This is an extract from a recent edition of The Journal’s coronavirus newsletter, which cuts through the noise and misinformation to give you clear, accessible facts about the coronavirus, Ireland’s fight to contain it, as well as developments further afield. 

This is your one-stop-shop for Covid news during a time when it can be hard or overwhelming to try and stay up to date with the latest.

You can read the full edition here, sign up to receive the newsletter here or at the bottom of the page. This version contains additional updates.

IRELAND’S COVID VACCINE programme is now a well-oiled machine.

More than 8 million doses have been administered in total, at a rate that once came close to 400,000 per week.

But this is still a machine with many moving parts: the logistics to deliver vaccines and equipment; the systems to book and log vaccinations; the involvement of GPs and pharmacies; and not forgetting the databases the communications, the call centres, etc.

It can take a while for its wheels to turn.

Damien McCallion, the HSE’s national director for vaccination, was keen to make that clear he spoke to The Journal for this newsletter yesterday.

I ask him whether ramping up the rollout again would be as easy as flicking on a switch? “The one thing I’ve learned about this is that there’s never a switch.”

And sure wouldn’t the HSE be able to organise any further campaigns in their sleep at this stage? Again, he makes it clear that it’s not quite as simple as that – but that they’re working out ways of getting it as close to that as possible.

Although Ireland has entered a new phase of its response to the Covid pandemic, the need to remain on guard against the virus remains, as well as the need to ensure that whoever is eligible for a vaccine can get one quickly and easily.

Ebb and flow

And over time, that number of people will ebb and flow, meaning the system that manages the vaccines will need to do the same.

McCallion gave the newsletter an insight into the planning behind that, but first on the HSE’s agenda is the rollout of an additional booster for everyone over the age of 65 and anyone over the age of 12 with a weak immune system.

There are roughly 750,000 people in this cohort, of which around 105,000 have received their next booster since appointments opened on 22 April.

McCallion said he’s happy with the progress made so far but stressed that the system is still in a phase of being ramped up, as in addition to vaccine centres and pharmacies, a lot of people will be receiving their dose from a GP:

GPs are particularly successful with the over-70s [...] For an older person, you have a trusted professional that you have a relationship with, you might have other things going on.

But it takes time for GPs to order stock and arrange vaccination clinics (which are most likely not their primary focus anymore) so it takes a few weeks for this to be wrapped up and for there to be a clearer picture of what uptake has been like, something which McCallion says the HSE is “watching closely”

Where there is some concern, however, is among the ‘delayed’ booster population; people who were due a booster, and then caught Covid, and might not be pushed about getting their booster now.

The number fluctuates, but around 850,000 people – mostly from younger populations – are currently eligible for a booster but haven’t yet come forward. They are being reminded through measures such as text messages, social media campaigns, or the targeting of areas with low uptake by running advertising campaigns in chemists.

“There’s still a rationale to get the booster,” McCallion said.

It still gives you protection right through the summer. We’re all positive and much more optimistic in terms of the public health outlook, both globally and locally, but the risk is still there.

(It should be noted here that being vaccinated and getting infected gives you strong ‘hybrid’ immunity, but this still wanes just like the vaccines do. Getting another booster will not only train your immune system up further for the next encounter with Covid, but will also restore your protection against infection, which will still wane over time, regardless of whether it came from a vaccine or the virus itself)

McCallion was keen to highlight that although the number of people who are eligible for a booster but haven’t yet sought it out is a worry, it is of more urgent concern to the HSE that everyone who is at higher risk of severe illness comes forward to get their boosters. For some this will be their fourth dose, and others their fifth.

This is all being done through the HSE’s existing ability to vaccinate the population, built up during the pandemic, but which is now being slowly wound down. Capacity at vaccination centres is being reduced, and some are downscaling completely to smaller premises.

But that’s not going to be hugely helpful when either: a) a new group becomes eligible for another booster; b) an autumn booster campaign is called for, either for the general population or particular cohorts; or c) a dangerous new variant arrives on the scene, necessitating the need to give everyone another booster as soon as possible, as recommended by NIAC if that threat emerges.

“You can imagine what’s involved in standing up all of this every time and stepping down and stepping it up again. It’s a huge logistical exercise,” McCallion told me.

He said these possibilities are at the forefront of the HSE’s planning:

We’re trying to gradually step back, but to do it in a way where we retain the capacity to step back up. That’s my point on the switch: there isn’t necessarily one you can suddenly move, but on vaccines [given NIAC deliberations and how we’d see the threat of a new variant coming], there tends to be a bit more of a lead time.

Planning is currently underway for that autumn booster campaign. This was flagged as a possibility by NIAC, but the exact advice on it isn’t available yet; whether this is for everyone or just specific groups are questions that will be fleshed out closer to the date, and the fine print will likely be dictated by whether or not second-generation vaccines are available.

What we’re doing is we’re planning on that basis [that there will be an autumn booster campaign],” McCallion said, “And then obviously, if the advice comes that we don’t need to do that, then we’ll be able to step back from that.

There are also steps being taken to prepare an ‘emergency plan’, with the current thinking being that the most likely time this will be needed will be winter and a scenario whereby the general population may need another dose and at “maximum speed”.

(That will also likely involve scaling up the testing and tracing system, which McCallion also oversees.)

This will take in all of the learnings from the past 18 months of the rollout, and is also part of longer-term planning; Covid isn’t going away, and it will remain a threat for an unknown time to come, so this emergency plan could be used as a template for any further surges that come down the line.

The HSE’s rollout of Covid vaccines was not without its faults. It took a long time to fully ramp up; there were long queues as supplies outstripped demand; and there were issues with appointment availability. But on sheer numbers alone, which placed us at the top of the world’s league tables in terms of the percentage of the country’s population who received a vaccine, it was a success.

But the HSE can hardly rest on its laurels just yet. Any missteps in future planning or emergency responses will still have consequences. To what extent the well-oiled machine will be tested in the months ahead remains to be seen.

We will have more from this interview with Damien McCallion next week.

This is an extract from a recent edition of The Journal’s coronavirus newsletter, which cuts through the noise and misinformation to give you clear, accessible facts about the coronavirus, Ireland’s fight to contain it, as well as developments further afield. 

This is your one-stop-shop for Covid news during a time when it can be hard or overwhelming to try and stay up to date with the latest.

You can read the full edition here, sign up to receive the newsletter here or at the bottom of the page. This version contains additional updates.