GPs advised not to administer AstraZeneca jab until committee reports back

General practitioners across Ireland have been advised not to administer the AstraZeneca vaccine to very high-risk patients until the National Immunisation Advisory Committee (Niac) reports back on its review of the jab early next week.

In an email sent to GPs on Friday, and seen by The Irish Times, the Irish Medical Organisation (IMO) advised GPs to hold off on AstraZeneca vaccinations until Niac releases its latest recommendation.

Niac met last week to consider the findings of the European Medicines Agency (EMA) on the AstraZeneca vaccine. They are due to meet again early next week, to review the findings further.

The IMO email wrote: “Niac have advised that AZ [AstraZeneca] programme should continue, however you will be aware that Niac are further considering the EMA recommendations and in such circumstances it is advised that you wait to organise clinics for very high-risk patients until further advices issue from Niac.”

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There are about 2,500 GPs in Ireland, and while not all are IMO members, they are sent the organisation’s guidance on the Covid-19 vaccination rollout.

Niac has been consulting with EU counterparts on whether to change the Irish guidance on use of the vaccine in light of a new EU finding of a possible link to unusual blood clotting.

Dr Denis McCauley, chair of the IMO’s GP committee, said on Saturday he had advised GPs not to use the AstraZeneca vaccine until after Niac releases its decision, which he expects should happen on Monday.

Dr McCauley told RTÉ radio he was hoping for a "very practical and straightforward recommendation" from Niac, which would reassure people rather than add to any confusion.

He later told The Irish Times it wasn’t clear yet whether there would be restrictions on certain age groups in Ireland so it was better to “wait and see”.

Niac could recommend AstraZeneca to everybody over 30 or to everybody over 60, he said.

Asked to comment on what a pause on the use of Astrazeneca would mean for overall vaccine rollout targets, a spokesman for the HSE’s Covid-19 vaccine high-level taskforce said cumulative deliveries for the AstraZeneca jab “remain unchanged”.

“Their delivery schedule for the month has been profiled, however, and the next delivery will be 14,400, which is half what was originally scheduled (28,800),” he said. “This delivery change, which comes after the record 112,000 AstraZeneca delivery last week, has already been built into our vaccination plans for the coming week, so no further changes will be required. The delivery after next will be bigger than originally scheduled.”

The AstraZeneca vaccine comprises 20 per cent of the country’s national vaccine portfolio for the second quarter (April-June) of 2021.

In its advice sent to GP members on Friday regarding the vaccination programme for over 70s and “very high-risk” and “high-risk” patients, the IMO noted there had been a shortfall in delivery supplies for the week starting April 12th for the 70-74 cohort receiving their first dose.

This will be made up in deliveries for the week starting April 26th, said the guidelines.

GPs scheduled for deliveries the week of April 19th will “receive the full allocation to meet the numbers of your 70-74 1st dose”, it wrote.

The IMO said any patients who turn 70 during the month of April should be included in the cohort currently being vaccinated.

It also underlined that general practices needed to identify and vaccinate any patients considered “high risk” and aged 18-65 who suffer from diabetes, obesity, chronic respiratory disease, chronic heart and vascular disease and cancer, chronic kidney, liver and neurological disease.

Clinical judgement should be used when deciding which immunocompromised patients should be included in this high-risk category, said the IMO.

On the Johnson and Johnson vaccine, the IMO advised GPs that small supplies of the jab were due to arrive in Ireland in April and May.

"As the Johnson and Johnson vaccine is a one-dose vaccine, these initial supplies will in the main be used for homeless patients, members of the Travelling community, members of the Roma community and those with substance addiction issues for whom it may be difficult to ensure a second dose," said the organization.

“These groups will be vaccinated by community care teams. From June it may be possible that some Johnson and Johnson vaccine would be available to General Practice.”