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Missteps and current inflexible vaccine protocols have caused undue delays to vaccination roll out

Published 1 year ago 30th June 2021 by Ronan Quirke

The news this week of a delay to the opening up of indoor dining and the further easing of Covid-19 related restrictions has come as a major blow to those working in the hospitality sector.

The Government is exercising an abundance of caution as a new Covid variant (the Delta strain) sweeps
across Europe. The Delta variant is highly transmissible (40- 60% more transmissible than the Alpha variant that spread over Christmas). It is also associated with an increased risk of hospitalisation. By the end of August, it is expected that 90% of all Covid cases in Europe will be from the Delta variant.

So it is hard not to feel like we are back at square one. Back to where we were in early January when
the Alpha variant was rife.

Except, we are not back at square one, we are further down the vaccination road. There will be no full lockdown in response to the Delta variant. Over 90% of our aged over 70 population are fully vaccinated. But only 36% of those aged 60-69 are fully vaccinated while 75% of those aged 50-59 are fully vaccinated. Younger age groups are pretty much unvaccinated currently. I cite the data for full vaccination rather than those given one dose as it is clear that one dose of either Pfizer, Moderna or Astra Zeneca does not provide anything like the protection that two doses of these vaccines provide against the Delta variant.

So it is now a race against the variant. A race to get two doses into as large a proportion of the population as possible before the Delta variant threatens our under 70 population. A race to reopen hospitality, a race to vaccinate third level students so that college and university campuses can reopen in the Autumn. A race to get as many of the workforce vaccinated as possible, to get people back to work and off pandemic supports. And it is a race we are losing and we have lost time because we have used the precious vaccine supply so inefficiently.

Vaccine protocols have been laid down by Government in response to expert advice from Nphet and the National Immunisation Advisory Committee (NIAC). But protocols need to be fluid and they need to be sufficiently flexible to allow health agencies respond quickly to new variants and new data. In Germany for example, their Chancellor was given her first dose of Astra Zeneca in April and at that time the protocol in place would have resulted in her getting a second Astra Zeneca vaccine 12 weeks later. But the German protocol was flexible enough to allow her receive a Moderna vaccine as her second dose in response to concerns about Astra Zeneca in general and in response to the Delta variant in particular.

Interchangeability of vaccines allows for a person with one dose to alter the course of their vaccination journey. In Ireland we are sticking with a second dose of Astra Zeneca for those who began with Astra Zeneca no matter what. The most recent advice from NIAC (published only a few days ago) states that there ‘is insufficient data on the interchangeability of Covid-19 vaccine’s and ‘the same vaccine should be used for both doses’. And that is one further reason why we are losing this race.

Fluid protocols are necessary as new data is always emerging, especially as these vaccines did not
even exist this time last year. Larger populations in the UK and the US allow us to see trends emerge and globally we learn from countries that have had faster vaccine roll outs than we have been able to achieve. For example, we learned in February of this year that the Pfizer vaccine was stable in syringes on a 30km journey by road. What this data would have allowed for, had we adapted to it, would be to centralise vaccine dose preparation and this would have maximised the number of doses that we administered and we would be much further down the road of vaccinating our under 70’s and we would have felt safer about opening up hospitality next week.

In early June, over 1.2 million doses of Pfizer vaccine arrived into Ireland. But we have not utilised this stock optimally as we could have gotten a further 63,180 doses out of these vials if a few simple alterations to protocol had been allowed. Those wasted doses for example would have helped give a first dose to half the university students in the country, a group who are at particular risk of contracting and spreading the Delta variant. In general we are drawing 6 doses out of each vial of Pfizer vaccine. The Dutch are getting 7 and a half doses out of each vial because they are using a special type of needle and syringe system that we do not use in Ireland.

These syringes are more expensive but 70,000 extra doses of vaccine would deliver an extra €1.33m worth of doses that are currently being discarded. The extra syringe cost would be in the region of €119,000 but would save ten times that amount in the cost of Pfizer vaccine.

Vaccinators in Ireland are currently not permitted to pool vaccines. The Dutch are able to get 7 and a half doses out of a vial of Pfizer vaccine so they pool vials together to maximise the doses and minimise waste. Or, if they use three vials from the same batch they are getting 22 doses rather than 18. Such practice is common across Europe and Canada but is not done here. Hence, the waste and hence, we are losing the race.

The Janssen Covid-19 vaccine is effective against the Delta variant. It only requires one dose and recipients are deemed to be fully vaccinated two weeks after receiving it. Community pharmacies have access to 60,000 doses of this vaccine for nearly two weeks now but only one tenth of these doses have been administered at the time of writing. The reason? The NIAC vaccination protocol only allows pharmacists to administer this vaccine to those aged over 50: the vast majority of whom have already started their vaccination journey with either Pfizer or Astra Zeneca or are fully vaccinated. 85% of those aged between 18-24 have received no dose of any vaccine and yet doses are sitting in pharmacy fridges unused or worse, some doses are being wasted as pharmacists struggle to get five people together to vaccinate them and thereby use a full vial. And this is the age group who are vital to the reopening of hospitability, this is the age group on whom bar and restaurant owners depend in order to run their business.

And that is why we are losing the race against the Delta variant. It is hard not to have sympathy for the hospitability sector. Some have had very little trading days in the past 450 days. As a county we learned a hard lesson in our efforts to have a ‘meaningful Christmas’. It looks increasingly likely that we might not have a ‘meaningful summer’.

The Delta variant is a huge threat to our country and our health services and we must try and mitigate its effects. But after so many missteps and current inflexible vaccine protocols we have caused undue delays to our vaccination roll out. It is time to up our game even further, if we want to be at least competitive in this race.

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