TODAY, THE DETAILS of the government’s National Covid-19 Vaccination Programme were announced.
With the first vaccines set to be available soon – as early as before the end of this year according to Health Minister Stephen Donnelly – the strategy delves into the logistics and planning that will be required for large swathes of the country to be innoculated against Covid-19.
The plan also includes details on where people will be vaccinated, the process of arranging an appointment to get a vaccine and the systems that will be needed to monitor its rollout.
The plan says: “The objective of the vaccination programme is, in the first instance, to reduce mortality anod morbidity as a consequence of Covid-19.
In addition, successful deployment of safe and effective Covid-19 vaccine(s) will be a more sustainable long-term public health measure, over time allowing society to re-open more fully, our communities to reconnect in the ways we used to take for granted and for our economy to resume a positive growth trajectory.
So what’s in it? Here’s what you need to know.
Last week, the government published details of who’ll be allocated the vaccine first.
The focus at the start of the vaccination programme will be on adults over the age of 65 who are residents of long-term care facilities and frontline healthcare workers in direct patient contact roles, including vaccinators.
Those aged 70 and older will be next, starting with over 85s.
There’ll be three phases of rollout of the vaccines.
The initial rollout phase will see limited doses available. This will begin late this year or early next year.
Minister Donnelly said today: “If the European Medicines Agency meet on the 21st of December and if they conclude on a positive on the Pfizer vaccine, it would likely be several more days, potentially the 23rd of December, before the formal authorisation would be given by the EMA.
“It would then take a number of days, potentially up to a week for initial vaccination here. But it is important to stress that this would be an initial delivery, it would at a very low volume. We’re not looking at widespread vaccination but it would be very encouraging if it did happen to even see the programme of vaccination commence before the end of the year.”
Once a larger number of doses become available, the mass ramp-up phase will begin with larger cohorts of people receiving the vaccine.
It is not yet known when this phase could begin, and depends on the “vaccine delivery schedule”, according to the plan. It’s likely this may not happen until the second quarter of 2021 at the earliest.
The last phase is called open access, where the remaining people who’ve yet to receive the vaccine are then eligible.
There are a variety of locations where a person may receive the vaccine, including mass vaccination centres that are set to be created around the country.
A section of the plan delves into managing the supply, storage and distribution of Covid-19 vaccines.
The end-to-end supply chain plan will start with supply from manufacturers, through to central storage, the preparation for distribution, delivery logistics and, finally, to the vaccination location.
The plan says: “Initially, Covid-19 community vaccination teams will be deployed to administer vaccines to the residents and staff of Long-Term Care Facilities. To date, we have identified a number of large scale healthcare sites that will be used as hubs for mobile vaccination teams to collect vaccines prior to vaccinating in Long-Term Care Facilities.”
During the initial rollout phase, the vaccine will be administered in long-term care facilities and large scale healthcare sites.
Once we reach the mass ramp-up phase – when large numbers will begin to receive a vaccine – vaccination will also be done in mass vaccination centres, as well as GPs and pharmacies.
Examples of vaccination administration locations include acute hospitals such as Tallaght Hospital, St James’s and Beaumont (all Dublin), as well as Mayo General Hospital, Cavan General Hospital, Cork University Hospital and University Hospital Galway.
Vaccines will also be administered in community nursing units around the country.
Examples of the sites for mass vaccination centres are Citywest and the National Exhibition Centre in Cloghran.
Colleges have also been mooted as a location for mass vaccination centres.
Chair of the high-level vaccine task force Professor Brian MacCraith said today he has had discussions with a number of third-level institutions about using their campuses to develop mass vaccination centres, and that the HSE were “working on that” idea.
“I’ve spoken with the presidents of NUI Galway, Waterford IT, University of Limerick, and UCC in the past number of days, and all have expressed great support for the concept of actually being able to assist in the development of mass vaccination centres.”
The plan adds: “These centres will be located regionally and designed to cater for large numbers of recipients in an efficient and timely manner. Discussions are underway with the relevant authorities to ensure that a geographical distribution of such mass vaccination centres is provided.”
As explained above, a prioritisation list for who gets the vaccine will mean people get it at different times.
For example, people aged 65-69 are listed as the fifth cohort for who’ll receive the vaccine.
When it is your turn, you will be invited to register, provide some medical and personal details and consent to vaccination. People will be offered scheduled appointments to attend a named location for vaccination.
On the day of the appointment, pre-registered details will be confirmed on arrival.
When the person goes in to get their vaccination jab, the person administering the vaccine will confirm their details, complete informed consent and record their own details as well as batch details and a time/date stamp.
The vaccinator will then prepare the dose and administer the vaccine.
After this the patient will be asked to wait for 15 minutes to monitor for any immediate adverse reactions. Trained clinical staff will need to be on hand to observe the patients.
Aftercare will involve follow-up reminders to ensure people return for their second dose.
The strategy states the goal is to “provide a consistent process with a common data and technology platform, across all clinical settings in which the vaccine is administered”.
If there are any suspected side effects in the days or weeks afterwards, the recipient will be able to report this on a portal on the Health Products Regulatory Authority (HPRA) website and through their GP.
All vaccinators will be qualified and registered healthcare professionals.
Vaccinators may include:
As more doses of vaccines becomes available during 2021, the government noted in its plans today that there will be a need to expand the pool of skilled workforce to administer vaccines and to deliver the programme.
Currently, a number of options are being explored to support the scaling up of the workforce for the programme and discussions will be taking place with respective staff groups and bodies over the coming weeks, the plan outlines.
The government is considering actions being taken by other jurisdictions, such as the licensing of recently retired health professionals or maintaining registration in the case of others.
The plan noted that GPs and pharmacists can and have successfully delivered significant numbers of flu vaccines. Subject to agreement, they will be able to offer enhanced capacity for the programme.
Pharmacists, however, may need to be specifically licensed for Covid-19 vaccinations.
The vaccination programme will also require significant increases in the number of administrative and support staff. In this regard, there may be opportunities to leverage the broader public service to achieve this.
All staff working in the Covid-19 vaccination programme will receive training relevant to their role in the team and service.
Training programmes will be delivered online, and where required, in person.
Along with the specialist clinical training required for vaccinator staff, induction and orientation training will be given to all staff working in vaccination centres and as part of Covid-19 community vaccination teams.
This will include, but is not limited to, training in infection prevention control and in relation to the technology solutions which support the vaccination process.
Standard operating procedures will be developed for the vaccination centres and teams. These procedures will outline all required processes to support the vaccination pathway.
A new IT system is at the heart of the plan for the rollout of vaccines in Ireland.
Ireland’s healthcare IT systems don’t have the right functions needed to cope with the scale of the Covid-19 vaccine rollout, which means a system must be created from scratch and integrated with the HSE’s systems.
IBM and software giant Salesforce have been tasked with creating the system.
It will allow for the planning and scheduling of vaccines and will monitor the success and effectiveness of the programme.
The National Covid-19 Vaccination Programme: Strategy, published today, says:
A functionally rich and proven solution for the proposed vaccination programme must be sourced, purchased, implemented and integrated into the HSE ICT infrastructure before the end of the year.
“It’s an off the shelf CRM [Customer relationship management] system… We widely expect the IT system will be available,” HSE CEO Paul Reid said at a press conference this afternoon, adding that if it wasn’t ready in time for the rollout of the vaccine, they have a backup plan.
Across the IT infrastructure, it will track important elements related to pre-vaccination and vaccine administration.
As regards data processing, the HSE is liasing with the Data Protection Commissioner on the matter. How the system will impact on personal data, and an individual’s privacy and confidentiality will be the subject of a Data Protection Impact Assessment.
An Individual Health Identifier (IHI) is a number that identifies each person within the public and private health sector in Ireland, a unique number that is different to a PPSN.
They were first proposed by government in 2015, with patient safety cited as a key advantage of an IHI. Although planning for IHIs have been in the works for some years no, they haven’t been formally rolled out as of yet.
“Being able to uniquely identify each user will improve patient safety by reducing the number of adverse events that may happen, such as giving the patient incorrect medication or vaccinations or admitting the wrong person for surgery,” HIQA said, in its guidance on IHIs.
The commenced order for IHIs was signed in 2017, although work on implementing them across national healthcare systems has not yet been completed.
As part of the government’s vaccination implementation plan, the first step is enabling public registration and facilitating the booking of an appointment to receive the vaccination.
“Utilisation of the IHI is critically important as it will ensure that each person is uniquely identified for full traceability of the individual,” the plan states.
The identifying patient number would allow electronic recording of every individual vaccination. No medical information is stored on the health identifier record but is instead used by health service providers when they are communicating on your behalf.
“Being able to uniquely identify each user will improve patient safety by reducing the number of adverse events that may happen, such as giving the patient incorrect medication or vaccinations or admitting the wrong person for surgery,” according to Hiqa.
Under the Health Identifiers Act 2014, IHIs are considered to be personal data and are protected as such.
Serving as a patient identifier number, the IHI will be used in conjunction with the new vaccination IT system.
The requirements for GPs and pharmacies in this regard have not yet been defined. The report adds that the national solution will have to ensure that systems from GPs and pharmacies can be integrated as part of the overall plans.
A HSE spokesperson added: “People will, when registering for the vaccine, be provided with an Individual Health Identifier (IHI), a Data Protection Impact Assessment is being developed by the HSE. The HSE has and will continue to engage with the DPC to seek their guidance and advice to ensure we comply fully with the regulations.”
The European Medicines Agency (EMA) today brought forward its possible approval of the Pfizer/BioNTech coronavirus vaccine by a week to 21 December.
Announcing the vaccine strategy this afternoon, Minister Donnelly said vaccines will begin to be administered in Ireland within a week of this approval, opening the possibility of the process getting underway before the end of the year.
Donnelly stressed that this is conditional on the EMA validating the vaccine.
Vaccine taskforce chief, Prof Brian MacCraith, said following the approval it is expected to take 7-10 days for the first doses of Ireland’s allocated 2.2 million Pfizer/BioNTech vaccines to be delivered. However, the delivery schedule has yet to be finalised.
“We can’t be explicit at this stage. I suppose, it appears that it could happen before the end of the year,” Prof MacCraith said.
The EMA is set to make its recommendation on the Moderna vaccine on 12 January and delivery is expected within 10 days of the decision. Ireland has been allocated 880,000 doses of the American company’s jab.
The Astrazeneca vaccine is another promising candidate and is expected to be available in January 2021 at the very earliest. Ireland has around 3.3 million doses of this vaccine ordered.
Ireland also has 2.475 million doses of a vaccine manufactured by Curevac ordered, with its earliest approval date in February 2021.
Another 5.5 million vaccines have been ordered of those in development by Sanofi/GSK and Janssen, but these aren’t expected to be available until at least the middle of next year.
As it stands, the first vaccine to be administered in Ireland is almost certainly set to be the one developed by Pfizer/BioNTech.
A key part of the strategy centres on clear, transparent communication with the public around the vaccine rollout, its efficacy and any concerns that are raised.
The communications strategy will have two main phases.
The plan says: “The first is preparing for the vaccine, talking to the safety and regulatory processes that are taking place in Ireland, Europe and across the world, engaging with people who have genuine hesitancies around the vaccine, communicating the Government Plan from acquisition to prioritisation to distribution and talking to the results of the clinical trials when they are available.
The second phase will focus on the execution of the vaccine – national and local communication from medics encouraging the public to get the vaccine, informing who will administer it and where, identifying people of trust to act as ambassadors for the vaccine.
As part of the approach to building confidence, public health doctors will address misinformation which appears on social media and across the dark web, pointing people to trusted sources of information including gov.ie and hse.ie.
This first phase has already begun. For example, deputy chief medical officer Dr Ronan Glynn yesterday encouraged people who are vaccine hesistant to stay informed using appropriate sources and to ask their GP any questions they have about vaccine safety.
At all times the communications plan will aim to have a clear and consistent communication to encourage vaccine uptake.
NPHET will also also monitor vaccine uptake and provide regular updates on this progress.
Amid the positivity of today’s announcement, chief medical officer Dr Tony Holohan emphasised that just because vaccines are on the way, it doesn’t mean we can let our guard down.
He said: “We know we’re not through this yet. The virus doesn’t care that we’ve done well recently relative to other countries, it doesn’t care that we’re all tired, or desperate to see family and friends, and it doesn’t care that a vaccine is on the horizon.”
Dr Holohan also said the virus was “no different” in terms of the danger it poses to people who become infected than it was last March.
“The vaccine won’t have a positive effect on the trajectory of this disease for at least months to come,” he warned.
With reporting from Gráinne Ní Aodha, Daragh Brophy, Christina Finn, Michelle Hennessy, Hayley Halpin, Ceimin Burke and Adam Daly
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