By Michael O’Farrell – Investigations Editor
THE arrival of the first Covid-19 vaccinations into Ireland offered a hopeful new dawn for 2021.
During the current surge of cases, the vaccine represents the best hope for life returning to normal.
But even if everything goes smoothly with the Government’s planned rollout of the jab, that normality is still a long way off.
It’s entirely possible, for example, that not everyone reading this will have been inoculated by the end of this year.
If the Covid jab is a late Christmas present it’s not one ready to instil joy straight out of the wrapper.
It’s more like a frustrating jigsaw puzzle, with thousands of moving pieces, some of which are missing entirely and have to be fashioned on the hoof.
Many people, beginning with the most in need, will be vaccinated in the next six months and that will help ease some of the burden of this pandemic.
But there will be inevitable problems, delays and controversy along the way.
If 2020 was Covid hell, this year is purgatory and no one can say how long we’ll have to spend there.
Dr Tony Holohan and the HSE are acutely aware of this. He has warned that we still need to see what impact the Covid jab will have on transmission and warned that this will only become ‘known as the year progresses’.
This vital component is one of the parts of the jigsaw that’s still missing.
If vaccines don’t prevent transmission, ongoing restrictions cannot be eased at all until enough people are inoculated to achieve herd immunity.
In the meantime, there’ll be no change in the requirement to wear face masks and social distance for months to come.
Asked how long it will take to move between priority groups once vaccination begins, the head of the Government’s vaccination task force, Professor Brian MacCraith was also cautious.
‘That depends on the approval dates and the schedule of delivery from the vaccine companies,’ he said.
So how long might that be? We can look abroad to glean an indication of how fast things might go.
In the US, Operation Warp Speed, aims to get nearly all Americans vaccinated by June.
But that’s Trump-speak. Such a timeline depends on everything working seamlessly with no setbacks and an uninterrupted supply of vaccines.
And already in the US many early problems with the rollout have been encountered, with targets already missed. ‘We know that it should be better, and we’re working hard to make it better,’ Moncef Slaoui, scientific adviser of Operation Warp Speed, said on Wednesday.
Meanwhile, the UK is now vaccinating at a rate of about 41,000 doses a day. This rate will increase as more vaccines become available but at that speed it would take more than 600 days to achieve nationwide inoculation.
If Ireland – with its population of five million – was to achieve full inoculation by Christmas 2021 we would have to begin rolling out 13,698 daily doses now.
Then, since two jabs are needed weeks apart for most of the likely vaccines, we’d have to double that daily rate to more than 27,000 within a few weeks and keep it at that rate every day for a whole year.
Can we achieve that? As Taoiseach Micheál Martin told the nation this week it would be ‘an unprecedented national effort’.
That’s another way of saying; ‘We have no idea – but we have no other choice.’ In order to achieve this feat, setbacks must be minimal.
The already-approved Pfizer-BioNTech vaccine – and those on the horizon – cannot hit manufacturing delays, widespread or serious adverse reactions cannot occur and the HSE’s yet-to-be-built IT system must work without fail.
There are many other moving parts but the most vital is perhaps the supply of vaccines to Ireland. The jabs we have secured via the EU must arrive fast enough and keep coming in a coordinated fashion.
So just how fast will they arrive and how certain is the supply chain?
On St Stephen’s Day, Health Minister Stephen Donnelly welcomed the arrival of the first 9,750 doses, with Dublin grandmother Annie Lynch, 79, the first to get the jab on Tuesday, a day earlier than planned.
But now what? How quickly will enough vaccines arrive to vaccinate the bulk of the population? The answer – as a third wave takes hold – is no one can be certain.
‘The first shipment will arrive in the first week in January and it will be several tens of thousands of doses and we are expecting several tens of thousands of doses every week from then’, said Mr Donnelly.
Several tens of thousands a week sounds a long way off the 27,000 doses a day we need to already be doing to complete a roll-out within a year.
The reality is the Government can’t be sure yet what supplies will look like in a few weeks time, though the expected approval of the Moderna jab on this coming week will hopefully see more vaccines become available to Ireland.
‘Beyond that we have to see,’ Mr Donnelly conceded.
‘What we can accurately predict is the first few weeks. What we and every other European country is looking to see is what additional quantities of the Pfizer vaccine – and what quantities of the Moderna vaccine – will come in.
‘Then we and everyone else will be able to give more accurate predictions as to how quickly we can move through the prioritisation list.’
NURSING HOMES – No Quick Fix For The Most Vulnerable.
UNLESS you are a nursing home resident aged over 65, or a frontline healthcare worker engaged in direct patient contact – the arrival of vaccines is not likely to change your life dramatically before the summer.
Those older than 65, who are residents of long-term care facilities, are first in line on the Government’s priority list, since 56% of all deaths to date occurred in these settings.
So, from this month, vaccination teams will begin rolling out to the 550 nursing homes housing 30,000 residents throughout the country. There are more than 40,000 staff in these homes who are designated in the Government’s second level of priority together with all other frontline healthcare workers. But everyone is anticipating that both residents and staff will be inoculated as one – and that is what the Government is considering.
‘That’s our expectation,’ said Tadhg Daly, CEO of Nursing Homes Ireland, which represents private nursing homes.
‘If you’re coming to a home, it would make absolute sense to inoculate everybody on the one occasion,’ he said.
Nevertheless, the hope is that all nursing home occupants and staff will be covered by mid-March.
‘We’d be hoping that St Patrick’s Day might be a good timeline,’ Mr Daly told the Irish Mail on Sunday.
So much for St Patrick’s Day festivities in 2021 then.
Even if vaccination in nursing homes is completed by mid-March, it does not mean life will return to normal for those in care. We still don’t know whether or not the vaccines will prevent vaccinated residents from spreading the virus.
So while a vaccinated care facility with its own, internal herd immunity could allow residents to socialise together again, any visitors would still have to be masked and socially distant.
All going well, perhaps nursing home residents and their families will be able to celebrate St Patrick’s Day 2022.
FRONTLINE HEALTHCARE WORKERS – Supply Chain May Pose Difficulties.
HEALTHCARE workers in contact with patients have a high risk of exposure and transmission and will therefore be next in line – or vaccinated together with the nursing home sector.
Frontline health workers have been especially hard hit by Covid. In the summer, for example, 31% of all cases were among this group.
As with nursing homes these health workers are at the mercy of a supply chain that is not yet known.
‘We’ve been told that a trickle is expected first in January, and that in February it will speed up,’ Kevin Figgis from Siptu’s Health Division told the Irish Mail on Sunday.
In a stakeholder briefing on Tuesday the HSE told Siptu it expected to receive 400,000 Pfizer vaccines by the end of February – enough to vaccinate 200,000 people.
The HSE – which ultimately expects to use six different vaccines before the country is inoculated – is unable to give a figure for the expected amount of Moderna doses it will receive. It has 125,000 staff, almost 65,000 of whom work in acute patient-facing services.
There are, for example, nearly 40,000 midwives and nurses, 17,500 health and social care professionals, 18,000 health care assistants and 1,800 ambulance staff.
If the 400,000 expected Pfizer doses arrive by the end of February, as planned, they will be enough to cover all nursing homes and frontline workers – but little else.
OVER 70s & ESSENTIAL WORKERS – Getting Essential Staff The Jab Is The Easiest Part.
VACCINATING healthcare workers and those in nursing homes will, in some ways, be the easy part.
They are well-defined groups concentrated in specific locations.
Next on the list will be those aged over 70 and essential workers.
In particular, the over-70s being cared for in their own houses by home carers will be a logistical challenge.
There are more than 120,000 people aged over 80 living in their own homes, many of whom are disabled or incapacitated in some form and unable to leave without assistance.
Some 20,000 of these are cared for by private firms who are members of Home and Community Care Ireland (HCCI) – the sector’s representative body.
The HSE is planning 15 mass vaccination centres around the country and will also use GPs and pharmacies once easier-to-handle vaccines come on stream.
transport and logistical requirements needed to bring vaccination teams to tens of thousands of homes – or to bring those elderly people to vaccination centres – is something the sector is afraid the Government has not woken up to yet.
‘It’s a complicated problem to solve and I don’t see the thinking or the consultation going into how to solve it,’ said the HCCI’s Joseph Musgrave.
The CEO also pointed to a difficulty over informal carers that many families use privately to augment official care but who would not show up on any formal vaccination database.
The issue of which essential workers get priority could well be no less contentious.
Who’s more important – a Tesco worker or a soldier? A gas boiler repair technician or a bank clerk? A priest or a mortician? A tax collector or a dole clerk? The correct formula will not be straightforward and there will be lobbying from unions, interest groups and the self-entitled.
Joe Duffy’s Liveline show will hear from them all.
EDUCATION – Teachers Face A Long Wait For Their Turn.
WAY down the list – ranked 11th out of 15 priority categories – are those working in the education sector, followed by virtually everyone else.
Given the importance of schools, this low priority ranking has rankled with teacher unions, which continue to press for earlier access to the vaccine.
‘We sincerely hope you do not ignore our justifiable demand that when the Covid-19 vaccine becomes available that all those who work in our schools be included among the frontline workers to be prioritised, taking account of the prior demands of certain other cohorts, as specified above, for this vaccine,’ INTO general secretary John Boyle wrote to the Taoiseach this month.
Like nursing home residents and healthcare workers, the nation’s 100,000 teachers are a welldefined group situated in fixed locations so should not present too much of a logistical challenge.
But as with the healthcare sector, schools will have to figure out how to deal with those teachers who do not want to get vaccinated, those who may be pregnant and those with underlying health issues.
All that will have to take place amid a new extended lockdown and a new strain of the virus, said to be slightly more contagious among children.
The Government is determined to keep schools open but a new closure is not beyond reason.
Reopening after Christmas has been delayed by a week in the UK, and in the US, many school leaders have already written off 2021.
For now, as a matter of policy, the Government envisages the Leaving Certificate will take place.
There can be no guarantee of anything until we exit his purgatory.
And when might that be? None other than Luke O’Neill was cautious this week when asked just that.
‘Remember it has to be vaccines-plus for six months, because we’d be stupid to let people get sick in the six-month period,’ he said.
In the meantime, the Trinity College Dublin biochemistry professor envisages masks and hand washing will remain until ‘at least June’.
It might even be much longer until we achieve herd immunity.
‘The ultimate goal is to get rid of the damn thing, you need 80% coverage,’ said Professor O’Neill.
‘Now that’s a lot of people and that will take time. It’s a reasonable ambition and it might take a year; it might go into 2022.’
