Fairness, safety and effectiveness are the foundation stones of the Government’s Covid-19 vaccine rollout, the biggest project of its type undertaken in the history of the State.
But is that principle of fairness being overlooked in the practical implementation of the plan, to an extent that it is starting to undermine the overall rollout?
The breaches of the principle, which have seen an unknown number of people vaccinated ahead of their allocated places in the queue, seem all the worse given the sluggish supply of vaccines to Ireland, which is lengthening the delays for the vast majority of us who remain unvaccinated.
A series of specific incidents has attracted widespread attention: the vaccination of staff family members at the Coombe hospital; the Beacon Hospital vaccinating staff of a nearby private school; and University Hospital Tralee giving the jab to local builders.
However, a much bigger overall problem seems to be the lack of IT and other controls to ensure that those being vaccinated at present are in the appropriate prioritisation category. The HSE says 220,000 “front-line” healthcare workers have been vaccinated, yet only 80,000 of these work for the State health provider.
Even allowing for the GPs and pharmacists and their support staff, and all the other private-sector, voluntary, section 38 and section 39 health staff with patient-facing roles, it is very difficult to see how these numbers add up. The HSE was asked twice for a breakdown of the numbers vaccinated in these categories for this article, but did not provide one.
Due to the high numbers involved, it has taken three months to fully vaccinate this single cohort.
Some 177,000 people have been vaccinated in long-term residential care facilities. There are 32,000 residents in nursing homes, and about 20,000-30,000 staff. Perhaps the balance of vaccinations can be accounted for by staff and clients in other kinds of congregated settings. But who knows? Again, no breakdown of the numbers is forthcoming.
Meanwhile, HSE office staff in Dublin and Offaly have been vaccinated despite not having contact with patients, it has been reported. Credible reports suggest this practice was not confined to these locations. Many of these staff have been working from home during the pandemic.
Merchants Quay Ireland and St Michael’s House, both funded by the HSE, say their support staff have been vaccinated, along with workers dealing directly with clients.
While this is happening, large numbers of vulnerable people wait and wait for their vaccine. I have written recently about a 105-year-old great-grandmother in Co Galway, and a 97-year-old bed-bound grandmother in Dublin, who have no idea when they are going to be immunised.
The question of what exactly constitutes a "front-line" health worker was addressed by HSE chief clinical officer Dr Colm Henry in a document distributed across the health service in January.
Sequencing should not be based on where people work, who they work for or the category of worker or grade, Dr Henry advised. Staff in the community have as much right to be immunised as those in hospitals, and private-sector workers enjoy the same priority as those in the State health system.
Sequencing, he said, should be based on “the best practical estimate of exposure risk”.
Dr Henry effectively allowed some wriggle room by saying the vaccination programme “has to be practical to administer” and that no doses should be wasted.
He also recommended centres established stand-by lists of other healthcare workers available at short notice should front-line staff not be available.
There are legitimate reasons why some people might be vaccinated ahead of their place in the queue. As Dr Henry advised, it is important no doses are wasted, and it could prove difficult to find people in the right priority category at short notice. An office-based worker might need to occasionally visit patient areas, and so would need to be protected against the virus.
Some would sympathise with a manager who decides to put forward all of the team for immunisation rather than make a potentially divisive call for some staff not to be vaccinated.
Out of sequence
None of these reasons adequately explain the many credible reports, mostly from people inside the system, I have received of people being vaccinated out of sequence.
In the early stages of the vaccine rollout, hospitals were given an allocation of doses and effectively told to “get on with it”. The more doses administered, the better the figures looked. A lack of proper computer systems made it difficult to track the details of those receiving a vaccine.
Even now, the portal used for people registering for vaccination is unable to check their credentials, and it is only when they arrive at the vaccination centre that their eligibility can be assessed.
The HSE says the sequencing of cohorts is managed locally, based on the information provided by the person.
“We will do everything in our power to ensure that no vaccine is inappropriately allocated to people attempting to undermine the vaccination programme by seeking a vaccine out of sequence,” a spokeswoman said.
The case for some independent oversight of vaccine allocation is growing. Yet the irony is that none of this would matter if the rollout of the vaccine was proceeding faster and there was enough supply to go around the general population.