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HSE decides not to vaccinate at-risk individuals with mRNA vaccines

mRNA vaccines will not be used to vaccinate individuals with a medical condition that puts them at very-high risk of severe disease and death from Covid-19, it has emerged.

This is despite a National Immunisation Advisory Committee (NIAC) recommendation that mRNA vaccines should be preferentially given to this group, known as cohort 4.

Explaining the decision at the HSE media briefing on 4 March, Chief Clinical Officer Dr Colm Henry said it was taken to avoid a delay in vaccinating the group, who are to begin receiving vaccinations this week.

“I discussed with Karina Butler in detail, and others in detail, and we decided that based on the clear sense of direction that we will be leaving people waiting until the over-70s were complete, and you’ve heard about the difficulties we’ve had even with the over 85s, in terms of the inconsistencies that have happened in the programme, that the earliest we would be able to make vaccine available based on expected deliveries will be mid-April. And on that basis, rather than wait till then, we decided to proceed and give them this vaccine, the AstraZeneca,” said Dr Henry.

Cohort 4 refers to those aged 16-69 with a medical condition that puts them at very-high risk of severe disease and death, such as dialysis patients,  those receiving chemotherapy for cancer and people with uncontrolled diabetes.

NIAC recommended that while any of the three currently authorised vaccines can be given to the group, mRNA vaccines should be preferentially given.

But, the committee advised, if there was going to be a delay of three weeks or more they should be allocated the Oxford/AstraZeneca vaccine.

Sources say the decision was made to use the Oxford/AstraZeneca vaccine due to a shortage in mRNA vaccines, already allocated for use among the over 70s.

A decision to provide mRNA vaccines to the group would have likely resulted in mRNA vaccines being taken from the over 70s and/or delays in the delivery of vaccines to at risk groupings.

Sources say that it is important that the vaccine strategy underway for the over 70s was not disrupted.

The ICGP has informed members that those in cohort 4 will be contacted by hospitals who will arrange their vaccination directly. 

Those aged 16 and 17 in this group cannot receive the Astra Zeneca vaccine and will instead receive an mRNA vaccine, Dr Nuala O’Connor, ICGP Covid-19 lead, clarified in an email communication to College members on 4 March.

“The hospital system will be charged with finding as many people in this group as quickly as possible from their records based on the definitions circulated,” said Dr O’Connor.

“There will be some people at very high risk that will be more difficult to contact through the acute hospitals system. The HSE is working on a plan to contact them also but the details are not worked through at this point. 

“People who are concerned do not need to do anything or contact anyone. There is no requirements for GPs to make representations on their behalf. For the moment people should wait to hear from the hospital they attend.”

Chair of the IMO GP Committee Dr Denis McCauley welcomed what he described as the “clarity provided on the vaccine plan” by the HSE. 

He said the IMO would work with the HSE on plans to vaccinate the groups, who, he said would be vaccinated in GP surgeries, hospitals and other centres. 

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