Last Tuesday, I raised a number of issues at the Joint Committee on Health, such as the concerns about the second dose of AstraZeneca, vaccination on the islands and vaccination for the housebound.

Senator Seán Kyne

I welcome the expert witnesses. My question is similar to Deputy Durkan’s. I was contacted by a lady this morning who knows I am a member of this committee. She asked me to ask a question on behalf of her husband who is younger than 60 years and is part of the vulnerable cohort. He received the first dose of AstraZeneca and she made it quite clear that he will not take the second dose. Can he get another vaccine? I explained in the best way I could, as a layperson, the evidence relating to clotting, that there were very small numbers and a small percentage and the facts about the people who got the first dose. Her reply was that she knows the science, but that he is not taking the second dose of AstraZeneca. That is my first question.

Professor Karina Butler

First, I should point out that even after one dose of AstraZeneca vaccine, once about 21 days have elapsed, people are very well protected for at least a few months and probably longer. That is why we had the confidence in being able, for some, to stretch out that interval from 12 to 16 weeks while we got more information and protected against the severest forms of disease and hospitalisation. The good part is that the lady’s husband has already had a dose of vaccine. That is very helpful. For someone in his position in terms of his high-risk status, the risk from Covid-19 many times outweighs any potential risk associated with the vaccine. Even given his age, he is at the lower end of whatever small risk there might be.

Regarding other vaccines, there simply are no data yet, although they will be coming out, as to whether what is called a mix-match or using a different vaccine is effective or even, perhaps, advantageous. Quite simply, we do not have that data at present. Studies are taking place in the UK which are likely to report over the next month. Similarly, France and Germany, which decided to go that route, will be getting information. That information will be emerging over time. Now, however, the best advice for somebody such as that man is that he would get his second dose of AstraZeneca. He would not be scheduled yet because the second doses are not scheduled until the first week in May or so. His risk from Covid-19 far exceeds any risk related to the vaccine. All we can do is inform and try to share the information with people, but we must respect the fact that they ultimately can make decisions for themselves.

Deputy Seán Kyne

I thank Professor Butler. I will certainly pass on that message. My second question is for Dr. Henry or his team. Island residents received their first vaccination on the islands. The vaccine was delivered professionally. It was excellently co-ordinated by the Air Corps to drop vaccines to the offshore islands. People over 70 years and in some cases younger people, depending on the number of residents, were vaccinated. Will all other island residents be vaccinated in a similar manner? Will the vaccines be delivered to the islands rather than people having to come to vaccination centres on the mainland?

Dr. Colm Henry

We will be going through all other residents, as was said in previous replies, based on age cohort or underlying risk profile. We have not yet determined specific modes of administration to the offshore islands, but I can revert to the Deputy with a more definitive response on that.

Deputy Seán Kyne

The system of administering the vaccine or delivering it directly to the islands worked well and saved people who would not have transport having to come to the mainland. Perhaps Dr. Henry will revert to the committee’s secretariat with information on that.

Dr. Colm Henry

Yes.

Deputy Seán Kyne

My third question is on a matter that was touched on earlier. I have come across a 96-year-old lady who lives in sheltered housing in my constituency. There are ten others over 60 years old who are in similar accommodation. I have contacted the National Ambulance Service to try to get them vaccinated. Unfortunately, these people are falling through the cracks. They are at an age where they should have been vaccinated very early, but have not been. I am not sure where or how they are falling through the cracks. If there are other people who are housebound, is it their GPs or their families who should be making the calls to the National Ambulance Service in this case to get the vaccination?

Finally, I presume that for pharmacists and dentists who get the call to be part of the vaccination team that it would be through the portal as well. Somebody would be sent to Joe Bloggs, pharmacist, at 11 o’clock Wednesday week, for example. It will be the same type of procedure and it will be done through the portal. Similar to the vaccination centre or GPs, one would be invited to go to a certain location to receive the vaccine.

Dr. Colm Henry

I will respond briefly to the first question. As I explained earlier, for the housebound the system is working closely with the GP community, which is best placed to identify the people who cannot travel to a GP surgery for the over 70 years vaccine scheme. We have not been able to approach it with the same strict age-based incremental approach as we did with those who go to the GP surgery simply because the vaccine is a multi-dose vial. The National Ambulance Service has to deliver it and the vaccine, once reconstituted, must be used within five or six hours. Some of it is somewhat geographically based in the sense that the National Ambulance Service has to assess who needs it in a particular area and schedule the vaccinations on a particular day. It must factor into this not just the administration but also the lifespan of the vaccine after it has been reconstituted and the need to monitor the patient for at least 15 minutes after the vaccine. We urge anybody who has not yet heard to inform his or her GP. The GPs are informing us in turn of those patients who cannot go to their primary care centres for vaccination. We will leave nobody behind, and that has been our commitment from the beginning.

Mr. Damien McCallion

On the second part of the question, GPs are currently involved in vaccinating the over 70 year olds and moving on to the second dose. We have worked out agreements with the GP leadership on GPs also assisting us with regard to very high-risk and high-risk patients. As I said, we do not have national disease registries so most people with the majority of conditions, although not all of them, are known to general practice. That scheduling is done locally and through GPs. If people are in doubt about that, the HSE website gives details of the criteria for inclusion in both the very high-risk and high-risk categories. People will be called. They do not need to contact their general practitioner or hospital as they will be called through that process.

We are still working through the model of how people will be assigned to pharmacists. As stated earlier, the model for pharmacies is still being developed in the context of the technology and the operating framework. We will also have to take into consideration the vaccine types that may be available because some of those could be challenging for pharmacists. We have done an expression of interest for pharmacies in the context of the numbers involved. That will be closing out soon.. We will be running a trial over the coming weeks to see how that will work in terms of the technological solution involved and to make sure that there will be a clear framework for operating. We will make a decision on what is the best time to activate pharmacies as a channel. At the moment, we clearly do not have the supply. Some of the decisions relating to the Janssen vaccine could influence thinking as well.

Senator Seán Kyne

Does Professor Butler think there will be a requirement for booster doses later in the year or early next year or is it too early to provide an answer in that regard in the absence of sufficient data?

Professor Karina Butler

There are probably not enough data but there is a general feeling that the need for booster doses or a further dose similar to the flu vaccine is quite likely. It may not be every year. It might be every couple of years. Work is ongoing to develop a pancoronavirus vaccine, which would not be as changeable and might have a broader range of cover. It is too early to say but it is certainly possible that there might be a need for additional vaccine doses