"It wasn't a promise," the Minister for Health told Claire Byrne on RTÉ last Wednesday. "It was heavily caveated," he argued, when pushed about earlier projections that the entire population could be vaccinated by September.

A week earlier, Donnelly had told the Dáil that September was the goal, but that, too, he argued later was heavily caveated. Against an ever-shifting backdrop, concerns about the vaccine rollout, and associated political pressures, are a constant feature.

Defending his statements, Donnelly says it was important to give what information he had to the public when he could do so: “A very small number of people for political reasons have tried to characterise that as a promise.

Hospital Report

“The public understand the concept of provisional timelines and things being subject to change. They get that. I don’t know anyone who doesn’t understand that,” he says. “All of this is subject to change – and guess what? It changed.”

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A month ago 79-year-old Annie Lynch became the first person in the State to get the jab. So how likely are we to vaccinate everyone in the State who wants a jab by September – or will the caveats catch up with us?

Excesses and onus

In the beginning, there was caution about setting goals. In the last week of December, the HSE believed around 4,000 people would be inoculated by the end of of that week, rising to 20,000 per week from January 4th and between 30,000 and 40,000 per week from the week of the 11th.

Those projections held true. Since then, Ireland has averaged over 40,000 shots per week. At the start of January the strategy was conservative. Initially, for every vaccine delivered, one was kept in reserve.

As the rollout ramped up, confidence throughout the Government grew, bolstered by an agreement with Pfizer for 2.1 million doses later in the year. A Cabinet memo on January 12th talked of "substantial additional quantities of vaccine" coming "in a matter of weeks".

The onus, it hinted, now lay with the health system to get the vaccines out, rather than worrying about whether there would be enough. It even talked of how Ireland could be left with a “substantial excess” of vaccines, and whether they might be donated overseas, or given as boosters.

On January 12th, Stephen Donnelly told The Irish Times that 700,000 people – the first three cohorts of the vaccination priority list – should be vaccinated by the end of March, based on 600,000 AstraZeneca (AZ) arriving on time.

He repeated this in the Dáil that week, and the following evening, sent a note to all TDs projecting that 3.7 million doses could be available between April and the end of June, and a further 3.8 million between July and the end of September – enough to immunise 4 million people.

If there were concerns, they were couched in dry officialese – in the middle of the month, minutes from the vaccine task force meeting noted that there was a “high reliance on key assumptions holding true” in order to support the planned schedule for February and March.

Then, on January 15th, the good news came to a shuddering halt.

‘Many expletives’

Pfizer announced that it would be limiting deliveries from its Belgian plant. Initial indications were that a 50 per cent reduction would last for four weeks, which led to “many expletives” on the Irish side.

Following talks between Brussels and Pfizer, the reduction ultimately only lasted one week – with deliveries impacted in the week of January 18th. This led to only 32,760 doses being delivered to Ireland last week.

Pfizer’s news, however, was merely the beginning. Elsewhere, Donnelly flagged an attempt to get the AstraZeneca vaccine into the country early, before it was authorised, so it could be rolled out quickly - this was rebuffed by the EU, although the vaccine is now expected to arrive in the week commencing February 8th.

The storm clouds were quickly gathering. While Donnelly briefed the Cabinet on January 19th that mass vaccination centres would be ready by early February, ministers were also told there was less certainty on specific arrival times - AstraZeneca vaccines could only be expected “by mid-February”, and the “delivery schedule has not yet been finalised”.

The news on AstraZeneca got worse – significantly so. A week after Pfizer’s issues emerged, a major row erupted between AstraZeneca and the EU, given that the EU had expected between 100 million and 120 million doses by the end of March.

That figure had quietly been revised down to 80 million – but then, in a bombshell, the company told Brussels it would be shipping just 31 million doses to EU countries in the first quarter of the year, despite meeting its UK obligations.

Ireland had planned to make AstraZeneca the spine of its rollout to older people in the community. A €91 million deal had been struck with GPs and pharmacists to administer the shots. The plan had been to administer 600,000 doses by the end of March, but now only 285,000 are confirmed.

Cabinet papers show that Ministers were told last week that while AstraZeneca supplies for February are in line with what has been planned for “there is no certainty yet regarding the scale of AZ vaccine supply from March onwards”.

“The rate of completion of vaccination in of cohort 3 will depend significantly on the supply schedule of AZ vaccines from March onwards”, a cabinet memo reads.

Donnelly told The Irish Times that AstraZeneca have not “conducted themselves very well. They gave us very short notice about a very substantial reduction in an agreed delivery and it’s caused an awful lot of anguish for people in Ireland and across the EU.”

New plan

One month in, for Ireland and Europe, the vaccine programme has been challenging. Italy has threatened to sue Pfizer. Hungary has signed a deal with Russia for its Sputnik vaccine. The EU is suffering in the public mind with comparisons with the UK.

On the back of confidence about supply figures, and pressured by the dangers of a third wave, it had been decided on January 8th to accelerate to nursing homes, along abandoning the strategy of keeping a reserve dose.

The rollout in nursing homes had been slower to start – partially due to a desire to administer doses in acute hospitals first, in order to better manage any adverse reaction – but the pressure to begin was intense, especially given the speed of the third wave.

Under the new plan all residents and staff would receive their first dose by January 24th. Behind the scenes, this was to be facilitated by two things. Firstly, Pfizer delivered 70,200 doses, not the 40,950 that had been the norm.

The “repayment” of the bumper 70,000 shipment that allowed the push into nursing homes means that Ireland’s delivery volumes have been lower since- although it is worth noting that the overall deliveries will be the same.

The decision to take 26,000 doses from the buffer helped to ensure that the number of vaccinations in nursing homes leapt up. On January 13th, 70,000 shots had been given to healthcare workers, compared to just 8,000 staff and residents in care facilities.

A week later, those numbers were 73,100 and 48,800 respectively. On Wednesday just gone, 71,600 doses had been given to care homes, and 89,900 to healthcare workers - but the rate of new inoculations had slowed significantly among healthcare workers.

Only 3,000 first doses were administered in the intervening week, with the remaining 13,800 accounted for by second doses given those who were among the first to receive the jab. The consequences of this were soon felt on the ground.

In Our Lady of Lourdes Hospital, Drogheda, those working in the midwifery unit, who were helping Covid positive women give birth, were among those who had their vaccinations put back. By Wednesday 20, the Mater CEO told staff that its vaccine supplies were "exhausted".

Staff were told in a letter that “the hospital is making every effort to rapidly secure the next batch of vaccine” but “unfortunately the timelines are not within the hospital, or our vaccine clinic staff, control”.

Anger

Healthcare unions remain angry about the shift to nursing homes, with the Irish Nurses and Midwives Organisation telling members on Friday that it had clearly shared "your legitimate anger and frustration" with the HSE.

In turn, it said that “the HSE have accepted that it was not managed appropriately and have given firm commitments that they will not repeat those mistakes”. Donnelly says he understands the frustrations, but says the target to vaccinate 70,000 of them was achieved.

Donnelly now says that vaccination of care home staff and residents will be “largely done” – with two shots - by the end of February, and frontline healthcare workers largely completed by the middle of March, though this is a slippage on the end-February targets set in January.

Meanwhile, Government TDs fret. Telling the immuno-suppressed, those on transplant waiting lists, the elderly, family carers that there are no answers on when they will be immunised is politically difficult in any system – but particularly so in Ireland.

Donnelly told The Irish Times that the “main frustration” people have is the question of when they’re going to be vaccinated, by that “neither Ireland, nor any other EU member state, can give an answer to that just yet”.

January’s see-saw experience, though, may mirror the rest of the year. Setbacks are hugely demoralising for those waiting for jabs, but for those trying hard to give them out, too. “It’s about life and death,” said one involved.