The vaccines, they are coming! Imagine double-trailer freezer trucks speeding down frosty Irish motorways in the new year, carrying vaccine vials rather than cola to all parts of the country.

They – because there are several almost ready – will be a welcome sight and one that we didn’t think we’d see so soon, so there is much to be hopeful about after a bleak pandemic year.

While it will take a while for the worry of COVID-19 to recede, vaccines will hopefully bring an end to lockdowns, so they are providing great hope of a more familiar normality next year.

The situation now

Currently, in early December, the Irish Government has agreed five advance purchase agreements (APA) with pharmaceutical companies for their vaccines. These are Moderna, AstraZeneca, Janssen, BioNTech/Pfizer and CureVac.

On 1 December the cabinet signed off on the purchase of 875,000 doses of the Moderna vaccine.

A high level task force, led by Professor Brian MacCraith, has been set up to ensure that the vaccination programme is rolled out efficiently. The Defence Forces may be involved in the huge logistical challenge of rolling out the vaccine around Ireland in the new year, the Government says.

As with the swine flu jab in 2010, the State will underwrite the vaccine manufacturers against any liabilities that arise from complications with the rollout. This is to increase patient confidence and also display the Government’s confidence in the vaccines that are expected to be approved by the and the European Medicines Agency (EMA) by 12 January.

“We can start delivering within a few hours (of an approval),” BioNTech head of operations and finance Sierk Poetting said on 2 December.

The Taoiseach has said that the Government is “absolutely and wholly committed to the timely implementation of the COVID-19 immunisation programme once the vaccines are approved for us”.

The vaccine will be free and not mandatory, the Minister for Health has said. In Ireland, it is expected to be offered to care home residents, healthcare staff, the elderly and the clinically vulnerable first.

An information campaign related to the COVID-19 vaccination programme is planned, with politicians having it administered in public to bolster confidence and get the country behind it.

Britain became the first country in the world to approve the Pfizer-BioNTech COVID-19 vaccine for use on 2 December.

Almost 50 vaccines are being tested on volunteers worldwide and the Johnson & Johnson vaccine is also now being reviewed by the EMA after good preliminary results.

Any authorised vaccine will, of course, be subject to ongoing monitoring by the Health Products Regulatory Authority (HPRA).

One dose or two?

But will one dose or two be needed?

The number of doses needed will vary depending on the vaccine used. The Pfizer-BioNTech one, based on the current information, will require two doses per patient, with a gap of 21 to 28 days between each.

Storage and logistics of the roll-out

But what about the logistics of rolling-out the vaccine? The Moderna vaccine, for example, has to be stored at -70°C so it is unlikely that vaccinations could take place in doctors’ surgeries.

Kingston Mills, professor of experimental immunology at TCD, has pointed out that there are logistic hurdles to overcome.

“Ireland doesn’t have an integrated IT system between HSE, hospitals and GPs and we don’t have a patient identifier number like other countries do. This is the time to do that so that we can distribute these vaccines effectively. We have to up our game and the systems for distributing them,” he said.

Stephen Delaney of Q1 Scientific in Waterford – a storage company in the business of storing medical items like vaccines, infant formula, stents, contact lenses and inhalers – says that storage of the COVID-19 vaccines won’t be a problem.

The company currently has 52 temperature-regulated stability storage chambers in a 20,000 sq ft facility in Waterford but they have built capacity in anticipation of storage being needed for the COVID-19 vaccine.

“It was a bit tricky to do as we didn’t know what temperature the vaccines would have to be stored at,” Stephen says, “and the chambers for -25°C are very different to what you’d need for -70°C and you have to make a choice.”

Managing the distribution

While transporting the vaccines under the right conditions with dry ice is essential, the Q1 Scientific expert says that it is the expertise in managing the storage and transport of the vaccine vials that is important.

“You’d want to be working in the field for a long time because it’s going to be very pressurised, very valuable, with demand all over the country. No one wants to say that a batch of 5,000 vials can’t be used because the freezer switched off in the middle of the night or because the dry ice ran out. That’s obviously a disaster situation.

“Those doing it need to know the challenges, things like how long a dry ice transport will last or things that break in -80°C freezers. They do break, things fail, compressors break and you have to have the spare parts, know how to fix them and know what time limits you have to work within.”

Will he take the vaccine when it comes out first?

“Yes, I will of course,” he says. “When you look at the cross-demographic polls in Ireland, 75% of people are currently saying yes they will take it. It is understandable to have reservations but these companies have been working on vaccines for the last 100 years and this one is going to be no different. It’s amazing they’ve turned it around so quickly. It’s brilliant to see a bit of light coming back into the situation.”

Resumption of normal life will take some time

After the vaccine becomes widely available, the resumption of normal life will still take some time, according to Liz Canavan, assistant secretary general at the Department of the Taoiseach.

“In the interim,” she said, “while vaccine developments give us hope, it doesn’t lessen the need to stick to safe behaviours that have served us well so far.”

The head of the GP committee of the Irish Medical Organisation (IMO) has said GPs would be “ideally placed” to distribute the COVID-19 vaccine as long as it is easily transportable.

In what is a national emergency, he said that GPs are well used to giving vaccines and could vaccinate several hundred people nationwide in an afternoon.

“We’re also well placed to know the at-risk targeted groups in our communities,” he added.

For information about the WHO’s vaccine safety programme, see the WHO’s website.

How an mRNA vaccine works

An mRNA vaccine uses only the virus’s genetic code rather than producing a weakened form of the virus, as conventional vaccines do. No actual virus is therefore needed to create an mRNA vaccine. This means that the vaccine can be produced quicker.

An mRNA vaccine is injected into the body. It enters cells and tells them to create antigens (the substances that cause your immune system to produce antibodies). The immune system recognises these antigens and prepares it to fight COVID-19.

If a person gets COVID-19, antibodies and T-cells (the cells that activate and regulate the immune system) are automatically triggered to fight the virus.

The uncertainties

It is not known how long immunity from vaccines will last.

Data on how effective some vaccines are in older adults is limited.

There is very limited data on the vaccination of immunocompromised patients and women who are pregnant.

Experts say that the vaccine will be only one tool in the fight against COVID-19 and that public health measures like social distancing and hand washing will have to continue for some time.

Note about masks

Masks with exhalation valves are not recommended by the World Health Organisation (WHO).

If your mask has exhalation valves at the front or on the sides, the WHO advise against using these as they are not effective at preventing the spread of COVID-19 or any other respiratory virus.

These masks are intended for industrial workers to prevent dust and particles from being breathed in as the valve closes on inhale. However, the valve opens on exhale, making it easier to breathe but also allowing any virus to pass through the valve opening.

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