Health Editor Amid the general positivity around the vaccine rollout, members of one cohort feel much aggrieved over their treatment.

Those aged 60 to 69 differ from other age groups in that, by and large, they are being administered the AstraZeneca vaccine.

This is spite of concerns over a link between the jab and very rare blood clots; indications that this shot is less effective than others; and emerging evidence that giving a second dose of an mRNA vaccine to someone who has had a first dose of AstraZeneca boosts their immunity more than a second AstraZeneca dose.

Hospital Report

It is true that all the authorised vaccines provide impressive protection against hospitalisation for all the main Covid-19 variants. The frequently-used dictum that the best vaccine you can get is the first one that comes available may also be broadly accurate.

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Yet the State’s vaccination programme has shown extreme reluctance to vary the offering to 60-somethings despite the shortcomings of the AstraZeneca vaccine. It is hard not to think this is driven by concerns over available supplies, as well as an unwillingness to make further changes to the rollout that is now proceeding relatively smoothly.

As a result many in this age group are being fully vaccinated well after much younger people. Some will see their adult children vaccinated at the same time or even before them despite being at much greater risk from infection.

And this after being left for months with one dose providing inadequate protection against the Delta variant.

Deaf ears

Germany, France, Spain, the UK, the US and many other countries allow citizens to mix their vaccine doses. German chancellor Angela Merkel opted for a second dose of Moderna to add to her first AstraZeneca shot.

Members of the 60 to 69 cohort have aired grievances to politicians and in the print media, but less so on social media, where so much of political discourse is driven these days. Their pleas have fallen on deaf ears.

Chief medical officer Dr Tony Holohan did ask the National Immunisation Advisory Committee (Niac) to look at heterologous vaccination (mixing) but last week it effectively kicked the can down the road.

And since the HSE is aiming to give all 60-69 year-olds a second shot of AstraZeneca by the middle of the month, the option of a second dose of Pfizer won't – and can't – arise.

In its letter to the Dr Holohan, dated June 28th, Niac said data from the ComCoV trial of heterologous vaccination in the UK was expected shortly. “The data from the ComCov study is awaited to inform any further recommendations regarding heterologous vaccination,” the letter stated.

Yet three days earlier ComCoV had published a study showing the mix-and-match approach appears to give good protection against the virus.

In his recommendation to Government, also on June 28th, Dr Holohan said it was Niac’s view that “until there has been an opportunity to consider clinical trial data including from the ComCoV study” people who had received a first AstraZeneca dose were “strongly recommended” to get a second dose from the same manufacturer “to ensure the earliest protection against severe Covid-19 disease”.

Green light

It appears, therefore, the research is there but just hasn’t been considered yet. In contrast, Niac gave the green light for under-50s “who wish to opt for earlier vaccination” to receive available stocks of AstraZeneca and Janssen vaccines. This is in spite of its conclusion that an mRNA vaccine is “preferable for those under 50 years of age”.

Young people are being a given a choice of vaccines, while 60- to 69-year-olds have been told to stick with AstraZeneca.

There are grounds for being cautious about mixing Covid-19 vaccines, which are being administered under emergency-use authorisations. The studies done so far are small. Proving liability could prove difficult if something goes wrong – an important consideration in Ireland’s medico-legal environment.

Yet the available evidence is encouraging, with no sign of serious side effects. And with boosters likely to be needed in future and many more products in development, we are probably going to end up mixing vaccines anyway.