Holohan letter leaves question mark over achievability of goals

When Dr Tony Holohan resumed work in April, following a period of compassionate leave, one of the first things he did was sign off on a faster-than-expected series of reopenings in May and June.

It was the first really significant step in unlocking the long lockdown that followed the Christmas disaster, with outdoor hospitality and hotels reopening, and increased mixing outdoors given the green light.

From then, it has been clear the Chief Medical Officer is a true believer that vaccines could facilitate a shift in pandemic policy. It shouldn't be surprising that in his most recent letter to Minister for Health Stephen Donnelly, he wrote: "We will attain a level of vaccine coverage within the population which . . . will facilitate a transition in our approach to the public health management of Covid-19 in Ireland. "

The question now, as the Government embarks on what it hopes will be the final shift out of restrictions, is whether a shared faith in vaccination between the coalition and their top medical adviser will sustain progress.

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Holohan’s letter, sent last week, details a range of steps, ranging from the removal of some mask-wearing and social-distancing mandates, restrictions on indoor sports activities, weddings, nightclubs and the return to work, which form the core of the Government’s plans for September and October.

Tension

But it would be wrong to think that there is no tension between public-health officials and the Government. There are points of meaningful difference, if not radical divergence, between what was advised and the way the Government proceeded.

The National Public Health Emergency Team (Nphet) recommended that the relaxations could take place only when five criteria had been met, ranging from achieving 90 per cent uptake of vaccination among people aged 16 and over, through to the absence of a new virus variant of concern.

They include broad – and challenging – markers to be hit, including that the incidence, reproduction number, growth rate, impact and progression of infection “give confidence that we can suppress the infection sufficiently to minimise the harm of the disease”. Hospital and ICU capacity should be “reducing and/or reduced to low levels to protect the health service”, while public-health capacities such as contact tracing should be “sufficiently robust” to enable outbreaks to be rapidly identified and investigated.

The vagueness of these criteria has raised eyebrows in Government: when can you say there’s “confidence” infections can be suppressed? What exactly are “low levels” of pressure on hospitals? How do you define a “sufficiently robust” public-health capacity?

Charitably, you could say these criteria are broadly written to reflect the dynamic nature of the pandemic, rather than tying policy actions down to specific data points. Less charitably, it could be argued that they are so vague as to be unachievable.

What is clear is that at least some of these criteria are not currently being met – especially around the health service.

The letter is also devoid of dates, while the Government has published them, stating that they will move on these days to remove restrictions, without reference to criteria.

Pragmatic acceptance

The decision to go ahead with 100 per cent capacity on public transport is giving some on Nphet the “heebie jeebies”. However, there is a pragmatic acceptance among some senior health officials that it had to happen at some stage, and the political reality is the Government was always going to move somewhat ahead of the advice.

Nonetheless, some members feel the Government should have waited to see the impact of reopening schools, which should be clear in two weeks or so, and that the return to the office may also be premature.

Government sources counter that some of the criteria might never be met, and ultimately, it is the Coalition which decides policy. With Ireland among the top European Union performers for vaccination, when is the right time, if not now, they ask?

Since Nphet’s modelling was reworked to take account of the Delta wave, case numbers have threatened to explode at times, but generally trended towards the more optimistic range of possibilities, encouraging the Government. The next step is the most important moment in pandemic policy for some time – it is also an extremely delicate one.