The HSE has cancelled all AstraZeneca clinics for the rest of the week, except for those arranged for certain people aged over 60, it announced on Tuesday evening.

It comes after the National Immunisation Advisory Committee (Niac) recommended on Monday that AstraZeneca should not be given to people aged under 60, following reports across Europe of unusual but severe clotting events as very rare side-effects to the vaccine.

Health chiefs have been asked to explain to the party leaders and senior officials what the impact of the decision to restrict use of the AstraZeneca vaccine will impact on the State’s vaccination rollout in the coming weeks.

Hospital Report

The HSE and senior health officials were asked to an emergency meeting today to evaluate the effects of the AstraZeneca restriction before the news from the US that Johnson and Johnson was pausing the European rollout of its vaccine.

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The two announcements are a double blow to the Irish vaccination programme which was due to be significantly accelerated this month, and senior Government sources were reeling from the news today.

Contacts between Government Buildings and the HSE and Department of Health have been ongoing since last night. Taoiseach Micheál Martin is to meet the vaccine taskforce ahead of a Cabinet meeting on Wednesday.

Space out doses

Government sources said one option available to the State would be to space out the doses between vaccines still being administered. Senior sources cautioned that such a move would only follow advice from Niac on the issue, and that none had been received.

A source said that in common with all issues on vaccination, it would be considered by Niac, but the idea could prove attractive to both Government and the HSE. Well placed sources said all options would be considered.

Health sources said that mixing of different doses would be considered, as would the rapid rollout of AstraZeneca to the over 60s in an effort to keep momentum in the programme.

A number of sources asked how it was sensible to delay vaccines if, as the deputy chief medical officer Dr Ronan Glynn suggested last night, the country is at risk of a fourth wave of the virus.

Several people in Government suggested that the ultra-cautious approach advocated by Niac and accepted by the Minister for Health Stephen Donnelly and the HSE was an over-reaction to a minimal risk.

“You’re more at risk of a blood clot on a flight or using the pill and I’m not hearing any plans to ban them,” said a Government source.

‘Resetting’

Meanwhile, HSE chief executive Paul Reid said the health service would be “resetting rather than revamping” the State’s vaccination programme following the decision to restrict the AstraZeneca vaccine to the over-60s.

Speaking at an online conference, he said the HSE had another 24 hours to work on a plan for the Government setting out how it is going to “reset” the programme based on the “fundamental change” as a result of the National Immunisation Advisory Committee’s (Niac) decision to restrict the AstraZeneca vaccine.

Mr Reid said that volumes of AstraZeneca doses to be supplied over the next couple of weeks made up 21 per cent, or 813,000.

The HSE would have to “realign our operating model” because the AstraZeneca vaccine was originally going to be administered to medically vulnerable people through GPs, he said.

“Now we have to look at that very differently. We are going to recalibrate, reset the model for it,” Mr Reid told the RCSI University of Medicine and Health Sciences annual conference.

He pointed out that the HSE had to change the vaccination model 23 times over a 15-week period due to issues with supplies of the vaccine and changes to guidance on vaccine use.

“I expect that we will be resetting rather than revamping the whole programme. It is about the channels of delivery,” he said.

There has been a negative reaction amongst many senior figures in Government this morning to the news, with several high ranking sources suggesting privately that the decision was an over-reaction which will damage the state’s vaccination programme, leading to more infections and deaths in the coming weeks.

“How can you insist on an ‘abundance of caution’ when you’re in a race against time with the virus?” one source asked.

“I’ve never seen so much anger,” said another.

Meanwhile, Dr Mary Favier, Covid-19 adviser to the Irish College of General Practitioners, said limiting the use of the AstraZeneca Covid-19 vaccine to only those aged over 60 will cause "hesitancy and concern" with the vaccination effort.

The rare risk of blood clots from the vaccine needed to be kept in “perspective”, Dr Favier said.

Move

The move has meant a further reordering of the State vaccination plan at a time when officials hoped the vaccination campaign would begin to accelerate.

Dr Favier said there was a higher risk of clotting to people on a long-haul flight or from taking the contraceptive pill than from AstraZeneca.

The GP, who sits on the National Public Health Emergency Team (Nphet), told RTÉ Radio 1’s Morning Ireland that the risk from Covid-19 was much higher than from any vaccine.

The recommendation from Niac would now likely see those aged 60 to 69 vaccinated quicker, she said. More than 800,000 doses of the AstraZeneca vaccine are to be delivered to the State in this quarter.

When asked about Niac’s decision, Minister for Higher Education Simon Harris said he was not qualified to “second guess” the committee, but added there was no getting away from the fact it would cause upheaval.

However, he was encouraged by comments from Dr Glynn and Prof Karina Butler of Niac that the decision will not have an impact on the long-term rollout of the vaccine.

It was always important that concerns be acted upon and the caution exercised by Niac should give people confidence, he said.

If AstraZeneca had been the only vaccine available, the decision to pause would not have been made, he said. “We have to use the supply we have to best effect.

Liam Fanning, a professor of immunovirology at University College Cork, criticised Niac's decision as overly cautious. "I'm not quite sure why they jumped to Defcon level 10 at this stage," he said.

One in 200

Prof Fanning said there was a one in 200 chance of dying from Covid-19, and a one in a million chance of dying from a blood clot from the AstraZeneca shot.

Speaking on Tuesday, Tánaiste Leo Varadkar echoed concerns about the issues with AstraZeneca leading to hesitancy in people trusting vaccines.

Mr Varadkar said it was easy for people to “second guess” Niac, but the health service was successfully “pivoting” to adjust the vaccine rollout.

There were half a million people in the country over the age of 60 who were yet to be vaccinated so they will make “good use” of AstraZeneca supplies, he said.

Evolving situation

Prof Karina Butler, chair of Niac, acknowledged there had been “several twists and turns and modifications” in its vaccination advice, but said it was dealing with an evolving situation.

“We’ve never been in this situation before. As information comes off the boil we are trying to make the best decisions,” she told Morning Ireland.

There were a number of alternative vaccines available, so no one would be “left behind”, she said.