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Why is Niac bearing the brunt of criticism over vaccine boosters?

Pile-on over alleged tardiness is occurring without proper consideration of the facts

In the growing clamour for Covid-19 booster shots to be given to all, the National Immunisation Advisory Committee (Niac) is fast becoming the scapegoat for perceived delays.

In recent weeks, Government Ministers have repeatedly complained in off-the-record briefings about Niac’s alleged tardiness in making decisions on booster rollout. Other commentators have joined in the criticism, including academic scientists who have no direct involvement with patients.

This pile-on is occurring in the absence of proper consideration of the facts. This is November 2021, when over 90 per cent of the population is immunised, not December 2020, when no one had access to the protection offered by a vaccine against the virus. The four vaccines approved over the past year still only have conditional authorisation in Ireland and the rest of the EU. Data on the safety of booster shots remains scant.

Hospital Report

It also ignores the situation on the ground. Boosters are already being provided for the most vulnerable group, including anyone aged 60 and over, and the immuno-compromised. So before last week’s decision to add healthcare workers to the list for boosters, older health staff were already included.

For good reasons in this pandemic, Ireland has always followed the lead of the European Medicines Agency (EMA). It has tentatively given the green light for booster doses of the Pfizer vaccine to adults "at least six months after the second dose".

So that means anyone vaccinated after the middle of this year should not get a booster until the New Year.

Waning immunity

There has rightly been much coverage about waning vaccine immunity but this is mainly in the context of reduced protection against infection. Yet the main job of any vaccine is to stop a healthy person falling seriously ill, and the Covid-19 vaccines still do an excellent job in this respect.

Of the 507 patients with Covid-19 admitted to intensive care since April, just three were both vaccinated and had no underlying condition.

Niac is an advisory group of experts, many working on the frontline of health, not policymakers. Its members include representatives of the Department of Health and the HSE, and it is the department, and the chief medical officer, which decides its work agenda. There was some irony to the criticism of the length of time it took to approve boosters for healthcare workers, given that most of its members are healthcare workers. Clearly, they didn't feel they were at personal risk – at least until recently.

If something goes wrong in our vaccination programme, it is the members of Niac – not online commentators – who will be called to account. You don’t have to look far to see what can happen; the Irish courts are currently making €1 million awards to a succession of claimants who allege their narcolepsy is linked to a swine flu jab they received in 2009.

Critics have pointed to other countries that have been quicker to approve wider use of boosters, such as the UK and the US. But they have vaccinated fewer people than Ireland, so have a greater need for the compensatory effect of boosters.

Inflammation

By and large, initial safety concerns around the vaccines have abated. The EMA is still looking at the data on reports of heart inflammation among people vaccinated with mRNA vaccines. Several Scandinavian countries have stopped administering Moderna vaccines to young people over concerns around these cardiovascular side-effects. But in the context of the administration of billions of doses, these are exceedingly rare.

Politicians like boosters for all because they make it easier to get the pandemic under control. Does the Government see them as a quicker fix for the ills of our health service than the root-and-branch reform that was promised?

With a few exceptions, the Irish medical establishment has remained remarkably quiet on the ethics of using spare vaccine shots as boosters in Irish arms rather than initial doses in the arms of those in the developing world.

Rich countries have given out more booster shots in the last three months than poor countries have given out total doses in the entire year, yet all we have heard in Ireland are expressions of concerns and a small donation of unwanted AstraZeneca vaccines to Uganda.

Ironically, the faster we hand out boosters, the harder it will be to measure the effectiveness of the initial vaccines, a point made recently by AstraZeneca.

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