Covid-19: Vaccination of vulnerable under-60s to resume

Government open to considering offering AstraZeneca vaccine to people under 60 who request it

Last week Ireland reached the milestone of one million vaccines administered. Liz Canavan, Assistant Secretary, Department of the Taoiseach briefs the media on the latest measures introduced in response to Covid-19. Video: RTÉ

 

The Government is open to considering offering the AstraZeneca vaccine to people under 60 who specifically request it but a final decision will not be taken until further discussions are held with public specialists and the vaccine task force.

During Cabinet discussions on Wednesday the possibility of offering the vaccine to those under 60 who choose to take it was he subject of lengthy discussions – under the current plan some 870,000 AstraZeneca Vaccines are scheduled to arrive in Ireland this quarter.

The National Immunisation Advisory Committee (Niac) made a recommendation on Monday the product should not be given to people under 60 years of age after links emerged between the vaccine and very rare serious blood clotting occurrences.

At a media briefing following the meeting, the Government spokesperson said that no definite decision had emerged from the discussions but urgent work was ongoing to revise the national vaccination plan in the light of the three major developments this week: Niac’s recommendation on AstraZeneca, a pause in production of the Johnson & Johnson vaccine over similar concerns about blood clotting events; as well as the announcement that Pfizer/BioNTech will deliver an additional 50 million does of its vaccine to the EU, which will result in an estimated 550,000 doses for Ireland.

The spokesperson could not say exactly the revised plan would be ready. “The recalibration of the plan will be sooner rather than later.Work is ongoing. It is in everybody’s interest that it happens sooner rather than later,” he said.

Online portal

The Cabinet did give its approval to a new online vaccine portal for people between the ages of 65 and 69. The portal will go live on Thursday and the Government has said those who register should receive an appointment within a fortnight. There is also a phone line for people who do not have access to the internet. It will be phased in with people aged 69 given priority for the first day of operation.

There were also a discussions on other aspects of the vaccination programme, including lengthening the time period between the first shot and the second shot, and also on allowing the second shot to be a different product than the first.

The spokesman said there was no decisions reached on those issues but the news about additional supplies of Pfizer Zeneca/BioNTech meant that it was still on target to have 80 per cent of the population vaccinated by the end of June.

“The Pfizer/BioNTech vaccine has been a very reliable workhorse (for the EU). It has been very reliable on supply and very effective,” said the spokesman.

The spokesman admitted that until the news from EU Commission Ursula von der Leyen yesterday, the situation had looked challenging in terms of reaching its own targets.

The spokesman said that the single-dose Johnson & Johnson vaccine was to be used to target vulnerable people for whom it was harder to arrange two doses. They included homeless people and travellers.

Uncertainty

Earlier, the Government confirmed that the vaccination of vulnerable groups aged under 60 is to resume using an alternative to the AstraZeneca shot.

Thousands of appointments were cancelled this week as the HSE and Government assessed the impact of new advice from the Niac on the vaccine.

It comes as the European Medicines Agency (EMA) said it expects to issue a recommendation on the single-shot Johnson & Johnson vaccine next week.

In a statement issued today, the Government said that those aged 59 and younger in the very high risk and high-risk categories “will receive an alternative vaccine to the AstraZeneca vaccine. The roll out to these groups will continue now on this basis”.

It also states that the Government will make efforts to ensure the success of the vaccine roll out “so that we can all look forward to the restrictions being lifted over the next while as we look forward to the summer”.

Uncertainty remains, however, over the precise role to be played by the single-shot Johnson & Johnson vaccine, which had been due to arrive into Ireland today. However, the company delayed its deliveries to Europe after regulators in the United States announced they were investigating reports of clotting events potentially linked to the vaccine.

In a statement issued on Wednesday, the EMA said its safety committee was reviewing the issue as well “and will decide whether regulatory action is necessary. The agency is working closely with the US FDA and other international regulators”.

It said it was expediting this evaluation and “currently expects to issue a recommendation next week”.

In Dublin, the Government statement said the benefits of the vaccination programme are already being seen with significant decreases in cases in healthcare workers and with people living in nursing homes.

It says upcoming milestones include the substantial completion of second doses for residents and staff of long term residential care facilities, continued administration of the second dose for frontline healthcare workers, and completion of the first dose for the over 70s and those over 70 who are housebound.

It said the immediate focus of the vaccine plan is on those at higher risk and those aged 60 and over and that rollout is continuing. The remainder of the population in order of age will follow.

Under 60s cohort

On Wednesday, it emerged the HSE had written to Ireland’s vaccine watchdog asking them to clarify if AstraZeneca’s Covid-19 vaccine could in fact be given to under 60s in some circumstances.

While the use of the vaccine is currently not recommended for this cohort by Niac, one of the conclusions in the guidance from that body to the Department of Health on the vaccine has drawn considerable political attention.

One of the final paragraphs concludes that the shot “can be used in adults aged under 60 years where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits.”

It is understood that the matter was discussed at cabinet today. One senior source said the paragraph could be seen as a “green light” or a “pass” for giving the vaccine to younger people in certain circumstances, if they consented despite the slightly higher risk of clotting.

Sources said the HSE had written to Niac seeking clarity as part of a process to check options before finalising the reorganised vaccination plan, which is due either tonight or tomorrow. A source cautioned that it was a preliminary step to help establish what is meant by the paragraph in the letter.

This morning, the Minister for Health said the possibility of spacing out doses of the Pfizer vaccine beyond four weeks was being looked at.

Stephen Donnelly said that everything that can be done to keep the vaccine programmes on track is being done and that officials are working “flat out” to reprofile the vaccination programme.

He said those in high and very high risk categories are now being rescheduled for mRNA vaccines.

The Government is scrambling to reorganise its response to the Covid-19 pandemic after both the vaccination and quarantine programmes suffered major setbacks on Tuesday.

Following advice from its vaccination experts, the Government accepted restrictions on the use of the AstraZeneca vaccine, only to be told later that the Johnson & Johnson vaccine had encountered similar difficulties in the US and its European rollout was being paused.

On Wednesday Minster for Health Stephen Donnelly said one possibility was spacing out of doses of the Pfizer vaccine beyond four weeks.

Mr Donnelly said everything that can be done to keep the vaccine programmes on track was being done and that officials were working to recalibrate the vaccination programme.

The Government will do “all within our power to ensure vaccinations are distributed as soon as possible”, he told RTÉ’s Morning Ireland.

Everyone was aware of the importance of the rollout and the importance that it continue as efficiently as possible, he said.

Sinn Féin’s health spokesperson David Cullinane told Newstalk Breakfast that “the last people” who should be commenting on the Niac decision to pause use of the AstraZeneca and Johnson & Johnson vaccinations were politicians.

While the rescheduling of vaccines was going to be “a big challenge”, it was best to listen to the experts, he said.

Niac had a panel of experts who had done the research and reached a conclusion, he added. Mr Cullinane said it was “the right thing” to put safety first and it was now up to the HSE to reschedule the vaccine rollout to ensure there were no delays.

‘Silver lining’

Dr Mary Favier, Covid lead for the Irish College of General Practitioners (ICGP) and a member of Nphet, said that the “rejigging” of the vaccine rollout was going to be “a significant challenge”.

Dr Favier told Newstalk Breakfast “our hearts sank yesterday” when GPs heard about restrictions of the Johnson & Johnson vaccine, but it was not unexpected as it was so similar to the AstraZeneca vaccine.

Dr Favier told of how many GPs had been receiving calls from patients who wanted to take the AstraZeneca vaccine and were prepared “to sign on the line.”

The cautious approach adopted by Niac had served the country well to date, she said.

In the meantime GPs would focus on vaccinating high risk groups and there was a silver lining that those aged 60 to 69 could now be vaccinated sooner with AstraZeneca, she added.

The latest figures from the HSE show there were 189 people in hospital with Covid-19 on Tuesday night, of which 47 were in intensive care (ICU).

Twenty-two hospitals have fewer than ten cases of the virus. Beaumont Hospital in Dublin has the highest number of Covid-19 cases in the country at 24, followed by the Mater Hospital with 20 and St James’s Hospital also with 20.

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