Derek Mooney: Defer Second Doses Now To Unlock Sooner

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From top: Taoiseach, Micheál Martin at the Meath Primary Care Centre in Dublin last week as patients over 85 received their vaccinations; Derek Mooney

It has long been accepted that the primary responsibility of government is the safety and protection of its people.

Though we can be critical of this government for many things, accusing it of not taking this responsibility seriously is not one of them.

True, their execution of this responsibility has been patchy and erratic. The gradual depletion of our defence forces and the wanton neglect of national cybersecurity are but two obvious examples of how governments over the past decade have fallen well short of their duty to protect us, but – for the most part – the State has shown the political willingness and institutional capacity to keep us safe and well.

Right now, this solemn duty to protect underpins the vaccination programme. And, once again, while the government has the right intention, its execution falls short. Well short.

This is a curious failure from a government nominally headed up by a Taoiseach whose political watchword is to under-promise and over-deliver.

As I have said before in this column, Micheál Martin believes deeply in managing expectations. Under-promise and over-deliver has been his political modus operandi for most of his career. His approach is the polar opposite of that of the former New York governor, Mario Cuomo, whose famous maxim was: campaign in poetry, govern in prose.

Martin has long eschewed the poetry part. He prefers to campaign in prose and then govern, when he gets the chance, in a dirge-like prose…

While I am on the Cuomo side (the daddy Mario, not the handsy Andrew) and favour campaigning in poetry, you must still ensure your campaign poetry does not soar so high as to lose touch with the grounded reality you hope to govern.

The under-promise and over-deliver stratagem only works as a campaigning tactic when it pursued by folks who plan, when elected, to increase delivery to a level well above that which would have happened without their intervention. It tends to be used more by governments seeking re-election, rather than oppositions seeking to replace them.

When they do, then all too often it is deployed by insipid, uninspired, or even cynical politicians planning to do as little as possible when elected and then taking credit for everything that would have happened whether they were elected or not.

Under-promising and over-delivering is more a conventional governing strategy than a campaigning one. We see this across the Irish Sea where the post Dominic Cummings crew around Boris Johnson, especially Downing Street’s new press officer, Allegra Stratton, is deploying the under-promise and over-deliver approach with some success.

The polls have seen Boris Johnson pull ahead of Labour in recent weeks and months, thanks to a vaccination rollout that has exceeded everyone’s expectations – even Johnson’s fiercest critics. This is a lesson that Micheál Martin, Stephen Donnelly and others in government need to learn fast.

We saw one of the major downsides of Martin’s iteration of the under-promise approach with An Taoiseach describing the latest failure to reach a modest delivery target as a “bump in the road”. Missing the target by almost 20% is no mere bump.

Almost all vaccination delivery targets are being missed. This is not to say that the programme is failing. It isn’t. It has undoubtedly improved enormously since February. Nonetheless it is hard not to conclude that we now have a programme of under-promising and under-delivering that is sapping all public hope and confidence.

The stock answer that our failure to reach targets is due to problems with EU the supply pipeline is hard to sustain when you look at the number of other EU countries who use that same pipeline, but who are fare ahead of us, particularly Denmark.

Denmark vaccinated all people in care homes with their first dose by the end of the first week in January. This is something that we didn’t achieve until over a month later, indeed we only started to vaccinate people in care homes with their first doses on the date Denmark announced it had finished theirs.

At a time when we were still storing and hoarding supplies of Pfizer in fridges Denmark was putting them into arms and then going to Brussels and demanding extra supply. It went out, as it was perfectly entitled to do, and sourced extra supplies for itself.

Our lethargy on this is amazing. Perhaps there is a fear in government that looking to source Sputnik V or unused AstraZeneca in France and Germany risks being seen as over-promising and under-delivering. Who knows… but it is hard to fathom why ministers have been so unenthusiastic about pursuing these options?

What I do know is that the current approach is not working and should not be maintained. While our situation is not hopeless, the various institutions of the state from Cabinet to NPHET to HSE have succeeded in expunging almost all hope from the national discourse.

However, in that horrible phrase: we are where we are and where we are right now is at least two months behind Northern Ireland and the UK and several weeks behind many other countries in Europe.

Though we are in the top third of the table of 27 EU countries in terms of vaccine rollout, our problem is that we lead the EU table when it comes to workplace closures.

We have endured the longest lockdown, closing all but essential workplaces for 163 days from the start of the pandemic to the middle of January (See Reuters Graphics report). The comparable figure for Germany was 34, for France it was 84 and for Italy it was 134.

The Irish figure now stands at almost 200 days. So, coming 7th or 8th in Europe when it comes to vaccine rollout simply is not good enough. We need to be at the top of the vaccine rollout league. That means we need to have a greater percentage of our people vaccinated, even if only with one dose, by the end of April or May.

For that reason, I strongly believe we should be considering adopting the UK strategy here and deferring the delivery of 2nd doses for eight to twelve weeks. This would allow us to vaccinate more people, more quickly and then unlock the country after what will easily be the longest continuous lockdown in Europe.

There is sound medical evidence for taking this approach. The University of Minnesota’s Center for Infectious Disease Research and Policy has produced a very detailed scientific report advocating the deferral of second doses where vaccine supply is faltering and the threat posed by new variants is increasing.

It considered the risks associated with deferring the administration of the second vaccine dose beyond that recommended by manufacturers and concluded that:

…evidence from other vaccines suggests that an extended time between vaccine doses does not generally compromise – and indeed may increase – the antibody response to a vaccine boost.

It further found that:

“High levels of protection, however, were measured even after the first dose, with a vaccine efficacy over 92% for both vaccines [Pfizer + AstraZeneca] beginning at 14 days post–dose one. Even among older adults, vaccine efficacy remained high following both dose one and dose two…”

Various studies show that the level of immunity offered by a single dose is extremely high and that the first dose also dramatically reduces your chances of spreading the virus.

So, if we expect to get 1 million doses of vaccine per month in April, May and June allowing us to vaccinate 1.5 million people with two doses, would we not be better in vaccinating 3 million people with one dose and then proceed to give them their second doses from the ever-increasing levels of supply due in July, August and September? We might even have sufficient supplies of the J&J one dose vaccine by then to complete the programme sooner.

This strategy would allow us to unlock earlier, making the mid-summer deadline look like an under promise that was over delivered. This is not an untried theorem – it is happening on our doorstep, in Northern Ireland, Scotland, Wales and England and we can see it is working.

We are weeks behind where we should be, but we can still play catch-up and get back to where we should be, but only if we act now.

I hope someone, somewhere in government is looking seriously at this option and that they have been looking at it for some time, as we will need a decision on this over the next two weeks, so that everyone vaccinated from the March 31st onwards can be given one dose and told not to expect to get their second dose until sometime from the end of June.

We’ve had enough under-promising. It’s time to focus on some serious over delivery – and fast.

Derek Mooney is a communications and public affairs consultant. He previously served as a Ministerial Adviser to the Fianna Fáil-led government 2004 – 2010. His column appears here every Monday. Follow Derek on Twitter: @dsmooney

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18 thoughts on “Derek Mooney: Defer Second Doses Now To Unlock Sooner

    1. Charger Salmons

      Indeed.
      Hard to believe it Derek but there were some dunderheads on here as recent as last weekend proud of the fact that Ireland had double-dosed more per percentage of population than the UK.
      Their desperation at not wanting to admit Ireland is failing miserably compared to north of the border and on the mainland is really quite sad.
      Fodder for the fada.
      By the by, a chum this morning Whatsapped me about his brother-in-law working at a vaccine centre in North London run by Army medics.
      An Irish guy turned up,saw the uniforms and said ” I’m not speaking to you ” and walked off.
      There really isn’t much you can do about such mind-numbing stupidity.

  1. Brother Barnabas

    “So, if we expect to get 1 million doses of vaccine per month in April, May and June allowing us to vaccinate 1.5 million people with two doses, would we not be better in vaccinating 3 million people with one dose and then proceed to give them their second doses from the ever-increasing levels of supply due in July, August and September? We might even have sufficient supplies of the J&J one dose vaccine by then to complete the programme sooner.”

    this would make sense if we knew for certain that its ok to administer different covid vaccines for 1st and 2nd dose

    there are trials underway but even in the UK – where theyll likely doing this – the current guidance from the JCVI is that the same vaccine should be given for both doses

      1. Brother Barnabas

        it would become logistically really difficult – especially if there are supply issues with one or the other

        1. Mr. T

          If it doesnt really matter that much as to when you get your second dose, then you can just wait a little longer for your second.
          The state records who gets what vaccine anyways, so when theyve nearly done all first doses, thats as many second doses as you have to procure of each vaccine.

          Any excess can be donated to other countries in EU or elsewhere.

  2. Joe

    Derek , the FFFGGP government has made a shambles of the vaccine rollout.
    Constantly failing to meet targets and under delivering along with p poor logistical control. Funny thing is, it all could have been an easy win for FFFGGP but their combined incompetence has blown it.

    Based upon real world stats, especially proven stats from our Scottish friends experience, it is entirely a sound suggestion to use the existing vaccines as an initial single dose to prevent severe Covid hospitalisations and death.
    But will the FFFGGP clowns do it? I doubt it.

    “The study shows that, by the fourth week after receiving the initial dose, the Pfizer and Oxford-AstraZeneca vaccines were shown to reduce the risk of hospitalisation from Covid-19 in up to 85 per cent and 94 per cent, respectively. ”

    https://publichealthscotland.scot/news/2021/february/vaccine-linked-to-reduction-in-risk-of-covid-19-admissions-to-hospitals/

  3. ian-oh

    Is there anything to be said for drinking the blood of those who already have antibodies?

    *Asking for a Transylvanian friend of nobility.

    1. Micko

      :-)

      I met a lady from Transylvania a few years back at a party.

      Upon telling me where she was from, the sheer level of will power I needed not to bring up Dracula or vampires was incredible.

      I eventually broke and she looked at me like a piece of dirt.

      .
      I lasted a good 4 mins or so – which I’m still impressed with myself about ;)

      1. Charger Salmons

        It could have been worse Micko – at least you didn’t wave a string of garlic at her …

  4. Kevin Quinn

    I can see advantages in what Derek is proposing, but I can also soo a major disadvantage: it lets the Government off the hook.

    People who finally, eventually, get both jabs of a vaccine can feel legitimately that they are immune — that is, they will not catch Covid-19 and will not therefore spread it. That is an enormous relief to those lucky people. It means that they can start behaving normally again. My 86-year old great-aunt is one of them. She will get her second jab in the Helix next week, and she reckons that five days later she will be able to come around to us for dinner and a hug — the first time in a year.

    If she were given just one jab and told ‘come back to us in July’, she would not be able to do that. She would have to stay cooped up until July, or whenever Julie Andrews and her arrogant sidekick Sandra Gallina, the HSE, NPHET and Stephen Donnelly get their act together, start behaving like Covid is a war and nor a procurement process, and ramp up *production* of the vaccines we all need by diverting all available plant (ie rival pharmaceutical companies) to this task.

    I appreciate that the public health officials do not actually want my great-aunt, or anyone else, to start behaving differently just because they are immune. Another example of this is how every scientist in the world will tell you that people who have had Covid and recovered are in effect immune for a minimum of a year — but every public health official in the world will tell them ‘there’s still not enough evidence’ and so everyone has to wear their masks anyway. This is normal. Public health officials live in fear of the vaccinated or immune changing their behaviour, and the non-immune and possibly infected being so irritated that they follow suit.

    But…people are not stupid. No matter what NPHET or Stephen Donnelly say to us in grave tones on the Six-One, there will come a point where a sufficient number of people know they are highly unlikely to get Covid, and that the most vulnerable have already been vaccinated, so, F*%k this for a game of cowboys, I’m playing an illegal game of golf/inviting my friends around for dinner/ etc

    This is going to happen anyway, whether or not people’s second jab is delayed. But as the summer approaches, the big issue is going to be whether people who are vaccinated or immune are going to be allowed to travel.

    If we go for Derek’s approach, they will not be allowed to travel. The ‘vaccine passport’ that the EU is going to unveil next week will be only for people who have completed both jabs (if two jabs are required). Once again, Ireland will have the most restrictive regime in the EU, and once again Micheál Martin and his government will be able to blame ‘EU regulations’ for the situation. Into the bargain, we will all be grounded, but other Europeans, those with ‘vaccine passports’, will be arriving here on holidays. That’s going to drive people absolutely mental.

    So basically, I don’t think they should be let off the hook. I think we should continue to vaccinate the recommended dose with the recommended interval — but rather than accept the hopelessness of our position we should place relentless pressure on the government to catch up.

    We should start with RTÉ and the Irish Times, who have failed quite obviously to hold VDL, Gallina, Martin and Donnelly to account. Why are there not graphs every night on the news and every morning in the newspapers showing the progress of our vaccination roll-out against the North, the US and other EU countries such as Denmark? Why is Donnelly allowed to get away with claiming that, for example, it is impossible for us to import J&J vaccines in anticipation of the EMA finally getting around to approving the J&J vaccine this week, so can start vaccinating that day? Why is Micheál Martin never questioned about why he and the other 26 members of the European Council allowed the Commission to continue with its disastrous vaccine strategy even after it was exposed as such in December, and when everyone could see that failure to act would come at the cost of many European lives? Do they not understand that that means Irish lives too?

    And all the time, every single day, every one of us should be asking the question of Stephen Donnelly and Micheál Martin: “When am *I* getting the vaccine, the full dose. Give me a date. Give me a date. Give me a date. It’s your job to give me a date.”

    This is how democracy works. We can’t hold Julie Andrews to account — although thankfully the Germans will end her career as soon as they can — but we can, and must, hold Martin and Donnelly to account.

    1. Charger Salmons

      Eloquently put.
      And far better than my lame attempts to convey the same message over many weeks on here.
      Sadly I suspect the reaction to you will be the same.
      Tumbleweed with the occasional insult.
      It is no longer in the nature of Irish people to question authority and rage against the machine.
      Resistance is now considered futile.
      The voice of the people, the very heart and soul of national pride, is irrelevant.
      It was sold for the price of a few hollow promises on October 2nd 2009.
      Mehole and the rest are not players.They’re Punch and Judy puppets with an unelected hand up their backsides working the limbs.
      Pawns on a chess board.
      Useful idiots.
      The extras in the chorus line at the back acting their hearts out to be seen while everyone’s attention is on centre stage.
      The next election is the only time your voice will be heard.
      Don’t waste it.

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