The Covid-19 vaccine rollout could be "speeded up" by allowing pharmacies administer the Oxford/AstraZeneca vaccine to healthcare workers, the pharmacists' group has said.
The Irish Pharmacy Union has called for a change to the sequencing of the vaccine rollout to the top priority groups and for pharmacies to give AstraZeneca vaccines to health workers after it was advised that the Pfizer and Moderna vaccines be given to people over 70 where possible.
The call comes after the State's chief medical officer Dr Tony Holohan recommended that those over 70 years of age receive the Pfizer and Moderna vaccines rather than the recently approved Oxford/AstraZeneca shot given the absence of data on its effectiveness in older age groups.
Hospital Report
The High-Level Taskforce on Vaccines and the Health Service Executive (HSE) are working through operational changes to the vaccine rollout in light of the advice on the Oxford/AstraZeneca jab.
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Older people may face vaccine delay as HSE scrambles to revise rollout after advice on AstraZeneca
Tánaiste Leo Varadkar told the Dáil on Thursdaythat the recommendation that the Oxford/AstraZeneca Covid-19 vaccination should not be used for those over 70 "will probably change".
He confirmed that the vaccination programme for those over 85 will start in the middle of this month with the Pfizer or Moderna vaccine following the recommendation of the public health authorities.
The rollout for those over 70 “may well be slower” than originally planned he said, but for healthcare workers and other groups it would go faster.
‘Other cohorts’
HSE chief executive Paul Reid said the recommendation not to administer the AstraZeneca vaccine to the over-70s would have "significant implications" but this did not meant that the planned vaccination timeline was "up in the air."
He told the HSE weekly briefing that the recommendation meant they would “move into other cohorts” in parallel with giving the Pfizer and Moderna vaccine to the over-70s.
Speaking to RTÉ’s News At One, he said there were now three vaccines authorised for use and the plan to vaccinate frontline healthcare workers would be continuing, using the AstraZeneca vaccine now.
Prof Karina Butler, chair of the National Immunisation Advisory Committee (Niac), said that there would be no significant time delay in the rollout and that the HSE was working very hard on the delivery of vaccines, whether through vaccinations centres or GPs.
She told RTÉ's Morning Ireland that the AstraZeneca vaccine could still be used for people aged over 70 if there were delays in the delivery of the Pfizer and Moderna vaccines.
“If there are going to be significant delays, the best vaccine is the one that is available to you at the time,” she said.
All vaccines could be used across all age groups and all could protect people against being hospitalised and becoming seriously ill with Covid-19, she said.
Minster for Health Stephen Donnelly said the first Oxford/AstraZeneca vaccines were expected to arrive into the State next week with initial deliveries of 35,000 doses.
The Government is vaccinating the top two priority groups – people aged 65 years and over in nursing homes and long-term care facilities, and frontline healthcare workers – and then plans to start vaccinating people over 70 and other healthcare workers not in direct patient contact.
The decision to favour the Pfizer/BioNTech and Moderna vaccines over AstraZeneca for the over 70s leaves all three open to people of all ages to avail of any of the first three Covid-19 jabs.
Germany, Austria, Sweden, Poland and Belgium have opted not to use the easier-to-handle and cheaper AstraZeneca vaccine due to the lack of data on its effectiveness on people aged over 65.
Switzerland decided not to authoriseit at all because of insufficient data on its benefits.
Sequencing change
Secretary general of the Irish Pharmacy Union Darragh O'Loughlin said the HSE should allow pharmacists use the Oxford/AstraZeneca to vaccinate the remaining healthcare workers in the second and fourth priority groups so GPs could use Pfizer and Moderna vaccines in older people.
“Instead of everybody having to wait their turn, while the GPs are vaccinating the over 70s, we can use the vaccines that GPs won’t be using and start getting it into the younger population: healthcare workers and working-age people, in their pharmacies immediately,” he said.
Pulling all working-age people out of the queue and “putting them in the AstraZeneca queue” to receive that vaccine in pharmacies “just speeds up the whole vaccination plan,” he said.
He did not believe that the change in sequencing would cause confusion.
“People will know if they are over 70 or not, so if you are over 70, you are going to hear from your GP who is going to give you the Pfizer or Moderna vaccine,” he said.
“If you are a health worker, get yourself to your pharmacy and identify yourself. Let’s sequester all of that [the Pfizer and Moderna vaccines] for the older population over 70s and let GPs crack on with that population and maybe get the two populations done in parallel.”
‘Maximum protection and rapid protection’
Prof Butler told Newstalk Breakfast that a mixed response in the vaccination programme could provide the best level of immunity for the whole community.
If there was a vaccine that was good at preventing transmission, then this would be favoured for younger people “who are out and about the most” rather than among older people, she said.
“You want maximum protection and rapid protection as fast as you can for those who are most vulnerable and you want to break the spread as much as you can in those who may be more at risk of acquiring infection because they are out and about, but have much lower risk of transmitting it,” she said.
The combination “might give us the mix” to get a level of immunity in the population “that can actually get us out of the situation that we are in at the moment,” she said.
“Every one of these vaccines is going to find its place,” she said.
Vaccines ‘highly effective’
Dr Denis McCauley, chair of the GP sub-committee of the Irish Medical Organisation, said the three vaccines were "highly effective" but the evidence on the effectiveness of the AstraZeneca jab was not there but that it would still be offered to the over 70s if it was the only one available.
The vaccines would not end up “sitting in a fridge,” he said.
The AstraZeneca vaccine is easier to manage and can be given from being stored in a fridge.
The Pfizer vaccine must be stored at very low temperatures, has a shelf life of five days after being defrosted, can only be transported for 12 hours and must be used within two days with specific mixing and preparation requirements before it can be administered to an individual.
“If you were being offered the AstraZeneca vaccine, I would say, grab it with both hands. Do not look down your nose at AstraZeneca at all. It has gone from doghouse to penthouse in a week,” he told The Irish Times, pointing to new evidence showing that it substantially reduces transmission as well as preventing symptomatic infections.
“The best vaccine would the first one you are offered.”
The decision to favour the Pfizer and Moderna vaccines over the AstraZeneca vaccine for the over 70s just meant there would be “a swapping” out of the vaccines earmarked for older people.
‘Co-ordinated approach needed’
Clare GP Yvonne Williams said that there had to be a co-ordinated approach to the rollout of the vaccines with a very clear message from the Niac.
"The last thing anybody wants to see is a patient refusing a vaccine or waiting for a different type of vaccine," she told RTÉ's Today with Claire Byrne radio show.
The three vaccines approved in Ireland are “all safer than waiting and taking a chance and getting a Covid infection.”
“It can be a little confusing for patients because we are getting new studies, new data almost every day now. Older patients would like to be reassured on that,” she said.
Paul Moynagh, professor of immunology at Maynooth University, said that all three vaccines are effective and he would have recommended using AstraZeneca for the over 70s.
“We need to look at other possibilities in terms of making use of the available vaccines that we have, to make them go further,” he said.
He said he would be surprised if it did not turn out to be as effective as the Pfizer-BioNtech and Moderna vaccines.
Dr Williams said that a plan was needed to vaccinate elderly who are housebound. She said that GPs still could not register patients on the HSE’s IT system.
“It would be great to have that up and running,” she said.
