THE ONLINE PORTAL for vaccine registration is open today for people aged 45-49.

Health Minister Stephen Donnelly yesterday confirmed the move and the HSE expects some people in this cohort will be able to receive a first dose by the end of this month.

There have now been dozens of changes to the vaccination programme since it was launched, so it is not surprising that people are confused about how their own vaccines will be impacted by these developments.

As part of The Journal‘s Reader Q&A series, we’ve been we have been breaking down the latest developments with vaccines and the rollout in Ireland, trying to answer as many of your questions as we can.

As the vaccination programme moves on to people aged 40-49, here’s what readers want to know.

Registration launch

• When can over 40s expect to be called?

The registration portal is now open, with those aged 49 being invite to register first, followed by those aged 48 tomorrow, 47 on Friday and so on. People aged 45-49 can all technically register today, but the HSE is asking that people do it in order over the week. 

The portal will be open to all people aged 45-49, including those who may be in another vaccination allocation group such as people with very high-risk or high-risk conditions who haven’t yet been given an appointment. 

People registering for their vaccine on the HSE website will need: 

• Their PPS number
• Their Eircode
• A mobile phone number
• An email address

People who don’t have all of these, or who would prefer not to register online, can call HSELive on 1850 241 850 for assistance with the registration process. 

When the system opened for those aged over 50, people in that cohort started to get appointment slots in the week after registration opened, so there should be a similar timeline for this cohort. 

It is expected that those aged 40-44 will be invited to register for their vaccine soon,

Choice of vaccine

• If someone over 40 refuses either the Astra Zeneca or J&J vaccine and chooses to wait for a mRNA vaccine, will they have to wait until all other cohorts are vaccinated to receive it?
• If someone in their 40s refuses the Astrazenaca or Johnson vaccine as they are worried about clots and other side effects how long would they have to wait for a Pfizer vaccine?
• Are we given the choice between AZ, J&J and waiting or is it the choice between now (given AZ/J&J with no choice between those) and waiting (mRNA).
• What information will we be provided to make this decision?

For now, the HSE will be offering Pfizer or Moderna jabs to those aged 45-49 who register. 

The HSE has said it is aware of the impending NIAC guidance on use of other vaccines for this age group and is considering its implications.

“No decisions have been made at this point pending this evaluation and replanning process,” the HSE said.

“We will continue the safe and efficient rollout of the programme while this is underway.”

It is expected that, once this new guidance has been considered and worked into the plan, people aged over 40 will be given an option to take AztraZeneca/Johnson & Johnson or to wait until there is a Pfizer/Moderna jab available for them.

The majority of the supply of the Johnson & Johnson vaccine is due to arrive in late May and June. HSE CEO Paul Reid has previously said that the health service will therefore need to be able to administer the J&J vaccine to those under the age of 50 as this jab – and the AstraZeneca doses – will make up part of Ireland’s available supply.

The National Immunisation Advisory Committee  (NIAC) has recommended the age limit for these two vaccines can be reduced from 50 to 40, with some conditions. The HSE is now assessing how to tie the proposals into the vaccination programme. 

Final plans are yet to be confirmed, but it is unlikely that the HSE would take a ‘back of the queue’ approach to those who refuse the AstraZeneca/J&J vaccine because they would prefer to have an mRNA vaccine.

Reid has said in recent weeks that the HSE is keen to continue moving down through the age cohorts in order, vaccinating as many people as possible in each group before moving onto the next. 

NIAC has said the health service needs to ensure people have full information about any potential risks. 

It is not likely that a choice will be offered between the AstraZeneca and J&J vaccines, rather the choice will be one of those two or a waiting longer for an mRNA vaccine. How long that wait might be is not clear. 

Blood clotting risk

• I have a condition which requires anticoagulant medication, due to a previous blood clotting event. Is there any guidance on how people who have had clots previously should choose which vaccine to get? I’m keen to get vaccinated and would consider all vaccines once above is clarified.
• I have had a low platelet count all my life. It doesn’t affect me in any way, I don’t take medication, I’m fit and healthy, have no other complaints. Is it safe for me to take the AZ vaccine with a low count?

Last month the European Medicines Agency concluded that unusual blood clots with low blood platelets should be listed as very rare side effects of the AstraZeneca vaccine.

It stated that most cases had been reported in women under the age of 60 within two weeks of vaccination. The agency’s safety committee had carried out an in-depth review of 86 of these suspected side effects reported in the EU drug safety database as of 22 March this year, 18 of which were fatal.

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People in their 40s set to get choice of AstraZeneca and J&J, or wait for mRNA vaccine

The cases came mainly from spontaneous reporting systems of the European Economic Area and the UK, where around 25 million people had received the vaccine.

The EMA stated that based on available evidence, specific risk factors such as age, gender or previous medical history could not be confirmed.

The agency noted that Covid-19 is associated with a risk of hospitalisation and death. It stated that the reported combination of blood clots and low blood platelets is very rare, and the overall benefits of the vaccine in preventing Covid-19 outweigh the risks of side effects.

In the UK, 46 of the total reports of these events were reported in people aged 40-49, 33 were in the 30-39 age group and 25 were in people aged 18-29.

The EMA also last month concluded that a warning about unusual blood clots with low blood platelets should be added to the product information for J&J vaccine. As of 13 April 2021, over 7 million people had received Janssen’s vaccine in the United States and there had been eight reports of this rare side effect.

All cases occurred in people aged under 60, within three weeks of receiving the one-dose jab and the majority were women. Based on the currently available evidence, specific risk factors have not been confirmed.

However it said one plausible explanation for the combination of blood clots and low blood platelets is an immune response, leading to a condition similar to one seen sometimes in patients treated with heparin, a blood thinning medication.

Again the EMA concluded that due to the risk of hospitalisation and death associated with Covid-19, the benefits of this vaccine still outweigh the risks.

The HSE has previously issued advice in relation to the AstraZeneca vaccine, stating that even those who have a history of blood clots should take the vaccine. People aged 50 and older are more than 30 times more likely to die from Covid-19 than get this very rare side effect.

Someone aged 60-64 is 85 times more likely to die of Covid-19 than to have any clotting event following the vaccine

Specific information on these two vaccines for the over 40s has not yet been issued, but the HSE has pointed out that between four and 10 people in every 1 million people who get one of these vaccines may have this side effect. One of these people may die.

Do you have a question on Covid-19 vaccines or the rollout in Ireland? Send it to answers@thejournal.ie and we’ll do our best to get the information you need.