Public participation in Vaccine Preparedness Plans as a Respite to Lockdown: Is Ireland Ready?

October 20, 2020

By Key Correspondent with the Irish Global Health Network, Dr. Sebastian Kevany, MA MPH PhD

There is no way that Ireland, like so many other small countries, could have been expected to lead the way in vaccine research.  Irish innovations in contemporary epidemic responses have been limited to social and behavioral interventions, many of which have both functioned well in the Irish setting and inspired others — even if sometimes difficult to export to other countries without adaptation. 

Despite this, it is the responsibility of Ireland, as it is with every country around the world, to be fully prepared for vaccine rollout when the time comes.  To date, there has been little evidence of the government’s preparedness in this respect, even though the country has now clearly decided to adopt a ‘hold-your-breath’ approach and wait for vaccines – rather than attempting normal societal functioning under the new status quo, Sweden-style.

Ireland has instead, perhaps, been forced in to a vaccine orientation as a price for two critical limitations: pre-existing public health demands, including those imposed by alcohol, smoking, and sedentary lifestyles; and the failure of successive governments to strengthen the public health system.  Neither of these can be addressed in the short term. 

Yet there are, currently, a range of preparatory activities that Ireland can undertake to make sure the country is prepared for vaccine roll-out.  It would, perhaps, be far better to have these in place — and the subject of public debate — in advance of any vaccine announcements rather than choosing to wait for medicine development and approval before beginning this challenging, complex, and large-scale process.

Simple Initial Paradigms

A straightforward place to begin, however, would be with target populations.  Most would agree that vaccine roll-out should, ethically and otherwise, first focus on those populations most at risk of severe illness.  These include those in older age brackets, those with underlying conditions, and other vulnerable groups.  Either in concert with those target demographics, or possibly preceding it, the needs and risks faced by health care workers will be a priority.

A second straightforward consideration is in terms of spatial dynamics: it may be fair to suggest that those counties, and areas within counties, that have been most highly-affected should be vaccinated as a priority.  Similarly, those counties and sub-county areas that have been least affected might be considered better protected until later in the process — without compromising ethical or equity standards — if needs be.

Licensing, supply chains, and production capacity are all considerations that will have to be negotiated by the government – as well as the cost of the effort.  All of these will require planning, regulation, and possibly even legislation (should vaccine uptake be considered, even enforced, in the legal context?): if left to the last minute, these issues could add months to the roll-out effort.  Similarly, it is by no means too soon to consider the production and use of certificates of vaccination (e.g. for use when attending sporting or other events).  Adverse event reporting will also play a key part in the early stages of any such roll-out, even after such processes have been competed at the clinical trial level. 

The potential networks of vaccine centers should also be carefully considered: it may be fair to assume that Ireland will, as with the influenza vaccine, focus its supply efforts on general practitioners, and selected chemists, for general availability.  Yet will this, one wonders, be enough?  There may be a need, under such extraordinary circumstances, for government to consider other options: extending availability to all chemists and pharmacists; door-to-door services; and even pop-up vaccination centers (using the same model as for existing testing centers).  Cost-effectiveness will, of course, be a key consideration in this regard.

Setting the Tone

In Ireland, as in many other countries, there is also an urgent and contemporary need to combat fear, disinformation and suspicion surrounding vaccines.  In other countries, inappropriate and misguided suspicion that vaccine development had been manipulated for political or electoral gains has already both threatened to delay the process and eroded public trust.  This parallel fake-news and media-driven epidemic of fear and suspicion will undoubtedly affect uptake, and should to be addressed by government through public information campaigns, and other measures, far in advance of actual medical roll-out.

We have already experienced the negative effects of too much guardedness and pessimism in the face of the virus: only six months ago, many experts, and at times the World Health Organization itself, failed to recommend the use of face masks to prevent infection.  In the same way, there is the risk that related negativity and guardedness around vaccines may inhibit or delay such processes unnecessarily. Of course there are going to be risks with vaccines, just as there are with face masks – but society has to be willing to accept some form of risk for the common good, as well.

The European Union Can’t Do Everything For Ireland

Vaccine preparedness policies and represent a unique opportunity for Ireland to be at the fore in the European Union context in this regard.  Despite the reassurance of EU presence and related ECDC directives, there is still a high degree of autonomy in national level decision-making — one that should, rightly, be maintained — and it may yet be possible for Ireland to help to lead related processes at the EU as well as the national level. 

In this context, it has been unfortunate to see the country resort to the blunt (and worryingly authoritarian) employment of the police force, once again, for epidemic control, rather than adopt other more innovative, civilized, and creative measures.  By contrast, a good vaccine preparedness plan will mean that Ireland is leading the way in terms of creative, just, and effective responses: in that way, something also would undoubtedly be given back to other EU actors and international partners.  Ireland must not forget that the EU is a union, rather than a governing body, and it is the responsibility of each member state to contribute to the well-being of the whole — as well as benefitting from it.

Optimism through Structure

But this isn’t all about supranational politics: in terms of social, societal, and community-level morale — and other dimensions of health — as winter approaches, it is important for Irish society to have clear potential targets mapped out in terms of vaccine efforts – even if, in the final reckoning, these need to be pushed back.  Without such a temporal-chronological-psychological framework, the risks of low morale associated with potentially unlimited lockdowns could be a high one.

Without a vaccine orientation, Ireland also faces, like many other countries, the risk of Stockholm Syndromes as both government, and certain elements of society risk becoming overly-comfortable with the social control that comes with lockdowns.  Even if vaccines are still months away, people need hope in the form of targets, timelines, and structures.  Would Sir Ernest Shackleton’s men, at the South Pole, have survived their winter had they not had rescue firmly set in the consciousness: would they have managed, had they not been ready — every day — for rescue, and expected it to happen? 

Of course not: in this way, as well, adherence and compliance to current prevention and containment measures will undoubtedly improve if they become framed as short-to medium term emergency efforts, rather than long-term impositions.  Likewise, the Irish civil society voice, which has been muted in the absence of lobbying, marches, and other forms of protest, has been muted, with only journalists, politicians, and academics now in control of the narrative.  It is time, in the context of both vaccine planning and containment measures, for public preferences and needs to be both heard and responded to.

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