A HSE REVIEW into the Beacon Hospital’s Covid-19 vaccination programme has found that the hospital did not consider a number of alternative options to use leftover vaccine doses at risk of being wasted. 

On 23 March, the Dublin hospital was the focus of controversy after it emerged that it had administered 20 leftover Covid-19 vaccines to a number of teachers at St Gerard’s School in Wicklow.

In July, a report commission by the board of the hospital found that the decision to provide these vaccines to the teachers was incorrect, but made in good faith. 

The review found that proper procedures were not followed in giving the excess vaccine doses to teachers from St Gerard’s School.

The HSE commissioned an external review of the Beacon’s vaccination programme in April and this has now been published. 

This review, conducted by retired HSE Assistant National Director Cornelia Stuart, has found that the choice of school was considered a “feasible” option to receive the spare doses, but that other options should have been considered. 

“The Reviewer is of the view that there were a number of other options available that could have been considered before the teachers taking into account the sequencing guideline in place,” the report said. 

It said the most obvious option would have been to contact HSE community healthcare organisation CHO 6 which was at an earlier stage in the vaccine programme. The hospital could have requested to send staff for vaccination.

It said other alternatives could have been those living or working in crowded conditions where social distancing was difficult, key workers in the food supply system, public and commercial transport workers and other groups. 

“Where the Beacon Hospital is located there are a number of retail outlets within the hospital complex itself and both the Beacon South Quarter and Sandyford Industrial Estate are proximal.

“There is also a large Garda station less than 3km away which may also have represented a viable option at that time of day.”

It said: “The Reviewer is therefore of the opinion that, had the Beacon Hospital considered the allocation of these vaccines to groups higher on the sequencing list, that this would have been feasible.”

The report said the school itself accepted the offer of the doses in “good faith” and on assurances received from the hospital’s CEO Michael Cullen that it was legitimate and above board.

23 March

The report further outlined how the situation arose and how the 23 March clinic differed from others.

Cullen told the reviewer that he wanted to identify a group of people who would be available at short notice when it became clear spare doses had to be used up quickly. 

He was familiar with St Gerard’s School and had the headmistress’ mobile number for “legitimate family reasons”, the review said. 

The headmistress received a call from the CEO at around 4.12pm. She was informed the hospital had five surplus vaccines that needed to be used by 6pm that would otherwise be wasted.

The headmistress told the reviewer that the CEO “had assured her that this was in line with the HSE’s zero-wastage policy” and stressed the urgency of the situation. 

She received a text a few minutes later to say there were now ten vaccines available. 

A further text from the CEO told the headmistress that the provision of the excess doses to the teachers was legitimate and above board with the permission of the HSE. 

At 5pm, the CEO once again phoned the headmistress to say a further ten vaccines were now available – a total of 20. 

20 teachers were mobilised and they attended the hospital for vaccination. 

As they arrived, the teachers were registered on the CoVax system which shows they were listed as healthcare workers. 

The Beacon Hospital responded to a draft version of this HSE report to say they do not believe they could have found such other suitable people at short notice. 

Speaking to the reviewer, Cullen said the hospital had been told by the HSE not to give the vaccine to oncology patients or other patients aged 16-69 with medical conditions that put them at very high risk of disease. 

At this time, the advice on the use of the AstraZeneca vaccine had changed on a number of occasions due to rare blood clot reports. 

The reviewer said the CEO said he had not considered asking staff from CHO 6 or to ask groups such as transport or food industry workers. 

Cullen said there were a number of other options that could have been considered with the benefit of hindsight, but the report said “in the moment, he thought the teachers were a viable option that could be used within the very short timeframe available”. 

Vaccines in syringes  

The report said 1,034 staff attended for vaccination on 23 March. This was greater than the 910 confirmed to attend, but less than the number planned for a 16 March clinic which had 1,368 slots. 

The report said the extra doses left at the end of the clinic appears to have been 52. 

The clinic was left with an “unprecedented amount of pre-prepared left over vaccine drawn up in syringes on the 23rd March because doses were being prepared in advance for the next slot of scheduled people”, the report said. 

The reviewer was told that in the Beacon, vaccines were drawn up in advance from vials into syringes and given on trays in each vaccine booth ready to administer.  

In the CityWest vaccination clinic, vaccine booth were provided with a tray containing an unopened vaccine vial and syringes and other administration items.

The report said that the Beacon’s approach to pre-prepare the vials “sough to maximise throughput”, it “ran contrary to the HSE’s Clinical Guidance for COVID-19 Vaccination developed by the HSE National Immunisation Office”. 

It said the HSE’s guidance on this issue was even referred to in the Beacon’s own vaccine policy, stating that “there is no information on the stability of vaccine in pre-prepared syringes”. 

The report said the Beacon, in response to a draft version of the report, said it reviewed HSE and international policies and procedures and “carried out a risk assessment to determine a plan of action”. 

The hospital told the reviewer it concluded that pre-prepared syringes provided a safe option for the vaccine clinic. 

“However, despite this the Reviewer remains of the view that the BHVC was required to operate in line with guidance issued from NIAC, the HSE and the relevant regulatory bodies,” the report found.

The reviewer was advised that vaccine doses need to be used within a period of six hours after a vial is pierced. When it is drawn into a syringe, the time period reduces to one hour, they were informed. 

The hospital “therefore considered it was necessary” to identify people who could arrive within that timeframe to avoid wastage. 

The report said: “If the vaccines had been drawn up in line with manufacturer’s directions i.e. that they remained in the vial until administration, then it is the Reviewer’s opinion that the perceived urgency to use them within an hour would not have been as great.”

Further, the report said the first of the teachers attended beyond this one-hour after being drawn up, so “none of the 20 vaccines should have been administered to the teachers as they were, by the time the teachers had arrived, beyond the timeframe of one hour from being drawn up”. 

Unlike other clinics

On the day the doses were administered to teachers, 23 March, the report said this day was “unlike clinics held previously for a number of reasons”. 

The first reason was that it was a rescheduling of a clinic originally planned for 16 March. This was due to administer AstraZeneca vaccines but was cancelled after a NIAC decision to suspend the use of this vaccine temporarily over blood clot concerns. 

On 19 March, NPHET confirmed that this vaccine could recommence usage following updated advice from NIAC. 

On 22 March, the Beacon rescheduled its clinic to the next day. 

The 16 March appointment slots were relocated to 23 March. Some staff were texted instead of called with the short timeframe to reschedule the appointments. 

“It was anticipated therefore that more staff may turn up to the clinic on the day than the number who responded to the text,” the report said. 

Staff who had not received their vaccine on 16 March were listed as ‘unvaccinated’ on the online registration portal. 

However, the report said a number of these staff had been given appointments for the Aviva vaccine centre in the meantime,. 

On 22 March, the Beacon reported receiving a “considerable number” of queries from staff given appointments at the Beacon on 23 March to say they had also received a booking for the Aviva. 

The Beacon asked these staff to attend the hospital’s clinic instead, but the report said this situation “further left a degree of uncertainty” about the number to attend the 23 March clinic. 

The report later states that the Beacon said it subsequently learned from attendees that the HSE advised them to attend whichever clinic they preferred in this instance. 

“HSE did not inform us of this decision and it is difficult to understand how that decision could have done any other than create further confusion and difficulty,” the report said the Beacon explained. 

Lastly, the staff to receive their doses at the Beacon clinic were heading towards the end of the eligible list. The availability of staff to attend at short notice was becoming an issue, the report said. 

DNAs

The ‘did not attend’ (DNA) rate on other clinic days was between 8% and 10%, the report outlined, however the hospital said it was in excess of 20% on 23 March for the reasons outlined above.

The report said it is the opinion of the Beacon that this rate was the “key contributing factor and the reason for the excess vaccine doses at the end of the clinic day”. 

The report said this reason is “worth further consideration” as this DNA rate was on the basis of the 1,368 clinic slots made available. 

However, this figure was the number of invitations issued and not the number of people who confirmed they would attend. 

The reviewer said the rate is more accurately calculated on the basis of the number of confirmations.

Using this calculation method, the reviewer said the rate of attendance was actually 13.6% higher than the confirmation rate, meaning a greater number had attended the clinic than had been confirmed. 

“That being said the Reviewer would agree that on the day there was a higher degree of uncertainty about numbers that would attend than previous clinics and that this would have increased risk for the predictive model in place for managing clinics at the Beacon Hospital,” the report said. 

Conclusions

The report said the clinic “contributed significantly” to vaccinating non-acute healthcare staff, but that it had two main weaknesses – relying on a predictable flow of people to be vaccinated and drawing doses into syringes in advance of people attending for their vaccines. 

The report also said the move to mobilise a group of people considered to be a viable solution to avoid waste was done “without considering alternative persons or groups higher on the vaccine allocation groupings”. 

“There is no evidence that the School had solicited the BHVC for vaccines prior to being offered the vaccines on the 23rd March.

“The Reviewer is therefore satisfied that on the 23rd March the School acted in good faith and on the assurances received from the CEO of the Beacon Hospital, that the offer of the vaccines was entirely legitimate, above board and with the permission of the HSE,” the reviewer found. 

Minister for Health

A spokesperson said that the Minister for Health Stephen Donnelly has reviewed the report, provided to him by the HSE this week.

The Minister said:

“It is clear that Beacon Hospital failed to follow the national vaccine allocation strategy and HSE guidance. The Reviewer concluded that sufficient efforts were not made to prioritise groups who were higher on the allocation list in respect of the 20 vaccines that were given to teachers in a school.

“A number of other options could, and should, have been considered. Those options included prioritising other healthcare staff, who were at higher risk. The Covid vaccination programme at the Beacon Hospital was suspended following these revelations.“