The first round of Covid-19 vaccinations for thousands of vulnerable patients will not be completed until "well into April" as a result of the decision to suspend use of the AstraZeneca vaccine, it has emerged.

The European Medicines Agency (EMA), which last week began an investigation into reports of blood clotting in people who had received the vaccine, meets on Tuesday to review the evidence and is due to announce a decision on Thursday.

With France, Germany, Italy and Spain on Monday following Ireland's example by temporarily suspending use of the vaccine, Irish officials are working on contingency arrangements in case the EMA decides to pause or vary the existing authorisation.

Hospital Report

Options are being examined to deal with the logistical fallout of the suspension of AstraZeneca, which is due to make up 20 per cent of second-quarter supplies.

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Even this week's pause in the use of the vaccine means some of those who have conditions that place them at high risk will not get their first dose until next month, according to Dr Colm Henry, HSE chief clinical officer.

He said the impact of the delay would mean “the completion of first doses for category four [would happen] well into April”. Category four includes those with cancer, chronic diseases, the immunocompromised and those with Down syndrome, among other conditions.

The target of vaccinating 10,000 medically vulnerable people last week was missed by about half partially due to the suspension, with a further 20,000 appointments now pushed back this week.

Some healthcare workers who had been due to receive AstraZeneca will also face delays.

Mental health facilities

On Monday, the Psychiatric Nurses Association said it was worried the suspension could affect residents in mental health facilities and the timetable for completing vaccination of its workers by the end of March may now be missed.

Sources involved in the rollout said any advice from the EMA would also have to be incorporated into a restarted programme, including extra screening or patient evaluation that may be stipulated.

Opposition health spokespeople were briefed on Monday that in a worse-case scenario, if AstraZeneca were ruled out entirely – an outcome not seen as likely – those who had received their first dose could be given a full regime of the Pfizer vaccine, or a single shot of Johnson & Johnson, in the future. Vaccine mixing is not currently advised, although there is research on it under way in the UK.

As no second doses are due until May, the problem is not seen as immediately pressing. The HSE said there were about 49,100 doses in its cold chain, with 124,510 administered so far.

Since the National Immunisation Advisory Committee (Niac) recommended suspension, it has learned the UK has been administering the AstraZeneca vaccine to high-risk patients without any adverse events, according to its chairwoman, Prof Karina Butler.

Clotting

Niac's decision was taken after reports of complicated clotting in four patients in Norway, two of whom had died, she said.

It was not yet clear whether the report represented a single phenomenon or involved different rare conditions, she told a Nphet briefing on Monday evening.

In a statement, the EMA said “many thousands of people develop blood clots annually in the EU for different reasons” and the number of incidents in vaccinated people “seems not to be higher than that seen in the general population”.

The EMA said it “currently remains of the view that the benefits of the AstraZeneca vaccine in preventing Covid-19, with its associated risk of hospitalisation and death, outweigh the risks of side effects”.

With 575 new cases of the virus reported in the State on Monday, Nphet officials said case numbers were “static, if not increasing” and called on people to reduce their social mixing. For the second day in a row, no new deaths were reported.

Assistant chief medical officer Dr Ronan Glynn acknowledged people were "shattered" and "want it to be over", but warned the virus "doesn't care" and will spread if given an opportunity.

He also warned against people congregating for protests planned on St Patrick’s Day, and against drinking that could break public health advice.