We can’t afford to allow vaccine rollout to turn into an arena for playing politics
IRELAND tops the league in the European Union for the rate of our Covid-19 vaccine rollout – but a closer look shows this may be a cause for concern and not celebration. By tomorrow, 140,000 people will have received the first dose of the vaccine. These have been split almost down the middle between those given in hospitals and those in long-term care facilities.
And while everyone is suffering during the pandemic, it is the healthcare workers manning the front line who have sacrificed the most.
Bernie Waterhouse, clinical nurse manager at St James’s Hospital in Dublin, became the first healthcare worker to be given the second dose of the Pfizer/ BioNTech vaccine this week.
She gave a harrowing insight into life on the front line.
‘They deteriorate quickly, they go to ICU quickly and they die quickly,’ she said.
The vivid imagery of life on a Covid ward, where staff send a video feed of dying patients to their families who cannot join them, is bleak.
And the horror is deepened by the realities faced by those who work there.
It doesn’t stop when they finish their shift. Many frontline workers fear they may pass the virus on to vulnerable loved ones at home.
Ms Waterhouse described how some nurses living at home with their parents have avoided contact with them for months on end, for fear they may have the virus and umwittingly pass it on.
They are deemed to be the most high-risk group in the hospital and it is because of this that they are at the top of the sequencing order when it comes to vaccines, followed by paramedics.
Residents aged over 65 in long-term care facilities, where more than half of all deaths have occurred, are on the top of the prioritisation list.
The decision was made to roll out the vaccine to both hospital and care home settings in tandem.
Despite the adulation over the widely shared league table for vaccinations per head of the population, revealed by Minister for Health Stephen Donnelly, there are still unvaccinated healthcare workers going into Covid-19 wards, and paramedics who have also not been vaccinated, who are picking up Covidpositive patients.
If they have not received the vaccine at this point they will not receive it until February 5 at the very earliest, as supply runs dry.
It is important to look at how this happened, rather than cheer at deceptive headline figures that will be meaningless to those risking their lives daily.
Vaccinations started in our hospitals on December 29, slowly at first, due to short supply, and ramped up the following week.
Hospitals and nursing homes should, in theory, be the easiest to vaccinate. In reality the management of the rollout locally has fallen short of expectations.
The high-profile cases of ten builders at Kerry University Hospital getting vaccinated as well as family members of staff at the Coombe and Rotunda hospitals being vaccinated sparked nationwide fury.
While it has rightly sparked anger that family members of staff not in the top priority order should receive the vaccine, I would argue that the greater outrage has gone under the radar.
The sequencing – that is the order in which different cohorts of our healthcare workers are due to get the vaccine – appears to have been abandoned. No data is provided on who within the hospitals has been vaccinated, though Labour Party TD Duncan Smith received a reassurance from Mr Donnelly on Thursday that this data will be published.
What we do know is that the CEO of St Vincent’s Hospital, admin staff in at least seven hospitals and some retired staff at Cork University Hospital (CUH) have all been vaccinated. CUH undertook a plan to ‘vaccinate all staff’ rather than look outside of the hospital to see if those who work in the most-at-risk settings needed the vaccine.
A note circulated to all hospital managers on January 12, by chief clinical officer of the HSE Dr Colm Henry, and obtained by this newspaper, shows that this is what was intended. ‘Every effort should be made to ensure that vaccines should be made available to frontline healthcare workers in order of sequencing rather than given primarily to people later in the sequence who work in the institution that host the vaccination centre,’ he wrote. The note highlights issues of ‘geographical equity and equity of access for people who... do not work at large [vaccination] centres.’ On Thursday, in response to a question from this newspaper, Dr Henry said time constraints meant that in practice this wasn’t possible. ‘If there wasn’t the pressure of time, you’d put together a plan where you would equally apply the vaccine in all settings at the same time going through all priority networks; there isn’t time to do that,’ he said. This is difficult to understand, given the length of time we waited eagerly to receive the vaccine. It also does not appear that some hospitals even made an effort. Staff at Nenagh Hospital in Co. Tipperary, who made a plea to the Government via a social media video, for vaccines to be delivered to the hospital, have said that they were not contacted to be put on any stand-by lists.
Similarly, as reported by this newspaper today, when there were excess doses at the mass vaccination centre last weekend in the Phoenix Park, 16 administrative staff with the National Ambulance Service received the vaccine while only ‘a handful’ of Dublin Fire Brigade (DFB) paramedics were given the jab.
To compound these initial ‘teething problems,’ as they have been generously described, a major political decision caused further chaos. On January 8, Mr Donnelly announced that he was accelerating the rollout of the vaccine to nursing homes.
Like any complex system, it cannot be tampered with on a whim without their being major consequences. The move by Mr Donnelly, who is ultimately responsible for the rollout, directly led to the cancellation of vaccination appointments for frontline staff. The acceleration also required using a large portion of the one-week buffer (reserve) supply.
This newspaper reported that paramedics with DFB had their appointments cancelled last week, as did frontline workers at Our Lady of Lourdes Hospital in
Drogheda, Co. Louth.
After initial denials by the HSE and Minister Donnelly, the consequences were finally confirmed by HSE chief executive Paul Reid on Thursday.
The argument is not that we needed to ignore nursing homes in favour of frontline hospital staff. The crucial point is that if hospitals knew their supply was going to stop last week, they would have been much more frugal, you would hope, with the vaccine, and ensured those who most needed it in their hospitals at least would have been vaccinated.
Mr Donnelly said he had received ‘reassurances’ from Pfizer on supply, when justifying the move to dip into the buffer supply.
Pfizer sources told the Irish Daily Mail, at the time, that ‘no new guarantee’ had been given on supply. A week after the announcement, Pfizer said there would be a slowdown in production that has led to 20,000 fewer doses (50%) being delivered next week.
Last week, the recommended time between the first and second dose changed from 21 days to between 21 and 28 days.
If this had not happened, it is likely that some second doses would have been delayed because of the move.
To compound matters, the target to complete all long-term care facilities will be missed, and by some distance.
A total of 78 facilities with 6,550 residents and staff will need to be vaccinated next week.
Amid the difficulty of managing this mammoth logistical challenge, some within the political system felt they had justifiable cause to meddle in the rollout.
With depressing predictability, a Fianna Fáil minister and some party colleagues expressed the view that they should be able to influence who got the vaccine.
Asked if it was appropriate for politicians to interfere in the rollout, Fianna Fail TD for Tipperary Jackie Cahill said: ‘That’s the name of politics, the squeaky hinge gets the most oil.’
Darragh O’Brien, the Minister for Housing, declared: ‘I personally contacted the HSE, the Department of Health and Minis
They will now not get the jab until February 5 ‘All efforts should be made’ to get it to frontline staff
ter for Health to ensure remaining vaccinations for Dublin Fire Brigade are undertaken.’ He added that he was informed that it would happen in the coming days.
Fianna Fail TD for Dublin NorthWest Paul McAuliffe asserted that it should be a Government-led and not a clinician-led decision.
‘At the end of the day, Government makes decisions and, as per any other element, of course there will be representations made, but overall, I would agree with the approach to follow the guidance from the HSE and the NIAC.’
The revelations in this newspaper led to vitriol from some Fianna Fáil supporters. It also led to an ‘unapologetic’ response from Mr O’Brien, who contacted Mr Reid directly, saying his actions were justified as the DFB is under his department’s remit.
The substance of the story was lost on some within Fianna Fáil, who took to launching unbecoming and baseless insults at this newspaper on social media.
They failed to understand that the story was not about getting vaccinations for frontline paramedics, who of course should have been vaccinated.
It was about showing that senior figures in Government felt they could interfere with the process, and that this would set a precedent for wider abuse throughout the vaccine rollout
Ultimately Mr O’Brien lost on all
Forced to defend his self-claimed interference
fronts. He was forced to defend his self-claimed interference with the vaccine rollout, only for Mr Reid and Mr Donnelly to forcefully proclaim that there would be no political interference.
On top of that, the impression he gave, that he had ensured vaccinations would take place this week for DFB paramedics, also did not materialise.
New vaccinations for healthcare workers outside of care homes will not take place until February 5 at the earliest. The rollout is challenging enough for clinicians without the cynical desire to play politics with it.