If the push/pull of lockdowns and reopenings dominated the first year of the coronavirus pandemic, vaccines and variants will preoccupy the public and the State in the second.

Even with ambitious projections for mass inoculation, the Government last week raised concerns in its plan for the next phase of the pandemic about public fatigue with lockdowns, more infectious and potentially dangerous variants, and the effectiveness, supply and uptake of vaccines.

A paragraph in the latest Covid-19 plan on what might be facing us next autumn and winter was particularly worrying, with the Government conceding that even when a significant majority are vaccinated, there remain “real risks” that the same challenges will continue to emerge.

Hospital Report

The plan notes the unknown impact of vaccines on transmission and uncertainty around variants. It warns there could be increased transmission due to indoor mixing in poorly ventilated spaces which could lead to more respiratory illness and “a double pressure” on the health service.

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It was a bleak but frank assessment, coming days before the one-year anniversary of the first Irish Covid-19 case, that year two of the pandemic could be tough.

"Vaccination will do an enormous amount, but we are just so dependent on getting a grip on the pandemic across the world because, as variants continue to emerge, it is extremely possible some will render vaccinations potentially ineffective," said public health expert Dr Gabriel Scally.

Variant complexity

Any reduction in the spread of the infections that could come from a speedier rollout of vaccines will help, but this is dependent on increased supply of three vaccines authorised for use in Ireland and approval for new vaccines such as the one-shot Johnson & Johnson jab.

"It gets more complicated now because we have these new variants to worry about and we have the vaccine supply chain to worry about," said Prof Luke O'Neill, immunologist at Trinity College Dublin. "Those would be the two things I would be worried about if I was the Taoiseach."

The arrival of South African, Brazilian and Nigerian variants has heaped further pressure on the Government to get the proposed mandatory hotel quarantine regime up and running as quickly as possible. Travel and the absence of mandatory restrictions taught lessons in the pandemic’s first year as the more infectious UK strain made the third wave the most devastating.

It will be even more important this year, according to infectious diseases consultant and UCD professor Paddy Mallon, who describes 2021 as "the year of the variant".

“Not only is it important we don’t reseed the country with new viruses that could cause a fourth wave, but the variants we may introduce next time around may also threaten our vaccine programme, and that could just make our whole control strategy even more difficult,” he said.

The State inevitably has to step up its response against these year-two threats.

Health workforce

Minister for Health Stephen Donnelly said he had sanctioned a doubling of the public health workforce – the biggest expansion in its history – though he accepts much more are needed.

The State is increasing capacity on genome sequencing to be able to identify and detect new variants. Contact tracing will be strengthened, to investigate retrospectively and to include locations of infections. Rapid antigen testing is likely to be used in new situations to identify and prevent the spread of asymptomatic infections.

After the first year of the pandemic, Donnelly feels that ways need to be found to help staff across the health system already exhausted by the experience of dealing with three Covid-19 waves.

“We need to figure a way of giving them a bit of a break,” he said.

Health Service Executive chief executive Paul Reid believes there will have to be a wider response in year two. "The public service will be required to mobilise and work together in a way I haven't seen before."

Beyond Ireland in year two of the pandemic, O'Neill sees a scenario where Europe could be a "green zone" where every country is heavily vaccinated and travel is controlled between European "green countries".

“That should be the case a year from now or else something has gone badly wrong,” he said.

Tomás Ryan, associate professor at the school of biochemistry and immunology at Trinity College Dublin, says “the trick” over the coming year is to ensure the State’s vaccination programme and disease surveillance is “always ahead of the virus”.

“If we keep playing catch-up, then the pandemic and the virus keep evolving, and the pandemic will keep being prolonged.”