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It's been 'another rollercoaster week' - so what does the Q2 plan for the vaccine rollout look like now?

Despite significant setbacks this week, health officials are confident they can keep the vaccination programme on track.
Apr 17th 2021, 12:05 AM 30,358 18

“ANOTHER ROLLERCOASTER OF a week…”

At the HSE’s usual Thursday media briefing, CEO Paul Reid came armed with ‘bump-in-the-road’ metaphors as he rushed to reassure people that the health service can manage what is the 25th change now to the vaccination programme.

On Monday the National Immunisation Advisory Committee (NIAC) recommended that the AstraZeneca vaccine only be used in those over the age of 60, following concerns about very rare side effects that cause unusual blood clotting events in 4-10 people for every one million doses administered.

On Tuesday, Johnson and Johnson announced its decision to postpone the rollout of its vaccine in Europe. This news came after two US agencies – the Food and Drugs Administration (FDA) and the Centres for Disease Control and Prevention (CDC) – recommended the vaccine be paused “out of an abundance of caution” after six cases of a rare type of blood clot were reported.

Wednesday brought a much-needed positive development as Pfizer agreed a deal with the European Commission to bring forward the delivery of 50 million doses of its vaccine to the second quarter of the year. This will see Ireland receive an additional 545,000 doses over April, May and June.

“There have been many twists along the road, there have been many bumps – some of them rougher than others – there have been many setbacks, there have been many body blows to us along the way,” Reid said on Thursday.

The health service chief has asked the public not to lose sight of the “big picture” aim of the vaccination programme – to reduce illness, hospitalisations and mortality and to protect the country’s most vulnerable people. He urged them not to focus entirely on numbers and targets and forecasts. 

But more than two weeks into the all-important second quarter of the year, as the rollout moves onto the 65-69 age cohort, the public focus is still very much on what these significant changes to the vaccination programme will mean for them.

AstraZeneca

The change in advice for the AstraZeneca vaccine means those who are in the high risk and very high risk categories will now receive either the Pfizer or Moderna vaccine – unless they have already received a first dose of AstraZeneca.

  • Those aged 60 and older should receive their second dose of AZ 12 weeks later as scheduled.
  • Those aged under 60 years with a very high risk or high-risk medical condition should receive their second dose 12 weeks later as scheduled.
  • Those aged under 60 years who do not have a very high risk or high-risk medical condition (mostly healthcare workers) should have the scheduled interval between doses extended to 16 weeks to allow further assessment of the benefits and risks as more evidence becomes available.

The AstraZeneca vaccine will now be used solely in those aged over 60 and will be the only vaccine offered to those aged 60-69. 

Anyone aged 65-69 who wishes to receive a vaccine can register using the HSE’s online portal or by calling 1850 24 1850. People who are deaf or hard of hearing can text HSE Live on 086 1800 661.

This cohort can only receive the AstraZeneca vaccine and can only get the jab at a vaccination centre

The HSE and GPs have urged people not to call GP surgeries about receiving a vaccine if they are in this cohort – all queries should go through the HSE and all registration should be through the online portal or the phone line. 

Health officials have acknowledged that some people in this cohort may have concerns about receiving the AstraZeneca vaccine following reports of rare but serious blood clotting events. However, this vaccine has been deemed suitable even for those who have a history of blood clots. 

These rare blood clotting events occur in 4-10 cases in every million AZ vaccine doses administered, in which one person may die. As of 4 April, 221 cases of these rare events were reported to the European centralised database. Around 34 million people had been vaccinated in the European Economic Area (EEA) and UK by this date. 

Evidence shows that these very rare side effects have been mostly seen in people under 60.

The HSE has said those who have a history of blood clots in the family, as well as those who have recently had a clot or who are on blood thinning treatments should still have the AstraZeneca vaccine when offered it. This advice also applies to those who have a condition or who are on treatment that makes them more likely to get a blood clot – they should still get the vaccine.

HSE Chief Clinical Officer Dr Colm Henry this week said balance of benefit is “heavily in favour” of them getting the vaccine as it prevents the most serious consequences of Covid.

“The clots that have been described here with the EMA are unusual venous clots, they’re different from the common clots people have,” he explained.

Dr Henry said the advice is for “anybody in this age group, particularly people with underlying conditions” is they have “everything to gain by getting vaccinated”.

He said only those who have had a very severe reaction to the first dose of the vaccine or a known allergy to a constituent part of the vaccine would be advised against taking it.

In all other circumstances, with all other medical histories, conditions and medications, people aged 60 and over are advised to take the AstraZeneca vaccine.

Officials have said if there is good take-up among the 60-69s, it is unlikely that Ireland will be left with a surplus of the vaccine.

Johnson & Johnson

Paul Reid confirmed this week that the first delivery of 14,000 vaccines from Johnson & Johnson did arrive in Ireland as scheduled, but are now in storage – or “in quarantine”, as Reid put it. 

Officials and government have said they expect – or rather hope – the one-dose vaccine will come back on stream over the course of the second quarter of the year.

However current modelling is based on the assumption that this particular vaccine may not be available for use over the quarter. 

“It’s a 605,000 delivery for us in the quarter, it is early in the quarter and I don’t know how long it’ll take for the EMA [European Medicines Agency] to come to that consideration,” Reid said. 

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Pfizer

Thanks to a new deal between Pfizer/BioNTech and the European Commission, Ireland will receive an additional 545,000 doses of the Pfizer vaccine over April, May and June.

Health officials have said this will help to keep the vaccination programme on track, despite changes relating to the AstraZeneca vaccine and the Johnson & Johnson pause. 

Consideration is being given to an extension to the gap between first and second doses of mRNA vaccines. Currently there is a four-week gap between the first and second dose of the Pfizer vaccine in Ireland, but internationally the gap has been extended – up to 12 weeks in some cases. 

The new schedule

The HSE has warned that any projections it makes now are subject to change, but officials have said the change in advice on the AstraZeneca vaccine and the pause on the Johnson and Johnson jab should not cause significant delays.

The vast majority of those aged over 70 will have received their first dose by the end of next week. The vaccination programme is also focusing now on 250,000 people aged 16 to 59 who are at very high risk. These vaccinations will be done in hospitals, GP surgeries and community vaccination centres. 

  • Around 70,000 have already received a vaccine;
  • GPs will commence their very high risk patients in late April (around 120,000 people);
  • 16/17-year-olds in this group will be completed in late April using Pfizer (3,000 people);
  • Vaccination centres and hospitals will recommence appointments next week (after the pause due to the change in advice on the AZ vaccine), with a target of completion in mid-May (50,000 people).

The rollout to the 65-69 cohort will be happening in parallel, but these vaccines will all be administered at a vaccination centre.

  • The HSE has estimated there are 420,000 people aged 60-69 who are yet to receive a vaccine.
  • Vaccination for the 65-69 cohort will begin next week and the HSE has said it will take three weeks to give first doses to this group;
  • Those aged 60-64 will be invited to register for a vaccine in late April. 

The HSE has also laid out its plans for Cohort 7, people aged 16 to 64 who are at high risk.

  • A schedule for GPs is to be finalised with a target of commencing with this group towards the end of April (295,000 people);
  • Vaccination centres and community vaccination teams will administer vaccines to those with mental health or intellectual disabilities (50,000 people);
  • The majority are to have received a first dose in early June.

It is still expected, despite all of this week’s changes, that four out of five people will receive their first dose by the end of June. 

 

 

 

 

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Michelle Hennessy

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