Vaccination Programme and Covid-19: Statements

I thank the Leas-Cheann Comhairle and colleagues for the opportunity to update the House on the Government's response to the roll-out of the national vaccination programme and to the ongoing Covid-19 pandemic.

On Tuesday, the Government announced a plan that we all hope will be a permanent path out of this pandemic. Because people to date have backed the level 5 measures advised by the National Public Health Emergency Team, NPHET, the public health doctors, Ireland now has one of the lowest Covid rates in Europe. While other countries, sadly, are imposing new lockdowns, in Ireland we are having a national conversation about a cautious, but steady, path out of the pandemic. The progress made in fighting Covid has been hard won by every person and household across the nation playing their part. We need to protect that progress and to protect the prospect of having what could be a really a good summer. For that to happen, the advice from NPHET is clear; as a nation, we need to keep the virus down for that bit longer. The analysis from NPHET shows that every week we can do this makes a difference. Every week we do this makes it possible to consider more and better options for the summer. Every week we do this gives time for enough people, particularly those most vulnerable to Covid, to be vaccinated. As the acting chief medical officer said this week, the next six to eight weeks are vital.

To that end, I thank colleagues across the House for their broad support of the measures announced this week. Many of our neighbours in Europe are suffering brutal resurgences of Covid-19. Some are experiencing a very real shortage of hospital beds, including critical care beds. I take this opportunity to ask colleagues across the political spectrum for their help in engaging with people to reinforce this important message. While the end may be in sight - we hope it is in sight - the Covid situation in Ireland is still highly volatile. It would take very little for another surge to happen here and so it is as important as ever, possibly even more important than ever, that we stick with the measures in place for that bit longer.

On a positive note, I was glad to note on Tuesday evening that the total number of confirmed Covid-19 cases in hospitals had dropped below 300, for the first time this year, to 290 . Our national vaccination programme is a huge achievement. It represents our best line of defence within our ongoing comprehensive public health programme. Our national vaccination programme will not replace our existing public health guidance in the short term, but it will allow us all to resume a sense of normality in the future.

Are copies of the Minister's speech available?

They are outside.

They are usually outside.

They were not there before I came in here. There is no point in them being put outside after the Minister has started.

They were put outside before I started. They were there before the session started.

To date, nearly one in six adults in Ireland have been vaccinated and we are prioritising the most vulnerable. Covid-19 infections in long-term care facilities, among healthcare workers and those aged 85 and over have fallen dramatically. We could not begin to fathom being in this position 12 months ago. Vaccination has prioritised those with underlying medical conditions that place them at very high or high risk of negative medical consequences, severe illness or death should they contract Covid-19.

On Tuesday, the Government approved an update to the Covid-19 vaccination allocation strategy. This strategy sets out the groups to be prioritised for vaccination to best achieve the vaccination programme objectives of preventing serious illness, hospitalisation and death. It is based on clinical, scientific and ethical frameworks and evidence produced by the national immunisation advisory committee, NIAC, and my Department. The evidence is unequivocal that risk of hospitalisation and death increases with age. A review conducted by NIAC found that the only occupation or sector showing a significant increase in risk from Covid is healthcare. The evidence from NIAC about the risk of severe outcomes based on age is clear and stark. Comparing someone aged 20-34 to someone aged 50-54, the 50-54-year-old is three times more likely to be hospitalised, ten times more likely to end up in intensive care and 15 times more likely to die from Covid. If we compare someone aged 20-34 to someone aged 60-64, which will be part of the first new age cohort, the 60-64-year-old is five times more likely to be hospitalised, more than 20 times more likely to end up in intensive care and more than 70 times more likely to die. Given the huge extra risk associated with age, the Government decided to accept NIAC and NPHET's recommendations. This approach will maximise the benefit of the vaccination programme, minimise serious illness and death, reduce Ireland's risk to Covid as quickly as possible and in so doing allow Ireland to open up as quickly as possible.

The vaccination programme has already had a big impact on reducing the high levels of hospitalisations due to Covid. The data show clearly the impact vaccinations are having. It is hugely encouraging. The available epidemiological data show a spectacular fall in the number of cases among those aged over 85, with experts expecting that downward trend to continue as we proceed with the vaccination of those aged 70 and over. As the volume of vaccinated people increases, the incidence of disease in our communities will fall.

One of the greatest successes of the programme to date is for those living in nursing homes. Our nursing homes were among the most vulnerable settings to this virus. In January, we averaged 38 outbreaks per week in nursing homes; in the last four weeks we averaged two per week. That is a huge drop. Nursing home residents and staff were the among the first to be vaccinated. Serial testing for Covid in nursing homes is now showing a positivity rate of less than 0.2%. Healthcare workers and people in long-term residential now make up 3% and 1%, respectively, of all confirmed cases. This compares with 16% and 15%, respectively, of all cases at the end of January. We have started to see the benefits of the vaccines for our family and friends. In making nursing homes safe again, visits resumed in many facilities from 22 March.

The new advice for those that are fully vaccinated will also provide additional relief to those who in many ways have been impacted most by this pandemic. Four safe and effective vaccines have now been approved for use in Ireland. Ireland has secured allocations for approximately 18 million doses of vaccines. The single-dose Janssen vaccine, recently approved by the European Medicines Agency, EMA, will be the fourth vaccine available for use in Ireland, making up 15% of total vaccine doses in April, May and June if, as always, deliveries arrive as scheduled. There will be further progress in the vaccine roll-out. Over the next three months, between April and the end of June we expect to receive over three times the number of vaccines we received over the first three months of the year.

We expect to receive an average of 1 million vaccines per month during this quarter, dependent, as always, on the ability of manufacturers to deliver consistent, ongoing supplies. We have a plan and we are making rapid progress towards the finish line. As we proceed, we will continue to pursue our core priorities, which are to protect our most vulnerable, enable the safe return to education and childcare and protect our health and social care services. The next few months can be transformative in our response to Covid-19.

I welcome this opportunity to update the House on the impact of Covid-19 on socially excluded groups and to outline the plans for administering the vaccine to those groups. Not everyone faces the same risk from Covid-19. From the outset of the pandemic, the Department of Health identified socially excluded groups living in congregated settings as having a heightened risk due to underlying health and social factors. The Health Protection Surveillance Centre, HPSC, provides weekly updates on outbreaks among socially excluded groups in congregated settings. Since the start of the third wave, there have been 355 such outbreaks, which represents less than 3% of all outbreaks in that period. There were 3,863 cases associated with the 355 outbreaks. The largest share of the outbreaks is among the Traveller community, members of which account for three quarters of all outbreaks, four fifths of all cases and nine out of ten hospitalisations. Regrettably, there have been eight deaths among Travellers associated with these outbreaks. This trend is reflected in the data for the past week, with 21 outbreaks and 112 associated cases among the Traveller population.

The incidence among other socially excluded groups is much less. In addiction services, there have been ten outbreaks involving 60 cases. In homeless services, there have been 24 outbreaks involving 163 cases. Among the Roma community, there have been 11 outbreaks and 72 cases. It is clear from the data that the impact of Covid-19 on homeless services and addiction services has been less than expected. This low incidence has been achieved by the actions of health and social care services in shielding the medically vulnerable homeless population. These services are saving lives, perhaps not in hospitals but by ensuring that people with underlying health conditions do not end up in intensive care in the first place.

The long-term strategy for protecting socially excluded groups, as well as other vulnerable people, is through vaccination. The Government has agreed a vaccination allocation strategy that provides the provisional sequencing for groups to be vaccinated based on clinical priorities and ethical values. Importantly, disadvantaged socio-demographic groups that are more likely to experience a higher burden of infection, and include individuals at highest risk of Covid-19 due to medical conditions, are prioritised in group 9. There are others within the socially excluded groups who will get a higher priority due to underlying health conditions and on the basis of living in long-term care facilities, such as long-term homeless accommodation. The numbers in these categories are small. For the homeless population, the total is approximately 700 individuals. It is critical that they are prioritised along with other high-risk groups.

There has been a lot of focus on age as a risk factor for Covid-19. We need to be cautious in how we apply this criterion to socially excluded groups, for the simple reason that they experience premature onset of illness - up to 20 years earlier - compared with the rest of the population. Furthermore, many of the people in these groups do not live to 60 or 65 years. We cannot be complacent about the on-paper prioritisation of socially excluded groups, because there may be unintended barriers to equal access to the vaccine. These barriers could include difficulties in attending designated vaccination centres, lack of contact with, and trust in, the health services, vaccine hesitancy due to a lack of information, and low levels of literacy or language barriers.

I am advocating a targeted campaign to reach vulnerable groups who otherwise may not have equal access to the Covid-19 vaccine. Advance preparation before vaccine roll-out is the key. Listening to, and engaging with, vulnerable groups is critical to building confidence in the vaccination programme. The HSE has already commenced its communications campaign with a series of webinars for service providers working with specific groups, namely, Travellers, members of the Roma community, migrants and residents in direct provision. The purpose of the webinars is threefold. They will provide information and guidance on the Covid-19 vaccination programme, including where to access trusted vaccine information, answer queries about the programme, and answer questions about the different vaccines that are available. While considering the vaccination allocation strategy for vulnerable groups, we must be aware that roll-out is contingent on the supply of vaccines into the country.

The Covid-19 crisis has brought into focus the health inequalities faced by socially excluded groups. It has demanded an intense and targeted public health response. Fortunately, there have been many secondary benefits from these measures in terms of easier access to services and the adoption of an inclusion health approach based on individual care plans, inter-agency working and an emphasis on long-term solutions, such as Housing First. I am determined that these benefits are captured within the health system and, to this end, the Department of Health has provided very significant additional resources to the HSE through its winter plan and service plan. I look forward to hearing the contributions of Deputies on these matters.

I am sharing time with Deputy Quinlivan. The Minister stated that he is looking for help from all Members of this House. He has got that help. We have come in here, week in and week out, offering solutions and putting forward ideas. We have asked people time and again to abide by the public health advice. We have discouraged unsafe activity and will do so again. People need help from the Minister and they need him and the Government to get it right. I have said repeatedly that when it comes to issues like test and trace, checks and controls at ports and airports, and the vaccination programme, people do not believe that the Minister and the Government are getting it right.

On the vaccine roll-out, we have discussed over the past number of weeks the problems on the supply side and the problem of some GPs not getting their vaccine allocations on time. Since we last discussed these issues, we have seen the disgraceful behaviour at the Beacon Hospital, where teachers in private schools got vaccinated and members of senior management in the VHI were offered vaccines. We saw what happened earlier at the Coombe hospital. In recent days, we have heard of problems with the IT system, with reports this morning of potential widespread abuse whereby people posing as front-line healthcare workers were able to get vaccinated. How in God's name is that being allowed to happen?

We have had a fundamental shift in the policy on vaccinations, without any consultation with people working on the front line. Those people include teachers, special needs assistants, SNAs, gardaí, and people working in the food sector, retail and many other sectors. Without any consultation whatsoever, they are now being told that the allocation groups they were in have been abandoned. It is shocking that there was no consultation with any of those groups. The message it screams at people is that this is a very shambolic and chaotic process. All of these problems are undermining confidence in the vaccination programme.

The Minister had the opportunity to set out his stall in his opening statement and I have set out my analysis of the situation. I have a number of questions and I ask that he answer them directly if he can. First, what is the number of doses expected to arrive in the State in the month of April? The Minister might answer that question now.

I acknowledge the support of Deputies. We all have a job to do and there is a very important role for Deputy Cullinane and others in holding the Government to account. I wanted to make the point in my opening statement that, across the board, there has been a largely supportive response and important work done by Deputies, both in opposition and in government. I wanted to acknowledge that.

I know the test and trace issue is not the question but the Deputy raised the matter. He has raised it most weeks that we have come in here and I have heard this party leader be critical of the test and trace system as well. I would be happy to meet the Deputy and his party leader because we have looked into this and compared our testing and tracing capacity and genome sequencing capacity-----

I will take the Minister up on that offer, but I ask him to stick to answering the questions. I have limited time and the clock is ticking. People want answers to the questions I am putting. The question I put was how many doses of the vaccines are due to arrive in the month of April. It is a straight question and I am looking for a simple answer to it. I will take the Minister up on the offer of meeting him with my party leader to discuss the test and trace system.

It is important for people to understand that Ireland compares favourably on testing and tracing. I will be delighted to sit down with the Deputy and listen to any specific concerns he has.

The question of forecasts is a debate or discussion we have every week. For April, May and June, according to expected deliveries, we expect in excess of an average of 1 million vaccines to arrive per month, ramping up from April through to June. As I have said before, I am reluctant to give specific forecasts on figures that we all know will change because when they change, as we know they do regularly, they cause anxiety.

My question is for the month of April. This is the third time I have asked. For the month of April, what is the anticipated delivery?

It is the same answer. Giving specific amounts that we know are going to change has caused much anxiety. We are expecting approximately 1 million doses in April. The expected supply is slightly less than 1 million doses to be received in April.

Unfortunately, we all get a front row seat at the Fianna Fáil and Fine Gael Party Parliamentary meetings. That is the nature of those parties' meetings. It was reported that the Minister and Taoiseach stated the figure would be 860,000. The Minister is now saying it will be 1 million. This is what confuses people. He then says the figures cannot be 100% accurate. People need to know exactly what the figure is or at least what the estimated figure is. If it changes, it changes and if it is down to pharmaceutical companies, it is down to pharmaceutical companies but people have a right to know the actual figure. Now we have different figures. The Minister just referred to a figure 1 million. It has been reported from Fianna Fáil Parliamentary Party meetings that the figure is 860,000. I will ask my question for a fourth time. What is the actual target figure that the Minister has been given by the HSE in respect of the anticipated number of vaccines that will arrive for the month of April?

With respect, I did answer the question. The answer is that slightly less than 1 million vaccines are expected in the country. The contribution the Deputy has just made, like the contribution one of his colleagues made on television last night, is exactly why giving forecast figures that we know are going to change causes anxiety. Last night on television, the Deputy's party colleague was outraged and gave all sorts of negative commentary about the national vaccine programme. This was because - as we could have guessed - the figure had changed. We are saying repeatedly that the figures we are being given by the pharmaceutical companies are changing. This happens sometimes daily and sometimes weekly. The debate the Deputy and I are having right now is exactly the issue. When we give accurate figures that we know will change and they then change, people jump up and down and say it is an outrage and undermines the programme.

With respect, it is not about jumping up and down. We accept that they are estimated figures and if they change, they change. However, when they are changing overnight and different figures are being given at different meetings in different settings for different reasons, it does not inspire confidence.

There is another question I want to put to the Minister now and he can answer it quickly. Was the Cabinet briefed in advance of the national immunisation advisory committee coming out with its changes in prioritisation and categorisation? Was the Cabinet briefed on that?

There are two and a half minutes left for Deputy Cullinane's colleague.

The Minister might answer that first.

A memorandum was brought to Cabinet. There was a discussion on the proposed approach at the Covid-19 Cabinet meeting the night before. There was a discussion the previous week at official level as well. However, the memorandum was brought on Tuesday and it was discussed in detail by the Cabinet. That was when members of Cabinet saw the memorandum and when it was discussed.

I will raise a number of questions in the short time I have. In answering my colleague's question on the 1 million doses for April or lack thereof, the Minister said the figure would be slightly less than that. Slightly less in this case means 140,000 fewer vaccines, a number that would probably vaccinate the whole of County Limerick. It is not, therefore, a minor reduction.

There is concern about the slow roll-out of the vaccination and the different figures being given out. The Minister has to accept some responsibility for that. According to the Irish Examiner, last night's Fianna Fáil Parliamentary Party meeting heard the figure for April would be 860,000. The Minister is now saying this morning - I hope he is correct - that 1 million plus vaccines will be given out.

I have specific questions on vaccination centres for my constituency. Is the Minister considering additional vaccination centres for Limerick city and county? The one we have is in County Clare, not in the city, and is quite difficult to get to for people who live in the county area.

I met the HSE on Friday and this is why I am asking the question. Is the Minister confident there will be a smooth implementation of the vaccines? Do we have enough qualified staff trained and ready to deliver the vaccine in increased numbers to ensure that when supplies arrive into the country they are administered to those who are waiting to receive them?

On the question with regard to the vaccination centre, while I take the Deputy's point on the geography, it was located there to try to facilitate the population of County Limerick. If there is a requirement for another centre, the Deputy may rest assured that we will put one in place. The HSE can keep that under review. This does not have to be the final set of where the vaccination centres go. It is also worth pointing out that the vast majority of general practitioners will continue to vaccinate in their clinics. Many of the pharmacies will also do so as we ramp up.

Leaders' Questions starts at 12 noon so I will have to stick to the rules on time. The Labour Party is next with Deputy Alan Kelly.

Last week, I asked the Minister how many vaccines would arrive in the last week in March and the first week of April. The Minister stated:

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.

I never received any note. What is the point in the Minister even coming to the Dáil? I wrote to the Minister that evening and reminded him to supply me with the note. I wrote to him again yesterday to remind him and, because of today, to give him another chance. That was ignored.

The Minister for Health reports to the Dáil. It is absolutely irrelevant and this whole charade is a waste of time if the Minister is not going to answer questions. What is the point in him saying he will be more than happy to give me a note when he never gives notes, despite being reminded? What the Minister said to the Deputy who spoke previously in respect of figures is rubbish. Transparency is the Minister's friend here. Giving out estimates is what he should be doing. Coming into the Dáil saying he does not want to give out figures is not acceptable.

The Taoiseach went further than the Minister yesterday. By the way, the Taoiseach is also writing me a note today in respect of the figures the previous speaker asked for. The Taoiseach can give the details to me but the Minister cannot give them to the Dáil. What the hell is going on here? The Minister is responsible to Dáil Éireann and the people of Ireland but he is refusing to give out estimated figures for vaccines for the next three months. The whole country is dependent on them. It is not acceptable.

This is not about having confidence in the Minister. This is about incompetence. This is not fair or right for the people working with the Minister who are watching this. The people are being let down. This is incompetence. It goes beyond politics. The Minister has to be accountable to the House. When he is asked questions about figures, he should give them as he knows them at this moment in time. I will not blame him if the figures change. We all know at this stage that the figures change.

I have three other points. The first is the change to the prioritisation.

NIAC made the recommendation and this is fair. I want to know what parameters changed that now say that age is the best way of doing this? What has changed from day one because the parameters do not seem to have changed but the recommendation has? That was my second question.

My third question relates to NPHET, which gave fairly startling figures yesterday on what would happen if our social contacts increase. I accept their figures and their maths. Have we any projections from NPHET based on the vaccines having come in over the next number of months? Are the figures it is giving us based upon the increase of the virus plus vaccines or minus vaccines? This is a critical question. Is NPHET taking into account the volume of people the Taoiseach has told us will be vaccinated, that is 80% of the people will have some vaccination by the end of June? Are these projections incorporating this information?

My final question relates to the Pfizer vaccine and the syringes that are being used. Many pharmacists have said that Zeringe syringes are being used in other jurisdictions which create a zero residual value. In other words, one can get more doses out of them. Why are we not using these syringes? Is the Minister aware of this? For instance, in Holland, the authorities are getting an extra dose, which would mean that hundreds of thousands more doses would be available. Has this been checked out and factored in and if so, why are we not using it? I thank the Leas-Cheann Comhairle.

The Minister has been left with 25 seconds to reply.

I thank the Deputy who has asked some very important questions and has made some accusations which obviously are his right to make-----

The Minister said that he-----

-----but he has only left me with ten seconds to respond. I can respond to all of these and in fact I have to hand the most detailed figures I can give him. I brought them in because I thought he might be looking for the figures but he has not, however, left me with any time to give them to him.

I asked him-----

With respect, Deputy, I brought the figures into give to the Deputy but he has not left me any time to give them to him. I will revert to him on that.

I gave the Minister plenty of time.

I need to keep to time. We are going to move on within what I have and Deputy Kelly is now taking time from other speakers. He can take any issues up later. I ask for co-operation as the Deputy is now eating into his colleagues' time and I move now to the Government speakers, of whom there are three and I will be sticking to the time allotted. I call Deputy Brendan Smith to speak, who has three minutes.

The Minister is taking us for fools here.

I thank the Leas-Cheann Comhairle. As we all know a swift, effective and fair vaccination programme is essential to deal with the pandemic which has unfortunately been with this for more than 12 months. It continues to cause untold hardship in so many ways right throughout this country and indeed the world. People I have spoken to over 80 years of age and other health front-line healthcare workers who have had the vaccine say that it has been transformative. It is heartening to speak to older people to see again the confidence that they have regained in themselves where they hope to get out and get back to a more normal type of life. We are all very glad to know of the very effective results of vaccines. That is clearly demonstrated by the dramatic reduction in infection rates in those groups which have had the vaccine. This is a clear proof of the value, efficacy and complete importance of getting the programme rolled out as soon as possible to all persons who are entitled to the vaccine.

The recent changes announced by the Government on Tuesday night to the vaccination allocation strategy is causing concern to many personnel providing front-line services. On different occasions in the Dáil and in representations to the Minister, Deputy Stephen Donnelly, I have raised the need to prioritise certain front-line workers within the vaccine programme. In those instances I have made representations on behalf of members of the Garda, teachers, special needs assistants and carers. The change to an age-based approach must be fully explained to the representative organisations of these front-line workers. Many of the people to whom I have spoken over the past 24 to 36 hours have put forward legitimate cases for prioritisation and they need answers. These personnel had expectations of getting the vaccine based on their prioritisation pertaining to their work being essential and oftentimes being based in crowded settings. I appeal to the Minister to outline why there has been a change in strategy. I know that it came from the national immunisation advisory committee but it needs to be clearly outlined why this is seen to be a more effective and fairer approach and one that will deal with the concerns of the community at large. I thank the Leas-Cheann Comhairle.

The Minister has 40 seconds to reply.

I thank the Leas-Cheann Comhairle and the Deputy for his question and statement. The answer is that NIAC looked very carefully at all of the evidence to date, including new information which it did not have when it came up with the original provisional prioritisation. As the Deputy will be aware, for example, NIAC have shown that if one compares the risk of death from Covid-19 for someone between the ages of 20 to 35 and between 60 to 64, the 60 to 64-year-old is more than 70 times more likely to die from Covid-19. Age is the single biggest predictor and the prioritisation from NIAC and NPHET has come to Government on the basis that this is how we minimise the damage of Covid-19 in the quickest time possible, saving as many lives as possible and allowing us to open the country as quickly as possible.

I call now Deputy Durkan.

How many minutes do I have, a Leas-Cheann Comhairle?

As the third speaker does not appear to be in the Chamber, there are five and a half minutes left.

I thank the Leas-Cheann Comhairle. I first acknowledge the work done by the front-line workers at all levels throughout the country in this long difficult battle. They have given everything and still have to give more because there is still time to travel with this virus and it is a challenging time. It appears to me that the crucial issue at this stage is the availability of vaccines, together with the practising of isolation, social distancing, hand hygiene etc. to the maximum extent possible. There are a couple of worrying factors. We all have people who have been in touch with us who can point out breaches in social distancing, in the meeting of groups and congregations, which are unnecessary other than for recreational purposes. I ask that instead of pointing fingers at one another that we encourage one another to observe the social distancing and everything that is deemed to be helpful in the fight against the virus and to, at the same time, ensure that the country can avail of extra doses of vaccine at short notice if it is needed. One thing that would be unhelpful at this stage is if it should transpire that a glitch in the system might cause further delay in the availability of vaccines.

Can the Minister have regard to the concerns of gardaí and teachers who have direct dealings with the public in different ways and to bear their concerns in mind with a view to taking specific steps, in the event of that being needed, in the shortest possible time? They have to do their jobs in any event and they will be called upon in various emergencies that will expose them to possible infection.

My last point is on the predictions. I am somewhat concerned about predictions as it can be both beneficial and negative. We have to give hope to people and the more that the Minister can say to generate that hope the better at this particular stage.

I call now Deputy Griffin.

I thank the Leas-Cheann Comhairle. While I was in the Chamber, for whatever reason her information had not been updated. Can I put to the Minister first and foremost-----

I did not have the Deputy's name on any list but that is fine and I am allowing him in to speak now.

I am sure that the Leas-Cheann Comhairle did not have the name but it had been given in by the Whip's office. I will try to put the questions and answers here to the Minister within the three minutes that I have.

What measures are in place to ensure that what happened at the Beacon Hospital does not happen again and can he give assurances that there will be protocols in place to ensure that anybody who is contacted at short notice is assured that everything is kosher? As a result of what happened at the Beacon Hospital, we could have a situation where people are afraid to take up offers because they are afraid that everything might not be legitimate?

Can I ask the Leas-Cheann Comhairle is the time that has been mentioned for the Deputy who has just spoken?

The time allocated is shown on the clock.

I have two further questions, so I ask the Minister to-----

That is no problem. What happened at the Beacon Hospital was completely unacceptable. These vaccines do not belong to the Beacon Hospital or, indeed, to any hospital; they belong to the Irish people. Very clear guidelines and protocols were and are in place and had been communicated and understood. I have written to the Beacon Hospital on the issue and asked for a full review, including any responses from the board. I have appointed a senior official from the HSE to go in immediately and assess the situation. As the Deputy will be aware, I have suspended vaccine operations at the Beacon. I share the sentiment that what happened was completely unacceptable and should not be happening anywhere.

As regards vaccinations at home for people who are housebound, I am finding it extremely difficult to get information on the roll-out of home vaccinations for people with serious medical conditions. I ask the Minister to update the House on that situation and to provide information to Deputies on it, even if that has to be done privately. There is a significant amount of concern on the issue.

I am more than happy to speak to the Deputy privately on the issue. The National Ambulance Service, NAS, has started providing this service. It is moving regionally through the country. In many cases, general practitioners, GPs, have identified their patients who cannot make it in to the GP clinics and the NAS is moving as quickly as possible to get to the homes of those people, support them and give them the vaccinations.

I refer to the change announced this week in terms of the roll-out. I too have been contacted by a significant number of people, particularly teachers and gardaí, who have serious concerns about the change. Rather than going the full hog and moving to the system that is now proposed, would it not be more advisable to first look at those high-risk categories and the older cohorts of individuals within those categories? If they cannot all be vaccinated now, will the Minister not look at the older and more vulnerable members of An Garda Síochána, teachers, etc.?

I thank the Deputy. Unfortunately, we must move on as the time is up. Each slot is for questions and answers. Deputies may choose how to use their time.

I welcome this opportunity to raise the issue of the vaccine roll-out. If we are to emerge from the pandemic in any sort of efficient or timely manner, we need to significantly increase the supply of vaccines. Sinn Féin has called on the Minister to raise the matter with the European Commission and to put pressure on it to be more proactive around approving other effective vaccines. Other countries are doing side deals while the Government sits on its hands. Germany has done a deal with Pfizer, as has Denmark. Austria has followed suit. Slovakia and Czechia have signed up for Sputnik V, the Russian vaccine. What actions is the Government taking to speed up the European Commission and the European Medicines Agency, EMA, in terms of the approval of other effective vaccines?

I wish to specifically raise the situation in respect of the elderly. All those over the age of 80 are supposed to have been vaccinated. I know of a 97-year-old woman in my constituency who has not yet been vaccinated. Another constituent of mine, a 95-year-old man, has not yet been vaccinated. We cannot get information as to when they will be vaccinated. This issue was raised by a previous speaker. Both of the constituents to whom I referred are housebound. My office telephoned the HSE helpline on this issue but we cannot obtain information on when these elderly people will be vaccinated. I cannot get an answer regarding the mobile vaccination service and the mobile vaccination unit in Laois-Offaly. Is there such a unit? All Deputies will agree there is no shortage of managers in the HSE. In fact, there are legions of them. Can one person be put in charge of the vaccine roll-out in each county or perhaps pairs of counties to try to deal with these problems? These are real issues. They were also raised by a Government Deputy. It is a real problem on the ground. I am telling the Minister sincerely that this must be dealt with. It is not acceptable that people who are approaching 100 years of age have not yet been vaccinated.

I refer to the announcement this week of changes to the vaccine roll-out. It shows that the Government has abandoned the plan it was pursuing as it has come to the conclusion that the plan is not fit for purpose. Key workers such as teachers, gardaí and taxi drivers have been downgraded. Taxi drivers who provide services for the HSE, whose situation I raised in the House several months ago, as well as special needs assistants, SNAs, who work in close proximity to others, childcare workers and essential retail workers, have not been vaccinated. In my constituency, there has been an outbreak at the Midlands Prison in Portlaoise. Prison officers need protection. They have to deal with conflict in the prison daily. They work in close quarters with no room to socially distance and they are in a very difficult situation. Some of them have raised this issue with me.

I refer to family carers and those who work in day services for the intellectually challenged and physically disabled. I have visited such services through the years and I am sure the Minister has too. We need to try to do something to get these services working and ensure they are safe.

In short, what I am saying is that we need a fair roll-out of the vaccine. I know the Minister does not have time to come back to me on the issue of the mobile unit and those aged over 90, but I ask that his office revert to my office with an email in that regard, today if possible, because it is a really important issue. It is a life-and-death issue. I know the Minister is aware of that. I ask that his office revert to me on it.

I agree that the vaccination programme has the potential to be transformative, but only if it operates properly. I do not have confidence that it will operate properly. For probably the sixth week in a row, I ask the Minister to publish a plan for the roll-out of the vaccines. I agree with the points made earlier by Deputies. One sometimes wonders what the point is of coming in here on a Thursday morning. I have lost track of the number of notes that have been promised. It is not possible for Opposition spokespersons to get answers to questions. The Minister does not provide the answers and there is no other way of getting them. The HSE does not provide such a service. The whole thing is very unsatisfactory.

My concern is that we do not have a published plan for how the vaccines will be rolled out at scale. The memory of the promises made in respect of testing and tracing is clear. That plan did not work out and there were many problems with it. The current seven-day average number of vaccines being administered daily is 18,000. When we get to the point in a few days' time of receiving nearly 1 million doses in April, we will have to increase the daily number of vaccines to 33,000 per day. That is nearly double the maximum that has been done up to now, on an average basis. If what the Taoiseach stated about the expected number of vaccines to be delivered is correct, when we get to June and July we will need the capacity to deliver and administer 50,000 vaccines per day. Today is 1 April and there is no plan. Pharmacists, for example, have no idea where they fit into the plan.

We know that CPL Healthcare had to extend the recruitment date because it has not recruited enough people. There are several problems relating to the long and convoluted application process that has been put in place. Why have they not been sorted out? Why are we still asking well-qualified doctors to produce their leaving certificate results? This is just ridiculous. The Minister has to cut through the red tape. Those with a medical qualification are registered with their professional body, so there should be no question of going back years to check out various aspects of their qualifications. Can the Minister cut through the red tape? I do not have confidence that we will have the capacity to deliver at scale in the coming months. The Minister needs to assure the House that we can have that confidence but he has provided no evidence whatsoever in that regard.

I refer to allegations of queue-skipping in terms of access to vaccines. We have already had stand-out examples of that at the Coombe hospital, the Beacon Hospital and with the VHI. These occurrences are so dispiriting for people. There are allegations about many healthcare workers within the HSE who are not front-facing, have clerical jobs and are working from home but are getting ahead of other people who should be getting the vaccine. Can we have an audit of who has received the vaccine within the health sector? I am not satisfied about that at all.

I refer to those with a serious underlying health condition, that is, those who are at high risk or very high risk. There are 160,000 people in the very high-risk category. Only 30,000 of them have received the vaccination to date.

How is the Minister going to identify the others? When is he going to develop a database that will ensure the roll-out will take place quickly over the next few weeks? The same questions apply, of course, in respect of people with underlying conditions who are at high risk.

My final point relates to the recategorisation and reprioritisation for the vaccination programme. I fully accept the evidence around these matters and decisions should be based on evidence. The evidence we have so far is that age is the single biggest predictor when it comes to severe outcomes but not when it comes to risk from exposure. That is the key difference. Has any study been done relating to exposure as opposed to severe outcomes to support the reprioritisation? I would appreciate it if the Minister would send me replies to those questions.

I have three or four brief questions to which I would appreciate responses. Given the alleged difficulties with the vaccination portal up to now, can the Minister clarify details about the veracity of the new portal? Will personal public service, PPS, numbers be used as identifiers? What legislation or statutory instrument will be required to address the problem with children's shoes? Will the Minister clarify when the change will be brought in? Will the Minister outline what contact he and his Department have had with community pharmacists to inform them of their upcoming role in the roll-out of the vaccine?

I also wish to inquire about people with underlying conditions who are aged 16 and under, including those with Down's syndrome. Has any consideration been given to those people and their parents, who are their primary carers, given that those parents are likely to be young enough? Has any consideration been given to them in terms of the roll-out of the vaccine?

I thank the Deputy for his questions. On children and vaccinations, there is ongoing work and clinical trials are being carried out. As Professor Butler said yesterday, the vaccines are not currently authorised for children but the clinical trials go on. If the EMA looks at the data and authorises the vaccines for children, NIAC and other agencies will consider whether it can be implemented here.

Pharmacists are going to play a key role in the vaccination programme, particularly in the coming months as we scale up. There is a deal in place with the Irish Pharmacy Union in terms of pharmacists vaccinating on their own premises and working in the vaccination centres. I would envisage pharmacists coming online more and more as capacity is ramped up as we move through the age cohorts. The sense is that on the underlying condition cohorts, that is, cohorts 4 and-----

Thank you, Minister. I know it is unsatisfactory, but the time is up.

The new vaccine allocation strategy announced on Tuesday evening has not been welcomed by many in our public sector. Those working in the education sector, An Garda Síochána and the Defence Forces were not expecting the news on Tuesday evening about the new strategy. I am not alone in finding it difficult to go from discussing workers in occupations essential to the functioning of society last week to a completely different allocation strategy. We debated the issue only seven days ago. There is anger among occupations working in high-risk situations and this needs to be sorted and addressed.

I am seeking information on what key performance indicators, KPIs, will be used to monitor our vaccination centres over the coming weeks and months. The Mayo centre is now up and running but updates will be needed, in time. I want to avoid using crude metrics which would result in counties being compared to neighbouring counties and discussions about who got the most vaccines. Some thought need to be given to KPIs and associated metrics that do not feed an us-versus-them approach to the roll-out of the vaccines. I will keep my contribution to those two points, the vaccine allocation and the KPIs for the vaccination centres.

How long have I got to reply? I have only 14 seconds. Perhaps I should revert to the Deputy in writing. He asked important questions and I cannot address them in 14 seconds.

I thank the Minister for being here. I will stress the case for Ireland to start looking seriously at the possibility of implementing a vaccination green certificate. It has been successfully trialled in other countries which are considering its use. In two months' time, we will be in a situation where a large percentage of our population will be inoculated for the Covid-19 virus and we should give serious thought to whether the green certificate system could be implemented in Ireland given that we are a leading country in the technology sector. The system has many benefits for the reopening of society and the economy.

I have listened with interest to discussions of the new vaccination portal. Will the PPS system be linked to the new portal? As I understand it, there has been much abuse of vaccines and people have been able to secure them when they should not have been. I would appreciate it if the Minister could answer that question for me.

How long do I have?

The Minister has just under a minute.

I thank the Deputy for his questions. The green certificate is an interesting idea and, as the Deputy will be aware, it is being formally progressed by the European Union. It might provide a pathway for travel between EU member states that do not have the various biosecurity measures in place for EU citizens who have a green certificate to verify their vaccination or, potentially, to verify a recent infection with Covid. We will be looking at that with interest. As the Deputy has raised previously, there are some potentially interesting options. Israel is exploring a few interesting domestic policies for those who are vaccinated. I will revert in writing and respond to the Deputy's question about the portal.

There is some good news to report on an issue I raised with the Minister in the recent past. The HSE has decided to have a vaccination centre in Drogheda, the largest town in the country, where I live. That is welcome and any support the Minister can give through his office to ensure the centre is staffed with enough vaccinators to vaccinate the population as the vaccines come through would be very welcome. Four premises have been looked at and a decision is imminent. It is important to say that to the Minister.

It is also important for the Minister to understand that the people to whom I speak understand he is not hiding vaccines from the public in his office or Department. As I understand it, every vaccine the Department gets is delivered as soon as possible. However, we are at the mercy of the European Union with regard to vaccine availability. Notwithstanding that, there is professional integrity to what the HSE is doing but there was no integrity in the actions of private hospitals and private schools. I get a stink from their actions. They are looking after each other in the old-fashioned way of 200 years ago. It is not acceptable. The Minister should come down on that hospital and the Minister for Education should come down on that school like a ton of bricks. It goes to the heart of our society. There was no equality or fairness in what happened.

There are two people in my constituency with serious illnesses and who are in the very high-risk category. One has an obesity of 45% and the other has type 1 diabetes and suffers from Addison's disease. Their doctor cannot get them a vaccination timetable because they do not have a hospital consultant. Will the Minister address that issues in his reply to me?

Since last summer, one of the things that has been repeated time and again has been that education is a priority for this Government. It is a priority for the Opposition as well. We have supported many of the measures that the Government has brought forward in the educational sector, albeit we would have liked to have seen an awful lot of them go further. At times, we listen to what the Government says and believe that there is priority for education.

There was a request for greater prioritisation to ensure that schools remain open. The decision to remove prioritisation for SNAs and teachers leads one to despair of whether, in truth, there is any real prioritisation. I do not know how the Minister can say that with a straight face. The decision that has been taken in recent days on the vaccination prioritisation has pulled the rug from under so many front-line workers. They are angry and frustrated. Commitments were made to front-line workers, not only teachers and SNAs but bus drivers, childcare workers and others who work in settings of high risk, who were at least acknowledged in the original prioritisation. It is profoundly wrong and it undermines the commitment that was given to them. That was the basis on which they agreed to re-enter service in schools and childcare facilities, despite the fact that they were more risky than other scenarios. While age is clearly an enormous determinant of risk, there is a significant difference in the risk between an accountant or clerical worker working from home in their 40s and an SNA, teacher, childcare worker or special education teacher who is working face-to-face with children and young people in a crowded setting. Relatively speaking, whether they are 22 or 42 the latter groups are clearly at a higher risk. It is profoundly wrong.

Much has been said about what is needed to get schools open and to keep them open because it is not just about getting them open. It is welcome that schools are back, as education is vitally important. I heard reports of what the Minister for Education, Deputy Foley, said and I hope that is not just for show. I hope it leads to pressure within the Government and that the Minister listens to his backbenchers who are asking for change. Let age be the primary consideration, but priority should be given to front-line workers in key categories to ensure that services remain in place. I hope the Minister will listen to us, those workers and anyone who is arguing for them. I also hope the Government is having a real discussion on this.

The final point I want to make is about confidence. We all want vaccination to succeed as we all want to get to a time when we can resume some kind of normality, but this business of people jumping queues, a lack of checks, and private schools connected to private hospitals being given priority is profoundly undermining confidence in the equality of everyone's entitlement on the basis of risk and the other considerations to get access to a vaccine and to healthcare, which is fundamentally what this is about. This is important. I do not want to see confidence in the process being undermined; I want to see it restored. These anomalies and people jumping queues and failing to ensure fair priority must be addressed if confidence is to be restored.

I am sharing time with Deputy Barry, with three minutes for me and three minutes for him.

I wish to touch on the positive aspects of the Minister's statement because we are all anxious for the programme to succeed and that is the imperative. The positive aspect to the vaccination programmes in nursing homes in particular is very important as there is a sense that we are getting on top of this.

My main question to the Minister relates to the recruitment of vaccinators. There are credible reports of doctors being asked for their junior certificate results to prove that they meet the criteria. To say the least, that is most disconcerting. The Minister said many times that in the second quarter there will be a mass roll-out of vaccines and vaccinators will be the foot soldiers in the process. It is very important to note that the criteria for vaccinators that are being recruited by CPL Healthcare, which I presume is well paid for its service, are quite ridiculous. In one case a trained midwife was asked to provide evidence of her BCG shot. That seems very bureaucratic and arduous. Does the Minister consider the criteria are fit for purpose? Does he have confidence in the recruitment process for vaccinators by CPL Healthcare? This is a critical juncture in regard to what will happen in the coming months.

There is no question but that the recruitment process needed to be streamlined. The HSE has looked at it and it has streamlined it. Issues are being raised which to all of us might seem very strange and superfluous to hiring vaccinators. I have looked into those issues for the very reasons the Deputy raises. Retired doctors are being asked for their leaving certificate results. That might seem utterly superfluous to us. How anyone did in their question on Shakespeare really does not matter in terms of vaccinating against Covid. The reason is that when we are hiring healthcare workers to perform tasks like this, criteria are set out in law that have to be met and one of those criteria is previous qualifications. Do the leaving certificate results matter? Obviously not. It is a requirement in law, so what we could do is look at changing the law, but as we would both agree, speed really matters here, so that is the reason for some of these things which do not make sense to any of us.

I do not know, but on the BCG shot, for example, I would imagine again that there are clear protocols that have to be gone through, in particular when one is hiring healthcare professionals to vaccinate people who could be quite vulnerable.

I have a question for the Minister about level 5, following the events last night in Blanchardstown. Four trucks arrived at the Blanchardstown shopping centre just after midnight. Debenhams workers had a tip-off that they were going to come to remove stock and they had to go there from their beds. There was a stand-off for five hours between the drivers of the trucks and the workers, who were women, shop stewards and some supporters. Twenty five gardaí arrived on the scene and after a five-hour stand-off they physically lifted people who were sitting on the ground and carried them to a place that was more than 100 m away from where the trucks were. I was one of the people that was physically removed. That paved the way for the trucks to move the disputed stock and the strike-breaking was carried out.

There are 11 such stores around the country and there is stock in the majority of the stores. There may be attempts to move the stock from those stores tonight, tomorrow, over the weekend or next week. This situation should not be happening. This should not be allowed in level 5: that strike-breakers are allowed to come in, hired by KPMG, to remove stock in an industrial dispute. I have asked the Taoiseach to make it very clear that this should not and cannot happen in level 5, but he has waffled and refused to answer the question. Therefore, I am asking the Minister for Health to answer the question and say that this is ruled out and that they should not be allowed to do this.

Vaccination should have been done on age, with healthcare workers, those with underlying conditions and those living in residential care being vaccinated at the same time. We should continue with the plan to do this on age and at the same time prioritise those on the front line. We all got letters from teachers about their concerns. Schools have been a priority for us and that is great to see, but I ask that we consider a priority list for gardaí, SNAs, childcare workers and those in essential retail. They are a priority. We told them they were a priority to us. That is so important. Communication is key, whether it is talking to the unions or to the various sectors. We must improve communications.

I also wish to ask the Minister about the database. Are there concerns or issues concerning the database? He might respond to me on that.

I wish again to raise family carers. The Minister is aware that is an issue I have been working on with carers. My mother is receiving her second vaccine today, which is brilliant. As a family, it is great for us to see that. All families love to know when family members are getting their vaccines, and that is certainly the case for me with my mother. However, my sister, who is her full-time carer, does not know when she will get her vaccination. These are issues we need to work on and I urge the Minister to consider it.

Could the Minister clarify the change to category 9 in the revised plan?

Under the old plan, this category referred to people living and working in crowded accommodation. Now the line reads, "People 16 to 64 living or working in crowded settings". Maybe the Minister could come back to me on that.

On 6 April, everyone in New York aged 16 or over will become eligible for a vaccine, something that will be repeated across the US. It has priority groups but is also going by age. Can we categorise by age and priority? That is essential.

I want to make a few points. I thank the Minister. The plan announced the other evening is not ambitious and lacks strategy. It is a case of live horse and get grass, things will be better and in about two years' time, we can all look forward to eating al fresco with two people per acre while it is raining.

On the vaccination side, there is still nobody in charge. Once there is plausible deniability, everybody gets blamed - NPHET, NIAC, the HSE and everybody else. There is not an ounce of common sense when one considers that front-line retail workers and gardaí have worked for the entirety of lockdown without a mention and some teachers are dealing with children who are not in a position to wear masks for health reasons. We have not even thought about them.

It is governance by optics and the view of NPHET. We have not had the ambition to look for a balance in operating society. I have said to the Taoiseach, and put in writing to the Minister, that we should examine and analyse hospitalisations at the moment. Senior consultants who are naturally afraid, in the colosseum that Ireland has become, to speak publicly for fear of being thrown under the bus for dissenting have pointed out to me that up to 60% of hospitalisations do not require high-flow oxygen in high-dependency units or ventilation in ICUs and could be dealt with in settings such as the facility at Citywest. That could be replicated in five or six locations throughout the country and ensure that our acute hospitals are not in danger.

The Cabinet is responsible to all the people of Ireland. We are responsible for a functioning society. We are not remotely showing any ambition to achieve that. I appeal to the Minister to consider some of the points I have continually made to him and the Taoiseach in writing and otherwise since last March.

I have a couple of points regarding Limerick. Will partners be able to be present at the birth of their children in maternity hospitals? This is a major issue. Staff in the hospital have been vaccinated. At this point it is a human rights issue. Another issue that is coming up repeatedly is students who require vaccines for their placements in the health and other sectors. What is happening there? What is being done to ramp up ambulance services to provide vaccines at home for people who are in a vulnerable category and are unable to go to their GPs?

One success story is that 95% of vaccines delivered are administered within seven days. What can the Minister do to give an assurance within the time available for a response that that will be maintained when we ramp up the number of vaccines we administer? Do we have the capacity for that?

Can the Minister outline his view on the concerns expressed by the Attorney General and businesses in respect of the introduction of quarantine for people travelling here from other EU countries? I know of a lady who is based in New Zealand and wants to come home. Her mother has passed away. She wants to come through Frankfurt. If the new quarantine rules are introduced, she will have to quarantine for 14 days on arrival in Ireland. That does not make sense when she is coming from a country like New Zealand.

Last week, I raised the issue of long Covid and did not receive a written response. Could I have a written response on the plan the Department and HSE intend to put in place to deal with this issue?

I refer to the Sláintecare report on elective hospitals for Cork, Galway and Dublin. The plan has been totally and utterly watered down. Covid has clearly illustrated that there are not adequate facilities to deal with a pandemic. A report was produced in Cork in 2015 which clearly set out the need for a new hospital. According to Sláintecare, a day care facility will be open six days a week 50 weeks a year from, I presume, 8 a.m. to 8 p.m. That is not good enough. It is not acceptable. I am looking for a detailed answer on the proposal for an elective hospital in Cork. The proposal from Sláintecare will not be accepted.

It will be difficult to get through all of the questions. Deputy MacSharry, who was screaming for zero Covid about five or six days ago is now screaming that we are not opening up quickly enough.

I was not, actually. Clearly, they do not speak common sense in Harvard, MIT-----

With regard to long Covid, it is something I can revert to Deputy Colm Burke on.

Read the emails-----

I am more than happy to engage with Deputy Colm Burke on that matter. The short answer is that I agree with his position that we need some resources for this. We need to work here and internationally to make sure that we have the best possible treatments in place.

Why not bring in NPHET-----

With regard to elective hospitals, I am more than happy to revert to Deputy Colm Burke and meet him to discuss the position. This is a crucial issue and I assure the Deputy that no decisions have been made in terms of the type of operations he has talked about at this point.

On a point of order, I did not speak for my entire two minutes.

I looked for time for the Minister to answer me within the two minutes. My questions have not been answered. I am entitled, as a parliamentarian, to use the time as allocated. The Acting Chairman should have allowed the Minister to answer my questions. My questions have not been answered. That is unfair.

It is only unfair if I do not ask the Minister to answer the questions.

I used my two minutes to enable the Minister to respond, but he has not done so.

It is only unfair if the Minister is not asked to respond. I am asking him to respond. Deputy Colm Burke asked the same question.

I was allocated two minutes and I am entitled to have my questions answered.

I am actually agreeing with the Deputy. Deputies O'Donnell and Colm Burke asked questions.

I thank the Acting Chair. I tried to address Deputy Colm Burke's questions. He may not have heard that over the wailing of Deputy MacSharry.

With regard to Deputy O'Donnell's questions, I fully agree that as soon as it is deemed safe by local clinical leads, we must have as much visitation in maternity hospitals as possible. I fully support his view that the phenomenal reduction in cases we have seen in healthcare settings should allow for that. I hope he agrees that we have to respect and back local clinical advice on that.

Deputy Colm Burke's questions-----

Will I keep going with Deputy O'Donnell's questions?

Deputy O'Donnell had two minutes. Deputy Colm Burke-----

I think I have addressed Deputy Colm Burke's questions.

I have two other quick questions to which I would like the Minister to respond.

The Government's decision to dramatically alter the vaccine roll-out overnight has caused an unforgivable amount of concern and anxiety for workers who last week were classed as essential or front line. I have spoken to teachers, gardaí, prison officers, retail workers and other essential front-line staff who are beyond angry over these changes. Has the Minister at least arranged to meet and speak with their representative bodies?

Members of our Defence Forces also need assurances and the Minister needs to be explicitly clear. Will all members of the Defence Forces due for deployment be vaccinated before they leave for overseas service? Assurance were given by the Minister for Defence a few short weeks ago that this would happen. Is that assurance now defunct or will it be honoured?

Some vaccination centres in my constituency, Longford-Westmeath, are a considerable distance outside town centres. I ask that an agreement be reached with all transport providers to ensure that those with mobility issues or who do not have access to transport can be facilitated. I have been told that a range of transport options are being examined. What are those options? When will a decision be made?

On the move to age-based qualifying criteria for vaccination, under this new approach, at what age group can we expect to see further easing of restrictions and reopening of services?

Will it be when all those over 70 years are vaccinated, or all those over 60 or 50 are vaccinated? Who will make that decision and when?

It has been agreed that any of the Defence Forces being deployed overseas are being vaccinated. That has been and remains the case.

I share the Deputy's view on those who are homebound. The national ambulance service is working very hard to ensure those who cannot make it to their GP, hospital or vaccination centre will be visited in their house. Our approach is that no one will be left behind. I share the Deputy's view on ensuring that.

It is not just those who are housebound but those with no transport.

If they are incapable of getting to a vaccination centre we will find ways of ensuring that everybody gets vaccinated.

On progress, the detail of the plan announced two days ago shows the various measures that open up from 12 April, 19 April and 26 April and the things that will be considered for May. I take the Deputy's point, and some European countries have said that certain things will be possible after specific age groups are vaccinated, but we are keeping the situation under close review particularly in light of the B.1.1.7 variant and the surges that are happening all over Europe now. The road map is broadly in line with vaccination down through the age groups and as we significantly reduce the risk profile more and more options become available to open up.

Deputy Shanahan is next. Is he looking for answers?

Yes, a couple. First, I thank the Government for following through on the proposition to build a second cath lab at University Hospital Waterford which was announced in recent days. I addressed this with the Taoiseach yesterday. I look forward to engaging with the Minister in coming months to ensure the recruitment of staff and to get the lab operational as soon as it is commissioned.

The vaccine roll-out is the most topical issue at the moment. The Minister mentioned Israel. We could also look at Denmark and Estonia as best in class for the vaccine roll-out. A key component has been the support of ICT systems in place in those countries. I do not think that anyone would argue with the fact that it is very deficient in this country in the area of integrated health ICT systems. This arose at the Covid committee in relation to test, trace and isolate. Once there were over 1,000 cases daily, we did not have the ICT back up. What is the Department doing to address this? Significant funds have been spent on private contracts but can the Minister update the House on what is being done? Many GP systems are not integrated with the HSE dashboards. This will cause problems as numbers of vaccinations ramp up.

The number of vaccinators was recently given as 8,500. Maybe more are registered now. How many hours dedicated time will they be able to give? Other Deputies have highlighted some of the interviewing requirements which are frankly laughable but there are public dentists who have not worked in the system for almost a year. Are they on the list? It should be mandatory to allow retired GPs on. I do not understand why they must be interviewed and similarly with pharmacists. We need to get them into the vaccination centres if we are going to roll out a million vaccinations a month.

Deputies have raised issues already with the vaccine portal. There are about 20% more PPS numbers in the country than the population. Surely, this allows fraudulent applications through the portal. Will the Minister comment on that?

The responsibility for vaccination is huge. The Minister's portfolio is wide, I think too wide for any one Minister. Has there been any consideration for appointing a single Minister to oversee the vaccination process, such as the Minister of State, Deputy Feighan, to allow the Minister to look at the other significant issues, not least the burgeoning waiting lists and access to services which are vast. Covid has over-taken everything but many patient cohorts face significant hardships.

I raised industry engagement with the Minister by NIAC and NPHET. I brought antigen testing to NPHET last May, the technology and the company that could do it, yet nearly a year later we are still talking about starting to roll it out. Other best in class countries are way ahead on this. I ask the Minister to look at it again.

Vitamin D has been spoken about in terms of antigen testing. It has been used throughout the world and is recommended yet we have made no attempt whatever to see about giving vitamin D as a prophylactic.

I wrote to the Construction Federation of Ireland on the use of antigen testing to open the sector. It says it has used it. Can we not implement it for schools, construction, tourism and hospitality? What have we learned from Covid-19 and how are we defending against Covid-20? It is only a matter of time before there is a repeat of this, in the view of the WHO, or there is a significant variant in the country which erodes vaccine efficacy. What are we putting in place? Will we put health surveillance on a firmer footing here?

I applaud what the Government has done around mandatory quarantine. I have sought this for some time, although it is problematic. What is the Government's plan regarding new variants?

Communications are key. This comes up time and again. The Government can keep the public on side as we roll it out but the road map must be clearly highlighted and communicated and weekly updates on all aspects of the vaccine roll-out protocol would help immeasurably.

I share the Deputy's enthusiasm and happiness at the progress on the second cath lab. The Minister of State, Deputy Butler, has worked very hard on that and I also recognise Deputy Shanahan's efforts. We had spoken during the last Dáil with local cardiologists. It has been a core focus and is in the programme for Government. It is very welcome for the people of Waterford.

It is clear we need a comprehensive ICT system for issues like this. The teams are using various different systems. They have linked them together as best they can. I met analysts and IT experts only yesterday to discuss putting a proposal together for a new system. That will probably not be used for our current response but we need to ensure we have something solid in place for the future. We will make progress on that.

I have appointed an expert group to examine rapid testing. I will launch its report later today. It will not surprise the Deputy that the report is supportive of more widespread rapid testing, as am I. We are putting those plans together now.

The next four speakers are sharing time. In about 12 minutes the Minister will have a little extra time, so if they do not get an answer to their questions they may wish to wait in the Chamber.

In no way do I underestimate the overwhelming task of the Minister and the challenge of rolling out our vaccine programme across the country. I appreciate that it is a difficult challenge and he is doing his upmost. My concern is for the vulnerable housebound and I am thinking of elderly people in my constituency. I am thinking of vulnerable people in their 90s who have not received their vaccine.

They are housebound and need call-outs from the ambulance service in order to get vaccinated. This has not been done in the cases I am talking about. I have contacted the individuals' GPs and they have made the referrals. I just want the Minister to give me a little feedback on the roadmap for the people in question who are waiting on their vaccine.

I thank the Deputy for the question. Those who are housebound are an absolute priority for us. We are talking about people who are very vulnerable and who, as the Deputy says, are often elderly. It is essential that they be protected as quickly as possible. The National Ambulance Service is working very hard to this end. It is moving through the country. The people the Deputy is talking about are being identified by their GPs and the data are being fed to the National Ambulance Service, which is contacting the relevant households, making arrangements and going to see the individuals in question.

I was talking to one of the National Ambulance Service managers the other day on this exact issue. I commend the service. One of the things the manager said to me in passing was that while the ambulance service staff go to the houses in question primarily to deliver the vaccines, they also spot issues and identify opportunities to make things a little better and connect the individuals with local health and social care services. I share the Deputy's view. It is essential that we vaccinate the cohort as quickly as possible. The National Ambulance Service is engaging as quickly as it can with the cohort.

I support the prioritisation of older people and those at higher risk. The CSO data have been showing for weeks that the risk to people with underlying health conditions is 44 times higher than it is for those in younger categories. For those in their 60s, the risk is 18 times higher. Therefore, the prioritisation is absolutely justified, but the arrangement should not have been sprung upon the people in the way it was. The evidence has been available for a long time and the way it was dealt with is unacceptable.

I would like to see more information. I ask the Minister to provide more on the additional risk associated with variant B117. Earlier, we heard on the radio from an individual in the UK that the hospitalisation rate is 50% higher and that the ICU admission rate is 100% higher but I have not seen these data come from Irish sources. If they did, they would help to explain some of the decisions being made. Can the Minister provide accurate numbers in respect of each of the categories now provided for? People crave a date but if they could see the accurate numbers, including the numbers for each week, they would get some idea of the progress. I refer, in particular, to the numbers in the very high-risk category and the next category of risk. Can the Minister illustrate how, in respect of those over 65 and those with underlying health conditions who have been vaccinated, our elimination of 92% of fatalities and 100% of the ICU risk has been factored into the decisions? I do not see any explanation of how the lower-risk profile is changing the way we will make decisions.

I propose to ask a few questions and also to use my two minutes to get some answers. While the proposed changes in the restrictions, such as the removal of the 5 km radius and the opening of construction, were widely discussed and in the public domain for some time, and while people recognise the arguments in each case, the idea of reprioritisation on an age basis did not feature. It appears to have come out of the blue for so many people, such as teachers and gardaí, who were not expecting the kind of change in question. How much background discussion went into the proposed change? What research informed the decision? It appears to have emerged late in the day. Why would that be? If the goalposts have moved, people want to be assured they will not be moving again. What is the possibility of that?

Antigen testing can offer an easing of restrictions in so many areas. It can show that people are Covid clear and it is fast. I had the opportunity to try it out myself yesterday. Many people, including opticians and staff in meat factories, are using it. To what extent is it proposed to roll it out? It really offers an opportunity to people to try to get back to some semblance of what was normal. How quickly could it be done, and how much research is being conducted?

I thank the Deputy for his questions. Antigen testing is a matter the Deputy and I have been discussing for some time. I am of the view that there is a greater role for it than we have seen to date. I appointed an expert group, led by Professor Mark Ferguson, to examine this issue. The group has reported back and I am publishing the report today. It is important to note that there are highly credible experts on both sides of the argument, some of whom are very strong supporters of rapid testing and others of whom have valid concerns about some of the risks associated with it. Nonetheless, having heard the various views, my view is that there is a greater role for it. I am launching the report today and I will be working with various Departments to support the ramping up of rapid testing.

With regard to the research on vaccinating according to age, NIAC conducted extensive research on both domestic and international evidence. We have seen a very strong link between the risk of Covid and age. It is also important to note there is a strong link with occupation. NIAC examined the data on clusters and outbreaks in Ireland and on the various sectors. The only sector found to have a significantly higher risk of severe illness or death from Covid was the healthcare sector. That really underlined the recommendations made, which NPHET brought to me earlier this week.

I thank the Minister. I want to speak up for and ask questions on behalf of the hundreds of teachers who have contacted my office over the past couple of days. They are looking for a greater explanation for the reasoning behind the change to the vaccine roll-out programme and their removal from the cohort of key workers. They have some very fair requests. Their main request is simple, namely that after all those with underlying health conditions are dealt with, they be included among the category 9 cohort of those working in crowded workplaces. It is quite clear that teachers right across Ireland are working in crowded workplaces. Their class sizes are among the highest in Europe. They are working in circumstances where social distancing is quite difficult. I refer in particular to special needs assistants who, because of the nature of their work and how they assist their students, will always require an element of close contact. All those who have contacted me are asking for — it is quite a fair request — is that they be considered to be in the bracket containing those working in crowded workplaces. They are looking for an explanation and answers. Can they be considered to be in the bracket? If not, why?

I thank the Deputy for his questions. The reason NIAC made its proposal, the reason NPHET endorsed it and the reason I brought it to the Cabinet and the Cabinet agreed to it was the very strong evidence that the single biggest predictor in terms of risk is age, particularly when, as we are aware, those with underlying conditions are already prioritised in cohorts 4 and 7, for example. The group we are now talking about comprises people who do not have underlying conditions. Let me give the Deputy and other colleagues a sense of how strong the link is. A person in his or her early 50s is three times more likely to be hospitalised, ten times more likely to end up in intensive care and 15 times more likely to die than someone in his or her 20s or 30s. A person in his or her early 60s, who will be part of the first group in terms of prioritisation, is five times more likely to be hospitalised, more than 20 times more likely to end up in intensive care and more than 70 times more likely to die than someone in his or her 20s or 30s. As I am sure all colleagues have been doing, I have been talking to essential workers and front-line workers, including teachers. I hear from every teacher and front-line worker I talk to about these figures that if I am telling them the people I am prioritising are 20, 40 or 70 times more likely to die than they are, they should be vaccinated first.

In many cases, they note that age cohort includes their mum or dad or aunt or uncle and then they ask us to vaccinate them first.

The final issue, which was raised by many Deputies, relates to the fact that classrooms are crowded, which we accept. NIAC looked at outbreaks in all sectors in Ireland to date. The only sector it found where there was a significantly higher risk of illness, hospitalisation or death for workers was healthcare and, therefore, that sector was prioritised.

If I could make one final point-----

Not at this point. I will give the Minister plenty of latitude at the end.

I am sharing time with Deputy Danny Healy-Rae.

I have raised numerous concerns in respect of health and Covid-19 and my questions over recent months, week in, week out, are never answered. To co-operate, I email the questions to the Department straight after raising them in the House in the expectation of an answer but, as of yet, I have never had an answer from the Minister. He might think it is fine to ignore the concerns of the people of west Cork but his party's candidates will suffer at the doorstep in the next election campaign due to his failure to respond to simple questions week after week.

Today I raise the concerns of members of the Garda, as I have done over recent weeks. They have been dropped down the list for vaccines. They have been working on the front line throughout the pandemic but are left at the back of the pack when it comes to vaccines. Will the Minister give a straight answer? When will members of the Garda who want to be vaccinated get their vaccines? In light of the changes to the roll-out that were announced earlier this week, when will teachers, SNAs and school secretaries, who work with large numbers of pupils in west Cork and throughout the country, be vaccinated? They cannot be dropped down the pecking order. They have to be prioritised.

I have raised grave concerns for housebound elderly people in Cork and Kerry, who number up to 2,000 in their 80s and 90s. Only 5% of these people have been vaccinated to date. The National Ambulance Service has been designated to roll out their vaccines but it is overstretched. Surely the local GP or even pharmacist should be allowed to call to their houses and administer vaccines. These people need to be respected and not forgotten. Will the Minister change the guidance regarding who can administer vaccines to these elderly people?

I would appreciate if the Minister could answer last week's question. Why did GP clinics in Clonakilty and Bantry that contacted me each get up to 200 fewer vaccine doses than it should have got? This was a cause for serious upset for the people of Clonakilty, Timoleague, Courtmacsherry, Barryroe, Rosscarbery, Ballinascarty, Kealkill, Durrus, Glengarriff and other such areas that were expecting to get vaccines. What I cannot understand is that Beacon Hospital in Dublin had 200 vaccine doses left over but in west Cork our GPs are getting 200 too few. What is wrong here? What is wrong with the roll-out? We have a very serious situation. Our tourism and hospitality sector is suffering severely because the roll-out of vaccines is not getting to the places it should.

There is one other issue I keep raising, on which the Minister keeps failing to give me an answer, relates to the endoscopy and physiotherapy units that were promised to the people of Bantry. Why has the Minister not delivered on that? Where are we in that regard?

I would appreciate a written reply to all my questions.

I will ask two questions and if I have time left over, I might follow up with a further contribution. When will vaccines be rolled out to elderly and vulnerable people living at home, such as a man in his late 70s in east Kerry who has had a leg amputated, as well as a stroke and several other health complications during his life? Carers are in and out of his home daily to try to keep him alive and at home. He needs the vaccine. When will vaccines be delivered to the people of Kerry who are confined to their homes?

Nurses and other people are coming back to work to administer vaccines but they cannot get clarity as to how much they will be paid. We need to pay them properly and look after them. They need clarity as to what they will get. Otherwise, we will be in trouble in regard to rolling out the vaccine.

I might make one point in response to the previous Deputy This is a question and answer session. He asked really important questions and I really want to engage with him and answer them but he has never once, in any week, given me time to answer him. If he makes statements in the House, I cannot answer him. If he wants written statements-----

Answer his questions, for God's sake.

-----there is the system we all use, which is parliamentary questions.

I have asked questions.

Can I take a bit more time to respond to Deputy Healy-Rae? What I am saying to him is-----

I did not ask the Minister.

-----I want to engage with him but he must leave time for me to respond to his questions.

The Minister may respond to Deputy Healy-Rae but I will take time from the Minister's final contribution. I have been quite generous in the time he has been given and we are up against the clock because of Leaders' Questions. I ask him to be conscious of that.

Thank you, Chairman. With regard to those who are homebound, it is an absolute priority. We are acutely aware of exactly the kinds of cases that Deputy Healy-Rae talked about. In many cases, people who are very vulnerable have not left their homes in a year. The National Ambulance Service is working very hard. It is moving through this cohort and GPs are identifying patients who were not able to make it to either the GP clinic or the vaccination centre, and the National Ambulance Service is going to their houses-----

When will it come to Kerry?

I will get the Deputy a note on the timing but the process is as I have outlined.

With regard to people being trained as vaccinators, if there are issues such as people not being able to get the information, the Deputy might let me know and I will act on it straight away. It is certainly the case that the hiring process appears to have been more burdensome initially. The HSE has moved to streamline it as much as possible but if there are specific issues, the Deputy might contact me directly.

May I ask a further question?

The Deputy may ask a question but the answer will not come until the very end.

The Minister made a promise to teachers and other front-line workers such as members of the Garda that they would get the vaccine in order that we could keep schools open and gardaí on the road. Will he follow up on that and ensure he adheres to the promises he made?

I am sharing time with Deputy Joan Collins.

I would like to establish the parameters of this question and answer session. What does it mean when the Minister says something in this House? If a Minister says something in a parliamentary democracy, we assume it to be true if words have meaning. To borrow a quote, it is a beautiful thing, the destruction of words. What does the Minister mean when he says that 80% of people will be offered a vaccine by the end of June? I ask because the Minister previously stated:

I assure the Deputy and other colleagues that with regard to penalties, religious services are non-penal in that there is no penalty attached to them ... I signed the regulations last night and I assure Deputies that it is a non-penal provision and it will remain thus.

What did that mean? If it means that somebody can be fined, what does what the Minister says in the House mean? Of course, we all make mistakes and we have the opportunity to correct the record of the House. If we say something untrue, we have the opportunity to correct if it we choose to, but if it is not untrue, what does what the Minister says mean? Doublethink is the power of holding two contradictory beliefs in one mind simultaneously and believing both of them to be true, for example, freedom is slavery, war is peace or the healthy are sick. I will allow the Minister to respond.

I am not entirely sure what the question is. If there is a specific question, I would very much like to answer it but at this point-----

The question is what words mean in this House. If they do not mean the truth, are they doublethink? If what the Minister says is untrue and he does not correct the record, we assume it is true and truth becomes untruth. How do we understand when he says, for example, that we will have vaccinated 80% of people by the end of June? How are we to understand if he says that no penal provisions are attaching to religious services, but fines are handed out for religious services and the State adopts a position in the High Court asserting that religious services are covered by penal provisions? What do the Minister's words mean?

Deputy Joan Collins has to speak now but the Minister can respond to me in his closing remarks.

I will raise two points and I hope the Minister will have time to come back to me on them. With regard to the changes to the cohorts under the vaccination programme, I have listened to what the Minister has to say but I would like him to put that information, both the study and the scientific background from the national immunisation advisory committee, NIAC, on the website so that people can see it. That is crucial.

My second point relates to something that I believe will become an issue over the next two weeks or so. Hundreds of students are doing Erasmus courses in Italy, France, Germany and all over Europe. The Minister made a statement the other day to the effect that France and other countries may be added to the list, although that has not been done yet. This has created absolutely tremendous anxiety among the students involved because they are supposed to remain in their host countries until 30 April to finish their courses. If they do not, their course may not be recognised. We are talking about something that is only three weeks away. I ask the Minister to give clarity to these students today or over the coming days and to tell them that, if mandatory hotel quarantine is brought in for arrivals from those countries, the State or their colleges will pay for it. These students cannot afford to pay €1,800 for hotel quarantine. Will the Minister do that over the coming days?

The NIAC report was published yesterday and is online now. If the Deputy goes to the national immunisation advisory committee's website, she can look at it. It issued quite a detail report with a lot of references. It is well worth taking a look. It goes through many of the issues we have discussed here today. With regard to Erasmus students, the issue is much broader. The reality is that mandatory hotel quarantine is very serious. The epidemiological situation right across Europe is very concerning. The Deputy will be aware that France has just introduced significant lockdown measures. Other countries are doing the same. Mandatory hotel quarantining is one of the measures being taken to protect against variants coming in.

Will the Minister give clarity to the students?

With regard to ability to pay specifically, Irish citizens or other Irish residents who find themselves in, or having to travel through, a category 2 country within that 14-day period, will be liable to mandatory hotel quarantine. If there is real and significant issue with regard to their ability to pay, they should contact the relevant Irish embassy in the first instance.

We have eight minutes remaining rather than ten. In the interests of impartiality, I was generous with regard to ministerial responses. Deputy McAuliffe has three minutes and the Minister has the remainder of the time available. I ask that this be reflected on the clock.

I have listened carefully to what the Minister has said. Unfortunately, I missed the beginning of the debate because I have come directly from one of the new walk-in test centres in Finglas. Before it opened at 11 a.m., there was already a queue of people waiting. Yesterday, we received briefings from suppliers of antigen tests as to the availability of such tests. With regard to both walk-in test centres and antigen testing, I believe that frequent testing will be a key part of how we move forward in a vaccinated world. Of the 11,500 people who did not have symptoms who were tested last week, nearly 350 tested positive for Covid. We therefore know that, while frequent testing and rapid testing are not silver bullets, they are extra tools in the process.

On vaccination prioritisation, I listened to people yesterday and they are really frustrated and disappointed. They thought they would get vaccinated at a certain time but they will not. There is a report on the NIAC website but it takes a lot for one to get one's head around such scientific reports. If the science has changed, I ask that the Minister seek a recorded briefing from NPHET, NIAC and the HSE that key workers would be able to watch. I seek a five, ten or 15-minute briefing online which would explain this decision to them.

I spoke to one teacher in his 20s yesterday whose father is a bus driver in his 50s. He told me that he would far rather that his father get the vaccination. There has been a lot of talk about different categories, but it must not be forgotten that public transport workers and food supply workers were in the category above that of those working in education. They are even more disappointed and yet I have not heard the same level of discussion about them. Bus drivers are at real risk. We saw how they suffered in London. We need to explain to these groups why the vaccination programme has changed. The Minister himself has admitted that this decision came quickly. We need to give people the information in a way that allows them to digest it in their own time.

On the issue of vaccines, I know the Minister is reluctant to give deadlines but will he outline to us when the Janssen vaccine might arrive? That will be a key tool in the vaccination process. I hope more people get vaccines. The vaccination programme will be the real test for this Government over the next two or three months. We have promised that, once vaccines are delivered, they will be administered. We need to do everything in our power to make that happen.

I thank the Deputy for his questions. The walk-in PCR testing centres we recently opened have proven to be very successful. As the Deputy has quite rightly said, these centres are for people who do not show symptoms of Covid. People who do have symptoms should call their GP for a referral for testing. These centres have picked up hundreds and hundreds of cases. The feedback has been very strong. We are hearing from people who say they just went down to check but who did not, for a moment, think they were positive for the disease. They just wanted to double-check because there are people vulnerable to Covid in their lives. Some of these people have tested positive and are now going to follow the protocols and stay away from people, thereby protecting their friends and family. As the Deputy will be aware, we are opening such a centre in his own constituency. I pay tribute to the National Ambulance Service for moving so quickly in this regard. I want to see more and more of these centres. We want to deploy them in areas in which Covid rates are very high. The response has been very good so far.

I share the Deputy's passion for rapid testing. There are highly credible and respected people on both sides of this debate. Some are very worried about the potential negative effects of rapid testing. These tests are nowhere near as accurate as PCR tests in identifying positive cases. There is a real concern that some people might get a negative test result and, despite being told that such a result may not mean that they do not have Covid because the test is not as accurate as a PCR test, they may take it that they do not have the virus and engage in higher risk activity, having misunderstood the test result. There are highly credible people who are genuinely concerned about that. We have to be very clear and appropriate in our communications and we have to ensure that people understand the limitations of rapid testing.

However, as the Deputy will be aware, I appointed an expert group, led by Professor Mark Ferguson, to look at the issue. The group's report is more positive about rapid testing and makes some recommendations. I will be launching that report later today. I will also be working with my Cabinet colleagues to look at rolling out rapid testing in various sectors. For example, the Minister, Deputy McConalogue, and I are already involved in a large-scale pilot in meat processing plants. Tens of thousands of rapid tests are being deployed in that sector. We will be looking at doing more of that.

The Deputy's suggestion of a video briefing on the rationale behind moving to prioritisation based on age is excellent and I will take it back to the Department today. I have had conversations with people in the education sector, who were of course feeling disappointed, but when they hear about the NIAC analysis or that people in their early 60s - to the Deputy's point, such a person may be someone's mum or dad - are 70 times more likely to die from Covid than they are, they have all responded that, if that is the case and the risk is so much higher for older age groups, these older groups should be vaccinated first. Such a person may be one's work colleague, parent, friend or family member and the people I have spoken to want these people protected first.

It is also worth saying that NIAC looked at any potential link between the risk of severe illness or death and the sector in which a person works. It looked at the education, construction and healthcare sectors and others but the only sector in which it found a significantly higher risk of harm from Covid was the healthcare sector, which has been prioritised.

With regard to the Deputy's question about the Janssen vaccine, I authorised the use of this vaccine yesterday by way of a regulation. We expect Janssen vaccines to arrive in late April. It is a very interesting vaccine and will be our fourth. Clinical trials show really high levels of effectiveness and protection, which is very encouraging.

Janssen is the only vaccine that we have or that we have advanced purchase agreements in place for which is a single dose shot. That makes it particularly useful if we are trying to engage with harder to reach communities, for example. As the Deputy will be aware, one of the groups that NIAC has pointed to as being harder to reach is those who are homeless. Many people who are homeless are leading difficult and sometimes chaotic lives, and although we will have to wait for the clinical advice from NIAC and the HPRA, the Janssen vaccine is an interesting one to be able to use for people who are in more vulnerable situations and who might find it harder to be able to come back to a vaccination centre or a GP clinic in exactly four, six or 12 weeks. I thank the Deputy for his comments and suggestions.