Five months ago, Belfast nurse Joanna Sloan, an emergency-department sister with the Belfast Health and Social Care Trust, was the first person on the island of Ireland to receive the Covid-19 vaccine.
This week, she watched on as Northern Ireland reached its millionth vaccination: "Reaching this milestone felt so far away at that time," she told The Irish Times.
The campaign is significantly ahead of schedule. The target had been to reach more than 800,000 injections – both first and second doses – by May. Now, Northern Ireland could have most done by the end of July.
The programme extended to people aged 25-29 this week, with about 20,000 slots available weekly, while the head of the vaccination programme, Patricia Donnelly, said all age groups would get offers "very shortly".
As always, speed is dictated by supply, which is currently limited as the UK is suffering some shortages, which are “incredibly frustrating” given that “we have lots of vaccinators and lots of capacity,” she said.
Uptake is “at a very high level, over 90 per cent” among the over 50s, “but as we drop down through the age categories we expect the uptake to be a bit lower”.
For this reason, Donnelly said, “we’re also doing some slow and careful stuff – mobile teams are out going to workplaces, going to communities where the appetite for vaccinations could be lower”.
Teams have vaccinated fishermen in some fishing ports, in a large food-processing factory, and also across Derry and Tyrone, where uptake has been low and transmission rates high.
Transport is sometimes a problem for people: “If you bring the vaccine to them they’re more likely to take it,” said Donnelly, adding that men are often slow to think about their health.
“Sometimes it’s not even hesitancy, it’s just they don’t organise themselves,” Donnelly said. “We found women were really good at getting the vaccine and coming early,” she goes on.
“This is not different from other healthcare,” she said, adding that more men than women have turned up to meet the mobile teams “ but that was probably because more men needed to get it”.
Throughout, the vaccination programme has been flexible and nimble, she said: “There are three of us that sit down several times and say, ‘Okay, where are the issues?’
“I always talk about pulling a thread. We try and intervene very fast so it doesn’t go off the rails, we detect things that are going wrong or have the potential to go wrong.”
In all, though, everything has gone “exactly as expected”, if only more quickly, which is “remarkable” given that the programme did not exist in early December.
The North’s “highly successful” winter flu programme help set the ground, since GPs vaccinate a third of the population annually and nobody notices: “So I knew it needed to have a significant GP element to it.”
The first Pfizer vaccinations in December were complicated by the need to keep the vaccine at extremely low temperatures, administer it within five days and the fact that it came in 1,000-dose boxes that could be used only in vaccination centres.
These were set up by the North’s regional health and social care trusts in leisure centres, but, meanwhile, Donnelly and her team sought ways to get the vaccines into nursing homes.
“At the time the infection rates in care homes were significant, the number of deaths in care homes was significant, and we felt a very strong moral imperative to vaccinate that group first,” she said.
With support from pharmacists, they were able to take part of the Pfizer vaccine packs out to care homes; by the end of February, all care-home residents and staff had been vaccinated.
“It felt such a sense of relief to us that we did the most important group first, and when we looked around the UK no one else managed to do it, because they were waiting for the next [AstraZeneca] vaccine.
“We’ve just celebrated a million doses but actually the first 100,000 doses for us was the milestone, because half of that were care-home residents and staff, and that meant everything for us,” Donnelly said.
At the start of January, GPs were able to begin vaccinating the over-80s using the AstraZeneca vaccine; the next big change came on March 29th.
“A lot of the vaccination centres and GPs were going to be tied up with second doses, so therefore we had to find a different way to deliver the first doses,” Donnelly said.
Hence the opening of the mass-vaccination centre at the SSE Arena in Belfast – which has the capacity for up to 8,000 vaccinations per day – and the involvement of community pharmacies.
On Friday almost 7,500 people received a vaccine in the North, including about 1,500 first doses and 6,000 second doses.
GPs have administered almost 700,000 doses, community pharmacies 51,000, and the rest have been given by the trusts. Thousands of people have been involved.
“It has been a total team effort . . . we are talking an army. And every one of them will tell you what it has meant to be part of it. People were doing it for themselves, for their families, for the community,” Donnelly said, proudly.