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Dáil Éireann debate -
Thursday, 21 Jan 2021

Vol. 1003 No. 4

Covid-19 Vaccination Programme: Statements

I understand the Minister is sharing his time with the Deputy Devlin.

I am sharing time. I will take the first ten minutes approximately.

It is now a year since the World Health Organization declared the prevalence of Covid-19 to be a public emergency of international concern. Since that day, we have found ourselves living lives very different from those we may have expected or hoped for previously. Case numbers, people hospitalised and, most regrettable of all, the number of people who have lost lives to this illness have become the backdrops to our lives. In the space of less than a year, we have seen the benefits of what has been an unprecedented collaboration between the public and private spheres and between those behind the initial spur of invention and those responsible for channelling investment to foster that invention. The result is that we now have vaccines. They are currently being administered. They are being administered for free and they will be available to everybody.

Two days ago, Ms Annie Lynch, the first person in Ireland to receive a vaccine, got her second dose. It is a great news story at the end of what has been a very tough year for the country and for every community, business, family and group. The availability of vaccines provides great hope to all of us. It is wholly understandable that everyone should wish to be vaccinated as soon as possible to protect themselves and their loved ones, colleagues and friends against illness. At present, demand exceeds supply, but that will not always be the case. The European Commission, acting on behalf of the member states, has negotiated six advance purchase agreements with a range of vaccine suppliers. Currently, two vaccines have been approved for use. These vaccines - one produced by Pfizer–BioNTech and the other by Moderna - have been reviewed and authorised by the European Medicines Agency, which concluded that both are safe and effective.

The vaccines are currently being administered as part of Ireland's vaccination programme. Thankfully, we are doing well by comparison with other EU member states in respect of the pace of the vaccination roll-out. I fully understand, as I am sure we all do, the very human desire to get vaccinated to be protected against this awful disease. Given that a limited number of vaccines will be available initially, it will take some time for everyone to be vaccinated. This has necessitated an allocation strategy to ensure those most at risk of Covid-19 and those who care for them will receive a vaccine first.

On 8 December, I published Ireland's national Covid-19 vaccine allocation strategy. It is very clear. It prioritises, in the first instance, those over the age of 65 living in long-term care facilities, front-line healthcare workers and those over the age of 70. These are the first three cohorts. Our Covid-19 vaccine allocation strategy was based on a paper by the Department of Health and the National Immunisation Advisory Committee. It was endorsed by the National Public Health Emergency Team, NPHET, and it was approved by the Government. The allocation framework combines ethical principles as well as equitable access, with prioritisation for those most in need. The first priority is to vaccinate and protect the most vulnerable among us, directly use vaccines to save lives, and reduce serious illness.

While we want to roll out our vaccine programme as quickly as possible, speed should not trump safety and confidence in that programme. That is why I was troubled by a small number of stories that emerged recently indicating the prioritisation strategy was not used. Family members and possibly some others were prioritised. I note that the board of the Coombe hospital has decided to commission a review. I welcome the appointment of a senior clinician at the hospital to lead the next stage of the vaccination roll-out. I have asked the HSE for a report on the other reported incidents.

About 94,000 people received the first dose of the vaccine by last Sunday. Our vaccinator teams are working hard right across the country. At the end of this week, our most vulnerable citizens - those in long-term residential care - will have received the first dose of the vaccine. As a nation, we should all be really proud of this.

I am delighted to be able to share with the House that we are on course to meet our target for this Sunday, that is, 140,000 vaccines. Broadly speaking, there is a 50:50 split between front-line healthcare workers and those in the long-term residential care sector. In that sector, the focus is on residents over 65 and the staff in the nursing homes. There are 589 nursing homes. Also included are residents over 65 in residential mental health settings and residents over 65 in residential settings for those with disabilities. There are some cases in which not everyone can be vaccinated because of the prevalence of Covid-19 or infections within a particular setting but these cases are being prioritised and will be got to according to the relevant clinical advice.

The news on vaccination is very good. I thank, in particular, the task force and the HSE. Not only have we accelerated vaccination in the nursing homes and other long-term residential care settings, for reasons all in this House understand, but, even in spite of a 50% reduction in our Pfizer allocation this week, we are still on target to reach 140,000 vaccinations by the end of the week. This was a really important target for us to hit. It essentially means we are emptying the buffer down to a very small level but that is the decision we took. We wanted to make sure we got the residential care sector done by the end of the week. I acknowledge the considerable work of our vaccination teams, clinicians and staff running the programme not only in being able to hit the target but also in being able to do so when we were given about 24 hours' notice of a quite substantial reduction in the Pfizer allocation this week. Well done to everybody involved.

As a nation, we are on a long journey together in terms of the vaccination programme. Even with the great start the country has had, stumbling blocks have been encountered, as with any complex process.

There is, for example, the issue I have spoken about of the short notice of a 50% reduction in the Pfizer supply. I am happy to report to colleagues that the supply schedule is expected to return to what was agreed from next week and we have indications we will get higher future amounts to make up for what happened this week, which is important. The AstraZeneca vaccine, which I was delighted to find out is being produced on a not-for-profit basis, can be administered more easily outside of the dedicated vaccination centres. As we know, Pfizer and Moderna have to be stored at -70° and -20°C. Pfizer, from when it is taken out of the freezer, has 120 hours to get into somebody's arm. That can still be done through GP practices but it is much more complex. AstraZeneca is still a two-dose regime but it can be kept at refrigeration temperature, which makes it much more amenable for use in other settings. Ireland has secured 3.3 million doses of the AstraZeneca vaccine through advance purchase. It is envisaged that its availability will provide the backbone for the next phase of vaccinations, which will include being administered by pharmacists and GPs in our communities.

Plans are being progressed to ensure vaccines can be delivered at pace as volumes increase in the coming weeks. The scale-up will be achieved through a number of partnerships, including, as I said, GPs and pharmacists, but others as well, and through the mass vaccination centres. Planning is ongoing to mobilise the mass vaccination centres soon. From early February we will see them in operation.

We expect to receive news from the European Medicines Agency, EMA, about the AstraZeneca vaccine at the end of January. The date set is 29 January. At that point we will be in a position to provide more accurate vaccination timelines for all citizens. I know people are looking for it and I hear that loud and clear and fully agree. As I said before, we are planning our programme based on a supply of vaccines that would mean every citizen can be vaccinated by September. That is what we are working to but, as colleagues are aware, the timelines are indicative. It is hoped they will provide reassurances and clarity for people but I re-emphasise that these timelines are based on assumptions for the future delivery of other vaccines, including at this point AstraZeneca, which have yet to be approved. Companies behind the other vaccines have not even applied for approval yet. These are tentative timelines, but I know people want a sense of where we are going and when people will get to be vaccinated.

In the shorter term, I have told the vaccine task force to ensure clarity is provided to pharmacists, dentists, carers and other front-line healthcare workers in the coming days regarding when they will be vaccinated. Colleagues from my party and right across the House are asking when that will have gone through for the pharmacists, dentists, hospital workers or other groups in their constituencies. I hear that loud and clear and want to get that certainty to people as quickly as possible. There is the possibility that other issues will arise over the course of such a big vaccination programme. However, I have every confidence that when these issues are identified, they will be dealt with.

I acknowledge again with thanks the commitment of all involved in the roll-out of the vaccination programme, which will deliver a safer Ireland for everybody in the coming months. I also thank the public, who have sacrificed so much to keep each other safe and who have followed the current guidelines, thus pushing the current Covid case numbers back down. Vaccines are on the way and we as a nation are on our way.

If the Minister has a few more words to say, he can use the time.

I thought I was sharing with Deputy Devlin. Is he not here?

No. Does the Minister of State, Deputy Butler, wish to contribute?

I will leave it at that.

We move on to the second group. Deputy Cullinane has ten minutes for questions and answers.

I will take my time for questions and answers, if that is okay. It is important that we get as much information from the Minister as possible. I will start with some of the concerns that have been put into the public domain and raised in recent times. It is important for us to learn lessons, and the Minister has acknowledged that.

We know issues were raised in relation to two hospitals with family members of senior management in those hospitals receiving the vaccine. There is also anecdotal evidence coming from other hospitals in relation to non-patient facing staff getting priority over front-line staff. What level of complaints have been made and what number of concerns have been made to the Minister and his Department directly relating to such activity? How many hospitals is he aware of where complaints have been made about either family members of management receiving the vaccine or non-patient facing staff getting priority over front-line healthcare workers?

I thank the Deputy. I am personally aware of three hospitals that I have had queries about: the Coombe Hospital, the Rotunda Hospital and a situation in County Kerry. On the Coombe, I spoke to the chair of the board last night who told me they are conducting a review. I believe they are hiring senior counsel. They want to establish all the facts. They have found out more since the initial statements were made. On the others, I have asked the HSE to look right across the system at any of these allegations and report back to me on the situation. I can tell the Deputy, and I am sure we are in agreement on this, that the protocol agreed by Government has to be followed.

I thank the Minister. Those lessons have to be learned and that is the most important thing that can happen.

I wish to ask the Minister about the regularity of supply. As he said in his introduction, we are all being lobbied by different cohorts of society, whether it is dentists, pharmacists, carers or people who provide home help. There are many genuine questions these people have. None of that will probably change until we have more doses coming in weekly. At this point, how many doses are coming in per week from Pfizer and Moderna? What is the number at the moment coming from both of those companies?

I will provide for everyone whatever schedule I can at the end of this session. Broadly, we have had so far slightly more than 40,000 per week from Pfizer and low numbers to begin with from Moderna. The schedule I have seen shows they are coming in every two weeks. The good-----

What is the number from Moderna?

The initial shipment from Moderna was 4,000 or 6,000. I will get the Deputy a note on it. That ramps up. That good news is on Pfizer. The Deputy will be aware that the allocation was based on getting five doses from the vial. They arrive in trays and there is a certain number of vials per tray. It turns out that if it is done right with the right type of syringes and the vaccinators are sufficiently trained, six and sometimes seven doses can be got out. That means that, along with the 40,000 doses that were scheduled, we can get up to 20% extra, potentially up to 48,000. That is good news.

So at the moment it is about 40,000 but we can get more from it. From Moderna we have so far got 2,000, which is a very low number.

The next question concerns if and when AstraZeneca gets approval, which we hope will happen towards the end of January. I have spoken to that company. It has done a great deal of advance manufacturing. First, what is the advance purchase agreement we have with AstraZeneca? Second, given that it is easier to distribute and to get into the State in terms of delivery and storage, I imagine we can get more of that stock in quickly. It can be sent to GP surgeries and pharmacies, as well. How many of the doses for which we have paid and completed an advance purchase agreement with AstraZeneca can we get into the State very quickly?

The advance purchase with AstraZeneca is for 3.3 million doses. I agree wholeheartedly with the Deputy that it is a game changer. Because of the temperatures, we can get it straight out to GPs, pharmacies and potentially others. The quarter 1 volume is approximately 600,000 doses. It is a two-dose regime, so that will be about 300,000 people. At present, the advance purchase agreement, APA, is for a monthly delivery. We are getting vaccine once a week from Pfizer and once a fortnight from Moderna at the moment, and the indication is that the AstraZeneca vaccine will arrive once a month, in quite large quantities. The advance purchase agreement is written with us and all other EU member states such that the first batch will arrive in mid-February. We expect to have authorisation on 29 January, so we are working with AstraZeneca and the European Commission to try to bring forward the delivery. That may not be possible, however, because anything that is brought forward has to be done on a full Commission basis. A country cannot get special treatment as a single member state. My view is that having the vaccine authorised on 29 January and getting it in according to the original APA is certainly not what we want to happen. We are trying to bring that forward as much as possible.

I have been informed that AstraZeneca has done a great deal of advance manufacturing. While the figure of 600,000 doses in the first quarter is significant, why are they coming monthly? Why not get more? Is it because that is all that have been produced? Are there logistical reasons for getting them monthly? Why not get all 600,000 at once and get them into GP surgeries and pharmacies in order that they are here? People will ask these questions. If the doses have been made and are sitting in locations in England or elsewhere in Europe, we should get them into the State as soon as possible. That was my question. Why not increase the numbers of doses coming in so that we can equip GP surgeries and pharmacies, and so that the mass vaccination centres we want to put in place and the staff to roll that out have the vaccine to roll out as quickly as possible when it is here? Why is it only monthly and why will there be only 600,000 doses?

I agree wholeheartedly with the Deputy's ambition. It is exactly in line with what we are trying to do, namely, to get in as much vaccine as possible as early as possible and get it into people's arms straight away. That was what was agreed with the EU. The EU bought as much as it could. Every member state gets a per capita amount, so we get 1.11% of the total amount the EU could get. It is shared equally for each delivery each month. The figure I mentioned is the maximum amount the EU could get and we get a pro rata portion of that.

I fully agree about the mid-February delivery. We are doing everything we can to bring in the vaccine early. I have received the same confirmation that the Deputy mentioned. The first question was whether the vaccine exists and whether it will be delivered in mid-February only because it has not yet been produced. We have confirmation that it does exist, so that is exactly what we are trying to do.

On the detailed note the Minister mentioned, he might provide all that information to us. The more information he can provide to us, the better. As for the email address for submitting questions that was given to party health spokespersons, the response time is reasonable but could be better. I ask the Minister to take that up with his officials.

I acknowledge that the Minister cannot get loaves and fishes out of 40,000 doses coming in weekly. Nevertheless, genuine questions have been raised by different cohorts, which is healthy because it shows there is high interest in the uptake, so I take heart from that. I raise the issue of home help and carers. The response I got from the support email address that was given to us does not answer the question. Are carers in category 2 or 6? The Minister mentioned dentists. Many dentists have contacted me. Obviously, they are in patient-facing roles and interact closely with people. Where do they sit in terms of the allocation groups? I have also had inquiries from undertakers, who have a difficult job to do. They have asked about their position in the allocation.

I have raised the Deputy's concern about the email address with the officials and asked that the response time be made shorter. On the issue of carers, I asked for a clinical judgment from the HSE, which I got in the past 48 hours, and it is as follows. Carers who work in the formal sector, that is, those who work for the HSE or for one of the private caring companies, are included in cohort 2. As for dentists, I can confirm they are included in cohort 2 as healthcare workers.

I will ask questions back and forth of the Minister, if he will allow me. As of 13 January, 69,700 front-line healthcare workers had received a vaccine, according to the HSE's figures. The Minister stated, however, that as of Sunday next, 24 January, a target of 140,000 will have been reached, split more or less evenly between healthcare workers and people in nursing homes and their staff. If 70,000 - half of 140,000 - are to be vaccinated in the space of two weeks, how will those figures match up? Are we making any progress? Is it the case that those people will get a second jab and that is being counted twice in the figure? The Minister might answer that and allow me to come back in.

This week, the main focus is on long-term residential care settings. I think we are covering 367 or 369 individual nursing homes in this seven-day period. As of Sunday next, 69,000 front-line healthcare workers will have been vaccinated, as the Deputy noted. This week, 3,900 of them, or thereabouts, will get their second dose, while others will get their first dose. When we get to Sunday and the numbers are tallied up, it will not be exactly 70,000 and 70,000, but it will be broadly 50:50.

I raise that issue because we are at an important juncture in the vaccine roll-out. It is early, but confidence has been shaken by the incidents spoken about earlier. The first guiding principle of the sequencing document is transparency and practicality. Transparency is really important. The Minister and the HSE need to get this right now, to fix the mistakes and get confidence going. Resentment is breeding within the healthcare sector, as we are hearing through our constituency offices. There is one group of healthcare workers, but within that, as the Minister will be aware, eight subsets in the sequencing document are listed in order of priority. I ask him, in the interests of transparency, which is the number one guiding principle, to include in his reporting the numbers within each subset of healthcare workers who have been vaccinated. Within the acute hospitals and the healthcare settings, there are workers who are front facing with people infected with Covid, and who are looking either down the corridor or up the stairs and asking why and how others have been vaccinated when they have not yet got it despite their position.

There is no doubt that the national roll-out of a vaccine is difficult, but the first guiding principle is transparency, so we should have figures for those subsets. Last week in the Chamber, I requested figures compiled by the Health Protection Surveillance Centre, HPSC, that showed the number of workers who were sick with Covid. The Minister provided them and that helped. It did not bring down the ceiling. It helped with transparency and allowed people to understand. The CEO of the Galway hospital group has talked about the challenges he is facing with workers being out sick. The more transparency and data there are, the better we can all respond. Will the Minister please consider that?

I would appreciate if I could follow up with another question.

Absolutely. From my perspective, the more transparency, the better. We have made a real effort and I hope that has helped in some way. Members of the Oireachtas should be getting a daily briefing and there will be a biweekly one from me. We set up the email address to receive queries from party health spokespersons such as the Deputy and many others who are in the Chamber. We are trying and if there is more we can do, we will absolutely do it. I will seek to get as close as possible to what the Deputy has just requested. That is no problem.

That would be most helpful. The indicative dates for everyone else in all those groups - October, November or whenever it may be - such as meat plant workers, other healthcare workers, dentists and retail workers, may shift and change based on supply but, again, transparency and communication will help. My worry is that if the Government goes wrong here, resentment will breed and we will end up with some kind of The Hunger Games feeling in the country in respect of the vaccine.

We must avoid that at all costs. Therefore, it would be helpful if the Minister could work on providing indicative dates.

The language used by the Minister was that we will have gone into a buffer on the vaccination by the end of this week. What implications will that have? Are we going to enter a period where we may have a hiatus in the vaccination roll-out or is the Minister confident we will be getting enough vaccines to keep going at the rate planned?

The next speakers are Deputies Christopher O'Sullivan and Cathal Crowe. Is Deputy O'Sullivan making a statement or asking questions, or both?

I will do questions and answers, if that is okay. I thank the Minister. At the outset, I want to say one of the simpler requests I received before the new year and Christmas was that Ireland should not be behind the curve in terms of vaccine roll-out within the EU. Thankfully, that is the case that we are not and it must be acknowledged. We are ahead of the curve. We have all had queries, however, and we are all receiving multiple representations from members of our constituencies. I have a few who are looking for a bit of clarity. The Minister touched on some points already. I came in towards the end of his answer to Deputy Cullinane so I want to get further clarity on that.

Pharmacists, pharmacy workers, GPs, carers and dentists are the people who are getting in touch with us in terms of when they will be vaccinated. Of course, we must welcome the deal that has been done with GPs and pharmacists in terms of the roll-out of the vaccine. With that, however, come questions as to clarity and certainty on when this cohort will be vaccinated. In his answer, the Minister might focus particularly on pharmacy workers and pharmacy staff. Unfortunately, what is happening in the community is that people with Covid-19 symptoms are walking into pharmacists and chemists. They should not be but it is happening and staff are obviously concerned. Could the Minister please give further clarity on those cohorts?

I am receiving many of the same understandable questions. I have asked the HSE to produce a detailed note in the coming days on exactly this issue. At a high level, however, cohort 2 includes pharmacists and dentists. As I said earlier, the HSE has made a clinical position on carers, which is that carers in the formal sector, that is, carers who are employed as such, are also included in cohort 2. By Sunday, we will have hit a little under half of that group of front-line healthcare workers. There are 150,000 people, or thereabouts, in that group. We will have hit, perhaps, a touch above 70,000 people and then we will keep going. From Sunday, notwithstanding some outliers, the residential care facilities and nursing homes will have been done. The vaccination path for those two groups is set because it is 28 days after a person gets his or her first vaccination. The vaccination path for the 70,000 who are done is set for the same reason and the other group we will do straight away is the other half, that is, the pharmacists, dentist, carers and many others who are moving into that between now and mid-February.

That is important. I also take it that pharmacy staff are included in cohort 2. In my second question I am looking for a definition. Many people are contacting my office asking what a key worker is. Will the Minister point me to somewhere, perhaps on the HSE website or some documentation, that will show what exactly defines a key worker?

The first place to look is the website. The Deputy will see the vaccination protocol is there and the report from the national immunisation advisory committee, NIAC, was published as well. That is all there.

The first level of key workers in the prioritisation are those who were involved in the vaccination programme. Many of them are covered in cohort 2, which are the front-line healthcare workers and, for example, people involved in supply chain logistics in moving the vaccines around. A lot of administration is involved behind the vaccinators, so they are key workers specifically for the vaccination programme. Another cohort is education essential workers, and another group is wider essential workers. A good place to look for that information is in the lists that were used for the Covid-19 measures.

I want to speak out on behalf of people who suffer with cystic fibrosis and chronic lung disease. They are among the most vulnerable in our country now terms of succumbing to this virus. At the moment, I believe they come in at point 7. I am talking about people between the ages of 18 and 64. I must speak up for them because they are vulnerable. Is there any way that could be reviewed?

I wish to use my time in a question and answer format with the Minister. First, it is good to see that Ireland was top of the league table in terms of the roll-out of Covid-19 vaccines in recent days. We may be at the lowest ebb of Covid-19 at the moment. We were in a huge battle. We have seen ICUs and the pressure our whole country is under, but there is also huge cause for hope. I thank the Minister, Deputy Donnelly, and his staff, who are helping to keep that supply chain of vaccines open to us.

I have a few questions. I mention mental health staff in the mid-west, particularly in County Clare. The mental health staff and mental health nurses who leave their base hub each morning and go around the community and into people’s homes have not yet had Covid-19 vaccines. The vaccine seems to have bypassed them in some ways and administrative staff, who have the benefit of a Perspex screen giving them protection, have had the vaccine. Those who are on the front line going into people's homes have not, however. I have also been corresponding with Professor Colette Cowan of the UL Hospitals Group on this. I know it has autonomy on how it disperses the vaccine but this step of the ladder cannot be missed. It is front line and it is essential.

The next issue I wish to raise is that of GPs in County Clare. Again, many of them are being told it could be mid- to late February by the time they receive a vaccination. They are absolutely front and centre on the front line. They are meeting patients every day and putting themselves at high Covid risk. There was an error with the online registration system. Many of them tried to get online and book in for vaccination. That system was not working, however, and there were some problems with HSE IT unit. It has left them floundering and now waiting a couple of weeks behind where they would like to be. I hope the Minister and his Department can intervene in some way. There were write-ups in the newspaper last week about Deputies fighting for constituents. I will be unapologetic in this Chamber in ensuring those who are on the front line in my constituency get their vaccine, that all-important gold dust jab into their arm, to protect them from Covid-19.

The last thing I wish to say is about the community, both in Clare and nationwide, who suffer profoundly from cystic fibrosis. It is such a debilitating disease at the best of times each winter in Ireland because our climate is extremely tough for them. Now, on top of this they must grapple with Covid-19. They are extremely high risk. As I understand, at the moment they are in category 7 of the 15 categories of prioritisation. I hope that can be looked at in terms of bumping them up a bit. I would appreciate if the Minister could respond to some of those queries I put to him.

I acknowledge that the Deputy raised the issue of the mental health nurses with me previously. It is one I will be raising with the task force and the HSE. The short answer is they are front-line healthcare workers. There is no question about that. It is just a question of when in the next few weeks they will receive the first dose, as it is for the GPs.

I would like to make a point, which is there is no political involvement in how this wave is allocated between different front-line healthcare workers or from one nursing home to another. An allegation was made, which was beyond the pale, suggesting there was political involvement in diverting vaccinations away from front-line healthcare workers. It was made by a member of the Opposition and it was very disappointing. There is no political involvement in this. These are operational decisions. The political involvement from all of us is the setting of the prioritisation, and that is by NIAC.

I hear the Deputy loudly and clearly on all three issues, that is, the mental health nurses, GPs and people with cystic fibrosis. Indeed, many other people have many other conditions which also make them vulnerable. We are obviously using the NIAC prioritisation. As we have said, however, that is a living document and we must always be up to reviewing it based on new information, new science and new information about the vaccine and how it is progressing.

I call Deputy Seán Crowe. How does the Deputy wish to make his contribution?

I want to make a few points and then, perhaps, ask a couple of questions if we have time at the end. The vaccination programme will only work with successful engagement and buy-in from the public. The vaccine programme needs to be as fair, open, transparent and honest as possible. Some people have genuine concerns at the speed, safety and effectiveness of many of the vaccines that have appeared and they have worries about the possible side effects. We need to respond to those concerns with responsible, accurate and up-to-date information.

We see media reports of non-front-line healthcare staff and family members receiving vaccines outside of the priority scheduling. No one wants to see the vaccine go to waste but there has to be accountability and transparency in the process. If there is an extra dose per vial, all hospitals and vaccination centres must be made accountable for those extra doses and be prepared to stand over what they do with them. This information will be vital in order to be able to give people their second doses if required.

This is an incredibly complex programme with many moving parts. My worry is that we see the hallmarks of an attitude that everything will be grand, it will settle down and somehow it will sort itself out. We cannot adopt a Mickey Mouse amateur approach. It has to be logical and precise. There can be no oiling of the hinges and taking of shortcuts. I have great concern at the concerted efforts of a few who would sow doubt and fear of the vaccine in the minds of the public. We have to up our games and explain exactly what is in the vaccine, why it is safe and why it is necessary. I have heard anecdotal evidence of some healthcare professionals expressing doubts about the vaccine and even about the virus. Covid-19 is not a flu-like virus. One should ask the families of those who are fighting for their lives in ICU wards across the country about the virus, or ask Martin Ward, a nurse in University Hospital Galway who was on "Morning Ireland" this morning, whose mother and father died of the virus.

Are proper records being kept of the excess doses of the vaccine that are being given to those outside the normal schedule? These should not be pen and paper records that could be shoved into a drawer. Will the full IT recording system be available to all vaccination teams ahead of the progression to the larger category groups? What is the HSE doing to combat the disinformation campaign we are seeing springing up online and on the streets? Is the HSE willing to step up its public information campaign to help allay some people's legitimate concerns around the virus?

All vaccinations are being recorded. There will be an electronic record for all vaccinations. Critically, when we have the wider roll-out, including to those over 70, for example, that will be electronic.

On disinformation, I agree wholeheartedly with the Deputy and it is something we are taking seriously. In some good news, we got in new research on the public's view of the vaccines. I put the results of same out online yesterday or the day before. It is showing that we were starting from a pretty good position. A majority of people were definitely going to take the vaccine and a lot more people were open to it and were probably going to take it. Those numbers have shifted markedly in the right direction. It has been fantastic for the public to see, right across the healthcare world, such a high demand for the vaccines because ultimately, it is our healthcare professionals and scientists who really know what they are talking about on this stuff.

The Minister said earlier that it is his intention that every citizen would be vaccinated by September. Maybe he will clarify that. He presumably meant every resident as opposed to every citizen.

On the target date for completing vaccinations in nursing homes, the Minister had set a target for the first jab and then the second jab. It is unlikely that those target dates will be met so have new target dates for the completion of both rounds been set?

I refer to the unfortunate incidents we saw in which the order of priority was not observed in three hospitals. That is such an Irish thing and it undermines confidence hugely if there is a perception that there is pull or political influence of any kind and that it is a matter of who one knows. Now that the Minister has put the protocol in place, and it is important to bear in mind that this was announced on 12 January and those incidents were mainly before that, does the Minister intend to introduce sanctions if that protocol is breached?

On registration, when will the system go live? What about people who do not have access to a computer or to the Internet? How will that be addressed? What about people who do not come forward to register, namely those hard to reach people who we always have difficulty with for other public health programmes? They need vaccination so what is the plan for reaching those people?

I have a concern about governance. I strongly felt there should be a separate governance framework for the vaccine programme. My understanding is it is being led by the chief clinical officer, who is more than busy with all of the other work he is doing. It concerns me that there is no dedicated lead on the vaccine programme. I am also concerned that there is confusion about the task force, the national immunisation advisory committee, NIAC, and the HSE and who calls the shots here, except that ultimately the buck stops with the Minister. It would be better if there was a dedicated lead for this, rather than somebody who is already exceptionally busy.

On the order of priority, there is a lot of concern among patient groups, including among people who have had transplants and people who have serious conditions such as cystic fibrosis or Down's syndrome. There is a lot of concern that the number of front-line workers will be growing all of the time and that they will be pushed further down the list. While there are a lot of people with loud voices speaking on behalf of different front-line and other workers, it is important that we ensure that people who have serious medical conditions are treated or get access in time.

Residents will be vaccinated. One does not have to be a citizen. The vaccine is for anybody who is here.

We are on target to have the nursing home residents and staff vaccinated. We set an ambitious target for this Sunday to have them all done or to have all of them done except for the outliers where there will be residents who, because they have Covid-19, cannot be vaccinated.

Is that a significant number at this stage?

It is unfortunately a significant number but the target was always to do all the nursing homes, with an understanding that one cannot vaccinate those who have Covid-19. I am pretty comfortable saying that we are on target. There has been a huge amount of work done to meet that.

On family members, I disagree that it is an Irish thing. We are seeing reports from all around the place that this kind of incident is going on but it should not have happened.

Will there be sanctions if it happens again in the future?

The protocol was not put in place on 12 January. That was a secondary protocol. The protocol that was in place was the one that was agreed by the Government many weeks ago. A secondary nuanced protocol was not needed to know that one's family members are not front-line healthcare workers. That was clearly in place.

Will there be any sanctions?

On sanctions, I am awaiting the report from the HSE on the settings other than the Coombe Women's Hospital. The board in the Coombe Women's Hospital is doing a thorough investigation and we need to give that space and see what happens.

I fully agree with the Deputy on registration. There will be online registration but there will be many people who do not have online access. One of the ways we will be dealing with that in the first group, those over 70, is with direct GP contact. All of those over 70 have a GP visit card and the GPs know their patients well.

To use my time efficiently, I just want to make a statement and a few points. The Minister can use other time to respond to me or he can write to me. I do not want him to eat into Deputy Lawless's time by answering me.

As I said last week, it is crystal clear to me that we did not prepare adequately. This is borne out by the fact that senior consultants in the Coombe Women's Hospital were bringing in the family and friends to use the additional doses, even though they could have been put in a taxi or an ambulance and have been down in St. James's Hospital in a matter of minutes or have been over at the Mater Misericordiae University Hospital in a few extra minutes, where there seems to have been some delay in a lot of the front-line workers being vaccinated.

In terms of supply, I reiterate my call that, as opposed to the appropriate people talking to the companies as the Minister stated last week, he should get on the phone to AstraZeneca, Pfizer, Johnson & Johnson and Moderna and secure additional supplies. There are no gold medals for being good Europeans on this one. I might quote the German Chancellor, Dr. Angela Merkel. It was reported in The Irish Times on 6 January that Dr. Merkel stated, "We don't want national solo runs and think the most effective protection for us can be reached with a European approach." That was fine. Dr. Merkel already had her additional supplies in the bag at that stage and she just wanted to make sure nobody was following suit. I want us to take the old fashioned lift-the-phone approach, secure supplies and if they want €70 a dose, give it to them. Otherwise, the Minister is looking forward to a fourth wave and an indefinite lockdown, and that is no good to any of us. We did not prepare - 20 lashes. We are where we are now. It is time we got with the programme, up our game, secure adequate supplies and have the target ultimately of a 24-7 365-day vaccination to bring all of this to an end for all of us.

Like Deputy Shortall and, I am sure, other colleagues, I have a concern about how we are selecting who is prioritised and why. An email from the national immunisation advisory committee, NIAC, to a kidney transplantee states that the Department of Health, based on assessment of risk and disease and balance of risk of exposure through work or daily living, is what determines who is on the list. The email goes on to say that determination of the make-up of specific groups is beyond the scope of this committee. If NIAC is not deciding with its expertise who should be getting vaccinated, who is doing it? Is this not more of our ridiculous approach? Why is NIAC not saying it? Why are transplantees, who, because of their medication, are immunosuppressed, well down the field? A personal friend of mine is a kidney transplantee from Clontarf. Her husband has had to work from home since last March. Her children are being home-schooled since last March. She is well down the field to September-October. It seems we will get to her but others are more important; they must come first. It gives me no pleasure but I am bound to say there is a continuing headless chicken approach here. I do not doubt the Minister's personal commitment to want to get this right, but who is he defending? Is it National Public Health Emergency Team, NPHET? Is it NIAC? Is it the Department of Health? Is it the HSE? Where is our ineptitude coming from on this?

Of course, I have to put on record today - indeed, it is in the media today and the subject of parliamentary questions to the Taoiseach - the idea that, without it coming before the Dáil for approval or, it would seem, according to the Minister, Deputy Harris, a memorandum to Cabinet for approval, we will up the price of the Secretary General of the Department of Health by €81,000. I am sorry but we need to address these issues.

I intend to ask a few questions of the Minister, if he has time to respond. If he cannot respond to them all, perhaps he can do so in writing.

At the outset, I acknowledge this is certainly not a political issue. In fact, it is not even really a medical issue or a health issue as such. It is a supply chain management issue. It is a logistical issue. That is the challenge that we face in shipping this, gathering this and packing this around the country with the attendant storage requirements, etc. In that vein, there are sectors of industry and society, such as the hauliers, shipping companies, big pharma, distribution networks, and all sorts of private and public sector knowledge bases on this. My first question is: have they been consulted, are they on the advisory boards and are they in the room? Even within the State, I had a contact from a former Teagasc colleague last week who stated that at the time he worked there, it was the pre-eminent distribution network for agricultural supplies and samples around the country and he stated that could be tapped into again to ship vaccines and provide storage, etc., with refrigeration. There is lots of knowledge out there. Perhaps the Minister could confirm whether that is being accessed. I hope it is.

I wrote to the Minister on this second matter last week and I tabled some parliamentary questions. I note the Minister has taken up some of the suggestions. I suggested that the AstraZeneca vaccine could be shipped pre-approval to be ready to go because the approval is only about dosage. It is not about the formula. It is about what dosage to give to the patient. Another Minister has run with that since. A follow-up question is whether people can be trained in it. If there are any differences with how the Pfizer and AstraZeneca vaccines are administered, people should not only have it ready to go in the fridge but have the trained staff ready to start injecting it. That would be really helpful. Similarly, on the Pfizer vaccine, I asked in a parliamentary question last week on whether we can get six rather than five doses out of the Pfizer vaccine. That would be helpful also, if that is confirmed as a working protocol.

My next question has been raised elsewhere, but I will ask again. There are certain sectors that are a bit of a grey area. Dentistry is one that has been raised with me this morning. Dental nurses, dental hygienists and dentists themselves are in a healthcare setting. They are performing emergency work in many cases but they are not currently on any list. Family carers are another. Professional carers have been mentioned, but where do family carers, where somebody is looking after an elderly relative, a person with special needs or somebody who requires significant assistances and who maybe could not provide that assistance were he or she to get sick, sit on the list?

My next point is information. We have debated this a lot. My office, and I am sure every Member's office, is being inundated with queries, such as how one gets it, whether one presents to one's GP, or whether one goes down to the hospital and whether they call the person or whether the person calls them. Is it do not call us, we will call you? How does that work? Will it be preselection based upon age and certain criteria or do they need to make themselves known? Do they need to go online? How will that work? I appreciate it may not be quite there yet but the sooner we can get that information out there, the better. If we can tell people what to do, do they wait for the call? Do they make the call? We really need to get answers to all those questions out there as soon as possible.

I would have had a lot of exchanges with the Minister over the summer on getting the Covid statistics on the app and out there in terms of caseload and I would make the same point about the vaccines. If we can get the statistics out there with daily publication, ideally, on the app, that would help to generate confidence.

This is my last question before the Minister responds. There is some suggestion within the EU that some countries are getting the vaccine quicker than others based upon their propensity to administer it. Denmark is said to be an exemplar and it is getting more of it more quickly because it can use it. Is that holding us back to an extent? Is there any of that at play? If there is, can we address that? If there is not, the Minister might reassure the House. I thank the Minister.

The Minister gets to answer one of those. He has 30 seconds.

In terms of the supply chain, there is a lot of expertise involved in the national cold chain storage and the drug distribution network is being used.

On whether we can get AstraZeneca ahead of the scheduled delivery, we are doing everything we can. The scheduled delivery is mid-February. We are looking for authorisation on 29 January and we are doing everything we can do see what we can be done there.

On Pfizer and the sixth dose, we had really good news. Apologies, I will get back to the other Deputies in writing.

Can I ask a quick question of the Acting Chairman?

In my efforts to counter misinformation from Deputy MacSharry last week, I asked permission of the Leas-Cheann Comhairle in what was without a doubt an unacceptable and inappropriate way. It is certainly something that I sincerely regret. Given what I believe to be misinformation from Deputy MacSharry on something that is so important, I wonder would it be in order for me to give a brief response.

The Minister will have a period at the end where he can do that.

Deputy Daly has three and a half minutes. Has the Deputy questions or a statement?

A statement.

In order for the vaccine roll-out to succeed - we all want it to succeed - it needs a plan to deliver buy-in and trust from participants. Buy-in should be very high. The Covid-19 vaccine is likely to be the most desired vaccine the world has seen in decades. The plan should set out goals and timelines and performance indicators and all of this will build trust. If the plan is good, it will work.

Unfortunately, the last couple of weeks have shaken the implicit trust that many people had. Educators and teaching staff, early years, special needs assistants, SNAs, special education teachers, all teachers, facilities and office staff want to be sure that they and their students are safe in the workplace. They have worked exceptionally hard since June to plan for reopening with very little direction from the Department with minimal resources. The rate of spread in schools has been well contained for the most part thanks to staff. However, the new virus strains have completely changed circumstances for them. We are not dealing with the same situation we had from August to December. Not only are teaching staff wary of the Department of Education's reopening plan, they have been largely abandoned in the vaccine plan. The mantra that schools are safe is not good enough. It is the educators in the State that the Minister is talking to. The Minister is not trying to sell the monorail to residents of Springfield.

Teachers are ranked priority 11 out of 15. This defies all logic. I have been informed by healthcare workers that they are a broad category in the plan. While many in hospital settings have now received a vaccine, numerous others have been brushed aside. Home helps who go into the homes of elderly and vulnerable people and have close patient contact should be in priority 2. However, I am hearing from home help workers, who have not even been contacted about receiving the vaccine, that they are gravely concerned and need clarity. Dentists are in close contact with their patients and are exposed. We were assured they were in priority 2. Dentists in Kerry, however, have told me that they cannot even get clarification on when they will be contacted to arrange for the vaccine. I was also contacted by an adult day care worker in Kerry who told me his appointment for the vaccine was cancelled due to IT difficulties. When he complained, he was offered the vaccine in Cork city, two hours away. More chaos.

Every plan must have contingency. While I appreciate the vaccine is new and the methods of distribution present new challenges, this should have been accounted for. Surely the most basic plan would have stated leftover vaccines must be used for priority 2 workers. It is incredible that the communication of the plan was so poor and rushed. However, it is not surprising. This should have been addressed but like every other plan it was amended after pressure from the Opposition parties.

I have heard from teachers and special needs assistants who are terrified to re-enter schools. They care for their students but are being left to balance at-home students with in-person students without additional resources and no commitment to test for close contacts for them. In fact, there has been no additional consideration or resources for this cohort despite evidence of the new virus strains affecting younger people at a far greater rate.

Once the trust is broken, it is difficult to repair. Clarity must be provided and the rationale must be clear to all. I urge the Minister to ensure that the priorities fit with public health guidance, as well as investing the right effort and energy. The Government knew what had to be done in ICU but did not take action. The Government knew what had to be done regarding test and trace but that did not happen. It needed to tighten airports and borders but it did not. The Government needs to address the concerns of teachers straight away.

The next speaker is Deputy Gino Kenny. Is it questions or statements?

It will be questions and answers.

I welcome last night's news about the funding for and the establishment of the medical cannabis access programme. I presume over the next few months we will have a discussion about the roll-out of that programme.

Over the weekend, a number of the Minister's Cabinet colleagues were somewhat contrite about the public health advice given in late November. Does the Minister bear responsibility for the circumstances in which the State is now?

I thank the Deputy for his kind words on the medical cannabis access programme. I acknowledge that he has been at the forefront of this from day one, along with Deputy Aindrias Moynihan and others. It is good news. I look forward to going through the details of it with the Deputy and others. We are allocating a sizable amount of money. The programme existed before but, as the Deputy is all too well aware, it was not able to be rolled out because there was not an allocation for new drugs. That is being rectified and I look forward to talking to the Deputy about it.

I am more than happy to answer the Deputy's question. However, it is a session on vaccines and the Deputy's question is about the public health advice in November. I am happy to answer it, Acting Chairman, but we might be doing a different session at another time. I am happy to answer it if it is in order. If it is not in order, we could move on to vaccines.

It is Deputy Gino Kenny's time. He asked the question.

That is no problem at all.

Ultimately governments are responsible for the decisions they make. That has to be the starting point. I have absolutely no doubt that in time there will be a full and thorough review of what happened. None of us would want the surge that we saw and the subsequent impact it had on the hospitals, ICU and so forth.

Had we or anybody known then what is known now about the prevalence of the UK variant, as well as potentially the South African variant, the public health advice would have been different. I have no doubt that the Government's decisions would have been different, as well as public behaviours. It all would have happened differently.

We did not know about the UK variant until the Friday before Christmas. That was when the UK Government raised an alarm and said it had a problem. We worked right through the weekend with the public health officials. We were back and forth with our counterparts in the UK. By Monday, the Government was shutting down travel between Ireland and the UK, which was completely unprecedented, and recommending moving to level 5. To give the Deputy a sense, the day before that Friday, on the Thursday, the public health advice, which I believe was the right advice based on what was known at the time, was to bring forward level 3. The original plan had been to move to level 3 in early January. They were saying that given the rise in cases, we should move it forward to St. Stephen's Day. The Cabinet sub-committee met on Monday and made a recommendation to the Cabinet without NPHET advice but, in fairness, with CMO advice to move to level 5.

I would be happy now or on another day to compare and contrast the information. There has been much focus on what happened coming into December. The advice was to move to level 3 which we did. There was one area of difference where the advice was to close hospitality. We did open the restaurants. Hospitality was not open. The pubs, hotels and nightclubs were not open but restaurants were. At the same time, the public health advice was to open up households. As the Deputy is aware, we kept no household visits right through to 18 December.

Would 3A versus 3B have made much of a difference? Personally I do not think so. There is an interesting question to ask, namely, whether we should have tried to extend level 5. Might that have worked? My own view, for what it is worth, is that I do not think it would have worked. It would not have been in line with public health advice. The public health advice, if it had been level 5, would not have been in line with what was happening on the ground. People right around the country were very tired. We had just done six weeks of level 5. We had the lowest case rate anywhere in Europe. These are important and real questions which will be examined in a lot of detail in time.

We are back to the Government side with Deputy Colm Burke. Is it statements or questions and answers?

It is questions.

I thank the Minister and all of the people involved in trying to get the vaccine rolled out at the earliest possible time. Everyone involved is working extremely hard. In the South Infirmary in Cork, over two days, 1,200 people were vaccinated. This included people working in the hospital sector, GPs, their assistants, ambulance paramedics and front-line workers. Vaccinating 1,200 people in two days shows the commitment given by people. People were also working on a voluntary basis.

We still have not received clarification on home helps calling to five to six houses a day to provide care to elderly vulnerable people. If the company they are working for has a contract with the HSE, it appears to have no difficulty in getting its employees vaccinated. However, in the case of companies not directly doing work for the HSE but which have contracts to provide home care, their employees do not seem to be able to get access to getting vaccinated. I would like to see some clarification on that issue.

My understanding is that those receiving dialysis are on the seventh cycle, way down along the list. These are people who might travel to hospital three or four times a week. Someone must take them and then someone must bring them home, meaning they have much contact with people outside their own home. They appear not to be prioritised. It is a small - around 2,000 people - but important group. Can they be prioritised?

I thank the Deputy very much for the questions. Yes, those in the formal carer sector are included as front-line healthcare workers.

For example, the Minister of State, Deputy Butler, spoke about this exact group of people being vaccinated in Waterford. They are included. The clinical guidance on this is that those in the formal sector are included as front-line healthcare workers. With regard to dialysis, a similar question is being raised, very understandably, by other Deputies, and it is coming to me and, I am sure, to all colleagues almost daily. Cystic fibrosis was mentioned and many other people have many other serious conditions that make them very vulnerable to this.

The question is being asked whether it is reasonable for us to change the prioritisation so they can be vaccinated earlier. What I can say at this point is NIAC, which is the expert group, has considered all of these issues and laid out the principles on which it was providing the advice. The advice it has was looked at in great detail by NPHET. NPHET endorsed the prioritisation that was there and this was subsequently agreed by the Government. However, as we said from the start, it is a living document, and as new evidence emerges and as we learn more, get new vaccines and find out more about new vaccines, we must always be open to reviewing the prioritisation. On a personal level, I am very sympathetic to the point the Deputy is making. I know people who, if they get this disease will be in very serious trouble, and I am sure every Member of the House does also, as does everyone in Ireland. It is a very important question. The position before any review is the NIAC prioritisation, which is what we are going with, but of course we must be open to reviewing it.

I thank the Minister. It is very important at the outset that we state we have come on an incredible journey in a short space of time in terms of the vaccination roll-out. We have moved from being the laggards of Europe to being the top performing country in the continent, and this is the level at which we need to be operating. As of last Sunday, we had administered 94,000 vaccines. We have a team of 1,700 vaccinators operating and a total of 4,000 people trained to vaccinate. It is important that we emphasise that this is the largest ever vaccination programme undertaken in the country. I commend the Minister and his team on their Trojan work in this regard.

It is also important that we put on record that we have paid a massive price in terms of Covid. As of yesterday evening, we have logged 179,000 cases and, sadly, we have recorded 2,768 deaths. For them, sadly, the vaccines will come too late. It is these deaths, and doubtless there will be other deaths that will surely come in the coming weeks, that need to keep us focused on the stated goal of the Minister and the entire House that we complete our vaccination programme by September. We have been issued with a roadmap, which is very welcome . As some of my colleagues have said, it needs to be delivered with authority and conviction.

An important aspect of the plan is the messaging. We will shortly commence vaccinations for everybody over the age of 70 not living in long-term care facilities. Here the message needs to be precise, timely and reassuring. It is critical these recipients, many of whom live alone and are isolated, know as soon as possible and affirmatively when they are to get their vaccine and where they will do so. I am conscious that many of my colleagues have already highlighted the call for earlier vaccinations for cystic fibrosis patients and mental health nurses, and I support these calls.

Everybody in the House agrees it has been a tremendously difficult week for the parents of special needs children and the children themselves. The Minister is determined to get the resumption of special needs education classes as soon as possible, and there is an earnest expectation that we will shortly see our schools reopen. The current schedule of vaccinations will not see education workers vaccinated until April. I encourage the Minister to look at every opportunity to see whether this can be brought forward. Similarly, childcare staff have been working in facilities since the start of the year and it seems they have been overlooked. They also need to be prioritised. We have heard the case made here today for pharmacy workers. If this can be fast-tracked, it would be greatly appreciated. Crucially, we need clarity on the situation of family carers as it seems that at present they are included as key workers in cohort 6 but in reality they are healthcare workers. I note the Minister's earlier clarification that paid carers are now categorised in cohort 2 but, for clarity, will the Minister confirm whether those in receipt of carer's allowance or carer's benefit are now included in this category also?

Everybody in the House received an email from Siobhán this week. She cares for her elderly parents and her daughter who has cystic fibrosis. For ten months she has gamely battled to keep her home Covid free. It has been pressurised and extremely stressful but her efforts have taken a huge amount of strain off our other front-line workers. It is important that we prioritise the Siobháns of this world, the people who are working, north, south, east and west, in this country for a fraction of the minimum wage.

I have a number of questions which I will put together and the Minister can respond as best he can. I seek clarification on several points in the Minister's responses to Deputy Culliane. He mentioned that dentists are included in cohort 2 as front-line workers. They do not know this so there is a need for improvement. Will the Minister clarify exactly how the roll-out among this cohort of very important workers will take place?

I reiterate the question put by the previous speaker in respect of carers, particularly family carers. It is crucial that the roll-out of the vaccine is seen to be fair and that equality is seen to underpin everything done. In this respect, it should not really matter who is paying a carer. If people are carers or working with vulnerable people, they should be included and prioritised as part of the roll-out.

This principle of equality and fairness also needs to apply in respect of the workers and staff in hospitals. Over the weekend, we all saw a headline that hospital staff in the south west are four times more likely to have been vaccinated than staff in the north east. This is not what we need to see and I am sure the Minister will agree. We need to ensure the roll-out is balanced and fair. This week, one of my local radio stations, LMFM, heard harrowing stories from staff in Our Lady of Lourdes Hospital in Drogheda with respect to false dawns. Staff were told to prepare for vaccination programmes being rolled out, but on Tuesday they were told it was not going to happen. I do not know whether the Minister has clarification on this case. I do not know whether the Minister is aware that, in the Cavan and Monaghan hospital group in my constituency, staff and workers in Monaghan have been expected to travel to Cavan to get vaccinated. This is not fair or equal and, in my view, it is not effective. Will the Minister give an update on whether there will be a vaccination roll-out in Monaghan hospital?

Will the Minister clarify, and I hope the answer is a simple one, for staff who are resident in the Six Counties of the North and working as front-line workers in hospitals in this State that they will be part of the vaccination programme?

I thank the Deputy for his question. With regard to dentists, I am happy to confirm they are included in cohort 2. I have spoken directly to their professional body and have stated it publicly on several occasions. If they do not know, we will do everything we can to let them know. Communications have issued but we can always do more.

With regard to carers, it is a clinical decision based on the prioritisation from NIAC, which is the expert group, that those in the formal sector who are employed as carers are covered. To answer the Deputy's direct point on family carers, it is not my decision but a clinical decision based on the expert advice that they would be covered under the various categories into which they might fall. For what it may be worth, my view is that an even bigger priority are the people being cared for. In many cases, the vaccinations will begin in mid-February for those aged over 70.

It is not everyone, obviously. Some people who are being cared for will have underlying conditions and there has been a lot of discussion on that. I will revert in writing with the other answers. I thank the Deputy.

I call Deputy Seán Canney for questions and answers or statements.

I have a short statement and a few questions. I do not want to repeat what others have said. I thank the Minister for fielding all the questions this morning. From my constituency point of view, what is missing is the fact we do not have a clear programme. We have a plan but we should have a programme. A programme would include where we are getting our supplies from, when we expect them, how we are going to distribute them and how we are going to reach our target in September.

It is being rolled out and I congratulate everybody on what has happened so far, but there is a huge lack of information for people who are worried. People ask how they are going to get the vaccination, who is going to contact them and whether they need to register. I know of people living on their own who are not able to go to a GP. How are they going to get the vaccination? They need to know. It is the need to know which is creating the questions, and many questions have arisen. The HSE, or whoever is in charge of this, should prepare a programme, not a plan, indicating when we are going to get the supplies and then, for each month, how we are going to administer them. If I know I am in category 9 or 10, and that is in September, at least I know that. This is what is missing. People do not know what category they are in and it seems to be very complicated.

People have contacted me who are living at home and not able to access the GP because they do not have a car. They ask whether the GP will come to them to administer the vaccination. A woman rang me the other day who is caring for her parents. She is paying two people to come in to help to care for her parents, who need 24-hour care. She is not being paid through any organisation, company or otherwise - she is not on the radar. She needs to get the vaccination for her parents and for the key workers who are coming to her home, which is important. A couple in their 70s are living beside me. Their son came to me last Sunday and asked how he would get his mum and dad registered for the vaccination. Where do they go? Do they wait for the GP to contact them or do they have to ring the GP? How is this done? I do not have the answer and I do not know if the Minister has the answer. However, we need to be able to give out this information as quickly as possible. This is our great hope; it is the hope that this is going to get us out of this situation. However, these questions are being asked by people who are genuinely concerned.

I want to return to the situation with special needs education. One of the areas we need to look at is that we have 18,000 children without any educational service, and they are also without other services, such as speech therapy and so on. We need to do something to help everybody to get these children back to school. If that means trying to get some of the staff, including SNAs, vaccinated, I think we need to do it. I know everybody will say it is something that should be done today, and everybody wants it today and we are not all going to get it.

To come back to my original point, we need to be able to say to people when we expect they will get it. It is not a document that would be used to beat the Minister's head with if we do not fulfil something. It is to try to give some sense of the arrangement for everybody in regard to how this will be done.

It is also vital to state that what I read in the newspapers last Sunday really upset many people, whether it is true or false. I welcome the Minister's statement that there is no political interference. There should not be any political interference. This is not a political issue; it is a serious life or death issue and a health issue which we all need to work together on. Everybody will get vaccinated and I understand that, but the frustration is there.

The other component that arises in regard to the roll-out of the vaccination is whether we have looked at every available asset in the State to ensure we have the resources to deliver. I welcome that the GPs and the pharmacies have signed a deal, and that that will happen. However, have we looked at the Army and the Army Reserve from a logistical point of view with regard to delivery and helping out in creating these vaccination centres that we talk about? When are these going to be set up and can we make use of the resources we have in the State? Do we talk to the Office of Public Works about buildings which may be vacant and which can be used as drive-through vaccination centres rather than creating more cost elsewhere?

We are doing well in the roll-out of the vaccination. The only criticism I have, and it is more the offering of advice than a criticism, is that we need a plain language plan or programme so we can say to people they are going to get their vaccination and, for example, they will not get it until July, but at least they know they are going to get it in July. That is the target. Effectively, there are two parts to it. We have to get the supply right and we have to get the distribution and administration right.

I have concerns about the nursing homes and getting it out to them, and, in particular, getting it rolled out to all the staff involved. The problem with some of the nursing homes is that they are really against the wall at the moment. Where there is an outbreak and people have the virus, they are not being vaccinated, and the homes are trying to get additional staff but they do not know if these staff have been vaccinated. There is a huge issue. Whether it is private or public nursing homes, I ask that the Minister would make sure they get whatever they require. What I see and hear happening is not great for older people, and we need to protect them.

The most critical thing is information, clarity and a clear programme so that we, as politicians, will know and be able to tell everybody how this is being done. We will support the Minister in every way we can on that.

I call Deputy Dara Calleary, who is sharing time with Deputy Kieran O'Donnell. The Deputy can make a statement or have questions and answers.

Thank you. I cannot speak on Covid without acknowledging that it has been an incredibly difficult few weeks for our country, but particularly for my county of Mayo. I want to put on record my thanks to the staff of Mayo University Hospital for their extraordinary efforts, which are ongoing, and to the GPs and ambulance drivers across the county, who have been faced with huge challenges. My thoughts are with all the families who have lost people.

I say to the Minister of State, Deputy Mary Butler, that communities around the country, not just in Mayo, need mental health supports to guide them through this very difficult time. I would like her to put some time into rolling out mental health supports, as well as the vaccine programme that will roll out in the coming weeks.

I want to acknowledge the work that has been done to date on the vaccine programme. We saw over the weekend the vaccination of GPs and the beginning of vaccinations in the major hospitals. I want to acknowledge the management and staff of Saolta University Health Care Group for the work they have done.

I am listening this morning and I am garnering information all the time on who is in what group. That information is not publicly known or is not widely known. We need to get a communications plan that actually explains to people in clear and simple language who is in what group and when they can genuinely expect to get it. The Department showed the ability to get information out to every house in the country around Covid initially. What we need now is a plan that goes to every house in the country and we should not assume that people are going to see it on Facebook or Instagram or in the newspapers. Every house in the country needs to get some sort of communication once the Minister has an idea on supplies, and I would ask him to think of that.

I am also concerned about the decision by the national immunisation advisory committee, NIAC, around family carers and home helps in particular. I know it is focusing its concentration on the client, but the client would not be in the health they are in without the work and commitment of the family carer, the home help and carers generally. I would ask the Minister to engage once again with NIAC around that. We have seen that hospitals were flexible around vaccine doses. When administering a vaccine dose, surely the person who is keeping another person healthy should also be considered, and should also be considered as vulnerable. Family carers, home helps and carers are front-line staff. Much of the focus of our Covid policy to date has been on keeping people out of hospitals. The extraordinary work of carers is doing that and doing much more, and we need to acknowledge them.

The information we are getting is that the GPs and pharmacists will be part of the roll-out but pharmacists still do not have any idea where they and their staff will fit into the timeline. If they are going to be on the front line of the roll-out, I would ask that, similar to last weekend, we organise mass vaccination centres for them around the country.

Similarly, palliative care nurses who are with families in their darkest hours also need guidance around that. I also seek confirmation on those. I welcome the note the Minister gave in relation to those with conditions such as cystic fibrosis. We need that information to get out to people. The vaccination process will be done through GPs and pharmacists. We need a much wider roll-out than we have had to date. We need vaccination centres in all large towns so that people can get it done quickly. Many people are unable to travel to major urban centres. Consideration must be given to how we get it to those who are housebound.

Will the Minister tell us his thoughts on the communication plan? Will he look at the graphic which Deputy Lahart prepared last week on the communication plan? That showed simply, based on current projections, where it is going. We need simple, effective communication. There should not be an assumption that everyone has access to social media.

The big issue with the vaccine now is supply. Will the Minister indicate the level of supply coming into Ireland over the next month, by week and company?

I am happy to provide the Deputy with a note on that but it is changing, sometimes daily. For example, in recent days we got about 24 hours notice that this week's delivery of the Pfizer vaccine, instead of being about 40,000 would be 20,000. As we are getting a sixth dose, we are getting an agreed amount of vials that give 40,000 doses, but we are getting a lot more out of them. That is new. The reduction for this week is new. I am happy to provide the Deputy with what we have but would make the point that the big game changer is AstraZeneca. We do not have a decision on AstraZeneca. We are working hard to see when that can be brought in.

For the public, is the Minister saying that we are getting 40,000 of Pfizer, there will be 40,000 next week and 40,000 thereafter? If approved, what type of level will the first order be from AstraZeneca?

These details are being worked out right now, not only in Ireland but with the company through the Commission with every member state. I can give the broad figures for the end of March, because the day-to-day and week-to-week figures move an awful lot. The plan is that we will have approximately 1.4 million doses in the country, about 600,000 would be AstraZeneca and the majority of the rest would be Pfizer BioNTech and the rest would be Moderna.

UHL is in my area of the mid-west. It has only received 3,400 vaccines to date. The South/South-West Hospital Group appears to have to administer over 19,000. When the next roll out comes, the mid-west share must balance that.

Dentists are front-line workers. Dentists have been calling me and they are petrified about Covid. They deal with patients everyday and they do not know whether or not they have Covid. They along with pharmacists need to be treated in the same way as GPs.

Why has the roll-out of vaccines been disproportionate to the South/South-West Hospital Group of the order of 19,000 when in the mid-west area, which I represent, the hospital has only received 3,400 vaccines? It is about supply.

The roll out to individual hospital groups, as I am sure the Deputy will acknowledge, is an operational matter. There is no political involvement whatsoever in how many doses go to different parts of the country. They are operational decisions. I asked the HSE the exact question posed by the Deputy and was told that to begin with, the HSE contacted the hospital groups and asked how ready they were and how much could they take. The initial amount dispersed was done on that basis, and then they immediately moved to a pro rata basis based on the numbers of front-line healthcare workers in each hospital group.

Dentists are included in cohort 2.

The Minister has just said that the hospitals were contacted to see how many vaccines they could take. Deputy O'Donnell has spoken of the 3,400 vaccines that came to Limerick. The Minister is saying that it is a management problem in some of the hospitals that they could not deal with the amount of vaccines.

I give all the praise in the world to the front-line staff, from doctors, nurses, carers, porters and across the board. In Limerick, the area I represent, there are front-line staff in Covid wards who are not getting vaccines and I hear that there are people in management, not directly involved in Covid care, who are getting vaccines. That is a management problem. The Minister has inherited this. It has been apparent for years that the HSE and the health system is broken. The rolling-out of the vaccine proves that mismanagement of hospitals without a shadow of a doubt. I brought that up on my first day in the Dáil. If someone cannot manage something, he or she should ask for help. It is not a sign of weakness to do that if one is managing a situation. We have a runaway train.

The Minister said there would be full traceability of the vaccines that have gone out. I hope this is not like the mother and baby homes where people will be apologising in 40 years' time for mismanagement of vaccines which are going to people who do not work on the front line. The people providing front-line services must get the vaccines first. GPs are getting emails to say they are on the list for a vaccine and getting another email an hour later to say that was a mistake. It is mismanagement. It is not the carers' problem but a management problem. The management of the HSE and the Department of Health are wrong. We need to get it fixed. After the pandemic, I seek the Minister's help to fix it.

I am thankful the Minister is here because it is a very important issue for every constituent. The public has so many genuine questions about vaccines. When will people with cystic fibrosis get it? When will those over 70 and home carers get it? The home help service in west Cork, and everywhere, is at the front line like no other. There are approximately 1,000 elderly and vulnerable people getting home help in west Cork and 350 home helps providing a service to these vulnerable people. Many home helps visit numerous clients daily, exposing themselves to risks and putting elderly clients at risk of infection. Will the Minister tell us when exactly home helps in west Cork will be offered the vaccine?

I wholeheartedly agree on the value that home helps in west Cork and around the country provide every day. I am happy to confirm that the clinical decision is that the formal carers sector, which includes the people the Deputy mentions, are included in cohort 2. That is very important. On when exactly those in different groups in different counties or parts of counties will receive the vaccine, there is an operational schedule in place for each hospital group which the hospital groups are managing according to a prioritisation from the HSE. I am happy to make an inquiry about the planned schedule for that group to the relevant hospital group on the Deputy's behalf.

I would appreciate it if the Minister could furnish me with that information.

I want to commend the community hospitals in west Cork that had doses of the vaccine leftover but called in a number of home helps to use them up. It was a great idea and the right way to use up the few vaccines that were available. The intimate care home helps have to provide, which in many cases includes washing and changing patients, does not allow them to keep a distance of 2 m. It is imperative that they get the vaccination ahead of many others. I would appreciate it if the Minister could be more specific in terms of a deadline in that regard.

I very much agree with Deputy Collins. I have raised previously with the Minister the need to prioritise both persons providing home help and those who are receiving home help. People providing home help go into multiple homes and, likewise, people who receive home help receive it from multiple carers.

I want to ask a specific question. I agree very much with many of the points made with regard to the necessity to vaccinate people who want to be vaccinated in mental health facilities, including those who work in those facilities, as well as hospitals, and for them to be treated exactly the same, and likewise, persons with cystic fibrosis or other underlying vulnerabilities. However, a suggestion was made by some senior people in the Minister's Department that persons who have had Covid-19 would not be vaccinated for some time because presumably if they had it and recovered they would have developed antibodies from that. What is the position on that because if they are not a priority, why are they being vaccinated right now? How many people who have had Covid-19 have been vaccinated? I am aware of medics who have contracted Covid-19 through their work, and we all sympathise greatly with them in that regard, but who have had the vaccine even though they were not sure whether they needed it in light of the fact that they had recently recovered from Covid-19.

I thank the Deputy for the question. My understanding is that this came from research out of the UK where they were looking at the reinfection rates of healthcare workers who had it. It was suggesting that a large amount of protection was afforded if one had had it and the suggestion was being made in the UK that that might be something that can be examined. I have discussed it with the Chief Medical Officer, CMO. He is looking into it in detail. The current position, however, is that it is not one of the factors. I am straying way outside my own expertise but if it is helpful, one of the reasons I was given was that people get infected with different viral loads and therefore the antibody response can be at a different level depending on that. One of the issues we would need to look into very closely is whether an equal protection, for example, is afforded to people. Given all of that the position right now is very clearly that whether one has already had Covid-19 is not taken into account in terms of vaccination.

I thank the Minister.

First, I sincerely thank everybody who is involved in the vaccination process from start to finish. We have a long way to go but we have made a start.

A few days ago I listened to a report on the TV about a care home where the process of vaccination had started. Everybody was delighted and happy. That is the way it should be but, unfortunately, it is not always the case. An example of that is Sligo University Hospital, in my constituency. The vaccination process started and then it stopped. The questions asked were whether it was patients and staff who were vaccinated and when the process would start again. Instead of people having clear and good information the priorities had switched to care homes for this week. People were left asking questions. People were frustrated and angry. I ask the Minister to do his best to ensure that in terms of the vaccinations we have good, clear communications about who, when and where. People may not always like it but at least they will understand it.

Even more so I ask the Minister also to clarify who in particular are front-line workers. People need to have a sense in their heads that this will be them at a particular point in time. That gives people comfort. Not knowing, seeing others getting vaccinated and asking why they themselves are not vaccinated angers people hugely. The process is important but the communication and the information around it are hugely so.

Finally, I ask the Minister to look again at people like family carers, those with Down's syndrome and people suffering from cystic fibrosis.. I know it is a medical decision. I am delighted it is not a political one but I ask that those who are in a position to make these decisions look very carefully at the impact of Covid-19 on those populations.

That concludes the speakers on questions. Before I call the Ministers of State, Deputies Butler and Feighan, to respond, the Minister, Deputy Donnelly, wanted an opportunity to speak. There is some spare time if he wants to do so now.

No. I am happy to cede that time to the two Ministers of State.

I thank Deputies for sharing their views and observations on what is a key component of our strategy for transitioning out of the current pandemic. As I am sure Deputies will agree, the scale of the current vaccination programme is unprecedented. I again acknowledge with thanks the efforts of all those who have brought us to this juncture. Without the efforts of healthcare workers we would not have managed to halt the progress of Covid-19 sufficiently prior to the roll-out of the vaccination programme. Without the initiative taken by the European Commission and our member state colleagues we would have been hard-pressed to access the quantities of vaccines that have been allocated to us to date. Without the work conducted by NPHET, the national immunisation advisory committee, NIAC, and the vaccine task force distribution of the vaccines would have been chaotic and disruptive to the health system. Without the efforts of the staff of the HSE vaccines would not be properly stored and ready for use, vaccinators would not be properly trained and vaccination of the most vulnerable of us would not have commenced. Finally, without the efforts and sacrifice of members of the public we would not be in a position to manage the progress of the disease and maximise the benefits that vaccines provide for us. To all those who have been working flat out for the past three weeks to deliver the vaccine I want to say "thank you".

On vaccine supply, we have heard many calls today from various Deputies for the vaccination of different groups to be accelerated. I want to make it clear that the administration of vaccines to members of the public will be limited only by supply of the vaccines available. As new vaccines are authorised by the European Commission Ireland's vaccination programme will be scaled up with a view to the fair administration of vaccines across key groups. These groups have been identified on the basis of careful consideration of what is known about the disease, the vaccines available to combat it and where public health benefits can be maximised. Eventually, vaccination will be made available free of charge to all those who seek it. That will be dependent on the supply of vaccines available at any given time. Administration of the vaccine is subject to continuous review such that any decisions to speed up the campaign or to vaccinate particular groups will be evidence based. I reiterate what the Minister, Deputy Donnelly, said earlier. Evidence based, clinical based reviews will be key. There will not be political decisions in regard to who receives the vaccine and when they receive it. Everything will be evidence and clinically based.

I want to talk about the vaccination and side effects. As with any vaccine some side effects are to be expected. I can advise that they are being carefully monitored and that as of 11 January, 81 adverse reactions were detected. All reports made to the Health Products Regulatory Authority, HPRA, were generally consistent with those typically observed with other vaccines and included events of a mild to moderate nature, which resolved or were resolving at the time of reporting.

It should also be noted that vaccination of some groups, for example, children or those with certain chronic conditions, cannot take place until more data is gathered to ensure that a particular vaccine is safe to administer to a particular age group.

This may inform decisions as to who should be administered the vaccine until further data are obtained.

I agree with many Deputies here today about the criteria. We have had much discussion about carers and front-line staff. Under the national immunisation advisory committee, NIAC, and NPHET, this is a living document. It can be revised. Every Deputy has been approached by many people to ask where they stand. The Department has been in ongoing dialogue with the HSE about the additional expenditure required to scale up the vaccination programme over the coming months.

Consultations have taken place with the Irish Medical Organisation and the Irish Pharmacy Union to establish an operational plan for their engagement in the vaccination programme after the initial roll-out phase. Fees have already been agreed and it is important that we give GPs and pharmacists, as private practitioners, the resources that they need to deliver vaccinations under the programme as rapidly as possible. This will include running dedicated vaccination clinics outside normal hours to ensure that normal medical services can also be maintained. The fees agreed with them reflect all these factors. While the Government believes that these rates reflect the level of resources necessary for GPs and pharmacists to administer the vaccine to a large number of patients in a safe manner, they also reflect a significant financial commitment on the part of the State. They will therefore be reviewed within six months to ensure that the vaccination programme is being delivered as efficiently and economically as possible, in keeping with the requirements of public health considerations.

This week, the focus is on long-term residential care facilities, with the intention that the majority of residents and staff will have received their first vaccine dose by the end of the week. Departmental and HSE officials have engaged with their EU counterparts and the Commission to secure a significant quantity of vaccine doses for Ireland. However, in the early phases of vaccine roll-out, there is a significant dependency on delivery of vaccine supplies. The HSE has been prudent in its early administration of vaccines, ensuring that sufficient doses are retained to allow vaccinations to continue where there is a shortage of supply. There is ongoing engagement with vaccine suppliers in relation to logistics, delivery and the safety and efficacy of vaccines by the steering board tasked with overseeing the EU procurement process. Most recently, this has included engagement on the issues of delays in the delivery of the BioNTech-Pfizer vaccine.

The availability of vaccines has the potential to allow us to combat Covid-19 proactively and begin to return to some form of normality. However, this will not be a quick process or a silver bullet and there is always a risk that any progress gained could be reversed. Vaccination should not be viewed in isolation from other health measures. The restrictions and travel limitations due to the possibility that new vaccine-resistant strains of the virus may affect members of the public, social distancing, cough etiquette and cleanliness minimise the possibility of infection spreading prior to vaccination. Vaccination offers hope for all of us but this must be tempered with continuing vigilance. However, 2021 holds a greater promise that we will, through our collective efforts, emerge from this pandemic with a new appreciation of all that we hold dear.

Sitting suspended at 11.54 a.m. and resumed at 12.02 p.m.