When it has fully vaccinated nursing home residents and carers, and frontline healthcare workers, Ireland will turn next to the third priority group for Covid-19 vaccination: the over-70s. When this age cohort has been vaccinated, next in line in Ireland will be healthcare workers not in direct patient contact, then people aged 65-69.
But not all countries have the same order of priority.
Deciding who would be among the first to be vaccinated against Covid-19 was always going to be an invidious task. How can you pitch one person’s vulnerability against another’s? And, how can societies begin functioning again if large groups of workers remain unvaccinated and therefore at risk of becoming seriously ill if they catch the virus?
In France, chauffeurs and taxi-drivers – who suffered higher death rates than healthcare workers in France’s first wave of infections – have been prioritised for vaccination. Five million other workers – including school staff, shop workers and people working in abattoirs or on construction sites – are also designated as being in high-risk occupations and prioritised for vaccination in France.
Indonesia has a Covid-19 vaccination strategy that is the reverse of the accepted approach in most other countries. Rather than giving older people CoronaVac, the vaccine developed by the Chinese firm Sinovac Biotech, the Indonesian ministry for health has started by vaccinating its 1.3 million healthcare workers followed by the 17.4 million workers in the public service, which include teachers, soldiers, police officers and office workers.
In Ireland, teachers are 11th on the list of priority groups for vaccination <br/>
The rational given is that stage three clinical trials for those over 60 have not been completed there, and the Indonesian agency for drug and food control has yet to decide if the vaccine is safe for people in that age bracket (trials also suggest it has a lower efficacy rate than those in use in Europe). “Only people aged 18-59 qualify for CoronaVac in Indonesia because the country’s regulator says it does not have enough data on the vaccine’s impact on older people,” a spokesman for the health ministry there said.
In the United States, people who work in schools – from teachers to bus drivers – are classed as category 1b, meaning that they are next in line after older people in long-term care facilities and healthcare workers. In some parts of the United States, teachers have already had their jabs, and more will be vaccinated in February.
In Ireland, teachers are 11th on the list of priority groups for vaccination, which puts them behind people aged 18-64 living or working in crowded settings (9th) and key workers in essential jobs who cannot avoid a high risk of exposure (10th).
Although the definition of priority groups remains open to interpretation, it is expected that people living or working in direct provision centres will be ninth in line for vaccination followed by meat factory workers. Both of these sectors experienced large outbreaks of Covid-19 in Ireland in 2020.
The Irish Pharmacy Union also urged the Government to arrange for pharmacists to be vaccinated immediately so that they can start vaccinating healthcare workers with the AstraZeneca vaccine, while GPs begin vaccinating older people in the community with the mRNA vaccines, as advised by the National Immunisation Advisory Committee earlier this week.
Dr Niall Conroy, an Irish consultant in public health medicine working in Queensland, Australia says that most countries agree that the first priority is to vaccinate the people at highest risk of deaths and the people who are needed to keep them alive.
“There are unhappy people in every country because in the early stages of rollout, each person vaccinated receives their shot at the expense of someone else. That’s completely understandable because younger people with chronic diseases, for example, have been cocooning for over a year now and they’re not being offered the vaccines as quickly as they would like,” says Conroy.
Home carers
On Tuesday, the organisation responsible for home carers said fewer than 300 home care workers out of 10,000 had been vaccinated. “It’s a moral obligation of the State to protect those in our community who most need protection. Home carers are being forgotten despite being in daily contact with the elderly and vulnerable, enabling them to remain in the safety of their home,” said Joseph Musgrave, chief executive of Home and Community Care Ireland.
There is an ethical justification for each group, which gives transparency <br/>
Dr Anne Moore, vaccine specialist and senior lecturer in biochemistry at University College Cork, says priority lists for vaccination are based on “culture which informs ethics”.
“I think the priority lists are good for the Irish population. There is an ethical justification for each group, which gives transparency as to why each group was put at a certain rank,” says Moore.
The ethical principles of [moral] equality, minimisation of harm, fairness and reciprocity are outlined in the National Covid-19 Vaccination Programme Strategy. “This takes away any idea that there might have been lobby groups behind the priority lists,” says Moore.
She adds that vaccine priority is based on the evidence of risk – and teachers, for example, aren’t in high-risk categories.
“The evidence is that teachers – especially in primary schools – are at the same risk of infection as other people at work. And any teachers who are medically vulnerable will have received their vaccination in a higher priority group.”
Moore says that as vaccine supplies increase, there are plans for mass vaccination centres, which would mean that vaccination for different priority groups may be able to happen at the same time. “Hopefully with the arrival of more vaccines and particularly the Janssen/Johnson & Johnson single shot vaccine, vaccination will get faster. But first, we have to build a shield around the vulnerable in hospitals and in the community,” she says.
Prof Brian MacCraith, chairman of the High Level Task Force on Covid-19 Vaccination in Ireland, says it is understandable and positive that lots of sectors of society want to get vaccinated as soon as possible.
“We get lots of emails and approaches from people with really strong and heart-rending cases, but the prioritised sequencing is a government’s decision based on advice from the National Public Health Emergency Team on foot of guidance from the National Immunization Advisory Committee,” says MacCraith.
He expects that the setting up of vaccination centres right across the country “no later than March”, in tandem with greater supplies of Covid-19 vaccines, will allow much greater numbers of people to be vaccinated over the coming months. The Covid-19 vaccination programme is the largest ever vaccination programme undertaken in Ireland.
Dr Niall Conroy says we need to change how we look at vaccination. “The focus at the minute is on personal protection but the real value of a vaccination programme lies is getting large portions of the population immunised. So success shouldn’t be measured in terms of getting high-risk individuals vaccinated early on; it should be measured in getting enough people vaccinated so as to alter the dynamics of viral spread in the population,” says Conroy.
Meanwhile, Dr Mike Ryan, the Irish man who heads up the World Health Organisation’s emergency response to Covid-19, has issued a stark warning to first-world countries squabbling about timelines for the delivery of vaccine supplies. “Consider a nurse from Pakistan and a midwife from Uganda pleading for vaccine supplies. They are right at the end of the queue. They see people at the top of the queue fighting about where they are in the line. It looks like fighting over the cake – when they don’t even have access to the crumbs.
“We all need to ask ourselves: ‘Would I have the vaccine if I thought it meant a health worker in the south wouldn’t get that vaccine today?’ We all need to examine our own consciences then tell our leaders what we want them to do,” said Ryan.
Conroy believes that not sharing out vaccines across the world will become one of the biggest errors of the pandemic.
“Even if you don’t agree with the ethical argument for ensuring that all countries have access to vaccines at the same time, it is absolutely in the interest of all countries to ensure that everyone has access to vaccines,” he says.
“If that doesn’t happen, there is a real risk that new variants will develop in poorer parts of the world where the virus is raging unchecked. That could mean that we’re all happily vaccinated in a few months time only to find out that a new variant has emerged in Sierra Leone or Liberia or Somalia that the vaccine is ineffective or less effective against.”
He adds: “It would be a real tragedy if it takes an event like this – which could set the vaccine programme back by a year – to realise how important global vaccine coverage is. The maxim ‘none of us are safe until we’re all safe’ is very, very true.”
