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Before vaccines, pandemics ended very differently. There was, explains a senior Irish drug industry expert, a “social end to a pandemic.” Either a virus mutated, becoming less harmful, or it brutally made its way through a population that had stopped trying to contain it.
“The Black Death didn’t end in a day, people just got fed up with staying at home,” observes the industry figure. Today, however, we are not in the fourteenth century, and society’s attitudes towards managing and ending pandemics have changed.
Covid-19 vaccines are now taking center stage, with as many as 10 expected to be approved in Ireland, arriving in a tidal wave of extraordinarily encouraging data on how effective they can be. But suppressing the virus brings new challenges.
Vaccination for Covid-19, industry experts say, is completely different than what has happened before. Every year Ireland vaccinates hundreds of thousands against the flu. However, that process is simple by comparison.
The State agrees to a tender with a company and the vaccines are transported and distributed throughout the country through general practitioners and pharmacies. There are no burdensome storage requirements, it is given in a single dose, and there is usually an ample supply.
Covid-19 vaccines are different. To begin with, there is not just one; Ireland is part of six bulk purchase contacts negotiated by the European Union, which, if the vaccines are approved, could generate more than nine million doses for the state.
“[There are] six vaccines, which may or may not all obtain authorization; if they do, they will be available at different times, [and] different vaccines may be more suitable for different populations, ”said a senior political source involved in the planning.
Hugely complex program
Everyone accepts that this vaccination program is enormously complex, different from anything before. But what does that mean? Some vaccines are based on novel technologies, specifically the messenger RNA method used by BioNTech / Pfizer and Moderna.
They should be stored at extremely low temperatures, minus 80 and minus 20 degrees respectively. Others, those made by the Belgian company Janssen and Oxford / AstraZeneca, are more traditional and can be stored at refrigerator temperature.
The latest vaccines can be “plugged into” the state’s normal vaccine distribution system: the National Cold Chain Service, administered by United Drug for the HSE. However, the first available are those requiring ultra-low temperatures: BioNtech / Pfizer and Moderna.
Pfizer says there are three options for storing your vaccine: ultra-low temperature freezers that can be stored for six months; a “thermal loader” made by Pfizer that can store doses for up to 30 days if dry ice is added every five days; or they can be stored for up to five days in normal refrigerator conditions.
Nine ultra-low temperature freezers purchased by the HSE have been delivered in recent days to boost existing cold storage. It’s enough? We will see. Even if it is, the temperamental nature of some vaccines will mean that they will have to be given to patients differently than before.
Multiple sources from both industry and the state say mass vaccination centers will be needed for super cold options, or mobile units to be shipped to install in hospitals or nursing homes. The Defense Forces may also be involved.
Who gets the vaccine first?
This week, the National Advisory Council on Immunization (CANI) prioritized hospital and nursing home workers, the elderly and people with underlying conditions in a letter to the National Public Health Emergency Team. Even within these groups, some will get the vaccine first.
There are also some “known unknowns”. Some vaccines may be more or less effective for some age groups, or for those with underlying conditions, so the state may have to adapt mid-flight. Furthermore, the government has yet to decide how much population it wants to vaccinate.
The complexity does not end there. Given the speed of development, these vaccines do not come in packaged syringes. Instead, they will come in bulk: “That raises the question of whether we have enough needles and syringes,” says a well-placed industry source.
The HSE must also train enough vaccinators, but this is more complicated than it sounds, as some vaccines require two precisely timed doses. Here, the government is confident, but some in the drug industry have doubts: “You can’t assume that people will understand,” said one executive.
Ireland also does not have a single national vaccination registry, which could complicate the administration of multiple doses, as it must be clear who received a first vaccine and when they should receive a second.
“[Today]We have no idea who gets vaccinated; we know who should do it, we know the priorities, but in general, because there are so many vaccines available, nobody cares too much. We don’t have the infrastructure that we can connect and use for the Covid vaccine, ”said one executive.
Last month, Health Minister Stephen Donnelly said the HSE was “currently” working to acquire a national immunization information system “that would be linked to regional and national immunization databases.
Such a system would be “important”, although decisions have yet to be made as to whether a fully developed system should be established prior to the immunization program, “or whether a satisfactory interim solution could be adopted.”
Such a database, sources say, would track negative reactions to vaccines between events, if they occur. And they would do it in real time, perhaps allowing other people to be treated with different vaccines if problems arise.
Meanwhile, there is the question of compensating those who react badly to a vaccine, if there is one. While there’s no reason to expect a higher number than usual, the publicity surrounding the launch is likely to spur claims.
The government, say a multitude of sources, now needs to introduce its promised no-fault compensation plan before such claims materialize, or else it risks spending years and tens of millions of euros bogged down in litigation.
The opposition in the Oireachtas is aware of these weaknesses. “We still use graphics in hospitals, so how are we going to make sure that we can handle every human being in this country? [for vaccination]Labor leader Alan Kelly said during the week.
Brexi
As The Irish Times reported on Friday, the issue of Brexit has also been raised extensively with drugmakers by the Departments of Transport and Health, concerned about the impact of potentially losing the land bridge in the UK.
All of these issues, and more, are being examined by the state’s Covid-19 task force, led by Professor Brian MacCraith. A wide variety of state agencies are represented on it, from HSE to Defense Forces and IDA Ireland, with the support of external logistics experts.
Although the task force has been at the center of the headlines, the HSE National Immunization Office and the independent NIAC are key players, concentrating on supply chain logistics, staffing, monitoring and reporting. reporting and information technology.
HSE’s procurement office, led by Sean Brosnan, will play a key role, alongside senior HSE officials such as Deputy Director of Emergency Management Tom McGuinness, Director of Community Operations David Walsh and Dr. Lorraine Doherty, Clinical Director. National Health Protection.
Given the unprecedented public attention to the launch and the complexity of the mobilization required, political pressure is inevitable. Kelly has already called for the appointment of a directly responsible cabinet minister.
Errors or delays are likely to come at a high political price. “This is not something we can be laissez-faire about,” Kelly said. “Everything has come much faster. We cannot have hesitations here, ”he said. “This needs to be dealt with executive, quickly.”
Under massive pressure, in the face of a new threat and an equally novel solution, state systems for planning and managing mass immunization programs must be tested like never before.
Having battled the disease, is Ireland ready for the vaccine?
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