Restrictions to curtail the spread of Covid-19 cannot be ruled out in future, the Chief Medical Officer will tell the Oireachtas health committee tomorrow.

In his opening statement, Dr Tony Holohan will warn that while vaccines have fundamentally changes the nature of the fight against the pandemic, the highly infectious Delta variant means it will be hard to suppress it and that vigilance will be needed, especially over the winter.

With the health service still reeling from the impact of the HSE cyber attack and the three previous waves of infection, admissions to hospital will place pressure on the system, and will have a “significant impact on the delivery of non-Covid care”.

Hospital Report

“We cannot predict with certainty the future trajectory of the disease and, consequently, we cannot fully rule out the possibility that the reintroduction of measures may be required in the future,” he will tell the committee. “We must continue to ensure our response is agile and flexible, with an ability to pivot rapidly and respond to any emerging threat.”

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Dr Holohan will tell the committee that the incidence of Covid in Ireland at this time is high "with an uncertain trajectory", and that while the prevalence of the disease in younger people aged 18-24 is falling, there has been an increase in testing rates and confirmed cases in those aged between five and 12 years old.

“This trend, and in particular the impact of the return to school and the opening of the third level sector, will continue to be monitored closely over the coming weeks,” he will say.

The level of infection among young unvaccinated people, Dr Holohan will say, is such that there is a “significant number of infections in older, vaccinated people”, including in places where vulnerable people congregate such as nursing homes. While vaccine uptake has been high across the board, people aged between 16-29, given high levels of social contact and still-partial vaccination, “have the potential to sustain a large wave of infection until such time as this cohort achieves very high levels of immunity”.

Nonetheless, the committee will hear that the vaccines are providing very effective protection and “have fundamentally changed the risk profile of this disease”.

This will enable a shift in how the pandemic is managed, although due to how infectious the Delta variant is, the vaccines will not be enough to bring the R number, which measures how the virus is spreading, below one.

“Through this coming autumn and winter, possibly in the face of high levels of infection, we will remain dependent upon public understanding and buy-in to the basic public health measures in order to minimise opportunities for this virus to transmit.”

Booster shots

Prof Karina Butler, the chair of the National Immunisation Advisory Committee (Niac) will tell the committee that booster shots may be called for due to inadequate responses to an initial course of vaccination, waning immunity or vaccine resistant strains emerging.

She will say, however, there is a difference between additional shots extending the primary course of vaccination, or a “booster” proper, which needed for a waning immune response. The former may be given to those who have severely compromised immune systems that need extra help fighting off the virus.

Older people in nursing homes, meanwhile, have a “poorer response to the primary vaccine course and more rapidly waning immunity because of their age and underlying conditions”.

Niac has recommended additional vaccines be given to those with serious immune system issues over 12, to the over-80s, and anyone over 65 in a long-term care facility.

The group is still examining whether there is a need for a booster shot for other groups, such as healthcare workers and other older people outside the categories currently approved.

“Niac is conscious of the global demands on vaccine supplies and recognises that facilitating vaccination on a global level is important on a humanitarian and global equity basis,” Prof Butler will tell the committee.

“Until global control is achieved, all countries remain at risk and return to normality will be compromised,” she will say.

Less than 2 per cent in low and middle income countries have received a first dose of vaccine and many will not have received their first shot until late 2023.

Noting that the pandemic requires global cooperation, she will say Ireland’s participation in the Covax initiative, which supports distribution of vaccines around the world’s poorer countries, is welcome.