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Dáil Éireann debate -
Thursday, 22 Apr 2021

Vol. 1006 No. 1

Covid-19 Vaccination Programme: Statements

We can start with the Minister of State, Deputy Mary Butler.

Throughout the course of Ireland’s vaccination programme, we have sought to ensure the administration of vaccines is conducted in a manner that is fair and has due regard to the protection of the most vulnerable in our society. I am pleased to note, in that regard, the significant positive impact the programme has had in long term care facilities, including nursing homes. The positivity rate for the current cycle of serial testing in nursing homes is down to 0.11%.

The vaccination programme has now been extended to people aged 65 to 69 and the vaccine portal opens for everyone aged 60 to 64 tomorrow morning. The HSE is asking people aged 64 to register first on Friday and the process will then work down through those aged 63 to 60. More information can be found at As of 17 April, more than 95,000 individuals who are at very high risk of being negatively affected by the symptoms of Covid-19 have received their first vaccination dose. There are 25 mass vaccination centres fully operational as of today, vaccinating people between 60 and 69, including the Waterford Institute of Technology arena, Carlow Institute of Technology and Cillín Hill conference centre at Kilkenny. Vaccination of those over 70 has already been administered in many of these centres.

These are positive steps. Over time, we will see further positive measures being put in place and further resources being assigned to ensure the vaccination of every individual who wishes to receive the vaccine. I acknowledge, with huge thanks, the hard work of the HSE, its vaccinator teams, general practitioners and others that have contributed their time and effort to achieving this level of progress.

I will now refer to housebound vaccinations as there have been many questions asked about this in recent weeks. To date, in excess of 3,500 referrals have been received as part of the housebound vaccine programme. Due to the complexity of the triage process, which involves follow-up with both referring GP, individuals to be vaccinated and their family, a number of additional referrals are awaiting triage, and as such this figure is likely to increase further. So far, as part of this programme the HSE has offered more than 1,800 appointments to people referred by their GP. Appointments may not be completed for a range of reasons, including refusal or a person entering long-term care or being unwell. The National Ambulance Service continues to follow up on these appointments.

The ambulance service is currently operating a seven-day service which deploys more than ten vehicles each day to undertake between 50 and 60 appointments, with around 400 appointments each week. The length of time it is taking to complete the project is driven by the complexities involved in triaging referrals, logistics of vaccine delivery and the requirement for more than 30 to 40 minutes at each residence. In around 10% of cases, visits can take up to 50 minutes due to medical histories, which require a 30-minute observation period. As individuals to be vaccinated are dispersed throughout the country, it can also take ambulance staff a considerable amount of time per visit to reach their destinations. The completion of first doses as part of this programme is expected in May 2021 while the second dose is expected to conclude in June 2021. To provide assurance to the individuals and their families who still await vaccination under the programme, the HSE will make direct contact with them over the coming days, starting today.

The initial number in this cohort was 3,200 but much work has been done and more people have come into the scheme. An ambulance may travel around County Waterford with 30 minutes or 40 minutes between each call. There may also be 30 minutes or 40 minutes spent with the person receiving the vaccination. It is taking quite a lot of time. We must remember these people are very vulnerable and older. I thank the ambulance for the work it is doing. It is very important for the HSE to make direct contact with everybody who has not been vaccinated to date as people are worried.

As of 20 April, in excess of 645,000 vaccines have been administered by GPs to those over 70 and we are on target to deliver approximately 692,000 vaccines by this weekend. The Helix was in operation last weekend with approximately 2,700 second doses administered to people aged between 75 and 79. The focus this week has largely been on completing the first dose vaccination of those in the 70 to 74 age cohort, on continuing the second dose of the 75 to 79 age cohort, and largely completing the second dose vaccination of the 80 to 84 age cohort. The vaccination hubs in Cork and Galway will be in operation on 24 April, with more than 1,500 patients expected to receive the second dose. It is expected that more than 757,000 vaccinations for people over 70 will be completed by the end of next week's cycle.

The focus next week will be on completing first dose vaccination of the 70 to 74 age cohort and on largely finishing second dose vaccination of the 75 to 79 age cohort. A dedicated GP team is fully operational, supporting distribution and allocation, linking with GPs and their practice staff to resolve quickly snags and issues that arise.

The vaccination programme's primary aim has always been to protect the most vulnerable among us. Tremendous progress has been made in this regard and this is clearly reflected in the levels of Covid-19 present in vaccinated groups. Levels of disease in long-term care facilities, including nursing homes, mental health settings and among older citizens, continue to substantially decline. This has been an incredibly traumatic year for so many, but we are now starting to see the benefits of the vaccination programme. As supply increases over the coming months, more individuals will be offered vaccination as we place those most vulnerable to Covid-19 at the forefront. Ultimately, everyone who wants to receive a vaccine and for whom it is deemed clinically safe will be offered the protection it affords. This pandemic will not end until everyone is protected, but as we progress from spring to summer, there are much brighter days ahead.

I welcome the opportunity to update the House on Ireland’s Covid-19 vaccination programme. There has been much progress since we last discussed it. We hit the milestone of 1 million vaccines administered, and now more than 1.2 million vaccines have been administered. The vast majority of those living and working in long-term residential care have been fully vaccinated. First vaccine doses for healthcare workers have been substantially completed. Ireland is one of only a handful of EU countries that have achieved this. Ireland is leading the EU in prioritising and vaccinating people over 80 years of age. The majority of people aged 70 years and over have had at least their first vaccine dose. Approximately 95% of this group will be covered by the end of this week.

More vaccination centres are opening, and next week 28 of the 38 centres in total will be open. Recruitment continues for the vaccination centres. For April and May, we have many more vaccinators ready to go than are needed, with recruitment continuing for June onwards. The online registration system is going strongly. It opened last week for those aged from 65 to 69 years. By last night a very encouraging 83% of people in this age group had registered and vaccinations for this group started earlier this week. Tomorrow the online registration system opens for those aged 60 to 64 years, which is another important step. Vaccinations are moving at pace for those with underlying conditions that put them at very high risk from Covid-19. More than 100,000 people in this group have now had their first vaccination dose.

It is fair to say that we have had a busy few weeks. What is very encouraging is the impact of the vaccination programme, which is nothing short of astonishing. We have the lowest level of Covid-19 hospitalisations in a long time. From January to last week, there has been a 98% reduction in Covid-19 cases among healthcare workers, a 99% reduction of incidence in those aged over 85 years and a 100% reduction in the incidence in nursing homes. Given all this, it is not surprising that public confidence in the vaccination programme is strong. Nine in every ten people are saying they will take a vaccine when offered one. I thank the thousands of women and men throughout Ireland who are making this programme work. It is not easy. Last week, we had to adjust to major changes for the AstraZeneca, Johnson & Johnson and Pfizer-BioNTech vaccines, while keeping the programme running. Currently, we are awaiting further advice from the national immunisation advisory committee, NIAC, on the Johnson & Johnson vaccine. In the past week alone we have had changes to the delivery schedules for every vaccine for nearly every week.

In spite of this, vaccination centres are opening, general practice is running the vaccination programme at full speed, and online registration opened and is expanding. Critically, people are getting vaccinated at the pace at which we are getting vaccines into the country. I thank everyone working in general practice and in the vaccination centres. I thank the Defence Forces, the vaccination teams in hospitals and communities and everyone working in long-term residential care and disability services, in the National Ambulance Service and in the voluntary sector who are involved in this programme. I also thank everyone else working so hard to make Ireland’s vaccination programme a success, to ensure we protect the most vulnerable and that we have a path out of this pandemic.

The benefits of vaccination have put the Government in the position where it can continue to reopen carefully. Thanks to an all-Ireland effort, we are ahead of the best-case scenario presented just a few weeks ago. The R-nought number remains below one, and the number of close contacts has remained steady at 2.6. This is a major achievement for Ireland, particularly given the prevalence of the B117 variant. It has only been possible because of the continued solidarity across Ireland and the daily efforts of every person, family and community. The recent decline in incidence of the disease across all age groups has happened through our joint efforts, contributing to the protection of our loved ones and communities. As a result of these efforts to suppress the virus at home, Ireland has one of the lowest rates of Covid-19 in Europe. We also have the strongest measures in place against variants coming into the country. We have a vaccination programme which is consistently performing among the best in Europe.

The plan is working and great progress is being made. To protect it, we still must proceed carefully. Social interactions are increasing. We all can see that. GP referrals for Covid-19 tests have increased this week. The number of daily cases is still higher than any of us want. If we reopen carefully, adhere to the public health measures and ensure enough people are vaccinated, we can look forward to what we all want, which is a good summer with our friends and families.

I will briefly address specific issues relating to specific vaccines. Safety is a cornerstone of the vaccination programme, and Members will be familiar with the recent advice from the European Medicines Agency, EMA, and NIAC regarding AstraZeneca. The EMA has added unusual clotting events with low platelet counts as very rare side effects to the vaccine product information for AstraZeneca and recommended the same for the Janssen vaccine. The EMA has been in regular contact with its American counterpart. The European Commission’s vaccines steering board, which oversees the procurement of vaccines on behalf of member states, has been kept apprised of developments during the course of all these deliberations. The EMA completed its review on 20 April, recommending the product information for the vaccine be updated to refer to the possible, but very rare, side effect of these blood clots. The EMA also said the overall benefits outweigh the risks.

NIAC carefully weighed the advice provided by the EMA on AstraZeneca. It has recommended that AstraZeneca can be used for all those aged 60 years and more. NIAC has also recommended that all those who have had a first dose of AstraZeneca should have their second dose. This applies to all age groups. The interval for those under 60 years is 16 weeks, except for those who have an underlying condition that puts them at high or very high risk from Covid-19, for whom the interval recommended is 12 weeks. NIAC is currently considering the EMA’s recent position on the Johnson & Johnson vaccine and I expect a recommendation on that early next week. The European Commission has also successfully concluded an agreement with Pfizer-BioNTech to accelerate deliveries into April, May and June. This means more than 500,000 additional Pfizer-BioNTech vaccines will be in Ireland in the coming months, which is very welcome.

Notwithstanding the range of vaccines currently authorised or in various levels of production and testing, there is a need to consider the future trajectory of Covid-19 and the measures required to address it. The degree of protection provided by the various vaccines is being monitored closely. However, it is likely that further rounds of vaccinations will be needed next year. In conjunction with this, it is evident the disease is evolving such that a range of variants of differing severity and infectiousness have already been detected. Plans are being advanced by the European Commission for future procurement of vaccines. The Commission recently commenced negotiations with Pfizer-BioNTech with a view to securing a new agreement on behalf of member states. This agreement is for the delivery of 900 million doses of a reconfigured version of the vaccine across member states over a two-year period, which is very welcome.

If our collective experience of Covid-19 has taught us anything, it is that we must be flexible and adaptable.

The disease continues to evolve and our response to it must also continue to evolve. This applies to testing, tracing, genome sequencing, rapid testing, home and hotel quarantining and public health measures. Of course, as the past few weeks in particular have demonstrated, the need for adaptability applies all the time to our vaccination programme.

The past few weeks have been particularly busy as we incorporated several very big changes from NIAC advice on AstraZeneca to actions taken by Johnson & Johnson on the delivery of its vaccine into the EU to the very welcome news of more than 500,000 additional Pfizer doses for April, May and June. I have no doubt that changes like this will continue to happen every month, possibly every week, and will keep coming at us. We must continue to adapt to make sure that safety, as always, is a cornerstone of our vaccination programme and that we meet our core target, which is that people are vaccinated at the pace that vaccines are coming into the country.

We move on to Deputy Cullinane, who will share time with Deputy Tully.

First, I join the Minister in commending all those in the HSE and NIAC on the work they are doing on the vaccine roll-out. I also commend those in our wider health services, both in public health departments and in our hospitals, on all the work that has been done over the past year in difficult and trying circumstances.

As we come out of Covid-19, there are an awful lot of lessons to be learned on how we approach our public services, and most especially, putting a more positive emphasis on public health. That lesson is being learned.

Life is starting to open up and we can see the finishing line on the horizon. That is all for the good. The quicker we see the easing of restrictions, the better. It cannot come quick enough or soon enough for all of us. I fully appreciate it must be based on the public health advice. I appeal to people to stick with the advice over the next number of weeks. If we do that and get it right, there will be opportunities for people who want to get back to work and do more outdoor activities in areas such as sport. People obviously want to open up their businesses again and get more normality back into their lives. We all want to see that happen. I appeal, therefore, for people to stay the course over the next number of weeks.

However, we also need strong leadership and competent management in whole range of areas, however. The Minister referenced all-island co-operation. He will notice that this week, people in their 30s are being offered the vaccine in the North. We are starting to see substantial reopenings in the North and that is all for the good as well. That was because we had a very strong and steady roll-out of vaccines. That competent management is, therefore, really important. It has to be seen in contact tracing, travel checks and quarantine and the vaccine roll-out.

I will start my questions with the vaccine roll-out. At the Oireachtas Joint Committee on Health, the HSE said the projection for delivery of vaccines for the month of April is 800,000. We since learned that there were more changes to the AstraZeneca supply with the delivery of 40,000 doses on Saturday reduced to 9,000. Then, the delivery on 30 April of 160,000 doses was pushed out a couple of days. Is 800,000 still the figure for the month of April?

I thank the Deputy for the solidarity and support in people sticking with the measures. We are in a slightly cautious space right now where more and more people believe that we are through it, whereas we are not. We are getting much closer so I thank the Deputy for his words on that.

My latest figures are from the task force on Monday. I believe they were with him the following day. The figure I have for April is a total of just under 940,000 doses to be supplied. To address exactly what the Deputy was saying, however, that includes almost 41,000 Jannsen vaccines coming into the country as well as an accelerated number of Pfizer vaccines. As the HSE will have covered with the committee on Tuesday, there was a large delay of one week to AstraZeneca, which moved its delivery from the last week in April to the first week in May. The numbers, therefore, have been moving around, as the Deputy will be familiar with.

We have been calling for this now for some time. In my view, we need weekly reporting on the estimated delivery of vaccines. We accept all the caveats that can be put on it. The Minister is correct that the HSE confirmed to us that there were a number of interruptions on the supply side. We accept that those interruptions are not the responsibility of the HSE or, indeed, the Government. It is important we get weekly figures for the actual deliveries that came in but also weekly supply projection targets. My understanding is that the weekly reporting of what has arrived will now be fortnightly reporting. That is wrong. Can the Minister, therefore, confirm that it will not be fortnightly and that he will retain the weekly reporting of the vaccines that have arrived in any given week?

My understanding is exactly that. There will be a detailed report, per vaccine, for everything that has arrived week by week.

Some journalists have been getting emails from the Department of Health stating that it is going to move to fortnightly or biweekly reporting. I ask that the Minister takes that up with the HSE and makes sure reporting is on a weekly basis. The projection of all those targets for each week also needs to be set out.

The issue of pregnant women was raised with Professor Karina Butler and with the HSE at the meeting of the Oireachtas Joint Committee on Health. While the HSE said the vaccine is being rolled out according to age, which we all accept, Professor Butler stated: "If it is recommended in pregnancy it is not so much that pregnant women require a specific prioritisation as such but as pregnancy is time-limited it may be that giving it to them might need to be facilitated in some way." That it "might need to be facilitated in some way" is not really what we want to hear; we need a firm recommendation. Will the Minister follow that up with NIAC? We have all received representations from women, gynaecologists and staff in maternity services in hospitals who say this should be looked at. Rather than saying it might be necessary, and I am sure that NIAC is looking at it, it would be better if we had a consistent message and a firm approach. I ask the Minister to take that up with NIAC.

Regarding new variants, what is his opinion on the Indian variant and on what we are seeing in India at the moment? Some 295,000 cases per day and 2,000 deaths per day is really worrying and yet, as I stand here and he sits here, India is still not on the red list. It has been added to the list in the North and that was the right thing to do. The Minister spoke earlier about flexibility and adaptability. Speed is important but staying ahead of the virus and new variants is also important. Why has India not been added to the list given what is happening in that country on a daily basis?

It is an excellent question. In fact, yesterday India had in excess of 300,000 cases. I believe it is the highest number of daily cases for any country since Covid-19 arrived. It is absolutely heartbreaking. The team that advises the CMO met yesterday for this week's review. The deputy CMO and I have spoken directly about India and I expect a recommendation on it this week. To answer the Deputy's point, I am concerned about it. When the deputy CMO and I spoke on this yesterday, the Indian variant had not yet been classified by the multilaterals as a variant of concern. We know the UK has added India to its list, however. We are looking very closely at India for the reason outlined by the Deputy.

I thank the Minister for that response. I believe it is an urgent issue. One of the lessons we have surely all learned over the past year is that we must, at all times, stay ahead of the virus and new variants. Pushback from some within government, mainly within the Fine Gael Party regarding mandatory quarantine, is not helpful.

When NIPHET talks about that horizon, the finishing line and the ability to substantially reopen society, which all of us want, it is contingent on strong leadership and getting all the measures right, including quarantine. We must make sure we prevent any new variants coming in. Given what is happening in India, I believe that would be prudent.

Today, the health Minister in the North, Robin Swann, told its health committee that he was concerned about the level of co-operation between North and South. He said this was shared at the highest level, including with the First Minister and the deputy First Minister. He specifically said there are difficulties with data sharing, sharing information about the passenger locator form and new variants. He said that the first he learned of the three cases of the Indian variant in this State was through the media. What level of co-operation exists? The Minister of Health in the North said at official level it is working but he specifically said that at ministerial and decision-making level it is not. That is of concern to me. Will the Minister address what engagement there is between the two?

I thank the Deputy. For reasons we all understand, we take North-South co-operation seriously, no more so than on this issue. The closer we can have to an all-island approach to this, the better. I will have to see Mr. Swann's comments for myself. However, there is a good and constructive ongoing relationship.

Mr. Swann and I recently held a health sectorial meeting for the North-South Ministerial Council, something that had not been in place for many years. We are co-operating on data sharing and Covid. It would not be normal for me to directly contact the Minister, Mr. Swann, about the identification of variants, any more than he would contact me about specific variants being identified in Northern Ireland. There is close ongoing co-operation between the chief medical officers. The more co-operation we can have on an ongoing basis North and South, the better.

On those who are housebound and still have not received the vaccine, there are many in my constituency affected by this. I have a case of one woman who is 99 years of age, turning 100 in August, who had difficulty receiving her vaccine. She was notified there was a vaccine for her at beginning of March. However, she was not able to go to her GP and nothing happened. In the end, her family, with great difficulty, managed to get her to the GP to give her the vaccine but it caused a lot of distress. Will the Minister clarify the processes around the National Ambulance Service in this regard? What are the conditions attached to it? Does the service need a certain number of people within a locality before it can allocate the vaccine? There are different stories floating around about that.

On those identified as very high risk, as opposed to those categorised as high risk, have GPs been given clear instructions on how to categorise people? I have had several people with MS ask me what category they are in and how they will be notified, for example, as to when their vaccine will be ready.

I apologise if I missed an announcement on the two jabs as I was delayed at another meeting. However, there is much anxiety among those who have received the first jab, especially among the over-70s and the very high risk groups, if the time between the two jabs is extended. Could that be left as it is for those who already received their first jab? If it is going to be extended, can it be done for those who are receiving the jab at a later stage after the announcement?

I am concerned family carers have still not been offered the vaccine or have not been prioritised as front-line healthcare workers, which they are. A testing centre was moved to Castle Saunderson in County Cavan. It is a remote and beautiful forested area which people use for exercise. Many are annoyed the testing centre has been moved there, bringing much traffic to the area. It is not serviced by public transport and is difficult to locate. Why was this done with no consultation with locals?

To date, there have been 3,500 referrals of housebound persons. Of that, between 300 and 400 came in the last week alone. The GP refers the person who is housebound and it is then triaged. The complexity of the triage process involves following up with the GP, the individual to be vaccinated or their family. Several additional referrals that came in this week are awaiting triage.

There are ten ambulance vehicles on the road, operating seven days a week. One must understand the complexity of the number of people we have to get to. Each call would involve maybe 30 minutes to 40 minutes with a particular person. Up to 1,800 people so far have received dose 1 of the vaccine through the ambulance service.

The HSE is making contact, starting today and into next week, with everyone who has not yet received a call-back to reassure them that nobody will be left behind. However, it is quite complex. When the National Ambulance Service has turned up at houses, it has been met with different issues. In some instances, the person has been vaccinated already by his or her GP. In other instances, the person has gone to hospital or to a nursing home and was not aware of the call. There also have been refusals and, in several cases, the person had passed away.

It is seven days a week covering the whole country. Nobody will be left behind.

I thank the Minister and Minister of State for their statements. It is helpful to have specific detail. I also acknowledge how difficult the vaccine roll-out is, coupled with uncertainty and changing delivery schedules. I understand how logistically that is an extraordinary strain. I commend all involved in grappling with an ever-changing situation.

I want to focus on one vaccine and one cohort to seek clarity. The only eligible group of citizens to receive AstraZeneca now are those in the 60 to 69 age cohort. I am one of those myself and I know other colleagues here fall into the same category. Most of us, certainly including myself, have no problem at all in receiving AstraZeneca. Indeed, I would be delighted to receive it. However, there are issues which we need to address and be clear about. AstraZeneca has proven to be the most unreliable in terms of delivery. Up to 45,000 doses were expected this week. We know only 9,000 were actually received, a fact we only found out at the last minute. Some 165,000 doses were expected on 30 April. Now that has been put back to at least 3 May. Few would bet their house that we will get 165,000 doses on 3 May.

There is only one cohort, namely, those aged between 60 years and 69 years, who are totally dependent on this single vaccine, AstraZeneca. To add to the issues for that cohort, this is the only vaccine currently where there is a 12-week gap between doses. All the others are much shorter. As the vaccine programme continues, younger and, according to the clear medical advice, less vulnerable groups could be fully vaccinated before the 60s age cohort group is. I believe that would be unacceptable.

Since the 60s age group is dependent on AstraZeneca, how can the Minister be certain that the 840,000 doses to fully vaccinate the 420,000 people involved in that group will arrive in a timely fashion? How sure is he that this group will not be pushed behind the lower age groups and, by definition, less vulnerable people before it is fully vaccinated? Does he believe this group uniquely should have to wait 12 weeks between doses and be, potentially, overtaken by less vulnerable people? Will he review that situation?

I thank the Deputy for his kind words on the programme and his questions.

There are several cohorts which are either fully or partly using AstraZeneca, including cohort 2 which is healthcare workers of all ages. They will be getting their second dose. NIAC has put a 16-week interval in place for people under 60 with no underlying conditions. Quite a number of people in cohort 4 have had AstraZeneca as well and NIAC has said that regardless of their age, their second dose should be administered after 12 weeks. The same applies to any in cohort 7 which is high-risk, although it is a much smaller number. To answer Deputy Howlin's question, AstraZeneca will also be given to cohorts 5 and 6, which is essentially persons aged between 60 and 69 years. There are a few things to say here. First, I will take his question directly back to NIAC and to NPHET as well. It is a very fair question because I think, based on the intervals, younger people could be fully vaccinated beforehand and there could be significant bonuses to being fully vaccinated, including, for example, exemption from hotel quarantine, potentially the EU green certificate and so on. I will therefore take those questions back today and ask NIAC to add them to its deliberations. It is considering a variety of issues right now.

There are a few points it is important to stress. One is that the protection from the first dose is very significant for all the vaccines and is quite a bit ahead of what the clinical trials suggested. That is why we are looking at extending the intervals for the mRNA vaccines. Another point is that we may well have a recommendation from NIAC around Johnson & Johnson. My hope is that Johnson & Johnson will be for all cohorts. Indeed if that was applied to some of the cohorts we are talking about, then very shortly after the first dose - it is a one-dose vaccine - those people would be fully vaccinated. Let us wait to see what NIAC says on that.

Finally, I am aware people have been asking questions about AstraZeneca because of the restrictions being put on its use. We want to listen very carefully and respectfully to people who are raising those and come back to them with the best scientific evidence available.

I thank the Minister for the commitment to go back and re-present the issue of the 12-week gap and the understanding of it. My second question is on the clarity about supply of the 840,000 doses which will be required for this group. In the event of the date of 3 May not being reached what is the Minister's contingency plan? He should remember that everybody in the age group will have already registered and will presumably have been assigned a date at that stage.

At this point we must wait to see whether the vaccines come in. While the Deputy quite rightly points out that there have been very significant volumes moving around, they are only moving by a week or two. Thus, for April, May and June we are due to receive just over 800,000 doses of AstraZeneca and while the deliveries are moving by a week here and there, the task force, HSE and the Department are working very closely with the company to ensure the total volumes do still arrive.

We move now to the Government slot. Deputy McGuinness is sharing with Deputies Calleary, Richmond and O'Connor, according to my list.

I join the previous speakers in complimenting those who are on the front line in the delivery of the vaccines. I include those who are close to that front line and are managing it and so on. There is a growing confidence about the vaccines and a growing desire among a lot of people to have a vaccine and to have it delivered as soon as possible. However, there is an issue around how we deliver that message. The message has been confusing at the best of times. We must be clear on our messaging. We must inform people of what we expect is going to come, then we must inform them as to what is here and has arrived and out of what arrives who is going to be vaccinated next. People are watching this space very carefully because this is a health issue for them and they want to see that clarity. In the case of people who have received their first vaccination and have got an appointment for the second jab that appointment should be kept, not cancelled. There is a fear that it very well may be, so I would like to hear some clarity around that particular question for those people.

I am disappointed that we continue to hold the position that we will not deal with carers, those who are involved in the front line of education or Garda members. In order to gain the confidence of everyone we need to listen to what they are asking and to understand it, even to the extent that those who may not want a particular vaccine might be encouraged by the evidence to look at the vaccine they have been allocated or where that is not possible, that another vaccine should be considered for them. Therefore, I ask the Minister to listen more carefully to what is being said in this House and indeed in parliamentary party meetings. It may be a different point of view than his own or that of all the professionals he listens to but it is a point of view and if we want to bring the people with us that is what we must do.

Having one voice, in relation to the messaging, would be helpful. I appreciate that the Minister has his shadow Minister from his own constituency on his shoulder and that we have three parties in Government but we must respect the people and in respecting them we must respect their concerns and their issues.

On the reopening, I ask the Minister to look at the whole issue of religious ceremonies, at masses, prayers at the mosque and so on because it is hugely important for the mental health and well-being of people.

I ask the Minister to look at the mental health issues which are arising now and the fact that people cannot get appointments to be assessed, cannot get appointments to have their medication reassessed and are facing into a very dark space when they do not hear the Government speaking to their cases and making the appropriate changes necessary for their care.

I too join Members in commending everyone involved in the vaccine roll-out and particularly the registration portal which has worked very effectively.

I have two key questions. One is for the Minister of State, Deputy Butler, who I thank for her contact in recent weeks about the vaccinations for home-bound people. I am disappointed to hear there are still 300 people remaining as their vaccinations were all due to have been completed by last weekend. Can the Minister of State give me an idea of where they are geographically and will extra National Ambulance Service resources be assigned to those areas? I am concerned that the administration of second doses to some housebound people has begun before all the first doses in the cohort have been completed. Given what the Minister has just said about the protection offered by the first dose, surely it would be fairer to complete all the first doses for housebound people before commencing the second doses.

Turning to the Minister, on the vaccination centres, he previously assured me those signing up for the vaccine would be given a choice of either a vaccination centre or their local GP or pharmacist. Now, when one goes on the portal, one is assigned to the vaccination centre. In County Mayo that currently means a round trip of at least two and a half hours if a person is coming from Erris or a two-hour round trip if he or she is coming from Ballina. If we are sending people to vaccination centres then we need extra centres in Erris and Ballina in order to ensure people will keep their appointments.

I would like answers to those two questions.

Maybe we will hear Deputy Richmond and then come back to the Minister.

I will take just a minute and hopefully the Minister and Minister of State will be able to fit in as many replies to myself and the preceding Deputies in the remaining five minutes or so.

I have two questions for the Minister. The first relates to the many people in the over-60 cohort who still have concerns about vaccines and the need to provide clarity on that and reassurance that they will be vaccinated in due course in a quick and efficient manner if they are unsure about taking certain vaccines.

The second question is far wider and something which has become very topical in the past week. I have raised it with the Minister a couple of times. I am referring to the absolute failure of a certain drugs company to meet its commitments to the European Union, and by extension to all Irish citizens, in terms of supply. Supply and safety are the only game in town. We must vaccinate as quickly and as safely as possible throughout this country and throughout the EU but we cannot do that if a company consistently fails to meet its contractual obligations for very many reasons. My very blunt question for the Minister is what are the ramifications.

What will happen to that company which has let the people of Europe down so spectacularly in their darkest hour?

In response to Deputy Calleary, anybody who is housebound or over 70 will be getting the mRNA vaccine made by Pfizer-BioNTech or Moderna and the second dose will be given within 28 days. That is the process that has been taking place since we started the vaccine roll-out and it will continue as far as I know at the moment. That is why the second vaccine is being offered. The Deputy mistook me. Approximately 300 to 400 new people have come on the list in the past week. To date there have been 3,500 referrals from GPs. A total of 1,800 people have been vaccinated successfully. I do not have some on the statistics yet for those who have refused. It is not that another 1,700 people are waiting. There have been many refusals due to issues I mentioned such as people having gone on to nursing homes or to hospitals, people who had already got the vaccine through their GP and people who, unfortunately, have passed away.

The National Ambulance Service is currently operating seven days a week and it has more than ten vehicles, each of which undertakes between 50 and 60 appointments a week. We are currently covering about 400 appointments. I will bring back the point the Deputy made about putting more National Ambulance Service jeeps on the ground. I have been repeatedly contacted in recent weeks. People are very concerned. The HSE is starting today to contact those who had not been contacted yet to let them know they will not be left behind.

I thank all three Deputies for their very supportive comments on the vaccine programme and all those working on it. Deputy McGuinness asked, as several Deputies have, what the position would be for those who have already received the first dose of the mRNA vaccines. If NIAC recommends to me that we extend the four-week interval to eight weeks or 12 weeks, for example, what will happen to those who have already received their first dose and therefore know when their second dose is due? It is my position that those who have received their first dose would remain with the four-week interval. However, if NIAC makes an overwhelming argument to the contrary that it would be in the public interest and protect more people, obviously that is something we will consider. However, my position very clearly is that those who have had their first dose should get their second dose four weeks later, as scheduled.

Regarding religious services, I had a very constructive meeting with the Archbishop of Armagh on Monday. We went through many of the issues. I know concerns were raised about a recent statutory instrument. That statutory instrument did nothing new; it simply maintained the status quo. It is very important to let people know religious services and religious worship were not singled out in that statutory instrument nor in any other statutory instrument. All that was being done was that regulations were being put in place to maintain the status quo about not having large indoor or outdoor gatherings for public health reasons, which we all understand. The archbishop asked me if, for example, a priest could tend to a bereaved family. The answer is "Yes". Could they tend to someone who is suffering in terms of sacraments? I said that they absolutely can. There is no measure in place targeting religious services. There are measures in place, it is hoped for as short a time as possible, targeting indoor and outdoor gatherings. In the coming week, the Government will look explicitly at religious services.

I thank Deputy Calleary for his comments about an additional vaccination centre in Mayo. I will pass that directly to the HSE for consideration. Obviously, we would prefer that people who may be very vulnerable would not to need to make a 2.5-hour round trip.

Deputy Richmond spoke about the concerns over the AstraZeneca vaccine. As I said to Deputy Howlin, we need to listen very carefully and respectfully. We need to acknowledge people's very reasonable concerns. We need to provide people with the best scientific advice. Based on everything I have seen, I would take the AstraZeneca vaccine today. NIAC is operating under an abundance of caution and in the context of multiple options being available in Ireland.

The European Commission has initiated a legal case over AstraZeneca. Earlier this week I joined Ireland as one of the parties to that legal case specifically relating to AstraZeneca's complete failure to meet its contractual delivery agreements for April, May and June.

Owing to the time constraints, I will ask my questions together. My office has been inundated with calls from people outlining very hard cases and highlighting the confusion that is coming from the Department of Health. This week we have strict following of vaccination groups. Last week the Minister flew a kite about vaccinating young people. Next week we might have something else; I do not know. People are fed up with the indecision and we need clarity. There is too much confusion and misinformation. The Department, the HSE and NPHET need to get on the same page. I listened to the Minister for Agriculture, Food and Marine on "Ireland AM" this morning. When asked a question, he described last week as a bit of a blip. However, it was a bit more than a bit of a blip.

The family of a lady in her 90s came to me last week. She had been in hospital recently and was unable to attend her vaccination appointment. Hospitals do not do vaccinations apparently; at least that was what I was told. Therefore, she is falling between the cracks. I find it bizarre that hospitals do not vaccinate people. Unfortunately, she is not in a golden circle and cannot rely on well-connected friends to look out for her. When will hospitals be able to vaccinate vulnerable people in hospitals as a matter of routine?

Teachers, SNAs and early childhood education workers have contacted me in recent weeks to express their concerns over the spread of Covid-19 in schools. They are particularly concerned about teachers who are medically vulnerable. Can this category be prioritised so that we can ensure continuity of education?

Deputy Tully asked about carers. I am very concerned about carers who are doing amazing work for little or no reward. When will we be able to vaccinate our carers to protect them and the people they are caring for? Those carers are saving the Government an absolute fortune by doing the work that they do.

I thank the Deputy for her questions. She asked about the multiple changes causing confusion. The advice we are getting in a very fast-moving programme is changing. The advice we are getting from the EMA is changing. The advice we get from NIAC is changing. The delivery schedules we get are changing. We have a choice. We can listen to the experts and adjust our programme to ensure it follows the clinical advice which requires change, or we can ignore that clinical advice and run a vaccination programme against the best clinical advice and not make any changes.

I think we would both agree we always need to be ready to update the vaccination programme according to clinical advice. It is simply that that clinical advice is being updated quite regularly. It requires some very large logistical changes and changes to which groups get which vaccine. No more than the Deputy, I would love for there to be no changes and for there to be one message outlining when every cohort will be vaccinated and with which vaccines. However, on balance, it is far better for us to take the clinical advice and change the programme, sometimes regularly, and ask the people to stick with us. I think people accept all these changes are in an effort to put safety first.

The Deputy asked about teachers. Any teachers who are medically vulnerable and at high risk or at very high risk are being prioritised along with those cohorts. Indeed, there are teachers in cohort 4, comprising those whose underlying conditions put them at very high risk. About 104,000 people in that cohort have now received their first vaccine and we need to press on with that.

I agree wholeheartedly with the Deputy on the value of carers, the work they do and the contribution they make.

It is absolutely phenomenal. If we had an abundance of vaccines and not a limited supply, there would be nothing that I nor anyone else in this House would want to do more than vaccinate important groups such as carers straightaway. The absolutely clear advice we got from NIAC, endorsed by public health officials in my Department, was that the way of saving the greatest number of lives, protecting the greatest number of people and getting out of this pandemic as quickly as possible was to vaccinate according to vulnerability. Age is overwhelmingly the characteristic that increases risk so vaccinating according to vulnerability is what we have decided to do.

I realise the Minister is against the clock but I have just one more question to ask. Is there anything we can do for the lady in the hospital?

Would the Deputy mind sending me on the details? I will ask the relevant officials directly.

The Deputy may communicate directly with the Minister.

I wish to return very briefly to the issue of housebound people aged over 70. The response we have received is not adequate. I have had contact from the family of a 90-year-old woman who is housebound. Her general practitioner referred her case in January. She has two people living in the house with her who are in education – they are teachers – with all the risks that involves. The woman is not living in a remote area but in a major urban area in Dublin. It is really hard to understand why she has not had a vaccine yet. What the Minister has set out is not good enough. A substantial number of people are in circumstances similar to those of the woman. Saying to them that they should get their vaccination within the next month is not good enough. There are pharmacists, GPs and others who are ready and willing to vaccinate. The Minister really needs to revisit this because what he has set out is not adequate.

The Tánaiste used very different figures from those of the Minister of State earlier in response to a question. Can the various Ministers get their story straight and, most of all, ensure people in the circumstances in question will be dealt with within the next week? I ask for a commitment on that.

I join others in commending all those working on the front line in regard to the action programme. For those managing it, I completely accept it presents a major logistical challenge given all the changes that are taking place. There is momentum, however, and it is fantastic to meet people who have had their vaccine. They are so excited and relieved. We really need to keep that going. An important element of that is ensuring clear information is available to people and the data are up to date. That has not been the case.

There are four questions I want to pose on data. It took us a long time to get the Minister to commit to providing delivery information weekly. It used to be provided on the Wednesday night prior to the session. There has been no information provided since 22 March and then a somewhat outdated note was provided last night. We need the information weekly so everybody is clear on what the situation is.

My second point on data is that we have not had a supply forecast for a number of weeks. Given all the changes, I ask the Minister to commit to providing it at least on a weekly basis, again so people can know what to expect. People accept that there is a lot that the Minister and others do not have control over but he should at least make the information available so everybody will clear on what is proposed, when they are likely to receive the vaccine, and what the progress is likely to be. That obviously will have a significant impact on the opening up of various aspects of society and the economy.

Many in cohort 4, the very high-risk group, have had their vaccination cancelled because of recent changes. When will they get a new appointment date? It is really important. They are extremely vulnerable and have been set back as a result of changes. When will the Minister be in a position to provide the exact dates on which they will receive their vaccines?

What is the protocol in the case of a person aged over 60 who has a personal or family history of severe clotting? How is this being monitored? What is the response to it? We are getting queries on it. It is very hard to know the situation. Is there a protocol? Where can the affected get advice? What are the options for them if their view is that their circumstances are too dangerous for them to receive the AstraZeneca vaccine?

I have a couple of points. The Minister said that the GP referred the case in January. The roll-out to the housebound started in the middle of March, just in case anybody believes the person in question has been waiting since January. That is not the case. The figures I have were given to me an hour before I came in here and I know they are accurate.

We also need to point out, because I certainly do not want to play politics on this, that those in the group in question are very vulnerable. It is very difficult to get around to all of them quickly. National Ambulance Service staff never rush when they enter a home. They may have to spend an hour with a person and then travel for 45 minutes to respond to the next call, where they may have to stay another hour. There are ten ambulance jeeps on the road and we are trying to get to everyone as quickly as possible. We want to make sure the programme is safe and effective.

I thank the Deputy for the various questions. I will answer the last question first. Several people have come to me with the exact same question on those over 60 with a history of blood clotting and I put it to public health officials. I want to be careful not to give medical advice as I am not a medic but the answer I got back was that AstraZeneca is safe regardless of any such history. That is the very clear advice I got back. If the Deputy would like, I would be more than happy to revert to her with a written position from the medics themselves.

With regard to data, we are always striving to do more. I understand it is a question of the delivery of numbers by week, although I am aware that someone suggested it is moving to every fortnight. With regard to forecasts, it is absolutely the case that we can publish them. However, it is worth saying that I published, last week, I believe, the delivery forecasts for all the vaccines for April, May and June and that within about six days of the information going out, almost every single number changed. I have a sheet to hand from the vaccine task force from Monday. The numbers do not really matter; it is about the colour. That shows the projected deliveries per week for each of the vaccines. In the past week, every single number for every vaccine to be delivered in every week changed bar one. It goes to show just how much the numbers are changing. My view, however, is that the more information we can put out, the better. I will go back to the Department and ensure that the weekly figures on what has been delivered are being published.

I have two points, but not questions, for the Minister and Minister of State. Since we are all so caught up – rightly so, and I absolutely get it – in the delivery of vaccines, it is so easy for us to forget that so many have died from the virus since January 2021. Even newspapers seem to forget. There were more deaths from the virus in January 2021 than for the entirety of 2020. We should somehow mark that and not leave it out of our sight. I am not saying the Minister is doing so but there was a time when the newspapers were publishing names, obituaries and memorial pieces. It is funny how quickly we move on. I am just asking that we never lose sight of the fact that the virus has taken a significant toll.

A point that is not often made here is that the Minister and his Ministers of State have got more right than wrong. I hear colleagues in the Chamber thanking the front-line workers. We always thank the front-line workers and public health experts when things go right.

The Minister has had a good week in terms of the public health consultants' contract, which will stand the test of time, but it is so easily forgotten. I know the impact of the recent decision the Minister made - he was the first Minister for Health to do so - on provisions for additional gynaecological assistance for women with endometriosis, which is very much appreciated. These matters can get lost very quickly in the sands of time because of the pace of change.

I do not think the public are really that exercised about timelines anymore because momentum is building, and people are getting the inoculations into their arms. I do not know why we are sticking so steadfastly to the commitment of 250,000 a week. It must heap a huge amount of pressure on the HSE. It has been promised for weeks. The Minister might reflect on that. He will not have much time to answer questions.

The Minister answered a question I was going to ask about people with underlying conditions. There were catastrophic, Armageddon-like predictions about the portal collapsing and not being able to cope, yet we are looking at the hundreds of thousands of people who have successfully logged on to it to date. The Minister has very little time to respond, but there are a few seconds.

I call Deputy O'Dowd. The Minister can respond at the end.

I have an update for the Minister on the vaccination centre for Drogheda. I understand that five potential premises were visited on Monday, but I request that we look again at the Drogheda Institute of Further Education, which is effectively a hospital-orientated vaccination centre for high-risk patients in the community. It is urgent that the decision is made now.

The vaccination roll-out is very welcome. I am meeting a lot of very happy people, but I am also hearing about significant and serious concerns expressed by some medical professionals about the impact Covid is having in particular on the child and adolescent mental health services, CAMHS, in Our Lady of Lourdes Hospital, Drogheda. I will compare pre-Covid times to post-Covid times. From January to March 2020, some 47 children were admitted, but between January and March 2021, the number had grown to 74, an increase of 27 additional children and young people. The problem is there is no out-of-hours service after 4 o'clock in the evening. No qualified professional is available to deal specifically with CAMHS issues. Some 72% of admissions occur after hours so there is an urgent need to have more CAMHS staff in the mental health services in hospitals. The most serious point of all is that the average age of the children attending Our Lady of Lourdes Hospital, Drogheda with significant mental health issues has dropped from 16 to 14. That indicates there is a real crisis here. Rolling out the vaccine is one of the keys to the solution, but we need more qualified staff to look after these children.

Another question relates to Dealgan House nursing home where more than 22 people died more than a year ago. The families are still in great distress. They are still being charged €250 or whatever it is for freedom of information requests, almost a year later. That is unacceptable. The main question they have is what is happening to the request for an exceptional inquiry into the deaths. I would like to get an answer to it from the Minister today.

I acknowledge the good work done by the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler, in recent months on the vaccination roll-out. I concur with Deputy Lahart's point that much of the time such work goes unacknowledged.

I would like to leave most of my time for the Ministers to respond so I will ask three brief questions. Rapid antigen testing has been a hobby horse of mine for several months. Are there any plans for a mass roll-out of such testing and to encourage its widespread use? I know it is intended to run a pilot scheme in universities and that it could possibly be in place for schools in September.

I understand a couple of hundred people who are housebound have still not been reached by the National Ambulance Service. I take it that the Minister is to contact those people in the next week. We must do that as expeditiously as possible. Could the Minister consider involving local GPs, if they can play a role?

My third question relates to the stand-by list for vaccination centres. Could the Minister clarify how those lists are currently compiled? We heard stories in recent weeks about people in schools or gardaí being contacted at short notice to avail of excess vaccines. Has the system been changed again to take age cohorts into consideration or has another process has been put in place?

I will have to ask the next two Deputies to be very brief if we are to get a reply from the Minister.

I too thank the Minister and the Minister of State for their hard work. I also commend the HSE on the vaccination roll-out, which is so important. It was announced today that the portal would be open tomorrow for the 60 to 64 age group. That is so important. I have had many queries about the HSE's number, which is really good, because some people do not want to use the portal. I welcome that. The vaccination centre at Carlow IT opened yesterday, which was very welcome and important. Communication is the key here. That is something we need to work on.

The work to vaccinate those living with disabilities in residential services and those utilising day services is ongoing and welcome, but we need to complete the programme. St. Dymphna's is another vaccination centre in Carlow that is doing great work.

I accept what the Minister said about carers. I know he is working with NIAC on that and on vaccinating gardaí and teachers. There was such confusion this week about religious services. I am delighted that the Minister answered the question in that regard and that he is working on it. That is so important.

What is the position regarding fully vaccinated people being able to avoid hotel quarantine? What vaccines are accepted? It is important to know that. We are all working so hard, including the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler, and the HSE. It is important that we get the message out there that things are going to be all right. It is taking time, but communication is the key, in particular now that we are opening up the vaccination centres. If something happens to prevent a person getting his or her vaccination on a given day, could the Minister look at the communication in that regard? That is the most important issue going forward.

Deputy O'Connor has 30 seconds.

I want to relay a very clear message to NPHET and all those in the HSE who are working on restrictions at the moment. In recent days I have been working closely with people working in the events industry, the arts, travel and air travel and they are very concerned about the Government's current strategy and the map for reopening in terms of our adaptation of technology. That is the critical point I want to stress. I call on the Government to start rolling out additional technological means by which we can scan for Covid-19 to allow for the reopening of society a little bit earlier than scheduled. We know that by the end of June 80% of the population will be vaccinated and we must try to reopen the economy for the summer. I urge the Minister to do that.

I agree with Deputy O'Dowd that we have seen an increase in the referral of young people, especially since the turn of this year. Last week, for example, I met the mental health lead from every CHO in the country. I will come back to the Deputy in writing on his query.

I assure Deputy O’Sullivan that, starting today, the HSE will make direct contact with every single housebound person to let them know what the situation is and when they can expect to get the vaccine. I take on board all the comments made.

I thank the Deputies for their support for the vaccine programme. I will feed in Deputy O’Dowd’s question on the Drogheda Institute of Further Education.

Deputies Pádraig O’Sullivan and O’Connor both referenced rapid testing. I appointed the expert group and launched the report some time ago. It is being embraced by various Departments, including the Department of Agriculture, Food and the Marine. We are doing tens of thousands of rapid tests a week now. The Department of Further and Higher Education, Research, Innovation and Science and the Department of Enterprise, Trade and Employment are both looking at this. I see rapid testing playing a greater role.

I thank the Minister. We are out of time.

I also thank the front-line workers who have been working day in, day out on the roll-out of the vaccine. I understand that the roll-out process is very difficult but I would like to refer to an email I got from a member of the Garda.

She and her partner are members of An Garda Síochána who live in my constituency and they have worked consistently throughout the pandemic in a support role on the front lines. They have two children and her mother was looking after the childcare. Unfortunately, they have not seen her since last March because of the role they are in as they do not want to put her mother into any difficulty. They have dealt, like all gardaí have, with protests, arrests and prisoners who they know have Covid-19. I know this has been raised time and again but it is important. Others on the front line have got the vaccine and then the system was changed. Yet, gardaí and other front-line workers such as prison officers do not even have a date because of the changes in the processes of the roll-out of the vaccine. If extra vaccines unexpectedly come into the State, could prison officers, gardaí and other front-line workers be vaccinated in a separate process to allow them to be safe?

The vaccine register for those aged 65 to 69 was launched last week. Can the Minister confirm how many in that cohort have registered since last Thursday and how many people have had an appointment confirmed? I am aware of many people in my constituency who have registered using the HSE’s online service last week but who have yet to receive an appointment.

Could the Minister comment on the concerns that there may be a need for a third vaccination with the Pfizer vaccine and would it be the same with the AstraZeneca vaccine? Is there a plan in place to test people who have been vaccinated to ascertain if they are carriers of the virus without showing symptoms but with the potential to spread the virus? That is important, particularly as we are talking about mandatory hotel quarantine and how we can open up safely.

The Minister mentioned earlier that this will be with us for at least a couple of years and probably forever. We are really concerned about the impact this will have on the budget. Are there implications for the roll-out of Sláintecare or other services that have been pencilled in for extra supports? Is there a plan to increase this in the next budget and to cover it as a separate entity, outside of the budget that is already in place for the HSE?

I ask the Minister to allow for GPs to prioritise family carers who are in need of vaccines. GPs know their patients in the community and are well placed to spot families that are struggling. I find it wrong that in the present vaccine roll-out process I could potentially get a vaccine before somebody like a carer, a garda or a prison officer. That is wrong and that needs to be changed.

There is a substantial amount of money in the budget for this year in various different places. There is a contingency fund, which is a central Government fund, and then there is a significant amount in the health budget. An awful lot of the activities involved in the vaccination programme are being funded out of that such as testing, tracing, genome sequencing and pop-up walk-in centres. The Deputy makes an excellent point on subsequent years. I have no doubt that one of the line items that will be in the health budget, for example, will be around vaccinations and Covid-19.

I am sure the Deputy would join me in welcoming the historic agreement that was struck just last year with the public health doctors. We will, for the first time ever, have what we need here, which is public health consultants. That is something they have been seeking for over 25 years. As well as that, we are doubling the public health workforce and putting a lot of investment into upgrading IT systems as well as a national reform programme. On the Deputy's point, not only do we need the budget, which we do, but we need a world class public health system. In recent months, we have been putting the building blocks for that in place because that is what Ireland deserves and needs.

We start on a very positive note in the statement the Minister made today. Every week we come here and there are positive soundings from the Minister's statements. That is very good and there is no doubt but that the virus in Ireland is in retreat. The settings that have received it have been liberated by the vaccine because that is the way to get out of this situation.

Over the coming weeks and months a number of scenarios could play out in the roll-out of the vaccine relating to the recommendations by NIAC on the AstraZeneca and Johnson & Johnson vaccines. There could be a situation where if the recommendation for the Johnson & Johnson vaccine goes the way the AstraZeneca vaccine has gone, that will change the picture. There could be a scenario where there are excess vaccines but only for a particular age cohort. There will be a stage where that age cohort will be reached in the roll-out but there could be an access issue around a vaccine, particularly around the Johnson & Johnson vaccine. That was in a report today on the The Irish Times online. Does the Government have a contingency plan if that scenario happens and if there is an excess of vaccines that we could possibly swap with other European countries or other blocs?

The situation the Deputy describes is not one we have at the moment. We are vaccinating several groups in parallel in order to make sure we are using all of the volume of all of the vaccines we get so that we have as fast and effective a programme as possible. However, it may well be the case that we will have excess vaccines as the Deputy said. Given that the countries that we could potentially swap with are in exactly the same position with the same vaccines, I doubt there would be an awful lot of room for manoeuvre. If we are in that situation, I would like to see what we can do in terms of our international obligations. We have an ethical and moral obligation to lead. We are a very small country but in things like international development we have always batted way above the average and we have led by example, even for a small country. If we have the situation the Deputy has discussed, I would like to see that we would begin to help provide vaccines to some of the poorest parts of the world. First and foremost, it is the right thing to do. Second, this has to be a global solution. It would ultimately be enlightened self-interest as well.

Yesterday, the The Irish Times online ran a headline which stated: "Easing Covid restrictions: Ministers want as wide a reopening as possible". This is not the first lockdown. We have had three lockdowns and a number of premature reopenings. We had two premature reopenings which had disastrous consequences. We should remember December and also last June. Last June the number of cases per day and per week was at quite a low level. If we had held out for a couple more weeks and had in place proper test and trace and proper international travel restrictions, we could have had zero Covid in this country. That does not mean zero cases but it means a very low number of cases that can be controlled. However, the Government reopened last June, under pressure from business interests and lobbies. Instead of having zero Covid, since then 3,000 people have died as a result of this disease. We should be in a position to be able to have a full reopening reasonably quickly if proper test and trace systems had been put in place by the Government but it has failed to do that. The reopening that is being discussed poses two questions. Is there a danger of another premature reopening? Is the Government in danger of opening the door to a fourth wave? The Government may say that this is different and that vaccination is under way. Vaccination is well under way in Chile.

It has a target of 80% by the end of June, which is exactly the same as us. In fact, it has vaccinated almost double the amount of its population that we have. However, a premature reopening there has resulted in a major wave that has put its hospital system under pressure. Will the Minister comment on these points? My advice is to be careful. The Government should not lose the run of itself. I detect in the comments of one or two Ministers in recent days a little bit of a tinge of what we heard in December. I would like the Minister to comment on these points.

I thank the Deputy for the question. I have a different view on his analysis on zero Covid and test and trace but I know that is not what he wants to discuss. My view is we need to be very careful right now. We are in a slightly risky position in that all of the indicators are very positive but we are not through this, to respond to the Deputy's point. There is a risk that too many of us believe we are through this, and maybe we believe we do not need to be as careful and we can have more social interactions and meet our friends in our houses because Ireland is doing well. The reason Ireland is doing well is because we have kept to these measures and because we have been careful. I agree with the Deputy. Right now, we need to begin to open up. We have started to open up but we still absolutely need to be very careful because this needs to be the last time we do this.

Notwithstanding the issue with supply, we are making real progress on the vaccine roll-out. I was delighted to take a call from a woman from Lanesborough in her 70s this morning who told me she was finally getting her vaccine this afternoon. I thank the GPs and their staff who have put in a massive effort and who are performing a real national service in the roll-out of the vaccine programme for the over 70s. I am delighted our vaccination centre in Longford will open on 3 May and will be administering more than 900 vaccines a day with a staff of 45 people on site. We do not get a county-by-county breakdown of the vaccine roll-out, but with 5,900 people aged over 65 in Longford in the 2016 census, it is reasonable to assume we are tracking the 22% national first dose average.

The public appreciates and understands there will be issues with supply, and in the main are appreciative of the huge logistic effort that has gone into the vaccine roll-out, which we have to remind people is the single biggest public health initiative ever undertaken in the country. What has continually frustrated the public in recent weeks is the mixed and negative messaging from senior figures in government regarding reopening our economy and a return to normality. A total of 90% of households in the country have put their lives on hold for the best part of a year. They have waited patiently, abided by an unnatural suite of restrictions and abided by the Government's every demand.

I appreciate that the process has required leadership from various Ministers, and I commend the Minister, Deputy Donnelly and the Minister of State, Deputy Butler, on the huge personal sacrifices they have made throughout this period. At this stage, the public wants to see them and their senior colleagues in government take the bravest of steps. We want to see a structured but defiant reopening against the backdrop of the escalation of the vaccine roll-out. Publicans, cafés and retailers throughout County Longford want to reopen. We want to return to mass and we want to play sport again. The reality is that normality will not come with the flick of a switch. With Northern Ireland escalating its reopening, it is not unreasonable to expect we should see a significant reopening of our economy by Monday, 24 May. For many, it has to be said, May is a line in the sand and I fear we risk losing the room after that date. It is often one of the best months of the year weather-wise and we are pinning a lot of our hopes on outdoor hospitality this year. In this respect, it is very important that the sector gets an opportunity to reopen in May.

We will see the easing of some restrictions on 4 May, including public worship, and I welcome the Minister's comments following his meeting with the archbishop. I earnestly feel that households and businesses throughout Ireland need to see a plan next week clearly setting out a timeline for the reopening of our economy throughout the month of May.

My understanding of recent reports is that a glut of vaccines will be available in the United States, with 800 million doses in total from start to finish being available. Has there been engagement with the US authorities on accessing this supply from the US? I understand Moderna, Pfizer and Johnson & Johnson vaccines will be available. Will there be engagement on this issue?

The next issue I want to raise is with regard to maternity services. There are still a lot of complaints from women in hospital maternity care whose partners and husbands cannot get to visit. In particular, I understand that even though a decision has been taken that partners can attend the 20-week scan, this is not being allowed in the maternity units of two hospitals. Why can we not have a common set of rules throughout the country? Recently, the Rotunda issued a directive and set out a clear timeline for people visiting their loved ones in a maternity setting. Will the Minister make a comment on this? Will the Department and the HSE issue a directive to all of the maternity hospitals on this issue?

With regard to the roll-out to those who are bed bound and cannot access their GPs, will the National Ambulance Service engage with the Army to see whether it can help to expedite the situation? Families are extremely concerned. They are not being contacted and do not know when their loved one, who may be in their 80s or 90s, and there has been one person aged over 100, will be vaccinated. I ask that this be expedited and a clear message sent back to families on this issue.

I support my colleague, Deputy Burke, on vaccinations and all of those women going through pregnancy in the middle of Covid-19 having their partners with them. I am so encouraged by the progress that has been made on the vaccination roll-out. The Government promised that in April we would see the roll-out being ramped up and we have seen exactly this. We have seen a huge increase in pace. We have seen it in vaccination centres such as my local vaccination centre in Citywest. Many of my constituents in their late 60s have now received their first vaccination. In fact, one fifth of all adults have received their first vaccination at this stage. It was announced today the portal will open tomorrow for those aged 64 and above. This is huge progress despite all of the challenges the vaccine roll-out programme has had to overcome.

In my constituency there is a clinic not administering vaccinations. Its patients over 70 have been left in limbo. At present, I am dealing with a couple in their very late 70s who feel completely left behind by the vaccine roll-out programme. Will the Minister open the HSE portal to those aged over 70 so those who are willing to take AstraZeneca can do so in centres such as Citywest?

I also want to point out that people in their 60s who have diagnosed blood clotting disorders feel they have been sent to the back of the queue because they do not want to take AstraZeneca and have not been offered an alternative. Is there anything we can do to assure these people it is safe to take AstraZeneca and allow them to get their vaccination as quickly as possible?

I will keep it short to give the Minister time to reply. Cork South-West is very lucky to have two vaccination centres covering the region at the GAA complex in Clonakilty and the primary care centre in Bantry. It is absolutely fantastic to have them and I thank the Minister for his work. I also thank the HSE and the local community healthcare organisation, CHO. The question people now want answered is when vaccinations will begin in them. People have seen footage of how they are set up and now they want to see vaccinations happening. Will the Minister give me clarity and an answer on this?

My next question is similar to that of Deputy Higgins on those aged between 60 and 69 who will be administered the AstraZeneca vaccine.

I have been contacted by people in that age group who are concerned, because they see that in Denmark they have suspended the use of this vaccine. They see similar steps being taken in South Africa. All I am looking for from the Minister today is assurances, clarity and a explanation as to why this approach and these steps have been taken so that I can go back to them and say this is the rationale here. I would appreciate it if he could come back to me on those.

I thank the Deputies for their questions. I will run through them quickly to try and get to all four.

I take Deputy Flaherty's point on wanting to get back to normal life as quickly as possible. We all want it. We are all desperate for it for ourselves and our communities, and our business communities are all desperate for it. However, we still have to proceed with care. One of the reasons Ireland is doing so well, our vaccine programme is going so well, we have one of the lowest virus levels in Europe and we have the strongest measures against the importation of variants is we have approached all of this from a safety and public health perspective. Even though it is harder now than ever, as the weather gets better, as case numbers are lower and as more people get vaccinated, we still must proceed with care and the caution that our public experts are still urging.

In response to Deputy Higgins's point, if she wants to give me the details of a clinic that is refusing to administer vaccines, I ask her to let me know because all of the patients from that GP practice must, of course, be vaccinated in their local community. The question on the portal is one I can take back.

A question Deputies Higgins and Christopher O'Sullivan both asked was around reassurance for AstraZeneca. What we can do is keep asking the experts to go on the radio and television. There is a great deal of advice online on and the HSE and NIAC's own page. The reports underpinning the advice that comes in to me, and indeed the letters from the deputy CMO, are all available online. I will revert to Deputy Christopher O'Sullivan regarding the west Cork vaccination centres.

In response to Deputy Colm Burke on the maternity visitations - it is something that has been raised with me on several occasions - I am aware that for mums and their partners, it is important that they can get in, particularly sometimes when things may not be going as well as we would want. These are decisions being made locally by the maternity hospitals. They are obviously putting the safety of mums and babies first and they are aware that we want to relax those restrictions as quickly as possible.

Finally, the Minister of State, Deputy Butler, will take back the points on the Defence Forces and the housebound.

The HSE recently sent out an invite to all elected representatives to visit the vaccination centres in the midlands, Louth and Meath area and there was a list of eight vaccination centres. Drogheda was No. 8 on the list but it was on the list as "to be confirmed". They still have not identified a site. In fairness, they have had ample time to do that. I have been chasing it with them. Will the Minister get on to the HSE and ask them to expedite the identification and opening of the vaccination centre in Drogheda?

I also wanted to ask the Minister some questions about the vaccine roll-out in terms of tourism and hospitality. Public health experts have clearly stated that a rapid and efficient vaccine roll-out is the only way out of this pandemic and to allow the reopening of society, but I am sure the Minister will also be aware that representatives of the tourism and hospitality sector have been looking for some vaccine metrics as a way to guide them to the reopening. Does the Minister have a percentage of the adult population that will need to be vaccinated in order that the hospitality sector can reopen and can he confirm that by the end of June 80% of adults will have received at least one vaccination? Has he a level of community transmission that will need to be met to allow for reopening? Finally, can he confirm whether there will be different rules for people who have been vaccinated as opposed to those who have not? If the Minister could answer those first, then, if I have a chance, I will come back in with some other questions.

I thank the Deputy for her questions. With regards to the vaccination centre for Drogheda, I will take that back to the HSE later today. Deputy O'Dowd has asked the same question.

The short answer on the other questions is there are not precise numbers that public health follows. There is no single measure or metric in terms of the level of cases, the level of transmission or the percentage of people vaccinated that leads to certain measures being relaxed. Essentially, what happens is NPHET looks at all of the data in the round and brings a recommendation to me that I then bring to Cabinet. At the same time, Government looks at a wide variety of additional measures around the economy and various other social metrics as well. The Covid committee meets and then Cabinet meets. That is the process whereby decisions are made. Many different matters are factored in.

I hear loud and clear the same calls that we all are getting from our constituencies right around the country that people want society to open up as quickly as possible. Obviously, hospitality wants to open as quickly as possible. Hospitality, the music industry and the arts, for example, have borne some of the heaviest brunt of all of this. The reality is their worlds, the wonderful things they do for us, are to allow us to congregate to meet each other to experience music or whatever it may be and, unfortunately, that is where this virus spreads. We cannot give exact dates at present.

With regard to four out of five people who want a vaccine being offered one by the end of June, we are on track but, as the past week has demonstrated, it can be a very bumpy road. We had a lot of vaccines restricted and the next day we had more than 500,000 additional doses come online. At the same time Johnson & Johnson stated it was pausing delivery of its vaccine. People talk a lot about targets. Our target, my target and the HSE's target is that the vaccines are administered as they come into the country. If they continue to come in at the rates that we have been told, then we are still on track at the end of June for four-in-five adults who want a vaccine to be offered one.

Deputy Berry is sharing his time with Deputy Tóibín.

The House will be aware that I am a big supporter of the Covid-19 vaccination programme, despite all its obvious imperfections. Every Deputy recognises that this is our ticket out of this crisis and that every available resource that the State has at its disposal should be brought to bear on this problem and used to assist this programme.

I have two questions for the Ministers. They are not criticisms but rather observations and suggestions for improvement. The first relates to the appointment of the chair of the vaccination task force, Professor Brian MacCraith, who is doing a good job under difficult circumstances. Is he employed in a part-time or full-time role, and if he is not employed full time in this role focusing exclusively on this problem, might the Minister consider elevating his appointment to that of a full-time position in light of its importance?

The second question relates to the National Emergency Co-ordination Centre. That is located on a floor of a building on the Leinster House campus. The centre was established specifically to deal with a multi-agency response to a national emergency. It has served us well over the past ten or 15 years when it came to severe weather events and it can serve us well again. It is lying completely idle at present.

My own experience of the vaccination programme tells me that we are lacking a centralised hub, a one-stop shop or location from which to co-ordinate the national vaccination roll out. It would make the Minister's job much easier. I empathise with his position; he is dealing with a very complex situation which is fast moving and has a lot of moving parts. We need a centralised location, manned 24/7 to co-ordinate the roll out of the programme because it is of such importance.

The National Emergency Co-ordination Centre was established for a very good reason, namely, to provide a nationwide co-ordinating facility. I find it unusual that we have decided to dispense with our national emergency response framework right on the eve of battle, when we need it most. I would welcome the Minister's comments on this. I have no further questions but look forward his response as to whether the role of chairman of the vaccination task force should be full time and whether he will consider using the National Emergency Co-ordination Centre to co-ordinate the vaccination programme.

I thank Deputy Berry for his questions and can assure him that Professor Mac Craith is working beyond what would normally be considered full time. If full time is 40 hours per week, although I know it is a lot longer for a lot of people, then Professor Mac Craith is working well beyond that. I speak to him almost daily, including early in the morning and late at night and I commend him and the rest of the task force on the work they are doing.

I do not believe the National Emergency Co-Ordination Centre is the right place for the vaccination programme, which is a core competence of the Department of Health and the HSE. Notwithstanding what has been a bumpy road, with by no means everything done right, the vaccination programme rightly sits with the Department and the HSE. That said, the Deputy asks a very fair question in the context of a whole-of-Government response to an emergency like Covid-19 and it is something that we will keep under review.

Last week the Minister flew a kite about 30 year old people being vaccinated. I was shocked because I had just been on the phone to a family of a 92 year old who still had not had her first vaccination. I submitted a parliamentary question asking if all 85 year olds who wanted vaccines were fully vaccinated but did not get confirmation of same. When will those who are over 85 who seek vaccination receive their first dose and when will they be fully inoculated?

I also submitted a parliamentary question on a claim that has been submitted to the State Claims Agency by a family whose loved one contracted Covid-19 in a hospital setting and subsequently died. Obviously, we offer our sympathies to that family. I have heard of many people who have had similar experiences. I have no doubt that most hospitals did their best to keep the illness out. However, many front-line workers felt abandoned by the Government in terms of understaffing over the course of the pandemic. Such understaffing is incredible given that 74,000 people responded to the Be On Call for Ireland campaign, with only 54 employed by the State this time last year. I have also heard of situations of negligence by the HSE in terms of people contracting Covid in hospital and subsequently losing their lives. Have similar cases been brought to the Department which have not yet made it to court? The Government indemnified vaccine companies against any adverse effects that might occur. Has anyone approached the Department regarding compensation for adverse effects experienced following vaccination?

There is no doubt that there is a need for caution but the Government's approach to lockdown right now is disproportionate. This is not December or January. Hospital admissions are now, thankfully, low, ICU occupancy is also low and 1.2 million people have had a vaccine. In that context, there is a necessity to open up elements of Irish society now. First and foremost, when will cancer, heart disease, stroke and mental health services be fully reopened? People in need of such services have been de-prioritised, even though many are in life-or-death situations. When will the provision of outdoor hospitality and pub services resume? We know that the levels of transmission of this illness in outdoor settings have been extremely low. Finally, every time I ask the Government about religious practice, I am told that it will resume at the same time that museum and gallery visits resume. Museum and gallery visits are important but religious practice is an international human right. Are they pitched at the same level by this Government?

I thank the Deputy for his questions. The over-85 cohort has been substantially completed but there is no doubt that across our country there will be people in that age group who are still waiting. Deputy Higgins, for example, said earlier that there is a GP in her constituency who is refusing to vaccinate his patients who are over 70 and that alternative arrangements need to be put in place. Similarly, the Minister of State, Deputy Butler, has given a lot of detail in this session about housebound people, the majority of whom have now been vaccinated, although not all of them. Can I tell Deputy Tóibín that every single person over 85 has been vaccinated? No, I cannot. What I can say is that the vast majority have been vaccinated. There is a relatively small number, some of whom are housebound, outstanding. If there are others, like those referred to by Deputy Higgins, they must be prioritised.

I will provide a note to the Deputy on legal cases. On the resumption of health services, Deputy Tóibín and I discussed this the last time we interacted in the Dáil and I wholeheartedly agree with him. In fact, I had a meeting yesterday with the chief executive of the HSE and one of the items we discussed was the resumption of services. All I can tell the Deputy, and I hope he believes the good intent of the Department and the HSE, is that we are acutely aware that so much important healthcare had to be paused during the pandemic. Many essential services have continued but we want to get them all back up and running as quickly as possible.

I welcome the Minister and Minister of State and am grateful for the opportunity to examine the Covid-19 vaccine roll out. At the outset I want to place on record my own appreciation to the doctors, nurses, members of the Defence Forces, vaccinators and others involved in the critical effort to bring our nation out of this pandemic. News that more than 1.25 million vaccines have been administered is extremely welcome. We have seen the positive impact of the vaccination programme on our nursing homes and hospitals and internationally in countries like Israel, the UK and the USA.

The vaccination programme combined with other public health measures will bring us out of this dreadful pandemic and allows us to return to normality during the summer. The programme has generally been successful but there are challenges. Like other Deputies, I have also been contacted by people over 70 who are housebound. The National Ambulance Service has done a fantastic job in administering vaccines to approximately 1,700 people in their own homes but I understand that around 300 people are still awaiting their first jab. It is critical that good communication is maintained with those people and their families so they can be reassured that they have not been left behind.

Many people in the high risk and very high risk categories have also been in touch with me. Some GPs are not dealing with this cohort at all and in such cases, arrangements should be made for them to register with their local HSE area office. Finally, I understand that a number of genuine, front-line workers in category 2(g), who were registered through the portal may have been left behind. I hope that is not the case but will forward the details to the Minister's office.

Will the Minister investigate the possibility of including other vaccines approved by the EMA, the FDA and other regulatory bodies in the list of accepted vaccines for people entering Ireland?

I have been a long-time champion of walk-in PCR testing, particularly in hot spot areas. We have seen a reduction in case numbers over the last few weeks. Has an analysis been done of the impact of the walk-in test centres in hot spot areas on overall numbers? Does any such analysis suggest a role for such test centres or for more widespread PCR testing as we continue to vaccinate people, as well as in the post-vaccination period?

We know vaccination alone does not end Covid, much as we would like it to be the case. Will increasing asymptomatic testing be available? I believe it has had an impact in my area. I can see it, anecdotally, and would love to see if there was data to back that up.

I will speak about the vaccination roll-out. It may not be known by the public that the great majority of people will be vaccinated by Pfizer and Moderna, in the main. When does the Minister expect the European Medicines Agency to come back to NPHET in respect of reviewing and extending the second-dose period? Has he looked at information from Pfizer showing 80% efficiency-proof against the virus after the first dose? Has he looked at extending the second-dose interval period from four weeks to six, eight or 12 weeks and the impact that will have on the roll-out of a first dose to the population at the end of May and the end of June?

I thank the Minister, the Minister of State, all in the Department and, moreover, the front-line staff who are helping to deliver vaccinations at huge speed at the moment. It is massively appreciated. I will speak briefly about mandatory hotel quarantine. It had a real high-value purpose in the early weeks of this year when there was a major risk of new strains of Covid coming into the country. The Minister has evolved and refined it in recent times but I am still concerned that the Sinopharm vaccine, which many Irish citizens domiciled as ex-pats in Abu Dhabi have received, has not been recognised in Ireland as a legitimate vaccine for exemption from the mandatory quarantine period. That urgently needs to be looked at.

In Ennis, our Covid vaccination centre at the West County Hotel opened yesterday. It is going fantastically except that there are long queues of people waiting. There needs to be a refined way of rolling it out, perhaps by waiting in the car park area. There is a no seating area about which many elderly people are complaining. That is just an administrative issue I hope the Minister will communicate within his Department.

The National Ambulance Service has been tasked with getting vaccines to the infirm and those confined to bed. However, Margaret Morgan from Kilmurry McMahon, a woman in Clare aged 101, is one of about 1,500 who are still a little uncertain about how this is working. She is one of the oldest citizens in our country and is still awaiting her vaccine. I ask the Department officials to put her out of her anguish. Her family have been on the airwaves all week trying to find out what is happening for their mother. I do not expect answers today but maybe the Minister of State, within the chain of command, can try to rectify that for her.

On church and religious services, others have made the point that we need at look at churches for what they are. They are large, vaulted buildings. Most days of the year people in them are socially isolated anyway. Very few people are going to Mass, in the traditional sense, as they would have in years gone by. We urgently need to look at them in the next tranche of reopening.

I thank the Minister and the Minister of State for making sure our country is seeing a massive ramping up of the roll-out in recent days and weeks. I particularly thank the Minister for the roll-out of the community vaccine centres. I had the privilege, last night, of meeting the staff who are ensuring that happens in Cavan and Monaghan. It was a fantastic sight and I thank those staff, who are all exhausted at this stage, who took time out to show Oireachtas Members around a state-of-the-art set-up in a hotel. It is unbelievable what can be done. A recovery area and booths are all set out in such a safe way I am sure they will have no difficulties. I thank Cara O'Neill, Celine Corcoran and Aisling Duffy for their time, care and professionalism in delivering vaccinations across Cavan-Monaghan. The ramping up has been incredible over the last couple of weeks.

I again echo what the Minister heard today regarding those who are housebound. We have had difficulties in being able to get clarity and information to people. It seems that information is being lost in translation. I do not know whether that has to do with systems. I urge that, if there is anything more to be done, it is speeded up for people.

I also draw the attention of the Minister and the Minister of State to maternity services. That was mentioned here today. I am delighted that the Minister has made the point that hospitals can make their own decisions on numbers, capacity and the extra pressures on them in this area. As the Minister knows from his visits to both Cavan and Monaghan, and seeing Cavan General Hospital, we are incredibly lucky to have both the maternity service and the midwifery led unit, MLU. It is critically important that we start to allow husbands and partners in for women, particularly for first-time mothers who find it traumatising to head into hospital without their loved one.

Finally, I came across a case of somebody who has spent a long time in hospital. Their GP missed the deadline, through no fault of theirs, in registering for the vaccine. This is a person who was brought home from hospital in the last number of days. The GP and I are finding it difficult to find out who in the HSE is responsible for ensuring somebody home from hospital will get the vaccine as well.

I thank the Deputies for their questions and kind words for everyone working in the vaccination programme. As I know all Deputies will fully appreciate, the people running the programme right across the country, in so many different areas, are working flat out. I engage with them at weekends, at 7 o'clock in the morning and at 11 o'clock at night. They are working non-stop. It is a great privilege to be part of that. I would like to share with the House that it is fantastic to see such a national effort. The HSE, the ambulance service, general practice, everyone in the vaccination centres and the Defence Forces are all involved. It has been an incredible thing to watch Ireland at its very best rolling this out.

As regards Deputy Devlin's question, the current situation on fully-vaccinated exemptions from hotel quarantine are only for EMA-approved vaccines. There are currently 12 vaccines in use around the world. To date, four are approved by the EMA and as of now they are the only ones that have an exemption. I will feed the Deputy's point into the Department so that it can be considered.

On Deputy McAuliffe's question, the walk-in, pop-up PCR centres have been a major success. We are launching another load of them this evening. I believe we are getting one in Wicklow. I know the Deputy has one in his constituency. The positivity rates out of them are, generally, in excess of 8%, which suggests they are very useful. About one in every 11 or 12 people going in is testing positive. Critically, people who are concerned and who may have friends or relatives who are more vulnerable to Covid are getting tested to make sure they are not infected at this point. There has not been an analysis on the wider effect. It is certainly something we can look at. There is much demand locally, we are doing more and more tests and they seem to be going very well on the ground.

On Deputy O'Donnell's question with regard to a decision on the mRNA vaccine, I expect a recommendation in the coming days. Exactly what the Deputy has suggested is being looked at, which is, what happens if we extend the interval from four weeks to eight or 12 weeks.

I thank Deputy Crowe for his comments. We are very aware of the issue he raised around some longer waiting times for the vaccination centres that have just opened. Every one of those centres is working to get faster and faster.

Today I was approached by a group of Irish citizens working in Abu Dhabi. There are 10,000 Irish citizens living and working there. The United Arab Emirates is the fifth most vaccinated country in the world. The group which has been in contact with me will not be allowed into Ireland without mandatory hotel quarantine even though they have been fully vaccinated and can quarantine at home. In January they were offered Sinopharm as they faced significant local pressure to take the vaccine so they could keep their jobs. A number of these Irish citizens are tested weekly for their schools. One Irish citizen told me that he has had 37 PCR tests. This group has no issues providing antibody tests, prior to travelling, to show the effectiveness of the vaccine.

Sinopharm is currently undergoing approval from the World Health Organization and has been exported to more than 70 countries globally. The United Arab Emirates has a population of 10 million and has had 2,000 deaths, half that of Ireland's. To date, the United Arab Emirates has administered 9 million doses of vaccine.

This group of citizens is looking for permission to return home without having to do a hotel quarantine, since they can quarantine at home. Please accept that they have been vaccinated and let our citizens home.

I am aware of the situation. The current public health advice to me is that the exemption should apply to EMA-approved vaccines. I believe that list will grow. Sinopharm is one of the 12 which is not within the four that have been recognised by the EMA, but it is a reasonable question. The question being posed by Irish people who are in the Emirates right now is reasonable and I will seek a view from public health on it.

To clarify a question Deputy Christopher O'Sullivan asked about when vaccination centres are opening in west Cork, I thankfully have the answer, for once in my life. My brother is a councillor and member of the south-west regional health forum. He tells me that the Clonakilty centre will be open on 3 May, which is important for the Clonakilty, Bandon and the Skibbereen area. The Bantry primary care centre will be open on 28 April. That is a bit of clarity.

The Tánaiste said that anyone who refuses the AstraZeneca vaccine will have to go to the back of the queue. Many people I know in the 60 to 70 age bracket may have a history of clotting in their family. They should not be put to the back of the queue. What are the Minister's view on this?

I thank Deputy Collins. It is good to see him be so generous with information for his constituency colleague.

I thank the Deputy. The question has been put to me directly in the last week and a half. I do not want to stray into giving medical advice, which I am not qualified to give. I put the same question to public health and the Department and the answer I got was that the issue has been looked into in great detail, and the advice from NIAC is that there is no additional risk. However, I am conscious that I am not an expert or a clinician, so I would like to revert to the Deputy and, indeed, to other Deputies with a precise answer from those who are experts in the field to explain the position.

Thousands of Irish people living in the United Arab Emirates got the Sinopharm Covid-19 vaccine at the first opportunity in February with the hopes of being able to travel back to Ireland this summer. They are now unable to get any other vaccine. On Sunday, the Minister, Deputy Donnelly, tweeted that people who are vaccinated will be exempt from the hotel quarantine. He listed Pfizer, Moderna, Astra-Zeneca and Janssen, with no mention of the Sinopharm vaccine. More than 70% of people in the United Arab Emirates are vaccinated but this seems not to be enough for the Irish Government to allow them to quarantine in their own towns. I am looking for clarity on this issue. I know my time has run out so the Minister cannot give it.

While I have the floor, since I do not have much chance to raise it, Vera Twomey and the medicinal cannabis issue is a significant issue and I would appreciate the Minister meeting us.

I ask the Ceann Comhairle to ask the Minister to reply to me in writing. I have never got a reply in writing and I have raised the matter with the Minister and with the Government Chief Whip, Deputy Jack Chambers. It is an insult to the people who elect me in Tipperary.

Why are the HSE and the Department of Health not collating figures of people who have a delayed diagnosis of cancer and a missed diagnosis? There are 38,000 people waiting for colonoscopies alone and many other diagnoses have been delayed. What are we hiding?

Regarding the AstraZeneca vaccine, in March, student nurses were forced to take it. The Taoiseach said they had to take it or their careers would be forfeited. In April, they were told that they should take it. In February, it was not safe for young people and in March they had to take it or their careers would be forfeited. In April, we see that it is only for over-60s. What about the nurses who have been forced to take this? How is the Government going to compensate them or give them any sense of fair play or respect?

The Taoiseach met church leaders last Thursday. On the same day, the Minister was signing into law penal sanctions against priests who say mass, hear confessions, go to mass or whatever else. What does the Minister have against the church and the Christian faith especially? It is time that he answered the question and told us.

I want to know about the UAE too. I know many teachers who want to come home. They are vaccinated. They have been tested numerous times. Why should they be quarantined? That question has also been asked.

When will the Minister of State, Deputy Butler, and the Minister, Deputy Donnelly, meet with Councillor Kieran Bourke and the action committee which they committed to meeting with, to save St. Brigid's Hospital in Carrick-on-Suir? It is a wonderful facility which the Minister shamefully closed down. It is a shame on the Minister of State, Deputy Butler. It is up the road from her own family who might be using it. They closed it down and turned their back on the people.

That is a separate matter and not for today's discussion.

It is. It was being used as a Covid centre and then it was unceremoniously closed down, so it is very much so.

Deputy McGrath has come in here week after week and made contributions like he has just made. He has just said several things which are verifiably false, and importantly so. He has stated some quite outrageous things, such as the Taoiseach-----

Why will the Minister not put the answer in writing and refute it?

Let us not have an argument.

I am serious. I have never got an answer from the Minister.

Can we hear the Minister and then we will see how we progress?

The Deputy has just stated some really dangerous things, such as saying that healthcare workers are being forced to take vaccines. The problem is that this is a questions and answers session. Every week, the Deputy comes in here and, every week, just like this, he has said many things, many of them false and several of them dangerous.

I asked questions for answers. I do not get answers from the Minister.

I asked questions. I did not say things. I asked questions.

Can we hear the Minister?

Deputy McGrath has never once, just as with this week, left time for me to answer or address anything he has said. The protocol in this session is not that Deputy McGrath stands up and makes a list of false claims then gets responses in writing from me. It is a questions and answers session. If the Deputy wants answers, I am here, but he has to leave time for me to correct many of the dangerous and false things that he continues to say every week.

I am on the Business Committee. I understand quite clearly that we can choose to use our time for questions and written answers. That is part of the protocol. The Minister, Deputy Donnelly, is telling lies to the House as he did about the churches some months ago. We can ask questions and ask for written replies if there is not time. Is that right or wrong?

I will try to bring some clarity to this. It would be better if we did not start accusing each other of acting inappropriately. My understanding, for everybody's benefit, is that this a questions and answers session and it is desirable that those asking the questions leave time for the questions to be answered, but in circumstances where people have more questions than they have time available to them, it is and has been my understanding that Members might indicate that they would be happy to have a response in writing. Deputy McGrath has raised this repeatedly at the Business Committee. It seems as though we will have to resolve the communications difficulty at that level because it has not been resolved to date.

The Minister will excuse me if I leave out the "thank yous". We are dealing with a pandemic where we have had almost 250,000 cases and the up-to-date figure for deaths is 4,856. I have always said that vaccination is part of an overall programme. I stand here week after week in utter frustration that there is no overall discussion. I do not blame the Minister for that. The Taoiseach should lead an overall discussion about where we are on this.

I have a specific question for the Minister about the call centre. More than four weeks ago, he mentioned it as part of his speech. To sort out communication difficulties, he established a call centre. I do not wish to waste my time now. I ask the Minister to answer in one sentence where it is, what it costs and why I have not got an answer four weeks later.

Are we referring to the call centre for GPs or the HSE Live call centre?

I am not going to go through this and I will tell the Minister why. He included it in his speech four weeks ago. When he had finished his speech and I eventually got my turn, I asked him about that call centre. He said he would come back to me with the details. I emailed his office and it came back to say that it would tell us, but it did not. Then it came back to ask which call centre. We said it was the call centre that the Minister referred to in his speech. I will park it unless the Minister can answer me because I am not talking down the clock. The Minister referred to a call centre as part of the solution to the communication difficulties.

The Minister was to give me all of the details. I have not got them. Can the Minister commit today to giving me all of the details?

The Deputy most definitely should have got those details if I committed to doing that. The only question I am trying to clarify concerns the fact that there are two call centres. There is one for GPs and one for the public.

I thank the Minister, but I will have all the details. It is not a question of how much knowledge the Minister or I have. It is a question of the Minister including it in his speech four weeks ago. I know nothing about that now because I am still waiting. I ask the Minister to please give me a commitment that he will do that, and I will be happy with that. Mind you, I have got a commitment twice already with no result. It is important, because at that point there was huge consternation among GPs regarding communications difficulties and the roll-out of the vaccination programme. The Minister said that this was part of the solution. I would like to know the details.

I thank the Minister and the Minister of State for their speeches. Regarding the ambulance programme and vaccinations, I would like to know how that is managed operationally. Does the National Ambulance Service work from Dublin or is it based locally?

The ambulances are based in the various CHOs and are not just coming out from Dublin.

Lovely. While the Minister of State is on her feet and regarding respite services, I know her heart is in the right place. However, more than a year later the families have no respite. They are going to go under. Surely, it is not beyond the ability of the HSE, or whatever is the appropriate organisation on the ground, to restore safe respite services

Respite services are available in certain cases. Those services have not stopped completely. For example, I dealt with a case in Galway last week concerning respite. I also dealt personally with another case in Waterford where the person concerned had to have home adaptations and respite was provided for two weeks. Therefore, respite is still available, but on a case-by-case basis. The Deputy can come back to me on this issue.

That is fine, but I am going to come back to this issue. I do not like doing this case-by-case, because I know that Ministers and Ministers of State are very busy. I must come back to it, however, because we have to know about the situation on the ground.

Turning to temporary accommodation for healthcare workers, I would like the Minister to address this issue. Briefly, why has this debacle arisen where two healthcare workers were sent home? I have tried raising this before referring to it here on the floor of the Dáil. I always try to do that first, but I have been told in a reply that that temporary accommodation scheme has not been stopped. Yet, the interpretation of that scheme allowed for two workers to be sent home. Can the Minister add to that or clarify the situation for me?

I apologise, I am genuinely trying to be helpful. I will need more details on the specific case. If the Deputy has not been getting the detail in writing from me through parliamentary questions or, indeed, through our debate here, she should be. It is something I will take back with me today.

That was not my question. I had moved on from that. This is about an issue which arose, and that has been in the news on RTÉ and in various newspapers, about two healthcare workers being sent back to direct provision centres, as it happens, because temporary accommodation was not available. I have gone to the trouble of tabling questions on this issue and I am told that the temporary accommodation scheme is up and running. Yet, it is being interpreted that temporary accommodation will only be provided to workers in the case of a cluster or an outbreak. I will leave that issue with the Minister.

Turning to some general comments on vaccination, I think the comments by the Tánaiste that people would go to the bottom of the list were appalling and unacceptable. It is an insidious interference with the doctor-patient relationship and the manner in which the programme for those aged 60 to 69 has been rolled out. They must go onto a portal, regardless of their medical history. I cannot tell the Minister how many calls I have received from people with different medical backgrounds, cancer being one of them, and who have had previous clots. Those people were told to go on a portal, take what they got or go back to the bottom of the list. The Minister did not say that, but that is the message coming from the Government. It is totally shocking and unacceptable. I would appreciate if he could take that message back.

I refer to a compensation scheme. A report prepared by Mr. Justice Charles Meenan was published in December of last year concerning alternative mechanisms for medical negligence. Part of that related to vaccinations. What progress, if any, has been made in that regard? What discussion, if any, has there been concerning these vaccines, which are very much in a trial mode given the pandemic? What is going to happen in respect of a no-fault liability scheme? What estimate has been made of the indemnity given to I do not know how many pharmaceutical companies at this stage regarding liability for the State in that regard? Only a few seconds remain, so I am simply raising this issue once again on the floor of the Dáil in the hope that in due course it will come up for discussion here or perhaps the Minister will be able to enlighten me in a reply on the issues of the indemnity, the actions taken following the published report and the implications for the current round of vaccinations.

I thank Deputy Connolly. I call Deputy Carey now, and then the Minister will wrap up.

I commend the Minister on the vaccine roll-out, especially for those aged over 70 and front-line workers in the healthcare sector. In recent days, however, several cases have arisen in my constituency of Clare concerning elderly people who are housebound. These are the very people who were born just after the previous pandemic hit our country. I am aware there are technical details to be accomplished and that these cases were referred by GPs to the NAS in early March to deliver the vaccine.

The first case concerns a 98-year old woman, Sarah Ryan, who is housebound and waiting for the NAS to deliver the vaccine, but she has heard nothing. Her family are worried, and they have spoken on national media about there having been little or no communication from anyone. Ms Ryan feels she is now divorced from her GP. The family feel they have just been left twisting in the wind and Ms Ryan feels she has been forgotten about.

The second case is that of a 99-year old man, Joe Kinneally, living in Kilshanny, County Clare, who hopes to celebrate his 100th birthday in July. He was referred by his GP to the NAS, as directed by the HSE, in early March. Mr. Kinneally's family have heard nothing since. They are becoming increasingly upset and are seeking clarity on whether he will receive his first vaccination, and hopefully his second as well, before his 100th birthday. They do not seem to be able to get answers from anyone. In fact, when watching the President celebrate his birthday last week on the "The Late Late Show", they mused which would come first for Mr. Kinneally: the President's cheque for his 100th birthday or his vaccine.

The third person is a 100-year old west Clare woman, Margaret Morgan, from Kilmurray McMahon, who is also waiting on the NAS to deliver the vaccine. Ms Morgan is hoping she will receive both doses of the vaccine to celebrate her 101st birthday on 1 June. She is hoping to celebrate this occasion with her family as she could not celebrate her 100th birthday because of the first lockdown.

Therefore, I am asking the Minister to investigate the progress the NAS is making with the 1,500 people referred to it by GPs. These people feel forgotten and lost in bureaucracy. My appeal is for him to direct the NAS to write by letter, and I emphasis write, to everyone on this list and confirm to each person that he or she is on the list and to also give those people an indication regarding when it is expected that it will be possible to deliver the first dose of the vaccine.

I thank the Deputy for raising this important issue, which has been raised several times today. To date, we have received more than 3,500 referrals from GPs concerning elderly and vulnerable people who are housebound and not able to go directly to their GP for the vaccine. Due to the complexity of the triage process, which follows from the referral concerning the GP, the individual to be vaccinated and their families, it has proved to be the case that the roll-out has taken longer than originally anticipated.

The NAS is operating a seven-day service and deploys more than ten vehicles every day to undertake appointments. We are averaging 400 appointments every week. The time it has taken to complete the project is driven by the complexities involved. For example, the requirements regarding remaining for 30 to 40 minutes at each residence. In approximately 10% of cases, visits can take up to 50 minutes due to medical histories that require a 30-minute observation period. We have also found that when the NAS has arrived at some locations, people have been vaccinated already. In other cases, the person concerned might have been admitted to a hospital or a nursing home. Unfortunately, in other cases, a couple of people have gone to their eternal reward, while others have decided they do not want the vaccine. At the same time, the NAS has gone to that particular house. However, I take on board what the Deputy said.

We will have an meeting in the next few days to see how we can expedite this. I want to highlight to the Deputy that nobody will be left behind. I know people are frustrated and angry. There probably has been a lack of information. We are telling people they will be got to, and they will be. At the same time, the National Ambulance Service is doing the best it can.

There are four minutes remaining, should the Minister wish to use them, or we can conclude the item.

I will be guided by the Leas-Cheann Comhairle.

We have come to the end of the list of speakers.

Am I to wrap up on the item?

Or was that Deputy Carey's time? I am happy to do whatever the Leas-Cheann Comhairle thinks best.

The time is running now for the wrap up.

I see. Thank you.

When I came in for the changeover, Deputy Carey had finished.

I thank Deputies across the House for their contributions. It is most valuable to hear them. Certainly, one of the things that the Minister for State and I will take away is the need to have an immediate conversation with the HSE and the Department in respect of doing everything possible to get to the housebound. The National Ambulance Service is doing Trojan work, but we will engage, particularly after today's session, to see what more can be done. It is very clear, as we know from our own representations also, there are many people who are still desperately waiting to be vaccinated and protected.

I will summarise by saying that it has been a very difficult year as we know, and we do not need to get into it again. The Leas-Cheann Comhairle quite rightly spoke to some of the very dark parts of what has happened over the past year.

I will state that the plan is working. It essentially has three elements, namely, the virus at home, variants abroad and the vaccine programme. All three elements of that plan are working, thanks to huge efforts from thousands of women and men all over Ireland.

In respect of the virus at home, we now have one of the lowest rates in the EU. Cases are down below 400 a day. There is a 10% reduction in cases week on week in comparison with last year. The R number remains below zero, though I am going straight from this session to an update meeting with NPHET and we will see what the R number is now. There have been no new outbreaks in nursing homes in the past three weeks, which is phenomenal. The number of close contacts for positive cases has remained steady, at 2.6. This means the credit for case numbers staying low does not go to the vaccination programme - not yet - but to the public for following the public health advice and keeping close contacts low. Many of the meetings that are happening are taking place outdoors, which is making a huge difference.

We obviously need to be careful. I know there is a growing desire for things to open and to open quickly, but we have been here before and there was a big clamour to open everything as quickly as possible. We must be careful. GP referrals have gone up again this week. The positive test results coming out of the laboratories have gone up again, and nearly every new case is the B117 variant. That means the situation remains volatile. While it might feel very positive, and indeed it is, it would take very little for cases to rise again very quickly. Therefore, for the next number of weeks we need to continue doing what we have been doing as we carefully reopen, which is something we all want.

In terms of guarding against the variants coming into the country, we do not live in an airtight container and there is no perfect protection against that, especially given there are two jurisdictions on the Island. However, the barriers to the variants are working. Mandatory hotel and home quarantining, preflight PCR tests and genome sequencing are all together having the desired effect. Ireland still has a relatively low number of variants, but we are very conscious of surges in variants in places like Canada, France, and most recently, as discussed today, in India. We are constantly keeping those under review. We now have by a long way and of any country in Europe the strongest measures against the importation of variants. It is working.

Our vaccine programme is working. Ireland has the highest percentage of over-80s vaccinated out of any country in the EU. It is something we should be very proud of. We are one of a handful of countries that have fully vaccinated - at least with a first dose - healthcare workers.

I will finish by reiterating my thanks to everybody involved. It is a huge effort right across Ireland in every town, village and city, and right across the healthcare, voluntary and public sectors. It has been an immense task. We are dealing with repeated large changes to the programme which we have to work very quickly to incorporate so that we can keep the momentum going. Therefore, I want to express my thanks to every single person who is involved in this effort.