Fintan O’Toole: Those who did what they were told on vaccines now feel like eejits

The German chancellor Angela Merkel, who is 66, has just received her second dose of a coronavirus vaccine. Her first dose was AstraZeneca. Her second was Moderna. She is lucky she is not Irish.

In Oscar Wilde’s The Importance of Being Earnest, Miss Prism explains the ultimate outcome of her long sentimental novel: “The good ended happily, and the bad unhappily. That is what fiction means.”

For those of us in Ireland who are in our 60s, it feels like the Government is determined to prove that the rewards for being good are indeed fictional. This is not a wise strategy.

The message was clear: get your AstraZeneca now or you will not get vaccinated at all until the autumn, or whenever the rest of the population is done. This was Government policy: the bad (ie the Astra dodgers) will end unhappily

Being good, in this case, means doing what we were asked to do in the middle of April, which was to register for our first doses of the AstraZeneca vaccine. And in case the carrot of partial immunity was not enough, we also had a big stick waved in front of our faces.

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Simon Coveney warned us that if we tried to hang on in the hope of getting a choice of vaccines, “then you’re essentially putting yourself to the back of the queue until everybody else gets vaccinated”. Leo Varadkar reinforced the threat by scolding us that, if we were bad boys and girls and tried to hold out for a more effective mRNA dose or the one-shot Janssen vaccine, we “would have to wait until the end, and it’s not possible to know when the end would be but it wouldn’t be June or July, it would be later than that”.

The message was clear: get your AstraZeneca now or you will not get vaccinated at all until the autumn, or whenever the rest of the population is done. This was Government policy: the bad (ie the Astra dodgers) will end unhappily.

These warnings were both unnecessary and patronising. As of last week, 92 per cent of us sexagenarians had received our jabs.

But the threats were also, to be polite about it, fictions. The good have ended unhappily; the bad have been rewarded.

Almost a fortnight ago, on June 14th, pharmacies were allowed to give a Janssen shot to anyone over 50 who had not been vaccinated. No need to register – just call for an appointment, walk in and you’re done in 15 minutes.

Janssen takes 14 days to become fully effective. So if you took up this offer on the first day, you will be free and clear by Monday.

But only if you did precisely what you were warned not to do. You get this reward only if you took a gamble that Coveney and Varadkar were – again to put it politely – bluffing when they admonished that you would go to the back of the queue if you declined the offer of AstraZeneca. Your bet on political mendacity has paid out handsomely. The cynical have ended happily, the naively obedient unhappily.

Now, all of this is very annoying for those of us directly affected. It is not nice to be misled and made to feel like an eejit for doing the right thing. But so what? It isn’t the first time and it won’t be the last.

The problem, however, is the arrival of the Delta variant. It has turned the situation of people in their 60s into a serious public health issue. Before Delta, one dose of AstraZeneca gave good enough protection to those of us who have had it. But the new variant changes everything: the effectiveness of our single shot against symptomatic Covid-19 has dropped dramatically, to just 33 per cent.

This has been known for more than a full month now. It was on May 22nd that Public Health England’s scientists announced it. The Irish response to this news has been, as far as those in their 60s are concerned, both slow and limited.

There is a contradiction in the design of the overall vaccine programme. But until the Delta variant came along, it didn’t matter much.

Back in March, the programme was redesigned to make age the governing criterion for deciding who gets vaccinated first. The advice from the National Immunisation Advisory Committee (Niac) was that "the single highest risk factor remains age, and these groups should be prioritised".

This was very tough on frontline workers like teachers and guards who had been promised priority and now had it taken away. But the logic was unarguable: the older you are, the higher the risk and therefore the sooner you had to be vaccinated.

However, the subsequent decision to use the 60 to 69 age group to mop up the supplies of AstraZeneca meant that this system would soon go out of synch. Younger people who get the Pfizer or Moderna vaccines have to wait just four weeks for a second shot. The sexagenarians had to wait at least 12 weeks. So people in their 50s are now fully vaccinated, while many 69-year-olds are still waiting. The programme is no longer calibrated to age-related risk.

There is a price to be paid for this short-term convenience, however. Public trust is a precious commodity – governments squander it when they mislead citizens so blatantly

And then, with Delta, this risk hugely increased. The system had to respond to this change. It has done so without any evident sense of urgency.

The necessary response is twofold: cut the interval between the two doses and allow those who got AstraZeneca for the first one to choose Pfizer or Moderna for the second.

Most western European countries are doing both of these things. Ireland has done the first very, very slowly and is not doing the second at all.

It took almost two weeks – from May 22nd to June 4th – for the Government to respond to the news about the risk from the Delta variant and announce its intention to cut the gap between AstraZeneca doses from 12 weeks to eight. And even this is “contingent on supplies”.

Meanwhile, on June 3rd Niac actually recommended against allowing those of us who got AstraZeneca to get an mRNA jab as our second dose. This goes completely against the advice of the European Medicines Agency (EMA) and of Irish experts like Prof Luke O'Neill or Prof Kingston Mills,  who wrote this week in The Irish Times: "A recently published study from Spain showed that boosting with the Pfizer vaccine dramatically increased (45 fold) neutralising antibodies in people given one dose of the AstraZeneca vaccine. In comparison, earlier studies showed that boosting with the AstraZeneca vaccine only increased neutralising antibodies by three to sixfold."

I don’t doubt the sincerity of Niac’s advice, or of its conviction that it knows better than the EMA, Canada, France, Germany, Finland, Norway, South Korea, Spain, Sweden, Austria and other countries who are mixing doses to protect their citizens. But for those of us on the wrong end of this policy, it feels like we are being treated simply as the most convenient group, in Kingston Mills’s words, to “‘use up’ the stocks of the AstraZeneca vaccine”.

There is a price to be paid for this short-term convenience, however. Public trust is a precious commodity – governments squander it when they mislead citizens so blatantly. And if you make people feel foolish for obeying the authorities in a crisis, they will be less inclined to do so when the next one arrives.