The National Immunisation Advisory Committee (Niac) is meeting on Thursday to discuss further key elements of the State’s Covid-19 vaccine programme.
Meeting again? Hasn’t there just been a big reorganisation?
Yes, last week the HSE redrew the plan after use of the AstraZeneca vaccine was limited to those over 60. This was done following Niac advice, in turn based on a European Medicines Agency (EMA) assessment of clotting events possibly linked to the vaccine. Over-60s have been getting the AstraZeneca this week.
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Why are we back here again?
Shortly afterwards, concerns emerged about similar issues relating to the Johnson & Johnson vaccine, which is due to play a growing role in Ireland. The company paused deliveries, but following a favourable EMA assessment, which said the benefits outweighed any marginal danger from the vaccine, is set to resume them from Monday.
So what’s happening now?
All EMA advice is, in turn, parsed by Niac, which advises the Department of Health, with the Minister ultimately deciding. There can be variations, for example, the EMA advice is that AstraZeneca is okay for over-18s, but Niac, in common with many regulators, advised to limit its use locally to the over-60s. That same process is now under way for the Johnson & Johnson vaccine. But it's not quite so straightforward this time.
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Why not?
Niac's AstraZeneca decision was taken on the basis that Johnson & Johnson vaccines would be available, before similar clotting concerns emerged. If the use of both is severely curtailed, it would damage the programme, and make it more reliant on Pfizer, Moderna and other as-yet-unapproved vaccines. There has been audible grumbling in Government that Niac was limiting the use of the AstraZeneca vaccine without considering the damage to the rollout of the programme.
Some external voices, such as Prof Luke O’Neill, have argued strongly that the advice is too cautious. A similar limit on the Johnson & Johnson vaccine to that imposed on AstraZenca would mean a significant slowing down of the programme.
Where does dose spacing come into it?
In the aftermath of the successive blows on AstraZeneca and Johnson & Johnson last week, the idea emerged of spacing out the doses of Pfizer in order to cover more of the population with a single dose. The pressure to do this was alleviated with the news Pfizer would deliver an extra 545,000 doses from April 26th but, nonetheless, Niac has been asked to examine the merits. There is support in Government for the idea.
So what exactly is Niac looking at?
Niac is looking at the EMA advice on Johnson & Johnson and also at more data on AstraZeneca, which has been requested by the European Commission from the EMA to help deliberations on vaccines. This may have an impact on age constraints, and whether a "broad brush" approach is needed, Niac chairwoman Prof Karina Butler said on Tuesday. They're also awaiting more data on the impact of spacing in the UK.
Crucially, they’ve said they will consider the availability of vaccines and the impact of their advice on the wider programme when making their decisions – a nod, possibly, to Government concerns.
How big a role do AstraZeneca and Johnson & Johnson have in the programme?
They comprise more than 1.4 million doses due before June – more than a third of the total for the quarter. Some 605,000 of these are Johnson & Johnson, a single-dose vaccine. Some 14,400 doses of this vaccine have arrived in the State, with 26,600 due next week. This shot will likely be important for hitting targets. Regulatory and supply issues have stalled weekly vaccination numbers at about 140,000-160,000, well below the hoped-for pace of 250,000 a week.
When will we hear more?
Niac says it could be next week. Government is very keen it should be sooner than that. The vaccine taskforce and the HSE then have to figure out how to implement the advice, and make any changes to the programme necessary – something that they may have to do several times as advice, data and research are constantly changing.
