When will the first vaccines be given?
Tuesday, according to the chief executive of the Health Service Executive (HSE) Paul Reid.
And where will this be?
It is likely the first jab will be given in one of four hospital sites that have been selected as initial sites for immunisation next week: St James’s and Beaumont hospitals in Dublin, Cork University Hospital and University Hospital Galway.
How many doses do we have, and how many will we have?
Currently there are just less than 10,000 doses of the two-step Pfizer-BioNtech vaccine in the country, and about 30,000 more are due this week. This will be followed by 40,000 per week throughout January and early February, which will largely be devoted to the nursing homes’ programme once it gets into gear.
The indications are that Moderna’s vaccine, which is similarly complex to administer, may be approved as early as January 6th, so there could be extra supplies coming into the State shortly after that happens. All told it seems there will be upwards of 300,000 delivered to the State before the end of February, more than enough to immunise the entire nursing home sector.
Who is first in line?
Under the Government’s prioritisation plan over-65s living in long-term residential care facilities such as nursing homes are first in line, followed by healthcare workers. However, the rollout in nursing homes will not begin until the week commencing January 4th, initially at a smaller scale, before substantially getting into gear the following week. A draft timeline drawn up by the HSE starts from January 11th.
So if not nursing homes, who will get it this week?
It is likely that healthcare workers in the four hospitals, as well as older and more vulnerable patients, and those living in long-term residential care units on these campuses will be inoculated first.
In reality, sources involved in the rollout say that the initial push, while focused on nursing homes, will also immunise healthcare workers where it is convenient and pragmatic to do so – for example, if there are leftover doses and a healthcare setting is nearby.
Why aren’t immunisation teams going straight to nursing homes?
According to sources, rolling out the programme to nursing homes is particularly complicated for several reasons. First of all, the network of care homes is very spread out, with some 580 around the country and more than 70,000 residents and staff to be immunised.
The issue of consent is also challenging, with protocols in place for establishing consent from those who are impaired in terms of cognitive function or their ability to communicate. There is a huge logistical effort under way from nursing home operators and the HSE, with 55 individual pieces of information needed for each person wishing to be vaccinated. This must be completed several days before the vaccination team is due to arrive.
Some nursing homes will be quicker to organise this than others, while the HSE said its schedule must also account for “unforeseen events” and Covid outbreaks. The intention is to finalise the schedule for delivery this Thursday, and a full six-week programme – including two rounds of vaccinations – will be complete by February 28th, the HSE said.
Another reason nursing homes have been put back is due to concerns raised by the National Immunisiation Advisory Committee (NIAC) over reports of anaphylaxis among a small number of people who received the jab in the US and UK. Prof Karina Butler told The Irish Times that due to this, the committee had requested that the first tranche of vaccines be given "in facilities where there was medical support available, and in the intervening time vaccinators would gain confidence and experience handling it if there were reactions".
Why are other countries moving more quickly?
Several EU countries subject to the same regulatory timeline as Ireland began their vaccine rollout on Sunday, some with high-profile photoshoots involving senior politicians.
The HSE said that in addition to planning for the issues outlined above in nursing homes, several steps still had to be taken over the Christmas period before the vaccine was administered. This included advice being published by the NIAC on the use of the vaccine, which took place on December 23rd, and the completion of public information materials, which were published on December 24th.
These will now be printed and distributed to support the informed consent programme.
The HSE's National Immunisation Office also had to finalise training and education materials for vaccinators based on the NIAC advice, with online seminars planned for this week on administering the Pfizer-BioNtech vaccine.
An IT system procured to support the rollout will be ready from day one, sources said.
In short, the State’s argument is that the logistical programme underpinning the rollout is far from simple – but it doesn’t end there.
It is understood that there are concerns about managing the risk of any potential litigation arising from the vaccine rollout programme, due to recent cases taken in relation to the swine flu vaccine programme. Sources indicated that this is one of the reasons that obtaining clear consent from those receiving the vaccine – and designing a programme that secures that consent before the vaccine is rolled out – is so important.
Senior medics, including Dr Tony Holohan, were in the spotlight arising from recent actions, one source said, arguing that there was a problematic culture around medical negligence.
Sources involved in the vaccine rollout say that the difference is effectively cosmetic, and point to the fact that while some European countries have moved quickly, others have not – the Netherlands, for example, will not start its programme until January 8th.
Minister for Health Stephen Donnelly told The Irish Times that "there is no question of Ireland being left behind. We have expert advice as to the steps we need to take in Ireland to make sure the vaccination programme is safe and effective; we're following that very closely."
If it is the case that the differences are skin deep, upset over who had needles in arms first will be short-lived. However, if Ireland’s vaccination programme does seem substantially more sluggish than others it will become a significant political problem for the Government.
Covid outbreaks in nursing homes that are yet to be vaccinated will also be an emotive issue, and the State will face ongoing questions over why issues such as consent were not thrashed out months ago.
How many people will be immunised this week?
Sources involved in planning the rollout said between 2,000 and 4,000 people may receive their first shot across the four sites this week.
What does the vaccine promotion leaflet say about potential risks or side effects?
The HSE's vaccination leaflet for the Pfizer vaccine addresses questions about the safety of the vaccine and the medical trials used in its development, as well as detailing side effects and issues relating to allergies, pregnancy, breastfeeding. It also states that consent must be given to receive the vaccine, and states that the leaflet and a second patient--information leaflet must be read before the vaccine is administered.
Will the Government make it mandatory for certain groups?
Any move to do this is fraught with constitutional difficulties, and the Government has not indicated any intention or desire to do so. That is not to say it won’t become a de facto requirement for accessing services such as air travel or hospitality.