Dr. Daniel McCartney:

I am grateful for the opportunity to present to the committee today. I am joined online by my colleagues, Professor Rose Anne Kenny, Professor J.B. Walsh, Dr. John Faul and Dr. Martin Healy.

There is now an extensive body of international research showing the protective role of vitamin D against Covid-19 and supporting the need for population supplementation at higher doses than those currently recommended. For example, very large background studies pooling data from dozens of individual trials have described an approximately 10% reduction in risk of respiratory infection among people taking vitamin D supplements, and a more than 50% reduction in risk among those with low vitamin D levels to begin with, especially if taking supplements daily. Therefore, there is very robust evidence that vitamin D protects against respiratory infections in general. That is not in question.

Since May 2020, geographic studies have shown that Covid-19 incidence and mortality are higher in countries that are far away from the equator and in countries with confirmed low vitamin D status. Furthermore, the population groups who are most likely to be vitamin D deficient are the same groups who have suffered the worst effects of Covid-19. These include older adults, those from black, Asian and minority ethnic, BAME, communities and those who are obese or who have pre-existing diseases, such as diabetes or high blood pressure. The unifying characteristic of these different groups is that they are all much more likely to be vitamin D deficient. It is also clear that the pro-inflammatory blood profiles seen in vitamin D deficiency foretell the aggressive, overwhelming so-called cytokine storm that has claimed the lives of so many Covid-19 patients.

Long before we had any data showing a direct relationship between low vitamin D levels and Covid-19 incidence and severity, we already had strong evidence to support the likelihood of such a relationship. From May 2020, data showing a direct relationship between low vitamin D status and increased risk of SARS-CoV-2 infection, severe disease and death began to emerge. These studies included work by Dr. Faul in Connolly Hospital, Blanchardstown, which clearly showed much higher ICU admission rates in patients with low vitamin D levels.

Are these relationships causal? There are now several studies published showing lower rates of ICU admission, ventilation and death in those given vitamin D during their admission. There is also an unpublished public health initiative in Andalucia, Spain, which has demonstrated a remarkable reduction in Covid-19 mortality since vitamin D supplementation of vulnerable older adults started there in mid-November. Yet, despite the now dozens of positive studies including tens of thousands of participants, there has been no policy change in Ireland to advance what we believe to be an extremely low risk, readily implemented, cheap and potentially highly effective intervention to mitigate this public health crisis. While some have called for randomised, placebo-controlled trials to prove definitively the relationship between vitamin D supplementation and reduced risk, these are now ethically untenable, they are often imprecise and they are wholly impractical in the current crisis given the time required to execute them properly. They are also unnecessary. One need only think of the spectacular success of the workplace smoking ban to realise that not every effective public health intervention requires a placebo-controlled RCT behind it. As Dr. Mike Ryan, executive director of WHO stated early in the pandemic:

Be fast, have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly. If you need to be right before you move, you will never win. Perfection is the enemy of the good when it comes to emergency management. Speed trumps perfection.

My colleagues, who the committee will hear from today, are not just the top clinicians in the country, they are people of international stature in their specialist fields. Just as importantly, though, they are leaders who have had the integrity, the moral courage and the ethical compass to pursue this issue and to advocate for policy change in this area which will protect the Irish public. They have weighed the pros and cons of changing current policy on vitamin D supplementation and they are in unanimous agreement that the benefits of a new policy will far outweigh the very minor costs.

We are very privileged to share with the committee today this information that has the potential to save many lives over the coming months, but we also must recognise that we are all standing in a moment. As domain experts, we can provide the committee with the information and the context, but the political decisions and recommendations which flow from today’s meeting must be the right ones, and the policy actions into which they translate must be delivered swiftly and decisively to alter the trajectory of this pandemic and to save lives. The imperative to act quickly and courageously has never been more profound nor the rewards greater. What we are asking of the committee today is leadership, the leadership required to enhance vitamin D policy as a central element of our living with Covid-19 strategy, and to steer us a better course out of this crisis.