Covid-19: All nursing home residents, staff could be vaccinated by February, taskforce head says

All nursing home residents and staff could be vaccinated by the mid to late Febuary, according to provisional modelling, the chair of the State’s Covid-19 vaccine taskforce has said.

Prof Brian MacCraith told the Oireachtas health committee that while this was not a goal or target modelling, had been undertaken of different rates of vaccine arrival, staff available to administer the vaccines, and the number of people in residential care settings in the State - a category which includes nursing homes.

He said there are almost 600 such facilities in the country, with some 78,000 residents and staff living within them.

“If you look at those numbers, and you look at that initial cohort of vaccinators, you can start to think that that cohort might complete their vaccinations by mid-to-late February, for example,” he told Fine Gael TD Colm Burke, emphasising that this in turn would be dependent on the numbers of vaccines arriving.

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Prof MacCraith also confirmed that the current expectation is that several “shippers” of the Pfizer Covid-19 vaccine would be arriving in the State before the end of the year, each containing some 5,000 doses. While he said there wasn’t “absolute confirmation” on the numbers, when pushed by Sinn Féin health spokesman David Cullinane, he said that before the end of the calendar year it is expected “small multiples” of that number would be delivered.

“If you take that 4,875 (doses) per shipper, and we would expect a small number of shippers. It may be one, it may be two. We don’t know exactly that yet, it hasn’t been confirmed”.

He said quarterly allocations there would be “hundreds of thousands” of doses allocated. Prof MacCraith told the committee that they did not have firm information beyond that there is likely to be a small supply of vaccines delivered before the end of December.

He said the taskforce has seen “indicative schedules” but they have been “shifting” as the situation develops. “The only strong indication we have is a small supply of initial quantity of vaccines is likely to be delivered before the end of December to us”.

Premature complacency

Despite positive news on the vaccine, Dr Ronan Glynn, the deputy chief medical officer, said there is a “risk of premature complacency” setting in as people will react to recent developments and “see hope and light on the horizon”.

He warned that the State is "looking at a number of months before we see a vaccine having a significant effect on how we manage this disease in Ireland. "

Dr Glynn said the situaition in Northern Ireland is of “real concern” and that the National Public Health Emergency Team (Nphet) would be discussing it at its meeting on Thursday. In the Republic, he said the situation is “very fragile, we’ve seen numbers tick up in recent days, and the indications are we have bottomed out… and we’re beginning to see a deterioration again”. The deputy CMO said there is no plan in place for mandatory vaccination of anyone in the state, and that the key to vaccine uptake is “information, trust, confidence and engagement”.

Prof MacCraith also warned against “conflation” between a vaccine certificate and an immunisation passport, which he said is something “very different”. What is currently being examined, he said, is a “simple record of vaccination”. The committee heard that more information was needed about, among other things, how the vaccines interrupt transmission before an immunisation passport or similar approach could be mapped out.

The committee heard that there are up to 15 potential sites for mass vaccination centres being considered around the country, including the National Exhibition Centre and Citywest in Dublin, and third level institutions such as Waterford Institute of Technology, NUI Galway and the University of Limerick. Dr Henry told the committee, however, that the initial phase of vaccination would “lean into” existing teams of vaccinators such as those involved in the school vaccination programme.

Pregnancy

Prof Karina Butler, the chair of the Naitonal Immunisation Advisory Committee (NIAC) said that there would be advice produced on immunisation for pregnant and breastfeeding mothers, as well as women considering becoming pregnant. She said it would be produced once conditional marketing approval for vaccines was given by the European Medicines Agency, but told Social Democrats co-leader Roisin Shortall that it may not be definitive when it is produced, as there is a lack of data on the impact on pregnancy. It is generally seen as unethical to include pregnant women in vaccine trials.

Ms Shortall also raised issues around obtaining informed consent from those who are incapacitated, which would include some in nursing homes and other long term residential facilities. Dr Henry told her that for those who lack capacity, family networks or those involved in a person’s care would be involved in obtaining informed consent, and that there would be efforts to help those who are not computer literate or are of limited capacity through the self-registration system which will be used to sign up to be vaccinated.

The Committee also heard there were “solid alliances” between the health service, Nphet and GP groups which had been developed over the course of the pandemic. With GP groups recently raising concerns over clarity on their role in vaccine rollout plans, Dr Colm Henry told the committee that a group has been established to furnish GPs with real-time information, and that the GPs will be particularly important as the phased rollout scales up.

The challenge of rolling out a Covid-19 vaccination programme is “unparalleled” either in Ireland or around the world, due to the “scale, complexity and desire for speed” involved, the Committee was earlier told.

Successful rollout

In his opening statement, the chair of the Covid-19 vaccination taskforce, Prof Brian MacCraith, told Oireachtas health committee that the team set up to plan the rollout will be kept on and will play an “ongoing role” in overseeing and monitoring the implementation of the vaccination programme.

“Successful roll out of the vaccination programme is dependent upon careful and precise coordination,” he said, between state agencies, the Health Service Executive (HSE) and a wide range of advisory, regulatory and other actors spanning both private and public sector bodies.

The taskforce will ensure that the rollout is "coordinated within a single integrated work programme", Prof MacCraith said in his opening statement, "and it will play an ongoing role in the oversight and monitoring of programme implementation" with input from the wide cast of bodies represented on it – from government Departments, to the HSE and the Defence Forces.

He said that due to the range of actors involved and the “level of responsiveness that will be required” as the programme progresses “there will be a need to augment and support existing arrangements”.

He outlined the complex arrangements, which govern planning for the rollout, with different roles being played by the Department of Health, the HSE, the National Immunisation Advisory Committee (NIAC) and units of the HSE such as the National Immunisation Office and the Health Protection Surveillance Centre. The Health Products Regulatory Authority and the National Public Health Emergency Team also are involved, the committee was told

The challenge of devising and implementing a vaccination programme “of this scale, complexity and desire for speed is unparalleled here and around the world,” Prof MacCraith said.

The taskforce has been structured into seven different workstreams, each with a senior responsible officer, who combine with him and a programme director to form a working group, which ultimately reports to the Government. Activity is “well advanced” across each of the workstreams.

The taskforce, which is set to meet again on Wednesday afternoon, has drawn up a strategy document and an implementation plan, which will change over time “as required to serve the overall goals of the programme”.

Prof Karina Butler, chair of the NIAC, told the committee a redress scheme for those who have adverse reactions to the vaccines would be developed.

“A further challenge is to finalise the development of a national injury redress programme to provide support and care in the event that any vaccine recipient develops a serious vaccine reaction as recommended by the The World Health Organisation,” she said.

Prof Butler added that the speed at which vaccines had been developed was “inconceivable” but “has not been rushed or reckless”.

She said ongoing monitoring of the vaccine is needed, and that the efficacy recorded in trials of the vaccines may drop a little in the “real world” roll out.

Prof Butler said that some side effects, including short term reactions, can be anticipated, but that reports from regulatory agencies overseas “raised no significant safety concerns”.