Covid-19 Vaccination Programme: Statements

We will begin with statements and questions and answers on the Covid-19 vaccination programme, which must conclude within 100 minutes. In that context, I ask Members to be conscious of time. The Minister has 15 minutes.

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

I thank the Leas-Cheann Comhairle for the opportunity to update the House on the Covid-19 vaccine programme. Like so much of our nation's response to the pandemic, the vaccine programme is testament to the way that Ireland, as a nation, has come together to show the best of what it can achieve. One of the most powerful demonstrations of how the pandemic has brought out the best is in the development of vaccines against Covid-19. Private sector innovation has merged with public sector investment and support to ensure the speedy development of safe and effective vaccines. This is particularly evident in the procurement process devised by the European Commission which allows member states to access a portfolio of candidate vaccines against Covid-19. Through the leveraging of the EU's emergency support instrument, funding has been provided to vaccine manufacturers to meet, in some instances, the cost of production for a vaccine.

Are copies of the Minister's speech available?

As of last Sunday, 24 January, 143,000 doses of vaccine have been administered to our front-line healthcare workers and residents of long-term care facilities.

Can we get copies of the speech?

This equates to almost 3% of our population. A full 66,000 doses were administered to residents and staff-----

Can we get a copy of the speech?

-----of long-term residential care facilities.

I am sorry to interrupt, but are copies of the speech available?

Are they being circulated?

The copies are here, somewhere.

I ask that staff would find them. I am sorry for interrupting.

As stated, 66,000 doses were administered to the residents and staff of long-term residential care facilities and 77,000 doses to front-line healthcare workers. The HSE also commenced administration of the second dose of the vaccine last week in 27 nursing homes and in hospital groups. That work of administering second doses is being significantly stepped up this week.

The presence of Covid-19 in a number of care facilities continues to be a challenge and has meant that some residents and staff could not be vaccinated. Due to outbreaks of Covid-19, four nursing homes out of a total of 589 were not included in the first series of vaccinations on the basis of public health assessments and in some others it was not possible to vaccinate all residents and staff due to their Covid status. Those who were unable to receive a first dose will be vaccinated once it is deemed safe to do so.

It is important that all stakeholders are aware of how dynamic the situation is with regard to supply chains. This means that Ireland has to employ an agile plan to react to changes. For example, some adjustments may be necessary to the original target of doses being administered in March to take account of AstraZeneca's recent announcement regarding reduced or lower than expected deliveries of its vaccine.

Acting on behalf of member states, the European Commission has negotiated six advance purchase agreements with a range of vaccine suppliers to date. In total, between initial volumes procured and additional opt-ins, Ireland has advance purchased over 14 million doses of vaccine. I wish to acknowledge the major efforts of the European Commission in developing the initiative and bringing it to fruition. Currently there are two vaccines in receipt of conditional market authorisation from the Commission and the European Medicines Agency, EMA. These vaccines, which are produced by Pfizer-BioNTech and Moderna, have been reviewed by the EMA which has provided significant assurance that they are both safe and effective. These vaccines are currently being administered as part of Ireland's vaccination programme. The reduction in the quantity of Pfizer-BioNTech vaccine supplies across the EU for one week was a challenge. The reduction in supply was required to allow the company to make necessary changes to expand its production. The increased level of production capacity will be beneficial for member states, including Ireland.

A third vaccine supplier, AstraZeneca, submitted its application for conditional market authorisation to the EMA and may receive approval from the European Commission as early as tomorrow. Obviously, we are watching that situation very carefully. Ireland has secured 3.3 million doses of this vaccine and it is envisaged that its availability will be crucial in the context of vaccinations to be administered by pharmacists and GPs in our communities. Recently, AstraZeneca advised that it will be unable to meet its initial delivery commitments if or when it receives conditional market authorisation. I am advised that this is due to difficulties arising at one of its manufacturing plants in Belgium. Negotiations with the company are continuing. At a meeting last night, the company was still not in a position to provide clarity on full deliveries after the middle of March. While it is anticipated that this should not impact on the start date for the roll out of the vaccination programme to the over-70s living in the community, its impact upon the pace of vaccinations is still difficult to gauge at present.

It is important to note that funding was provided by the Commission, which leveraged its emergency support instrument, to facilitate production of vaccines on behalf of member states. This instrument is ultimately funded by the member states themselves. AstraZeneca's vaccine has been delivered to other countries outside of the EU. The Commission, understandably, wishes to find out how the funds that it has provided to AstraZeneca were used, given the absence of agreed doses of the vaccine. Greater control measures to monitor the export of vaccines and associated transparency measures may be the best mechanisms to facilitate this process and is something on which the Commission is actively engaged with the company.

A feature of the vaccination programme is that the administration of vaccines will only be limited by supply. While vaccines are currently being administered to the first and second cohorts, namely, those in long-term residential care and front-line healthcare workers, the intention is to provide access to free vaccination for all adults. The vaccination programme conducted by the HSE exceeds expectations and is a testament to the commitment of all involved.

I would like to finish by acknowledging the work of everyone involved in the vaccination programme. This includes: our school vaccination teams, community teams and peer-to-peer hospital teams; our GPs, practice nurses and pharmacists; the trainers who have trained thousands to vaccinate and who will train many thousands more; the Defence forces who are working with us around the country; the national ambulance service, who have been quite extraordinary both in terms of vaccinations and their wider response to Covid; and the nursing home staff, both nurses and administrative staff, who have been really important in making sure we were able to get into the nursing homes as quickly as possible.

It also includes a group of people who do not get much attention and who are not seen, namely, the women and men working behind the front line. A large number of people are working behind the front line in logistics, management, IT and administration. The work done by both those on the front line and those behind it has been amazing. They have stepped up again and again. They work night and day and on weekends to make sure that the vaccination programme keeps moving and that the vaccine keeps getting out to the most vulnerable and to those who protect them. I will finish with a word of thanks to all of them. Not only are they stepping up and doing this incredible work, but they are doing it after a very difficult year in healthcare during which they and their colleagues have been asked to step up again and again, which they have done. I acknowledge them, their work and their commitment. Their work, commitment and professionalism are allowing us to protect our front-line healthcare workers and those who are most vulnerable and will soon allow us to move on to protect those over the age of 70 in the community. I thank them all.

I call on the Minister of State, Deputy Butler.

The Minister is sharing his time with Deputy Devlin.

I thank the Minister for sharing time and for his statement. I welcome the opportunity to discuss the roll-out of our Covid-19 vaccination programme. I thank the Minister and his ministerial colleagues in the Department of Health for all their efforts during this global pandemic. Equally, I acknowledge the tragic deaths of 3,120 people during this pandemic. Once again, I offer my deep condolences to all those who have lost loved ones during this pandemic. Like everyone in Ireland, I am extremely grateful for the efforts of our front-line healthcare staff who have worked tirelessly and diligently to keep people safe over the past year. Just yesterday, we saw 1,335 new cases of Covid-19 confirmed, 437 of which were here in Dublin. While this represents a considerable reduction on the peak of more than 8,000 cases three weeks ago, it is still very challenging and worrying for society as a whole. Almost 1,670 people are currently in hospital, with the HSE reporting that 217 are in ICU. While our seven-day average of cases has fallen from a high of 1,322 to 249 per 100,000 people it is clear that Covid-19 continues to pose a serious danger and threat to people. Sadly, more people will die but the public health message is very clear and straightforward: stay home and stay safe.

There is light at the end of the tunnel and, as we heard from the Minister, there is hope. The vaccine programme is being rolled out widely.

On a point of order, my understanding is that this slot is for the Minister. This whole session is supposed to be about the Minister's accountability for his responsibilities. Why is he sharing his time with a Government backbencher? It is not acceptable. I am not just making a political point.

I understand the point the Deputy is making.

My point is that we need to hear from the Minister.

We need an update from him. I object very seriously to what is happening.

I hear the Deputy. Her point is made.

I have never seen this before. The real issue is-----

I ask the Deputy to keep to the point of order.

On the point of order, I have never seen nor heard tell of a Minister, who is a member of the Executive, sharing time with a backbencher on such an important issue. It does not bode well. Will the Leas-Cheann Comhairle rule on this matter, because it may set a dangerous precedent?

As I will get to in my own contribution, the Minister's opening statement is completely unsatisfactory. We have not got the information we would have expected from the Minister and yet he is sharing his time with a backbencher. We are here to do business with the Minister for Health and to get information and the maximum of clarity and yet he is not using his ten minutes to give us that clarity but is sharing it with a backbencher. It is completely unsatisfactory.

The Deputy's point is made. As Leas-Cheann Comhairle, I had understood the Minister was sharing time with the Minister of State. That was my initial understanding. That is why I called on the Minister of State, Deputy Butler. However, the document on speaking time before me has the Minister, Deputy Donnelly, and Deputy Devlin. That was apparently the arrangement made. I was certainly expecting the Minister of State. The points have been made but I am afraid the Deputies will have to take them elsewhere because it has been decided that each group can share time. That was the agreement. I will call on Deputy Devlin again.

I understand what the Leas-Cheann Comhairle is saying but will she, through her office, check whether there is precedent in this regard and whether it is procedurally correct?

Will she also make a ruling in case it ever happens again?

I will not allow any more discussion because we will waste time allocated to a very serious matter. I hear the issue the Deputies have raised, which is serious. I had a slightly different understanding myself. I will not repeat my comments. I will go back to Deputy Devlin but we will take the matter elsewhere. I am told that each party is allowed to share time.

That is correct; the time is allocated by grouping. I was just saying that there is light at the end of the tunnel and there is hope with the vaccination programme well under way. As the Minister noted in his remarks, more than 143,000 vaccinations were administered up to last weekend, with another 51,000 due to be administered by this weekend. This will constitute the vast majority of nursing home residents and front-line healthcare staff. News that people over 70 years of age will start to receive their inoculations in the next two weeks is very encouraging. During the first wave, this cohort was particularly vulnerable and the worst impacted. Many such people have been cocooning or restricting their movements. News that the vaccination programme is well under way will come as a great relief to them.

There is a great enthusiasm for the vaccinations. Like all of my colleagues in the House, I have been contacted by constituents looking for more information on the vaccine programme. People want to know when they are likely to be vaccinated and what the arrangements will be. The Minister has highlighted the arrangement made with GPs and pharmacists. This is very welcome. I am sure there will be further news in that regard. There is a real hunger for information among the public.

Of course, all of this is subject to supply and, as the Minister highlighted in his remarks, there are issues in that regard at times and supply can fluctuate but people want a rough indication of when they will receive vaccination. I ask the Minister to ask the HSE about sending information to all homes or about a robust information campaign which might include a website and a helpline which people could ring to ask questions and get the information they desire about the vaccinations. I thank the Minister and his officials and all of the vaccination teams for the great work they are doing as part of this national effort.

I will make a very short opening statement before moving on to questions to the Minister. I have to say that his opening statement fell far short of what was needed. No timeframes or targets were given and the Minister did not revise the timeframes he had given to Deputies in this House and to the public over recent weeks. It pains me to say it but it is very difficult to retain confidence in the roll-out of the vaccination programme when we are not given the information we should be getting from the Minister for Health. He had ten minutes to set out a clear strategy that would provide people with clarity and certainty but he has not done so. He shared time with a backbencher and did not use the opportunity he was given today to give us the information we need. This is not a time for spoofing but a time for absolute clarity and certainty and a time to give assurances and reassurances to the public with regard to the roll-out of the vaccines. We need strong leadership on this issue and it once again pains me to say that we are not getting it. That is deeply disappointing.

Two weeks ago in this Chamber, the Minister said that the initial plan was "to inoculate 700,000 people by the end of March". In his opening contribution, he failed to point out that this was based on an assumption that AstraZeneca would be certified and that a set number of doses of its vaccine would be available. This only came out after I and others put questions to him. As we now know, that has run into difficulties. The Minister has provided no timeframes at all in his opening statement so let us get to them in the questions.

Does the Minister still anticipate that 700,000 people will be vaccinated by the end of March?

I thank the Deputy for that question. With regard to the plan, my understanding is that is exactly what we will get into now and I will certainly endeavour to provide any answers. That is what we are here for. Hopefully, the Deputy is still getting the daily updates as I asked that every Oireachtas Member would get a daily update on the vaccination programme. We are making a big effort to keep the Deputy and colleagues as updated as possible on a daily basis. If there is more that he would like or that he thinks that we can do, please let me know because we want to keep-----

My time is short, a Chathaoirligh Gníomhaigh. My question is a direct one on the 700,000 figure. I want to get information as I have six and half minutes left and I have many questions. Can the Minister answer the question? He said 700,000 people would be vaccinated by the end of March. Is that still the case?

I was responding to the Deputy’s statement, which he will appreciate we should all be able to do. As he quite rightly said, the figure of 700,000 was an effort to provide in an indicative target for the Oireachtas and it was, as he rightly referenced, heavily caveated and remains so. As the Deputy will recall from our interactions last week, I said that if we get the supply that has been tentatively agreed with the pharmaceutical companies, including AstraZeneca - remember both last week when we were discussing this and indeed right now, this company has still not even been authorised - the target is 700,000. The talk of the first, second and third quarter up to September is all heavily caveated around being conditional on supply. As the Deputy quite rightly pointed out, there are issues with AstraZeneca which I referred to in my speech-----

I have to ask the Minister again please to answer the question. It was a very simple, direct question. Is the figure of 700,000 by the end of March still the target?

I am trying to answer that question for the Deputy. The figure of 700,000 was conditional on supply coming in, including from AstraZeneca. As we are all aware, AstraZeneca has, very frustratingly, signalled that it will not deliver the full amount that was anticipated. Of the 700,000, which referred to people rather than doses, included in that-----

Is that a "Yes" or "No"?

I am trying to answer the Deputy’s question. Included in that was an assumption for AstraZeneca of just a little bit less than 600,000 doses. Right now, the company is not committing to that 600,000 and we are in negotiations to see what we can get. The 700,000 figure is contingent on the supply that comes in, which is still under negotiation with the company.

My reading of the Minister’s answer is that the 700,000 target may now not be met, which is exactly what he has just said. He said last week that we were expecting 600,000 doses of the AstraZeneca vaccine in the first quarter of this year. It is obvious that is not now going to happen. There are media reports that that figure could be as low as one quarter of that 600,000. Can the Minister give the House any information today as to what the estimation is now for the first quarter of this year for the AstraZeneca vaccine?

At the moment the conversation and negotiation is still ongoing and quite a robust set of meetings are taking place between the Commission and the company, and the relevant officials are also in touch with the company, including from Ireland. At the moment, Ireland or any other EU state, or indeed the Commission, cannot say what the final agreed amount for the first quarter up to the end of March will be.

I have many more questions for the Minister now on that issue but I do not have the time to put them.

On the question of family carers which I asked last week and which I have also asked in various different ways, I got four different answers as to where they will sit. I was told that they could be in group 2, group 4, group 6 and group 10. The Minister said last week that carers who work for the HSE and for private providers are in group 2. Can he give for the first time a straight and consistent answer to this question? What group do family carers sit in? They want to know, they are watching this, they are asking and lobbying all of us, and have a right to know. They are not looking to jump the queue but they simply want to know in what category they sit. Rather than getting multiple answers, which confuse people and which is not what we should be doing, can the Minister please answer that question for me? We should be providing clarity.

I fully appreciate that I am being asked exactly the same questions. The answer is the same as last week. There is not a single cohort we can point to. Perhaps this is part of what needs further explanation. The clinical judgement from the HSE, as the Deputy said, is that those in the formal caring sector are in cohort 2 and that family carers as a group are not in any individual cohort. Different carers who are in different positions themselves may fall into different cohorts, based on age, for example, and so forth.

That is an unsatisfactory answer. Can I point the Minister to the HSE’s own roll-out of the flu vaccine, where carers are seen as a distinct cohort, yet when it comes to this vaccine they are not, and they are concerned about that. As the Minister knows, they do an invaluable job.

I also wish to raise the issue of people in long-term care facilities and people with disabilities and the staff who work in these facilities. I am aware, for instance, in my own constituency in Waterford, many of the staff and residents have not been vaccinated. They are asking when will they be vaccinated.

In my limited time remaining I also want to ask the Minister about pharmacists. I met with the Irish Pharmacy Union, IPU, yesterday and they are concerned about when pharmacists will, in the first instance, be vaccinated themselves, and their role in the roll-out of the vaccine. It is reported that the Minister discussed dentists playing a role yesterday at his own parliamentary party meeting. It is my understanding, however, that pharmacists have informally been told that they will not be part of the roll-out for over 70s and yet they are obviously part of the roll-out for the flu vaccine. It is ridiculous that we have 2,500 pharmacists who can play a role, with all hands to the pump, to get this done quickly.

I ask the Minister then to answer these questions please on pharmacists and on people with disabilities in long-term care facilities.

On the first question regarding disability settings, what has been done so far and the target for last Sunday was that residents aged over 65 both in the mental health and disability long-term care settings would be vaccinated. That is being done. They are moving now on to the vaccination of the staff both in the mental health and the disability sector and this is happening this week.

As to dentists, there has not been an agreement as to vaccination with them. I have asked the Department to put such an agreement in place. Dentists, as they have pointed out themselves, are clinically trained to give people injections all the time. My understanding is that there has been initial conversations between the Department and dentists.

With regard to pharmacists, the deal is in place and they will be part of the roll-out. Exactly when and how they are brought in, as we begin to scale up from the over 70s is an operational decision for the HSE rather than a political decision and they are working through it in detail at the moment.

I call Deputy Alan Kelly. Will the Deputy be asking questions or making a statement?

I will just be asking questions as I will not have enough time for a statement, which the Acting Chairman will be glad to know. I will try to do a quick-fire round of questions for the Minister, if that is okay. I am not trying to catch him out as these are just straight questions to elicit information. I thought that I had six and half minutes. How many do I have?

It is five according to my schedule.

That is not what I was told.

It is five according to my schedule and the Deputy is using his time up.

Okay. Can the Minister tell me how many vaccines came into the country this week? I do not want to know how many people were vaccinated as we have all of those figures.

I will have to check whether the Moderna vaccine came in this week or last week because it is coming in every second week. The initial weeks for Pfizer was an agreement-----

As I have only a short time, can the Minister tell me how many vaccines arrived this week?

The initial agreement with Pfizer was for just less than 41,000, I think. However, we have been able to extract a sixth dose. That was based on five doses per vial. The best information I have from the HSE at the moment is in the weekly amounts coming from Pfizer we should be able to extract approximately-----

How many vaccines arrived this week?

Approximately 48,000 arrived from Pfizer, if we get the sixth dose out.

The Minister has committed to two sets of numbers that have not arrived. First, two and a half to three weeks ago, the Minister committed in the daily updates to provide the volume of people who have been vaccinated. Why has this not happened, as we were told that it would happen within a week?

On the second set of numbers, the Minister also committed to my colleague, Deputy Duncan Smith, approximately two weeks ago that he would break down the number of Covid-facing healthcare workers who have been vaccinated and their location.

Those figures have not been provided either. When will they be provided and why is the Minister not providing both those sets of figures?

Regarding updates on the volume of people, those figures are being provided. I will get the Deputy the information that has gone around but-----

I mean provided publicly.

They are provided publicly by the HSE. I have the figures to hand, but I will make sure the Deputy gets them. Regarding the healthcare workers, Deputy Kelly is right that I made that commitment to Deputy Duncan Smith. The HSE is working on that issue and as soon as I have the information, I will make it available to all Members.

Surely the Minister has that information instantaneously. What sort of an organisation would not know who it has vaccinated? That information must be provided, otherwise we have bigger problems here. It does not make any sense that we do not know how many Covid-19-facing front-line workers have been vaccinated in University Hospital Limerick, UHL, or the Coombe or any other hospital in this country. It is worrying that the Minister cannot provide those statistics.

As I have limited time, I will ask a few other questions. Regarding the volume of people who are to be vaccinated, we now know that we will not hit the targets for March. The Minister did not say that but I am going to take it in respect of the 700,000 people. Is the Minister still of the belief that we can have every citizen in this country vaccinated by September?

Turning to the role of the Minister, I appreciate that he is under severe pressure. I can see it this morning and it is not something I am comfortable with, to be honest. I appreciate it. The Minister is now in charge of quarantining, vaccinations and everything else in the area of health. I do not believe that the Minister and his Department should be in charge of quarantining; it should be the Department of Justice. Does the Minister believe that all three jobs should be done from his Department? I have nothing against the Minister personally. When it comes to the volumes of people being vaccinated, does the Minister think that people over 70 years old will be reached in the timeframe which he has stated previously? Turning to the nursing homes, I implore the Minister to not forget people in other elderly residential settings, such as people in assisted living etc.. Those settings are forgotten about at times.

I will start at the end. I agree fully that there are older residential settings which do not come under the nursing home group, so they would not naturally fall into cohort 1. Most of them will come into cohort 2, which includes those people aged over 70 years old. We are starting with those over 85 years of age. We were only discussing this topic with the HSE this week to see what could be done, because, regarding the Deputy's point, there is a higher risk of contagion among a group of older people. I thank the Deputy for making that point and we have asked the HSE to look at exactly that matter within cohort 3.

Regarding September, as Deputy Shortall rightly pointed out to me, it is not "citizens" we are referring to but "residents", and adult residents. I will finish on this point and respond to the Deputy's other points in writing. The September figure was, and remains, if the vaccines arrive according to a provisional schedule. However, that not only includes vaccines which have not even been authorised but those vaccines for which the companies have not even applied for authorisation yet. Were those vaccines to come in, the advanced purchase agreements we have and the conditional delivery schedules would allow the vaccination of every adult resident of Ireland by September. As per last week, though, that is all entirely conditional on supply coming into the country, vaccines being authorised and even vaccine production companies applying for authorisation.

To clarify for Deputy Kelly, normally, when the statements and questions and answers are to last 135 minutes, his group would have six and half minutes but we have 100 minutes for the session this morning. We move on now to the Government side, and I call Deputy Murnane O'Connor.

I will ask a few questions and I would like the Minister to respond at the end. First, I acknowledge all our workers who have been working so hard throughout this Covid-19 pandemic. I have also been thinking of all those families who have lost loved ones because of Covid-19. Some 70,000 front-line workers have yet to be vaccinated, however. I have seen the concern this causes in hospitals. In my constituency, only half of the staff in St. Luke's General Hospital, Kilkenny, have been vaccinated. Will those who have not been vaccinated be prioritised and vaccinated as soon as possible? I was also shocked to learn this week that eight residents of a nursing home in Kilkenny, living in adjacent properties, were not vaccinated, while 34 of those inside the main home were vaccinated. That is a concern. I understand the situation because I rang the Minister of State, Deputy Butler. In fairness, she responded with information stating that the situation arose in respect of those residents because they have a front door and are therefore on a separate list.

I reiterate, however, that we need a common-sense approach to this process. It is unacceptable to send our front-line workers to vaccinate 34 people, whether those are elderly residents or carers, and not to vaccinate eight elderly people who are adjacent. I believe they are on the community vaccination programme but that is only scheduled to begin in February, subject to the approval of the AstraZeneca vaccine. I ask the Minister to respond on that issue. We were expecting 230,000 doses of that vaccine next month but it seems we will now only get 200,000 doses, with another 100,000 doses in March. How far off the expected range of delivery of AstraZeneca vaccine will we be?

I again raise the issue of family carers, who do a marvellous job. It is important to ensure hey are on the priority list. Members of the Garda and other front-line workers also do great work, and there are many other similar groups. The main point I believe we must look at concerns information. We need an information campaign of some kind because there is such confusion surrounding the lists for vaccination. We have also seen that in respect of our disability services, which are so important. Many important sectors must be prioritised. I am trying to go by the lists we have but I believe we must look at this again. I know everyone is doing their best but I ask the Minister to look at a separate information campaign in order that we are able to go back and provide proper information, especially to front-line workers and those providing other great services.

I thank the Deputy for raising this matter with me again today, as she did last week. There was confusion regarding this residential home in Kilkenny. My understanding is that there are eight houses adjacent to that home, and that they all have their own front doors. We can say that it would have been logical to vaccinate all those people at the same time. Unfortunately, however, my understanding from the HSE is that when that application was submitted for the quantity of the vaccine, those eight adjacent houses were not included. Last week, through the HSE, I tried to secure the extra vaccine for those eight adjacent locations. Unfortunately, no surplus vaccine was available then but those residents will come under cohort 3 in the category of those aged over 65 years old. I have ensured that they are on the list.

Do we have the full five minutes?

No, the Minister has less than one minute.

I will respond to Deputy Murnane O'Connor in writing regarding those questions I do not get a chance to cover. Regarding the position with AstraZeneca, the European Commission is in active and pretty robust conversations with that company. Neither the Commission nor the company has yet been able to provide a firm delivery schedule for the second half of March. We are waiting on that timeline.

Many Deputies are very fairly raising the issue of family carers. Deputy Murnane O'Connor referred to members of the Garda as well, while, rightly and reasonably, reference was made to teachers in special education and cystic fibrosis patients last week, as well as many others. What I can tell the Deputy is that the national immunisation advisory committee, NIAC, the expert group, thought through these issues in great detail and came up with a recommended list, which was then reviewed and endorsed by the National Public Health Emergency Team, NPHET, and ultimately signed off on by the Cabinet. That is the prioritisation with which we are going but obviously we must keep these things under review.

I welcome the Minister to the House, and I have some serious questions to ask him. First, I pay tribute to people working in nursing homes where people are seriously ill, to the doctors, the nurses and the families who cannot visit their relatives and who are waiting, worried and extremely distressed. I welcome any initiatives the Minister can continue to undertake to supply services where they are requested by people working in nursing homes. Those people are doing a fantastic job, and they have unbelievable commitment.

In Our Lady of Lourdes Hospital, Drogheda, there is serious concern about not enough vaccine arriving. Half of those in the hospital were vaccinated but the other half were not. Yet, we read about events in the Coombe Hospital and in other hospitals where there seems to have been an abuse of the vaccination process.

It affects credibility in the context of what is happening. There is also a report that the level of vaccination at all hospitals in the south east was 100%. Why was that not the case in the north east? I appreciate that the Minister may not have the answer now, but I would like to hear his comments on that point.

I wholeheartedly endorse and echo the Deputy's praise of the nursing homes and for those working in the nursing homes. I add my thanks to the Minister of State, Deputy Butler, who is taking the lead on nursing homes, and who is doing a fantastic job and working very closely with the nursing home sector to ensure that it gets whatever help we can give it. This is a really tough situation. Many nursing home staff are out of work because of Covid-19, either directly or indirectly. A bit of hopeful news is that the number of staff who are out has decreased in recent days. The latest figures we have show that the number went from 1,800 to 1,700, and we hope to see this continue now that the vaccination programme is being rolled out, at least with dose 1. We are now moving into dose 2.

In the context of the specific hospital referred to by the Deputy, the roll-out is an operational matter for the HSE. The political involvement was, essentially, to set and agree the prioritisation. Cohort 2 comprises healthcare workers. Within that is a sub-prioritisation that was provided by the HSE. I will explain how it worked. In the first instance for the first few days, four hospital groups were involved in an initial roll-out, and that was widened very quickly to all of them. The volume of vaccines going to which healthcare workers in what hospitals is an operational matter determined by each hospital group. The Deputy referred to half of the healthcare workers in a specific hospital being done. That is not out of line with the total. The estimate is that the front-line healthcare worker cohort is some 150,000 people. As of last Sunday, nearly 77,000, which is about half, had been done. It will be more now because second doses have been going on this week for healthcare workers. It is the case that, based on the supply we have, nearly half of the members of that cohort across the country have been inoculated. I share the Deputy's-----

Perhaps the Minister could reply to me in writing further on that issue because I have some other questions.

That is not acceptable to the people who have been talking to me. I accept that the HSE is accountable but I am waiting to get an answer from it, as are many of the workers in the hospital. They are angry, concerned and frustrated. What happened at the Coombe hospital and elsewhere is not acceptable. I appreciate that this is not the Minister's fault.

My other question is on vaccination in the community, which I am aware is to be carried out by GPs and pharmacists. Are issues relating to guidance and consent being dealt with? There may be issues regarding people's mental capacity and ability to give consent. If older, vulnerable people are in a household bubble, will the entire bubble be vaccinated or just the individual? I appreciate that I have no time left, so perhaps the Minister will ask his Department to provide the answer as soon possible.

Perhaps the Minister can come back to me in writing on some of the points I will make in the short time I have. There are huge issues that will be a major factor in the vaccine roll-out, one of which is the importance of access for those in rural communities. There has been a commitment for 15 mass vaccination centres in the State. I understand the logic with regard to the Pfizer-BioNTech vaccine because of the temperature requirements, but as the other brands come on stream we need to have significantly more centres than currently planned. We will need at least one vaccination centre each county. My constituency of Laois-Offaly, which is more than 90 miles in diameter, would need at least two centres to reach into those communities. A significant challenge in reaching communities in the roll-out process will be low income groups and rural areas. We need to make the process as easy and as accessible as possible to ensure that uptake is high. The more localised we can make it, the better the uptake will be.

It is good that GPs and pharmacies are signed up and ready to go. However, we also need to maximise the vaccination teams through the use of public health nurses, Army medics and school vaccination teams during the summer. I ask the Minister to consider this proposal and to reply back to me on it, or perhaps have one of his officials do so. These three groups are qualified to vaccinate people, they are there and they can be utilised. The vaccination teams in schools have a great track record. The Minister knows this and I know this. We should try to utilise them. Will the Minister come back to me on that? The Tánaiste talked last night on television about having up to 1 million doses per month. We need to make sure that all hands are on deck in order to ensure a speedy and efficient roll-out of the vaccines.

I will now address the vaccination priority list. There are many competing groups that feel they should be prioritised due their role and their vulnerability. That is a challenge but I appreciate there has to be a pecking order. This must be based on logic, science and health. I want to address just three of the groups, the first of which is family carers, a group that has been referred to already. They really need to be higher up the pecking order. They do an important job and work with people who are in a very vulnerable position.

The second group which has been overlooked is taxi drivers who have contracts with the health services. This is a very important one. I have been contacted by a number of these people in Laois and Offaly. They transport patients between hospitals, they transport blood samples and other supplies back and forth, they bring patients to the hospitals for kidney dialysis and so on. Is the vaccination of these taxi drivers a matter that the Minister has considered? Will the Minister have his officials look at it?

The third group that must be considered is undertakers. They do a very hard and difficult job, and especially over the past ten months, which involves interacting with large numbers of people. It is very hard to avoid it. They do removals and funerals. They must go into nursing homes. There is a particular issue for undertakers when they go into private nursing homes. They have told us that if they go into a public nursing home the bodies are sealed in body bags, but in a private nursing this tends not to happen. An undertaker must go in and handle the body. Tragically, some of those undertakers have died having contracted Covid-19. I ask that the Minister consider the position of undertakers, who do a very important and difficult job.

I ask the Minister to review the priority list, and that the vaccination centres are as local as possible. There will be a better reach and a better uptake. I am aware that the Minister will not have time to respond here, but will he ask his officials to revert to me on those questions?

At the outset, I must express my complete dissatisfaction at the way the Minister has dealt with his speaking slot this morning. The whole purpose of this session is that he be accountable to Members with regard to the vaccine programme. That is the purpose of these sessions every Thursday morning. It is entirely unacceptable that the Minister would give away more than half of his time to a Government backbencher. I put it to him that this is not accountability, it is avoiding accountability. We need a ruling from the Chair on that. It is not acceptable that this would happen ever again.

There is a real problem with the Minister overpromising. He talks a lot about the vaccine programme when in the media but he talks very little about the actual management of Covid. There is no opportunity for accountability on the announcement the Government made earlier in the week, which raises huge questions. There are credibility issues, and many of the proposals from the Government on quarantining are just nonsense. We must have accountability in that regard also. The restrictions are to be extended until 5 March and yesterday the Minister was asked what will happen then. His response was that we would have the vaccine. We will not have the vaccines. A very small proportion of the population will be vaccinated by 5 March. The Minister is playing two sides of this. He is avoiding accountability in respect of the management of Covid and on the roll-out of the vaccine.

The Minister is hugely overpromising. Everybody accepts that there are serious problems with suppliers and with pinning down supply. AstraZeneca has been a disgrace in the way it is failing to meet the terms of contracts it signed. Other pharma companies are not delivering on what they promised and there is uncertainty about aspects of different vaccines, not only in supply but also in efficacy. The Minister needs to be upfront about this.

He must be frank and level with people about what they are rather than overpromising, because that gives them a false sense of security. That is what happened in the run up to Christmas, when there was an overselling of the vaccine. It contributed to people letting down their guard and we know the consequences of that. I ask the Minister to be upfront and frank with people, to give us the honest figures and to stop overpromising.

We are not getting daily updates. We are getting weekly updates, and that is not sufficient. We asked for a daily update on the number of vaccines delivered to this country and the number administered. I again ask the Minister to give a commitment to do that. What is the exact position relating to the two cohorts that are the priority, which the Minister made promises about last week and which have not been delivered? How many nursing home residents and staff have still to get the first dose? When does he expect all nursing home residents and staff to be completed with the second dose? I have the same questions with regard to front-line healthcare workers. How many of them have received their first dose? At this point, when does the Minister expect all of them to be completed with the second dose?

I also have a question relating to disability long-term care facilities. It is good that residents aged over 65 have been vaccinated in those facilities, but I cannot understand why staff have not been vaccinated. Why would the Minister not have the staff vaccinated, just as there is a plan to vaccinate staff in nursing homes?

I would appreciate it if he could answer those questions. If he does not have time, can he refer back to us as early as possible with the exact figures?

I will be strict on the time limits, Minister.

I will get back to the Deputy with a detailed note. Regarding the daily updates, the Deputy should be receiving them. I have asked for that for every Member, so I will follow that up immediately.

If the Deputy is not receiving them, I will ensure that it is rectified. With regard to getting them online, they are being changed twice a week at present and we are moving quickly. I want to get the daily updates done and up as quickly as possible both on the data hub and on the app.

I wish to make a point on the overpromising. I was asked for indicative timelines. In fairness, if one looks at the record of the debate in the House last week, there were heavy caveats with all the numbers. It was, and remains, a genuine attempt to give people a sense of the timeline. Members were asking last week if we are talking about the start of summer, the end of summer, next year or two years hence. I said, and this continues to be the position, that if all the supplies come, these are the timelines. It is reasonable to try to give people that type of direction-----

-----but I hope that it would not be mis-characterised as making promises. They are not promises but a genuine attempt to try to give people a sense of the type of timing we would like to see.

Will the Minister commit to providing the figures before the weekend?

I thank the Minister for attending this morning to answer questions on the vaccination strategy. It is important to outline to him the worries people have about what is happening with the AstraZeneca vaccine. The appalling way in which the company has treated EU member states and the Union itself has been incredibly unfortunate considering the major investment the company has received in public funds from across the Union. We must ensure that it upholds its commitments to the EU. In a certain sense, Ireland is being held hostage by that situation in respect of vaccinating its population. There is a high degree of expectation on the Government and the Minister to deliver in this area. Unfortunately, however, we do not produce vaccines. A multilateral approach is required on this issue and progress on vaccination can only be achieved by member states working united together. It is important to state that.

There is another matter I wish to raise with the Minister regarding the groups in society that have been inquiring about when they will receive their vaccination. Obviously, it is imperative that those who are most vulnerable receive their vaccinations as soon as possible, but, if it is at all possible the Government should put enormous focus, at the appropriate time, on trying to return teachers and students to full-time secondary education. Perhaps it would look at that sector and give it an increasing focus when it comes to the vaccination strategy and where it lies on the chart at present. I believe that is the only way we can return people to normality in education. There may be many bumps along the road that we have not yet encountered, but I am sure we will rise to those challenges when they arise. I have every confidence in the Minister, the Ministers of State and department officials, who are working exceptionally hard to deal with the challenges. However, on the specific issue of getting children back into schools and students sitting State examinations properly again, we must try to get them vaccinated as soon as possible to minimise the risk to their growth and development. Ultimately, this pandemic has been a horrific incident overall for the development of children and their lives. Unfortunately, it has made a massive dent in growth and development for anybody growing up in Ireland. It has been incredibly challenging for all age groups, but particularly for children.

Can the Minister give some information on his understanding of what is happening with AstraZeneca? I understand as of this morning, although the situation is constantly evolving, that the company is meeting the European Commission tomorrow, but perhaps the Minister might be able to provide the House with some information on that.

The Minister has one minute.

I thank the Deputy for his contribution and questions. I agree wholeheartedly with him that we need to get the information to people. There is a real hunger for it, particularly with regard to people over 70 years old. They are asking how it is going to happen and when they will be contacted. That information will be out shortly and much of it will come from GPs to their patients. There will be information shortly on that. The most important thing to say is that people will know ahead of time when and how they are to be vaccinated.

Regarding AstraZeneca, there is an ongoing, robust exchange between the European Commission and the pharmaceutical company. There has not been closure on it. There was a meeting late last night about it and there is still no agreed quantity of supply to the Commission and, therefore, to us, as we take 1.11% based on our population, with the company at this point.

I wish to delve into one element with three questions momentarily. Before that, many Members have mentioned various categories in society and their places on the list. I do not take issue with that, but I ask the Minister to provide clarity on one niche area, which is Irish citizens based abroad who are in the service of the State and when they might expect to receive the vaccine. I refer to members of the Defence Forces who are on peacekeeping missions and our diplomatic corps. A number of foreign diplomats who are based here have been called home to receive their vaccines. What is the plan for those Irish citizens who do such important front-facing work?

I do not wish to labour the point about AstraZeneca because Deputy O'Connor and other Members have dealt with the details, but I would appreciate if the Minister would elaborate on one of the replies he gave to Deputy Cullinane regarding what type of engagement he or his officials are having with European Commission officials or other ministers across the EU. Is there an Irish Sherpa when it comes to vaccine procurement? Perhaps he would also elaborate on the status of both the CureVac and the Janssen Johnson & Johnson vaccines as they go through the various processes.

The Minister and Deputy O'Connor talked quite rightly about the importance of giving people clear information. I am very concerned about the deliberate misinformation that is being spread by Members, members of the media and members of the public in terms of what exactly a vaccine procurement programme is. There are glib comments that we can just abandon the EU and get the vaccines ourselves. They ask why we cannot act like Hungary and get the Sputnik V vaccine or engage with Chinese or Indian pharmaceutical companies. It is important that the Minister elaborate on the exact importance of this programme, the opportunities it presents and how isolated we would be outside it.

That level of misinformation and disinformation is starting to seep through. People are already emailing my office asking why we cannot just throw money at the problem and get a workaround. The vaccine nationalism being pushed by certain organs in the UK media is compounding the issue.

I thank the Deputy for his contribution. With regard to his first question on Irish citizens abroad in service to the State, I will ask for an update on that and will make sure it is brought to him. On the engagement of the State with the EU at various levels, that is absolutely happening. We are part of the process whereby the Commission is engaging with AstraZeneca and there are contacts at an official level. As well as that, we are not just engaging with but are part of the European Medicines Agency. Very serious consideration and decisions are going on there about AstraZeneca and not only are we engaging with it but we are part of that process through our own agency, the Health Products Regulatory Authority, HPRA. I assure the Deputy that the State is very much involved at the relevant levels. I have raised the issue and the Taoiseach raised it at a Council meeting last week as well.

There are two issues with AstraZeneca, which are our priorities. First is maximising the supply. What we and the Commission want is for the company to deliver according to what was agreed. The second issue is getting the supply in here as early as possible. I fully agree with the Deputy that we cannot go on our own. People who are advocating that are either being deliberately mischievous or are just honestly mistaken about what Ireland as a very small country on its own would be able to procure in a very competitive global market. I will supply the Deputy with a table on this matter. Through the EU advance purchase arrangement we have pre-purchased 14.4 vaccine million doses. AstraZeneca will not disappear and we will start receiving its vaccine very soon, but even if, hypothetically, we got no AstraZeneca vaccines, of which we have pre-ordered 3.3 million, we would still have over 11 million doses of other vaccines. That is absolutely the way to go.

I raise the matter of family carers. I have been in contact with many carers in my constituency and their stories are heartbreaking. They look after the most medically vulnerable people in the State and they feel they have been completely abandoned. One constituent of mine cares for her elderly parents, both of whom have serious medical conditions. After one of them recently visited a hospital, both now have Covid-19. Their daughter appears to have no choice other than to care for them and potentially expose herself, her partner and their family to the virus. The other option is to leave them to fend for themselves, which is not in fact an option as they are both unable to look after themselves. Where is the plan for family carers? The Minister certainly did not clear that up when he was asked about it earlier on.

I have been contacted by many constituents who work in Our Lady of Lourdes Hospital, Drogheda, about the roll-out of vaccines. I have been told that many workers who do not have contact with patients, such as clerical workers, have received the vaccine ahead of staff who have direct contact with patients. Nobody has an issue with extra vaccines being put to good use but staff expect the priority list to be adhered to and that does not seem to be happening in that hospital at the moment. On top of this, many staff members, including those who work in paediatric wards and the maternity unit, were due to be vaccinated last Monday week and the plan was cancelled without explanation. It is 11 days on and they are still waiting for a new vaccination date. As the Minister knows, staff are already under huge strain trying to deal with enormous workloads, the stress of looking after patients with Covid and the additional pressures of other staff being absent due to sick leave. Under the Government's plan, these staff were to be prioritised for vaccination. That is clearly not happening and I am not the first to flag it with the Minister.

The maternity unit at Our Lady of Lourdes Hospital is running a full service. Its staff regularly deliver babies to mothers who are Covid-positive, they are running full face-to-face antenatal clinics and they also work daily shifts in the emergency department. Not one midwife nurse has been vaccinated at Our Lady of Lourdes Hospital despite the fact that County Louth has some of the highest rates of Covid in the State. Front-line workers at Our Lady of Lourdes Hospital have been putting their lives at risk to look after people since last March. They are saving lives and the Minister expects them to put on their uniforms every morning and face into another difficult, stressful and sometimes heartbreaking day at work. All they are asking is to be prioritised in line with what the Minister and the Government said the plan was.

When can family carers expect to be vaccinated and when can midwives, nurses and other front-line staff at Our Lady of Lourdes expect to be vaccinated? The Minister said earlier that vaccination was an operational matter for the HSE. That is not acceptable. He is the Minister in charge and he cannot absolve himself of responsibility in the middle of a pandemic. Will he intervene to make sure those staff, who are very scared and have to face that risk every single day, are vaccinated?

The Deputy's time is up. I call Deputy Bríd Smith.

I am sharing time with Deputy Paul Murphy. It is quite tragic listening to all the cases for urgent vaccinations, whether for midwives, carers, ambulance drivers or people involved in funerals and so on. The reason for that tragedy is that our vaccination programme is a shambles and there are reasons for that other than the lack of vaccines. They include the underlying weakness in our public health system, the lack of a national immunisation database, and the fact that we do not have the numbers of public health doctors we require. The row over vaccination production is being cast in terms of the UK versus the EU and we should be very careful about seeing it in that way. Like many companies, AstraZeneca has form in this. It was before the European Court of Justice in 2012 in another case of abuse of intellectual property rights. I am making a very clear call today for us to move away from the idea that we have to compete with other countries and other areas of interest. Rather, we should move towards something that has been called for on a global scale by Oxfam and international human rights groups, led by India and South Africa. They are calling for a "people's vaccine", as it has become known, which would mean freeing up the intellectual property rights and agreeing that on a global scale in order that every country that has the ability to engage in the pharmaceutical industry can do so. We certainly have that ability here. Just before Christmas, People Before Profit put a motion on the Order Paper. It read:

That Dáil Éireann, in view of the serious threat that Covid-19 poses to people all over the world:

— calls on the World Trade Organization (WTO) to allow all countries to choose to neither grant nor enforce patents and other intellectual property [rights] related to Covid-19 drugs, vaccines, diagnostics and other technologies for the duration of the pandemic;

— mandates the Government to demand that European Union policy is changed so as it votes at the WTO to allow this to occur

[...]

— calls for full open disclosure of all scientific and clinical trial data related to the development and production of such vaccines, and should this occur, further calls for the convocation of an expert panel to independently analyse the data and develop public health communication strategies based on their findings ...

I ask the Minister to support that motion. Will he please respond to it?

The Minister has very little time to respond.

He can answer at the end or in writing.

I ask him to answer the Deputy in writing as I have to move on. I call Deputy Paul Murphy.

It is clear from listening to the Minister that he prefers vaccination aspirations to targets, because people can be strung along with aspirations that will not be met and because that allows him to try to avoid the fact that if we continue the living with Covid strategy, there will be more lockdowns before we achieve full vaccination. Earlier this week the Minister, unbelievably, claimed that one of the reasons we could not pursue a zero Covid strategy was because we did not know for sure that another Covid variant would not arrive that would make the vaccine ineffective. What on earth did he mean by that claim?

I would have to go back and check exactly what interview or statement the Deputy is talking about. As he has characterised that comment right now, it does not sound right to me but I am more than happy to look at what was said on the record and engage with him on it.

I am fairly certain it was said at the press event to announce the extension of restrictions to 5 March, etc.. If we want to reduce the chances of more dangerous mutations that could undermine vaccines getting into the country, it would make sense to pursue elimination strategies within each country and to seek to keep new variants out. This also makes sense in respect of the points made by Deputy Bríd Smith regarding a people's vaccine? By the end of this year, nine in ten people in the lesser developed countries in the world will not have been vaccinated. That is morally outrageous in view of the fact that we have the physical capacity to produce vaccines but are prevented from doing so by intellectual property considerations. Also, it is a health risk for the entire world because there is a chance of mutation each time the virus jumps from one person to another. Is this not a reason the Government should be supporting a zero Covid strategy and a people's vaccine?

I thank the Deputy for his questions. We are in agreement on the strategy relating to the new variants. For example, South Africa and Brazil have the identified variant. Last night, the visa programme for those countries was suspended. In the context of new variants emerging globally, I agree that we need a robust system of protection in place which will keep those variants out of Ireland.

I am out of time. I am happy to study the Deputy's proposal. For what it is worth, my own view is that Ireland the more developed and wealthier world do have an obligation to make sure there is vaccine availability for those countries that cannot afford it. I am more than happy to engage with the Deputy further on that point.

I call Deputy Colm Burke who is sharing time with Deputy Cahill.

I thank the Minister, his Department and all of our front-line workers for their work and commitment during the pandemic. I have three questions for the Minister, the first of which is in regard to Johnson & Johnson. There is speculation that it is about to announce that it has a vaccine suitable for dealing with Covid-19. Has the Department of Health engaged with Johnson & Johnson, which has a base in Ireland, and has there been engagement by the European Commission with the company on long-term planning in respect of its vaccine?

I know that there are a number of groups demanding assistance in regard to vaccination at an early date. One such group is the parents, brothers and sisters of young people with intellectual disabilities who are caring for them while working full-time at home but are not getting the necessary supports. Can they be prioritised for vaccination at an early date?

There is clear evidence that people who have a vitamin D deficiency have fewer defences if they contract Covid-19. I took part in a Zoom conference on Monday last. One of the presentations made by a medical expert referenced that vitamin D deficiency is a huge problem in the context of depression and mental health. We need to roll-out a national programme advertising and promoting the use of vitamin D. In the UK, a four-month supply of vitamin D is being provided to people in nursing homes and the elderly. We need to do this. What is the Department doing in terms of the promotion of the use of vitamin D?

I thank the Deputy for his questions. With regard to Janssen-Johnson & Johnson, I will ask the Department for the most up-to-date note on it. I have heard various different accounts over the past few days in terms of timing. I can confirm that not only are we and the EU aware of it, the Janssen-Johnson & Johnson vaccine is one of the vaccines we have advanced purchased in anticipation of the company applying for and securing market authorisation. We have advanced purchased 2.2 million doses of that particular potential future vaccine. It is a very interesting one for two reasons of which I am aware. First, the latest information I have is that it would be a single-dose vaccine, which would be very welcome. Second, as with the AstraZeneca vaccine, it can be kept at refrigerated temperatures. A single-dose vaccine at refrigerated temperature would be very attractive. However, we do not yet have information on the effectiveness of the Janssen vaccine in clinical trials or the effectiveness of it in the field. We will be keeping a close eye on that.

With regard to carers, if I understand the Deputy correctly - my apologies if I do not - he is seeking prioritisation for those caring for people with disabilities. I will get him an exact note in that regard. In the context of those with disabilities who are in long-term residential care, it includes all staffing working in long-term care and caring for those with disabilities in long-term residential care. That is happening right now. In the formal sector - the paid carer sector - the decision of the HSE was that those who are employed as carers in the sector are deemed to be front-line healthcare workers and will, therefore, be in cohort 2. If there is a subgroup in this area in respect of which the Deputy would like a little more clarity, he can let me know.

I am aware of much of the commentary on vitamin D and its potential to boost the immune system and provide protection against viruses, including Covid-19. I am happy to ask the relevant group within the Department and NPHET for a view on that and other potential opportunities in terms of public health.

I compliment the Minister and Minister of State, Deputy Butler on their work. Mental health is a huge issue within the Covid-19 scenario, one that we cannot underestimate.

We are in a loaves-and-fishes situation in terms of the administration of the vaccines. I propose to focus on the prioritisation of particular sectors within my community that have made representations to me. A couple of weeks ago, I was criticised in the national media for making representations on behalf of front-line workers at Nenagh hospital. As long as I am privileged to be a Member of this House, I will make no apologies for making representations in regard to the genuine grievances of my constituents. Thankfully, some of the staff have been vaccinated. It was unfortunate that other hospitals within this group received the vaccine and that Nenagh hospital was left behind.

As previous speakers noted, carers need to be moved higher up the priority list. It makes no sense that the patients for whom they are caring will be vaccinated and they will not. They are an essential part of our battle against Covid and their assistance is vital to people being cared for in their own homes. We are all aware of the pressure our hospitals are under. I urge the Minister to look at the higher prioritisation of carers within the vaccination programme.

Teachers, SNAs and school staff also need to be vaccinated. We all want to see our schools to be reopened as quickly as possible. The Minister also needs to review where these staff are on the priority list in terms of vaccination. Pharmacists and pharmacy staff can play an important role in the roll-out of the vaccine. When there is greater availability of the vaccines, pharmacists will hopefully play a key role in administering them. Pharmacists and their staff need to be prioritised for vaccination in order that they will be able to administer the vaccines safely.

When I was in the Chamber earlier I heard a point made about undertakers. Undertakers have to deal with people who have died from Covid and as such they are at risk of contracting the virus. As in the case of deaths from other causes, they have to meet the families and large numbers of people. Their case for higher prioritisation in terms of vaccination is overwhelming. I ask the Minister to also review their position on the priority list for vaccination. Cancer support centres and other groups that are meeting many people also have a strong case for higher prioritisation for vaccination.

I would like to comment on the agrifood sector and veterinarians. In the spring time, veterinarians have an extremely large workload. They might have to visit up to 25 farms per day.

They have a lot of exposure to different people. There is talk that they will be used to administer the vaccine when we have more quantities of it. Vets should be given greater prioritisation for vaccination.

Later in the spring, industries will be under pressure if there is a cluster of infections in their vicinity. Much of the focus in the past year was on meat processing facilities and the clusters that were there. We have spare capacity in that sector across the country and we will be able to deal with them if there are clusters there. We hope there will not be any such clusters as we move forward. Milk processing peaks between mid-April and 1 June. We have absolutely no spare capacity in that processing sector. I ask the Minister to look at the possibility that workers in milk processing would be prioritised for vaccination.

I know the Minister has an awful lot of people roaring at him to prioritise them for vaccination. I am making the case for constituents of mine who, in my view, have a genuine case for priority. I ask him to look at those groups.

First, I pay tribute to the HSE staff nationwide who have put huge effort into the vaccine roll-out programme, from the pharmacists reconstituting each phial to the nurses administering the vaccine and ensuring that the maximum number of doses of this precious vaccine are obtained, as well all the support staff. I am sure it is painstaking work and particularly stressful with the eyes of the whole country on them.

My first question is what consideration has been given to parents of children with high-risk medical conditions? These include children who are immunocompromised following chemotherapy or recovering from a transplant and children with additional needs who require a high level of care. Has the Minister considered the impact on the child's well-being, the difficulty in caring for those children and the very real risk to their life if their parents were to catch Covid-19? Will there be consideration for those parents and carers to be prioritised in order to protect their children, or will they have to wait?

That is a very important question, similar to many of the other questions, in terms of prioritisation. The prioritisation we are using was proposed by the expert group and NIAC, considered and endorsed by NPHET and then agreed by Cabinet. That is what we are using. Of course, it has to be a live document and we have to be open to updating it as we learn more. That goes without saying.

I am not an expert on viruses but one of the points made to me in terms of the type of situation the Deputy is talking about is that we do not have any information on the impact the vaccines have on transmissibility. If I understand the very reasonable question the Deputy is asking, it is whether NIAC or the expert group would prioritise, or increase the prioritisation of, the parents who are in this very difficult situation such that they would not contract the virus themselves and then give it to their child. I think that is the crux of the very important question the Deputy is asking. I will get him a written expert response because I cannot give him one. For what it is worth, one of the things that has been said to me by the experts on similar questions is that the vaccine would protect the parent from getting sick but would not necessarily protect the child because we do not know what level of impact it has on reducing transmissibility. That is just one of the considerations. However, I will get the Deputy an expert response.

I thank the Minister. Why is antigen testing not being used for nursing home residents and staff? This issue has been raised a great deal in the media. It is a cheap way of testing. It is not foolproof but it certainly would be of great assistance.

I thank the Deputy for another excellent question. Rapid testing, or antigen testing, is now being deployed across the healthcare settings at a significant volume as of this week. I have set up an independent expert group to report back to me very quickly on exactly the question the Deputy asked: can we deploy antigen testing in non-healthcare settings such as schools, nursing homes, workplaces, here in the Oireachtas or wherever it may be? I am looking forward to getting a view on that. The short version - I will finish on this because I know we are over time - is that the evidence on antigen testing is that it is not a good surveillance tool and that PCR is what we use for that. As the Deputy will be aware, there is now weekly PCR testing in all of the nursing homes, which is very valuable. Antigen testing is not good as a surveillance tool. The tests to date suggest it is not particularly good for mass testing and picking up non-symptomatic infections. However, apparently what it is good at and what it has been successful in - there are mixed studies from around the world but this is what has been shown, at least in some of the studies - is picking up those who have a higher viral load and are more contagious. I am looking forward to hearing back from the expert group as to where we could, and how we would, deploy exactly what the Deputy has suggested.

I have a number of questions for the Minister. The questions are coming from people in my constituency who are asking when they may be vaccinated. They include, for instance, people who have cystic fibrosis and their carers, people with Down's syndrome and their carers, people who are on dialysis and people who suffer from chronic obstructive pulmonary disease. People in those four groups have been on to my office wondering whether they can be brought forward up the chain of command.

Ability West in Galway sent a submission to me which I forwarded on to the disability matters committee. The organisation is seeking a vaccination plan for its service users, their carers and their families. The people in Ability West are willing to help and engage, they have the expertise, they have the staff available as trained vaccinators, they have locations for vaccination and they have a strong network and community of disability services ready to help across the entire sector. We need to vaccinate people with disabilities, both those over and under 65 years of age, regardless of where they live. We need to vaccinate all staff in the disability services, including section 38 and section 39 organisations and all the HSE-delivered services. We also need to vaccinate family carers who are taking on the key worker role.

I have two further comments to make before I ask the Minister for a response. The first relates to firefighters. I read with interest during the week - I do not know whether it is true - that Dublin firefighters have been vaccinated on foot of an intervention by the Lord Mayor of Dublin. Firefighters living in Galway East, in Tuam, Athenry, Gort and Loughrea, do the same work. They are first responders. When will all of them be vaccinated?

Finally, we have had a lot of discussion about people coming into the country. I understand the Taoiseach told his party last night that 800 people arrived into Dublin yesterday, 397 of whom were returning from holiday. If that is still happening when we are trying to curtail and eliminate a deadly virus, questions have to be asked about how we are patrolling and controlling the exits and entries from and into this country. I ask the Minister to comment on the points I have raised.

I thank the Deputy for his questions. As with other Members and people across the country, he is rightly raising issues for those who are more vulnerable, including people with CF, people with underlying conditions such as Down's syndrome and their carers. If the Deputy looks through the prioritisation, he will see that one of the groups we are coming to as quickly as possible is people with certain underlying medical conditions. With regard to their carers, the position at the moment is that if the carers are in paid employment, as many are, they are deemed front-line healthcare workers and are being vaccinated at the moment. They are part of cohort 2. Indeed, as the Deputy referenced, for long-term residential care settings for disability, including section 38 and section 39 organisations, residents over 65 and the staff are included in cohorts 1 and 2. They are part of the plan at the moment. Residents over 65 have been vaccinated and the staff are being vaccinated now. They are being prioritised now.

Forgive me if I have the details wrong, but if there is a particular disability community group that the Deputy is referring to, there are two things the group can do. It can engage directly with the HSE centrally, because these are operational matters for the HSE. Alternatively, a local group could engage with the local hospital group. That would be the place to go because that is where those operational decisions are being made. I would certainly be happy to facilitate that if it was helpful.

I wish to make a point with regard to the firefighters. I cannot speak for the Lord Mayor or the particular incident; I have no knowledge of it whatsoever. However, there is an important principle we have to protect with the vaccination roll-out. There cannot be political interference by me, any Member or any elected politician. Our role is to set policy. We have done that by signing off on the prioritisation schedule recommended by the national immunisation advisory committee and endorsed by the national public health emergency team. After that, the distribution according to policy is an operational matter for the HSE and there should be no political interference in that process.

Certainly, at a policy level it is our job to ensure that the policy is right and appropriate. I can offer an example relating to the current prioritisation. One task I have asked NPHET to look at is a profile of those who have been hospitalised with Covid-19. A look at those profiles is one proxy for those most at risk. We can then map that against the prioritisation to ensure the prioritisation does indeed cover those who are getting very sick and being hospitalised by Covid-19.

There are different firefighters in different areas. Obviously, those responsible are looking at paramedics and they may indeed be looking at the firefighters themselves. Again, each of the hospital groups is putting detailed plans together and will communicate them, as they have been doing.

I agree with the Deputy on holidays. Right now, there is meant to be no non-essential foreign travel and no non-essential domestic travel beyond 5 km either. The Cabinet agreed on Tuesday to a range of significant additional measures to clamp down on exactly the issue raised by him.

I intend to use my four minutes to make statements. Then, in his wrap-up at the end of the session, the Minister might address my comments.

I am here as a Member of Dáil Éireann for Cork North-West. I am here because of events that took place 100 years ago and I pay tribute to those who were in Tureengarriffe on this morning 100 years ago. My community and family were closely involved in that.

We have fierce challenging times in respect of Covid-19 and with the management of the vaccine. Yesterday, Deputy Canney attended a meeting of the Joint Committee on Disability Matters. We raised the issue of people with disabilities. I have had engagement with some of the section 38 and section 39 organisations. Representatives of these organisations have been speaking about those aged over 65 in residential care getting the vaccine. However, they have to be taken to centres for vaccination. In one incident people had to be taken to Cork city, which is several miles away from the organisation - I do not wish to mention it by name.

I believe there should be a facility for people who are long-term residents in section 38 or section 39 organisations to be vaccinated on-site. This should apply to all of the staff who need to be vaccinated as well agency staff. Many people who are working for these organisations throughout the country are agency staff. They need to be considered and we need to try to ensure that it is possible to have vaccination on-site. I understand the challenges, the question of the loaves and fishes and that everyone is trying to do their level best to get to the right people in the first instance. However, I believe that people with a disability should be prioritised and should be looked at as a matter of urgency.

I have seen comments tweeted since this debate started in respect of pharmacies and getting the vaccines rolled out as fast as possible. That is highly commendable. We need a sense of urgency. The difficulty is that there is divisiveness in respect of the vaccine. We understand what is happening right across the world and with Europe and AstraZeneca and so on. The reality is that we have to be seen to prioritise vulnerable people and do what we can in the right way for the vaccination programme. We have to ensure that those who are less well off, the vulnerable, carers, home helps, those providing essential services for the care of elderly people and those with intellectual disabilities are looked after as fast as humanly possible. The Joint Committee on Disability Matters reiterated these points yesterday. We have been contacted and briefing documents have come back. We welcome this and we ask that we are continuously kept briefed as a committee on what is happening. We want to be informed as we make decisions. I call on the Minister to bear those points in mind. We need to ensure that our less well off are being prioritised and that there is a clear pathway for the vaccine as we go into what we hope will be an accelerated vaccine programme. It should allow everyone to get some breathing space from this horrific pandemic that has beset the country during the past 12 months.

I wish to clarify that there will be no concluding remarks section for the Minister. We will move on to Deputy Marc MacSharry.

I thank the Acting Chairman for the opportunity to make some points. Like Deputy Moynihan, I will simply make a statement and ask that the Minister take the points on board.

I want to make three points. The Minister made the point that our role is to make policy. Our role is a little more than that. Our role is to provide leadership in what is a difficult time. It must be reflective of the front-line workers whether they be cashiers or shelf packers in retail outlets, our heroic healthcare professionals or front-line gardaí. That part is missing somewhat. I understand the difficulties of the Minister with the loaves and fishes side of it, and I will deal with that in a moment.

The second issue is communications. There are too many cooks. We have the Minister for Health and the Taoiseach trying to get a message out. We have the Tánaiste, Deputy Leo Varadkar, throwing in a well-timed torpedo now and again. We have 30 members of NPHET, all with their own individual media careers at this stage plus the nightly announcement of figures and so on. We have approximately 30 other medical academics and professionals on media. We have Deputies, commentators and journalists. This is adding to the polarisation of society. It is adding to the anxiety that all of us have in the context of this ongoing nightmare. It needs to be addressed. I was saying this to the Taoiseach even before he became Taoiseach. I said it last night at our meeting and I am putting it on record today. The Minister needs to control the narrative with the truth and not have anyone with a profile adding or deducting from that in a Government setting. It should come from the Minister for Health and the Taoiseach rather than others, for example, 30 members of NPHET and 30 academic qualified people, adding or deducting from the facts of the matter.

The Minister said NIAC decides. Last week, I read into the record an email relating to NIAC and a transplantee. It was crystal clear and I will provide the email to the Minister later today. NIAC said it does not determine who is on the list. That is a problem. As a result, all of us in public life at the moment are getting email after email, call after call, text after text and social media message after social media message asking about this group or that group. They are all worthy. The transplantees are a major group. These people have had to cocoon, along with their families, for obvious reasons, since last March. They do not know where they are. This morning we heard from the Irish Association of Funeral Directors. Undertakers have no choice but to go in and out of various houses to care for the deceased and their families. They have no visibility on what the situation will be. We need to be far clearer about that but I am afraid there is ambiguity around it.

The third point relates to vaccine supply. Again, I have said every week that Europe has failed us on this. Anecdotal evidence suggests we were coming to the queue late because we put our European eggs into one basket. We put them into the development of a French vaccine that has not yet materialised. We came late to the queue with Pfizer and Moderna and later again with AstraZeneca. This suggests that, in what was a fraught Brexit negotiation environment, we were passively leaving anything associated with Britain until last.

Last night - I know it is in the media today - I made unfortunate comments that I immediately withdrew, and I apologise again for any offence that was caused, but the point is a real one. Wherever there is a viable vaccine that is safe and available, we need to be at the table. I might not like the idea personally of dealing with Russia on products, but if they have a vaccine that is safe, let us talk to them. The UAE has approved its vaccine. Hungary seems to have gone off and tried to do a unilateral deal. Whoever has a vaccine to put an end to this misery, we want their assistance and we want to be at the table.

Finally, whether the number of vaccinations is 40,000 per week at the moment or the 100,000 per week speculated by the Tánaiste yesterday evening, we are looking at a full year of this. A full year of lockdowns is not acceptable and, therefore, we must look at seriously limiting North-South access, other than to those who have to have it, and seriously limiting who can come into and leave the country in order that, within the country, when we flatten the curve, we can get back to some level of normal life in the interest of the mental health of our entire nation.

Deputy O'Donoghue is sharing time with Deputy Michael Collins.

Yes, two and half minutes each, and that includes our questions and answers.

Early years preschool and afterschool services are currently finding it very difficult. The providers are essential workers who have been asked to keep their premises open to look after children of essential workers and vulnerable children. A 28-page document came out yesterday stating that the services to be opened are getting funding, yet other services that are closed are getting the same funding. They cannot survive at 70% capacity. The cost is the same. They are very concerned as to how to keep themselves safe. They are not included as a priority group for Covid vaccination, even though they are front-line workers. I wish to highlight their legitimate concerns. I was contacted by 38 groups in Limerick city and county. They are looking at opening communications; not a hurried email on a Friday evening telling them they have to remain open for front-line workers. Communication is key. Surely other families could also avail of the services. It is not sustainable to operate at their current capacity. Crèches have been in contact with me stating they are operating at 20% capacity. Some crèches have only five or six children where they previously had 50. As it stands, those businesses are not sustainable. One preschool owner is waiting to see whether they will get their ECCE payment. They do not know if they will get it. This goes for all services. They still have the same overheads. They will be unable to open next Monday if this payment is not made.

PPE gear is another major issue. While the Minister for Education, Deputy Foley, said there was no cut to PPE gear, schools are closed and crèches and early education services, which are open, have been given no funding for PPE since last June. I now call on the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, to do his job and turn the childcare sector into a safe place to work.

The Minister for Health is always saying he would like to simplify and explain to us how things work. Let us say I am self-employed and I go into a shop tomorrow morning looking for a sandwich that costs €1. Let us simplify it. If I have 70 cent, I do not get that sandwich, or else the person who owns the shop has to take on the loss of the difference. Anyone who is keeping his or her premises open for front-line workers needs to be represented and paid 100%.

It is mainly questions I have. I would like a bit more time but I do not have latitude for statements. I asked the Minister last week about the urgent need to offer the vaccine to home helps in west Cork and throughout the country. In his answer, he promised to furnish me with more details as to when this may be offered but as of yet I have had no information. Could he give us any update? Home helps, as he knows, are working with the patients one to one and, in some cases, washing them. It is not something they can do in a socially distanced situation, so it is vital they be offered the vaccine.

May I clarify that I am right in thinking the Deputy is talking about home helps or carers who are working in the formal sector in west Cork? Is that correct?

The answer to the Deputy's very reasonable question, then, is that the hospital group that covers the area is at the moment putting together a detailed plan to answer exactly that. I will make sure that as soon as it has that ready it sends that information on to the Deputy.

I thank the Minister. I would greatly appreciate that being furnished to us and getting some timeline. I have also had numerous queries from, as he mentioned, carers, pharmacists and part-time fire brigade personnel, who have a huge issue because they are attending home fires and accidents on roadsides and have not been offered the same as the elderly and undertakers. I suppose there is a clatter of them out there.

AstraZeneca Pharmaceuticals is a registered company in Ireland and has headquarters in the Liffey valley area of Dublin. Has the Taoiseach spoken to the CEO of the company to establish when Ireland will obtain the vaccines? If not, why not? Surely Irish citizens deserve answers. The time for allowing EU bureaucrats to dictate when an elderly Irish citizen gets vaccinated has passed, and this is beyond incompetence on the part of the Government. This is an extremely serious situation and leadership must be shown. Are the delays due to the EU being slow to place an order? Given that the AstraZeneca vaccine is only a tenth of the price of others available, why did the EU hold off on ordering? It now looks like Northern Ireland and Great Britain are most likely to be back to some kind of normality in the next three to six months, way ahead of the Irish Republic. We have people coming in. I raised this issue a number of months ago with the then Taoiseach, Deputy Varadkar, and asked that he make sure that PCR tests were done in the airports, and that was denied to me. Now we are talking about an all-Ireland approach. The sad thing is that in Northern Ireland they cannot agree among themselves, so I cannot understand how we will get some kind of agreement with the Northern Ireland Government. However, we certainly could have controlled our own airports and we failed to do so month after month. It is not a matter of stopping people coming in here; it is making sure they have PCR-----

I thank Deputy Collins. I am calling the next speaker, Deputy Catherine Connolly.

Táim ag roinnt mo chuid ama leis an Teachta Harkin. I ask the Minister to forgive me if I do not use my two and a half minutes to table questions for answer but I wish to make a few comments in the context of openness and accountability, the importance of which I am sure he very much appreciates. He made a speech today. He did not use his time. He did not share it with the Minister of State. I would have thought this was the perfect time to bring an element of openness and accountability into the title of this, which is the vaccination programme. It is absolutely - I will put it mildly - unfortunate that the Minister did not use his time to do that because I am on record many's the time as saying I have worked with the Government on draconian legislation in return for maximum information. We did not get that today. In fact, the Minister used his time again to acknowledge the wonderful work being done by the front-line staff, which I absolutely agree with. Let us put that aside, though. Let us acknowledge that and deal with issues and let us have reasons. The Minister failed to use his speech to deal with practical issues such as the problems with spare vaccines and how they were used - I would have liked him to have dealt with that - and vaccines having to be discarded because they were incorrectly stored. He gave us figures, which are very welcome, but he did not put them in the context of how many front-line staff and residential staff are still waiting. That would have been very helpful to us in then working through the figures and working with him in what is a pandemic that is absolutely threatening to our health and our lifestyle. I am really angry that this is what has happened today and that the Minister chose not to use his time.

It is quite clear that he believes vaccines are the only game in town. I would have thought vaccines were just part of an overall programme. I would prefer if there were a zero Covid strategy. I agree with my colleagues on the left that that is what we should aim for and that vaccines should be a part of that. I would have thought the Minister would have come in here today and told us about the vaccine contracts. What have we signed up to? How much money have we given? He had an extraordinary sentence in his speech: "Private sector innovation has merged with public sector investment ... to ensure the speedy development of safe and effective vaccines." What we have ensured, certainly, is the production of vaccines at a huge profit to the companies. It would be very helpful if we had copies of the contracts and details of the indemnity. How much money has been put in? The Minister has chosen to do none of these things, so it is difficult to have trust. Most of all, there is no overall plan with vaccines as part of that strategy.

I have time only for a statement. I raised with the Minister a few weeks before Christmas the need for a separate Minister or Department or part of a Department, or a separate and unique voice, in the overseeing of the roll-out of the Covid vaccine. While my suggestion was met not quite with derision, nonetheless there was a strong sense of we know what we are doing, that we do not need a separate Department or section to deal with what I then described as the single most important piece of work this Government will undertake during its time in office.

From a human perspective, our response in rolling out the vaccine matters more than anything. From a political perspective, it will be the benchmark by which this Government is judged. As Minister for Health, Deputy Donnelly already has a significant workload. Twelve months ago, nobody could have foreseen the unthinkable challenge that would be faced by the healthcare system. It is not possible for one person to manage healthcare and be in charge of the vaccine roll-out. What I am saying is not personal or political; it is practical. I refer to the putting in place of a national plan to facilitate the macro picture and the micromanagement that is needed as well as the detailed planning that helps to ensure confidence, buy-in and belief in the system.

A few weeks ago, I raised the issue of Sligo University Hospital, where there has been real concern about those who got the vaccine, those who did not and when the latter group will get it. Such concerns are repeated throughout the country. A significant part of the problem is the lack of full transparency with regard to detailed planning. Many people, especially those on the front line, are on edge. Any hint of unfairness, injustice or queue-jumping feeds the sense that we are not in this together. The only way to combat this is by appointing a chief vaccinating officer or other person who would be the face and voice of a vaccine roll-out. That person could be the Minister or others could take on board some of the responsibility, but we desperately need a single face and voice to reassure people.

I thank the Deputy. Her time is up.

As the old phrase goes, when the facts change, I change my mind. The facts have changed.

Sitting suspended at 11.52 p.m. and resumed at 12 noon.