision was announced by the Danish Health Authority in a statement on Tuesday and follows the decision last week to also offer a booster to people fully vaccinated with Johnson & Johnson’s single dose vaccine. 


A significant number of people who work in the healthcare sector were during the spring given a first dose of the AstraZeneca vaccine followed by a second dose of Pfizer or Moderna, following Denmark’s decision to remove the AstraZeneca jab from its mainstream vaccination programme.

The booster jab will enable people with mixed vaccinations to travel to countries which do not recognised a mixed course of vaccines as a completed vaccination course, according to the Danish Health Authority.

However, the country’s foreign ministry last week cast doubt as to whether all countries would recognise the fully vaccinated status of people who receive a booster jab of Pfizer or Moderna following Johnson & Johnson vaccination.

People who are cross vaccinated including a first dose from AstraZeneca do not require a booster from a medical perspective, according to the Danish Health Authority. That is because this form of vaccination is considered to still give strong protection against the coronavirus.

“Mixed-vaccinated people are particularly well protected with the two different vaccines they have received. We actually view mixed vaccination as being just as effective as vaccination with two mRNA [Pfizer or Moderna, ed.] vaccines,” the health authority’s head of department Bolette Søborg said in the statement.

“At the same time, we also have great understanding for them not being able to travel where they want to. Therefore, those who need it and wish to will be given the option,” Søborg added.

Mixed-vaccinated people with no plans to travel currently need not receive a booster jab at the current time, she also said.

The authority does not consider there to be “risk of serious side effects with a third jab when you have previously received one dose of the AstraZeneca vaccine and one dose of an mRNA vaccine,” Søborg said in the statement.

The UK government changed its much-criticised Covid border rules on Monday October 4th.

With that change, the UK government now accepts that people with mixed doses of two Covid-19 vaccines – such as Astra-Zeneca and Pfizer – will now be considered fully vaccinated.

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Who is eligible for a fourth Covid vaccine dose in Denmark and when?

Public health officials in Denmark say a low turnout for the second round of Covid booster shots — for most people, their fourth jab — has made them concerned that many don’t realise they’re eligible.

Who is eligible for a fourth Covid vaccine dose in Denmark and when?

 Danish authorities have hardly clear on whether to offer fourth Covid jabs and to whom, since the beginning of 2022.

In January, the government announced that fourth shots would be given to the very elderly and other high risk populations— but that decision was reversed just four weeks later and the fourth Covid dose program was ended.

At a June 22nd press conference, Prime Minister Mette Frederiksen announced plans for a more general booster program in the autumn and added that the ‘particularly vulnerable’ would be eligible for new doses the following week. 

When the Covid vaccination program began in early 2021, Denmark estimated the number of ‘selected patients with particularly increased risk’ that should be prioritised for vaccination at 240,000. But in the month since Frederiksen’s announcement, only about 3,500 people have come in for a fourth jab. Experts say that’s in no small part over confusion as to who is ‘particularly vulnerable.’

Indeed, the Danish Health Authority website doesn’t appear to currently provide a list of conditions that qualify for a second booster and instead refers readers to their primary care provider. That’s unfortunate since even general practitioners are finding it hard to determine who the rules say can get a fourth shot, Danish broadcaster DR reports.

The failure to resolve the issue is putting many patients at risk, some public health experts worry. “With the spread we are seeing with Covid at the moment, I think the Health Authority needs to be very clear about who should get the fourth prick now and who should wait,” Torben Mogensen, chairman of the Lung Association, told DR. 

READ ALSO: Danish health minister says further Covid-19 vaccinations could ward off restriction

What we know for sure 

  • Pregnant and breastfeeding women are already eligible for fourth doses
  • People with suppressed immune systems are already eligible 
  • Approximately September 15: fourth doses begin for people in care homes and among ‘particularly vulnerable’ elderly people 
  • October 1st: fourth doses begin for everyone 50 years of age and and over 

Your primary care provider (the one on your yellow card) can refer you for a vaccination appointment, as can doctors at hospitals. 

What factors will your doctor consider? 

Guidelines provided to doctors by the Danish Health Authority ask them to weigh the patient’s age, risk of serious course of illness if infected, their presumed immunity status based on recent infection, and their overall risk of infection based on their living conditions (strangely, crowded living conditions and living in a sparsely populated area both suggest you may need a booster shot). 

…and now for the riddles

In lieu of a list of conditions that might qualify a patient for an early fourth shot, doctors have been offered a series of ‘example patients’ that are eligible for a booster  under the new rules. 

  • 45-year-old woman with reduced immune system due to haematological cancer
  • 74-year-old man with severe obesity and heart failure, who has had recurring lower respiratory tract infections for the past six months and declining functional level
  • 65-year-old woman with severe obesity and diabetes with serious co-morbidities, e.g foot ulcers or chronic kidney failure
  • 82-year-old woman with rapid onset of functional loss (e.g. failing memory, reduced mobility and need for help with personal care) and beginning signs of malnutrition (eats too little, does not gain weight)
  • 23-year-old with cystic fibrosis with frequent pneumonia and hospitalisations
  • 50-year-old male with bowel cancer who has recently completed chemotherapy
  • 85-year-old man who lives with his children and grandchildren in a small home
  • 65-year-old woman who has been operated on for breast cancer and has diabetes, and who needs to travel to an area with high infection
  • 39-year-old resident of a social psychiatric residence, with heavy tobacco consumption, occasional alcohol overconsumption, overweight and in treatment with many different drugs

READ ALSO: Danish hospitals see rise in number of Covid patients 

It’s worth a call or message 

With a particularly nasty flu season on the horizon, public health experts say it’s worth a call, email, or message to your primary care provider if you have any reason to suspect you might be eligible for vaccination. 

“We know that infection rates have been rising both in Denmark and in Europe in recent weeks, and a new variant is on its way in,” Aarhus University professor emeritus of infectious diseases told DR.  “Then comes autumn, when we know that a respiratory virus spreads more than it does in summer. So there’s every reason to get that fourth jab if you’re in the vulnerable groups and it’s been more than six months since you had your third.”