Will you take it yourself?
As a GP, this is one of the questions I am asked most often. Here in the midwest we are waiting for the vaccine with a mixture of hope and trepidation. The scientists and the World Health Organisation (WHO) tell us the Covid-19 vaccines have been produced in an unprecedented spirit of worldwide co-operation. Scientists across many disciplines have shared information and these vaccines have arrived long before it would have been thought possible a year ago. But the logistics are formidable.
Was it all too fast?
Hospital Report
The scientists say no and that they have not cut any corners. Older patients are avid radio listeners and often have the latest information before I do. They realise they will be among the first in line to get the vaccine and are keenly interested in developments.
Will the GPs be giving it and will it be given in their surgeries?
I don’t know.There are many logistical difficulties .We know that the Pfizer vaccine has to be kept at a very low temperature, far lower than we have in the office vaccine fridge.When delivered it can be kept in an ordinary vaccination fridge for up to five days. Every shot has to be reconstituted before delivery,which is a painstaking job, with up five doses given at a time.There are 975 doses if we open a pack, which have to be given in a working week. The flu jab comes in individual syringes, and has minimal side-effects. Giving the Covid-19 vaccine will be a slower task. The recipient will have to come into the building, we will have to have separate exits and entrances so the people don’t mingle, keep an eye on them for 15 minutes after the injection in case they develop side-effects. Then we have to disinfect the room and do the computer entries. We will have to keep unused vaccines to a minimum. And, a small but important point, our vaccine fridges are small and usually full up before the new vaccines arrive.
GPs are excellent at identifying patient groups and delivering vaccines but vaccinating the adult population is a huge task. If we have to collate which patient comes first in the 15 categories, and who gets the Pfizer, Astra Zeneca or Moderna Vaccine, as some may work better than others for different types of patient, it will take a lot of thoughtful planning.
What about allergies?
A surprisingly large number of patients have an allergy flagged on their notes. It might be that an antibiotic gave them a gastric upset, or they cannot remember what sort of reaction happened or even the name of the drug. The latest advice is not to give the Pfizer vaccine to anyone who has had anaphylaxis.
Have the vaccines been tested in all groups?
Covid-19 infection is dangerous to those in the late stages of pregnancy.The vaccine has not been tested on pregnant women. Hopefully the R number will go down as herd immunity goes up and they will benefit from the lower level of circulating virus, but only if enough people get vaccinated. And even vaccinated people, while remaining well themselves, could still be contagious. It is simply too early to say.
How many will need to get the vaccine?
Current evidence suggests 60 per cent of the population to achieve herd immunity. There were long delays in the supply chain for the flu vaccine this year. GPs had to explain to their vulnerable groups that we were waiting for the flu jab to come in while it was being heavily advertised by the HSE. Nobody wants a repeat of that.
How long will vaccination last?
The vaccine may confer immunity for a year, five years or life – nobody knows.
Which vaccine will we get?
It may be that some are different and will be given to different age groups. GPs have learned what to do with Covid-19: the plunging oxygen levels, the use of PPE, etc. Now we will have to learn the ways of a new vaccine, in a quickly evolving situation.
What level of uptake can we expect?
The clearer the message and the smoother the delivery there will be the sooner the crisis will pass. The WHO has identified disinformation as a major difficulty in this pandemic. The Government information needs to be honest, coherent and clear.
In my office, people in the older age group and anyone I have met with a serious medical condition is keen to get the vaccine. People who deal with the public, especially the hospitality workers, are worried that it will take months to get around to them. Many of the fit and younger are wary, and say they will wait to see how the vaccinated get on, and it will be a while before they are called anyway.
I have volunteered to get the vaccine live on the Tipp Today radio show. It will be a relief to finally get vaccinated, and banish the troublesome little virus to the rare diseases section of the textbooks.
Pat Harrold is a GP in Nenagh, Co Tipperary, and an ICGP tutor