Health (Amendment) Bill 2021: Second Stage

Minister for Health (Deputy Stephen Donnelly)

I move: "That the Bill be now read a Second Time."

I am sharing time with the Minister of State, Deputy Butler.

I am pleased to address the House on the Health (Amendment) Bill 2021. The purpose of the Bill is to improve Ireland’s ability to respond to the ongoing threats to public health from Covid-19. It does this by amending the Health Act 1947 to allow for the introduction of mandatory quarantine at designated facilities for all passengers arriving from countries where there are variants of the Covid virus that present a particularly high risk. The Bill also provides for mandatory quarantine for passengers who arrive in breach of the pre-departure negative PCR test requirement, until such time as a not-detected test result has been returned.

It is almost a year since the first case of Covid-19 was confirmed in Ireland. The pandemic has had a very significant impact on life in Ireland, not just in terms of morbidity and mortality but also in terms of our way of life. To reduce transmission of this awful virus, we have had to live with public health measures that have required enormous personal sacrifices and taken a huge toll on people across the country. It has been a difficult winter. I truly hope that the roll-out of the vaccination programme is providing some much-needed hope and light. We are making progress and have administered over 350,000 vaccine doses. We are building capacity to be able to administer more than 250,000 doses a week to prepare for a significant increase in supply from April. Depending on vaccines arriving as scheduled, we will administer, on average, more than 1 million doses per month during April, May and June.

Unfortunately, we still face challenges. New variants of Covid-19 have emerged that can be more transmissible and may cause more serious infection. The variant first identified in South Africa is understood to be 50% more transmissible than the original strain. Less is currently known about the variant which originated in Brazil in terms of transmissibility and disease severity. There are, naturally, serious concerns that the vaccines which have been developed to date may not be as effective against variants of the virus as they are against the original strain. It is vital, therefore, that the vaccination programme is enabled to provide the maximum level of protection to our population in the coming months.

We have already introduced measures to limit the importation of the so-called variants of concern. A regime of mandatory home quarantine is now in operation. Arriving passengers, regardless of nationality, are required to present a Covid-19 passenger locator form and evidence of a negative pre-departure PCR test taken no more than three days before travel. We have also stepped up enforcement measures in respect of regulations which prohibit non-essential travel abroad, and people travelling abroad without an essential purpose can be subject to fines and prosecution. This is being enforced by An Garda Síochána.

We have significantly increased the amount of genome sequencing we are carrying out. Currently, arrivals from countries that are designated as category 2 states due to the presence of variants of concern must complete the full 14-day period of quarantine at home. These regulations were made pending the preparation of primary legislation to require travellers from designated high-risk countries to quarantine at designated facilities. This is the purpose of the Bill. While travel volumes are significantly depressed compared to the same period last year, there are still approximately 1,000 to 3,500 arrivals into the country each day, with 10,500 people arriving into Dublin Airport last week. Furthermore, there is a need to provide for a further increase in the fixed penalty for non-essential travel overseas to deter people further from travelling to a port or airport for the purpose of leaving the State without reasonable excuse.

The proposals in the Bill may be regarded by some as harsh and by others as insufficient. While the UK has introduced mandatory hotel quarantine, very few countries in Europe have introduced such a regime. However, the Government believes that the risk of importing variants and their potential impact on our vaccination programme means that we must act.

We believe that this Bill strikes a fair and proportionate balance between the protection of public health and the common good in the unprecedented emergency which we face, on the one hand, and the limited restriction of individual rights, on the other. We believe we can learn from the experience of the relatively small number of countries that have imposed such measures. Last week, I spoke to the New Zealand minister with responsibility for Covid-19 who outlined to me how their system works. We will, undoubtedly, face operational challenges just as they did. We may not get everything exactly right from the very start, so where we need to learn and to adapt the arrangements, this will be done. I am committed to ensuring that happens in a fair and transparent manner and we will constantly strive to improve.

I will now outline some key provisions of the Bill in more detail. The Bill is divided into nine sections. Sections 1 and 2 set out definitions and interpretative provisions. Sections 3 to 6, inclusive, amend the Health Act 1947 to increase the penalties for existing offences relating to the Covid-19 pandemic. This is intended to permit the fixed penalty notice for travellers going to or from an airport without reasonable excuse to be increased.

Section 7, the longest part of the Bill, relates specifically to the introduction of mandatory quarantine and related matters. The Bill inserts a number of new sections in the Health Act 1947. These will be numbered in the 1947 Act as sections 38B to 38M, inclusive.

Travellers who have been in a designated state within the 14 days prior to their arrival in Ireland will be obliged to undergo a 14-day period of quarantine. The Bill includes a provision to allow exit from quarantine before the completion of 14 days if travellers return a not-detected Covid test upon arrival and a further such test on day 10 of quarantine. There is a limited number of other circumstances under which travellers may leave quarantine, such as for medical treatment or other humanitarian reasons. The Bill also includes provisions requiring travellers who arrive in Ireland from any other country without a not-detected PCR test, that is, if an individual arrives without their preflight PCR test, to be quarantined until a not-detected test is returned, or for a full ten-day period if deemed necessary on public health grounds. Travellers who test positive for Covid during quarantine will be required to remain in quarantine until they have satisfied the criteria for release.

Travellers will be required to pre-book their accommodation in designated facilities. Appropriate provision is made for unaccompanied minors or those seeking international protection.

The Bill includes provision for travellers to appeal a decision that they are subject to mandatory quarantine, while Section 38B(25) includes categories of travellers who are exempt from the requirement to quarantine, such as drivers of HGVs, maritime or air crew, or elected officials travelling for official reasons. It will be possible to designate other exemptions by regulation.

Section 38C sets out the power to return travellers to quarantine if they have left inappropriately. Section 38D sets out offences associated with the Bill and establishes the relevant penalties. Section 38E sets out the power and the process for the Minister to designate the states relevant to mandatory quarantine and Section 38F makes provision for the designation of facilities and to require passengers to pay for quarantine. Section 38G sets out the regulation-making powers of the Minister and sets guiding principles for use in that process. Sections 38H and 38I provide the authority for the Minister to make arrangements for transport and accommodation and related matters for quarantine purposes. Sections 38J and 38K set out requirements and obligations related to record-keeping and data protection. Section 38L allows the Minister to make arrangements with other Ministers to carry out some of the functions associated with the requirement to quarantine as they relate to the designation of facilities for quarantine, making service contracts, and data protection. Section 38M establishes a requirement of travel organisers, such as airlines, to inform a traveller of his or her obligation to pre-book their quarantine, check that those bookings have been made and potentially refuse to allow travel where a booking has not been made.

Section 8 of the Bill makes minor consequential amendments to section 42 of 1947 Act.

Section 9 sets out the Short Title and operation of the Bill and establishes that the quarantine-related provisions of the Bill will fall three months from its passing, unless resolutions extending them are passed in both Houses of the Oireachtas. This sunset clause is an important feature of the Bill and reflects the exceptional nature of its provisions, which are required in the context of the Covid-19 pandemic.

In parallel with the drafting of this Bill and its consideration by the Oireachtas, a concerted cross-Government approach is being taken to prepare for the introduction of mandatory quarantine at designated facilities. This includes the service design, specifications needed to ensure the quarantine is of a high standard, hotel, security and ancillary services, as well as the health services and testing services required to meet public health requirements.

In conclusion, I welcome this opportunity to provide an overview of some of the key provisions in the Bill and I look forward to discussing the Bill in more detail on Committee Stage and to listening to colleagues' contributions during this Second Stage debate. This is a radical measure but these are no ordinary times. I commend the Bill to the House.

Minister of State at the Department of Health (Deputy Mary Butler)

I am pleased to address this House on the Health (Amendment) Bill 2021. As the Minister for Health has outlined, this Bill has been introduced to add to the State’s ability to robustly respond to the ongoing threats to public health from Covid-19.

We have been improving and reframing our mechanisms for responding to Covid-19 in the past year. Since the first set of restrictions were announced in March 2020, the aim has been to identify the virus to the greatest extent possible and to protect essential public services, including the health services, and to protect the most vulnerable in society. I wish to acknowledge the work undertaken by all those involved right across society in working with us to ensure the measures were implemented safely.

We must remember that more than 216,000 individuals in our country have now tested positive for coronavirus and sadly, more than 4,100 people have died. Each of these deaths represents a loved family member or friend who has sadly passed away to this disease.

Throughout the pandemic, the Government has been guided by the recommendations of the World Health Organization and European Centre for Disease Prevention and Control, ECDC, in framing our response. The National Public Health Emergency Team, NPHET, has in turn provided guidance to the Government in terms of the progression of the disease in Ireland and its review of the available evidence.

Given the constantly evolving nature of this pandemic, it is critical that we adapt our approach. We are now at an important point in our response to Covid-19. We have made good progress in reducing case numbers in the third wave. Our vaccination programme is up and running. We now need to address the threats posed by new variants of the disease. These new variants can be more transmissible and may cause more serious infection. The risks to the Covid-19 vaccination programme are a major concern and it is vital that the effectiveness of the vaccination programme is maintained.

The Health (Amendment) Bill 2021 provides a proportionate response to this risk we now face. It does this by amending the Health Act 1947 to allow for the introduction of mandatory quarantine at a designated facility for all passengers arriving from countries where variants of the Covid virus that present a particularly high risk are in evidence.

Mandatory hotel quarantine will be required for passengers who have been in designated countries, including those who have transited through a port or airport in a designated country. The Bill also provides for other measures such as mandatory quarantine for passengers who arrive in breach of the pre-departure negative PCR test requirement until such time as a not-detected test result has been returned.

Regardless of the measures that will be announced, however, it is important that we maintain our observance of the recommended public health measures, many of which have been in place since the beginning of this pandemic. That is especially important to protect the most vulnerable in society. As we move forward over the coming months, I urge all Deputies to continue to promote the public health messaging on Covid-19 in order that the most vulnerable in our society will be protected. I wish to recognise the hard work of the public in keeping with us for the past year. There is hardly an aspect of Irish life that has not been impacted in some way by coronavirus and it is acknowledged that the pandemic has affected us all very deeply.

The pandemic and associated restrictions have posed many challenges for people’s mental health, including increased stress, anxiety and fear. That has been exacerbated by experiences of isolation, bereavement and loss of income and work, among many others. The HSE has responded rapidly by reconfiguring existing mental health services and putting additional services and supports in place. It continues to plan, in collaboration with the Department of Health, for any surge in demand as it arises. In line with the WHO guidance, the HSE published a psychosocial framework in January. This builds on a range of supports introduced earlier last year in response to Covid, including self-help and psychological first aid supports for staff. The framework acknowledges the impact of the pandemic on mental health in all areas of society and identifies priority groups, including healthcare workers and people bereaved due to Covid. The framework provides a cohesive, co-ordinated, consistent and collaborative approach to the provision of mental health services and supports across five key levels from mental health promotion to specialist supports.

Older people have been isolating for extensive periods during the past year. They have had the added burden of being the most vulnerable to the effects of Covid-19. Last week, the vaccination of those over the age of 70 began, starting with those aged 85 and over being vaccinated by their own GPs. All those over the age of 70 who wish to be vaccinated will be contacted by their GPs and will be fully vaccinated with first and second doses by mid–May. As we continue to roll out the vaccine, there are a number of supports older people can avail of including: the Community Call initiative, which provides local helplines through local authorities to deliver practical supports, and befriending; the Keep Well campaign provides valuable information on supporting people through the difficult months ahead; and ALONE, in collaboration with the Department of Health and the HSE, is running a national support line that is available Monday to Friday from 8 a.m. to 8 p.m. on 0818 222 024.

I welcome the Government’s further initiative to strengthen our responses to Covid-19 and I commend the Bill to the House.

An Ceann Comhairle

We move now to the Sinn Féin spokespersons. I call Deputy Cullinane, who is sharing time with Deputy O'Rourke.

Deputy David Cullinane

This Bill has been a long time coming. It is nine months since NPHET recommended that discretionary elements of travel should end. It is disappointing the solutions in respect of checks and controls at airports are still not in place today when we are debating a Bill which still does not solve the problem. It is still a case of half measures. The Bill will not deal with the real threat of the importation of the virus from outside this State.

It is important for me to point out that we are having this debate at a time of increased anger and frustration among members of the public. They are very angry and frustrated because they want leadership. They want a coherent plan that they can have confidence in and they need hope. The reality is that they are not getting that from the Government or from the Minister for Health. The Government needs to get its act together. It has to stop sending out mixed messages. It has to stop the poor communication. It has to stop the botched media interviews. It has to stop the half measures and it needs to be putting in place the solutions that people can have confidence in and believe. That will not only get the numbers down low but it will keep them low.

As we gather here today and as the Minister knows, people have been through a horrific year in terms of the sacrifices they have made. People lost their jobs. People are stuck at home and they cannot leave save for essential purposes. They have been home schooling their children for months. I welcome the moves in the right direction in terms of reopening schools. People have seen their businesses close. Many businesses have not been able to open their doors for almost a year. All of those sacrifices have taken their toll on people's mental health, as well as socially and economically. When they make those sacrifices the very least they expect is that the Government will get its act together and put in place solutions to problems that only it can solve.

While people are playing their part abiding by restrictions and getting the case numbers down low, they have a real fear that, because the Government is failing to make the investments in certain areas and to go the distance in respect of mandatory testing and quarantine on travel, their efforts will be in vain and that we will again lose control of the virus. That is a very serious issue because when people lose confidence in the process, it is very dangerous. I want people to have confidence in the Government, in the process and in the ability of the Government to be able to deliver but I have to say that people are losing faith, if many have not already lost faith.

People are making the sacrifices they are making and are being told that they cannot stray outside 5 km from their own homes yet we are still not putting in place mandatory hotel quarantine for all international travel. How can that be the case? Can the Minister explain that to people because it has not been explained? I ask the Minister to listen to what I am saying. This is an important debate and having conversations with backbenchers is not appropriate. This is an important issue. The Minister had his chance to have his say and I listened so I ask him to please give me the respect of listening to what I am saying. People cannot understand why the Government is not going the full distance when they are making the sacrifices they are making. They are asking us why people who can still come in from some countries are not subject to mandatory PCR testing or hotel quarantine. Some people from some countries will be but we are still leaving ourselves exposed and we still do not have sufficient checks and balances. I cannot explain that to people. I do not have the answers for them because there is no excuse. There is no reason.

We in Sinn Féin will be tabling a number of amendments to this Bill and we will do so constructively. We are tabling amendments because we want a system that is fit for purpose. We are nearly 12 months on from the start of this pandemic and the Minister still has not got his act together in the context of sharing data on travel with his colleague in the North. That is on the Minister. He cannot blame anybody else. That matter is under his purview. That is his job. The Minister of Health in the North has reached out time and again on this issue but neither the Minister for Health nor the Government have responded. We are tabling an amendment to ensure that we have that level of data sharing. We are tabling an amendment to make sure that anybody coming into this State, irrespective of the country they are coming from, will be subject to mandatory hotel quarantine for all non-essential travel. If the Minister does not facilitate the latter, he will make a mockery of the whole process because he cannot enforce people quarantining at home. It is impossible to do that. It is the type of nod-and-wink solution that got us into the mess in which we find ourselves. Unless the solutions are real, robust and effective, we will continue to see more cases of the virus imported.

It must be said that this is on the Government and its failure to act in these areas. It is also extraordinary that even in this Bill there is still no provision for mandatory PCR testing post arrival for people quarantining at home. It is still only advisory. How can I explain that to somebody who is making sacrifices at present? How can the Minister or anybody in the Chamber explain that when we know what we have been through?

I want people to have hope that restrictions can be lifted in the summer. Everybody wants to have the sense that come the summer, we may be in a position to ease restrictions and give back people their lives. This will not be done if the ingredients necessary for maximum suppression are not there. I received figures this week from the HSE on testing and tracing staff. The target set months ago by the HSE was for 2,000 swabbers and contact tracers but fewer than 1,600 have been employed. Again, when people are making sacrifices and playing their part, the Government is falling short on testing and tracing. We hear from healthcare trade unions that we still do not have serial testing in hospitals. What in God's name is going on when we are not even hunting down the virus in hospitals? We need to use testing and tracking to hunt the virus when numbers are low, thereby putting us in a position where we can stay ahead of the virus, as opposed to losing control, which we have done in the past.

There are obvious ingredients in a maximum suppression strategy given to us at the outset of the entire process. They include testing and tracing but we have never got that right. That is on the Minister and his Government. We have never got the all-island response right in terms of sharing data and that is on the Minister and his Government. We are debating travel checks at ports and airports but we are still not getting it right. It is infuriating for people that even today, as Members debate this Bill, there is no commencement date on when the Bill will come into effect. We have no idea.

Many of us had a briefing with some senior civil servants from the Department about this and it seems the detail of the Bill is still being worked out. We have no idea when this will come into effect and I cannot tell anybody what day, week or month hotel quarantining will be introduced. Perhaps the Minister has the answer but it has not been given to us. How does that inspire confidence and how can I leave the Chamber today saying we had a debate and there is a Bill before the Dáil, although I have no idea when it will come into operation or if all the detail has been worked out. Moreover, I have a good idea that most of it has not been worked out and there is much work to be done nine months after the Government was told by NPHET to remove the discretionary elements of travel with respect to testing post arrival and quarantines.

The Minister must really get his act together and the Government must pull itself together once and for all. People are really angry and frustrated and I do not blame them. When they are making these sacrifices, the very least they could expect is that the Minister, the Taoiseach and the Tánaiste should do their jobs. Please stop competing for headlines and botched media interviews. Please stop competing with the Taoiseach, the Tánaiste, the leader of the Green Party and others to be first to a microphone or to talk to a journalist about what may or may not be in any plan. People should be given the hope they need, as that is really what is lacking from the Minister and his Government. There must be a big step change in the weeks and months ahead.

Deputy Darren O'Rourke

I welcome the opportunity to contribute to the debate on this Bill.

To begin, I must ask why the Minister for Transport is not here taking this Bill through the House. Where is the Minister for Transport, Deputy Eamon Ryan, today? He should be anchoring this Bill but he is missing in action. I mean no disrespect to the Minister or the Minister of State, Deputy Butler, but their responsibility and focus should be entirely on the health system and the critical vaccination roll-out. It is wholly inappropriate that the hotel quarantine Bill was loaded on the Department of Health. It is clear the Bill was dumped on the Minister, which is absolutely not helpful. It was a selfish move by the Minister's Cabinet colleagues, who shirked their responsibility in this area.

While Sinn Féin welcomes the broad thrust of this Bill, and I thank the departmental officials for their briefing on Monday, it will come as no surprise to hear we do not believe this Bill goes far enough. NPHET set the bar on 14 January when it recommended "that every effort be made to ensure that discretion as it currently applies to the need for restriction of movements and PCR-testing post-arrival in Ireland is removed". The question is whether we can do more to limit discretion on restriction of movements and PCR testing post arrival. When we look at this Bill and the wider regime, the answer is absolutely clear. Yes, we can; yes, we should; and yes, we must.

Limiting the provisions of this Bill to arrivals from just 20 countries is wholly inadequate. One of our amendments seeks to extend mandatory hotel quarantine to arrivals from all countries and the Minister should accept it. As the Bill has a three-month sunset clause, we believe mandatory hotel quarantine for all non-essential arrivals during this time is necessary, appropriate and proportionate. We need strong action now to prevent new variants being imported and to protect the vital vaccination programme over the coming months. I urge the Minister and his colleagues to reconsider and listen to the Opposition on this point. He should heed the public appetite for it. Too many mistakes have been made in the Government’s international travel policy, lessons need to be learned and now is the time to do it.

Central to the Government's argument against our proposals is that it wants to continue with the approach of reacting to variants or outbreaks in other countries as they arise. This does not work and will not work. The Government has stated, as if it were a badge of honour, that on first hearing of the British variant it imposed a travel ban the next day. What decisive action. While this is how the Government intends to carry on, did it work? It did not, not by a million miles, as 90% of all cases here are now from that exact variant.

The Minister knows that by the time variants are discovered in other countries, it is too late and the ship has sailed, both literally and figuratively. The Government's plan runs contrary to the fundamental principles of outbreak management and prevention. For 170 or 180-odd countries in the world, we will rely on mandatory quarantine at home. Let us just be straight with people. There is no such thing as mandatory quarantine at home. It is a misnomer and does not exist. It cannot be monitored or enforced. It is mandatory in name only and is quarantine in name only. It means nothing and as a result, this entire plan is wholly inadequate.

This is why the collective Opposition and the vast majority of people are asking for proactive measures in this regard. That is why nothing less than including all countries in this will work. We must take a cautious approach until the vaccination programme is more advanced and more information about variants is known. The Government acknowledges this and we must take measures that will help allow our population get back to some level of normal life. The best way to do that is to drive the virus down and to prevent it and new variants from reseeding. Closing the door to unchecked international travel for the time being should be one part of this plan. Sinn Féin’s amendments deliver that and I urge the Minister to reconsider his position.

Related to the need for more comprehensive mandatory hotel quarantine is the urgent need to expand the checks and balances currently in place. Number one must be the introduction of a mandatory PCR test post arrival for all non-essential travel. A pre-departure test within the previous 72 hours, as currently required, is not enough. The Minister knows this and the experts have told him. NPHET's modelling indicates that even the best-performing pre-departure Covid-19 tests will miss up to 40% of cases within that 72-hour period. We have submitted another amendment that would require a post-arrival test for all non-essential travellers, regardless of whether they are in hotel quarantine. The Minister should accept it.

Currently, people are arriving back into the State and possibly quarantining in their homes. They are mixing with family members or housemates and without testing post arrival, this has the potential to lead to significant numbers of clusters.

Post-arrival mandatory testing must be introduced. It is about closing the net and managing and minimising the risk. We have all heard about the Swiss cheese model and the layers of protection. Pre-departure testing will miss up to 40% of cases. When combined with a post-arrival test on day 5, it will miss up to 15% of cases, according to the submission of the Chief Medical Officer, CMO, to the Joint Committee on Transport and Communication Networks. It is true that 15% is much better than 40%. NPHET set the bar, and on the issue of post-arrival testing, the Minister has not even tied his laces.

It is a similar case with the practicalities of the proposed regime. Given the current state of affairs, it will happen in very limited circumstances and maybe none but technically, someone landing in Belfast and living in the South is expected to voluntarily present at a designated facility. The question arises as to what happens if one does not. There are fines and penalties, which is fair enough. However, to ensure that this measure is implementable and enforceable, passenger data must be shared in real time between Belfast and Dublin, in order that the authorities here know who should be presenting at a designated facility and can contact them if they do not. It makes sense and we have submitted an amendment in this regard. I ask the Minister to support it.

Finally, we must acknowledge the impact that all of this will have on the aviation sector. I was genuinely taken aback to hear the response of the Tánaiste in the House last week when I raised this matter with him. In a highly disingenuous way, he suggested that asking for mandatory hotel quarantine and advocating for support for the aviation sector was trying to have it both ways. That is absolute nonsense. Of course, we realise that extra measures will add further to the difficulties in the aviation and travel sectors but look at those industries now. Look at what the Government's policies have achieved. The summer of 2020 was lost and now we are being told that the summer of 2021 will be lost. If we do not get ahead of this virus, more months and jobs will be lost.

Government half-measures and this permanent purgatory will not do. The Government’s approach to aviation has been disgraceful. It has failed to support the sector and its workers. The level of State supports is a fraction of what is required. The Government has turned a blind eye to ghost flights leaving with people’s money. We are told that nothing can be done. It has turned a blind eye to loyal customers being given the runaround on refunds and vouchers and being gouged on rescheduling fees. It has turned a blind eye on loyal workers being denied their short-time work support and to Aer Lingus strategically moving its operations elsewhere. The Minister wrote to me this morning, stating that the privatisation of Aer Lingus is "a positive evolution for the company". That is absolutely incredible. It is completely outrageous for the Tánaiste to come into the Dáil and claim that this half-baked plan, which is in front of us today, is about protecting aviation. It is no wonder that aviation sector workers are at their wits' end.

The Government cannot continue to ignore the need for crucial protections for workers. Tailored supports must be introduced for workers in the aviation industry who are facing months more of uncertainty and possible further job losses. The Government is sitting on a quarter of a billion euro in the so-called connectivity fund. This must be used. Massive investment is needed to protect aviation. It should come with conditions, including the protection of workers, jobs, strategic connectivity, and delivery on climate change goals. The Government has the power to do this. The Minister should stop pretending that there is some happy balance to be struck somewhere between 20 and 200-odd countries. It is an insult to ordinary workers who are looking to the Minister and the Government for hope. Instead, they are being used as a political football.

This legislation is important. It has come very late but at a crucial juncture in our effort to get ahead of this virus. Sinn Féin has proposed a number of amendments. I ask the Minister to consider and adopt them.

Debate adjourned.

Dáil Éireann debate - Wednesday, 24 Feb 2021