The recommendation by the National Immunisation Advisory Committee that the AstraZeneca vaccine should not be given to under-60s once again leaves Ireland’s vaccination rollout in a quandary.
The decision to implement the committee’s recommendation leaves too few mRNA vaccines for some groups, potentially unwanted stocks of AstraZeneca that were intended for other groups and a growing challenge with vaccine hesitancy.
The new advice means the HSE will have to issue a safety notice to doctors immediately to give effect to the changes.
Hospital Report
The administration of doses to high and very high-risk patients currently taking place in hospitals and GPs surgeries will have to stop for people under this age limit. This is likely to affect thousands of patients who were due to be inoculated this week.
Doctors will be able to proceed with giving a second dose of the vaccine to most people, aside from very high risk and high-risk patients. The interval between doses is being left at 12 weeks for those aged 60 and over, and extended to 16 weeks for those under 60.
A decision will have to be made about which vaccine to give to the cohort who were supposed to have received AstraZeneca. The problem is that most of the supplies of the Pfizer/BioNTech and Moderna vaccines are being used in the over-70s.
This leaves the 60-70 age group as the one cohort that could receive large amounts of AstraZeneca. There are about 400,000 people in this cohort, giving a requirement for 800,000 doses. Coincidentally, this is the amount of AstraZeneca doses due to arrive in Ireland this quarter.
But with this latest flip-flop in policy over the AstraZeneca vaccine, there is likely to be considerable consumer resistance from those still due to receive this vaccine.
More than 120,000 vaccines doses were administered last week and this was due to increase to 180,000 this week, but this was before any changes in the advice on the AstraZeneca vaccine.
Short notice
This is the fourth time the National Immunisation Advisory Committee (Niac) has issued new advice that has forced those implementing vaccine rollout to rejig components of the programme, often at short notice.
It was originally intended older people, who most need protection from vaccines, would be given AstraZeneca by their GPs, as this vaccine was easy to transport and store.
But a dearth of trial evidence on its effects on older people gave Niac the heebie-jeebies and at the start of February it expressed a preference for giving the other vaccines to older people.
Despite their extra cost and requirement for ultra-cold storage for the Pfizer/BioNTech and Moderna jabs, the task of vaccinating older people has largely been achieved now. Since Niac made its original decision, real-life data has shown AstraZeneca is just as good as its rivals in preventing serious disease among older people.
In mid-March, the committee recommended a pause in the use of AstraZeneca as the first concerns were expressed internationally about a possible link to blood clots. Once again, the system had to adapt.
After a week, it gave the green light for the tap to be turned on again, and HSE staff started using AstraZeneca for healthcare workers and high-risk patients under 70.
April targets
Each successive swerve has chipped away at the standing of the AstraZeneca vaccine, and possibly of all vaccines.
Even before Niac’s revised recommendation on the use of the AstraZeneca vaccine, it looked highly unlikely the Government’s target for vaccinations this month would be reached.
The programme is accelerating, but not at the pace that foresaw 860,000 vaccines being administered in April.
In the first 10 days of this month, to last Saturday, 193,000 people received a dose. This week was forecast to be the busiest yet, with 180,000 doses administered.
GPs had already held off giving the AstraZeneca vaccine to at-risk patients from late last week in anticipation of a change in advice. Now at least a partial pause in the use of the vaccine seems likely while new plans are made.
But with fewer than 400,000 doses administered up to the end of this week, the system will have to operate at full pelt in order to meet the end-of-month target. Officials have said they aim to be carrying out 250,000 inoculations a week by the end of the month, so the target is barely achievable.