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THE HEALTH SERVICE is having to move quickly to change its vaccine roll-out plans after new guidance on the use of the ‘game-changer’ AstraZeneca vaccine in older people.
The vaccination programme began with people aged over 65 living in long-term residential care facilities and frontline healthcare workers. The third phase of the programme, focusing on those aged over 70, is due to begin in the middle of this month, starting with people aged 85 and older.
It was expected that the AstraZeneca vaccine, which is easier to transport and store, would be the main vaccine used in this third phase of the programme. However advice from the National Immunisation Advisory Committee (NIAC) this week that it should only be used in those aged under 70 means some significant adjustments to the plan are required.
As part of TheJournal.ie‘s Q&A series, we have been breaking down the latest developments with vaccines and their roll-out in Ireland, trying to answer as many of your questions as we can. With these new revelations, readers have a lot of questions about what they mean for the roll-out in general and how it may affect them.
Here are some of the issues on readers’ minds this week – and what we know about them right now.
There has been a lot of discussion in recent days about the use of the AstraZeneca vaccine, with a number of European countries opting to restrict use of this jab to those aged under 65.
Several questions from readers were about what Irish authorities will do and whether they can choose which vaccine they get.
The European Medicines Agency (EMA) has stated that the AstraZeneca vaccine is safe to use in adults of all ages and protection from serious illness is “expected” in all age groups. However, it did note that there is not enough data to provide a figure for how well it works in those aged over 55. Most of the participants in the vaccine studies presented to the EMA were between 18 and 55 years old.
Further data from the vaccine developers, including results on efficacy in older people, is expected in the coming weeks. Despite the EMA’s guidance that the vaccine could be used for all adults, several European countries have decided to wait until the additional data is available and reviewed.
On Wednesday, Ireland’s immunisation advisory committee (NIAC) recommended that people aged 70 and over should receive the mRNA vaccines from Pfizer/BioNTech or Moderna “where practicable and timely”.
It recommended that for people aged 65 and older, a two-dose schedule of the Oxford/AstraZeneca vaccine at an interval of 4-6 weeks between doses is best. For those aged under 65, a two-dose schedule of the vaccine administered with 4-12 weeks between doses is recommended.
It said these recommendations are “based on current data and subject to ongoing review”.
The HSE has said – and reiterated this week – that people cannot choose which vaccine they receive. The vaccination programme is based on informed consent, so if someone does not want to be vaccinated at all, they can make that choice.
However officials have said they are conscious of people’s concerns, particularly around the absence of efficacy data for the AstraZeneca vaccine in people aged over 55.
Further data is still bring provided by vaccine developers as it becomes available. Just this week a new AstraZeneca study was published which showed that a single dose of the vaccine may reduce transmission of the coronavirus by two-thirds. The data has also shown the vaccine may be up to 82% effective if the second dose is administered 12 weeks later.
Health officials are expecting data from AstraZeneca on efficacy in older people to become available in the next couple of weeks. This will determine whether the National Immunisation Advisory Committee (NIAC) changes its advice in relation to the use of this vaccine.
It is likely that there will be a clearer picture of its efficacy by the time the programme reaches those aged 65-69 as they are in the fifth priority group, after healthcare workers who are not in direct patient contact.
Back in December the government published its Covid-19 Vaccination Strategy and Implementation Plan.
This plan included a sequencing list, laying out the order for the various groups in society. Here is the list in full:
The HSE is still aiming to begin the rollout to those aged over 70 – starting with people aged 85 and over – from the middle of this month. There are around 480,000 people in Ireland over the age of 70 living in the community and Paul Reid said this week the intention is still to complete all vaccinations for this cohort by the end of March.
That timeline may change slightly, depending on supplies of the mRNA vaccines, but the HSE is working to try to secure additional deliveries from those suppliers.
Ireland is due to receive 40,000 vaccine doses per week from Pfizer and 10,000 doses per week from Moderna in the first quarter of the year.
While the order of the priority list is unlikely to change as a result of the recent guidance, it may bring forward the vaccination date for some groups. Ireland’s share of the 40 million AstraZeneca doses the EU has secured for the first quarter of the year is around 400,000.
Reid said recent developments may bring the AstraZeneca vaccine “into play earlier than we might have thought for other cohorts”.
“We will be immediately working towards the prioritisation that we have agreed and the sequencing we’ve agreed with government, so we’ll continue with the frontline healthcare workers – the rest of the healthcare workers, – and we’ll commence that from next week with the AstraZeneca vaccine,” he said.
He said as that supply continues to come into the country it will potentially allow for other cohorts to receive their vaccination “in parallel” with the over 70s.
The first group in the next cohort to be vaccinated is people aged over 85 living in the community (as opposed to those living in residential care facilities).
The HSE has said they do not need to register in advance, their GPs will let them know when it is time and will arrange an appointment for them.
If you're aged 85 or over, you'll be offered a free #CovidVaccine next. You don't need to register in advance. As soon as your vaccine is available, your GP will let you know. For factual, expert information you can trust, visit: https://t.co/t56sdGDVdy #HoldFirm pic.twitter.com/mcCWNTGUCP
— HSE Ireland (@HSELive) February 5, 2021
For those who do not have a GP, the HSE told TheJournal.ie that it can support them through its phone lines: 1850 241 850 or 01 240 8787.
The HSE said GPs will go through their databases and will contact patients directly to arrange their appointments with them.
And GPs have said they are already working through their records now to ensure they have up-to-date contact details for those who are due to be vaccinated next.
The developments around the AstraZeneca vaccine will not change that. Health officials still believe the best way to manage this phase of the roll-out is through GPs, who already have a relationship with and contact details for people in this cohort.
An agreement reached between the HSE and the Irish Medical Organisation on Friday night will mean that the majority of people in this age group will receive a vaccine in their own GP surgery.
For GP practices with under 200 people over the age of 70 there will be a GP-run vaccination clinic at an agreed location. The could take the form of hubs in larger urban centres. The first of these will be located at DCU in Dublin.
The use of larger vaccination centres or hubs is due to the more sensitive nature of the mRNA vaccines. They require ultra-cold temperatures at the point of storage and there is a shorter window (just five days) to use them once they are brought out of this storage for transportation.
Stephen Delaney, CEO of Q1 Scientific, a Waterford-based company that specialises in stability storage for the pharmaceutical industry, told TheJournal.ie that there are “a lot more headaches involved” when working with the Pfizer/BioNTech and Moderna vaccines in terms of transportation and storage.
“With the AstraZeneca vaccine, it has a 2-8 degree storage ability,” he said. “Working with a product like that, you can load a large truck unit, with lots of those freely available, and you could go to five depots, dropping a pellet in each location and each of those locations would have a large 2-8 degree storage.
“You have 25-30 days to get that used, so it can be transported from each of those larger locations to smaller ones like a GP surgery.
With the mRNA vaccines, with lots of little locations all over the country the samples are harder to get there and harder to store. You have a smaller window at that 2-8 degree temperature of just five days.
“And you could lose half a day transporting it across the country, doing multiple drop-offs. This is all possible, it can be done, it just puts a bit more pressure on and it means it has to be very well planned so it’s not wasted.”
Currently, when batches of the mRNA vaccines arrive, they are immediately stored in ultra-cold fridges, like these ones at Citywest:
We're preparing for the #COVID19 vaccine roll out in Ireland. At the HSE National Cold Chain Centre, we have received and are currently commissioning & validating a consignment of 9 x Ultra Low Temperature Freezers for storage of the vaccines at -75 degrees. @HSELive pic.twitter.com/ooGUc9OSQo
— Paul Reid (@paulreiddublin) December 4, 2020
From here, they are transported in vehicles that can maintain a temperature of 2-8 degrees and on delivery they are moved into a fridge with the same temperature range.
Smaller deliveries to individual GP offices are, in theory, possible, according to Delaney, but he said the approach the HSE plans to take, bringing together multiple GPs in one place, would be the most practical and cost-efficient way of doing it.
“None of this is impossible, but wherever you’re adding more moving parts, you’re adding more opportunities for risk, for breakdowns in the system, and generally more operational headaches, so you want to streamline is as much as you can.
“That’s why they’ll be keen on large vaccination centres, large trucks that do a run every day and then scheduling it well so you know how many is needed. Bringing together multiple GPs reduces the likelihood that there’ll be waste if people don’y turn up for their appointment.”
Delaney pointed out that one issue the HSE will have to work out is how to get older people, who are not generally well or who are not mobile, to more larger and more centralised hubs that may be significantly further away from them than their local GP surgery.
“There are nearly 500,000 people in that over 70 group, and say 100,000 of those could be perfectly fit and healthy and can drive themselves to a location that’s further away at any time. But on the other end of the scale you could have just as many people who need assistance and can’t get there themselves.”
Dr Colm Henry, HSE Chief Clinical Officer, acknowledged this week that it will be “difficult” to organise vaccinations for people who are generally unable to leave their homes due to age or illness.
He said, however, that if it is deemed to be in their best interests to get the vaccine, arrangements can be made to bring them to a location where they can receive one.
The final details of this phase of the roll-out are now being nailed down with GPs and further details are expected to be confirmed next week.
However GPs are confident they will be able to do it.
Speaking to TheJournal.ie, Dr Denis McCauley, Donegal GP and head of the Irish Medical Organisation’s GP committee, said: “Nursing homes gave it [out], and we are equally competent, clinical people.” He said supply will be the main issue, unless the HSE can secure larger deliveries from the developers of the mRNA vaccines.
This is something that Monaghan-based GP Dr Illona Duffy is also concerned about.
“I think if there’s guaranteed deliveries on set days, we can plan accurately for that,” she said. “But we saw the debacle with the flu vaccines last year,” she said.
“Organising for receipt of these vaccines takes a lot of work. We’ll have to be very organised with who you’re giving them to and when you’re giving them.”
Do you have a question about a particular vaccine or about the roll-out in Ireland? Send it to answers@thejournal.ie and we’ll do our best to include as many as we can in our coverage over the coming weeks.
- With reporting by Sean Murray.
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