Age the ‘defining’ factor in Covid-19 risk, not profession

New vaccine rollout plan not a reflection on ‘how valued’ certain workers are, says Minister

The change in how Covid-19 vaccines are administered is “not a measure of how valued or how important” certain workers are, but is designed to cut rapidly the disease risk and allow reopening at a faster pace, according to Minister for Health Stephen Donnelly.

The Government has agreed to overhaul the national vaccination programme to an age-based system. This will happen once those aged 70 years and older, the vulnerable and people with underlying conditions are immunised.

The decision, which follows a recommendation by the National Immunisation Advisory Committee (Niac), has sparked concern among some groups including teachers and gardaí.

Niac chairwoman Karina Butler said age is the defining risk factor from coronavirus. People aged 60-65 years are 70 times more at risk than those aged 30 to 35 years, she said. The risk of hospitalisation, intensive care unit admission, and death, rises as you get older, she said.


The only occupation that comes out with more severe outcomes is healthcare work, said Prof Butler. She added that the aim is to protect everyone but there has to be some level of prioritisation.

The rates of serious illness can be lowered as vaccination goes through the age cohorts, she said. And she added that there are other mitigation measures for front-facing workers, such as face masks.

Prof Butler noted there may be complexities in identifying occupations (within the vaccination programme) but said this did not influence the Niac decision.

Evidence on the impact of the virus on pregnant women is being collated, she said.

Virologist Cillian De Gascun, director of University College Dublin’s National Virus Reference Laboratory and a member of the Niac, said the risk of hospitalisation, admission to intensive care and death is behind the decision to move to the age-based vaccination plan.

“It all increases significantly with age. No other factor really comes close,” said Dr De Gascun, chairman of the National Public Health Emergency Team’s Covid-19 expert advisory group. “So if the aim of the programme is to reduce morbidity and mortality, which ours is, then stratifying by age for the general population makes most sense.”

At a technical briefing on vaccinations on Wednesday, Mr Donnelly said he was willing to meet with Minister for Justice Helen McEntee and Minister for Education Norma Foley – as well as representative bodies – to discuss concerns.

Explaining the system, Mr Donnelly said that “by reducing the risk of Covid as quickly as possible it means we can open the country back up as quickly as possible”.

He said the change will “make us more efficient, more transparent and more effective in protecting the most vulnerable as quickly as possible. The allocation of Covid-19 vaccines is not a measure of how valued or how important people [engaged in] those roles are to our society or community. We know now that outside of specific clinical conditions, the main risk factor for poor outcomes from Covid-19 is age.

“It is a reality that someone in their 50s is at a significantly greater risk than someone in their 40s. Our options for opening up society depend on protecting those at highest risk first. This decision will maximise the benefit to everyone by increasing other options to return to more normal lives and a more open society.”

Parallel vaccinations

In the vaccine roll-out plan, category nine refers to “people 16-64 living or working in crowded settings” and this group will be vaccinated in parallel with the new age-based process.

Prof Butler said groups to be included in those “working in crowded settings” included members of the Traveller community and Roma community. There had been speculation that this could include teachers but this is not the case, although other groups may be added.

“I am confident that once people understand why decisions are taken, actually they will probably find no disagreement really,” said Prof Butler.

Mr Donnelly said that “as vaccine supplies increased significantly, some of these groups could be vaccinated in parallel. This will be a feature of the programme as more and more vaccines become available from April onwards.”

The Minister also said that in the coming weeks the department would tell the various specific age groups when they could expect to be vaccinated, saying that work is ongoing on this. Vaccinations will open for the various age-specific groups from May onwards, he said.

Mr Donnelly also said he supported the immediate reopening of shops selling children’s shoes.

Asked when pharmacists will be involved in the roll-out campaign, Health Service Executive chief clinical officer Colm Henry replied that they will be involved when mass vaccination centres open and the system switches to an age-based cohort. He said the HSE is not excluding pharmacists before then.

Earlier, Minister for Finance Paschal Donohoe defended the Government's decision to change the vaccination programme following sharp criticism from teachers and Garda representative unions.

Mr Donohoe told RTÉ's Morning Ireland on Wednesday that the scientific advice is that an age-based system would be quicker, with four-fifths of the country expected to be inoculated by the end of June under the revised programme.

‘Sucker punch’

The Garda Representative Association (GRA) described the decision as "a sucker punch" to its members. And the Teachers' Union of Ireland (TUI) said the move is "extraordinarily disrespectful" to teachers.

GRA president Frank Thornton said the decision "downgraded" work of gardaí and disregarded risks they take while policing during the pandemic.

Mr Thornton told RTÉ's Morning Ireland that when the GRA met Ms McEntee on March 18th she had agreed that An Garda Síochána should be vaccinated when the vulnerable cohort was completed.

TUI president Martin Marjoram told Newstalk Breakfast it is seeking engagement with Government on the matter. The union said this should have taken place before the public announcement.

General secretary of the Association of Garda Sergeants and Inspectors Antoinette Cunningham told the same programme that the change to an age-based system was "a poor decision". Gardaí, she said, are needed to police the pandemic and frequently have to operate in high-risk situations such as protests and parties.

She said “this disease is about transmission” and gardaí are exposed frequently to the virus in unique situations.

But Mr Donohoe said the Government had been advised that vaccinating on the basis of profession would slow down the programme and posed a greater challenge to public health.

The Minister said the advice is “crystal clear” and that risk increases with age. Mr Donohoe said the country is indebted to workers such as gardaí and teachers and that a step-by-step phased reopening would help get the country to a better place.

Expert advice

Tánaiste Leo Varadkar said the decision to change to an age-based system is based on the advice of health experts

“What they’re saying is the 15 cohorts were too many, trying to stick to those might actually slow it down,” he told RTÉ’s PrimeTime programme on Tuesday night. “So it’s better to have nine and of those nine, it’s really three big groups.”

“We are going with science and we are going with the medicine on this,” he said. “If you look at this from a scientific point of view . . . say you have a 35-year-old garda or a 35-year-old teacher, are they at more risk or less risk than a 60-year-old factory worker or a 60-year-old retail worker? It’s actually the 60 year old that’s at more risk.”

Meanwhile, data was given at the technical briefing around the level of risk associated with different ages groups.

The data, derived from the Health Protection Surveillance Centre, first detailed the risk of hospitalisation by age group for groups up to 64 years of age.

Those aged 60-64 had a seven times higher risk than those aged 0-19. Those aged 55-59 were at a five times higher risk than those aged 0-19.

In terms of intensive care admissions, the data found that those aged 60-64 were at a 40 times higher risk than those aged 0-19. This fell to 20 times higher for those aged 55-59.

In relation to deaths, those aged 60-64 were at 70 times the risk of their aged 0-19.

This fell to 30 times higher for those aged 55-59.