The smoother the vaccine roll-out, the faster we all recover our freedoms

Eilish O'Regan

Vaccinating according to age groups is straightforward. Graphic: Getty Images

April 01 2021 02:30 AM

The overhaul of the priority list for Covid-19 vaccinations has raised suspicion that it owes more to convenience than science.

However, we are assured by experts that it is the science that has guided the change.

Vaccinating by age, however, once the most vulnerable groups have got the jab, will also make it a lot more streamlined for the HSE.

The smoother the vaccination roll-out is, the faster we can all recover our freedoms.

Undoubtedly, the risk of catching Covid-19 is higher in certain occupations. The National Immunisation Advisory Committee points to healthcare workers and meat plant staff.

However, its overall analysis is that – once those who are at greatest risk of severe illness, hospitalisation and death receive the jab – the fairest way to proceed is by descending age.

The only exceptions are for Travellers, the Roma community, the homeless and people aged 16 to 64 in long-term care.

So how was this conclusion reached?

The committee said it is accepted that vaccinating people by age, beginning with the oldest at highest risk of severe disease if they catch Covid-19, is the most “effective and efficient approach to reduce Covid-19 deaths”.

There are risk ratios which compare the rates of Covid-19-related hospitalisations, intensive care admissions and death.

The hospitalisation rate from Covid-19 is four times higher in those aged 50-54 compared to a teenager or child under 19.

It is seven times higher for 60- to 64-year-olds.

This is based on Irish data gathered here since the start of the pandemic by the Health Protection Surveillance Centre.

When it comes to a chance of ending up in intensive care, the risk is 40 times higher in the 60-64 age group and 15 times greater in people aged 50-54 versus people under 19.

They also examined deaths and found the rate of death is 70 times higher among 60- to 64-year-olds and 15 times higher in 50- to 54-year-olds when compared to young people.

The differences in the odds are sharp.

It looked at occupation risk, but once frontline healthcare workers – who have nearly all received a full dose, with around 100,000 fully protected – are taken out, the other references are scant. Workers in meat processing plants had a higher rate of hospitalisation and intensive care admission in the first wave, but this has not been seen since last November.

It concludes that there is no evidence to show a significantly increased risk of severe Covid-19 disease, independent of age and other medical conditions, in any occupational group to prioritise them for vaccination above age.

Their guidance says that the age-based system will be operationally simple.

The HSE will be spared a logistical nightmare.

The first groups for vaccination – the over-65s in long-term care, frontline healthcare staff and the over-70s – were all easy to identify and verify.

The HSE is now finding it much more difficult to identify people who are in the very high risk group, should they get Covid-19, due to underlying illness.

It is now calling on GPs to help out and use their “best efforts” to identify these patients. They are asked to help find patients with uncontrolled diabetes, obesity, chronic respiratory disease and patients with Prader-Willi syndrome.

The patients in this category number as high as 250,000. Another 380,000 people are at high risk due to underlying illness.

This is showing how tortuous the roll-out even to one particular cohort can be.

Vaccinating people according to age is much more straightforward. The big test will be how the HSE’s registration system copes and how efficient it is.

The consolation for groups like gardaí and teachers is that, if they are over 50, they benefit early on from the vaccination by age rankings.