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# shot in the arm
Explainer: Here's what to know about the changes to Ireland's vaccination queue
The changes announced this week related to those with underlying health conditions.
IRELAND’S VACCINE ALLOCATION groups have been updated and people with underlying health conditions have been moved up the list.
The list has in fact been altered in a number of different ways, with some of the groups that were previously on their own in a distinct cohort now merged with others.
This keeps the list at 15 different cohorts with a number of different groups of people now to be vaccinated in parallel.
Health officials say that while some changes have been made the basis for decision-making has not.
Minister for Health Stephen Donnelly outlined that the sequencing is still allotted in a way that prioritises those who are at most risk of severe illness or death should they become infected with Covid-19.
What does the list look like now?
Ireland is currently on number 3 in the sequence, with the vaccinations of people aged over 70 beginning last week.
This does not mean that number 2 (frontline healthcare workers) has been completed but there is now capacity to do both together.
The first priority group of over-65s in care homes is largely completed.
The newly updated list is unchanged from cohorts 8-15 but there are some alternations between numbers 4-7. The first half of the list now looks like this:
- People aged 65 years and older who are residents of long-term care facilities (likely to include all staff and residents on site)
- Frontline healthcare workers
- People aged 70 and older
- People aged 16-69 with a medical condition that puts them at very high risk of severe disease and death
- People aged 65-69 whose underlying condition puts them at a high risk of severe disease and death
- Other people aged 65-69, other healthcare workers not in direct patient contact, and key workers essential to the vaccine programme
- People aged 16-64 who have an underlying condition that puts them at high risk of severe disease and death
The most immediate change is that the next cohort to be vaccinated are adults who are at “very high risk” if they contracted Covid-19.
After that the sequencing deals with people who are at high risk from the disease but who are also older.
The National Immunisation Advisory Group (NIAC) has emphasised that age remains the single most important risk factor and this is therefore reflected within those who have a medical condition.
What groups are high risk and which ones are very high risk?
The Department of Health has outlined an extensive list of the different conditions that go into each category, so this the best place to find a condition you may be looking for.
For example, all cancer patients that are actively receiving treatment or those with advanced cancer are deemed to be of “very high risk”. This means that such individuals are in cohort number 4.
Some other cancers patients are deemed to be of “high risk”, so are in cohorts 5 or 7 dependent on their age.
Other examples include:
- Obesity: People with in the BMI range above 40 are in cohort 4 and those in the BMI range above 35 are in cohort 5 or 7 depending on age.
- Immunocompromised: Those who are severely immunocompromised due to disease or treatment (e.g. transplant) are in cohort 4. Those immunicomprosed due to steroid treatment or due to HIV are in cohort 5 or 7 depending on age.
How many people in total are going to be moved up the list?
The HSE has said it is not possible to give a precise number of people that will benefit from the change because no such record exists. Instead, an estimate can be drawn up based on the prevalence of certain conditions and population size.
It is therefore estimated that there are perhaps 140,000 people in the “very high risk” category that are next in the prioritisation queue.
Within that, the HSE estimates that here are perhaps 42,000 people who have a particular severity of illness or may be immunosuppressed. This may be an over-estimated however because some individuals have a number of conditions and are therefore double-counted in that estimated
When can we expect the vaccination of the new cohorts to begin?
The HSE says its plan this week is to move from estimating the numbers involved to “a quick a prioritisation of this group”.
“I don’t see that happening this coming week because we have to collate the names and the census first, but certainly we’ll be aiming to start either at the end of next week or the beginning of the following week,” Chief Clinical Officer Dr. Colm Henry said on Thursday.
How will people know if they are impacted by the change?
Those who are impacted by the change will be identified both through the GP system or through attendance in a hospital setting.
For example, people with kidney disease who are receiving dialysis are listed in the “very high risk” cohort and may be vaccinated through that clinical programme.
Others however will be identified by GPs who are aware of patients’ conditions and GPs will therefore identify those who are at risk.
What vaccines will these people be receiving?
Of those people aged 18-69 within the groupings, they can receive any of the three currently approved vaccines.
However, a “small number” of people will be prioritised to receive one of the two mRNA vaccines, provided this does not significantly delay them being vaccinated.
NIAC has said that people who are immunosuppressed may not respond as well to viral vector vaccines, which work by triggering an immune response.
The Oxford/AstraZeneca vaccine is a viral vector vaccine while the Pfizer and Moderna vaccines are based on mRNA technology.
NIAC has therefore said that they should receive either Pfizer or Moderna as long as it doesn’t significantly delay vaccination. A significant delay is not clearly defined but more than three weeks may be considered a good estimate.
Speaking on Thursday, Deputy CMO Dr Ronan Glynn said this consideration would only come into play for a small number of people.
What about people with minor conditions, will they benefit from the change?
NIAC has said that for people with minor conditions age still represents the most important factor in their risk from Covid-19, so this is accounted for in the sequencing list.
Was there some controversy over carers not being prioritised the list?
Yes, there has been some significant controversy over this with Family Carers Ireland saying carers were “devastated” by the decision.
It even played out in the Dáil with Sinn Fein’s Mary Lou McDonald saying it was “very disappointing” and asking the Taoiseach Micheál Martin to “correct” the decision.
Martin said that NIAC had not advised that carers being prioritised and that politicians should “respect” NIAC. He accused McDonald of “playing politics” with this issue.
NIAC’s Butler said others who are potentially more vulnerable would have to be pushed down the list if carers were bumped up.
She also pointed out carers will benefit from the changes that have been made because in many cases those they are caring for are being moved up.
Despite this, the Minister for Health has asked NIAC to specifically consider whether family carers could be considered for inclusion in one of the other groups it is now reviewing.
So this does mean there may be further tweaks to the vaccine priority list?
Yes, there may be more changes to the sequence and even if there are no major changes we are still waiting for some clarity on the sub-groups.
NIAC has said there is a “rolling review” of the prioritisation list and that there may be modifications as the roll-out continues.
Within the sub-groups, we are still unaware of the definition of “key workers”.
Key workers appear twice in the list, number 6 “key workers essential to the vaccine programme” and number 10 “key workers in essential jobs who cannot avoid a high risk of exposure”.
NIAC has said it does not have a role in identifying key workers and the Department of Health is carrying out this process.
