Concern has emerged that thousands of people may be told they cannot have the new Covid-19 vaccine due to the risk of an allergic reaction.
It follows news yesterday that two NHS nurses out of thousands who received the jab had an anaphylactoid reaction.
They are both fine but in a precautionary move, the UK medicines regulator advised people with a history of significant allergic reactions not to have the vaccine.
It is unclear what the advice will be here when the vaccine, which is regarded as very safe, from Pfizer BioNTech is due to be rolled out after approval in January.
If the pandemic has taught us anything it is to expect the unexpected.
But how ready the Department of Health and HSE are remains a worry after neither could say yesterday how many over-65s in long-term care will receive the vaccine.
Professor Brian Hughes of the Psychological Society of Ireland, which has drawn up a document on vaccination uptake, says “most people hold favourable views about vaccination. As such, the attention given to vaccine scepticism can often be disproportionate. Nonetheless, it is important to address queries about vaccination in non-threatening ways, in the knowledge that most vaccine hesitancy results from barriers to motivation and not from hostile attitudes.
“The best available research tells us that vaccination programmes are most effective when they are routinised within standard healthcare, when they are easy to access, and when they are straightforward to navigate.”
The guidance says vaccination systems should seek to engage people directly, rather than wait for public attitudes to evolve. Public figures and other role models should be consistent in their statements about vaccination. Reservations about vaccines should be acknowledged and addressed in a non-threatening manner.
The difficulties posed by the need to store the Pfizer BioNTech vaccine at -70C will have to be overcome if the jabs are not to warm too much and render them ineffective.
Pfizer has developed a reusable suitcase-sized container where 975 doses of the vaccine are kept on dry ice.
The vaccine is suitable for 10 days from leaving the case and up to 15 days with more dry ice. The case can be opened just twice a day for one minute each time. So if too much is taken out the jabs can go to waste.
Getting the vaccine to nursing homes
It is unclear what the European Medicines Agency will say about breaking up the large packs to take to nursing homes and other long-term care facilities with maybe just 50 residents. The UK regulator says it is possible in the coming weeks but the European watchdog could take a different view.
Shortage of vaccines
Ireland has advance purchase agreements with five companies developing potential vaccines but it is unclear how soon they all will get regulatory approval, allowing for consignments to be sent here. There could be a long lapse where there is no supply next year.
Justifying more lockdowns
If Ireland faces another lockdown in January after Christmas and New Year celebrations, there will inevitably be resistance from businesses who will challenge the need for it if there is a vaccine starting to roll out.
Pressure to overhaul priorities is expected, to give the jab earlier to hospitality staff and other workers who have unavoidable contact with the public.
Explaining the limitations of the vaccine
For now there is no evidence the vaccine will stop transmission but it will provide protection from developing serious illness. A person who gets the vaccine could still pass on the virus to another person who has not had the jab.
There needs to be high compliance generally with physical distancing, hand washing and mask wearing.