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Minister for Health announces the allocation strategy for COVID-19 vaccines

Minister for Health announces the allocation strategy for COVID-19 vaccines

 

Minister for Health, Stephen Donnelly TD, has today announced the allocation strategy for COVID-19 vaccines, following sign-off from Cabinet.

 

The strategy prioritises those over the age of 65 living in long-term care facilities, frontline healthcare workers who are in direct patient contact and those aged 70 and over.

The Minister also announced that there should be no barrier to people accessing a vaccine, and therefore the vaccine programme will be available free of charge to everyone in Ireland.

The COVID-19 Vaccine Allocation Strategy was based on a Department of Health and National Immunisation Advisory Committee (NIAC) paper. It sets out a provisional priority list of groups for vaccination once a safe and effective vaccine(s) has received authorisation from the European Medicines Agency (EMA). This paper was endorsed by the National Public Health Emergency Team (NPHET) on 3 December.

 

The Minister for Health said: “Recent news from vaccine developers are a beacon of hope after a very difficult year. Vaccination is a hugely effective intervention for saving lives and promoting good health. Of course, the safety and effectiveness of vaccines is our absolute priority and any COVID-19 vaccine administered in Ireland will have to be authorised by the European Medicines Agency. While we await news on whether these vaccines comply with all of the EMA’s requirements of quality, safety and efficacy, the Government has been working ahead on plans for the roll-out of vaccines.”

“A key part of the roll-out will be ensuring that those most vulnerable to COVID-19 receive vaccinations first. Given the country’s experience with COVID-19 to date and the risks that vulnerable people and those in frontline roles in the health and social care services continue to face, it is only right that they are prioritised in the allocation of vaccines. The government has followed the advice from our leading medical experts.”

Though Ireland has secured large number of doses of candidate vaccines, the initial availability will be limited if authorised for use, therefore a prioritisation strategy had to be developed.

The COVID-19 Vaccine Allocation Strategy prioritises groups based on (1) ethical principles and (2) epidemiological considerations, and takes account of the current distinctive characteristics of the COVID-19 disease, its modes of transmission, the groups and individuals most susceptible to infection and what is currently known about the candidate vaccines.  The Strategy will evolve and adapt with more detailed information on the vaccines and their effectiveness.

The Minister advised that the continued adherence to public health measures is critical to keeping the disease at bay. We will still need to protect each other by continuing to wash our hands, cover our sneezes, avoid crowded places, physically distance, and wear face coverings.

 

He said: “While some may be tempted to let their guards down now that there are vaccines on the horizon, it is crucially important to continue to follow the public health guidance. COVID-19 is still a deadly disease. Through so much hard work and sacrifice, we now have the lowest 14-day incidence rate of COVID-19 in the EU. We are in a good position, and we want to keep it like that. Please remember that every single contact counts.”

 

ENDS

Notes to the Editor

  • The COVID-19 Vaccine Allocation Strategy is available to read in full here.
  • The planning and implementation of a COVID-19 immunisation programme, if/when a safe and effective COVID-19 vaccine becomes available, is being undertaken as a matter of urgency.
  • The Allocation Framework was developed to consider how to prioritise different groups. It is based on (1) ethical principles and (2) epidemiological considerations, and takes account of the current and evolving understanding of distinctive characteristics of COVID-19 disease, its modes of transmission, the groups and individuals most susceptible to infection and the characteristics of the candidate vaccines.
  • The Allocation Framework combines ethical principles as well as equitable access with prioritisation for those most in need.
  • Four core ethical principles, namely, the moral equality of all people, minimisation of harm, fairness, and reciprocity provide a guide for prioritisation for vaccination.
  • This is a first iteration of the allocation strategy; it will be adapted as more data and evidence emerges over time on vaccine effectiveness and the epidemiology of the disease. Scientists and clinicians will continue to play a key role in determining the ongoing evolution of vaccine prioritisation to ensure their optimum use from a public health perspective.
  • The Government is committed to the timely implementation of a COVID-19 immunisation programme, as soon as one or more vaccines in the EU portfolio are approved for use. In this regard, a cross-Government High-Level Taskforce has been established to support and oversee the development and implementation of the programme.
  • The overall Strategy and Implementation Plan under development through the High-Level Taskforce will be brought by the Minister for Health for consideration of Government shortly.
  • The current companies that Advanced Purchase Agreements (APAs) have been entered into with are:

Pfizer/BioNtech

2.3m

AstraZeneca/OU

3.3m

Janssen J&J

2.2m

CureVac

To be confirmed

Moderna

0.88m

 

Provisional Vaccine Allocation Groups

 

Please note: Row 2 and Row 6 in the below table are correct as per memo agreed by cabinet.

 (The earlier appendix issued to media should not be used in reporting)

 This is the updated appendix as of 19.11 on 8th December 2020

Group

Rationale

Ethical Principles

Adults aged ≥65 years who are residents of long-term care facilities. Consider offering vaccination to all residents and staff on site.

At greatest risk of severe illness and death.

In Ireland, in the first wave of COVID-19, 56% of deaths occurred in this setting.

In line with the principle of minimising harm, vaccination of this group would protect those at greatest risk of a poor outcome from infection. It adheres to the principle of moral equality and the principle of fairness in recognising the disproportionate burden this group has carried.

Frontline healthcare workers (HCWs)* in direct patient contact roles (including vaccinators) or who risk exposure to bodily fluids or aerosols.

At very high or high risk of exposure and/or transmission. In the first wave over 30% cases were in healthcare workers.

The principle of minimising harm is realised, as benefit will accrue to healthcare workers and the patients they care for, producing a multiplier effect. Society also has a reciprocity-based duty to protect those who bear additional risks to safeguard the welfare of others.

Aged 70 and older in the following order:

85 and older

80-84

75-79

70-74

At higher risk of hospitalisation and death.

The principle of minimising harm, moral equality and fairness are relevant as this group are at greater risk of carrying disproportionate burdens from the pandemic.

Other HCWs not in direct patient contact.

Provide essential health services, protect patients.

Maintenance of healthcare services, minimises harm by preventing injury, illness and death from causes other than COVID, and the principle of reciprocity is upheld.

Aged 65-69. Prioritise those with medical conditions** which put them at high risk of severe disease.

At higher risk of hospitalisation and death.

By protecting those at greatest risk of poor outcomes from the disease the principle of minimising harm is upheld.

Key workers (to be further refined).

Providing services essential to the vaccination programme (e.g. logistical support)  

Upholds principle of minimising harm by protecting the continuing functioning of essential services. The principle of reciprocity is upheld.

Aged 18-64 years with medical conditions** which put them at high risk of severe disease.

At higher risk of hospitalisation.

By protecting those at greatest risk of poor outcomes from the disease the principle of minimising harm is upheld.

Residents of long-term care facilities aged 18-64

High risk of transmission.

The principles of moral equality and fairness are applicable, given the higher risk of exposure to infection and the potential vulnerability of some who may not be able to adequately protect their own interests.

Aged 18-64 years living working in crowded accommodation where self-isolation and social distancing is difficult to maintain.

Disadvantaged sociodemographic groups more likely to experience a higher burden of infection.

The principles of moral equality, minimising harm (especially in the context of multi-generational households) and fairness are relevant. Prioritising this group recognises that structural inequalities make some people more vulnerable than others to COVID-19

Key workers in essential jobs who cannot avoid a high risk of exposure to COVID-19. They include workers in the food supply system, public and commercial transport and other vital services

High risk of exposure as unable to work without physical distancing.

 

The principle of minimising harm is upheld by reducing societal and economic disruption and the principle of reciprocity recognises the additional risk these groups bear in order to provide essential services

Those who are essential to education and who face disease exposure -primary and second level school staff, special needs assistants, childcare workers, maintenance workers, school bus drivers etc.

To maintain the opening of full-time education of all children who have been disproportionately impacted from the pandemic.

Maintaining children’s educational and social development and facilitating parents’ employment adheres to the principle of minimising harm. The principle of reciprocity is also relevant given the potential additional risk being borne by such groups.

Aged 55-64 years.

Based on risk of hospitalisation.

The principles of moral equality, minimising harm and fairness apply.

Those in occupations important to the functioning of society, e.g., third level institutions, entertainment and goods-producing industries who work in settings where protective measures can be followed without much difficulty.

Moderate risk of exposure.

The principle of minimising harm is upheld as protecting workers needed to maintain critical infrastructure and other important services will enable social and economic activity. The principle of fairness and moral equality also apply.

Aged 18-54 years who did not have access to the vaccine in prior phases.

If evidence demonstrates the vaccine(s) prevent transmission, those aged 18-34 should be prioritised due to their increased level of social contact and role in transmission.

The principle of minimising harm is relevant should it become clear that a vaccine can impact on transmission of the virus as this would indirectly protect the most vulnerable in society as well as restore social and economic activity.

Children, adolescents up to 18 years and pregnant women (to be refined).

If evidence demonstrates safety and efficacy.

The principles of moral equality, minimising harm (if vaccines are shown to be safe and effective in these groups) and fairness

 

*Includes health care workers who work in and out of all healthcare settings

**Chronic heart disease, including hypertension with cardiac involvement; chronic respiratory disease, including asthma requiring continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission; Type 1 and 2 diabetes; chronic neurological disease; chronic kidney disease; body mass index >40; immunosuppression due to disease or treatment; chronic liver disease.