Pat Leahy: Scrap the ‘abundance of caution’ approach to vaccine rollout
Prioritising the young over middle-aged is one approach that could pay dividends
You are ‘more likely to struck by lightning than to be seriously harmed by’ the AstraZeneca vaccine. Photograph: Antonio Dasiparu/EPA
Talk about a roller-coaster week.
Last weekend, Ministers and senior officials exhibited a mood of very cautious optimism about the future, grounded in the expectation that the vaccination programme was accelerating but tempered by the warnings of the public health experts about a possible fourth wave if we lost the run of ourselves.
By Monday the confidence had taken a jolt; the National Immunisation Advisory Committee said that the use of the AstraZeneca vaccine should be restricted to the over 60s. This meant a substantial reorganisation of the programme was required, and the HSE immediately cancelled thousand of vaccinations due this week.
But the Niac advice was only the first instalment of a double-whammy. On Tuesday, the situation deteriorated drastically when US health authorities announced they would “pause” the rollout of the Johnson & Johnson vaccine; the company said it would immediately hold off on deliveries to Europe pending a review by the European Medicines Agency.
At the moment there is a struggle behind the scenes between those who favour extending the gaps between the Pfizer jabs and those who want to keep the current pace
So it was an even gloomier than usual Cabinet that gathered in Government Buildings (in a few different rooms, as is now customary) on Wednesday morning. Jennifer Bray reported the tale of what happened next: the Taoiseach took a call from European Commission president Ursula von der Leyen and returned with the best of news: Pfizer was bailing everyone out with extra deliveries. From heroes to zeroes to heroes again.
In the days since, the view has grown in Government that the delay in the Johnson & Johnson vaccine could be short-lived. Senior figures in Government tell me they expect the scheduled deliveries of this one-shot vaccine to play a full part in the pre-summer dash to immunise most of the country. But this view could be based more on hope than hard information.
Whatever happens with that, however, the transformation of the current state of the country through vaccination is in prospect in the coming weeks – if the available shots can be put into arms at a sufficient clip. As has been the case since the vaccines arrived, nothing matters more for the country or its Government.
Rule of three
There are three things to be said in reflection on this topsy-turvy week.
Firstly, we should focus more on the long game, the overall progress of the programme, and not on the daily ups and downs. Most politicians, officials and journalists (this one included) overemphasised the damage to the programme on Monday. The lure of disaster headlines is great, but it pays to pause, consider the context and take a breath before making decisions or pronouncements.
The only thing that matters is that the programme is vaccinating hundreds of thousands of people a week. If the programme can do that, it’s on track. If it can’t do that – and this week has been a setback for sure – then we need to ask why, and what can be done about it.
Secondly, it’s clear that the programme will need constant tweaking. But these decisions need to happen quickly. In response to the AstraZeneca news on Monday, the Government immediately opened the booking system for the over 60s to get the shot. But that immediate response was the exception rather than the rule. Normally, these decisions happen too slowly.
Advice that will affect the vaccination programme should not be given without regard for its consequences
At the moment there is a struggle behind the scenes between those who favour extending the gaps between the Pfizer jabs and those who want to keep the current pace. Extending the time between jabs would enable more people to get the first jab, thereby extending the protection of the vaccine to a greater proportion of people. So let’s get on with it, rather than endlessly “examining” it.
There is another more controversial tweak favoured by some Ministers and senior officials that should be immediately considered: giving the jab to younger people before middle-aged people. One of the major fears is that, as the vaccine rolls out and society opens up, there will be a spike among the (unvaccinated) younger people, as their social lives reignite.
At present, according to one person who has received top-level briefings, the cases among older people are falling, the middle-aged numbers are holding steady, and the cases among younger people are beginning to grow. There are real fears of a sudden spike among this cohort.
It makes sense to give the 18-30-year-olds their shot before the more sedate middle-aged generation. Let’s face it: they’re going to go on the lash anyway.
Too much caution
Thirdly, an abundance of caution is too much caution. I heard people at all levels of politics and officialdom during the week that were critical of the AstraZeneca restriction as an over-reaction. It’s hard to disagree. As Prof Luke O’Neill pointed out, you are “more likely to struck by lightning than to be seriously harmed by this vaccine”. A Government source pointed out you are far more likely to get a blood clot if you use an oral contraceptive – 100 times more likely, actually.
Advice that will affect the vaccination programme should not be given without regard for its consequences. It’s not good enough for the vaccine experts to say the consequences are someone else’s problem. After all, slowing down the vaccine programme will cost lives, too.
If the situation is so dangerous that we have to keep the country substantially locked down, then how is the famous “abundance of caution” governing decisions about the vaccines? Surely it should be a balancing of risks. You could argue that caution dictates getting as much immunity in the community as quickly as possible.
It’s either a crisis or it’s not, and clearly it is. That demands flexibility, urgency and a willingness to balance risks. We’re not seeing enough of that.