The National Immunisation Advisory Committee (Niac) has issued new advice on the Janssen (Johnson & Johnson) and AstraZeneca Covid-19 vaccines. In principle, it has cleared them for use among people aged 40-49, but it is not quite that straightforward.
The advice is believed to have three important elements: the vaccines can be given to people aged 40-49 if they consent (having had the risks explained to them); if no mRNA (Pfizer-bioNtech/Moderna) vaccines are available; and people are permitted to reject the vaccines and wait for an mRNA shot.
What are the risk factors ?
Both the Janssen and AstraZeneca vaccines have been associated with very rare but serious blood clots in an extremely small number of cases involving people aged under 60, mainly women. The European Medicines Agency has said the benefits of both vaccines in preventing Covid-19 outweigh the risks of side effects.
What does it all mean?
Because the advice is not straightforward, the Health Service Executive is currently trying to figure out its impact. Accommodating those three factors – choice, availability and consent – is tricky. For example, if you choose to wait for another vaccine, how long will it take? How is that handled administratively? What exactly is meant by “availability” of mRNA vaccines? How will a higher standard of consent be obtained, and will this impact uptake among those offered these vaccines? We don’t know the answers.
How pressing is this?
It is not immediately urgent. Answers are more important for Janssen than for AstraZeneca, as much of the latter vaccine deliveries are earmarked as second doses. The big volumes of Janssen won’t arrive until probably the second half of next month. It is understood there are 45,000 in stock, and that 130,000 more will be delivered by the end of May. And upwards of 450,000 are due in June, probably weighted towards the end of the month. That might give time to figure out answers.
What might a solution look like?
One idea is to give these vaccines out in a dedicated channel – through pharmacies, for example, perhaps with a dedicated sign-up system. Making these vaccines available in just one setting would probably make it easier to comply with the consent, availability and choice issues, as people could give informed consent on arrival or when signing up. Also, in going to a specific setting where only these vaccines were available, people would in effect be saying that they don’t reject them.
Will that happen?
Hard to say. Another, perhaps more fundamental issue, is the amount of eligible arms to receive one of these vaccines. For the time being, 45-49 year-olds will be vaccinated under the current programme and they’ll be given largely mRNA vaccines. Many hundreds of thousands of people in their 40s may already be vaccinated by the time the big Janssen shipments arrive in June, meaning we may not be able to use them all. This reintroduces the prospect of lots of unused vaccines in fridges.
Is there any way around this?
Privately, some senior sources believe ditching the structured, age-based approach as vaccines flood into the country in June may be best. Opening the vaccine booking portal to all-comers next month, allowing people to judge the risks for themselves under certain circumstances, could lead to huge numbers signing up, attracted by the vaccine bonus in the shape of summer festivals, or later, travel. However, whether such an approach would get regulatory approval is unclear.
Another option would be that people in their 40s are asked to wait while Pfizer stocks are given to younger people. They would be given Janssen when it came in. A similar approach was decided against recently, so again, this is tricky.
What does this mean for targets?
If significant proportions of the Janssen vaccine go unused, the target to cover 55 per cent of the population by June entirely will be extremely difficult. Senior sources believe hitting the 82 per cent target will also be “very hard” – but current bumper levels of Pfizer deliveries may help.