Vaccination, argues one well-placed source, is always vital – however, "it's not essential to the political life of the country".
Covid-19 has turned that dynamic on its head.
That means extra scrutiny and pressure on the individuals and organisations charged with managing the pandemic, including groups such as the National Immunisation Advisory Committee (Niac). It is currently considering whether two Covid-19 vaccines can be widely administered to people under 50.
| Total doses distributed to Ireland | Total doses administered in Ireland |
|---|---|
| 15,011,914 | 10,799,130 |
Like many other groups, Niac is a pre-pandemic institution grappling with the intensity and pressure of the virus.
Formed in 1995, rather than being a full-time body with its own staff, it is organised as an independent committee hosted by the Royal College of Physicians of Ireland. Its membership comprises almost 30, drawn from across the healthcare system, including the HSE, Department of Health, training, regulatory and professional bodies and medical societies.
It isn’t established under statute and its advice does not carry legal authority. Industry veterans say much of the time, Niac is focused on important but low-visibility work around things such as flu shots, or issues that generate bursts of publicity, such as the HPV vaccine.
A report from 2010 shows it held eight meetings in the previous period; in recent months it has dealt with 10 requests for advice on Covid-19 vaccines, each requiring weekly meetings, if not more often.
Sawtooth quality
Niac itself is quick to point out it "does not determine . . . vaccination policy [and] has no role in the HSE implementation of the vaccine programme". Nonetheless, it has moved centre stage. Several times – most notably in relation to the AstraZeneca vaccine, and the occurrence of linked blood clots – its advice has led to significant redesigns or short-term turbulence in the programme.
Its advice on age-based restrictions has had a sawtooth quality – firstly restricting it among older people due to a lack of data in clinical trials, before reversing course as new evidence emerged on the clotting issue.
While this has been done in response to a rapidly-evolving clinical picture, and based on real concerns, it has led to frustrations. “They focus on safety and clinical issues and one of the key concerns is how much do they take account of operationalisation of recommendations,” one senior source remarks, saying some fear “they operate in isolation”.
This has been compounded by what some in Government see as the stately progress Niac makes when considering its advice. A complex system of issuing advice – which goes to the chief medical officer who in turn writes to the Minister for Health, who may go to Cabinet, while the HSE is then asked to implement – has caused some impatience.
Niac says that it weighs the benefits and risks for individuals and the community, the wider epidemiological situation, and the availability of other vaccines, with an overall priority to prevent severe disease and death. Defenders of Niac say it is rigorous and focused on clinical safety, while the pressure of policymaking during a pandemic exposes it to criticism no matter what way it turns.
