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Q&A: The vaccine rollout has begun - we've been putting your latest questions to the experts

Thousands of people have been given their first jab – and the programme will be ramped up in the coming months.

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THE COVID-19 VACCINE rollout has begun in Ireland and, naturally, people have a lot of questions about how the process will work.

TheJournal.ie has been breaking down the latest pandemic and vaccine developments in explainers, factchecks and other articles in recent weeks:

As well as this, we started this vaccine Q&A series in December to help answer questions readers may have – either about a specific Covid-19 vaccine or how the programme will work in Ireland.

We also looked at how the process that developers had to go through for these vaccines was different from the fast-tracked Swine Flu vaccine.

If there’s something you want to know, tell us and we can put your queries to the experts.

A quick note before we begin addressing reader questions: We’ve had dozens sent in since we put out our first call out for questions. 

As the rollout is ongoing, and additional vaccines are still being approved, there are some questions that can’t properly be answered yet – so if you’ve sent us a question this week but don’t see it appear here, it may be included in a future article in this series.

If you have a suggestion for a question you’d like answered, the email address is answers@thejournal.ie. Rest assured we won’t be including your name or any other identifying details in articles.

In this article, we’ll be examining areas like how you’ll know when it’s your turn to get the vaccine, whether you can pick which one you get, who’ll be administering it and whether you still need a vaccine if you’ve had Covid-19 at some stage.

Vaccine rollout plans

  • What order will people in Ireland get the vaccine?
  • When will I get my vaccine?
  • Can I register to get the vaccine? 

Ireland’s Covid-19 Vaccine Allocation Strategy has drawn up a provisional list of priority groups for vaccination.

The rollout strategy was developed by the National Immunisation Advisory Committee (NIAC) and the Department of Health, before being endorsed by the National Public Health Emergency Team (NPHET) and approved by the government on 8 December.

The vaccines delivered in Ireland to date were made by Pfizer/BioNtech, which was the first vaccine to receive approval from the European Medicines Agency (EMA). On Wednesday the Moderna vaccine was approved by the EMA, paving the way for its rollout in Ireland.

This is the provisional order in which people in Ireland will be vaccinated against Covid-19:

  • People aged 65 years and older who are residents of long-term care facilities (and staff on site)
  • Frontline healthcare workers
  • People aged 70 and older
  • Other healthcare workers not in direct patient contact
  • People aged 65-69
  • Key workers
  • People aged 18-64 with certain medical conditions
  • Residents of long-term care facilities aged 18-64
  • People aged 18-64 living or working in crowded settings
  • Key workers in essential jobs who cannot avoid a high risk of exposure
  • People working in education sector
  • People aged 55-64
  • Other workers in occupations important to the functioning of society
  • Other people aged 18-54
  • People aged under 18 and pregnant women

A full breakdown of who is in these groups, and the rationale for the order, can be read here.

The first groups to get the Covid-19 vaccine are:

  • people aged 65 years and older who live in long-term care facilities
  • frontline healthcare workers

The HSE has said the goal is to vaccinate people in these two groups by the end of February. The vaccine will then be offered to other groups.

download (6) Annie Lynch (79) receiving the vaccine in St James' Hospital on 29 December 2020 - she was the first person in the Republic of Ireland to receive the Pfizer/BioNTech Covid-19 vaccine. Source: Marc O'Sullivan

Priority group 1

People over 65 who live in long-term care facilities are the first priority group to get the Covid-19 vaccine. This is because they have a greater risk of serious illness if they get the virus.

Vaccination of this group started on 4 January.

The vaccine will be given to both residents and staff in 582 long-term care facilities across Ireland. The HSE is working with Nursing Homes Ireland to coordinate the rollout of the vaccine to people in this group.

Vaccinator teams will give the vaccines to people who live at each of these facilities. They will make two separate visits, three weeks apart.

Last night Health Minister Stephen Donnelly announced an acceleration of the country’s vaccination programme.

The new plan means that those in nursing homes, as well as mental health and disability residential centres, should receive the jab sooner than expected.

Donnelly said: “By the end of this week, our plan is to have given over 40,000 vaccines to frontline healthcare workers and nursing home staff and residents, the plan is on target.

“We had planned to vaccinate all 75,000 residents and staff with the first dose of the vaccine by the end of January. We’re now accelerating this plan to finish earlier, meaning that the first dose will be given to all residents and staff in the next two weeks.”

The HSE is now mobilising 65 vaccination teams including hospital vaccinators, community vaccinators, school vaccinators and the National Ambulance Service. Vaccinations will take place seven days a week.

“We’ve decided to use some of our one week buffer as our supply of vaccines has been constant and we’ve received solid reassurance from Pfizer that this will continue to be the case,” Donnelly said.

Priority group 2

Frontline healthcare workers are the second priority group to get the Covid-19 vaccine. This is because they have a greater risk of becoming infected with the virus. The vaccinations for priority groups 1 and 2 are happening simultaneously.

Vaccination of frontline healthcare workers started in four hospital sites on 29 December.

This has since been extended to include other hospital sites around the country. The HSE said this rollout “will continue, depending on the deliveries of vaccine we receive”.

Speaking to TheJournal.ie, Dr Colm Henry, the HSE’s Chief Clinical Officer, said the current focus is on the first two priority groups but this will widen once more supplies of vaccines are confirmed.

Once people in care homes and frontline healthcare workers are vaccinated, which is expected to be completed by the end of February, other groups will be made aware of when they are eligible to get the vaccine.

For example, over 1,000 staff members received the first dose of the vaccine at St Vincent’s University Hospital in Dublin from Tuesday to Friday.

“We will go through these two groups first and then as we get more confirmed shipments, we’ll be switching focus to bigger groups, going largely aligned with age but not exclusively so,” Dr Henry said.

“As we scale this up, we’ll be increasingly educating and informing people about how they can access and register interest for the vaccine.”

Dr Henry said people who are not in the first two priority groups should not yet contact their GP to register their interest in getting the vaccine.

He said people will be made aware, in advance, of when they can receive the vaccine. There will be a system through which they can register to get the vaccine, but the details of this are yet to be confirmed.

Dr Henry said the HSE “will make it as easy as possible” for people to register to get vaccinated.

  • Who is considered a key worker?

Key workers are currently sixth in the list of 15 groups who will receive the vaccine in Ireland. Healthcare workers are classed as separate to key workers and will be vaccinated earlier in the process. The full list of priority groups can be read here.

The HSE this week said list of key workers is “to be further refined” but includes people “in essential jobs who cannot avoid a high-risk of exposure to Covid-19″.

This includes workers in the food supply system, public and commercial transport and “other vital services”.

The government has listed 18 groups as essential services under Level 5 of the Covid-19 plan. However, the key workers list is not expected to be this broad.

These 18 groups are as follows:

  • Agriculture, horticulture, forestry, fishing, animal welfare and related services
  • Manufacturing
  • Supply, repair and installation of machinery and equipment
  • Electricity, gas, water, sewage and waste management
  • Construction and development
  • Wholesale and retail trade
  • Transport, storage and communications
  • Accommodation and food services
  • Information and communications (including journalists)
  • Financial and legal activities
  • Professional, scientific and technical activities
  • Rental and leasing activities
  • Administrative and support activities
  • Public administration, emergency services and defence
  • Human health and social work activities
  • Education
  • Community and voluntary services
  • Diplomatic missions and consular affairs

Obviously these groups are broad and include a large number of people. However, not all workers in these categories are considered essential workers. ‘Retail trade’, for example, is confined to ‘essential retail outlets’ such as supermarkets.

Vulnerable groups

  • Which people are viewed as most vulnerable to Covid-19?

The Department of Health has released the below list of “extremely medical vulnerable groups to Covid-19”:

  • Older People: People aged 70 years or older.
  • People with specific cancers:

- People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer.
- People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma that are at any stage of treatment.
- People having immunotherapy or other continuing antibody treatments for cancer.
- People having other targeted cancer treatments, which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
- People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.

  • People with severe respiratory conditions such as cystic fibrosis, severe asthma, pulmonary fibrosis/lung fibrosis/interstitial lung disease and severe COPD.
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SLID, homozygous sickle cell).
  • People on immunosuppression therapies sufficient to significantly increase risk of infection.
  • Women who are pregnant with significant heart disease, congenital or acquired.
  • Solid Organ Transplant Recipients
  • People who are obese

The department has advised that “if you are in any doubt about your vulnerability talk to your GP or Occupational Health Service”.

Different vaccines 

  • Can I pick which vaccine I get? 

In short, no. Dr Henry told us “we can’t go down that road”.

“This is a national emergency, an international emergency. We’re seeing vaccines developed at unprecedented scale and produced at unprecedented scale, and now being distributed at an unprecedented pace. And as such, we can’t pause for breath and afford choice in that matter.

“The important thing is the fact that these vaccines are safe and effective.”

Dr Henry noted that some vaccines, such as the AstraZeneca vaccine, appear to “lend themselves more to mass settings” because, unlike other vaccines which need to be stored at extremely low temperatures, it can be stored in a normal fridge.

However, this vaccine has not yet been approved for use here.

The European Medicines Agency (EMA) yesterday said it expects AstraZeneca to submit a conditional marketing application for its Covid-19 vaccine next week.

Approval by the EMA, which could happen by the end of January, would pave the way for the vaccine to be rolled out in Ireland.

More than 15 million doses of five different vaccines have been ordered for Ireland, but some of these have yet to be authorised and most supplies are not expected until later this year.

Dr Henry told us, if approved, many people in Ireland could end up getting the AstraZeneca vaccine.

“It’s likely that people who are outside healthcare worker settings or those in residential care settings, may get a different type of vaccine than the one that’s being administered now – one that lends itself more easily to distribution and to administration in settings that are easier for access,” he said.

Jumping the queue

  • Will there be an opportunity to go get the vaccine privately and pay for it like they offer with Covid-19 testing if we are required to travel and the government’s rollout is taking too long?

The helpfully short answer to this is: No.

There is an advanced purchase agreement for supply of the vaccine which is a state programme tied into the EU.

The Taoiseach has said non-State bodies, such as private healthcare companies, will not be able to offer the vaccine independently. He said if this was allowed it would jeopardise the vaccine rollout. 

“It will have to be under the aegis of the State and the authority of the State because, first, the allocation to various vulnerable groupings is key, and that would be jeopardised if people were going off, doing their own thing,” Micheál Martin said in December

And the national procurement of the vaccine, the State is procuring the vaccine, in the first instance, as part of the European procurement initiative and therefore, we want to make sure we have data records of its administration so we can monitor its uptake and its effectiveness, and evaluate it.

There is no charge for the vaccine through the public system and there is no option to pay and jump the queue through a private provider.

Staffing

  • Are they still planning on training extra people/hiring those who have previously stepped back/ retired from the medical field?
  • Will they look at hiring additional ‘lay people’ to help with vaccine rollout (admin for records, scheduling, tracking etc) to allow medical staff to dedicate more time to actually vaccinating?

The government’s Covid-19 vaccine implementation plan states that medical, nursing and dental professionals are able to administer vaccines under current regulations.

At this week’s HSE briefing on Covid-19, chief operations officer Dr Anne O’Connor said up to 2,000 vaccinators have been trained up in how to administer this particular vaccine.

This includes 200 school vaccinators, who would traditionally administer vaccines to school students, as well as peer vaccinators who would normally administer the flu vaccine.

There is additional individual training for each different vaccination in Ireland and there are learnings specific to this vaccine, how to reconstitute it from the vial, what the correct dosage is, what advice to give the patient and what to do after the vaccine is given.

“In relation to these vaccines, everybody has had to do more training, but we have also brought more people into that mix so there have also been additional training modules developed to support the administration of this vaccine,” she said.

Dr O’Connor said anyone who is trained as a vaccinator has been keen to get involved in the programme.

The government plan states that there will be a need to expand the pool of skilled workforce to administer the vaccines as more doses become available. GPs and pharmacists are likely to be involved – though pharmacists may need to be specifically licensed for these vaccines – and a number of other options are being considered, including:

  • Nurses in acute settings (including agency nurses);
  • Asking staff to work overtime, or making part-time staff full-time;
  • Ambulance service paramedics;
  • Contracted private vaccination services;
  • Other State and voluntary service providers;
  • Authorising and training other appropriate professions.

The government is also considering licensing recently retired health professionals or maintaining the registration in the case of others.

The government’s plan states that the programme will require significant increases in the number of administrative and support staff and there may be “opportunities to leverage the broader public service to achieve this”.

Dr Henry told TheJournal.ie that healthcare workers will not be pulled off the frontline to do this kind of administrative work. Some staff, who are not clinicians and already working in administration, have been and will be moved around and he said additional staff may also be hired for these job.

Immunity

  • How long does immunity last?
  • If we’ve already had the virus do we need a vaccination?

Again, the data on this is not strong as vaccine developers in their trials could not wait a longer period of time to assess immunity levels in participants. These are learnings we will only have once mass rollouts across countries progress.

If you have had Covid-19 at some stage over the course of the pandemic, you are still advised to get vaccinated. It is not clear how long immunity – either from a vaccination or from a previous infection – lasts. We also know there have been some examples of reinfection.

According to the US Center for Disease Control and Prevention:

“The immunity someone gains from having an infection, called natural immunity, varies from person to person. Some early evidence suggests natural immunity may not last very long.”

Even if a previously infected person does have some immunity, a vaccine will boost their immune response, giving them further protection. It is likely that people will be advised to wait around four weeks after infection to get their vaccine, to ensure it is effective.

Transmission after vaccination

  • If you are vaccinated, are you still a possible carrier of the virus – ie you are vaccinated but others around you have not received the vaccine yet is there still the same risk that those that have not yet received the vaccine will contract the virus from you, the vaccinated individual?

What we know is that the vaccine will most likely stop you from getting sick. We don’t know for certain that it will stop you from being a so-called ‘carrier’, but experts are optimistic on that point.

It is also thought that if vaccinated people remain carriers, there will be fewer days where the virus is transmissible.

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There is strong evidence from the trials of vaccines that have been approved that they are effective in terms of preventing people from becoming ill with Covid-19, the disease caused by the SARS-CoV-2 virus.

However, evidence around asymptomatic infection after vaccination and transmission from a vaccinated person to a person who has not been vaccinated is not comprehensive.

Recent data published by AstraZeneca/Oxford showed the number of asymptomatic infections among the vaccine group in the study was reduced compared to the placebo group (which did not receive the Covid-19 vaccine). However this was just a proportion of study participants monitored and the results were preliminary.

Dr Cillian De Gascun, director of the National Virus Reference Laboratory, spoke to TheJournal.ie about this before Christmas for The Explainer podcast. The whole episode is worth listening to if you want to learn more about vaccines, but here’s what he said on this particular issue:

“What we know about vaccines from other settings is that typically vaccines don’t cause a type of immunity that prevents the infection occurring. What the vaccination does is it prepares the immune response,” he explained.

“It primes the immune response with a minor form of the infection to ensure that the immune system is prepared to defend the host when the real infection occurs.

What that means is that if we look at say, a normal SARS-CoV-2 infection, if I get infected today on a Friday, it’ll take a week or two for my immune system to respond and I probably won’t have antibodies detectable in my blood for really probably 10 to 14 days.
That means in that time period, the virus has the opportunity to to replicate, to multiply, to infect lots of cells and to get into my nose and throat. And there’s an opportunity there for me to transmit the infection to other people.

“Now, if I have been vaccinated, that same process still occurs – the virus is still able to infect me. But because I’ve been vaccinated, and my immune system is prepared to respond, that 10 to 14 day period that occurs with natural infection, that’s really reduced probably to a couple of days.

“What that means is that the virus doesn’t have the same opportunity to replicate and to multiply. So it doesn’t have the opportunity to get up to the same high level of virus, it doesn’t have the same level of opportunity to get into my nose and throat and cause symptoms and allow me to transmit the infection.”

Dr de Gascun said even if the vaccine does not entirely prevent infection, experts expect it will still ensure the amount of transmission from people who are vaccinated will be reduced.

Vaccine supply

  • Will daily figures of how many people are vaccinated be published?
  • How many doses of the vaccine will Ireland receive?

Yes, daily figures of how many people are vaccinated will be published.

Health Minister Stephen Donnelly recently confirmed that the number of daily vaccinations will be included on the online data hub – which to date has mainly been used to show Covid-19 cases, deaths and related information.

However, the number of people vaccinated has not yet been added to the hub, but daily figures are expected to be added to the site soon.

“It’s important people know how the vaccination programme is going. I’m going to have the vaccination numbers added to the existing data hub which shows the COVID numbers,” Donnelly said on Twitter.

On Thursday, Paul Reid, the CEO of the HSE, confirmed that 15,314 first doses of the Covid-19 vaccine had been administered from the 81,900 doses delivered at that point.

During the week, the Taoiseach said that up to 135,000 people will be vaccinated by the end of February.

It has been estimated that about one million people in Ireland will be vaccinated by June. Education Minister Norma Foley told Prime Time on Thursday it is possible that “more than one million people” could be vaccinated by then.

When asked about that prediction on RTÉ’s Today with Claire Byrne yesterday, the chair of the High-Level Task Force on Covid-19 Vaccination, Professor Brian MacCraith, said this figure was “a positive and confident assumption”.

“It could be right indeed but it’s based on assumptions around the growth of vaccine availability. I think we are expecting that at some stage during the summer we will hit very large numbers if all the vaccines get approved and all the schedules of arrival happen,” he said.

“We certainly would be looking at in some months perhaps up to a million vaccines arriving per month, which means that we will get to a large number.”

Speaking on the same programme, Anne O’Connor, the HSE’s Chief Operations Officer, said that 35,000 people will be vaccinated this week – 32,000 healthcare staff and 3,000 in care homes – with 40,000 people to be vaccinated next week.

The EU yesterday struck a deal to double its supply of BioNTech/Pfizer vaccine to a total of 600 million doses. MacCraith said Ireland would benefit from an additional 3.3 million doses as a result of the deal.

Also yesterday, the EU’s drug regulator said that a decision to authorise the use of the Oxford/AstraZeneca Covid-19 vaccine could be reached by the end of this month.

The EMA expects AstraZeneca to submit a conditional marketing application for its Covid-19 vaccine next week.

Minister for Health Stephen Donnelly said on Wednesday that Ireland has also ordered 875,000 doses of the Moderna vaccine and the logistics of this “are being finalised”.

More than 15 million doses of five different vaccines have been ordered for Ireland, but some of these have yet to be authorised and most supplies are not expected until later this year.

Longer term monitoring

  • How will they monitor for side effects after you’ve had the vaccine?

In the short-term, on the day you receive the vaccine, you’ll stay wherever it has been administered for 15 minutes afterwards. Trained healthcare professionals will be on hand to monitor for any adverse reactions.

The majority of adverse incidents with vaccinations are minor, such as redness or pain in the arm you got the jab, and occur within those first minutes after it is administered.

Longer-term monitoring will be a key part of the process as developers did not have the time in trial phases to collect data on either efficacy long term or potential adverse effects that occur months after the vaccine has been administered.

It is important to note again here that with all vaccines, most adverse reactions appear very soon after the vaccine has been administered and should therefore have shown up in the extensive trials developers carried out.

In December, Lorraine Nolan, CEO of the Health Products Regulatory Authority spoke to TheJournal.ie about the monitoring system.

“We always monitor, we do it for all medicines and vaccinations but particularly in a situation where there is a new vaccine and a pandemic and there are many potential vaccine candidates,” she explained.

“We have been planning and preparing for this. We have a reporting system that is used for all medicines but we will intensify communication on that, both for the public and healthcare professionals, to get them to report to us.

We will analyse that data that we get and pool it with all European countries and the data will be reviewed at a European level.
These are the most intensely scrutinised medicines there have ever been. And that access to European data is an incredible source of information for us, it’s a huge data pool.

“If there is any unexpected or rare event picked up in another European country we can immediately address it and take action in relation to our recommendations on vaccine use.”

She said the example of the two severe allergic reactions to the Pfizer vaccine in the UK was an example of how quickly this process can work.

In the first week of the UK rollout, two nurses suffered anaphylaxis, a serious – and usually immediate – allergic reaction. Both of these nurses had a significant history of allergic reactions to the extent that they carried adrenaline auto injectors with them.

“Anaphylaxis is a known side effect in vaccinations, with about less than a one in 70,000 chance of occurring,” Nolan said.

“What we can see with that UK example is that the system immediately went into action and the advice was changed. We can expect that to happen here, there would be that process of adjustment if a rare event was picked up either here or across the EU.”

Nolan said clinicians will be encouraged to “err on the side of caution” in terms of reporting.

“Everyone has a huge heightened sense of awareness around these vaccines,” she added.

There have not been any reports of severe adverse reactions to the vaccination in Ireland so far.

About the author:

Michelle Hennessy and Órla Ryan

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