The vaccine strategy
We must inoculate as many as we can as soon as we can — and that is a big challenge for the health service, writes Luke O’Neill
‘We cannot use the prospect of vaccination as an excuse to let our guard down’
THE word ‘vaccine’ has been appearing in the media more often than at any time in human history. And for good reason. Mass vaccination is the only surefire way out of Covid-19, which is something we all so desperately want.
So where are we at? The vaccine roll-out proceeds apace. As of midnight on January 13, 77,303 vaccine doses were administered, with 69,378 of them to frontline healthcare workers. There should be 70,000 residents and staff in 589 long-term care facilities vaccinated by January 24. Beyond that, the Health Minister has said that the current plan is to vaccinate 700,000 people by the end of March. This will cover the top three groups on the prioritisation list — those in long-term residential care (staff and residents), frontline healthcare workers, and those aged over 70.
This is predicted to have a huge effect on the mortality rate — as much as a 90pc decrease. Beyond that, the plan is to vaccinate four million people by the end of September. Wake me up when September ends. GPs, pharmacists, and what are being called MVCs — Mass Vaccination Centres — will all be deployed.
All being well, Ireland will have achieved a huge level of vaccination against Covid-19, surely by Christmas. Think of that for a moment. The week before Christmas 2021 will see the announcement that the greatest number of people in the history of Ireland will have been vaccinated in less than one year.
NORMAL LIFE
A key question is: will this mean life getting back to the way it was? This will still take a few months for two reasons, although gradually things will begin to return. We’re still not fully sure that the vaccines will stop transmission of the virus. This is an important issue. It may appear odd. How can vaccines that we have heard are so great not be able to stop the virus spreading? This is because of how these vaccines work.
Your body mounts an immune response to the vaccine. That response will work especially well deep in your body. This means it will protect you from getting sick, because that only really happens when your lungs are infected, affecting your breathing. The vaccine has been injected into muscle in your arm, mobilising the immune system in your body. The trouble is, the immune troops may not make it to your nose in sufficient numbers, and so some virus might still grow there. Not enough to make you sick. But enough for you to maybe pass on the virus to someone else.
The unwanted viral guests will make it into the hallway of your house, but won’t make it as far as your kitchen to eat your food.
And they might leave your house and infect someone else’s house, and penetrate deeper if they haven’t been vaccinated, causing sickness.
We’ll therefore have to keep up with the measures we’ve all been following until we feel more confident. There can be some relaxation as the level of illness and death falls, but we would be wise to keep up with everything for the next few months. We certainly can’t use the prospect of vaccination as an excuse to let our guard down.
OPTIMISM
There is room for optimism on the issue of transmission though. Even if some virus gets into your nose, it won’t grow much and there may be some immune stragglers getting there which fight it. If you do spread it, the dose of virus coming from you will be low. This is good because it means that the person catching it won’t get sick and it might help protect them, by triggering a mild immune reaction, a bit like a vaccine.
And even better, initial reports from Israel have shown that the Pfizer/ BioNTech vaccine might decrease transmission by 33pc. Heading in the right direction, and the follow-on vaccines might be even better. Once we get to a large proportion of the population being vaccinated, anyone vaccinated who does get infected will only have mild symptoms, like the common cold, because the virus will only get as far as their noses and upper airways. In effect we might all turn into children, who when infected only have mild if any disease. If transmission is clearly blocked, that will be great as the R number will fall and spread will decrease substantially. This is especially important when the new variants are dominant, as they can spread more easily. In more vaccine news last week (it is unrelenting), signs are good that the Pfizer BioNTech vaccine works against the new variants.
All of this tells you one obvious thing. We must get as many people vaccinated as soon as we can. The first challenge is supply. The EU, our supplier, says this will not be a problem. Contracts were concluded to buy 600 million doses of the Pfizer/ BioNTech, 400 million doses of the AstraZeneca, and 160 million doses of the Moderna vaccines. All of these vaccines work. And then there are orders for vaccines still being tested: 400 million doses of the Johnson & Johnson and 405 million doses of the CureVac vaccines.
This is plenty to vaccinate everyone in Europe (population: 741.1 million). And yet the EU has been criticised for not being aggressive enough in its efforts to acquire vaccines. Germany has done a side deal with Pfizer/ BioNTech for 30 million extra doses in spite of the European Commission saying that EU countries should not ‘launch their own procedures for advance purchase of vaccines’, because the EU doesn’t want countries with less money to be left behind. A laudable goal but clearly one that Germany has disregarded, presumably because of the seriousness of the situation in Germany.
If supply becomes an issue for Ireland, my colleague Kingston Mills has made the compelling suggestion that those in a low-risk group who have been infected already might wait a few weeks. This is because of more and more evidence emerging that infection will confer substantial protection against reinfection, particularly against illness. This makes sense should the vaccine supply be an issue, which hopefully will not be the case.
Everyone is looking in awe at Israel. They secured a supply of the Pfizer/BioNTech vaccine back in November, paying a premium price. They have now vaccinated two million people and will have vaccinated 5.2 million people by March 20. They will have achieved in March what Ireland is hoping to achieve possibly by June. It would be great if Ireland could get there sooner.
Logistics is the second issue but hopefully this is also well in hand. Our aim in the coming weeks has to be to improve on this timeline.
HESITANCY
There is a third issue. Hesitancy. This is still an understandable response and the way to alleviate it is through information and reassurance. There was also criticism last week of the information campaign. This is to be rolled out extensively in the coming days and is a key element. Transparency and clarity are key here. Also, to tell the public how it’s all going by releasing the numbers of those vaccinated. The plan is to do this on a weekly basis, but I would favour daily.
Along with the grim tally of the case numbers, hospital admissions and deaths every night, why not give us the number of people vaccinated each day? Wouldn’t that give everyone a little lift, and certainly tell us that we’re making progress?
The Taoiseach has said the world will look very different in June when the vaccine roll-out is at an advanced stage. He told party colleagues this would give the Government more options when it comes to Covid-19 decisions. This can only happen if the health service delivers on the greatest challenge it has ever faced. We’ve started off well, with a vaccination rate second in Europe. Let’s keep it up.