The Government's decision not to make the AstraZeneca vaccine available as a matter of course for over-70s and instead to prefer the Pfizer and Moderna vaccines for use in that age group has sent health officials scrambling to revise the immunisation programme against Covid-19. But while the move will disrupt planning and extend the timetable by a few weeks, it was the right decision. Data from AstraZeneca's trials does not suggest its product is ineffective in older people, as Emmanuel Macron irresponsibly suggested this week, but those trials contained too few older participants to draw definitive conclusions on its efficacy levels. The European Medicines Agency was happy to approve the vaccine for use by all adults and expects it to protect older people given that it produces an immune response in all age groups and based on experience with other vaccines.
Some states, including Ireland, have nonetheless taken a cautious approach. By reserving for the most vulnerable groups the vaccines that we already know are highly effective for older people, it will help boost confidence in the vaccination programme among older citizens in particular. With a typical interval of 9-12 weeks between AstraZeneca doses, the new plan means over-70s will not have as long to wait between jabs.
The authorities now have two important decisions to make – and then implement at speed. The first is to work out who should receive the tens of thousands of AstraZeneca vaccines that will begin to arrive in the coming days. At the top of the queue should be those healthcare workers who have not yet had their jabs. But the Government should then use the extra supply to prioritise those under-70s who are designated extremely vulnerable by the HSE. These include people with cystic fibrosis or who are post-transplant, on dialysis or having chemotherapy. People in this category have an equivalent or higher risk of hospitalisation as over-70s, so it would seem odd to vaccinate a healthy 65-year-old ahead of them.
The second urgent decision is how to get the Pfizer and Moderna vaccines, which are harder to store and transport, to the over-70s. GPs will be central to that effort, whether from their own practices or from larger hubs. But big challenges await, not least reaching those with limited mobility and ensuring any hubs or vaccination centres are safe places for vulnerable people to gather.
It is far too early to relax. Hospitals are still full of Covid-19 patients, people are dying every day and case numbers are too high for comfort. But the new month has brought a more positive outlook. Real progress is being made in suppressing the virus, the vaccine rollout is proceeding steadily and by April, barring unforeseen problems, the picture should look a lot brighter, with most over-70s vaccinated and supplies arriving in much larger volumes every week.