Irish doctors do not expect reversal in plans to favour Pfizer, Moderna for over-70s

Doctors do not expect a reversal in the Government’s decision to favour the Pfizer and Moderna vaccines over the AstraZeneca jab for the over-70s despite a World Health Organisation (WHO) expert panel recommending its use in people aged 65 and older.

Chair of the GP committee of the Irish Medical Organisation (IMO), Dr Denis McCauley, said he wanted to see harder evidence to show its effectiveness among older people.

“The only thing that would change that is solid evidence that it is effective in the over-65s. The WHO statement doesn’t tell me that,” he said.

The chief medical officer Dr Tony Holohan and Minister for Health Stephen Donnelly last week backed plans to give the Pfizer and Moderna vaccines to those over 70 where practicable.

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Last month, German health authorities became the first to recommended that AstraZeneca’s Covid-19 vaccine should be not be given to those aged over 65 due to a lack of data.

But on Wednesday, scientists advising the WHO said the jab could be given to people aged 18 and above “without an upper age limit”.

Meanwhile, GPs have been told to start vaccinating people aged 85 and over but to create a list of others moving down to those aged 84, 83 and younger to those aged 70 in case people cannot attend.

The next phase of Covid-19 vaccine rollout will see GPs administer vaccines to about 490,000 people aged 70 over the coming months, beginning with about 72,000 people aged over 85.

Under the vaccination plan, doctors at about 900 practices each with more than 200 patients over 70 years of age, will vaccinate the patients in their own practices.

About 400 practices with fewer than 200 patients under 70 will be asked to send people either to a GP-run vaccine clinic in Dublin, Cork and Galway or larger GP clinic in their area.

Small GP clinics with fewer than 200 patients over 70, mainly in rural locations, are being asked to “buddy up” to a larger practice and send their patients to be vaccinated at those clinics.

In an IMO online presentation to GPs on Tuesday, it said the anticipated rollout would start with vaccine deliveries to 84 GP clinics from the start of next week.

The plan states that the first of the three GP-led vaccine clinics, at the Helix theatre at Dublin City University, will start vaccinating on February 20th taking in 121 practices across the capital.

From the following week, beginning February 22nd, 384 practices will receive deliveries for all their over 85s with the vaccine clinic at Cork Institute of Technology starting on February 27th.

The balance of the practices will receive their delivers from the first week in March.

GPs were told in the presentation that it was “critical” that there is a contingency list of patients to attend “at short notice so no vaccine is wasted.”

The plan to roll out the vaccines to the over-70s has been complicated by the decision to favour the mRNA vaccines, the Pfizer and Moderna jabs, for older people because of the lack of clinical data showing the effectiveness of the AstraZeneca vaccine on the over 65s.

Under the rollout plan, doctors will receive either the Pfizer or Modern vaccines; there will no mixing within a practice. The HSE will determine the vaccine for each practice and it will be dependent on supply.

Once delivered, the vaccines cannot be transported again. Vaccines must be used within five days, including a day for packing and delivery and four days to administer the vaccine.

The Pfizer vaccine is licensed for six doses per vial, with a minimum order of 36 doses, while the Moderna vaccine is licensed for 10 doses per vial, with a minimum order of 100 doses.

GPs have been told to identify housebound patients aged over 70 to the HSE and that suitable arrangements will be made to vaccinate these individuals once the initial rollout has started.

“No one will be left behind,” the doctors were told.

To give GPs an idea of how long vaccinations would take, the IMO used a sample practice with 250 people over 70 in its presentation and suggested that, for a first delivery of 40 doses for 40 people aged 85 and over, a four-hour one-day clinic with two vaccinators, with roughly 10 minutes assigned to each vaccination.