Professor Karina Butler:

I thank the committee for the invitation to attend. The roll-out of the Covid-19 and seasonal influenza vaccine programmes is managed by the HSE. I will update the committee on the need for the Covid-19 vaccine boosters and NIAC's seasonal influenza vaccine recommendation.

NIAC brings together a broad range of experts to formulate its advice. Its members regularly participate in meetings of the World Health Organization and European advisory bodies on immunisation. NIAC has sent comprehensive recommendations to the Chief Medical Officer on issues regarding the Covid-19 vaccination programme relating to priority groups for vaccination, vaccine safety, pregnancy, children, adolescents and, most recently, booster vaccinations.

The most effective way to prevent Covid-19 related hospitalisation, severe illness and death is to ensure that all eligible people are fully vaccinated. They are strongly encouraged and should be facilitated to complete the vaccination course. An additional Covid-19 vaccine dose may be required because of an inadequate protective response to the first course, waning immunity or the emergence of resistant variants. Additional doses are often collectively referred to as boosters. However, distinction should be made between the need for an additional dose where the scheduled course is inadequate, to which we refer as an extended primary course, and the need to reinforce a waning immune response, which is a booster dose. An additional dose or doses of the original or a modified vaccine may also be required to protect against a resistant variant. Those with severe immunocompromise, for example, after organ transplantation or receiving immunosuppressive treatments, may not have adequate protection following a primary vaccine course. For them, an additional primary dose increases the likelihood of achieving protection.

Residents of long-term care facilities and many older people living in the community have suffered severe disruption to their quality of life, with negative impact on their psychological and social well-being during the pandemic. This group has a poorer response to the primary vaccine course and more rapidly waning immunity because of their age and underlying medical conditions. In order to optimise their protection, NIAC has recommended that an additional vaccine dose should be given to those aged 12 years and older with immunocompromise associated with a suboptimal response to vaccines, those aged 80 and older and those aged 65 and older living in long-term care facilities.

NIAC has recommended that the Covid-19 and seasonal influenza vaccines may be given at the same time or separated by any interval. This will allow the uptake of both vaccines to be optimised. This year, an adjuvanted quadrivalent influenza vaccine is recommended for those aged 65 years and older as it provides better protection for this age group.

NIAC continues to examine evidence regarding the need for booster Covid vaccines for other age groups. These include those at increased risk of severe Covid disease, other older persons and healthcare workers because of their pivotal role in providing essential health services. Consideration for boosters takes into account whether the additional doses are safe, whether they are needed and whether they can provide benefit. Influencing factors include community levels of circulating SARS-CoV-2 and the impact of the high vaccination rate in Ireland, with more than 90% of adults fully vaccinated. This high uptake is a testament to the public confidence in the programme and credit to all involved in the development and roll-out of the vaccine programme.

NIAC is conscious of the global demands on vaccine supplies and recognises that facilitating vaccination on a global level is important on a humanitarian and global equity basis and essential to limit the continuing threat of Covid-19 in Ireland. NIAC is cognisant of the WHO position and advice on global vaccination and our duty to address inequities. Until global control is achieved, all countries remain at risk and return to normality will be compromised. Vaccines are a global public good for the benefit of all. NIAC is mindful that low and middle income countries have insufficient doses to protect those most at risk. Less than 2% of people there have received a first dose of vaccine and it is estimated that many will not receive a vaccine until late 2023.

Ending the pandemic requires global co-operation. Failure to mitigate high community transmission of SARS-CoV-2 in any country can facilitate emergence of resistant variants and prolong the global threat. NIAC welcomes Ireland’s participation in the COVAX facility, which supports low and middle income countries in vaccine access. NIAC encourages the Government to continue with, and expand its commitment to, the global co-ordinated effort based on the principle of solidarity to foster equitable access to Covid vaccines.

In upholding the principles of moral equality, minimising harm and fairness, as set out in the national allocation framework for equitable access to Covid vaccines, NIAC seeks to protect those most at risk from severe Covid while recognising that access to life-saving vaccines for those most at risk should not depend on country of origin or residency. As stated by the European Group on Ethics in Science and New Technologies, "It is more important than ever in this difficult time to uphold a form of solidarity that is inclusive of everyone, which recognises that respect is due to everyone, and not exclusive to those that live in our own town, region, or country".

NIAC acknowledges the significant support of our voluntary members and the collaboration with, and by, all involved in the vaccination programme in pursuing a common goal of reducing deaths and severe illness from Covid. Through maintaining confidence in a high-quality vaccination programme, we can maximise vaccine uptake and reap societal benefits. I thank the committee for its attention.