LAST UPDATE | 6 Feb 2021
GPS WILL BEGIN to receive vaccine doses allowing them to give the jab to people over the age of 85 from Monday week under an agreement reached between doctors and the HSE last night.
Pharmacists, meanwhile, have said they are “frustrated” waiting to receive and administer vaccines themselves.
Across a series of interviews by TheJournal.ie with GPs and pharmacists around the country, staff said they were ready to begin vaccination as soon as supply arrives and that clarity was needed over how the process would work.
They said that certainties over supply were required, and that it wouldn’t be a significant challenge to use the Pfizer or Moderna vaccine rather than the AstraZeneca one as had been previously planned.
In details agreed between the HSE and Irish Medical Organisation last night, the majority of people aged 70 and over will be vaccinated in their own GP practice with the Pfizer or Moderna vaccine. Of the 1,373 GP practices in Ireland, just under 1,000 of them will see patients vaccinated in their own GP surgeries.
For GP practices with under 200 people over the age of 70 there will be a GP-run vaccination clinic at an agreed location.
These will mainly be in larger urban areas such as Dublin, Galway and Cork. The first one of these will be in DCU in Dublin. They’ll be operated by GPs, practice nurses and admin staff.
There may also be a “buddy system” for small GP practices outside these urban areas for their patients to attend a larger practice to receive their vaccine.
All booking, registration and payment will be processed via each GP surgery’s practice management system. People within the appropriate age groups will be contacted directly when they are eligible to receive a vaccine.
These clinics will operate at weekends, and will continue to operate until all patients within the age range are vaccinated.
The first tranche of this vaccine rollout will see approximately 72,000 people over the age of 85 given the vaccination. There are approximately 490,000 people over the age of 70 in Ireland.
The first deliveries of vaccines to GP surgeries will start on 15 February and this is expected to “significantly ramp up in subsequent weeks”. The deliveries will be scheduled in line with supply lines and starting with practices who have the largest number of over-85s.
Twists and turns
Earlier this week, plans for over-70s to be given the Oxford/AstraZeneca jab in GP surgeries from later this month were thrown into flux after it was recommended that this age cohort be given the Pfizer/BioNTech or Moderna vaccines instead “where practicable and timely”.
The lack of substantial data on the efficacy of the AstraZeneca vaccine was cited as the cause. Although health officials are confident it is safe and effective in all adults, there is much more data to suggest it is more effective when given to people aged under 65 than over 65 – whereas the data indicates the mRNA vaccines perform strongly across all age groups.
This immediately sowed doubt over the speed and success of the vaccine rollout, as the mRNA vaccines like Pfizer and Moderna need to be stored at much colder temperatures than the AstraZeneca jab.
HSE CEO Paul Reid said on Thursday that the HSE has “always been clear that the Covid-19 vaccine rollout will have many twists and turns” in the first quarter of this year.
Reid said that the health service was now working through operational changes to re-adjust the country’s vaccine plan, and would present details on this to the government’s vaccine taskforce shortly.
However, doctors on the ground are still confident they can vaccinate the older population, regardless of which vaccine is being used, while the Irish Pharmacy Union says its sector could help the rollout by vaccinating remaining frontline healthcare workers with the AstraZeneca jab.
‘A learning process’
Dr Denis McCauley is a GP in Donegal and also head of the Irish Medical Organisation’s GP committee.
He told TheJournal.ie: “I think this curveball was partially expected. We did anticipate Pfizer would have to be given in general practice. GPs can give this vaccine. Nursing homes gave it, and we are equally competent, clinical people.”
Dr McCauley said the only real issue for GPs when it came to administering the vaccine would be supply.
“There’s been a learning process taking place from the rollout so far, and we want to use the benefit of that knowledge,” he said. “Because of supply, the amount that each GP will get will be relatively small.”
Dr Illona Duffy, a GP based in Monaghan, told TheJournal.ie that clarity over supply would be of crucial importance to vaccine rollout in GP surgeries.
“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. 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.
The only way to do it is if we’re guaranteed a set number of vaccines. We need to know how large a supply of vaccines we’re getting, and then do them. We’ve heard nothing. But these are difficult times, as we know. We shouldn’t let it be GPs only too, colleagues in pharmacies say they’re on hand to administer vaccines.
The CEO of the Irish Pharmacy Union (IPU) Darragh O’Loughlin said that there is “a lot of frustration and anxiety” among pharmacists over the vaccination rollout.
In a statement this week, O’Loughlin said pharmacy staff are “ready to start vaccinating” and that it makes sense for them “to be called into action” when the Oxford/AstraZeneca vaccines begin to arrive in the coming weeks.
The union this week urged the government to supply pharmacists with this vaccine to allow them to vaccinate frontline healthcare workers who have not yet received their first dose.
“Pharmacies are already part of the national vaccination plan,” O’Loughlin told TheJournal.ie. “The agreement is in place, but pharmacists haven’t actually been engaged with yet.
“This could speed up the rollout by vaccinating healthcare workers and then working their way through the list with pharmacies… The HSE hasn’t given us a [start] date,” he said.
“All of that can be arranged very, very quickly by sitting down now and engaging with the HSE and pharmacies and putting operations in place.”
However, community pharmacists haven’t yet been vaccinated, which could delay this process. The union has called for pharmacy staff to be vaccinated as soon as possible, alongside other frontline healthcare workers.
Kathy Maher, a pharmacist in Meath, told TheJournal.ie that it’s “really frustrating” to not have more information about what is required for the rollout.
“While we have been included and payment has been worked out with the government, we still have no idea about the operational issues. So we don’t know how the vaccines are going to be delivered, how to record it on online portal, we don’t know if there is additional training necessary,” Maher said.
She said pharmacies “need to see concrete plans and dates”, even if those dates change down the line.
“In our area, for example, we have been looking to see if we could do it in a church hall. We need to get our teams ready so we can get the vaccine into as many arms as we can, as soon as possible.”
The HSE said that all vaccinators “should be offered the vaccine” before they begin administering the vaccine to other people.
“Second doses should be administered as they fall due,” the HSE said.
“The HSE is committed to working with pharmacists as an essential component to the vaccine rollout,” it added.
‘There might be some frustration’
Given the scale and severity of Covid-19 and how long we’ve been living with it, it’s understandable that people – particularly in the over 70 age group who are next in line – want to know when they’ll be getting their vaccine.
Dr Illona Duffy said: “It’s important that we make sure the appropriate people at a particular time get this vaccine. We’ve had lots of calls from people asking if they can be on the first list. But we’re advising it’s been done by age groups. A lot of work at the minute is making sure to have up-to-date contact details to reach out to people to get their vaccination.”
“The patients are very well informed, intelligent people overall,” Dr McCauley said: “We’ve been giving the message that ‘we’ll ring you’. If they don’t have a date soon, there might be some frustration, a keenness to just know times and dates.
We would be disappointed if we’re not starting the over 85s by Monday week. Now, I could have egg on my face or a smile on my face for saying that.
Keeping track
Another aspect of the GP rollout will be accurate reporting of just how many vaccines have been administered. It has taken over a month for a system of regular reporting of the number of people vaccinated to be placed on the Ireland Covid hub. It’s expected this will be updated daily with vaccination figures from next week.
Dr McCauley said the “absolute need for information is extraordinary”, and there was a “great desire” for minute-by-minute reporting of how many vaccines were being administered.
“Like I could check now how many flu vaccines I gave last year, and the batch number on each one,” he said. “Our understanding is from the rollout that our software will be used and connected to a central system. If it can replicate the simplicity of what we have, then it’ll be a good system.”
Dr McCauley said there’d been plenty of discussion and commentary around the premises that would be used to administer vaccines, but he described it as “not an issue”.
“It’ll never be an issue,” he said. “Within the area I serve, there might only be a couple of hundred people over the age of 85. Smaller GPs will have a smaller amount. I might get 150 vaccine doses next week for my over 85s. That’s within the capacity for us to give in an afternoon.”
Dr Duffy, on the other hand, said that the best venue for administering the vaccines will depend on supply at a local level.
Another scenario GPs are keen to avoid is leftover vaccines with no one to give them to, such as happened when family members of staff at the Coombe received leftover vaccines last month.
“We’ll impose our own protocols around that,” Dr McCauley said. “This is a very finite resource. At first, we’ll give it to over-85s only. If we have some leftover and they’re all done, we call someone who’s 84-years-old to come in, and so on.
It’s a blood sport. If you do it [give vaccines to those not yet eligible], you’ll be found out. It’ll be on social media.
‘A lot more headaches involved’
In terms of storage and transportation, mRNA vaccines from Pfizer and Moderna need to be stored at extremely low temperatures, but that is not the case with the AstraZeneca jab.
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 mRNA vaccines in terms of transportation and storage.
“With the AstraZeneca vaccine, it has a 2-8 degree storage ability. 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.”
Paul Reid said this week that the vaccination of over 70s is now likely to involve more mass vaccination centres and smaller ‘GP hubs’, bringing a number of doctors’ surgeries together, as a result of these issues with transporting and storing the mRNA vaccines.
‘Experienced vaccinators’
Darragh O’Loughlin from the IPU said: “Pharmacists are experienced vaccinators already, so the act is quite straightforward. Pharmacies vaccinated 300,000 people with the flu vaccine in five or six weeks last year.
“They can safely vaccinate large cohorts of people. All that we need to do now is get pharmacists and their teams vaccinated.”
He said the government and the HSE have “dragged their heels” on the union’s calls for pharmacists to be vaccinated “urgently so they could start vaccinating the public”.
“There is the risk that this could cause further delay if they don’t start getting vaccines quickly,” he said.
Transparency
Going forward, there’s a recognition that things can change quickly and GPs say they’re ready to react to that.
However, they want some transparency from the HSE and government around the vaccine rollout as it involves them going forward.
“We’ve had situations where decisions were made overnight, and we hear about it through the media,” Dr Illona Duffy said.
We cannot have the HSE make announcements on this without having things put in place in general practice. It’s not fair, and we get the brunt of ire and displeasure [if things don't run smoothly]. They’ve got to avoid having unrealistic expectations. Each practice will do it in a different way, and it’s understanding that as well.
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