Vaccination of the population is due to take place on the basis of 15 priority groups, starting with the most vulnerable. If, as the Government has said, it hopes to have all adults vaccinated twice by September, what might the timetable be for the different groups ?
The uncertainties of supply and the different characteristics of the vaccines mean it is not just a case of vaccinating one group and then moving on to the next. So this will be a complex programme with lower down groups starting as higher up ones wait for their second doses. With supply still not tied down, the Government has been loath to give a timetable for different groups.
However, here is what it should look like, assuming supply emerges.
First quarter – January to March:
This should see the vast bulk of groups one and two – frontline workers and over-65 in long-term residential settings – completed. The one exception is the group of frontline workers now getting their first shot. They are generally getting AstraZeneca vaccines and so they will have to wait 12 weeks for their second dose– the gap now applying to anyone undr 65 getting this vaccine.
All the over 70s – group three on the list – should have their first shot by the end of the quarter and the older age cohorts within that group will have received their second doses.
To keep the programme progressing, some other groups will have to receive their first AstraZeneca vaccine in the first quarter.
Next on the priority lists is group four, healthcare workers not in direct patient contact, of which there are some 20,000. This is followed by group five – around 200,000 people aged 65 to 69. A key call will be whether to give this latter group the AstraZeneca vaccine – remember that a decision not to give it to the over-70s meant the programme had to be reorganised. Both these groups should get started towards the end of the first quarter, depending on vaccine decisions and the state of supply.
The next two groups – key workers involved in the vaccination programme and a large group of 350,000 or more 18-64 year-olds with certain medical conditions – could also receive their first jab in quarter one, or perhaps early in quarter two.
The HSE has published a listof people who qualify under the medical conditions heading, including people with a variety of chronic illnesses and conditions including, for example, heart and respiratory disease, diabetes and cancer.
The second vaccine dates for all these groups will depend on what vaccine they get. The 12-week gap for AstraZeneca, one of the likely mainstays, means, for example, that someone getting their first shot in mid-March will wait until early June for their second. The gap between shots for other vaccines is shorter – around a month.
What could go wrong?
The main issue in the first quarter, as we have seen, is vaccine supply. Original expectations of 1.4 million vaccines in quarter one was cut to a forecast 1.1 million a few weeks ago. However, the number looks more likely to hit around 1.25 million and could edge higher.
What could go right?
It would be a boost if a Johnson&Johnson vaccine, which involves just one shot, was approved and landed before the end of the first quarter.
Second quarter - April-June:
This will be the make or break period if the September deadline is to be met. Brian MacCraith, who chairs the High Level Vaccine Taskforce, has said supply should rise to more than 1 million a month, meaning 250,000 or more vaccinations could be provided a week.
This is the key ramp-up in the programme which will require not only GPs and pharmacies but also mass vaccination centres, of which 37 are planned around the country, including nine major centres.
One of the jobs during this quarter will be giving second doses to many of the groups who got their initial shot in the first quarter. All the over 70s should be finished by early or mid-May. Of the other big groups, the 65 to 69 year olds, the people with medical conditions, and the key workers should be largely inoculated by the end of this quarter.
Many other groups should get their first shot during the earlier part of the second quarter. These include people living or working in crowded settings; key workers who cannot avoid a high-risk environment, such as those working in food supply and the transport sector; and people working in education. It is up to the Government to complete the definition of who qualifies in which group and to decide if it wants to change the order of these groups.
The next large group is about 200,000 people aged 55 to 64, who have not qualified under earlier headings . They might expect their first shot sometime in the middle of the quarter, perhaps in May.
An interesting choice will be which groups will be given give the Johnson&Johnson vaccine, assuming it gains European Union approval. It would give the opportunity to accelerate the full programme for certain groups, though the first shot of other vaccines does give some protection.
By the end of the second quarter, it would also appear necessary to start the largest group – the 1.3 million 18 to 54-year-olds in group 15. It is not clear how this will be managed, but to meet the September target a significant number will probably have had to have had their first shot by the end of quarter two.
What could go wrong?
Supply is still uncertain, though should become less of a risk as more vaccines come on stream. If there is some problem with the Johnson&Johnson vaccine that would set things back. But the vital issue in quarter two looks likely to be getting the vaccines out and rolling out a massive programme involving online sign-ups for general population groups and the necessary IT infrastructure.
What could go right?
If all the vaccines are approved and come on stream, supply looks set to significantly exceed the 1 million a month figure during the quarter, possibly rising into the 1.5 million to 2 million range in May. Then the challenge will be how many can feasibly be delivered.
Third Quarter –July to September:
If everything in on target, the third quarter will be largely a time for giving second vaccinations – or perhaps one-shot programmes with the Johnson&Johnson product if this is needed for some groups. The logistics of getting the general 18 to 54 group done will be significant. However, it does look possible to get the vast bulk of the adult population vaccinated by September, provided the supply emerges.
A decision still has to be made in relation to younger age groups – some trials are under way now internationally.
What could go wrong?
By this stage the main risk is that the programme failed to achieve enough momentum in quarter two and the targets are all slipping.
What could go right?
Strong supply and delivery might allow some sections of the population to get completed a bit sooner.