The chief medical officer Tony Holohan has said people over 65 working in long term residential care facilities should receive an mRNA vaccine instead of the AstraZeneca vaccine because of their increased risk of mortality.

Mr Holohan and Minister for Health Stephen Donnelly have also backed plans to give the Pfizer and Moderna vaccines to those over 70 where practicable.

The High-Level Taskforce on Vaccines and the Health Service Executive have been informed of the decision, it is understood, and are "working through the operational implications."

Hospital Report

The use of these vaccines, based on a new technology called mRNA, in a GP setting had been seen as a challenge due to the demands of storing and administering them, as they need to be kept at ultra low temperatures.

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Family doctors are now working with the HSE to roll out these vaccines to older people, despite GPs, who are seen as key for vaccinating older people living in the community, previously being targeted for administering the more stable AstraZeneca shot.

While the European Medicines Agency (EMA) has approved the AstraZeneca shot for use in all adults, some national health authorities in member states are curtailing its use among older people.

Taoiseach Micheál Martin said the current vaccination plan will change because of the recommendations, and said this will present a logistical challenge.

He said the position is that all three currently approved vaccines are safe and effective but “given the higher efficacy data around the mRNA vaccines, namely Pfizer and Moderna, the chief medical officer recommends it would be preferable to use them where practicable and timely for over 70s… and given the over 70s are the most vulnerable to death and illness if they get Covid 19, the recommendation is that we apply those vaccines, Moderna and Pfizer to the over 70s and that is what is going to happen.”

“That will mean a change in terms of the operation of the plan and it will be a significant logistical challenge to the Health Service Executive. They are currently working through the implications of this. They will still be able to commence with the over 70s on February 15th as planned but it will be with the Moderna and Pfizer vaccines,” he told the Last Word programme on Today FM.

“It means for other groupings, the cohorts four, five, six and seven, that they will be able to come forward in terms of the AstraZeneca vaccine and we also have to complete the second cohort of healthcare workers.”

In a letter to Mr Donnelly, seen by the Irish Times, Dr Holohan said that “due to the superior efficacy demonstrated by mRNA vaccines, including in orlder persons, albeit the data is limited, and in recognition of their particular vulnerability in terms of their increased risk of death and serious disease if they contract SARS CoV-2, it is recommended that mRNA vaccines be administered to all those over 70 years in order to provide the highest level of protection available to this population.

“In addition, those aged over 65 years residing or working in long term residential care facilities who have yet to receive their first dose of vaccine, should also receive an mRNA vaccine based on their increased risk of mortality, morbidity and increased risk of contracting the virus in the congregated settings in which they reside and work.”

Preferential

The Irish Times reported on Wednesday morning that the advice from the National Immunisation Advisory Centre (NIAC) was that it would be preferential to give mRNA vaccines to older age groups.

On Wednesday afternoon, the NIAC published its advice to the chief medical officer, which found that mRNA vaccines “are associated with higher reported overall efficacy which makes them preferable for use in those at highest risk of adverse outcomes”.

The committee found that all approved vaccines were suitable for adults, and that “the best vaccine anyone can receive at this time is the vaccine that can be soonest administered”.

However, it recommended that while vaccinations should not be delayed, “those aged 70 and older should be given an mRNA vaccine”.

In an update to its GP membership seen by The Irish Times, the Irish Medical Organisation (IMO) said that it is "working with the HSE for the rollout of the Pfizer and Moderna vaccines through general practice for patients aged over 70".

“This programme and roll out is not without its challenges from a logistical perspective but in circumstances where General Practice has proven itself to be efficient and effective at mass population vaccines we are confident that it can be delivered as the starting point of this national effort,” Dr Denis McCauley, the IMO GP chair, wrote in a note to members.

Chief Clinical Officer of the HSE, Dr Colm Henry, said earlier that the preference would be to give older people vaccines like Pfizer and Moderna rather than the newly-approved AstraZeneca shot.

Advice

“The advice generally is to give the mRNA vaccines, namely the Moderna or the Pfizer, to preferentially give those to older people. Based on the evidence we have right now it affords them greater protection,” Dr Henry said in an interview with Bryan Dobson on RTE Radio 1 on Wednesday.

“The advice we’re getting from the EMA, through NIAC, is to preferentially give that Pfizer/Moderna vaccine to the over 70s, and we’ll be giving that in mid-February”. Dr Henry said the vaccine will be administered through GPs, “it’s just much more tricky”.

The HSE and the vaccine taskforce are currently working on a scenarios to roll out the vaccine through the GP network. However, the challenges associated with the stability of the vaccines are considerable - for example, sources cited the issue of small, rural practices where the 85+ people who are receiving the vaccine may also live remotely, and the associated challenge of safely bringing them together to be vaccinated.

It is thought that pooled vaccination centres, where GPs come together in a central location to give shots to their patients, are under consideration. These would differ from the mass vaccination centres as originally conceived in the State’s vaccine rollout plan.

Dr McCauley told colleagues that the IMO will have comprehensive details ready for members by this Friday, followed by an IMO webinar on Monday, February 8th.