Vaccine allocation strategy retains 15 categories but reprioritises risk groups

New ‘very high risk’ group agreed for next stage of inoculation programme

A revised Covid-19 vaccine allocation strategy has been adopted by Government following recommendations from the National Immunisation Advisory Committee (NIAC), retaining 15 categories overall by age and occupational priority but sub-dividing into ‘very high risk’ and ‘high risk’ vulnerable groups.

Changing the order of vaccination rollout means people aged 16 to 69 who have a medical condition that puts them at ‘very high risk’ of severe Covid-19 disease have been assigned to a new priority vaccination group (Cohort 4).

They are next in line to be offered inoculation directly after those aged 70 or over, whose vaccinations began last week with those aged 85 and over.

Under revisions to the priority listing, the plan then moves from the new ‘Cohort 4’ to a new fifth priority group (Cohort 5) which brings in those aged between 65 and 69 whose underlying condition puts them at ‘high risk’ of severe Covid-19 disease and death.

A general age category of people between 65 and 69 has moved down to the sixth group in line for inoculation. They are to be vaccinated alongside healthcare workers, who are not in a patient-facing role, and key workers essential to the vaccine programme.

A revision to the seventh priority group (Cohort 7) brings in a younger group, aged 16 to 64 (instead of 18 to 64 in the previous December list) at ‘high risk’ of severe Covid-19 disease.

Under the revised plan, the new ‘very high risk’ fourth priority group or ‘Cohort 4’ includes very high-risk patients with cancer, chronic severe respiratory disease, chronic kidney disease, uncontrolled diabetes, chronic neurological disease; genetic diseases, inherited metabolic diseases or are severely immunocompromised.

‘Very high risk’ cancer patients include those actively receiving (and/or within 6 weeks of receiving) systemic therapy with cytotoxic chemotherapy, targeted therapy, monoclonal antibodies or immunotherapies and radical surgery or radiotherapy for lung or head and neck cancer. Also, all patients with advanced/metastatic cancers.

Other very high risk patients include those with chronic kidney disease, on dialysis, or eGFR <15 ml/min; those with chronic neurological disease or condition with evolving ventilatory failure (requiring non-invasive ventilation) e.g. motor neurone disease, spinal muscular atrophy.

Also in ‘Cohort 4’ are those with chronic severe respiratory disease e.g. severe cystic fibrosis, severe COPD or severe pulmonary fibrosis. Uncontrolled diabetes patients with e.g. HbA1C ≥58mmol/mol are included in this cohort.

Other ‘very high risk’ conditions prioritised under this group are patients severely immunocompromised due to disease or treatment e.g. transplantation: such as listed for solid organ or haematopoietic stem cell transplant (HSCT), post solid organ transplant at any time, post HSCT within 12 months.

Those with genetic diseases such as autoimmune polyendocrinopathy candidiasis ecto-dermal dystrophy (APECED); inborn errors in the interferon pathway treatment includes (but is not limited to) Cyclophosphamide, Rituximab, Alemtuzumab, Cladribine or Ocrelizumab in the last six months are included in this new priority group.

Also in ‘Cohort 4’ are those with inherited metabolic diseases which include disorders of intermediary metabolism/at risk of acute decompensation e.g. Maple Syrup Urine Disease; Down Syndrome, in addition to patients with BMI >40 Kg/m2 and those with sickle cell disease.

The National Immunisation Advisory Committee (NIAC) has recommended that, while any of the three currently authorised vaccines can be given to adults aged 16 to 69, mRNA vaccines should be preferentially given to those aged 16 to 69 years at ‘very high or high risk’ who have certain medical conditions which may limit their immune response to the vaccine.

Prof. Karina Butler, Chair of NIAC, says that the most urgent goal of the vaccination programme remained to protect individuals at highest risk of severe Covid-19 disease.

Cystic Fibrosis Ireland (CFI) has broadly welcomed the increased prioritisation for the most vulnerable people with cystic fibrosis and other medically vulnerable groups. CFI noted that “some cystic fibrosis (CF) patients will qualify for ‘Cohort 4’ vaccination prioritisation on multiple grounds as they may have CF, but they may also be waiting for or have a double lung transplant and other co-morbidities/illnesses.”

The full guide to all the provisional vaccine allocation groups can be found here.

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