A distinct lack of vitality in Ireland’s Covid-19 response just now sits oddly with growing international concern over the current wave of cases and the possible threat posed by the new Omicron variant.
While Covid dominates the airwaves daily, the pace of change in terms of policy or measures implemented is slow and the public debate often focuses on the trivial.
Testing is maxed out and contact tracing has been overwhelmed during the current wave of infections, while the booster programme seems stuck in second gear. Genetic sequencing, which allows new variants to be identified, was in hibernation mode until Omicron arrived last week.
Hospital Report
We have managed to flatten the curve for a bit, but cases are at such a high level that this achievement is tentative. The endless shuttling back and forth between Government and the National Public Health Emergency Team, via numerous intermediate committees, is delaying prompt decision-making and exhausting the public’s patience and morale.
Last week was the first week over 200,000 booster doses were administered. This is only about half the number of vaccine doses administered at the peak of the initial vaccine programme during the summer. This is despite the fact that supply is not an issue, the cohort groups are large, this is the second time around for the rollout and doses can now be administered in pharmacies as well as GP surgeries and vaccination centres.
Implementation times
A protracted decision-making process and lengthy implementation times have contributed to delays in the rollout of boosters. Most people have to wait six months after receiving their initial vaccine – twice the period now applied in the UK.
The head of the HSE’s testing and tracing programme, Damien McCallion, is also leading the vaccine and booster rollout – which sounds like four demanding jobs rolled into one.
Testing capacity has doubled. Demand initially seemed weak with high no-show rates, then grew as public health officials sounded the alarm over soaring cases. By last weekend, there were long queues at the Citywest vaccination centre and plenty of disgruntled people.
Janssen vaccine
The National Immunisation Advisory Committee (Niac) has amended its latest recommendation on boosters to correct earlier, clumsy wording and allow for boosters to be given to recipients of the Janssen vaccine of any age between 16 and 49 years at the same time.
But 50-59 year-olds who received a one-shot vaccine that is more prone to waning effectiveness still have to wait for a booster until they are dealt with by age category.
The 80,000 Janssen recipients in their 50s are the equivalent of the sixty-something AstraZeneca recipients in the summer – a vulnerable cohort by reason of age who have less vaccine protection than their peers.
Niac’s own paper cites research showing the vaccine effectiveness of Janssen dropping to 23 per cent after four months. Yet based on its clarification, the HSE is sticking with the age-based rollout of boosters rather than providing them to Janssen recipients after three months, as Niac also recommends.
As for genomic tracking of the virus, one day Minister for Health Stephen Donnelly was claiming Ireland ranks third in Europe for the proportion of samples sequenced. Then Ireland was identified by the EU as one of seven states that "lag behind considerably" in this "crucial dimension" of slowing the spread of Covid-19. At the time of writing, we still didn't know whether Omicron is present here.
Just a few weeks ago, the HSE’s weekly report on outbreaks said there had been two outbreaks in schools, when every school principal in the country could have contradicted this. It is long since clear that we do not have a handle on the location and spread of outbreaks, just as we didn’t track them effectively in earlier waves.
Speaking at the last Nphet meeting, chief medical officer Dr Tony Holohan argued it was not reasonable to assume the healthcare system can cope "by means of increasing capacity or scaling up test and trace activity".
“The front line of defence,” he asserted, “must remain the public’s continued adherence to basic public health measures”.
It certainly is difficult to cope when Covid-19 is in full surge but the system must keep its side of the bargain before putting the emphasis on “personal responsibility”.
It wasn’t the public that ended contact tracing in schools, or failed to restore it when needed. People have queued for hours for boosters, and waited days for tests, so they are understandably fatigued. They also struggle to understand how antigen tests have gone from “snake oil” a few months ago to preferred solution today.
Ireland’s Covid-19 response isn’t broken; it just isn’t firing on all cylinders. With the virus increasingly looking like a medium-term problem, there is a need to regain focus and to put in place structures that can deliver more effective results in the years to come.