On Tuesday the letter arrived from chief medical officer Tony Holohan to those involved in rolling out the vaccine programme in the Department of Health, HSE and the High Level Vaccine Task Force. His advice was the AstraZeneca vaccine should not be used in the over-70s because of lack of proof of its efficacy.

Yet again the vaccine plan had to be revised and reshaped. We had got used to hearing about supply problems but here was another uncertainty: which vaccines could be used with which groups .

So where it is going now in the next few weeks? And what are the vaccination timelines for the months ahead? There will be a few more weeks of sweating about supply, followed by a massive ramp-up, with perhaps two million vaccinated by July or early August.

Hospital Report

The initial plan for the next few weeks , involving the rollout to the over-70s, has been reshaped by the Vaccine Task Force, chaired by Prof Brian MacCraith working with the HSE and the department.

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This will start on schedule with the over-85s in the week starting February 15th. Te time-line for completing vaccines within the wider over-70s group will now slip by a couple of weeks. However, rolling out the Pfizer and Moderna vaccines to this group will avoid the long wait for the second shot necessary with AstraZeneca. As well as efficacy, this was one of the reasons for the recommendation to not use AstraZeneca for the over-70s.

Timelines are still being finalised, but based on published numbers for supply, it appears that group could have substantially received two vaccine shots by later in April or more likely into May, though planning is difficult because only two vaccines can be used with this group now, rather than three.

The delivery of Pfizer and Moderna is more complicated due to the need for storage at very cold temperatures and their short shelf-life after they are removed from refrigeration.

Delivery plans

To combat this, delivery plans have had to be revised. Vaccines will be delivered directly to bigger GP practices and community hubs will be established where smaller practices can vaccinate their patients.

In some cases bigger practices may help out smaller GP practices, while plans are afoot to deal with people who cannot leave their home. One option for them could be the Moderna vaccine, which is more easy to administer than the Pfizer.

It will be a huge logistical exercise. The early weeks of the campaign have shown how supply shortfalls can appear out of the blue. But the picture for the first quarter is looking clearer.

Originally, it was hoped to have 1.4 million vaccines in the State by the end of March. Now 1.1 million is nailed down, but this could rise perhaps to 1.2 to 1.25 million. Perhaps even higher.

The delivery timetable for AstraZeneca supplies will be key here. They begin to arrive this weekend, with 250,000 doses due by the end of March – more than enough for first shots for the 75,000 frontline healthcare workers who have not received any jab yet.

Then, there will then be supply to spare, so vital decisions will have to be made about where this goes. Next on the priority list, as currently set out, are healthcare workers not on the front line – up to 20,000, along with nearly 200,000 people aged 65 to 69 and more than 350,000 medically vulnerable people aged 18 to 64.

A final decision on this has not yet been made. A key call will be whether it is used on the 65-69 year old age group – since the current advice against using AZ on older people deals only with those aged over 70. New research from AstraZeneca will be closely watched.

The vaccination campaign will change massively in April. Numbers will ramp up enormously, with jabs available in GPs, pharmacies, and up to nine large and more than 25 medium-sized mass vaccination centres.

Online bookings

People using this route will be able to make online bookings, using the HSE’s recently developed IT system. Vaccine supplies will quickly go over 1 million a month and will peak well above this in May/June, with monthly volume possibly reaching 1.5 million or more at peak.The vaccine schedule will need to ramp up from about 40,000 a week now to over 250,000 a week – and possibly well above that from May on.

This depends on the stability of supply, and we have seen the risks. The approval and coming on-stream of the Johnson & Johnson one-shot vaccine – now submitted for approval with the US authorities – will be vital. It could arrive here by late March or early April. Assuming the supply does arrive, the challenge beyond that will be to work through the priority groups and then the big general population groups, notably the 18-54 year old group which comes towards the end of the priority list.

No one is giving commitments on timing – not surprising given the problems in recent weeks. And exact forecasts are impossible because we are not sure yet of supply or who will be given which vaccine and what gap there will be between doses. But if you look at the number of vaccines due to come in and the size of the population, it does suggest that by the middle of the summer the programme will be well advanced into the general adult population, with a good chance of having most adults vaccinated by mid- to late September or October.

The benefit from the programme will first show up in mortality and ICU figures as the most vulnerable are covered, and later by a fall in cases. Public health experts warn that more transmissible variants mean 80 per cent of the population need to be covered to get to herd immunity, and even then caution will be needed.

If the vaccine numbers arrive and then can be got out, then we should reach the 80 per cent threshold during the summer.