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Dáil Éireann debate -
Thursday, 4 Mar 2021

Vol. 1004 No. 8

Covid-19 Vaccine Roll-out Programme: Statements

We move now to the next item of business, which is statements and questions and answers with the Minister for Health on the vaccine roll-out programme. I welcome the Minister, Deputy Donnelly, and the Minister of State, Deputy Butler, who is also with us. The Minister has 20 minutes.

I welcome the opportunity to discuss the vaccine roll-out with the House. By the end of this week, approximately 500,000 vaccine doses will have been administered. Our aim has been and remains to administer vaccines as they arrive into the country, while maintaining a small buffer to ensure people get their second dose as scheduled. This aim is being met.

At the start of this week, we had received delivery of approximately 520,000 vaccine doses. By the end of this week, approximately 500,000 of these will have been administered. I am delighted to be able to share with the House today that cohort 4, that is, those with underlying conditions putting them at very high-risk, will begin to be vaccinated next week. It is really good and welcome news. It is a complex group and complex work, planning and engagement is going on. The HSE is currently working through the details on how these patients will be contacted and where they will be vaccinated. I am sure it is a development we all welcome in the House today, however.

We have been able to do all this, in terms of the number of vaccines that have been rolled out, thanks to what really is an army of vaccinators, including our school and community vaccination teams, thousands in general practice, including GPs, practice nurses and administrative staff, hospital-based healthcare workers, both clinical and administrative, medical students, the fantastic support of the Defence Forces, the involvement of voluntary organisations, such as the Order of Malta Ireland, staff in nursing homes and other residential and day-care facilities and many more right across the country. It has been, remains and will continue to be a truly national effort.

There are challenges, of course. The HSE is managing a vaccination programme with uncertain supplies arriving, particularly from AstraZeneca. I remain concerned about the ability of AstraZeneca to deliver on schedule and at the agreed volumes. The HSE is managing a complex distribution network involving 1,300 GP practices across the country, with vaccines that must be handled very carefully, and in the case of Pfizer, a vaccine whereby there are five days from when the freezers are opened in Dublin to when the vaccine can be administered.

The HSE is managing a vaccination programme for which the clinical advice is updated on a regular basis, as it should be, as new studies and new evidence emerges from around the world providing our experts, namely, the national immunisation advisory committee, NIAC, the National Public Health Emergency Team, NPHET, and the HSE with the most up-to-date information.

Yet, in spite of all this complexity and uncertainty in this rapidly evolving situation, thanks to the efforts of everybody involved in the national vaccination programme, Ireland has consistently had one of the fastest roll-outs anywhere in the European Union. It is very important that we acknowledge the work of the vaccination teams across Ireland which has made that possible. It is no mean feat. We have achieved that while, at the same time, prioritising the most vulnerable.

Thanks to the efforts of all the people involved - 6% of our population have now had at least one dose - there has been a huge reduction in Covid-19 infections in nursing homes and healthcare settings and the vast majority of people aged 85 and older will have received their first dose by the end of this week. Most of our front-line healthcare workers will also have received at least their first dose by the end of this week. Our vaccination programme is only 65 days old. Much has, therefore, been achieved.

Next week, the European Medicines Agency, EMA, will make its decision on the Janssen vaccine. This is a single-dose vaccine serving to further enhance Ireland’s vaccine portfolio and facilitate the continued acceleration of the programme, which is something we all want. Our hope is that the EMA will authorise the Janssen vaccine.

Last week, I received the Government's approval to purchase additional doses of Moderna and opt in to future advanced purchase agreements with both Novavax and Valneva. This will take Ireland’s total vaccine supply to over 18 million doses. When one accounts for the fact that the Janssen vaccine will be a single dose, we have advance purchased enough to fully vaccinate more than 10 million people.

Ireland will also be contributing vaccine to other countries via the EU’s contribution to COVAX. This is only right and ethical. The pandemic will not end until everyone has access to a vaccine. At a meeting of EU health ministers earlier this week, I called on the EU to do more and to be the leading force globally when it comes to a just global vaccine programme. We need to do this because it is the ethical thing to do and we need the world vaccinated to have the best possible defence against this awful virus.

The Covid-19 vaccine allocation strategy sets out how the population should be prioritised for vaccination. The initial strategy was approved by the Government in December. Last week, I announced that the strategy had been updated to reflect emerging evidence on the disease. When compiling the initial vaccine priority list, the national immunisation advisory committee, NIAC, listed several conditions associated with increased risk of severe disease and death. It was indicated at the time that the allocation groups may be updated in the future, if necessary, in light of new evidence. In recent months, we have seen the emergence of the B117 variant of the disease which is more transmissible and more severe in terms of hospitalisation.

Thankfully, we now know much more about the disease than we did a few short months ago. There is a growing body of national and international evidence on which comorbidities present the greatest risk for those who contract Covid-19. NIAC has used these findings to inform its revised recommendations. The updated strategy identifies those with underlying conditions at either very high or high risk of severe disease or death as a result of contracting Covid-19. Priority will be given to these groups as the programme progresses. Vaccination for cohort 4, the group deemed to be at very high risk due to underlying conditions, will commence next week.

Accelerating the vaccination of those with certain pre-existing medical conditions adheres to the ethos of the vaccination programme to minimise harm and ensure equitable access to vaccination. The primary aim of the Covid-19 vaccination programme remains unchanged. We are continuing to vaccinate those most likely to suffer severe disease and, sadly, death as a result of contracting Covid-19. The changes made are based on the latest clinical and medical advice that those who are being prioritised would suffer the worst outcomes if they were to contract the disease. The approach is also consistent with the advice given to EU member states by the European Centre for Disease Prevention and Control. The vaccination programme is being adapted to account for NIAC’s recommendations to ensure those who are most vulnerable continue to be prioritised. NIAC will continue to monitor data around the disease and emerging evidence on effectiveness of vaccines on a rolling basis.

The Covid-19 vaccination programme is truly a national effort. Up to 1,300 general practices are participating in the vaccination programme at this stage. This week is also seeing those aged between 80 and 84 begin to receive invitations to attend for vaccination.

There is significant demand for and confidence in Covid-19 vaccines from the public. Up to 86% of the public now indicate they will definitely or probably seek the vaccination when it is available. There will be an extensive communications campaign in an effort to further increase uptake. We anticipate significantly increased vaccine supply from next month. Preparations continue to be made in order to ensure this can be administered without delay.

We continue to build the appropriate capability, processes and systems to quickly distribute all vaccines as supply increases. As of last Monday, 8,629 vaccinators are trained. I signed a statutory instrument last week to enable registered optometrists and dentists to administer Covid-19 vaccine. Large vaccination centres are already in operation in Dublin’s Helix Theatre, Cork’s Munster Technological University campus and Galway’s Merlin Park. These will be joined by many more in the coming period with 37 sites having been selected including one for each county.

It is just over a year since this disease resulted in the declaration of a public health emergency by the World Health Organization. Over the past year, it has inflicted an enormous toll of grief and hardship on so many, here and around the world. While we must remain vigilant and continue to adhere to public health measures, the vaccination programme continues to be a source of hope. Continuing to maintain reduced personal contacts is extremely difficult for the public, particularly as the weather improves after enduring an incredibly difficult winter. As vaccine supply increases, however, we have genuine cause for optimism. Vaccine availability is anticipated to increase significantly from April. From that point, we expect 1 million doses to be administered each month, subject to the delivery of contracted supplies. As we progress through spring and into the summer, I am confident there are better days ahead.

Ireland’s vaccination programme is designed to protect the most vulnerable in society, beginning with older residents of long-term care facilities. I acknowledge the huge contribution made by all involved in establishing and commencing roll-out of the vaccination programme. We are prioritising our most vulnerable to Covid-19 infection. Health workers who care for them come first in the priority list for vaccination. Priority groups were approved by the Government based on public health and ethical guidelines.

The vaccine is being rolled out to the initial cohorts outlined in the vaccine allocation strategy including residents of long-term residential care facilities, front-line healthcare workers and those aged 70 and over. As of 28 February, 159,350 doses have been administered in long-term care facilities and 62,654 residents have been fully vaccinated.

When a resident has been infected with Covid-19 or there has been an outbreak in a facility, vaccination may be deferred until it is safe to do so. The HSE continues to actively follow up with those residents and facilities where vaccination was deferred. As the Minister of State with special responsibility for older people, I assure the House that every resident in long-term care facilities will be offered vaccination once it is deemed safe for them to receive it.

The roll-out of the second vaccine dose to the majority of residents and staff in nursing homes is nearing completion. Vaccinations in residential and-or congregated settings which were not included in the first series of the vaccine programme, such as unregistered voluntary and religious order service providers, will be completed as soon as possible.

On 15 February, we began the process of vaccinating older people living in the community, beginning with those over the age of 85. We expect to be in a position to have administered a first dose to the majority of those aged 85 and above by the end of this week. Following those aged over 85, the focus then moves to vaccinate people aged between 80 and 84 in a timely and efficient manner. Those aged between 80 and 84 will begin to be invited for vaccination from this week. All over 70s who wish to be vaccinated will be contacted by their GP and will be fully vaccinated as a priority cohort in the coming months.

The vaccination programme is truly a national effort. By the end of this week, approximately 1,300 general practices will have participated in the programme. Without the assistance of GPs, it would not be possible to reach the most vulnerable in our community. I thank GPs and their staff for their ongoing efforts which will facilitate the delivery of our programme.

The vaccination programme continues to focus on vaccinating those most at risk of poor outcomes as a result of contracting Covid-19. The primary objective of the vaccination programme is to reduce mortality and morbidity which, in turn, will protect the healthcare system from becoming overwhelmed. The vaccine allocation strategy deemed those most at risk to be those over the age of 65 and residing in long-term residential care. I welcome the progress made with regard to protecting this vulnerable cohort.

As the Minister of State with responsibility for mental health, I am pleased that NIAC's updated vaccine allocation strategy was approved by the Government last week. The strategy will see those with severe mental health illness, including schizophrenia, bipolar disorder and severe depression, being prioritised for vaccination. The vaccination programme has already demonstrated agility in adapting to changing clinical advice, including the decision to prioritise the use of mRNA vaccines to those over the age of 70. The vaccine programme will make the necessary adjustments to accommodate the updated strategy, ensuring that those who are most vulnerable continue to be prioritised.

The pandemic has been a profoundly challenging and stressful time. It is of vital importance that mental health services continue to operate during this period. Despite the increased strain placed on the healthcare system, specialist mental health services are continuing to operate at between 85% and 90% of pre-Covid levels. I am pleased to inform the Dáil that Covid cases in residential mental health care settings continue to decline. As of 19 February, cases had reduced by more than half. The majority of cases that are being reported relate to staff, rather than residents. The majority of eligible staff and residents over 65 in mental health centres have received a vaccination. Second doses have been administered to service users and staff in some centres. Progress is continuing to be made with regard to those who are yet to be fully vaccinated.

This will be the largest vaccination programme in the history of the State. Remarkable progress has been made in a relatively short period of time. Our immediate priority, and our complete focus, is to look after the most vulnerable and our front-line healthcare workers who have worked so hard in the battle against Covid-19. They are being vaccinated as quickly and safely as possible. Supply of vaccines will be the only limiting factor.

The vaccination programme will take a great national partnership to complete. Pharmacists, GPs, all doctors, nurses, paramedics, nursing home staff and many healthcare professionals, as the Minister, Deputy Stephen Donnelly, outlined, have a role to play in the vaccination programme. We are now in a position where we have three authorised vaccines being used to protect our most vulnerable, something which would have been unthinkable until recently. I wish to thank everyone who has brought us to this point. The initial vaccine roll-out is focused on protecting the most vulnerable among us, but as supply increases in the coming weeks and months, vaccination will ultimately be extended to everyone who wants it.

I am sharing time with my colleague, Deputy Ward.

We are at a very important point in the battle against Covid. In fact, I would argue we are at a critical point in relation to suppressing this virus. We have had debates in this Chamber on a range of different ingredients to keep driving down community transmission and then keeping the numbers low. That includes having a first-class test and trace system. It obviously includes sufficient checks and controls at ports and airports. As the Minister and the Minister of State are aware, we have disagreements in those areas. The roll-out of the vaccine must be front and centre. Everybody in this State wants that process to be a success because it is a route out of the crisis we are in and it gives people hope that we will have some level of normality back in our lives in the next number of months.

However, it must be said that there are problems. It is our job to raise those problems with the Minister. Those problems are not only on the supply side but there have been some problems on the supply side. We are hearing that some countries, such as Denmark, Hungary and Austria, are ahead of us in vaccinating their population. Those countries have hit a target of 9%. We are on 6%. There are reports of some countries going outside of the EU procurement process and doing side deals and additional deals with pharmaceutical companies, and yet there is no sense that there are any additional vaccines coming our way in this State.

There were issues last week. Much of the evidence was anecdotal, but I spoke to many GPs who did not receive their vaccines on time. It was right across the State. County Monaghan, in particular, was bad, but there were many examples. I dealt directly with GPs and with the HSE in trying to resolve the problem. That was problematic. It showed, if there are problems at that level when we are only rolling it out for the over 85s, what will happen when we get to the general population roll-out. There are problems and I will get to some of those in a moment.

There are also issues in relation to transparency and daily reporting. We are still not getting sufficient information to give us confidence that there is absolute transparency about the number of vaccines in the country, the number of people vaccinated and the number of vaccines which are in storage on a daily or weekly basis. The absence of that information and transparency is problematic. We have mixed targets. We saw this week where targets were not met. We also have some groups, such as carers, who are not defined as a distinct cohort. These are all real problems that have been raised with us on a daily basis.

I have a number of questions for the Minister. The first relates to the procurement side of this matter. Many EU states have now gone outside of the current EU procurement process. Can the Minister confirm that has happened and can he state why we are not looking to increase supply as well? If other countries are able to do it, why is it not possible for this State to be able to do it? I want solidarity across the European Union. I want global solidarity but when people watch other member states going outside of the process, including Germany, they are asking reasonable questions. What is the Irish Government doing? What is Deputy Stephen Donnelly, as Minister for Health, doing? Is the Minister being proactive enough in ensuring that we maximise the supply side of the vaccine? As a first question, I put that to the Minister. Is it the case that other member states have gone outside of the process? Is that allowed and if it is, what are we doing about it in terms of increasing the supply side for this State?

I thank Deputy Cullinane for the question and for his remarks. The information I have is that a very small number of EU countries are looking at going outside the EU process. The Deputy referenced Hungary, for example. My understanding is that they have elected to use a vaccine that has not been authorised by the European Medicines Agency, EMA. I would hope one thing we would all agree on in the House is that, regardless of where the vaccines come from, we would stick to vaccines that are authorised by the EMA. It is a very small number.

If the Deputy looks at the table of countries in the EU and the total doses administered per head of population, he will find that Ireland has been consistently very close to the top. That is because we are getting them out as quickly as they are coming in and we are drawing down the total number of vaccines that are available to us through the process. As I stated in my opening remarks, we have now approved advance purchase of nearly 18.5 million doses. However, the Deputy's question is a reasonable one, and one I have engaged with the task force on as well to see if there are legitimate mechanisms in parallel with the EU process whereby we could secure vaccines that are validated and have been authorised by the EU.

It is worth restating the process we are going through so far. I know there is frustration all around the world in that everybody wants many vaccines as quickly as possible. It has given us access to a level of vaccine which, many people tell me, simply would not have been possible if we had tried to proceed on our own.

I come to the reporting - the daily reporting and the transparency. Why, even at this point, we do not have, even on a weekly basis, information on how many vaccines have arrived, how many vaccines have been administered and how many are in storage? Such information would give people confidence and it would ensure that we have full transparency. There is some reporting but it does not go far enough. Would the Minister commit to reviewing that issue and enhancing the reporting to ensure we can say to people that the vaccines are coming in, people are getting vaccinated as quickly as possible and there is not a situation where we have any amount of vaccines in storage?

I certainly can commit to talking to the task force and the HSE about this. If I may, I will respectfully push back a little here. I take Deputy Cullinane's point. He is asking about supply coming in and we will look at that. In terms of the doses administered, in fairness to the people who are running the programme, the House asked for weekly numbers and then daily numbers. I committed to that and that was done. They go up online every day. I asked for them to be put onto the tracker app as well so that people could access them.

The Members of the Oireachtas are getting a daily briefing as well. In fairness to the teams running this, much effort has been put into it. Of course, if there is more information the House would like to have, I will endeavour to make that available.

There are a lot of questions I want to get through, and I thank the Minister for his brevity in responding. Some GPs have claimed in recent weeks they did not get their vaccines in time, and many of us have been contacted by relatives of older people who were in GP surgeries expecting to get their vaccine and it did not happen. Does the Minister have numbers on reported cases where GPs were due to get their vaccines on a certain day and it did not happen? I am sure that would be valuable information for the Minister so we can learn lessons as we move on to the next numbers of cohorts. Are those data available and does the Minister know how many reported cases there were of GPs who were due to receive their vaccine on a certain day and it did not happen?

I thank the Deputy for that. On his previous point, I am publishing right now for the Oireachtas the deliveries to date so that, by the end of or even during this session, the latest figures, I believe for the start of this week, will be available. I certainly would like to see that published weekly for the very reasons given by the Deputy.

As to the GPs, there are approximately 1,300 GP practices involved and it was ramping up over a three-week period. The latest information I have as of this morning is that approximately 65 of the GP practices, which were practices with fewer than 200 patients over the age cohort, were not buddying up for various reasons. My understanding is these were smaller GP practices and, in some cases, due to location, it was very difficult for them to buddy up. These are all being contacted today and tomorrow and a delivery plan is being put in place so that they all get their deliveries next week.

Second, my understanding is there is a group of approximately 25 other practices with very small numbers of patients over 70 years of age, and the HSE is engaging with those practices. While the vast majority of the GP clinics got the deliveries - they may not have got them on the exact day but they did get them - there were a small number where there were issues in the supply chain and the HSE is working hard to resolve this.

I will put my remaining questions in one block. Will the Minister outline to the House the new target dates for all the over-85s and all the over-70s to be vaccinated? We are now hearing some other countries in Europe may use the AstraZeneca vaccine.

We hear Britain is now examining the possibility of a third jab of the vaccine in the autumn. Is that something that is being considered in this State?

Regarding people who are housebound, and while I, as somebody who first raised this issue, welcome the move starting next week to have people with underlying medical conditions vaccinated, some of those will be housebound, as are some of the older people, and there are questions relating to GPs being part of that. Perhaps the Minister could answer that.

I thank the Deputy. The target for the first dose for the over-85s was for the vast majority of them to have been done by the end of this week. There are a small number of GP practices, for the reasons I have just given, which did not receive their deliveries this week, and they will get them next week.

On the point, which the Deputy has raised before, about people who are housebound, the good news is GPs will be able to make, and are already making, house visits. The National Ambulance Service is being used as well. There was a question at the start as to whether the mRNA vaccines could be transported a second time. The clinical advice now is they can be.

On the Deputy’s question on the over-70s, the answer is partly in the second part of his question. He quite rightly pointed out some countries are now electing to use AstraZeneca for the over-70s. There is emerging evidence from UK studies the national immunisation advisory committee, NIAC, is looking at at the moment. The clinical advice remains that the mRNA vaccines will be used for the 70-year-olds and older, but NIAC is always looking at emerging evidence. Certainly, it would be the case that, if it advised as per France, for example, which I believe is now giving the vaccine for those above 65, it would accelerate the date.

This means, in answer to the Deputy’s final question as to when the end date for that cohort will be, as with so much in this programme, it depends. It depends on the clinical advice and on the deliveries coming in.

Because some of my time has already been eaten up, I will ask some questions and will appreciate if the Minister can get back to me in writing because he may not have time now.

The delivery of the vaccine to our citizens is of paramount importance in getting people back to work, allowing families and friends to meet up, enabling our children to get back to sports and to school, and basically in getting back to everything we took for granted before this pandemic reached our shores. Teething problems cannot be used as an excuse by this Government to explain away issues about the vaccination roll-out. They may have been an excuse or acceptable 12 months ago but not now when we have had more than a year to plan for these vaccine roll-outs.

The Minister mentioned, for example, that the HSE was in talks with the National Ambulance Service to see if something could be done in respect of vaccinating the over-85s who are confined to their own homes. Surely, these talks could have taken place months ago, and it is not as if the Minister has not had the time to do this. Did these talks include the ambulance service vaccinating other vulnerable groups in their own homes as we move forward? The next roll-out, for example, of 80 to 84-year-olds could be included.

As has already been stated, the vast majority of people are willing to take this vaccine when they know it works and is safe. Countless numbers of people's lives around the world have been saved by vaccines. Vaccination levels, however, have been dropping off over recent years. The Minister mentioned a public information roll-out. How will this be delivered to people who may not have access to broadband, to the Internet or to facilities through which they may be able to get that information? How will access to this information be rolled out to these people and to others who may be in vulnerable groups, such as Travellers, homeless people, and people who may have mental health or capacity issues? Those are some questions I would like answered.

Some issues have been brought to me locally. An elderly gentleman from Clondalkin was asked to go to the Helix on the other side of Dublin, which it would have taken him a couple of hours and two buses to get to, to get the vaccine. Another lady was told to go to her GP to receive the vaccine, and when she got there, the vaccine had not arrived. Another lady from Lucan, who works as a hospital cleaner, and her colleague, who is a security guard, have not received a vaccine despite working on the front line right throughout the pandemic. Will the Minister give me some reassurance on how these issues will be addressed? I will accept these answers in writing from the Minister.

The Minister will respond in writing to the Deputy.

I am very interested in the process by which the three companies which are providing vaccines - we hope there will be more – are providing information on the numbers of vaccines they are giving us as a country. We have heard the Tánaiste saying 300,000 people a week will be vaccinated in April. I pray and hope there will be even more. Have we as a country and the Minister been told in writing by each of the three companies - Pfizer, Moderna and AstraZeneca - how many vaccines they are going to provide us with for each of the three months, March, April and May?

I thank the Deputy. Yes is the answer. We have a provisional schedule week by week for all of the vaccines. The problem, as we are all becoming painfully aware, is that while the schedules for the Pfizer and Moderna vaccines have broadly come on time - there were one or two changes to the Pfizer schedule which we got at late notice, but by and large they have been coming in on time - there has been huge uncertainty around AstraZeneca, and it has been frustrating on a number of different levels. First, its deliveries are not always arriving when they are meant to. Second, we are receiving very late notice of that. Third, unfortunately, it has on more than one occasion forecast down the total volumes. AstraZeneca remains a very serious concern in terms of reliability and volume.

That is fair enough.

I have a question on this. Obviously this is sent to the Minister in writing every week. Is it possible for the Minister to publish it every week? That would help us to help the Minister. He has a schedule for the next three months. Will he publish that schedule each week so that we can have transparency? Transparency is a big issue. If the Minister published it we could transparently see how many vaccines are coming in from each provider and how much is projected to come in for each month. Then we can estimate with regard to the various cohorts and work with the Minister. Will the Minister commit to doing this?

I will certainly commit to speaking to the Department, the task force and the HSE about it. We all want maximum transparency and I hope the Deputy would agree that on the supply side, a real effort has been made to make the data available. The challenge is that anything we publish will change. As we in here know, it has changed repeatedly. If we take this week as an example, a figure was given in good faith. The hope was to vaccinate 100,000 people this week. For one reason, and one reason only, it will be lower than that. This is because at the last minute, mid week, AstraZeneca said we will not get what we need. Unfortunately, how this is being portrayed by some is that the HSE has missed its targets whereas, in fact, that is not the case. The HSE's target is to get out what it gets in. The HSE is hitting its target. My concern, and perhaps it is something for us to consider further, is that even if we publish the forecasts at this level of detail they will change regularly. My concern is this could cause an awful lot of concern among the general public and it might erode trust. It could be down to just one company moving around its supplies all the time.

I understand where the Minister is coming from but I respectfully suggest it would actually do the opposite. We would all see it transparently. We could not be called hypocrites in this House because we would know we were receiving vaccines and we would know that everyone projected honestly based on the timelines they had at the moment those projections were stated publicly. Once that changed we could see it. I would say the Minister should not do it daily but once a week, every Monday, every Friday or whatever. I urge the Minister to take this suggestion on board for the very simple reason that it would help everyone. It would help in politics because we would have to say honestly how it had changed and it would be transparent. We would not be second-guessing the Minister or the HSE. I ask the Minister to take this on board. It would really help the HSE also.

I will ask my next questions together. The Minister hit on my next question earlier. If we could get AstraZeneca approved for those aged over 70 it would change things and help with the timelines. When does the Minister expect that NIAC will update him on the use of AstraZeneca? I am not saying it will change its advice but I hope it will do so. When does the Minister see pharmacists in particular getting involved in vaccinations? I believe their role could be dialled up. Their access to the public and knowledge of the public and patients is pretty important.

On the issue of deliveries perhaps we can discuss it further. It would require co-operation. For example, in good faith I gave a detailed target for September and that then moved because of AstraZeneca. Within an hour I was being accused of making false promises. If we are going to use forecast information my ask back is that all of us in the House use it accordingly because it has not always been used in that way.

On AstraZeneca, NPHET will meet today. I do not believe there will be a recommendation from NIAC today but I know it is something we are keen on and NIAC is looking at. It may not make that recommendation but, in the context of the Deputy's question, if it does so it would accelerate vaccination of those aged over 70. With regard to pharmacists, cohort 3 is with GPs and the details for cohort 4, which comprises those at very high risk with underlying conditions, are still being worked out. The latest thinking is cohort 4 will be vaccinated by GPs and consultants at a mixture of GP practices and hospital settings because we are dealing with people with very serious conditions. I do not like hazarding a guess on these things because it tends to get one in trouble when it does not come true but very shortly thereafter, as we begin to ramp up to the more general population, the pharmacists will get involved.

We know that a lack of supply has been an issue in rolling out the vaccine. We also know there are extra supplies of vaccine in other countries. I ask the Minister not to consult with the task force but to mandate it to secure unilaterally extra supplies of vaccine for Ireland. The European Commission has said we are free to make these deals. Germany has done its own deal with Pfizer and it was followed by the Danes. The Danes and the Austrians are now in the first movers group with Israel for future vaccination roll-out. Sputnik V has arrived in Slovakia and there are rumours that the Czech Republic and the Austrians will follow. They are not waiting for EMA approval because they do not have to. Today, there are more than 1 million doses of the AstraZeneca vaccine in Germany not being used and 1.5 million doses in France are not being used. I ask the Minister to mandate the task force to get these supplies for Ireland.

I thank the Deputy. I certainly share his desire to get as much vaccine into the country as possible. As a starting point, we would use vaccines authorised by the EMA. I can confirm the EMA has now put Sputnik on its rolling review, which is a step on the way to the manufacturers of Sputnik applying for conditional marketing authorisation. I have asked the task force to take at look at what other legitimate avenues might be available. Certainly if there are EU countries that do not want to use all of their AstraZeneca doses we will most certainly take them. There are some countries where the uptake of AstraZeneca has been poor, for sloppy reasons to be perfectly honest whereby the wrong information was put out. In fact, the emerging and ongoing evidence on AstraZeneca in the field is very positive. I fully agree with the thrust of what the Deputy is asking. If there are other supplies we can access certainly the task force will look to see what they may be.

As the Minister is aware, the Limerick vaccination centre is technically based in Clare at the Radisson. What would be the process by which the Minister would expedite the roll-out of the vaccine with an additional mass vaccination centre based within the boundaries of Limerick city and county? We have had 17,000 vaccines delivered to Limerick to date. I believe this is way behind other areas. It would make much sense at this point to publish a breakdown of the cohorts by county. It would provide a transparent system that would give huge extra confidence to the public in the vaccination programme.

I thank the Deputy. With regard to a second larger vaccination centre for Limerick city and-or county, it is something that is kept under constant review for the whole country. If there is a demand for another centre one can be sourced and set up quite quickly. Remember the vaccinations centres are simply one part of the infrastructure. As we move out to the general populace, and particularly through April as we scale up to perhaps 250,000 vaccines a week, we will involve GP practices, pharmacies and vaccination centres.

Every town in Limerick will have at least one option and probably multiple options, and many of the villages as well. I can assure the Deputy that if that is not enough, and if there is an obvious need for a second vaccination centre for the city and-or the county, that can be done.

There was a question on the breakdown by county in terms of cohorts of vaccines being given out and a weekly breakdown of that.

It is certainly something I can take up with the task force.

I want to comment on the desire of people to have as much information as possible on the vaccine issue. I heard the Minister's answer earlier and I appreciate his bona fides on it. However, I think we are setting up a situation where we are being forced to manage a story that is ultimately in the control of the manufacturers. In many cases, open source data is a great solution in terms of communication with the public in other areas of public policy and we should adopt it here because it would give confidence to people. That open source data would also make transparent where are the issues and the blockages.

We cannot have enough coverage on the vaccine issue - more questions and answers, more briefings in the media, more opportunities for Professor MacCraith to be out and about and more up-to-date information. Even today, I see the Covid app has the details but it only has them updated to 1 March. The more updated information we have, the better.

I heard what the Minister said in regard to Germany and France’s approval of the AstraZeneca vaccine for older age groups. While NIAC is looking at that, if there is a date on which the Minister expects it to make that decision, I would appreciate that.

We discussed in detail countries such as Denmark, Austria and Malta, which have looked elsewhere, outside the EU arrangements. I would encourage the Minister to do that because we are getting many queries into our offices in that regard.

It was great to see the Minister at the mass vaccination centre in DCU in my constituency. The publicity around that has resulted in many calls for vaccination centres in other places. Can the Minister give us the percentage of people who will be vaccinated in those centres compared to those to be vaccinated in GP practices, given the vast majority will be vaccinated much closer to people's homes in their communities? If we knew that percentage, it would bring greater clarity.

I thank the Deputy. With regard to transparency, we will always endeavour to do as much as possible. I hope the House appreciates that real efforts have been made. There are daily updates online, daily updates on the tracker app and the Oireachtas gets a daily update. In my ten years in the Dáil, I do not remember ever getting a daily update from Government on anything. While we all want more information and I accept that, I hope the House appreciates that real efforts have been made and continue to be made in terms of transparency.

When it comes to forecasts of delivery, I reiterate what I said earlier. The forecast deliveries change all the time. They changed at least three times in the last week, for example, and AstraZeneca in the last seven days has changed its forecast to us three times. If we put out these forecasts and they get changed on a Monday, then get changed on a Thursday and then get changed on a Saturday, there is a real concern that people will say this programme is not under control when, in fact, all it would be is one company which, very frustratingly, has not been delivering accordingly. We want to make sure we get the balance and that we do not cause undue concern.

If we look, for example, at the coverage this week, something very simple happened. One figure went out for a forecast for administered vaccines but because of AstraZeneca not delivering, that was reduced, not by a lot but it was reduced by a bit. There was widespread coverage that the system was in trouble and certain Members of this House were on the media, giving out about it, attacking the HSE and attacking the Government. That was with one number for one forecast for one week. We have to try to get the balance right in terms of information that we know is going to change, and change regularly. We do not want to cause undue anxiety and we certainly do not want to erode confidence in the system.

With regard to the question of more centres, the situation in the Helix was absolutely phenomenal to see. It was incredible. It was like walking into a room of raw, undistilled hope. Certainly, if the right thing to do is to have more of them, we can certainly do that.

With regard to NIAC and the over-70s, that is being kept under review. Obviously, I do not want to pre-empt what it may say.

I thank the Minister, his staff, all of the HSE personnel and the GPs who are working very hard in rolling out the vaccine. There are two issues I want to raise. Although it is a bit down the road from being delivered, the first issue concerns those in category 4, for example, patients on dialysis and people on chemotherapy treatment, who were brought from category 7 to category 4. I want to know which facilities will be used for the roll-out of the vaccines for them. There is a lot of confusion. The GPs do not know, the hospitals do not know and the clinics they are attending do not know. It is important that clarification is provided as soon as possible.

The second issue is in regard to Johnson & Johnson. It is very likely that it will receive approval on Thursday of next week, 11 March. What is the time period in which the Johnson & Johnson vaccine will be made available in Ireland? What is the level or number of doses that will be made available? It is a single-dose vaccine and would really reduce the workload. I ask that we get clarification on that.

On cohort 4, the really good news, which I have just announced today, is that for cohort 4, which is people with underlying conditions who are deemed to be at very high risk of serious illness or fatality, that is going to start next week. The details are still being worked out and I ask the House to bear with us on that. The NIAC recommendation happened very recently and from the moment it was made the HSE has been working through its clinical programmes, through its consultant teams and through its GP networks to identify these groups. These are groups and subgroups of patients all over the country, with quite a wide variety of complex conditions. As to exactly where they will be vaccinated, the current thinking is that it will probably be a combination of hospital settings, where that is appropriate, and GP settings, where that is appropriate. The details are being worked through at the moment.

In terms of Janssen, I share the Deputy’s hope that it will be approved. We have seen what happened in the United States. I very much hope the dates the Deputy has given turn out to be correct. The task force is in very regular communication with Janssen. We have tentative dates but they are so tentative that I do not believe it would be useful to give them out right now. The thinking is that it would not be in March. We would be looking, as soon as that vaccine becomes available, at getting it into the country and into people's arms. As the Deputy said, it has the great advantage of being a single shot vaccine.