Covid-19 Vaccination Programme (Health): Statements

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

I welcome the opportunity to discuss with colleagues in Dáil Éireann this morning the progress of the vaccine programme. Covid-19 has presented Ireland and countries around the world with our biggest public health challenge in living memory. In recent months, more transmissible variants have driven up infections, and governments right across Europe are extending restrictions. As we are all aware, daily numbers of new cases in Ireland remain stubbornly high. Last Sunday, 769 new cases were reported in the country.

It must feel to many like this pandemic will never end. Many people are understandably frustrated at what can seem like a largely unchanging landscape. Pandemics end, however, and this pandemic will end too. Its end is firmly in sight thanks to the remarkable triumph of science and medicine, which have produced hugely effective vaccines very quickly.

Our biggest weapon against Covid-19 is our vaccination programme. More than 700,000 vaccines have now been administered. People right across Ireland, from Achill Island to Mizen Head, from Tory Island to Cape Clear Island, have been vaccinated. Many more will be vaccinated today.

The stories from GP clinics around the country have been uplifting. Dr. Mait Ó Faoláin described how the GP-led vaccination clinic at The Helix in Dublin vaccinated more people in one day than there were Covid-19 cases nationally over the previous week. I heard another GP describe the sense of collective mission and history being made. I believe he spoke for many when he expressed the deep satisfaction felt by so many directly involved at finally taking the fight to Covid-19 after what he described as a year of defensive skirmishes. That GP, Dr. Stephen Murphy, described what we are now witnessing as a kind of D-Day for GPs. These personal stories are filled with hope. There will be more of these stories in the coming weeks and months as our supply of vaccines increases.

We are using three highly effective vaccines and expect to have received in excess of 1 million doses by the end of March in just six days’ time. Next month, we are due to begin to receive deliveries of a fourth vaccine, made by Janssen. More than one in eight adults has now received a vaccine in Ireland. We now have clear and strong evidence that the vaccines are having a big effect in keeping people safe from the effects of Covid-19. This is hugely encouraging.

Our nursing homes were among the most vulnerable settings for this virus. Nursing home residents and staff were the first to be vaccinated in Ireland. Serial testing for Covid-19 in nursing homes is now showing a positivity rate of less than 0.2%. In late January, 11% of Covid-19 cases were detected in nursing home outbreaks. By mid-March, that had fallen from 11% to less than 1%. That is a big drop and it is bringing comfort and relief to nursing home residents, their families and, of course, everyone working throughout the country in the nursing home and long-term residential care sectors. Now, in-person visits to nursing homes are restarting. Many families will be wondering when they can hug a loved one in a nursing home or hold their loves one’s hand without worrying about putting them at risk. By reducing transmission in the community and ensuring widespread vaccination, that will become a reality again.

Good progress is also being made vaccinating older people. We are moving through the age cohorts. The first group was those aged 85 and older. We then moved on to those aged 80 to 84 and have now started vaccinating those aged 75 and older. Here again, the results are really positive. The number of cases of Covid-19 among those aged 85 and older has fallen by nearly a half over the past two weeks alone. Our Covid-19 vaccination programme is also having a spectacular impact on hospitalisations of older people. In January, 11% of people hospitalised with Covid-19 were residents in long-term residential care. That has now fallen from 11% to just half of 1%. Given this really encouraging data, it is no surprise that public support for vaccines in Ireland is very high.

In April, we are due to receive approximately a million vaccine doses. That will be approximately the same amount received up to the end of this month. In May, and then again in June, we are also due to receive around a million vaccines a month. As always, this is dependent on the pharmaceutical companies delivering to the agreed amounts. If they do, then four in every five adults can be offered either one or two vaccine doses by the end of June.

I want to finish by addressing the current situation with Covid-19 cases, something we are all watching very closely. It must be said that huge progress has been made since January. Ireland now has one of the lowest rates of Covid-19 cases in Europe. As we all know, cases are still high and have been rising in recent days. We are seeing a big fall in cases associated with the vaccinated cohorts. That big fall, unfortunately, is being offset by an increase in cases associated with increased mobility and increased interactions. I thank colleagues right across the Dáil for their ongoing efforts in engaging with people in their communities and nationally by encouraging them to stick with the public health measures.

While vaccines will facilitate our exit from these tough public health measures as more of the population is vaccinated, we are now also making other interventions. Enhanced measures are being introduced today at specific locations to help monitor and suppress the spread of Covid-19 in areas that are showing case levels which are persistently high. Measures include deployment of HSE mobile units with walk-in testing, that is, self-referral for testing, Community Call supports, and engagement with local communities by our public health teams. We are using antigen or rapid testing in the healthcare and meat processing sectors, and pilot projects will soon be launched to examine opportunities for rapid testing in other sectors as well.

We are introducing mandatory hotel quarantine for people travelling from what are regarded as high-risk zones. We are the first country in the European Union to introduce such a comprehensive system, and it builds on extensive measures already in place.

These include fines and-or prosecution for non-essential travel, pre-flight PCR test requirements, mandatory home quarantine and genome sequencing of positive tests from category two countries. Work is ongoing around a new campaign, delivered in co-operation with employers and trade unions, on compliance with the work safely protocol.

This will be the largest vaccination programme in the history of the State. Huge progress has been made in a short time. The vaccination programme is less than three months in operation and we are vaccinating people as quickly as possible. I thank all of those involved for their hard work which has brought us to this point which will, in time, result in the full resumption of our normal lives.

The national vaccination programme is unprecedented in its scale and will grow to become the largest immunisation programme in the history of the State. It is less than three months since the first vaccination dose was administrated in Ireland. Already more than 680,000 people have received a first dose with more than 184,000 of our most vulnerable and at-risk, including some of those with a disability, now fully vaccinated against the disease receiving both a first and a second dose. Ireland continues to perform above the EU average with almost 5% of the adult population now being fully vaccinated.

The vaccination programme continues to progress and has reached the community as we continue to vaccinate our older citizens. The benefits of the vaccination programme are being experienced as Covid infection rates continue to fall among the groups targeted for vaccination.

In the context of disability services, this is all being done while the provision of services continues. I must stress how grateful we all are to the staff working on the front line, continuing to deliver services for people with disabilities and their families, day in, day out. There have been a total of 317 outbreaks of two or more cases in disability services since the onset of the pandemic, 149 of which occurred this year. This has been a significant challenge for service users and staff. Services have done their utmost to keep people safe. I am pleased to report that two thirds of the disability outbreaks in 2021 have now been declared as closed as of 20 March. However, 53 such outbreaks still remain open.

Tragically, the Health Protection Surveillance Centre, HPSC, has advised that we have lost 35 service users to Covid in these outbreaks. To lose a loved one is always painful. To lose one during the pandemic, where nobody can shake a hand or give a hug, compounds it. To those families who have lost loved ones, I pass on my sincere condolences.

The most frequently asked questions I get about the roll-out of the vaccination are for people with disabilities and their carers. As the Minister, Deputy Stephen Donnelly, will confirm, we have had a number of conversations in recent months about this. I have also had discussions with several officials in the Department of Health and the HSE to ensure we can provide clarity around when people with disabilities will be vaccinated. From the very beginning, the vaccination programme has been built on fairness. The focus has been on ensuring those who face the greatest risk of severe disease and death, the oldest and most vulnerable in society, as well as those who care for them, were prioritised for vaccines.

Last month, the vaccination allocation strategy was revised to take into account the latest clinical and medical advice based on national and international evidence. Those with a medical condition that puts them into a very high risk of severe disease and death are now being vaccinated in group four. I am delighted the HSE recently began vaccinating this vulnerable group. This provides people with disabilities further reassurance of where they align in the vaccination allocation strategy. It is good to see that 1,200 people with a disability living in residential care, aged over 65, have been fully vaccinated, while an additional 4,000 people in disability services were vaccinated up to the week of 13 March. It is important to note too that disability services staff who are front-line healthcare workers are scheduled for vaccination as part of the prioritised healthcare worker cohort.

Next Monday, the vaccination programme will be three months old. Truly remarkable progress has been made in such a short space of time. There is no doubt that there will continue to be challenges but the programme has already demonstrated its agility in responding to unpredictable changes in delivery schedules and changes to clinical evidence. The programme sets out from the start to protect our most vulnerable, along with the front-line healthcare workers who place themselves at great personal risk to care for them. The vaccines are proving to be more than effective and more than we could have hoped for.

We are entering into a critical phase in the fight against Covid. This is the phase in which we can fight back and win. It is the phase in which we can give people hope that, over the next number of months if we start to get things right, we can see the easing of restrictions as we move into the third quarter.

For that to happen, however, the State has to get its part right. The contract we made with people was that they would abide by tough restrictions. They have been doing so for some time. The State then would step up its responsibilities and make sure it would get right what is under its control. In areas such as test and trace, travel and quarantine, as well as the vaccine roll-out, we fell short in the first quarter, however. To have any chance of winning the battle against Covid - the Minister said the same in his opening statement - in the next quarter we have to get all of those basics right.

What is the number of vaccines which will have been received by the State and administered by the end of March?

I acknowledge the Deputy's comments on this being the start of a period of hope. We all obviously have a job to do here. However, I think we would speak as one in looking to the coming quarter as one of hope as vaccines roll out, cases are reduced and as we can begin to have the conversation we all want to have about returning to normality.

In terms of test and trace, travel and vaccines, we will obviously just have to disagree or agree to disagree. The testing and tracing programme is very comprehensive. We have one of the highest capacities and compare very favourably. Our international border measures are now the most comprehensive in the European Union.

As with any vaccine programme in the world, of course there have been things that we need to learn and do better. The vaccine programme I think has gone well. In terms of the numbers, we are expecting significant deliveries in the next five days or so. We do not really want to get caught up in whether it is the last week of March or the first week of April. The contracted deliveries are for the end of March. We would expect to receive in excess of 1.1 million doses.

The target then obviously is to administer those doses as they come in. Approximately 95% of vaccines are administered within seven days. For April, May and June, the delivery schedules are such that we would expect to receive in excess of one million vaccines per month.

The 1.1 million doses are short of what we were expecting. Obviously that is down to the shortfall in the AstraZeneca vaccines. Will the Minister give us a guarantee that the shortfall, which comes to several hundred thousand doses and is quite significant, will be made up in the second quarter?

If everything comes in within the next five days as contracted, the shortfall would be fewer than 100,000 doses. Obviously, we want everything that has been committed to, as we have discussed on several occasions. AstraZeneca has not to date lived up on that. The shortfall will involve, rather than 1.2 million doses, 1.1 million doses or thereabouts. It is meaningful and it does matter. We are engaged closely and we fully expect to AstraZeneca to make good on its full deliveries.

The projection we were given some months ago was 1.4 million doses.

It was reduced to 1.2 million and then to 1.1 million. That is a bit more than a 100,000 shortfall. Will the vaccine doses that were previously committed to and were part of the advance purchase agreements and which did not arrive in the first quarter of this year be made up in the second quarter or will there be a continued shortfall as we move into the second quarter?

We want all of the deliveries from AstraZeneca as were originally committed. As we are all aware, there are very intensive discussions going on at an EU level with the European Council and the Commission. As of right now, AstraZeneca has not committed to the European Commission that it will fulfil its original obligations. Obviously, we are not happy with this and the Commission is not happy with it. We are continuing to push hard for as much vaccine supply as possible because that is what the Irish people deserve.

The bottom line is that it is down to the relationship between the European Commission and AstraZeneca but that shortfall will not be made up. That is what I am hearing. We are not going to get the vaccines that were committed to by AstraZeneca, which is deeply frustrating and deeply disappointing.

People want to know that the Minister can get what is under his remit right. I have two questions about that remit. The Minister spoke earlier about testing and tracing and said we can agree to disagree. I have never believed we got it fully right because testing and tracing has to be used to hunt down the virus and stay ahead of it. Many public health experts have written in our national newspapers and pointed out the same issue I have raised time and again. We simply do not have the capacity. We need thousands of contact tracers if we want to do the deep retrospective contact tracing that needs to be done. Last November the Minister and his Government committed to deep retrospective tracing to get to the source of infections and outbreaks, looking back over nine days and not 48 hours. Has that happened? Is it going to happen? How robustly is that going to happen? As we sit here today, how many contact tracers are employed in the HSE? How many of them are doing the type of deep retrospective contact tracing that is necessary?

Regarding the vaccine roll-out, will the Minister give us an assurance on it today? Of course it is good news that 1 million doses are coming in the second quarter, but as the administration of vaccines ratchets up, people will want to know the Minister can get the roll-out and the administration side right. Do we have the staff to make that happen?

To clarify, we will receive 1 million doses per month. Over the second quarter it would be approximately 3 million doses rather than 1 million, which is very positive.

The answer to the Deputy's question is "Yes" and it is exactly the question I have been putting to the HSE repeatedly. We are expecting a very high volume of vaccines to come in in the next number of days. We are not looking at an incremental increase in April; we are looking at a step-change in the number of people being vaccinated. As recently as yesterday I met with HSE management and we again went through this. I asked whether we are ready for a step-change in April to increase the GP clinics and vaccination centres significantly and the answer was "Yes". I fully expect that, come the first week of April, we will see the kind of increase we all want.

As regards testing and tracing-----

Are we out of time?

My colleague is coming in now.

I can revert to the Deputy on the other matters he raised.

I am sure many Deputies were contacted by a lecturer in Irish studies in the University of Liverpool during the week. I felt like writing back to him because anyone who wants to understand the inequalities in Irish healthcare would feel the lack of a proper system such as a national health service has been highlighted in the vaccine roll-out. I understand that pandemics highlight inequality. People who are housebound due to ill health have been contacting my office in Tralee as they have not received a vaccine. Their daughters have been contacting us and their GPs. The GPs told them to go to the HSE, and the HSE said to go to the National Ambulance Service. That roll-out has not worked out well for them.

If people are aligned to a large GP practice, they are top of the queue, but if they live in a rural area or are attached to a small practice, it has been suggested they buddy up with another practice. That is okay for organising a school tour to Fota Island but it is not good enough for getting a vaccine rolled out in a fair way. GPs feel the system was not managed. There was no system for pairing or buddying up, there was no guidance and there was nobody available to listen to them when they needed it most. Desperate patients contacting us is not good enough. The supply chain has not worked well enough. There is too much confusion, and when there were problems in the supply chain, the flaws in the Government's roll-out were exposed badly. What has the Government learned from the initial stage of the roll-out? What steps have been taken to ensure a smoother roll-out? What steps are being taken to ensure there is communication with patients and members of the public when they go to access the vaccine into the future?

The vision of reopening has to be apparent to people. The communication must be there so people can be motivated to keep going with all the restrictions.

I have three questions for the Minister. First, following on from Deputy Cullinane's question, how many doses is the Minister expecting to arrive next week and the week after from the three companies that are giving us vaccines? Will he give me the figures on how many vaccines will arrive from the three different companies next week, which is the last week in March, and in the first week of April?

I am more than happy to get the Deputy a note on that. What I can tell him is that by the end of March, which is in the next five days, we expect to have received in excess of 1.1 million doses. However, I must heavily caveat that statement because the delivery schedules move regularly. The Deputy and I have had this conversation a few times. A large number of vaccines due to come in on 30 March, for example, might come in on 1 or 2 April. Rather than getting too focused on individual days or weeks, which has caused a lot of anxiety for people as they have seen those dates move, we are trying to keep the discussion at a higher level, like what is coming in in March or what is coming in in April.

I have been down this road with the Minister multiple times and I respect the fact these things change. I have no issue with that and I know the Minister does not control the deliveries. However, I do find it extraordinary that he cannot stand up in the Dáil and say today how many doses he expects next week and the week after. That is the reason I did not ask way in advance. It is extraordinary. He is the Minister for Health. He should at least know how many doses are expected next week. Those figures should be in front of him. Getting me a note is kind of irrelevant.

Denmark has said it is going to have everyone over 50 years of age vaccinated by the end of May and it has a plan it is rolling out for then. It has a similar population and is of a similar size to Ireland. Why can we not do what Denmark is doing?

As to the Deputy's first point, we do have detailed numbers for every single day for each company. I will ask for a note to be provided but I just wanted to caveat it by saying the provision of that kind of information has caused real anxiety for the public. We obviously know what is expected to the day but these dates get moved around at very short notice.

With regard to the number of people we should be able to vaccinate, countries are saying different things. We will see what happens in Denmark, in Ireland and everywhere else. The date we have been looking to is June. If the vaccines come in as agreed, it will be possible to offer either one dose or both doses of a vaccine to four in every five adults in the country, whether under the age of 50 or over the age of 50, by the end of June. That is a very positive message. As we move into April, June is not so far away.

The final issue I will raise is very irritating to me and to many others. "The Hard Shoulder" has run this story multiple times. What is going on with the recruitment of vaccinators? We are heading into a critical period.

We are now extending the deadline again. I have no clue why we cannot widen the criteria for vaccinators; I have no clue why we need birth and junior certificates or any of these things; I have no clue why professors, GPs, nurses or other retired specialists in healthcare cannot administer vaccines; and I have no clue why medical students who are nearing the end of their studies, together with a range of other people, cannot be recruited. We are not going to have enough vaccinators the way things are going, which would be criminal. Can the Minister please intervene in this matter to ensure that the ridiculous nature in which the recruitment is done can be addressed? Can he also address the range of recruiters we can get so that it is widened as soon as possible?

I thank the Deputy for that question. I have seen some of the same coverage and I was concerned at some of the things that I was hearing. I have chased much of it up with the HSE and much of what I heard turned out not to be the case. For example, not only can medical students be in our vaccination team, they already are. I met medical students in the Helix who were vaccinating. The position with retired people is the same. We have now trained in excess of 10,000 vaccinators and are continuing to grow that. I think we share the same objective. He can rest assured that it is my intention that the team of vaccinators, which is exactly the point that he is making, is as big as it can be.

We move back now to the Government slot in which there are three speakers and I call Deputy John McGuinness.

I compliment those on the front line of the vaccine roll-out who are doing an excellent job. There is no doubt that things are getting better but we started from a very low base. My concern is that the positivity that the Minister expresses as to where we are now and where we are going and the caveats therein cause significant confusion with the public because they are deeply concerned through the stories that they are hearing from their GPs, on the radio or in print media, that the vaccine is slow in its arrival. The Minister cannot ignore that. At a time when we were talking about vaccines and were asking America for the loan of vaccines because they had a stockpile, we were being told that that was not the case. The New York Times carried a banner headline on an article about the AstraZeneca vaccine that was stockpiled in the US. The Minister cannot deploy spin to beat the facts and the fact is that AstraZeneca has failed us, Europe has failed us to a degree, and we are not getting sufficient vaccine.

The Devil is in the detail. When we talk about the categories that are being vaccinated, we have to continue to remember that there should be a political input into this. I reject the statement made yesterday that if carers in the home get vaccinated they are taking it from somebody else. That is simply not true. We are asking that they be recognised properly and that they be given a place within the different categories which respects the work that they do and their position. That can be said also of the Garda, vulnerable teachers and so on, and we need to address it and to show political leadership by responding in a way to the change that is needed in the different sectors when a case is made. That is not asking for anyone to jump the queue.

In the same way we hear the argument about going back to places of worship. The fact of the matter is that ten people attending a funeral in a massive church is absolutely ridiculous and there is no common sense attached to the argument that there should only be ten people. These are the issues that people are watching, understanding and questioning. They want to know why there can only be ten people in a church but that there can be as many people in a store as one likes.

I ask the Minister to look at the carers and at the places of worship and to give consideration-----

The Deputy’s time is up. I call Deputy Moynihan.

I thank the Leas-Cheann Comhairle. We are at a critical stage. The challenges that have been with us over the past three months have been aggravating and the public mood is very concerned about this and the issues involved. We need to be very fair in our comment on this. Europe has been behind the curve on this and we, as a result, have been taking the flak.

When European Commission officials were looking for vaccines, were they considering the price rather than the supply and did they put price before supply?

I also note the joy of people when they receive vaccines, such as the elderly, the front-line staff, and so forth, but we also need to look at the carers. There has been much talk about the carers who are provide a significant service on behalf of the State and we need to ensure that they are looked at in so far as it is humanly possible.

Whatever the figures are for the roll-out of the vaccine in quarter 2, when we are here on 25 June 2021, the facts must stand up that we have achieved what is needed. Society is on the verge with mental health issues, frustration and anxiety after having dealt with this for 12 months. It is important that we ensure that everything coming from Europe and every commitment that is given is followed through.

It is crucial for the public to know the time it takes once the vaccine arrives in Ireland to be in somebody's arm. It is very important that a sense must be given that there is an efficient roll-out of the vaccine as fast as it is coming in.

Can the Minister address the European issue, vaccines availability in the second quarter and the timescale for vaccination?

The Minister has been left with 30 seconds to respond.

I thank the Deputy and I will revert to him in writing because we will run out of time. I fully share his position on this because we must get the most vaccines possible. By working through the European Commission we have been able to pre-purchase 18.5 million vaccines, which is very positive. However, I am very frustrated with AstraZeneca and particularly frustrated with the fact that it has reneged on some of its commitments in delivery to the European Commission while apparently-----

I call Deputy O’Dowd to speak now.

The battle against Covid-19 has been fought very successfully on the front line in our acute hospitals up and down the country. Facts have been brought to my attention and perhaps the Minister can contradict them if I have been given the wrong information. There will be 138 fewer new interns, that is, doctors working on the ground, than there were this time last year. That will have a significant adverse impact in fighting Covid-19 and, indeed, as the numbers increase in our hospitals, on other services that people cannot avail of now. Hospitals such Our Lady of Lourdes Hospital Drogheda, which I am particularly concerned about, could lose three or four intern places. Can the Minister address this question, please?

I welcome in the Minister’s statement, which nobody else acknowledged, the reference to the work that has been done in vaccinating elderly people in their homes and, indeed, in institutional care. The reduction in serious illness and deaths in our nursing homes is remarkable. Too many people have died in our nursing homes. There is major concern about homes such as Dealgan House. There is a need for an inquiry to establish exactly what happened there.

The programme for Government commits to a statutory scheme for home and community care under which people will have an entitlement to care in their homes rather than in institutions. People are going into institutions now because they do not have a choice in many cases. What advance has been made in the provision of statutory and high-quality home care that is well-regulated and well-paid?

I thank the Deputy for his comments. To update the House, the housebound vaccination programme commenced on 12 March. At the end of this week, 740 people will have been vaccinated. The first dose has been completed in Dublin city and county, the north east and the midlands, and vaccination has commenced in the south east and will continue there this week. In the coming weeks, the programme will expand to the west and south of the country. All first doses are expected to be administered throughout the country in early April. A lot of progress has been made on the statutory home care scheme and I will get a note to the Deputy. This year, 128 people will be recruited to do an assessment of need, which is the InterRAI single assessment tool for the roll-out. I will come back to the Deputy with a more substantial note on this.

Will the Minister sort out the issue of recruitment of vaccinators? There are huge problems and we are all getting complaints about it. The application form is 14 pages long. No phone number is available for people to ring to clarify any point. People are complaining about their details getting lost. They are also complaining that they are repeatedly being asked the same questions for the same information. It is hard to see why on earth there are these glitches in the recruitment process. Will the Minister sort them out? We cannot afford any more problems in this area.

The Minister undertook to provide a daily briefing to Members of the House. We got one yesterday but it was the first one we had received in eight days. What is the reason for this? Why has the Minister not been able to live up to the commitment he gave to provide a daily briefing?

I want to ask about the delivery of the vaccines to this country. I have asked the Minister repeatedly to provide data on a daily basis about vaccines in and vaccines out. We should have this information per day. The Minister will not do this. He has said he will provide it on a weekly basis but it has not yet been provided on the data hub. When will the Minister do this? Will he reconsider providing the information on a daily basis so there is absolute transparency about this?

The Taoiseach said the target for the number of vaccines to be administered by the end of March would be 1.25 million. This was then revised by Paul Reid who said it would be 1.1 million. I cannot see any way this target can be reached. In the first three weeks of the month of March, 680,000 vaccines were provided. There is a huge gap to be made up if we are to reach the target. Is there now a revised target for the month of March for vaccines administered?

My next question relates to the need for a revised forecast for the second and third quarters of the year. The only figures we have are those in the document The Path Ahead, which is very much outdated at this stage. Will the Minister provide a revised supply forecast for the second and third quarters of the year?

My next question is on those aged over 70. It was announced that vaccination of those aged over 75 would be started this week and people were delighted about it. I have come across a couple of instances where the day before, by chance, people aged between 75 and 77 discovered that only enough vaccine was delivered to the GP for those aged 78 and 79 to be vaccinated. Will the Minister be clearer about his messaging? He is raising people's hopes and then those hopes are dashed a few days later. Will the Minister clarify this? Why did he say those aged over 75 would be vaccinated? He needs to be much more careful about this.

I thank the Deputy for the various questions. On the recruitment of vaccinators, absolutely I will look into it. A lot of progress has been made. In excess of 10,000 vaccinators have been recruited and this is a lot of people. Rest assured, if there is duplication and too much complexity, I will take it up with the HSE immediately because this process has to be as easy and seamless as possible while, obviously, being safe and secure.

I did undertake to have daily briefings and they should be happening. I will speak to the team immediately about it. It is very important to me that there is as much information as possible out there.

I will take it up with the team straight away because the Deputy should be getting the briefings. I directed that there should be daily Oireachtas briefings and the Deputy should be getting them.

There is daily information on vaccines. I know the Deputy is speaking about supply and doses administered. What we have so far online on the data hub and on the tracker app is that the numbers of first and second doses are updated every day.

I am talking about what is delivered.

I appreciate the Deputy is also looking for information on deliveries. It is something I will certainly take up. What is most important for the Irish people is knowing just how many are being taken. I take the Deputy's point and we have discussed it here previously.

I apologise if I run out of time in answering the Deputy's questions, and if I do, I will revert to her. With regard to the end of March, can we be clear that my target and our target is to get the vaccines out as soon as they come in? This target is being met on an ongoing basis. The Deputy is absolutely right. The initial projection was that we would have slightly in excess of 1.2 million vaccines in.

What is the current target?

Right now, what we can say is we expect in excess of 1.1 million vaccines to be delivered.

I thank the Minister.

May I add a quick caveat?

The number administered.

We are going to run out of time. The Minister might have a chance at the end to come back.

I will revert to the Deputy.

With regard to the vaccine priority list, the Minister has said medical conditions and the magnitude of the risk they pose will continue to be monitored and periodically reviewed. There is robust evidence for poor outcomes in Covid-19 in the presence of pre-existing heart failure. This is for hospitalised patients and patients in the community. I can send the references to the Minister. I understand the HSE's national heart programme has made submissions to the NIAC advisory group on cardiovascular patients. It believes they need to be placed in allocation group four. These are heart failure patients under 70 years of age and patients waiting in-house for cardiovascular surgery. The national heart programme believes an error has been made. Will the Minister seek a further review of the vaccine priority list given this error? When will this happen?

I thank the Deputy. Certainly NIAC undertook a rigorous assessment but no one has a monopoly on wisdom on these issues. If the Deputy would like to send me the technical information he has, I will, of course, make sure it is reviewed by the public health team and NIAC. If there are omissions, we should not be afraid of them and we should correct them if it turns out to be the case.

I thank the Minister. Is it the normal course of events that there are reviews? Are there ongoing reviews or scheduled dates for reviews? The Minister might come back to me on this.

The next issue I want to raise is the roll-out of vaccines to adults with intellectual disabilities and Down's syndrome, particularly adults with intellectual disabilities in residential care who have been shown to have worse Covid outcomes. Advocates and support groups in my county report that the roll-out is patchy. There seems to be a greater chance that people will be vaccinated if they are attending and back in day services. Separately, does the Minister know how many of the estimated 4,000 people with an intellectual disability in residential care have been vaccinated? The Minister of State, Deputy Rabbitte, mentioned 1,500 but I would like some clarification on this.

I thank the Deputy for the questions. A total of 1,200 people aged over 65 have been vaccinated. The 4,000 are residents of congregated settings or community homes who were vaccinated up to 13 March. We then paused it because of the issues with AstraZeneca. It has now recommenced and we have approximately 12,000 to do.

I ask the Minister to come back on whether the reviews are scheduled. I might contact the Minister of State, Deputy Butler, on one or two cases in my area with regard to the roll-out to people aged over 85 who are confined at home.

I thank the Deputy for his questions. I have set up a helpline, if we want to call it that, for Members of the Oireachtas and the Deputy should have those details. If there are individual issues on an ongoing or daily basis, I ask the Deputy to use this service.

The feedback we have got on it is very good and we want it to be as transparent and open as possible.

With regard to the NIAC review, NIAC keeps these under review on a rolling basis, so as new evidence emerges here in Ireland or internationally, it is linked in to an international network which reviews these on an ongoing basis.

I will take a minute to ask the Minister questions and he might respond. When will he get to a point, with the roll-out of the vaccine and the quantity of vaccines coming in, where he will be able to indicate to all cohorts when they will be vaccinated?

Second, when we see AstraZeneca hiding 29 million doses in an Italian warehouse, which were destined for the UK and had been manufactured in an unapproved plant in the Netherlands, have we reached a point where it will be impossible to work with AstraZeneca with regard to vaccine supply?

How much time have I to respond?

Just over a minute.

Thank you. The first question is an excellent one, namely, when can we tell everybody, broadly speaking, when they should be in line to receive the vaccinations. There are two pieces to this. First, there is a piece of work which we are finalising at the moment, which is about the cohorts and what the cohorts will be after the cohorts that have been agreed to date. Once we have that, we will be in a position to give an indicative timeline but with caveats, as always, given these timelines can change when the supplies change. We hope to be in a position to do that soon because we know it is really important for people, particularly as we are asking people to stick with these very difficult level 5 measures, that they get a sense of when it is going to be their turn.

On the second question, what I can say is that I am deeply frustrated with the situation in regard to AstraZeneca. There are very serious conversations going on at a national level, at an international level and at the European Commission. I want the European Commission and the member states, including Ireland, to be made whole and for us to get the amount of vaccine that has been committed to and contracted.

First, I want to acknowledge how positive it is that we are at the numbers we are at this week, and I thank the Minister for his work on that.

On foot of what Deputy Róisín Shortall said, will the Minister outline the number of vaccinators trained?

It is in excess of 10,000 and it may now be in excess of 11,000. I will get the Deputy an exact number.

That is fine. I thought it was in excess of 10,000. It will be great to get that information.

I want to highlight a couple of concerns that are being raised with me and, I have no doubt, with every other Deputy. I will give three examples. First, there is a single mother in my area with an immunocompromised child. The mother herself is young and fit but she cannot afford to become ill as she is the child's only carer. She does not know when she will be vaccinated. There is a couple caring for their young daughter with leukaemia. Their support system is gone because of Covid and they are now terrified of catching Covid and passing it on to their daughter. Of course, they too are young and healthy, so they are at the end of the queue in that sense. As carers, they will be prioritised but they do not know where, how and when. Finally, I have constituents with chronic fatigue syndrome who, if infected, are at severe risk of serious relapse. Their condition is not mentioned in the roll-out plan, even though it is classified as a neurological condition. Where can I get answers for those patients?

My bigger issue generally is about being able to get answers for my constituents without having to come in here and ask the Minister directly, or to badger him, his adviser or his private secretary. I cannot get a response from my CHO, and the HSE helpline refers me back to the vaccine roll-out plan. Any parliamentary question with the word “vaccine” in it seems to get a fairly generic response linking me back to the HSE website, so there is no point in me reading it out. I want to get answers for people, or at least answers that say, “We do not know yet, but...” Can the Minister please tell me where to get good answers?

We must move on. The Minister will have ten minutes at the end to reply to what has not been replied to now. I call Deputy Dillon.

I welcome this week's news that the vaccination centre for Mayo, at Breaffy outside Castlebar, is now up and running. I wish the centre manager, Frances Power, and her team every success as they ramp up to more than 2,500 vaccinations per day. It is very welcome news.

The members of the Garda Síochána have served our communities with the utmost distinction during the pandemic. Their unwavering commitment to public service deserves our thanks and we recognise their work involves duties that entail a high level of risk. I feel there is a genuine need to prioritise An Garda Síochána in the vaccine allocation strategy. I also wish to include the Defence Forces, who have done tremendous work in contact tracing and logistics, and will also play their part in the mandatory quarantine programme. I also want to highlight teachers, who have facilitated the reopening of our education sector. Their work involves a high level of interaction with students and they also should be prioritised in the vaccine strategy. I also make special reference to special education teachers and special needs assistants. We need them to be protected to ensure the education sector is protected.

One final area I want to highlight is that of maternity services. We have seen there is a serious need to reconsider and, in particular, increase the time allocated for birth partners and fathers to spend together with mothers after labour. We must end the current situation where fathers are not permitted to enter for scans, leaving pregnant women potentially receiving tragic news alone. This is an important step forward as we see many front-line workers and health staff have now been vaccinated. It is an important issue that I ask the Minister to address.

The Minister said earlier that the daily case numbers remain stubbornly high. Does he accept the correlation between the daily case numbers and hospitalisations, ICU admissions and even deaths is no longer what it once was because of the vaccination programme under way? Does he accept the vaccination programme has changed the risk matrix? Does he believe that, because of this, it is now possible to look at a more nuanced strategy for reopening, where we could look at it on a county or regional basis? No one is asking to go from national level 5 lockdown to complete openness but, because the risks have changed, can we not have more imagination and use what is actually in the plan, which allows for a regional or county level approach?

My final question is in regard to what the Danes are doing. They are going to be moving to something in May in regard to vaccinations but, in April, they will be opening outdoor dining, hairdressers and those types of services for people who have not just been vaccinated but also for those with proof of a negative test or those who have had Covid in the past.

I commend the Minister on coming into the House and taking questions every week, which is very much appreciated.

I thank the Deputy. There is a really interesting discussion that we are beginning to have around vaccine certificates or, as the Deputy said, not necessarily just that but it could also be negative PCR tests. We have seen very interesting pilots in Israel, for example, with open-air concerts available to people who can authenticate that they have been vaccinated. I know the Deputy will be well aware the EU is looking at so-called green certs, although, interestingly, the WHO, as of now, is not in favour of that because of the question around transmissibility versus protection. However, it is a very interesting question that we need to look further into.

To give a short answer on whether the risk profile is changing in terms of the link between the number of cases and the number of hospitalisations and fatalities, absolutely, it is. It is exactly what the national vaccination programme is doing. It is by vaccinating those most vulnerable that, essentially, for the same number of cases, what we will be expecting to see is significantly less illness, harm and death from that. That is exactly what we want so we can start having a very different conversation about people being able to return to more normal lives.

I appreciate that all the questions are important but the Minister is going to run out of time at the end anyway. He has a ten-minute slot at the end which will be reduced if we do not stick to the time. I call Deputy Cronin.

I put down several questions to the Department about vaccinations for several people aged over 70 in north Kildare. One has diabetes and COPD, and her spouse is recovering from lymphoma. They have been to their excellent GP practice, which tells them it too is in the dark, and does not know when they will get the vaccine. Also in north Kildare, there are people with complex illnesses, like advanced emphysema, being sent to their GP by their consultant, who tells them to go back to their consultant. None of them seems to know when they are going to be vaccinated. I had a similar call last night from a cancer patient in Celbridge who has been sent from the hospital to the GP, and the GP has told them to go back to the hospital.

Nobody is able to tell them when they are going to get the vaccine. I submitted a parliamentary question asking when people over 70 with chronic illnesses would be vaccinated and when their GPs would be informed of the plan and I got a one-line answer. This cannot be an Eircode lottery. I had to send that one-line response to several of my constituents last night, apologising to them and assuring them that I would be raising the matter with the Minister in the Dáil today. These people have worked all their lives. They cannot get answers from their doctors or their consultants about their vaccination. Many have been sheltering at home for over a year now and have been left hanging on.

Given the worrying case numbers, I urge the Minister to establish a forensic system of vaccine delivery. When it becomes clear that there will be doses left over, people who are next on the list should be on site to get the jab so that there will be none of this nonsense about vaccine doses going down the drain. We overbook planes and I do not see why we cannot overbook vaccinations. Everybody knows that the vaccinators are working to their limit and doing their best and people would not be upset if they had to come back the next day. After those who are next on the list, would the Minister consider spare vaccines for local carers, particularly parents of children with profound disabilities? These people are worn out. They have not been using day care centres because they are so worried about their children. They are terrified of getting Covid, even though they are fit and well, as they do not know who will look after their children if they die. Would the Minister consider creating a flying squad in each county to pick up those who are very susceptible to Covid but who do not have their own transport so that they can receive any spare vaccines, with a qualified person in charge of this at each vaccine centre?

I thank the Deputy for her questions and assure her that there are very strict protocols in place regarding spare vaccines such that the clinicians overbook to guard against exactly what the Deputy raised. We must use every single vaccine dose. The GPs, hospital teams or ambulance teams move down through the priority list. If GPs are vaccinating their 75 to 79 year old patients this week, for example, they might call in some patients in the 70 to 74 age group who may or may not end up being vaccinated on the day. That is the reserve list which is designed to address exactly the issue raised by Deputy Cronin.

I wish to start with the positive news in the Minister's statement regarding nursing homes. It lifts the country's heart to see the effect of the vaccine roll out in nursing homes. Covid-19 has had a terrible effect on people in the nursing home setting so the progress there is very welcome.

We are at a crucial stage in terms of the next quarter and the vaccine roll out. I wish to ask about what is happening in Europe, particularly in terms of the vaccine policy framework. A number of countries including France, Germany and Hungary are seeking additional vaccine supply from outside the sources that have been approved by the EU. They are looking to Russia, China and even Cuba for vaccines that have been developed and approved there. Has the Minister been approached by the Russian authorities in relation to the Sputnik V vaccine? Has he been approached by the Chinese authorities? Would the Minister engage with such authorities regarding vaccine roll out and will it be possible to provide additional capacity in the future?

Our priority is to maximise the availability of safe and effective vaccines for people in Ireland. I am sure the Deputy will agree that we should continue to look to the EMA as the regulator. The vaccines we use here must be deemed safe and effective, to the very highest standards, by the European regulator, as is the case with four vaccines. I can confirm that exactly the same approval process is now being gone through with the Sputnik vaccine. Of course, we are open to talking to everybody. Our only objective is to vaccinate people as quickly as possible with vaccines deemed safe and effective by our own regulators.

I will begin with a quote:

This is a massive missed opportunity to speed up and scale up the production of lifesaving vaccines worldwide, by waiving the intellectual property barriers that prevent more qualified manufacturers from joining the effort... It is unforgivable that while people are literally fighting for breath, rich country governments continue to block what could be a vital breakthrough in ending this pandemic for everyone in rich and poor countries alike.

These are the words of Oxfam's health policy manager, Ms Anna Marriott, on the failure of the WTO on 11 March to overrule the intellectual property rights of the big pharmaceutical companies and allow generic manufacture of Covid vaccines. Why did the Irish Government side with the pharmaceutical companies at the WTO? Does the Minister agree that our reliance on a handful of big pharmaceutical corporations has been a disaster for the people of Ireland, Europe and of the world's poorer nations and that the policy should change?

What we are seeing at the moment is, without a doubt, the most successful global collaboration between governments, pharmaceutical producers, science and medicine that the world has ever seen. For the Deputy to suggest that this is a failure is, quite frankly, preposterous. There is a very important discussion to be had, and policies to be developed, on global justice fairness and Ireland needs to play a leading role in that. I make no apologies for prioritising people living in Ireland but as we do that, we must also play our part globally. I wholeheartedly disagree with the suggestion that what has happened, whereby we now have four highly effective authorised vaccines for Ireland, with more coming, is a failure.

I have two questions, the first of which I asked the last time. How are the thresholds for decision-making changing in respect of restrictions that are imposed as the vaccine rolls out? We now have 13% of the population vaccinated, which means that two thirds of the risk of fatality is now removed, even in those over 80 and we are proceeding rapidly through the cohorts. However, I hear the same targets around the 14-day incidence rate, the R number and so on. I do not see any change in the thresholds. We need to have a more honest discussion about that and if we recognise that there are lower risks, when will we be able to have conversations with different sectors about how they can make small changes to make their sectors safer? We must engage people in a way that will get them on board with the challenge that faces the Government.

I thank Deputy Bruton for his questions. I share his view that as the vaccines take effect, the risk profile is fundamentally changing. As the risk profile changes, our analysis and evaluation of what is possible must change too. In fact, I am in the middle of a very detailed conversation with the modelling group, led by Professor Nolan, on exactly this issue. We know, for example, that 88% of Covid fatalities in Ireland to date have been among those aged 70 and over, rising to 93% for those aged 65 and over. There are different rates in terms of hospitalisation and serious illness but it is essential that changes to the risk profile because of the incredible impact of the vaccination are factored in. In other words, Ireland will be able to deal with a higher level of cases in a much safer way when we have vaccinated and highly protected the most vulnerable groups.

We have had a slow roll out of vaccines. We are now seeing increased cases among young children of school-going age. We have no vaccination for teachers or early childcare professionals. While we wait for them to be vaccinated, are there any plans to roll out antigen tests in school or childcare settings? We must do everything to protect these settings. These tests are cheap and can be another tool to combat this pandemic. Perhaps the Minister will come back to me on that.

With regard to information gathering, there is no database for vaccinations. Ireland has no national disease register or a national immunisation IT system. A vaccination portal has been live for healthcare workers to register for the vaccine. Is the Minister considering a roll out to the general public?

Carlow IT is the site for our vaccination centre, but it is not open at the moment. People from Carlow currently must go to Kilkenny to be vaccinated. Will the HSE or the Minister come back to me on this? I understand that it is supposed to be open in mid-April. Will the Minister come back to me with a date? People have contacted me about this.

I want to ask the Minister again about the carers. In the NHS just up the road in the North, a person in receipt of carers allowance can book a Covid vaccine online right now. In Germany family carers are on the priority list for a vaccine. Is there any update from the national immunisation advisory committee, NIAC, about vaccinations for carers? I am aware the Minister is working on this.

The HSE has set up an information line on the vaccination roll-out across the State, which is very welcome. It is really informative and gives us the information we are looking for.

I will be brief and will allow the rest of my time for the Minister to respond. Rapid antigen testing facilities have opened in Dublin and in Offaly today. For the past few months I have promoted the role of rapid antigen testing. I know why the centres have been opened in those two locations, but will the Minister clarify if he has any plans to promote this any further across the State?

There is a bit of confusion around where heart transplant patients lie in the vaccination cohorts. Will the Minister clarify under which category people on the heart transplant waiting list fall with regard to the vaccination roll-out?

Both of the Deputies asked about the rapid testing so I will answer that first. I believe there is a role for rapid testing but there are differently held views among experts on both sides of this. Some believe there is a very limited role for rapid testing, while others believe there is a very broad and useful role for it. I am in favour of rapid testing. There are risks, such as people believing they have a highly accurate negative test, but with rapid testing they do not. Serious concerns have also been expressed about how those people may then behave in social interactions. They would incorrectly believe that they have a negative result in the same way one would have from PCR testing. On the other side, however, rapid testing is very quick, it is easy and it is cost effective. If the right test is used in the right way, and when a person gets a positive result from it, the result can be very accurate, which is up to 99.9% accurate. I believe that rapid testing has a greater role to play.

The Deputies have asked what we are doing in this regard. I have established an expert group, led by Professor Mark Ferguson, to report back to me on that. The group has come up with some very interesting and thought provoking views. The Minister for Agriculture, Food and the Marine, Deputy Charlie McConalogue, and I have a large project happening in the meat processing plants. Rapid testing has been deployed into healthcare settings. We are looking at pilot programmes where other sectors and areas could use rapid testing, be they in the construction sector or other commercial and State sectors.

On the question of the heart transplant patients, I will ask NIAC for a view and the public health team for a detailed answer to that for the Deputy.

I thank both Deputies for their supportive words on the helpline and the enhanced local measures. As of 11 a.m. today, five new centres for walk-in testing have opened up. Four are in Dublin and one is in Offaly. I must clarify that this is not for rapid testing, it is for PCR testing and it is self-referral. We are starting with five areas for seven days and we can increase that if there is a strong demand for it. We are targeting areas with persistently high cases to try to encourage people in the local communities to get tested so we can really identify and get rid of this virus, especially in the areas where case numbers are very high.

I will absolutely take up the Deputy's point about the Carlow vaccination centre with the HSE. I am aware that more vaccination centres are now coming on line. Many of them have been tested and trialled with healthcare workers and others. As was said earlier in the debate, we said we expect to see a significant increase in testing very soon and the vaccination centres will play a very important part in that.

Has the Minister done a risk assessment for the provision of respite in instances where the residents in respite centres have been vaccinated, all of the staff have been vaccinated and those who seek respite have been vaccinated? How many non-front-line HSE staff, their relatives and friends have been vaccinated? Has the Minister done an investigation into it?

I welcome the walk-in test centres in Tullamore and those that have been set up in Dublin. Does the Minister understand how aggrieved the people in Belmullet in County Mayo feel when they hear this? They begged for a test centre that would prevent them having to travel a three-hour round trip to get a test when there were positive cases. People were dying and people were seriously ill, and the Minister would not give us a test centre in the north Mayo or Belmullet area. I ask the Minister to reflect on that and I ask that he would apologise to the people of north Mayo and Belmullet for the slow response to that.

I will read correspondence I received from an SNA in a primary school to the Minister. It reads:

Since we returned to school there has been none of the mass testing promised. We've been given a mask and told it is all perfectly safe. We've had an outbreak of Covid in our school since last week. I spent 2, 20 minute breaks sitting at a table with a staff member who tested positive for Covid one day later but, according to the HSE, I'm not a close contact... On Thursday a staff member in the unit presented with Covid symptoms and asked to be tested. [The] HSE told her, as she was not a close contact, she did not need testing. She organised a test privately and it came back positive so that unit was shut down.

The Minister for Education will not take any responsibility for what is happening within schools. We all want the schools to remain open. We desperately want them to remain open but I am asking for some honesty, some transparency and some action within the schools to keep the numbers down, to keep the schools open and to keep high-risk staff and students safe. Denial of the problems that exist is not going to deal with them.

I thank the Deputy for the question on respite. She might have missed my earlier contribution where I said that all of the over 65s in that cohort have been vaccinated. We have now moved into the cohort of under 65s right across disabilities, of whom 4,000 have been vaccinated. There is still a way to go on that. The risk assessment is being done on it but we have not got to the day services. As part of the formulation of it, this will be done in tandem so that we can have respite services up and running and more efficient.

I am sure the Deputy will appreciate that I have not got the detail on the specific case she mentioned, so I cannot respond to that. The safety of students and staff in our schools is of paramount importance. If the Deputy has a case that she is concerned about, then she must please come to me with that and we will have it looked into. If there are learnings to be had, and there are always learnings to be had, then I ask the Deputy to let me know. I will feed them into the system. We must have the best possible protections in place for our teachers and our students.

I welcome today's upbeat assessment. I certainly hope the Minister's expectations are delivered because there is a palpable change of mood in the country. That burst of hope that came with the news that vaccine roll-out was under way has evaporated. Despair, doubt and frustration have replaced it. With every passing day, patience and tolerance are fading. There have been problems, excuse after excuse and fingers pointing in all directions. As people hear about confusion and distrust, they become more swamped by despair. Their frustration grows. The public are very conscious that mass vaccination is the only route to personal freedom. The roll-out is sluggish and unreliable and what irritates people is the self-congratulatory comments of how well we are doing. The fact is that only 9% of our population have received the first vaccine and a mere 3% have received the second.

What criteria are used to determine priority? Seriously exposed and vulnerable citizens cannot comprehend why they are not prioritised. There is no logic or rationale as to why some groups are vaccinated and others are left behind. The HSE needs to be fair and just in its category calculations. How can it be fair to leave behind those who have undergone life-threatening bone marrow transplants? How can it be fair to leave behind people with cystic fibrosis, CF? How can it be fair to leave those afflicted with cancer wait? How can it be fair to leave those with advanced heart disease wait? I ask the Minister when this category of people expect to be vaccinated. Why has the Government resisted the use of rapid antigen testing for so long? Eight months have passed since I raised the need for such testing. It has been successfully deployed in the private sector. Why are we not using it in the public sector? Finally, can the Minister give a commitment today that, as previously stated, 250,000 people will be vaccinated per week starting next week?

The Minister has one minute to respond.

I cannot fully give the questions the time they deserve and need but the prioritisation is being done by very careful examination by the national immunisation advisory committee, NIAC, of the risk of severe illness, hospitalisation or death for those with underlying conditions. On CF, for example, Professor Butler said many people had expected a much greater link but that the good news from NIAC's perspective was that there was not as severe a link as it had expected. However, there is more information coming out in Ireland and across the world all the time and NIAC is constantly reviewing that. If the Deputy knows of people with specific conditions, please let me know and I will pass them on to NIAC and ask it to look at them.

A total of 480 people will get cancer today. Tragically, 24 people will die from cancer today. According to the experts, as a result of the cancellation and reduction in cancer treatments by the Government there will be an influx of massively advanced cancers. By any measure, that is an absolute disgrace. This week we hear that the Government will not resume cancer services fully until the end of 2021. How can the Minister stand over that? Will he reopen cancer services now?

I believe the management of this particular illness has been shocking. We have been locked down for nearly 190 days in this State. That is multiples of what other countries in Europe have experienced, many with similar mortality and morbidity rates. People across the country are massively frustrated. They are angry at the glacial rate of Government action. It has taken a year for mandatory quarantine to be introduced. People are shockingly frustrated about our vaccine roll-out compared with the North of Ireland.

People are being told that there is light at the end of the tunnel but that tunnel is getting longer and longer. Will the Minister tell the people the criteria for opening up this country? What cohorts of people, in his view, need to be vaccinated before we open up? What rate of hospital and ICU admissions do we need to get to for this country to be opened up? People are sick of being treated like children. We need to tell them the truth with regard to a pathway to opening up.

Like the Irish Council for Civil Liberties, I have real problems with the European talk of vaccine passports. Vaccine passports at European level would create a two-tier citizenship. Those with a vaccine passport will be entitled to freedoms and those without would be denied them. Given that so many people are being denied a vaccine, it would be a kick in the teeth to say to them that their freedoms will continuously be denied with the introduction of a vaccine passport.

I have two final questions. First, did the Taoiseach ask President Joe Biden for vaccines? Second, will the Minister clarify if people who have been vaccinated abroad will be quarantined when they come to Ireland as travellers?

The Minister should be mindful that he has a ten-minute slot at the end.

I thank the Acting Chairman. I thank the Deputy for his questions. With regard to the people arriving into the country from category 2 countries who have been vaccinated or who may have had Covid-19 in the past, the answer is "Yes". They will be subject to mandatory hotel quarantining. Everyone coming in has to have a negative PCR test, for example. They, too, will be subject to mandatory hotel quarantining.

I share the Deputy's passion and agitation around cancer treatment. It is a real issue but this is not the Government; this is Covid. The reality is that in Ireland and right across the board there has had to be an adjustment of services. We all know that. Much of the time it is because of infection prevention and control in the hospitals. I fully share the Deputy's passion and desire to get these services back. We have taken a few actions. In this year's budget, for the first time I have fully funded the national cancer strategy. The doctors, clinicians and oncologists I am talking to are very enthusiastic about what can be done in progressing cancer treatment in the country this year. The Deputy can rest assured that we will continue to do that in subsequent years. In addition, one of the areas the oncologists are very interested in is the allocation we have made this year of €50 million for new drugs. It is believed that approximately one third of that will be for oncology drugs so there is a lot going on. I fully share the Deputy's view that we have to get cancer services back open as quickly as possible for the reasons we all understand.

The Acting Chairman might remind me of the time available to me.

The Deputy has two and a half minutes.

I have been at a committee meeting so I apologise if I ask the Minister questions that have been asked. First, I raise the issue of the non-referral test centres. They are a very important step forward, particularly for those people in education about whom we all have many concerns. As of 11 o'clock this morning, any teacher, pupil or parent in our area who has a concern and needs to access a test can do so. That is a very welcome step for education, if not for the wider monitoring of the virus.

Second, I hope the five centres are the start of dealing with this virus. In my constituency, Whitehall-Artane, Ballymun and Finglas have some of the highest rates of infection in the country. The Minister might consider them for the location of an additional test centre when they become available. The two test centres we have are within a 5 km or 6 km distance but I imagine the Minister wants to catch as many cases as possible so I urge him to consider those areas with the highest numbers.

Third, April has been indicated as the month when the supply of vaccines will finally arrive. In terms of AstraZeneca particularly, can the Minister give the indicative dates and timelines the pharmaceutical companies have given him for delivery in April?

My final question concerns the continued desire to clarify the position of key workers. I refer to those driving buses, members of An Garda Síochána and family carers. I ask the Minister to update the House on that.

I will call the next speaker and give the Minister time to respond at the end.

I have three questions, the first of which is on long Covid. It has now been established that as many as 5% of people who contract Covid will suffer from long Covid. In Ireland, that represents more than 12,500 people.

More than 60 clinics have been established in the UK. What work has been done by the Department and the HSE on planning for the opening of clinics dealing with long Covid?

I published a Bill dealing with the regulation of homecare providers. What progress has been made in putting in a legislative structure for the regulation of homecare providers? With Covid, there will be a significant further move towards homecare.

The third issue, opening up regionally, was raised by Deputy Eoghan Murphy, but I do not think the Minister replied to it. The Cork-Kerry area has the lowest positive test rate in the country for Covid. Will we look at regional opening in our planning from 5 April onwards?

The public has put significant effort into the battle against Covid and has placed significant faith into the vaccination programme. The Minister and I both agree that we simply cannot disappoint these people. NPHET and the Government have significant decisions to make over the coming days but the reality is that the public needs to see the start of a pathway out of lockdown. At the end of the month, we will be 13 weeks into the current lockdown, and businesses need to know a start date, whether that is May, June or July. They certainly need some sort of signposting. We need to allow children back to play and practise sport or hobbies. They have lost out on the guts of a crucial year of their development and it is time to restart for them, especially as the evenings are getting longer.

As we approach the most important date in the Christian calendar, it is important that people of faith will be able to celebrate Easter in churches this year. The 5 km limit has outlived its usefulness and we need to look at allowing travel within counties. It is time for golf and other individual sports, such as fishing, to resume in a controlled environment, because all of these can be done in a controlled manner and people have proven sensible in the past. The retail and hospitality sectors need to see a roadmap. They need at least indicative start dates that they can work towards. They have lost staff, customers and suppliers. They will need to rebuild and cannot be restarted overnight. These are small steps but I feel that it is critical that, in the coming days, we give some indication of when activity can start to return.

I am pleased to see that the vaccination programme will ramp up in the second quarter. It is good to see that we have nailed down the supply for the next three months. These are potentially the three most important months in the modern history of this country. I thank the Minister for the work he has put in to this. If we can get these three months right, it will mark a turning point. As we look ahead to these three months and the implementation of the vaccination programme in earnest, it is also critical that next week sees the delivery of a message to the public that states that we are in this together and on a journey together. The public needs to see that pathway.

Deputy Burke asked about the regulation of homecare providers. The Deputy tabled a Bill last year. Much work is being done on that. I know that the Department has been in contact with the Deputy. We expect to meet the deadlines. It is important legislation. The Covid pandemic over the past 12 months has shone a spotlight on the care of the elderly in our country. I look forward to continuing to work with the Deputy on the regulation of homecare providers. We need certain standards that we can all aspire to. I thank the Deputy for his co-operation.

In response to Deputy McAuliffe, the news about the walk-in test centres is good. I echo the Deputy's message, which is for people living within 5 km of these centres to turn up and get PCR tests. It is only one measure. There is no silver bullet but it is an extra measure to target and find this virus. It is to support people, communities and geographic areas where people need this support so that we can find this virus, treat people, isolate the virus and get the case numbers back down. Regarding deliveries, we expect that by the end of this month, which will be in about five days, that we will have received in excess of 1.1 million vaccines, with 1 million in April, 1 million in May and 1 million in June. Those are the delivery schedules that we are working to. I share the Deputy's view that there are many key workers. We would love nothing more than to be able to vaccinate all of the worthy groups that have been referred to by many Deputies throughout this morning's debate.

I recognise Deputy Flaherty's point. I agree with the Deputy that what we are asking of people is really tough. People are exhausted. They have had enough. They need to know what the path out of this will be. We are asking people to stick with these measures, even though they are hard, for the time being to give the vaccination programme a bit more time and to get the most vulnerable protected so that we can begin this path back to normal living.

I have raised numerous questions from my constituents about Covid, as have Deputy Mattie McGrath and others, but we never receive a reply from the Minister's Department. I hope that the Minister will come back to me about the questions I ask today. I have done my best to raise the concerns of those who want to have the vaccine offered to them but I am not forgetting those who have said that they are worried or will not take the vaccine. They also need a voice and to be respected.

Besides the issues with supplies, Ireland's vaccination roll-out rumbles on at a snail's pace. Clinics and doctors all over west Cork have been trying to get vaccines for their patients. The Clonakilty medical centre was supposed to receive 210 vaccines last week. It received 85. These were supposed to be administered to people who are between 79 and 85 years old. Imagine the disappointment of these patients in Clonakilty and the surrounding areas at being told that they are getting the vaccine one minute, and then in the next minute that there is not enough supply. I was speaking to a doctor in Bantry, where only 40% of the promised vaccines are being received. This doctor said that if they received the correct number of vaccines, doctors and staff would work day and night to administer it. The doctor said that there are patients who desperately need it so that they can get back to some type of a life that they had before this hit. One patient went to that doctor last week. This lady had not left her home in more than a year. Take a minute to think about that and imagine not leaving one's home for a whole year. This roll-out is not good enough. This Government has to fulfil its promises to people in this country, vaccinate people who want to be vaccinated, get the country back up and running and stop playing with people's lives.

Why has the Government not applied for the EU emergency support funding? The gardaí have been at the front line in the pandemic but are at the back of the line to receive the vaccination. They have been in contact with me and have asked when they will be offered the vaccination. Student doctors in Cork University Hospital, Bon Secours and Bantry General Hospital are being told that their contracts will not be renewed, which means that we will lose many of these talented doctors. We are letting down our guard. The pandemic is nowhere near over. I ask the Minister to rescind this decision and renew these contracts. Hospitals such as Bantry General Hospital need these doctors. I would appreciate a written reply about that issue.

Does the Minister really believe that lockdowns are working? People are dying all over the country and are in pain because they cannot access medical treatment or mental health services. Teenagers are being kept at home from school. One described it as the most exhausting, lonely and sad time of their lives.

I would like the Minister to respond to Vera Twomey who has been seeking and deserves a meeting. The Minister promised a follow-up meeting which has not happened yet.

In Laois-Offaly, we almost have A Tale of Two Cities. County Laois is doing exceptionally well with a low incidence rate of Covid, while in County Offaly, there are reports of concern. We need to see the localised figures. It is not good enough just to give us figures for the county. We need to put it into context. We have had 331 cases in Offaly over 14 days, but that is out of 77,000 people. These figures being churned out create much fear and alarm. We need to give people the facts and the context. I am concerned and I know people are doing their best. Businesses are at breaking point where they have done their best to put every measure that they could in place to ensure the safety of all. The roll-out of the vaccine has been less than satisfactory. I have received a substantial volume of calls from people in Offaly who are concerned.

I am wondering if that is also a factor. Without pointing the finger at communities, perhaps the vaccine roll-out should be looked at, and how County Offaly is faring in comparison to other areas. I feel that we are faring much more poorly than many other counties and regions.

I was contacted again by a very concerned parent of an adult with CF. I have sent correspondence to the Minister's office on this issue. The adult in question has a number of other underlying conditions in addition to CF. The mother has corresponded with the HSE directly on this issue, as have I. The adult concerned has not yet received a date for his vaccination. I would appreciate it if the Minister would provide me with some information so that I can get back to my constituent.

The next point I wish to raise concerns cancer services. Professor Seamus O'Reilly stated this week that the closure of cancer services is causing untold damage to people. Can the cancer services not run during the restrictions? Professor O'Reilly, who is an oncologist, has pointed out that we are going to see very high death rates among cancer patients in the next decade. I call on the Minister and the Government to resume cancer services and do all they can for cancer patients and their families, who are going through a dreadful time. We need to focus on other health issues aside from Covid. We cannot let everything else go to wrack and ruin. Lives must not be lost unnecessarily. I ask the Minister to do more in respect of services for cancer patients.

The Minister and Minister of State will have ten minutes following the final speaker. I am conscious that the Minister and Minister of State may not have had the opportunity to respond to Deputy Colm Burke, who used less of his time than the other speakers in the slot. Perhaps they can respond to him in the ten minutes remaining. I call Deputy Catherine Connolly.

I welcome the opportunity to participate in this debate. Once again, I want to put this issue in perspective. Some 52% of Covid deaths, amounting to 4,628 of the total, have been registered since 1 January 2021. Of the 232,164 confirmed cases, 60% have been notified since 1 January 2021. More people have died and more cases have been confirmed in this phase of the pandemic, all of which were eminently foreseeable. I will not use up my time on this point because I raised it last week, but it is important to put it into perspective.

The Minister has given a statement, and I welcome him and believe he is taking the right approach by standing here and doing his best to answer questions. However, I am certainly not happy with those answers. The whole debate is phrased in terms of the vaccine roll-out, which I understand is the title of the topic at hand, but generally, vaccination is one part of an effective overall plan for dealing with Covid. I notice that the talk on the part of the Government is about vaccination now, not just today because that is the topic at hand, but generally. All our eggs are in one basket, which is totally unacceptable.

I will make a few general points in a moment. However, first I want to take issue with one or two points the Minister made in his statement. When he wants to quote GPs, there is an onus on him to get a broad variety of GPs for this purpose. I welcome the opinion of GPs who think the vaccine roll-out is a collective mission and that history is being made, it is D-Day and it is all marvellous. However, like many Deputies today, I can quote other GPs, in my case from Connemara. I have been told, for example, that the roll-out is totally inconsistent in Connemara. It is most unusual for doctors to contact me, so they are going out on a limb when they do so. One doctor told me: "Despite the Minister's assurances and his undoubted confidence in the information he is receiving, the fact remains that there are huge gaps in the amount of vaccines being rolled out." I know of GP practices with 500 patients aged over 70 that are only getting a small number of vaccines and other practices with fewer patients in that age group that are receiving more. I know of a case in the middle of February, where three out of four GP practices in an area three received a supply of vaccines and one got nothing. The GP in question spoke on the radio and was very vocal about the issue and has got any number of Pfizer vaccines since. He said this himself. He has now moved on to administering the vaccine to over 70 year olds.

There are huge inconsistencies, therefore, on the ground. I am not sure that we could expect any better, because the HSE was creaking before the pandemic and the public health system was in a mess. I want a debate some day in the Dáil on all of the important aspects of dealing with a pandemic. Last week I quoted Mr. Ryan, who said that we still had time to change in March last year. He reluctantly declared that there was a pandemic and stated that there are different aspects to this that we must deal with, namely, testing, tracing, isolation and treatment. To my absolute horror last week, I heard a very nice doctor from UCG talking about students who had caught Covid again. The entire conversation was about getting Covid a second time as opposed to testing, tracing and telling us how those students caught it in the first place. No question was put to this doctor on the national airwaves and no attempt was made by the doctor to explain the lack of tracing.

I am not sure if the Minister of State will have the opportunity to answer, but she told us that all those aged 85 would be vaccinated. Perhaps she could clarify by note whether that referred to the first or second dose of the vaccine. I also ask her to clarify how that relates to those who are housebound. I was contacted by a person at their wits' end who said that she is actually throwing things at the radio and the television when we are assured that everything is going well. She said that her 90-year-old mother is housebound and has not received any vaccination because the programme that the Minister of State said would be rolled out by the national ambulance service has not been rolled out yet.

Last week, the Minister stated that he would get back to me on the issue of call centres. Nobody has got back to me on call centres, the cost of them and how they will work. The people contacting me are at their wits' end.

I have 40 seconds left. At the outset I said that there is frustration at the constant chat about vaccination without any time being allocated to all the other aspects of the Covid pandemic. I am also tired of hearing Deputies calling on the Taoiseach to talk to AstraZeneca. It has utterly failed in its contractual duties. I have no idea how such a mess was made of that contract. Now we are going to appeal, as it were, to the bully who is stockpiling, as opposed to looking outside of the box and seeking to obtain vaccines on a non-profit basis in the future. We will face other variants and more epidemics. Why do we not look at the example of Cuba? It has a population of 9 million and seems to have a very low death rate. Have we talked to its government? I understand that five vaccines are in development there, one of which is to be rolled out in July on a non-profit basis. Are there other examples we can look at?

As we wrap up, I will speak on two different issues. One concerns the housebound individuals to whom Deputy Connolly referred. I will provide an update on how the roll-out is working for that cohort.

GP practices receive guidance from the HSE home vaccination programme for the over 70s who are housebound. They have the responsibility of referring eligible patients who require this service. We assumed that there would be approximately 1,500 people in this group, but 2,000 people aged over 70 have been referred for home vaccination.

The housebound vaccination programme started on 12 March, so it is now in its second week. By the end of this week, 740 people will have been vaccinated. Dose one of the vaccine has been administered to patients in Dublin city and county, the north-east and the midlands. Vaccination commenced in the south-east this week. In the next two weeks, the programme will expand to the west and south. All first doses are expected to be administered throughout the country in early April.

I will specify how the roll-out was determined. The roll-out of the programme is a significant logistical challenge. A decision was made that the national ambulance service would roll out the vaccines. There are dedicated regional teams in each area that are rolling out the vaccine. I wish to thank the service. This is a slower process than when a patient attends a clinic or a mass vaccination centre, because these people are very vulnerable and they are housebound. I have said it many times previously, but I want to emphasise that nobody will be left behind. We are getting through the first doses. To reiterate, 740 out of 2,000 people eligible will be vaccinated by the end of the week.

I want to move on to nursing homes. The prioritisation of those in nursing homes and long-term residential care facilities has proven to be the right approach, as those most at risk of a bad outcome or serious illness or death from Covid. I acknowledge Members have questioned how prioritisation is determined, but along with my colleagues, I fervently believe that prioritisation for those most at risk of Covid has to be based on clear medical and clinical guidelines. It can never be determined by politicians. As a result of a very successful roll-out of the vaccine in nursing homes, 99% of residents and more than 90% of staff have been vaccinated.

As a result, visitations resumed last Monday, 22 March, for people living in nursing homes, which was really welcome. Residents may now be facilitated to receive two visits per week on general compassionate grounds, commencing two weeks after their full vaccination. That is the norm in nursing homes. There is no requirement to limit visits to less than one hour. I want to state that categorically. The new provision is an increase from the current guidelines, under which one visit per resident was facilitated every two weeks.

In addition, it is not required that the same family members are listed to visit. For example, in the case of a family of six siblings and where the mum or dad is in a nursing home, it does not have to be the same two siblings who visit every week. The visitors can rotate. I am aware that some nursing homes are taking a cautious approach and saying that it must be the same two dedicated family members, but that is not the requirement. There is no obligation that it must be the same two family members making the weekly visits. I am asking all nursing homes to support and implement these new visitation guidelines, which are in line with existing public health guidance and advice. Vigilance in regard to general infection prevention measures must be maintained. The guidance will be kept under continuing review as new evidence and data emerge.

We have taken a cautious approach regarding nursing homes. The pandemic bore down really hard on them. A total of 88% of those who lost their lives from Covid were aged over 70 and more than half of all who died were in the nursing home sector. We must continue to take a cautious approach. As of today, there are 68 open outbreaks of Covid in nursing homes but they are not of the scale as was the case previously. A lot of the cases are now asymptomatic. I will end on a good note by pointing to how successful the vaccination programme in nursing homes and long-term residential care facilities has been. Last week, in round 9 of serial testing, of the 40,423 people who were tested, only 81 cases of Covid were detected, which is 0.2% of the total. That is really positive news for all those who have worked so hard in the sector for the past 12 months. I compliment everyone involved. There have been very difficult, traumatic and lonely days and it has been really tough on residents, families and staff. When we see how successful the vaccination programme has been in nursing homes, it shows there is light at the end of the tunnel.

If I may, I will use the time left to me to address some of the issues raised by Deputy Connolly.

Deputy Colm Burke raised a couple of issues and left ample time for a response, but the Minister ran out of time. He might respond to those points now.

I might revert to the Deputy in writing on those issues. Is he still in the Chamber?

I would appreciate an answer to my question about a review of lockdown arrangements regionally. The same point was raised by Deputy Eoghan Murphy but there was no reply on it. It is important that there be clarification in this regard.

I thank the Deputy. It is something that was part of the original plan. I prefer not to speculate on issues like that when there is a lot of thinking going at the moment in terms of what happens after 5 April. However, I take the Deputy's points very much on board.

Regarding the distribution of vaccines to GPs, I hope Deputy Connolly will not mind me referring to the GPs who have said positive things about it. There has been a lot of coverage of GPs who did not get the vaccines when they should have. Sometimes that was unavoidable because supply from the pharmaceutical companies did not come in, but sometimes, particularly in the initial few weeks, the system was not flawless. Improvements were needed and a lot of things have since been put in place. I would like to apologise to the Deputy because I committed two weeks ago to get answers for her on the call centre. She should have had those answers and we will chase them up for her. The GP model is working well. It is not flawless but we are hearing very positive things in terms of the call centre that has been put in place and the improvements to the supply. A week of notice is now given to GPs. There will always continue to be wrinkles for individual GPs as supply goes up and down and we manage what is a very complex logistical operation. We must always endeavour to get it as right as is possible and continue to learn.

Regarding people aged 85 and over, I can confirm to the Deputy that this cohort has now been very largely vaccinated. Within the three-week period we set, approximately 99% of that cohort was vaccinated by GPs. As the Minister of State said, the national ambulance service is engaged this week in a national programme of vaccinating those who are housebound.

Finally, Deputy Connolly, quite rightly, called for a wider debate. We debate the vaccines roll-out regularly in this House for the understandable reason that it is such an important part of our response to Covid. Within healthcare, there are, in essence, three things we are focusing on right now. The context is that huge progress has been made and we now have one of the lowest Covid rates in Europe. We have to protect that progress. As we know, cases have stalled. The question then is what we are doing to address that. As I said, there are three big areas of focus. The first is on targeting suppression of the virus in Ireland. Today, for example, we have opened five walk-in PCR testing centres. We are engaging locally with communities, as well as with unions and the employment sector, to look at work commutes and health and safety within the workplace to target cases associated with commutes to work. The second thing we are doing is further strengthening biosecurity at our borders to protect against variants. The latest measure this week is the launch of hotel quarantining. The third action, which has been the focus of today's debate, is that we are vaccinating as quickly as possible. We are fighting for every single vaccine we can get and we are ensuring that those vaccines are administered as quickly as they come into the country.

Sitting suspended at 11.57 a.m. and resumed at 12.01 p.m.