Covid-19: GPs urge caution on any significant change to over-70s vaccine programme

Data shows AstraZeneca as effective as other vaccines on over 70s, NIAC says

Family doctors have urged caution before any significant restructuring of the Covid-19 vaccination programme for the over-70s, saying it could risk confusion among older people.

It follows new advice on the suitability of the AstraZeneca shot for this cohort, issued by the National Immunisation Advisory Committee this week. Currently only Pfizer and Moderna vaccines are being administerd to over-70s in the State.

Speaking on Friday, Dr Denis McCauley, chairman of the GP committee of the Irish Medical Organisation, warned changing the programme – currently based on the use of Pfizer and Moderna vaccines – could cause confusion.

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He said he would be “loath to have any dramatic change to the system without it being carefully considered and planned”.


He said that there is a “supply guarantee” in the four weeks to come based on mRNA vaccines manufactured by Pfizer and Moderna for the over-70s, and “to change it midway could cause confusion among the over-70s”.

“The dust is settlinng on the present system; GPs and patients understand it,” he said. “The rollout of the mRNA vaccines is going very well, and we would hope that it would continue.”

In addition to chronic supply issues associated with the AstraZeneca shot, some European countries have curtailed its use following reports a small number of people had developed clots after receiving the vaccine.

However, the European medicines regulator has said there is no indication of an increased risk of blood clots assocaited with the shot. In Ireland, the Health Products Regulatory Authority said the nature of the reports did not raise a concern.

The office of the chief medical officer, located in the Department of Health, is currently considering the NIAC advice and will then send its own advice to Minister for Health Stephen Donnelly.

Earlier, the chairwoman of NIAC, Prof Karina Butler, had said Scottish data about the use of the AstraZeneca vaccine in the over-70s had shown equal efficacy and therefore gave more flexibility for use in all age groups.

NIAC has given updated advice to the chief medical officer that the AstraZeneca vaccine can be used in all age groups. “We are now spoiled for choice with vaccines,” Prof Butler told RTÉ radio’s Today with Claire Byrne show. “It is down to logistics now and when they will be delivered.”

The AstraZeneca vaccine had been in use in the United Kingdom since January 4th, and there were now reports in three scientific publications on “real world effectiveness”, she said, adding the positive data from Scotland now provided a little more flexibility.

When asked about patients refusing the AstraZeneca vaccine, Prof Butler said such refusals were based on a lack of understanding. She said there would not be a choice, and she encouraged patients to take what they were offered, all were very effective. “All vaccines have proven to be extremely effective.”

The effectiveness rates of AstraZeneca were no different from the MRNA vaccines – Pfizer and Moderna, she said.

There was assessment ongoing in relation to clotting concerns reported in Denmark, and there was always a risk on balance, she said, but added the risk of clotting could be down to other reasons. Studies had indicated very little difference between those who had taken the vaccine and those who had taken the placebo, Prof Butler added.

In the EU there had been five million doses of AstraZeneca administered and only 30 clotting events, which was a very small number that could have been seen anyway due to other factors, she said.

The longer time between doses of AstraZeneca was an advantage as it gave the opportunity for more people to be vaccinated, said Prof Butler.

Supply chains

Earlier Mr Donnelly said he had been communicating with the AstraZeneca representative for Ireland to convey the Government’s frustration with the revised volumes and delivery dates.

The representative had admitted that the company was facing “complex” problems with supply chains, the Minister said. AstraZeneca was doing everything they could and accepted that their actions were causing “real anxiety for people on the ground,” said Mr Donnelly on RTÉ Radio’s Morning Ireland. “They have committed to doing everything they can to fix that.”

High-level communications were also ongoing between AstraZeneca and the EU’s steering committee about supply for the European Union, according to the Minister. Mr Donnelly said he did not think there was “any funny business going on” about supply of the vaccine to the United Kingdom and the United States.

Ireland will keep up the pressure to get the supplies that were contacted and promised, he said, adding time mattters and that it was important to get people vaccinated quicker so the country could open up.

When asked if the Taoiseach would raise the issue of the 30 million doses of AstraZeneca preordered by the United States where it has not yet been approved, Mr Donnelly said if Mr Martin believed raising this would be of use he would do so.

Mr Donnelly said the Health Service Executive (HSE) is making “significant changes” to address the issues with delivery of doses of the vaccine to general practices around the country.

He also said 99 per cent of the target for the vaccination of the over-85 age group has been met.

The Minister acknowledged distribution problems had caused anxiety for patients.

The director general of the HSE, Paul Reid, has said a range of new supports have been put in place by the HSE to improve distribution of vaccines to general practices.

A call centre, relationship managers and specific plans for practices too small to participate in the buddy system had all been introduced he told RTÉ Radio’s Today with Claire Byrne show. If deliveries were ramped up the HSE could cope, he said.

Generally deliveries from Pfizer and Moderna had been “consistent and good”, but if there was short notice about a delivery being cancelled “that impacts us,” he said.

The AstraZeneca delivery issue was not just for Ireland – it was a problem for Europe, he added. “We built our plans on the reliability of deliveries, we paid up front.”

Discussions were ongoing with AstraZeneca and the HSE was going to sit down with Johnson & Johnson to discuss delivery schedules for the 600,000 doses pre-ordered for the second quarter, he said.