The Covid-19 vaccination plan has taken another twist.
his time it comes as the nation becomes increasingly anxious and impatient to get a jab as we take the first big steps out of lockdown. A Covid-19 jab also opens the way to a vaccine bonus with more signs about the possibility of restarting foreign travel some time in summer.
The proposed revamped plan, which is still under discussion with the Department of Health, has some old and new elements which will affect how soon people will get a jab and also change the type of vaccine they will get.
Age before youth
At the centre of the new plan is a decision to proceed down the queue for vaccines based on age. People in their 60s who registered over the past two weeks are now being invited for a vaccine.
From today, people in their 50s can apply, beginning with those aged 59 yesterday, working its way down by each year over the coming days. Both these age groups are vulnerable to serious illness if they get Covid-19.
The reason for the overhaul of the plan is due to recent decisions by the National Immunisation Advisory Committee (Niac) which assessed the one-jab Johnson & Johnson vaccine. This was in light of a very small risk of a rare blood clot. It recommended it be confined to people over 50.
It looked again at the AstraZeneca vaccine, also linked to a small risk of blood clots, and said its previous decision to confine it to over-60s should change. It could also be given to people in their 50s. It meant these two vaccines could not be given to people under 50.
The question was: should the HSE just give the AstraZeneca and Johnson & Johnson vaccines to people in their 50s and 60s, administering the Pfizer and Moderna vaccines to the under 50s?
There are no neat solutions to vaccine roll-out and it all comes back to supply. If the HSE decided to confine people in their 50s to the Johnson & Johnson vaccine alone, it could have been well into June because they got the substantial delivery of the 600,000 doses promised this quarter. That would leave a vulnerable age group waiting. In the meantime, supplies of Pfizer, Moderna and hopefully AstraZeneca vaccines will be arriving.
Should people in their 50s be asked to wait while the HSE started vaccinating people in their 40s or 30s before them with Pfizer and Moderna jabs?
Mixing it up
The new plan will see much more flexible use of vaccines. The rules about confining AstraZeneca and Johnson & Johnson vaccines to the over-50s are likely to be relaxed. The HSE plans to offer the other vaccines based on availability.
So people in their 50s can also be offered the Pfizer or Moderna vaccines. It means people in their 50s will not face any extended delay they might have encountered if they had to wait for supplies of Johnson & Johnson in June.
Next in queue
After people in their 50s are vaccinated, the portal will open to those in their 40s and then proceed to the younger age groups.
What makes the new plan different for the under-50s is that they may be offered the vaccines that are available. None will be off limits. They include the AstraZeneca or Johnson & Johnson vaccines, which Niac advised be confined to over-50s. It pointed out that the benefits of the vaccines outweigh the extremely low risks of unusual blood clots.
It allows for use of the vaccines in the under-50s where alternatives were not available.
In the UK, the cut-off for the AstraZeneca vaccine is under 30. That might still apply here and a recent report from the European Medicines Agency (EMA) on the risk versus benefit of getting AstraZeneca in people in their 30s and younger may include some restrictions.
Much depends on expected deliveries arriving here over May and June.