Dáil Éireann debate -
Thursday, 6 May 2021

Vol. 1006 No. 5

Covid-19 Vaccination Programme: Statements

Minister for Health (Deputy Stephen Donnelly)

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

Considerable progress has been made in reducing infection levels since the start of the year. The main reason for this is widespread adherence to the public health measures. I and my colleagues are very aware of the enormous imposition these measures have had on people, on mental health, on isolation, on loneliness, on wellness, on livelihoods, and on so much more. Despite this, and in spite of how difficult it has been for everybody, Ireland has achieved and sustained one of the lowest rates of infections in Europe, and that is something for which everyone in this House is immensely proud of our nation for having achieved. I sincerely thank everyone around the country for their collective efforts and support of the public health measures over the past months. We are now beginning to see the benefits of this collective national effort to limit the spread of the virus and its impact on our communities. Last week, the Government agreed to move ahead with the next stage of our plan, Recovery and Resilience: The Path Ahead. The only reason we could do this was because of the national effort put in to suppress the virus, protect against the importation of variants and roll out the vaccines.

Ireland is one of only a handful of countries in Europe that has fully reopened schools. Over the past few weeks, our young people have been back playing sports. From Monday next, personal services, museums, galleries and libraries will reopen. More people can meet up outdoors, and this will include in gardens, which has been warmly welcomed. Our churches are recommencing in-person religious services and the numbers attending weddings and funerals will be increasing. Intercounty travel will resume, and this means families all over Ireland will be able to meet up with their loved ones and friends for the first time in many months. From 17 May, all remaining retail will open.

The effect of easing the restrictions on ongoing public health measures is, of course, being watched closely so we understand the impact of these changes in respect of the spread of Covid-19. If the situation remains stable, the Government intends proceeding with the next phase of easing restrictions in early June. While we are all keen to hear good news, we must be balanced, of course, in our assessment. The reality is that there is much that remains uncertain. It is important we convey to people just how important it is that we all stick with the existing measures while we are opening. As of 4 May, the 14-day incidence rate per 100,000 of the population was 134. That is one of the lowest rates in the EU, but it is still significantly higher here now than it was just two weeks ago. That figure has been rising.

Despite the progress, we know this is a virus, and particularly the B.1.1.7 variant, which accounts for the majority of cases here, that quickly gains a foothold when given the slightest opportunity.

The Seychelles, which is the most vaccinated nation in the world, is experiencing a big surge in Covid cases. It is not alone. By the end of March 2021, more than one in three Chileans had reportedly received a full course of vaccination, yet Covid cases are surging in Chile and authorities have had to look at lockdown measures again. Several reasons have been put forward for this unexpected jump, including the spread of more virulent strains from neighbouring Brazil and reduced adherence to social distancing during the vaccination programme, which some are suggesting, due to a false sense of security before a sufficient number of people were vaccinated.

We need to remain vigilant and continue to reduce the transmission of this virus in our communities. In particular, we need to stick to the new guidance on numbers of households and individuals meeting up outdoors and minimise the risks of transmission during close contact. As we all know, it is something which, as a nation, we know how to do and are good at doing, which is how we have had such a big reduction in case numbers since January.

The Government’s approach to tackling Covid-19 is comprehensive and includes measures to deal with the risk posed to our population by the variants of concern. We have the strongest measures in place anywhere in Europe, by a long way, in terms of minimising the importation of the variants of concern. The measures we have in place are working, and working well.

Mandatory hotel quarantine is one part of this, and plays an important role in combatting Covid and, in particular, variants of concern. As of 3 May 2021, 2,511 people have entered mandatory hotel quarantine, with 1,567 people having completed their stay. Some 75 cases have been detected among those residents, with nine of these cases being variants of concern. More may be discovered as we do the genome sequencing on the latest cases. Mandatory hotel quarantine is mitigating the risk of the spread of Covid-19 and, more importantly, the variants of Covid-19. It is, for now, a necessary component of our public health response to protect the public, our health system and our vaccination programme. One of the biggest benefits of the hotel quarantining system is not even in the figures I have read out. The biggest benefit is the deterrent effect it has on reducing the number of inbound travellers from the countries that our public health experts have identified as those of most concern to us because of the presence of the variants of concern.

The roll-out of the national vaccination programme continues apace and I welcome the opportunity to provide colleagues with an update. As of 4 May 2021, a total of 1,655,866 vaccine doses-----

(Interruptions).

An Leas-Cheann Comhairle

Is a copy of the Minister's speech available?

Deputy Stephen Donnelly

-----were administered.

Deputy Alan Kelly

It has happened again

Deputy Stephen Donnelly

I will ask. There have been copies every time we have come in here.

Deputy Alan Kelly

This is the third time I have come to the House and there is no copy of the Minister's speech.

Deputy Stephen Donnelly

The Deputy keeps asking and I keep telling him the copies are available outside. I will make sure he gets a copy.

(Interruptions).

An Leas-Cheann Comhairle

Deputy, please.

Deputy Alan Kelly

They were not available outside.

An Leas-Cheann Comhairle

Deputy, please. We will not point fingers.

Deputy Stephen Donnelly

A Leas-Cheann Comhairle, can I continue with my speech?

Deputy Alan Kelly

The copies are not there.

An Leas-Cheann Comhairle

Deputy, please.

Deputy Alan Kelly

They are not there. The Minister should not tell me that something is there when it is not. I have checked.

An Leas-Cheann Comhairle

Can we stop the clock for a moment? It is important for Deputies to have a copy of the speech. I know the Minister has given such copies to Deputies on previous occasions. There is a delay for some reason; I am not sure what it is. We will get copies of the speech. I ask the Minister to continue.

Deputy Stephen Donnelly

Thank you, a Leas-Cheann Comhairle. I want to say to the Deputy that previously copies of my speech were available. On this occasion, I have them. I was running late, but as soon as I finish I will furnish the Deputy with a copy, if that is okay.

I was talking about the vaccination programme. A total of 1,655,866-----

An Leas-Cheann Comhairle

Sorry, Minister. Did not one Deputy get a copy? Will there be copies available soon for everybody in the audience, or in the room?

Deputy Stephen Donnelly

Yes. I have them all here, a Leas-Cheann Comhairle.

An Leas-Cheann Comhairle

Lovely. Go raibh míle maith agat.

Deputy Stephen Donnelly

Thank you, a Leas-Cheann Comhairle.

I was talking about the vaccination programme. A total of 1,655,866 vaccine doses were administered as of 4 May 2021. Some 1,201,373 people have received their first vaccine dose and 454,493 people are fully vaccinated. As of this morning, 430,758 people have registered to be vaccinated on the public online registration system. This means that 77% of those aged between 60 and 69 have made use of it. It is important to note that the percentage of 65 to 69-year-olds registering is a lot higher than 77%. The latest information I have is that the percentage is in the high 80s. The HSE is running the analysis on that. What this suggests, importantly, is that the total registration rates will continue to increase in the coming days and weeks. The total of those aged 57 to 59 who have registered is now 104,000. The majority of these applications have been made through the public portal, while HSELive registrations are currently running at about 13% of overall registrations. We are now inviting people in their mid to late 50s to register to be vaccinated. From this coming Sunday, the registration system will be opened for the 50 to 54-year-old cohort.

As vaccine supplies increase, a lot of work continues around the country to scale up the vaccination programme. The estimated vaccinator workforce needed in the vaccination centres is 350 for April and 450 for May. Through hospital groups and community health organisations, 860 people are trained and available as vaccinators. Currently, 30 of the 38 vaccination centres are in operation, with the remainder planned to come into operation this month. This week a further 220,000 to 240,000 vaccine doses are scheduled to be administered with a view to building on the progress already made in relation to the target groups.

Our progress in relation to the vaccination programme compares well with those of the 30 EU-EEA countries referenced in the European Centre for Disease Prevention and Control’s Covid-19 vaccine tracker. Our strategy is to distribute all vaccines that we receive as quickly as is operationally possible, and we are doing this.

Our priority now is maintaining control over the disease and preventing a further wave of infection until vaccination can offer widespread population-level protection. Significant progress has been made in managing the spread of the disease and this, coupled with the impact of the vaccination programme, is what is making it possible to open up our society and community again. It is critical that our approach to reopening continues to be cautious and gradual to enable a safe and sustainable reopening and to ensure we protect the gains of recent months and vital public services.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I would like to thank Leas-Cheann Comhairle for the opportunity to update the House on the Government's response to the ongoing Covid-19 pandemic. The focus of my statement is on socially excluded groups and, specifically, how the Government and the HSE have sought to protect them from the threat posed by Covid-19 and our plans for administering the Covid-19 vaccine to these groups.

Not everyone faces the same risk from Covid-19. From the outset of the pandemic, NPHET and the Department of Health identified socially excluded groups living in congregated settings as having a heightened risk due to underlying health and social factors. A range of protective and mitigating public health measures are in place to minimise the impact of Covid-19 on these groups.

I want to acknowledge the collective efforts of public health officials, the HSE social inclusion services, Departments and agencies, the many voluntary service providers and representative groups, in minimising the impact of Covid-19 on socially excluded groups.

It is concerning, however, that the incidence of Covid-19 remains high among the Traveller community. Outbreaks in this community account for 62% of all outbreaks and 80% of all associated cases.

The high rate of Covid-19 among the Traveller community highlights the poor conditions in which Travellers live, the social determinants of health, and the behavioural issues associated with family events.

The long-term strategy for protecting socially excluded groups is through vaccination and better access to health services. At the end of March, the Government approved an update to the Covid-19 vaccination allocation strategy, informed by advice from NIAC. This strategy sets out the population prioritisation to best achieve the vaccination programme's objectives of preventing serious illness and death. The updated strategy prioritises members of the Traveller and Roma communities and people who are homeless as specific groups at significantly increased risk of hospitalisation or death compared with the general population. These groups will be vaccinated in parallel with the age-based approach for the general population. The strategy also recommends that a single-dose vaccine, namely, Janssen, may be preferable for these groups, who may find it difficult to return for a second vaccine dose.

The HSE has established a national operational working group to develop and implement a vaccination pathway for the prioritised groups using bespoke and targeted vaccination clinics. This pathway will ensure accessibility, suitability, optimal engagement and participation for the administration of Covid-19 vaccines to the target population. I am happy to inform the House that the first phase of the vaccination programme for prioritised groups commenced yesterday for medically vulnerable people living in homeless services in Dublin. This group includes persons with specific underlying health conditions that mean they would be at significant risk of severe disease or death should they be infected with Covid-19. Over the next two weeks, 700 medically vulnerable people in homeless services will receive the single-shot Janssen vaccine, with approximately 350 due to receive the vaccine this week alone.

Earlier this morning, I had the opportunity to visit the temporary vaccination clinic set up by the HSE in Dublin city centre to deliver the programme, where I met both the staff and clients attending the centre. This dedicated clinic is a landmark event in the Covid-19 vaccination programme. The vaccination of medically vulnerable people in homeless services demonstrates the value the Government places on equality and inclusion in the public health service. I pay tribute to the front-line healthcare workers who have protected medically vulnerable people in homeless services during the Covid-19 crisis. Through the Dublin Covid-19 homeless response team, the HSE, the Dublin Region Homeless Executive, DRHE, and voluntary service providers have greatly minimised the potentially devastating impact of Covid-19 on this group. They are now seeing the reward for their efforts with the vaccination of their clients. I thank the staff administering the vaccine and the Salvation Army for hosting the clinic. I congratulate the individuals attending the clinic, who have had to endure personal sacrifices to remain safe during the Covid-19 pandemic. Today, they are being liberated to return to social activities. Their return to society will be a positive one due to the health supports they have received during the Covid-19 crisis.

A side benefit of the pandemic is that we found new ways to provide health services for people who are homeless. We are reinforcing those new ways through an additional investment of €11 million in health services for people who are homeless during the Covid-19 pandemic under the HSE's national service plan for 2021. The vaccination programme for people who are medically vulnerable in homeless services is being delivered in bespoke ways. It is using the one-shot Janssen vaccine, which is new to Ireland, and the HSE is providing transport to and from the vaccination clinic. There is an active communications plan to encourage and support people to take the vaccine.

The roll-out of the vaccination programme to all the prioritised groups will ultimately benefit more than 40,000 individuals. Its delivery takes into account the unique circumstances affecting these groups, including the difficulties they may have in accessing health services and their low levels of health literacy. Other at-risk groups, such as residents in direct provision and people attending drug treatment services, will benefit from this targeted approach in due course. Listening to, and engaging with, vulnerable groups is critical to building confidence in the Covid-19 vaccination programme. Continuing the collaborative approach between statutory and voluntary service providers is essential. To support this, the HSE has convened a series of webinars for service providers.

While the lifting of restrictions is to be welcomed, the reopening of society should not be taken as a signal the pandemic is over. We must all play our part in continuing to protect vulnerable groups, including those in congregated settings. The Covid-19 vaccination programme is well advanced, with more than 30% of the eligible population having received at least one dose. It is a key enabler of the reopening of society and the economy and protecting socially excluded groups at increased risk from Covid-19. I look forward to hearing the contributions of Deputies on these matters.

Deputy David Cullinane

I am sharing time with a number of colleagues. Is the Government going to support the TRIPS Agreement waiver appeal that has been submitted by India and South Africa to the World Trade Organization? As the Minister knows, this would involve a temporary waiving of certain intellectual property rights. If it is implemented, it will bolster supply of Covid vaccines, which we all want to see, and send a huge message of solidarity to developing countries, especially those, like India, that are really struggling with Covid infections and need to see a real urgency in regard to the vaccine roll-out. A waiver would mean a much greater supply of vaccines in this State and right around the world.

The appeal is supported by Amnesty International, Human Rights Watch and Oxfam. It is gaining widespread popular support because there is a logic to it. It is part of the European citizens' initiatives, No Profit on Pandemic and Right to Cure, that were commenced by a whole range of political parties and organisations in the European Union. I commend the former Sinn Féin Deputy, Caoimhghín Ó Caoláin, who has played a major role in representing the State in that campaign at European level. The Biden Administration in the United States is now supporting the waiver. What is the official position of the Government in this regard and does it intend to take a strong position in terms of the EU's approach?

Deputy Stephen Donnelly

I thank the Deputy for his question. I want to say at the outset that the objective, which we all share, is global distribution of the vaccine. That is important for two reasons, as we have discussed here previously. One is that it is ethical and absolutely the right thing to do and, second, it is in our interests. There is no point in Ireland or, indeed, the western world being vaccinated if much of the rest of the world takes several years. The only question is what is the best way to do it. Ireland is continuing our conversations on this as part of the EU. There are a few points worth making. The EU's current position is that the WTO's TRIPS Agreement already has significant flexibility in it. It allows compulsory licensing, which, as the Deputy will be aware, is when a government permits someone else to produce a patented product or process without the consent of the patent owner. The EU's position is that this is catered for within the TRIPS Agreement.

There is an additional point to make, which is the question of what is stopping a very significant increase in manufacturing. Manufacturing capacity, access to raw materials and distribution networks, particularly around some of the vaccines that have to be stored at very low temperatures, are big issues. There are a lot of different options available, including possibly licensing agreements. We are continuing our discussions on this with the EU.

Deputy David Cullinane

I appreciate the response the Minister has given but my time is very limited. The question I asked is whether we are going to support, at a European level, what the Biden Administration is now supporting, which is a waiver under the TRIPS Agreement.

When the matter comes up with the World Trade Organization, the European bloc will obviously have its position. Is the Irish Government going to be a leader in this regard? Will it be a voice within the European Union to ensure this is something the Union will support?

Deputy Stephen Donnelly

We will most definitely continue to be a voice within the European Union stating that there must be global justice and an acceleration of vaccine production and distribution right across the world. The only question for us is what is the right way to do that. There are differing views as to whether a simple waiver achieves those aims. It does not identify many of the other bottlenecks. I am sure the Deputy knows that the EU has set up a task force to look specifically at what the bottlenecks are so we can accelerate global production and distribution.

Deputy David Cullinane

I must say I am not comforted by that response. It was a heavily caveated response, which I was not expecting, but that is a matter for the Minister and the Government. It would be much better if we had a strong position on this but it is a matter for the Government.

I will move to the vaccine roll-out and a question about registration. I am getting a lot of calls from people who are aged between 65 and 69, who have registered online and are yet to receive a call for vaccination. I presume they will get a call. What is the average time period between a person registering and getting a call? If a couple of weeks goes by, people are obviously concerned that they have missed something. Can the Minister give us an indication as to the length of the time lag between a person registering and when he or she can expect a call?

Deputy Stephen Donnelly

I will get the Deputy a detailed breakdown. My understanding is that it might be slightly different in the 65 to 69 age category than it is for those in their 50s. There are also some regional differences. I will ask the Department to supply the Deputy with a detailed response.

Deputy David Cullinane

It is important. I have checked with some of my colleagues, including those in government, who have been receiving similar queries. We want to be able to give the people the assurance that they are registered and will get a call. It would be good if we had some sense of the timeframe involved.

I also wish to put to the Minister the issue of pregnant women and permission for their partners to accompany them for scans. I have raised the matter with the Minister previously. In fact, I raised it many months ago with the Minister of State, Deputy Butler, and we had a constructive engagement in the Dáil Chamber. That shows how long it is since I first raised the issue. What I was looking for then and am looking for now is a uniform approach across all maternity hospitals. I understand the position is that in the majority of hospitals, the partner of the pregnant woman is allowed to accompany her for the 20-week scan and the birth. Given that we are easing restrictions, we could and should look at that area and consider extending that permission to other scans, especially during a complex pregnancy. We should be more flexible in better supporting the expectant mother and her partner. Will the Minister outline his position on the matter? What movement might we see in that area in due course?

Deputy Stephen Donnelly

This is one of the good news stories of the vaccine programme and the considerable reduction in cases of Covid-19 in healthcare settings, including maternity hospitals. The maternity hospitals are making local calls themselves. As the Deputy is aware, there are different rates of disease around the country and hospitals are faced with different local epidemiological situations. I will, of course, support the local infection prevention and control decisions that are made by the hospitals but I want to see, as we all do, as open access as possible but, critically, within the confines of what the local hospitals believe is safe.

The Deputy asked me about the Government's position on the waiver and I have given him that. My position, for what it may be worth, is that the waiver is a good idea and I would like to see it. The Deputy asked me specifically about the Government's position. The waiver is not a panacea or silver bullet but we must find a way to get vaccines around the world as quickly as possible. My personal view is that I would like to see the waiver supported.

Deputy Ruairí Ó Murchú

There was a recent scare of Covid-positive cases in Dealgan House Nursing Home. All necessary protocols kicked in and the worries were allayed. I commend everyone involved. However, I want to again bring up the issue of Dealgan nursing home and the tragic outbreak last year that resulted in the loss of the lives of 22 residents. The Minister and the Minister of State, Deputy Butler, met some of the affected families. The Minister has accepted that the families require a mechanism by which they can be delivered answers. The families are, obviously, looking for a public inquiry and I believe that is the best method for learnings and for providing answers. The nursing home, HIQA and the HSE all have questions to answer and a right to their narrative. Will the Minister give me an update? A number of these families have corresponded with him. There is also an issue about information they require and have looked for from the HSE. I will deal with that later.

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

I am very aware that listening to families can bring great learnings to many situations. While we are still dealing with daily case numbers, we are continuing to look at options that may be available to the State whereby it can listen to the voices of those who have lost a loved one.

Deputy Ruairí Ó Murchú

I accept that. I have a couple of questions for the Minister and the Minister of State about information that is required from the HSE. I accept that, in the near future, they will have to go back to the families on the issue of the mechanism that will provide the affected families with the answers that are required.

Deputy Matt Carthy

I am still getting calls, as I am sure other Deputies are, from constituents who are housebound and awaiting vaccination. These are people within older age categories. The questions they ask relate to who contacts them in the first place, when they will be contacted and the process that will be involved. I understand the ambulance service provides the vaccinations.

I would like if the Minister could give us a sense as to where testing and tracing will go over the next number of weeks and months. We are all agreed that the one thing we do not want to see is a repeat of what happened during previous periods of restriction easing. To ensure that, one of the key weapons we have is contact tracing. Is the Minister satisfied that enough staff are employed to deal with contact tracing? What levels does he see for the coming weeks and months? Does he anticipate an increase? Is anybody using the Covid tracker application anymore? Does it have a role to play? I do not see it being promoted through the HSE to the same level it once was.

Is the Minister satisfied about the issue around passengers arriving into this State from destinations that do not fall under the mandatory quarantine regime? I understand that out of nearly 250 flights, there was at least one case. There has been a consistent issue around the contact tracing of other passengers on those flights. Is the Minister satisfied with the system in place? Will the Minister also outline, if he has time, the situation as it now pertains to testing and tracing within the meat industry? Is he satisfied it is now at a level that can provide assurances?

Deputy Cullinane made a point about the patent waivers and the need for an international eye to all of this. There is a European citizens' initiative campaign under way across the EU. I commend my predecessor, former Deputy Caoimhghín Ó Caoláin, and Sinn Féin MEP Chris MacManus on the role they have played in that regard. It would be very useful if the Irish Government endorsed that course of action at a European Commission level.

Deputy Stephen Donnelly

Do I have the Deputy's remaining time to respond?

An Leas-Cheann Comhairle

Yes.

Deputy Stephen Donnelly

I will ask the Minister of State, Deputy Butler, to answer the question about people who are housebound.

I fully agree with the Deputy on testing and tracing. It has been, and remains, an essential part of our response to Covid and it has increased in the past number of days and weeks. In the seven days to 3 May, 124,000 tests were done. Some 4.5 million tests have been completed to date. The positivity rate at the moment is 2.7%. Some 94% of referrals are getting a test appointment in less than 24 hours, which is positive. Testing has restarted in schools, special education facilities and childcare settings. There are now 788 swabbers and 960 contact tracers hired and retained. The Deputy will be aware that serial testing is ongoing in nursing homes, mental health facilities, food production facilities and now in mandatory quarantine sites.

The Deputy will also be aware that we have launched the walk-in PCR testing centres, which have had a really strong response. No appointment is necessary. They are free and very fast, and people get their results back very quickly. Essentially, they are for people who are asymptomatic. If a person is symptomatic, he or she is still meant to go to via his or her GP.

Areas included are Letterkenny, Castlerea, Nenagh, Dunmanway, Tralee, Youghal, Waterford, Newbridge, Edenderry, Mullingar, Tullamore, Blanchardstown, Ballymun, Galway Airport and Castlebar. Three new centres opened this week in Milford, County Donegal, Cavan and Ballina. We announced another two centres for Donegal earlier. The locations are changing but it has been going down very well.

Genome sequencing is playing a bigger part. It was initially used to try to track down source identification for major outbreaks. We are using it now, obviously, for variants of concern. We were doing approximately 1% of all positive tests. We are now doing 20% of all positive tests, including the cases coming into the country. It has, therefore, been really useful. As the Deputy will be aware, we have also had a big push on rapid testing. On 1 April, a report was launched, and I am now working with colleagues across Government to roll out projects in the different sectors. It has, therefore, played a big part. We are doing new things such as rapid testing, much more genome sequencing and the walk-in centres, and it will continue to play an important role.

An Leas-Cheann Comhairle

Unfortunately, the Minister has left 20 seconds for the Minister of State.

Deputy Mary Butler

I am sure I will be answering that question later. As we all know, the roll-out to the housebound is extremely important. More than 3,500 referrals have been received from GPs for housebound patients to date. The GP determines and refers the person on to the National Ambulance Service.

As of 2 May, a total of 2,045 dose 1 and 739 dose 2 vaccinations have been administered, so that is just under 2,800 vaccinations. Currently, fewer than 500 people are waiting for their first dose and they will be done by the end of next week.

An Leas-Cheann Comhairle

We must leave time for the Minister. Deputies must stay within the time as I am under time constraints.

Deputy Alan Kelly

I have two blocks of two questions; I only have four questions. I want to ask something I had not intended but it is based on the Minister's response to a previous questioner. On the maternity services, there seems to be a direct contradiction between what the Minister said and what Mr. Paul Reid said an hour and a half ago. Mr. Reid said: "We believe the conditions are right that restrictions should be lifted" [in maternity units nationwide]. That seems pretty black and white.

I raised the issue earlier of Gary Toohey and his partner, Joyce Tooher, who are neighbours of mine. At this moment, he is actually outside the maternity hospital in Limerick. I know the maternity hospital. I have been there many times myself, luckily enough. Mr. Toohey is on social media at the moment thinking what Paul Reid said means the restrictions have been lifted. This is heartbreaking. It is so emotional. I know these two young people and their families. Let us forget about the politics and all the rubbish we do here. We have to give these couples some consistency and compassion, please.

Last week, Dr. Colm Henry said something and it was not followed through. I thought the Taoiseach said something and it was not followed through. Paul Reid has said it now. I do not want to go back to these couples and say again that it is not going to happen. Joyce is literally in labour at the moment and there are hundreds of other people like her this week. Whatever we do collectively, can we please show some compassion and sort this out?

I have two sets of questions. I am not trying to catch the Minister out with them. When will he make a decision on the HSE's recent application for whatever it is, the 27th or 28th version, on the Johnson & Johnson vaccine for under-50s? I have no problem with the fact that happens. I genuinely have no problem because it is doing its best. I believe the HSE is doing a good job. When will the Minister going actually give a decision as regards the use of the Johnson & Johnson vaccine for under-50s, however? I believe it is a critical decision. I know the HSE is waiting on this. The domino effect has an impact all the way down the line so we need a quick decision. When will the Minister do that?

Second, I received the Minister's figure of 77% regarding the 60 to 69-year-olds. I understand that leaves more than 100,000 people who have not been vaccinated. The concern used to be vaccine hesitancy. The issue I am now genuinely hearing from people is that because they are getting the AstraZeneca vaccine, which has a 16-week wait until the second dose, they are afraid they will not be able to qualify for the green travel certificate. Can the Minister give them some comfort on that?

I have two more questions. First, however, when will the Minister make the decision? Second, can we give genuine comfort to the 60 to 69-year-olds who are getting the AstraZeneca vaccine that they will be able to travel like everyone else?

Deputy Stephen Donnelly

I thank the Deputy for his questions. I absolutely share his view on the maternity services. I heard Paul Reid's comments earlier. Mr. Reid was signalling that the conditions are right to do this. As the Deputy and as that couple will be aware, however, that has not happened yet, which is why the dad is currently outside the hospital. We wish them the very best at this hopefully incredibly joyous time.

As I am sure we will agree, to date it has been a decision on a local level. It is not decision for me. It is not a political decision, as I believe the Deputy will agree. It is a clinical decision. We are engaging with the HSE on this and we would like to see it move forward. The point I was trying to make earlier, though, is that we have to follow the clinical advice on this rather than trying to impose a political view. I fully share the Deputy's view that we want to get this open as quickly as possible, however.

I will tell him exactly where we are regarding the latest plan. The Department received a proposal from the HSE late on Monday night, which I looked at on Tuesday morning. The CMO, Department, public health team and I are in discussions with NIAC. We need to leave that a little bit of time. I cannot give the Deputy an exact date, although I would very much like to be able to do so. It will be soon enough, however. I cannot say it will be today or tomorrow but we are looking at it, as is NIAC. The good news is that we do not need a decision imminently. We have plenty of vaccines and plenty of people in the cohorts that are open to keep going at full tilt for now. The Deputy is, however, absolutely correct that in time, it will become an issue.

Finally, there is some good news on the 60 to 69-year-olds. First, for many people who are given the AstraZeneca vaccine, the waiting time is 12 weeks. I have the detailed NIAC advice, which is different for different groups. I can read it out or give it to the Deputy afterwards if he prefers. The important bit, however, is that people will be deemed to be fully vaccinated at an equivalent time. From memory, it would be AstraZeneca dose 1 plus four weeks.

Deputy Alan Kelly

Will that be accepted as a digital certificate? That is the issue.

Deputy Stephen Donnelly

It is certainly our proposal for Ireland, for example, for anyone coming into country who would like to say he or she is vaccinated. That is all still being negotiated and worked through with the EU. The understanding, and the basis on which we are proceeding, is that member states will be given a fair amount of leniency in terms of what they do locally.

An Leas-Cheann Comhairle

There are 50 seconds left.

Deputy Alan Kelly

I understand. When are we going to include the pharmacists? I will skip the final question to give the Minister time to answer. Pharmacists have a major role to play. I know the Minister spoke about 24-hour testing centres. If he wants to go down that route, I will support him 100%. Honestly, pharmacists have a huge reach into the communities. What is the plan? What is the timeline for including pharmacists?

An Leas-Cheann Comhairle

The Minister has 30 seconds to conclude.

Deputy Stephen Donnelly

I agree. Pharmacists have an important role to play. I would like to see them playing more of a role. A pilot scheme with 15 community-based pharmacists will start shortly. I spoke to the HSE this week about when the pharmacists are going to be in place. I have expressed my desire to see them playing a more prominent role than they have been. The position to date has been that the capacity they provide has not been required yet based on the volumes we have seen. The GPs, vaccination teams and vaccination centres have been enough for the volume that has come in.

An Leas-Cheann Comhairle

To be fair to everybody, I have to move on. We move now to the Government slot. Deputy Murnane O'Connor has four minutes.

Deputy Jennifer Murnane O'Connor

It is great to see the vaccination roll-out. Today, all 57-year-olds can register for their vaccine. What happens to those who do not register on the day their age comes up? What if they miss it or do not know about it? Can they register later? Will they be accommodated? If, for example, 220,000 60 to 69-year-olds did not register, can they do so now or must they wait until all ages are complete?

What is the plan for vaccine apathy, that is, those people who may not get around to a vaccination right now? According to recent National University of Ireland, NUI, Galway data, one in five women under the age of 30 is worried about taking a vaccine. As we approach the younger age groups, what are we doing to allow people to register for vaccines later if they wish to do so?

We are seeing a rise in vaccine myths with lockdowns and more people accessing the Internet. We see claims which make some younger people hesitant about taking a vaccine. They may not be against the vaccine but they are worried and are asking if they will be penalised for waiting.

Last week, the Cabinet approved the national immunisation advisory committee, NIAC, recommendation to offer women between 14 weeks and 36 weeks pregnant the mRNA vaccines, which include Pfizer and Moderna. This is most welcome and I understand expectant mothers were asked to speak to their GPs about this. I received calls this week from pregnant women, however, who asked their GPs about this but who said they did not know anything about it. Will the Minister clarify this as there is a bit of confusion around the matter?

On maternity hospitals, the HSE has told maternity hospitals to allow a partner to be present at the 20-week scan and during labour, while a parent should be allowed access to the neonatal intensive care unit. A pregnant woman in Carlow or Wexford can face a different rule depending on which maternity hospital she attends, however. It is important we get clarity on this issue and get the proper information out. All maternity hospitals throughout the country must apply the same rules.

Deputy Stephen Donnelly

What I want and what the HSE has asked for is that there is maximum flexibility in compassion when it comes to maternity hospitals. We all understand why that is. At the same time, the HSE continues to allow local hospitals apply discretion, which indeed they must. Some hospitals are dealing with much higher rates of Covid in the community than others. As I said earlier, we would love as consistent and open a national approach as possible. That is what Paul Reid was speaking to earlier on. However, it is not being applied uniformly because some maternity hospitals have made a call that they do not believe it is safe for them. I support that and their local right to make those decisions. Obviously, we would like to see things move more quickly.

In terms of registrations, the answer is "Yes". Once you are in an age cohort which can register online, you can do so any time you want. If you are 69 years of age, you will be able to register the whole time.

How do we deal with vaccine hesitancy? We listen to people. We respect them and we supply them with the best possible information in order that they can make informed choices.

Deputy Colm Burke

I thank the Minister for the information he has given us this evening and the work he is doing.

I have had many pregnant women on to me asking who they should contact about the vaccine. I have letters from both GPs and maternity hospitals stating they have got no information on this. People are anxious as there are more than 40,000 women at any one time who are pregnant. Clarification needs to be given on this. Will the Minister give some clarification on this issue this evening?

A study in UK shows that the condition of those with long Covid improved dramatically once they got the vaccine. Could we look at prioritising these patients? Many of them are out sick for between three to five months. It is important they are looked after. One way of doing so is by making the vaccine available to them, regardless of age.

I had to email Dr. Ronan Glynn today because a constituent whose wife got the vaccine had an adverse reaction to it for the past 12 days. The advice they were getting seemed to have been incorrect to such an extent that Dr. Ronan Glynn rang me and asked that the constituent would immediately go to hospital to get medical care. Will further information be given out to GPs about how they deal with those on whom the vaccine has an adverse effect?

Deputy Stephen Donnelly

With regard to pregnant women, I need to be very careful not to be stepping in and providing clinical advice which I am not qualified to give. The context is as follows. NIAC recommended that pregnant women should be offered an mRNA vaccine between 14 and 36 weeks following an individual benefit-risk discussion with their obstetric caregiver. While there are currently no data published from clinical trials specifically evaluating the EMA-approved Covid-19 vaccines in pregnant and breastfeeding women, there are ongoing clinical trials. There have been no specific safety concerns identified with pregnancy with the use of mRNA vaccines. The HSE is working hard on this issue to put the protocols in place as quickly as possible.

With regard to vaccinating people who previously had Covid, that is happening. There is not a situation whereby you will not get a vaccine if you have had Covid. You can be deemed to be equivalently vaccinated or protected for up to six months after a lab-confirmed test of Covid, but it does not preclude you from being vaccinated.

With regard to the GP advice, I will raise that. I understand there is comprehensive advice and materials have been provided to GPs. I will discuss that with Dr. Glynn and the HSE.

Deputy Pádraig O'Sullivan

I thank the Minister, health professionals and front-line staff for the progress made over recent months in the vaccination roll-out. It is heartening to see us rolling through the different age cohorts, with people getting those much-needed jabs. That needs to be acknowledged. I thank the Minister, his Department and all those on the front line.

On the 24-hour vaccination centres, will the Minister expand on their anticipated roll-out, where they might be and how quickly we might see them? What is the Minister's position on supporting the waiving of intellectual property rights in terms of the Covid vaccine?

On maternity services, last April, my wife and I were lucky enough to have a baby girl. As we had a child during Covid, we think back on the difficulties we had at that time. I was lucky enough to be able to be there for the birth of my child. I can empathise with much of what has been said here by other Deputies. We are expecting a third child in September. It would be great to get some clarification on a more streamlined approach with maternity services. What role potentially might a digital green cert play in the availing of such services? Would it permit people to attend such services in the future?

Deputy Stephen Donnelly

I start by offering the Deputy my congratulations on the birth of his daughter some time ago and on the future birth this year. My wife and I had our first two children very close together. While I congratulate the Deputy, we might have a conversation later about coping mechanisms for the very long tunnel that he is about to enter.

In terms of the 24-hour vaccination centres, this came from the minutes of a NPHET meeting where it was discussing the issue and may have contacted the HSE about it. We may or may not need 24-hour centres. There is significant capacity in place between the GPs, the vaccination centres, many of which are running seven days a week and very long hours, and the pharmacy network, which is yet to be brought online. If it is needed to run the vaccine centres 24-hours a day, we will absolutely do that. At present, we do not need to as there is a lot of capacity in place.

In terms of the waiver for intellectual property rights, personally I am in favour of it. I do not think it is a silver bullet, however.

I do not think that if we do it, we will suddenly have manufacturing of these very complex compounds all over the place. The EU is setting up a task force to look at all the bottlenecks. There are issues around manufacturing sites, the supply of raw materials and distribution, particularly as some of the vaccines must be stored at very low temperatures. The Government is working with the EU on it. The EU's view is that within the existing TRIPS agreement there is latitude for governments to proceed but, to be honest, a whole-system solution is required. What I and the Government want to see is a global programme that gets everybody vaccinated.

Deputy Violet-Anne Wynne

We know many complex circumstances and situations are coming to light with regard to the roll-out of the Covid-19 vaccine. Many people are falling between the cracks of the very rudimentary categories established by the current administrative systems for the roll-out. The co-ordination between the HSE, NAS, GPs and administrative teams working through the portal is exposing the patchy lines of communication that pass extremely important and sensitive information between essential stakeholders. I raise this as I find I am hearing about this every day. The information needs to be clear and concise for people and they need to know where they stand when it comes to the vaccine roll-out. Many concerned constituents have been flooding my communications channels with almost inconceivable personal circumstances concerning the roll-out and the distinct lack of clarity and compassion they are receiving when they are trying to confirm when they will be getting vaccinated.

I will detail the circumstances of some constituents who have reached out to my office. One example concerns a GP in west County Clare who unfortunately has been out sick for a number of weeks. I take this opportunity to wish him well in his recovery. Undoubtedly, though, this has caused significant interruption of the lines of communication about patients being referred to NAS. What is plan B in these circumstances? This has caused undue distress for lots of vulnerable people and their families in the west. I am aware of one woman who has multiple sclerosis and is completely bedridden. She will not be able to access a vaccination outside her home and although all six of her carers have been vaccinated, she has been repeatedly forgotten. This woman's family members reached out and after I communicated on her behalf, her family were then contacted but were unfortunately told she would need to register. This woman is not required to go through that process and it has caused undue distress to everyone involved. I am aware of another man who was unable to attend his appointment as he was quarantining on the date originally designated for his appointment. He went to great lengths to notify the HSE of this fact and outlined all the relevant details around his quarantine timeline. He was given numerous appointments within that timeline and we both made numerous phone calls just to get that information across. Now that his quarantine is over he has not actually received an appointment.

I raise also the case of prison officers. All establishments across the prison estate are operating quarantine areas to deal with potential or confirmed cases of Covid-19. It is known that outbreaks of Covid-19 have occurred in virtually all prisons and were managed by prison officers and nursing staff. We also know prison officers have worked on Covid wards at various hospitals with both compliant and non-compliant prisoners. Outside of a healthcare setting, prison officers and prison nurses are the only group who have no option but to work with people with confirmed cases of Covid. Prison officers clearly work in a congregated setting where social distancing cannot be maintained but they have not received the vaccine. Meetings between the HSE and the Minister for Justice have taken place but no clarification has been provided on the vaccination of prison officers. Furthermore, on the evening of Monday, 12 April it emerged that more than 500 gardaí from the Dublin area were vaccinated, arising from concerns that they may be called to deal with issues which may arise with hotel quarantine. Prison staff have now been working with quarantined prisoners for more than 12 months. All establishments across the prison estate are operating quarantine areas to deal with potential or confirmed cases of Covid-19. Approximately 6,000 prisoners have been quarantined since the pandemic began. Is there any indication of prison officers getting appointment dates?

Deputy Mary Butler

The roll-out of vaccinations to the housebound is an extremely important part of the programme and 3,500 people have been referred by their GP. No politician or layperson can register somebody for a housebound vaccine. Only a GP, medical clinician or consultant can because it is very important that politics does not intervene here. As I said, 3,500 people have been referred by their GP and between 23 and 26 April the HSE contacted 800 individuals who were outstanding. Thus medics and HSE staff have worked very hard and I congratulate them on the work done to date because there are many complex cases. The Minister moved very quickly two weeks ago and increased the number of ambulance jeeps on call so we can get to as many people as possible. There are 500 people outstanding but contact has been made with them.

Deputy Róisín Shortall

I want to return to the issue of pregnant women and the Minister confirming they will be offered an mRNA vaccine between 14 and 36 weeks. They have been left not knowing what the plans are and what the situation is. It is particularly worrying for people who are past 30 weeks of pregnancy. They do not know whether they are going to get it in time for that 36-week cut-off point. What, therefore, is the situation? Has that process begun? Who is going to be responsible, or who is responsible, for registering pregnant women? Where will those vaccines be administered and by whom?

Deputy Stephen Donnelly

The advice came in from NIAC and the HSE is currently working through it. I will read from the latest presentation from the vaccine task force as of this week. On the NIAC recommendations in regard to the vaccination of pregnant women, it states: "This will be implemented and a working group is being established, led by the women and infants programme, to develop the referral pathway and an operational plan as soon as possible". That is the latest report direct from the task force. Both the Deputy and I want to see it in place very quickly. We just need to be aware that there is a lot of complexity being managed within the vaccine programme. The NIAC recommendation for pregnant women came in as one of a series of recommendations and changes and while we all want to see this implemented almost immediately, it takes a little time to get the referral pathways in place.

Deputy Róisín Shortall

I accept the complexity involved but this particular cohort is time-limited, unlike many others. It is not really fair to leave them in that kind of limbo, where they do not know what the plan is. What does "as soon as possible" mean? That is not good enough. I ask the Minster to get some kind of concrete timescale so women know where they stand and when they are likely to receive it. On those other practical issues relating to registering, who will give the vaccine and all of that, the Minister has announced it without giving any of the detail and that is not very satisfactory. I ask that he provide that detail as soon as possible, and certainly within the next week.

I also wish to ask about the role of pharmacists. The Minister mentioned the pharmacy network. He knows those involved are ready and willing to do that. Can he now give a timescale for when pharmacists are likely to be brought onboard to start providing that service? In that respect, I highlight also that there is a very significant dip in the administration of vaccines every weekend. It happens on Saturdays and Sundays and this week it happened on Monday as well. The number dropped down to about 12,000, which is just not really acceptable at this stage when it should be rolled out as quickly as possible. Pharmacists obviously have a key role as well. What is the timescale for the pharmacists being involved?

Deputy Stephen Donnelly

It will be in the coming weeks. I have discussed this at length with the HSE. I want to see pharmacists playing a more prominent role in this. I know they are ready to go and we have had an agreement in place with them for a very long time. The IT systems and portals for the pharmacists are being piloted with a number of community pharmacists right now. As I said earlier, the view from those in the vaccine programme is that the capacity they bring has not been required yet. However, the volumes are increasing very significantly and I want to see them brought in very quickly. At this point the answer is that it will be in the coming weeks.

I fully take the Deputy's point about the HSE still working out the detail of administration of the vaccine to pregnant women. By definition, this is a time-limited group of people. I will take that back to the HSE. The Deputy said this was announced without detail, but to be fair to the HSE, while we announced the NIAC recommendation, we need to leave a bit of time for the HSE to work it through.

Deputy Róisín Shortall

It is seen as one and the same so we need that detail. I ask the Minister about the cohort of people that received the AstraZeneca vaccine before the recent advice on it being administered to those under 60 and under 50. As of today, approximately 7,500 healthcare workers would have been due to get the second dose as the 12 weeks is up. What is the position of that group? The suggestion is that they wait until 16 weeks but is that for all that cohort or just those under 50? What is happening with the people over 50?

Deputy Stephen Donnelly

I will read the exact advice on this from NIAC. It is the AstraZeneca recommendation for dose 2 interval. The HSE points out that much complexity is involved. Dose 2 for the over-50s and for those who are very high risk or a high risk will be given at 12 weeks. That is from mid to late May, in line with supply. For the under-50s who do not have a high-risk or very high-risk underlying condition, it will be administered on a 16-week basis. The majority of people the Deputy speaks about will be under 50. Some may have a high-risk or very high-risk condition but the majority would not. For that group it is 16 weeks.

Deputy Róisín Shortall

How are they being distinguished with respect to being under or over 50? Will people be notified automatically or do they have to register again?

Deputy Stephen Donnelly

They should be notified. The two distinctions are people aged 50 and older and then under 50. The people aged 50 and older will have an interval of 12 weeks. Those under 50 with a high-risk or very high-risk condition will also have an interval of 12 weeks. For those under 50 without a high-risk or very high-risk condition, the interval is 16 weeks.

Deputy Róisín Shortall

Are people in their 60s only receiving AstraZeneca or are any of the other vaccines being provided to those people?

Deputy Stephen Donnelly

The broad intention is that they would receive AstraZeneca. There may be cases where, if there is availability of an mRNA or Janssen vaccine, it can be used. We have received very little Janssen vaccine so far. The Deputy is aware we have started rolling that out now to homeless people, which is really positive to see. It is possible, at the margins, that some people in the group will receive an mRNA or Janssen vaccine based on availability of supply. The numbers are low. The broad thrust is that they will receive the AstraZeneca vaccine.

Deputy Joe Carey

I thank the Minister and Minister of State for their response and action in increasing resources to improve speed of delivery of vaccines to housebound people. They will recall that I raised the matter some weeks ago. One of the affected individuals, Mr. Joe Kenneally from Kilshanny in County Clare, has received his first dose of the vaccine. His family members are very thankful and they want to convey their thanks to the Minister and the National Ambulance Service for the care, courtesy and attention they showed to Joe when the vaccine was delivered.

I raise the question of fully vaccinated persons being permitted to travel into Ireland without having to quarantine in hotels. There is much demand, particularly from markets like the US, and fully vaccinated people want to travel to Ireland. There is also the specific matter of the large cohort of Irish people who live in Dubai and who want to come home to Ireland for the summer. They are fully vaccinated with a different vaccine, Sinopharm. Will the Minister update the House on the position of people who have received that vaccine? When will it be approved by the European Medicines Agency and in Ireland?

The first cohort of people vaccinated comprised front-line workers, including nurses and doctors. That was right. Nurses have led the charge in the fight against Covid-19 for the past 14 or 15 months. I request that the Minister and the Government look at trying to give some due recognition to nurses. I propose that the Government look at the registration fee for nurses. They currently pay an annual registration fee and I ask the Government to consider introducing a reform so a registration fee would be paid just once on qualification. I ask the Government also to examine seriously the unwinding of the additional hours from the Haddington Road agreement in recognition of the work that nurses have done throughout the pandemic.

Deputy Stephen Donnelly

How long do I have?

An Ceann Comhairle

Not very long. Be as quick as you can as there are two other Deputies looking to contribute in the slot.

Deputy Stephen Donnelly

Okay. The Deputy asked when the European Medicines Agency, EMA, will approve certain additional vaccines and that is a question that only the EMA can answer. I know it has a rolling review in place for vaccines. I will ask for a note to be sent to the Deputy on the position of various vaccines within the rolling reviews.

The Deputy should remember the registration fee paid by nurses is not to the Government but to the nursing professional body, which has been a really important part of the ongoing progress and development of the nursing profession. The Deputy asked about recognising the efforts of these personnel but I will stay away from the question of Haddington Road agreement hours or anything like it because that is a matter for national pay agreements.

My view is there should be recognition for nurses and everyone else who has worked across the healthcare system, including nurses, doctors, cleaners, healthcare assistants, nursing home staff, chefs, hospital porters and others. They went into work day after day and stepped up. They were at risk and this is a sector that saw significant additional infection rates. They deserve enormous credit and I want to see meaningful recognition for all healthcare workers for the extraordinary time they have put in this year and last year on behalf of our nation.

Deputy Jackie Cahill

It is right to acknowledge that the vaccination programme is certainly picking up pace. Since our vaccine supplies increased, we have seen a remarkable improvement in the numbers being vaccinated daily and weekly. There is no denying the early days of the vaccine roll-out were tough but the supply of vaccines was out of our hands and the control of the HSE.

I acknowledge the exceptional work by front-line staff, vaccinators and testers in fighting this disease. Every week we see the vast majority of vaccines received in the country being distributed in a matter of days, with exceptional efforts by hard-working individuals involved in the process.

Vaccinations to people who are at home were mentioned earlier and there are still a number of people in my constituency who are bedridden or housebound who still have not received their vaccine. I acknowledge the great work being done by the National Ambulance Service but could we have a timeframe for these people's vaccinations?

Deputy Carey raised the question of people in other countries, including Abu Dhabi in the United Arab Emirates, who are fully vaccinated but where the vaccine is not recognised here. Could this be rectified? Some of these people are coming to the end of contracts and they want to come home. They are fully vaccinated so could their process be streamlined?

I am thankful there is now a steady supply of vaccines and the time has come to operate 24-hour vaccination services. People getting the vaccine would not mind what hour of the day or night they are asked to come. People are extremely anxious to get this vaccine and get their life back to normal. We have a decent supply of vaccines so could consideration be given to 24-hour vaccination centres?

We want to keep the virus under control and we definitely do not want another wave. There should be testing, especially in higher population densities or where people are in workplaces.

We have a number of walk-in test centres in my constituency and all around the country. Can the number of those centres be increased and can they be set up in all towns? Can they even be set up where there are major employers? We have seen instances with major employers having clusters of the virus. More of these walk-in centres will be essential to make sure we continue with the progress we have made.

The rapid antigen testing also has a place. For major employers in places where there are many people congregating, it is worth considering that rapid antigen testing would become the norm in these workplaces.

Deputy Mary Butler

I will respond to the question on those who are housebound. As of 6 May, there are fewer than 500 individuals awaiting first dose vaccination and it is expected to have all first dose vaccinations completed by next week, the week commencing 10 May. To date, the National Ambulance Service has provided 2,784 vaccines. We will get to everyone by the end of next week. To be fair to the Deputy since he has raised it many times, the main message is that nobody will be left behind.

An Ceann Comhairle

The other questions could be responded to in writing because Deputy O'Connor is here and we have to move on to him.

Deputy James O'Connor

I thank the Minister and the Minister of State, Deputy Butler, sincerely for their close co-operation and help in recent days regarding the serious outbreak in east Cork and west Waterford, based around Youghal, in particular. It was an enormous challenge for our local healthcare services, schools and sports clubs to deal with that issue. I pay tribute to and compliment the HSE, the National Ambulance Service, our local GPs, the Minister and the Ministers of State. We are lucky to have the Minister of State, Deputy Feighan, the Minister of State, Deputy Rabbitte, and the Minister of State, Deputy Butler supporting the Minister and I am grateful for the work they are all doing.

We are moving into a positive phase in the vaccination roll-out. As we speak, 30% of adults over the age of 16, representing 1.1 million citizens, have received their first dose of the Covid-19 vaccination. This is a positive moment. We are hopefully reaching a tipping point where the vaccine roll-out will start to have a more meaningful impact on the level of Covid cases in the country, allowing us to further reopen society. I agree with what many Deputies said on the continued use of technology to ensure we are allowed to reopen our society. The digital green certificate for people who may wish to travel internationally is of critical importance and I hope the Department is being proactive in preparing for the implementation of such systems.

On the vaccination roll-out, I am getting positive feedback from people who have been to their local vaccination centres, whether they are attending the one in Mallow, Páirc Uí Chaoímh or the other ones around the Cork area. They are well-run and I want to pay tribute to the staff who are working in them. In fairness, there seems to be few problems. I want to concur with points made by other Deputies in the Chamber on people who are housebound. We get quite a few calls from people who are querying their status. I know the healthcare professionals in the National Ambulance Service are doing important work in that regard. I again ask the Minister, the Department and the HSE would give every support necessary to allow people to get vaccinated.

I will allow the Minister to utilise my remaining time if he wishes to answer.

Deputy Stephen Donnelly

I thank the Deputy for the questions and his kind comments. There is definitely a good political team in the Department of Health and there is a good working relationship with the HSE. It was good to see movement happen on Youghal that quickly. The Deputy raised points on the ongoing response and there was a comprehensive, rapid and flexible response to exactly the points he made. I can assure him that we will continue to work with the Department and the HSE so that the services he is advocating for and the people he represents get what they need and deserve. We will keep working to that end.

Deputy Thomas Gould

I have a number of questions. I will take three minutes and give the Minister the remaining time to answer if he could.

I was contacted by a lady whose mother is 69 and is housebound. She had received a vaccine appointment for a clinic but she had not received an appointment from the National Ambulance Service to come out to her house. When I contacted the HSE about this, it was confirmed to me that there is no system in place for under-70s who are housebound to receive their vaccines at home. To me the Minister has dropped the ball on this issue. Will the Minister instruct his officials in the Department to sort this out? Was the Minister aware of this situation?

Expectant mothers in Cork are still waiting to receive their vaccines. A lady contacted me whose GP is still waiting on instructions from the HSE. Cork University Maternity Hospital has told this lady that it will be back in touch in a few weeks' time. This lady is 25 weeks pregnant. She does not have weeks to wait for someone to come back to her. There are plenty more women in Cork, and right across the country from listening to other Deputies, who cannot wait and who need to be vaccinated. These are vulnerable women. I am not trying to be alarmist but the Minister made comments about the link between Covid-19 and stillbirths. Vulnerable women are worried by these comments. On 27 April the Minister said the vaccine would be rolled out for them. Why are these pregnant women waiting?

There is no vaccine clinic on the north side of Cork city. I have raised this issue before. People could be stuck travelling for an hour on public transport to get vaccinated. Why are we putting barriers in place when half of Cork does not have a vaccine centre? I mention facilities such as Upper Glanmire community centre. A local area representative, Mandy O'Leary-Hegarty, said the community is available to put that up. Neptune Stadium has been used in the past for similar purposes. Many other community centres, GAA clubs and sporting organisations are willing to offer their facilities for the vaccine roll-out on the north side. Will the Minister commit to a vaccine clinic being opened on the north side of Cork city?

SouthDoc in Blackpool was closed in March 2020 because of the Covid-19 crisis. I do not believe that was true; rather I believe SouthDoc used the crisis as a way to close down its services in Blackpool and Listowel. Will the Minister commit to making sure that SouthDoc reopens those facilities with a full service? The people of Cork North-Central need it.

Deputy Stephen Donnelly

I thank the Deputy for all those questions. On the housebound, the National Ambulance Service is doing a huge amount of work. As the Deputy will be aware, we worked with the HSE to increase the capacity available. The ambulance fleet that is directly allocated to this has been doubled and additional personnel were put in place to support the administration of the programme as well. The Deputy specifically asked about a constituent of his who is under 70. The Deputy's constituent needs to work with her local GP. The GP then needs to refer her and state that the patient is housebound. There are cases where the National Ambulance Service can provide the service. If the Deputy wants to provide me or the Minister of State, Deputy Butler, with the details of that person, we will look into that for him.

On pregnant women, I share the Deputy's sense of urgency and I know there are pregnant women all over the country who are saying that NIAC has made this recommendation and are asking when they will see it implemented. The HSE is working through this. I know the Deputy will appreciate that many additional recommendations came through from NIAC. We are working through them, as is the HSE. We want to see the referral pathways and protocols put in place as soon as possible and the HSE is working through that.

The third question was on vaccine centres. There are 30 centres operational and there will be 38 in operation in total. There are several vaccine centres in the Cork area. For anyone over 70, they can access a vaccine through their GPs. Pharmacists will also play a role. For people who are mobile, they can take a trip across a city to a vaccination centre to avail of these incredibly effective vaccines, which are free to everybody to use, to vaccinate themselves against a global pandemic.

Anyone I have been talking to has said that if they need to travel for half an hour, 45 minutes, an hour or a bit longer because they have been told that they get to go to a vaccine centre and be protected from this global pandemic with some of the most effective vaccines that have ever been created provided for free, particularly in the context of a lockdown, they are saying they will get in the car and go. However, it is worth reiterating that for those aged over 70s the GP network has been available. For people who cannot leave their homes the National Ambulance Service will be involved.

Deputy Thomas Gould

There are three centres in Cork but not one is on the northside. Half of Cork has no vaccination centre.

Deputy Stephen Donnelly

The pharmacy network will also be involved.

Deputy Gino Kenny

Today was significant in the fight against this pandemic. Today, the Biden Administration made an announcement, and other Deputies have mentioned this, with regard to waving intellectual property rights. This is significant for the people's vaccine. The EU has made soundings that it will review its position. Given that an astronomical amount of public money has been given to some of these companies it is the least that humanity could expect from them. The announcement by the Biden Administration has not gone down well with some of the companies, such as Pfizer and Moderna. Their share prices have decreased. It is quite incredible that these huge companies can almost blackmail humanity in the war with this virus. This is very important.

The Irish Pharmaceutical Healthcare Association made an extraordinary statement today and I had to read it a couple of times. It is urging the Government to oppose the waiver at the WTO in June. This is incredible. Humanity is at a precipice with regard to people getting the vaccine rather than monetising and monopolising it. What is the position of the Minister for Health? What is the position of the Government? Today, the Tánaiste was quite confused about whether the Irish Government will support the EU waving intellectual property rights on the people's vaccine. That is what we deserve.

Deputy Stephen Donnelly

I thank the Deputy. I want to see a global solution to this. We cannot have a situation where poorer countries are locked out of vaccinating their populations because they cannot afford it. It is ethically unacceptable and it would also be really stupid on behalf of the western world because the virus will continue to circulate. We need to do it for ethical reasons and for reasons of self-interest also.

The Deputy and I might have different views on the economic system and the pharmaceutical companies' right to make a margin on the work they do but clearly something in the global pharmaceutical system is working really well. We have a variety of incredibly effective safe vaccines quicker than they have ever been produced before. Last year, I spoke to leading experts who told me that based on previous pandemics and diseases it could be five, ten or 15 years before we saw this. Clearly something has worked really well. What we now need to do is channel this energy. I would like to see the waiver gone but it is important to say there is no silver bullet. If we got rid of that waiver tomorrow we would not suddenly see mass production. We have to look at manufacturing, distribution and other matters. As the Deputy is aware, the EU position is that there is already significant latitude within TRIPS that could be activated at this time.

Deputy Mick Barry

The Minister did not answer the question. Is the Government going to instruct its representatives at the World Trade Organization to vote in favour of waving intellectual property rights on the vaccines? That is the issue and the Minister has not answered the question. The Government has a choice to make. The Biden Administration has done a U-turn. It has changed its position under pressure from below. One option is to back the same position. The other option is to back the position argued by the pharmaceutical industry in this country, which this afternoon called on the Government to vote against it. The Minister needs to make his position clear. Which side is he on? Please answer the question. Will the Government instruct its representatives at the WTO to vote in favour of waiving the intellectual property rights on the vaccines? I would like a straight answer to a straight question please.

Deputy Stephen Donnelly

I thank the Deputy. The Government is working with the EU on this. I have told the Deputy what my view is. The Government is working through this very closely with our colleagues in the EU. The EU's position is that the WTO TRIPS Agreement already allows countries a lot of flexibility that is not being used. For example, it allows compulsory licensing, which is when a Government permits someone else to produce a patented product, which essentially is what Deputies Barry and Gino Kenny are advocating for. This is already contained within the TRIPS Agreement.

I restate that regardless of which way we do this, and whether nation states activate the clause within the existing WTO TRIPS Agreement or intellectual property rights were to be waived, there are significant additional obstacles that have to be dealt with. The EU is setting up a task force to look at this to see how we deal with increasing manufacturing. These are not simple compounds to make. How do we deal with distribution? How do we, for example, distribute vaccines that have to be stored at -20° in warm countries with limited infrastructure? All of this has to be solved at the same time to reach a necessary goal, which is as rapid a global vaccination as possible.

Deputy Joe Flaherty

It is very good to see that we now have momentum on the vaccine. I am especially pleased that our vaccine centre is open in County Longford. I thank the Minister for his commitment to opening the centre. From the very outset he was committed to a centre in Longford and it is good to see that it is now open. I thank the staff at the centre, in particular the centre manager, Carmel Breaden, and I wish them the best of luck in their endeavours. They have worked tirelessly to have the centre up and ready and open for vaccinations. I must also acknowledge the local GAA club, Clanguish, and Longford County Council, which have worked very closely with the HSE in this regard.

The public has reacted very favourably to our reopening plan. As a nation and a people we want to return to normality. There are some inconsistencies in the plan, which could be addressed in the interests of public goodwill and as a gesture of solidarity with small businesses and communities. Many small gyms will not be in a position to reopen outdoor activity on 10 May while peer facilities will. Gyms are scheduled to reopen on 7 June but it is not inconceivable that these facilities should be able to resume their indoor activities in line with non-essential retail on 17 May. They have proven themselves very adept at managing their facilities and adhering to all public health guidelines. Any analysis of case figures will validate this.

Stage and dance schools and local theatres have been challenged on all sides by Covid. In most cases, they were unable to access any State support. They now find themselves struggling to adapt to outdoor activities owing to inclement weather. It is the only outlet at this time for many young people and it is critical that we see them return as people are missing out on a crucial developmental year. On reopening last year, the sector proved itself more than willing and capable in terms of complying with public health guidelines.

I would ask that they could also reopen on 17 May in line with non-essential retail.

In particular, I welcome the Minister's commitment this week to trial outdoor events with spectators for the month of June. An obvious one must surely be the park runs which take place the length and breadth of Ireland. The park run movement will return for adults in the UK on 5 June and there is a compelling case that we should be able to follow soon after here in Ireland. Even before Covid, this was one of the best policed and managed public events in the country with all participants tagged for the purpose of timing, and full contact details already to hand to aid track and tracing. I would ask the Irish park run movement to engage with the Department of the Taoiseach and the Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media, Deputy Martin, in the hope that this could be one of the flagship events for the month of June.

I welcome the Minister of State, Deputy Feighan's overview of the Covid challenges in the Traveller community. There were 16 new Covid outbreaks and 65 new cases of the disease in the Traveller community notified to the HSE in the past week. These new cases bring to more than 3,600 the number of confirmed cases of the disease in the 35,000 strong Traveller community reported in this third wave of the disease which began just before Christmas. According to the statistics, 155 members of the Travelling community have been hospitalised with the disease since the third wave, 22 have required critical care and, sadly, eight have died.

We had a very public event in Longford town yesterday and, understandably, it has given cause for much concern locally. It was an event that ran contrary to the compliance and significant community commitment which has helped us as a community and as a county come to terms with the public health challenge in recent weeks. Some weeks ago, the Traveller health movement and the HSE convened a very successful pop-up test centre in Longford town. At the time, our statistics were among the worst in the country. Yesterday, for the first time in almost two months our national average over 14 days was back below the national average. However, there are concerns we may see a spike again in Longford over the coming days. With this in mind, I ask the Minister to request the HSE to convene a mobile pop-up test centre for Longford town for the next couple of weeks and until such time as we are sure that any risk arising from this week's events has abated.

An Ceann Comhairle

Do we want to hear Deputy O'Donnell or go for a response?

Deputy Kieran O'Donnell

I will be using my time over and back.

An Ceann Comhairle

Then we will go to the Minister for a response to Deputy Flatherty.

Deputy Stephen Donnelly

I will take back to the HSE this evening what the Deputy suggested and ask if that can be done. I thank Deputy Flatherty.

Deputy Kieran O'Donnell

I would like to ask questions and use my time over and back. First, the vaccination centre for Limerick is the Radisson Blu Hotel on the Ennis Road, technically in County Clare but obviously servicing Limerick and that region. While we have had a successful roll-out with more than 50,000 people vaccinated, issues have arisen for people who do not have access to private cars and who must use the bus service there. The current bus service, which is the 343 Limerick-to-Shannon bus route, goes every half hour during the day, every hour in the evenings and on Saturdays, and every hour and a half on Sundays. It stops at the other side of the N18, which is a motorway. For many people, it is very difficult. I note the local HSE, in fairness, has stated it is now reviewing the operation of the Radisson Blu because there will be a significant ramping up of the service. Will the Minister take up with the HSE the possibility of having an additional pop-up mobile centre in Limerick city itself or having a shuttle service specifically to serve the existing centre? The Minister might respond to that and then I have a further question.

Deputy Stephen Donnelly

I thank the Deputy. I would be happy to and I will revert to the Deputy on that. It is essential for people who do not have access to cars - many people simply do not have access to cars - that there is sufficient public transport to get to the vaccination centres. Sometimes that is required seven days a week. I would be happy to take the Deputy's point back to the HSE.

Deputy Kieran O'Donnell

I thank the Minister. A shuttle service or a location in the city as well would make a huge difference. You cannot have people crossing a motorway or dual carriageway. It is unsafe. In this modern age, we cannot have it. Vaccination is going well but we want it to be an absolute success.

I want to refer to another issue. We had Professor Mark Ferguson in before the Joint Committee on Transport and Communications Networks yesterday. Professor Ferguson was appointed by the Government to set up and chair a Covid expert group to look at rapid testing. We in the committee are very much looking at the aviation sector. With the vaccination programme going at pace, Professor Ferguson, whose expert group's report has been adopted by Government, is of the view that rapid antigen testing has a key role to play in the full restoration of air travel. Professor Ferguson is looking for the roll-out of a pilot programme of rapid antigen testing, and the expert group has made this recommendation in its report. That should be done.

The committee has written to the Minister for Transport and the Minister for Health seeking the establishment with immediate effect of a pilot programme for rapid antigen testing. Take a route from Ireland to the UK. The UK has started doing a pilot programme of its own. We can tap into the expertise they have to date. Furthermore, we have the digital green certificate coming on stream at the end of June. It would make a huge impact if we could be ready to look at the possibility of rolling out rapid antigen testing as one of the elements in terms of Covid safety to ensure people may not have to quarantine when they come to Ireland. Will the Minister take on board the recommendation of Professor Ferguson and his expert group and of the Joint Committee on Transport and Communications Networks to establish a pilot scheme of rapid antigen testing for air travel on a route from Ireland to the UK? It would probably take four weeks because we need to have that ICT structure in place prior to the digital green certificate coming in place at the end of June.

Deputy Stephen Donnelly

I thank the Deputy. It is certainly something I can discuss with the Minister for Transport, Deputy Ryan. The expert group reported in to me on 1 April and its report contained recommendations across a number of sectors. The way we are approaching it in government is that line Ministers are exploring what can be done in their sectors. The Minister for Agriculture, Food and the Marine, Deputy McConalogue, and I, for example, are working on rapid testing, much of it in meat processing, while the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, and I have been discussing rapid testing in higher education, etc. This one would fall within the remit of the Minister, Deputy Ryan, obviously, with public health advice.

I would urge caution on aviation before we are ready to go with the digital green certificate. We have very strong measures in place in terms of international travel at present. We have the strongest measures in place in Europe by quite a bit. In fact, the UK would be the closest to ours with its own mandatory hotel quarantine. I would be happy to discuss it with the Minister, Deputy Ryan, to see if it is something he wanted to pick up with the aviation industry, with that caveat that we have very strong protections in place for very good reasons. On the Deputy's point, however, my hope is we will fully engage with the digital green certificate and we might see an opening of travel from July.

Deputy Darren O'Rourke

Following up on that point, I second Deputy O'Donnell's proposal. I sit on the Joint Committee on Transport and Communications Networks. There is an interesting and important window of opportunity to carry out that pilot study. We have this hybrid model, which I have argued against because I believe it should be stronger, of mandatory hotel quarantine for a specific cohort and a pre-departure PCR test for other people travelling, for instance, from London to Dublin, as well as recommendations and other obligations, but only advice regarding a post-arrival PCR test. What has been proposed here is to add to that serial antigen testing. It would be an interesting study to run over the period of a month.

It would provide useful information for the Government in terms of opportunities for the future and could be of benefit in the time ahead. The Joint Oireachtas Committee on Transport and Communication Networks issued a letter on this and held very interesting hearings yesterday with Professor Ferguson. This is a real opportunity and I ask the Minister to respond on it.

The other issue I want to raise is the TRIPS waiver. While I do not want to repeat the questions asked by others on Government commitments, I do want to hear and see such commitments. I am firmly of the position that there is a real opportunity with the TRIPS waiver to increase the supply and reduce the cost of vaccines. The Minister referenced the success of the vaccine roll-out which may be the case from a European or North American perspective but from a global perspective, there are vast swathes of the planet that have not seen any vaccines. Indeed, some countries have not seen a single vaccine dose yet. There is enormous scope for improvement and the TRIPS waiver is part of that. What is the timeframe and at what level are discussions taking place? What is the role of the Irish Government in this? Does the Minister for Health have a role or is this a matter for the Minister for Foreign Affairs, Deputy Coveney, the Tánaiste or the Taoiseach? At what level are those discussions taking place and what is the expected timeframe for a decision?

Deputy Stephen Donnelly

I thank Deputy O'Rourke for his questions. In respect of a pilot for rapid testing, I commissioned a report on it and I support its findings. The Deputy will be aware that there are strongly-held views among highly reputable, well-informed people on both sides. Some people like Professor Ferguson believe there is a very substantial role for rapid testing to play while others believe there is significant risk because it can give people a false sense that they have had the equivalent of a negative PCR. They may then adjust their behaviour in ways that are risky for them and for the people around them. I believe rapid testing has a strong role to play and that, as Professor Ferguson argued in his report, as this year goes on the technology is going to get better and the tests will become more accurate and easier to use. There will be some really interesting developments during the year.

It is the Minister for Transport, Deputy Ryan, who would lead the work on an aviation pilot scheme, with support from the Department of Health and public health. What the Deputy has proposed is very interesting in that it would be in addition to the existing preflight PCR test. While I do not want to pre-empt anything, I imagine some people will say that if we are already doing PCR tests, there is no marginal benefit to rapid tests. It would be interesting to see if rapid testing could provide an additional source of protection in the context of the requirement for a PCR test being removed over time as we move to using a digital green certificate, whereby people who are deemed fully vaccinated can potentially travel without the need for a preflight PCR test. Perhaps the rapid test could provide an additional piece of protection and I am very happy to take that up with the Minister for Transport.

Regarding the waiver, I will revert to the Deputy directly. A lot of the issues he raised have been already discussed during this debate. What I want to see and what we need for ethical reasons as well as reasons of self-interest, is a fast global vaccination programme. That is going to require the Western world stepping up-----

An Ceann Comhairle

I am sorry to interrupt but we are running out of time. Deputy Canney is next.

Deputy Seán Canney

I was lucky enough to get a call to get my vaccination last Monday in the racecourse in Galway and I must say the operation that was being run there was absolutely phenomenal. There were no queues and everybody was vaccinated and out again within 30 minutes. I want to put on the record my appreciation for the work that is being done across the country in all of the vaccination centres. The buzz and confidence that people had going in was marvellous. The biggest joke we had was about our age. I met some of my classmates whom I had not seen in a long time.

We are moving on with the vaccination programme and a lot of people who use day services are now vaccinated. Organisations are now trying to get back to the provision of normal day services but transport will be a problem. There is still a requirement to maintain social distancing but the type of vehicles available to these organisations is a problem. Is there anything the Department of Health can do to make sure additional transport is put in place so that these services can continue? The Department must also work with those providers who were running day services in hotels, many of which are still closed. Will the Department and the HSE work with providers to make sure services are restored so people can meet again and have some sort of normality and socialisation in their lives after the long trawl they have had for last year and a half.

I also wish to raise the issue of primary medical certificates. The suspension of the scheme last June and its reintroduction in January was disastrous and with the perfect storm of Covid, there is very little happening in terms of assessments except by phone. Reviews are only carried out in Dublin except for once a year, when they are carried out in Cork. An appeals clinic was due to be held in Roscommon in October of last year but that was postponed. I was told the other day that it will probably be rearranged for 2022. Large numbers of people are waiting to get vehicles for people with disabilities. They have ordered vehicles but they cannot get an assessment or a review. This matter was raised by the Oireachtas Committee on Disability Matters with the Minister for Finance on a number of occasions. I implore the Minister to make sure that interim arrangements are put in place, such as providing temporary certificates to those who need them, until things are sorted out.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I will take those questions if I may. I thank Deputy Canney for raising these matters. I will take his last question first. He is quite right in what he has said about primary medical certificates. There was very little movement on them up to last December and into January. I met the primary medical certificate team myself two months ago. In the past two months, 471 assessments have taken place. The Deputy is correct in saying there have not been face-to-face assessments. In my own CHO area in Galway, more than 300 assessments have taken place and the plan is to get back to doing face-to-face assessments in the coming months. The team has already determined who needs face-to-face assessments. I must compliment the team for the work being done on this.

As the Deputy knows, most day services did not close during the most recent lockdown but services were reduced. I am assured by the Department and the HSE that there will be a resumption of services on a three-days per week basis. Transport is being reviewed at the moment by the Minister for Health, the Minister for Children, Equality, Disability, Integration and Youth, myself and the HSE.

Deputy Verona Murphy

I have three questions for the Minister today. The first relates to persons in category four. We need a clearer outline of how people in this category are to be notified about their vaccination. I am hearing about a lot of complicated scenarios, whereby consultants have told patients it is the responsibility of their GP but the GP has no knowledge and people are getting confused. We do our best and the staff we deal with in the HSE are excellent but I am keen to avert and avoid confusion. Unfortunately, according to Twitter today, there are doctors on social media saying that because of the abuse they are getting from those who are expecting to be vaccinated by their GPs and the lack of clarity, they are going to quit the vaccine programme. I ask the Minister to make sure that is addressed and the problem does not fester.

The second issue is that there appears to be no way to cancel a registration on the IT portal. People have come to me who have spent hours trying to cancel over the phone because they have been contacted by their doctor and have actually received the vaccine.

My concern, as well as theirs, is a no-show would mean a vaccine going to waste. I am not sure how it can be addressed but it is important.

Many people have been asking me for the daily vaccination figures on a local electoral area basis. I appreciate there is plenty to be done but people endured the daily death figures for the past 12 months and that had a significant impact on people's lives and morale and what we have been through. It would be a significant morale boost if people knew the vaccination figures, even on a county basis, so that if 150,000 people were to be vaccinated in County Wexford, we might get to a stage at which we can see we are nearly at 70%. It would have a significant effect on people's morale.

A cohort of people are living, married and have families in Ireland but are working abroad. Many of them have contacted me because they are in receipt of the Sinopharm vaccine which is not one of the recognised vaccines. It means they would have to enter into quarantine, fully vaccinated, but not with a recognised HSE vaccine. They would end up having to quarantine and pay for it, have little or no time to see their families and then, possibly, return to quarantine when they return to work. I ask that somebody might consider how that would be catered for.

Deputy Stephen Donnelly

I thank Deputy Murphy for all of those points. On her last point, I am aware, as we all are, many people are resident in Ireland or want to come or return to Ireland. Twelve vaccines are being used for Covid-19 around the world and the European Medicines Agency, EMA, has authorised four of them. The exemption from hotel quarantine is only for those four vaccines. That is the public health advice we have at present but I will take the Deputy's point back.

Much progress has been made on cohort 4 but I know, as all of us do, that some people are finding it difficult to get the answer they want quickly. In terms of the progress made, to date, more than 200,000 vaccines have been administered to cohort 4 and this is a big week. This week, 40,000 to 50,000 vaccines are targeted for cohort 4. A huge number of people in cohort 4 have been vaccinated and are being vaccinated this week. It is a big week.

In the first instance, people should be able to get an answer, either from their GP or treating hospital. The approach is that if a person has an underlying condition and is in treatment with a hospital group, that hospital group should be able to vaccinate him or her and should be contacting that person to tell him or her to come in to be vaccinated. In the majority of cases, that is exactly what is happening. Some people have the same underlying conditions but are not in active treatment with one of these hospitals, and in those cases the GPs can make the decision to vaccinate them.

An Ceann Comhairle

Thank you, Minister. We have to move on. I am not being awkward but I suggest you correspond with Deputy Murphy to respond to her outstanding questions. Deputy Devlin is sharing with colleagues.

Deputy Cormac Devlin

It is just me. Tonight's figures remind us of the need for vigilance, with 393 new cases and, sadly, eight further deaths. I acknowledge the great efforts by everybody involved in this national effort, especially our front-line healthcare workers.

The vaccination programme is certainly picking up pace. It is encouraging to see 1.7 million vaccinations have been administered, with almost 1.2 million people or 30% of adults over the age of 16, having received their first dose. I also express my appreciation to the Ministers present for their availability and assistance in matters in the constituency in Dún Laoghaire. News that people who have had their first AstraZeneca jab can be considered vaccinated after four weeks is particularly welcome and good. I ask that the Minister for Health considers getting that message out there as much as possible, because it would reassure many people who have been cocooning. Many of them believe they have to wait for the 12-week period and they do not want to stop restricting their movements or cocooning. It is important that message gets out there.

On the mandatory hotel quarantining, the Minister will be aware of several recent cases in which people needed to travel abroad for medical treatment. I ask that a streamlined process be put in place for those vulnerable individuals. I know the Minister is working on issues, and perhaps he might update us in his response.

I have some questions, especially on the Janssen vaccine. It is particularly useful for administration by pharmacists. When will the first significant shipment of Janssen vaccine arrive and when will the pharmacists begin vaccinating? In terms of vaccinations, will other organisations such as the Tropical Medical Bureau be involved or considered in the roll-out?

Deputy Stephen Donnelly

I thank Deputy Devlin for his kind words. With regard to when people are deemed to be fully vaccinated, we will redouble our efforts on that. It is important the message gets out that, for example, people who are being vaccinated with AstraZeneca do not need to wait the 12 or 16 weeks and then plus two after their second dose, rather a number of weeks after the first dose and it is different for the different vaccines. We will redouble our efforts to make sure people know that.

With regard to exemptions from hotel quarantine for people who are returning to Ireland because they have left for medical treatment abroad, the Deputy and I have discussed this and individual cases. We are dealing with a number of individual cases to make sure people are met appropriately, dealt with compassionately and get what they need. However, we need to go further than that. We are putting an exemption in place, which I hope to sign soon and share the details of. It will cover people who need to travel abroad for urgent, time-sensitive, material medical treatment abroad and provide them with an exemption.

In terms of Janssen, the latest I have, which is subject to change almost daily, is that during the week of 10 May, approximately 75,000 doses of the Janssen vaccine will arrive here.

Deputy Cormac Devlin

The Minister for Health might come back to me on whether the pharmacists will begin from next week in their vaccination programme and whether other agencies such as the Tropical Medical Bureau will be involved or considered.

A number of special needs assistants, SNAs, teachers and carers have been in contact with me. They accept the new age-based vaccination roll-out but wonder if arrangements could be put in place to allow people to register online for last-minute vaccinations. If there are excess vaccines in a local vaccination centre or through a GP, could they be considered?

The Minister of State, Deputy Butler, is probably aware I am involved in a day care centre in Glasthule. Throughout Dún Laoghaire and the country, there is real eagerness for that cohort to go back to the day care centre setting of enjoyment, fun and interaction with others. Does the Minister of State have any update on when we might see them return? Obviously, that age cohort has been vaccinated, by and large, as have the staff who work in those day care centres.

Deputy Mary Butler

I thank Deputy Devlin for his important question. As we know, day care centres and services have been closed since March 2020. It is a key priority for me, working with the HSE and the Department, to ensure services for older people can open as soon as it is safe to do so. As Deputy Devlin has quite rightly said, the vaccination programme has been rolled out to persons over 70 years of age and as a result, further guidance has been sought from public health on the provision of day care services and how they can be operated safely.

Day care services have been asked to assess what can currently be delivered and requirements to reopen. A subgroup has been established to develop an individualised risk assessment that can be carried out in respect of clients returning to the services. This will focus on safe transport to the service, identification of clients who are safe to return, protection of carers who have not been vaccinated and the impact of this. Finally, we also need to support clients who will not be in a position to return to day care services.

I am hopeful we can move on this soon.

Day care centres are a huge lifeline for the people who attend them. They are important to their well-being and they are looking forward to going back. I am hoping to open centres on a staged basis. If a day care centre previously operated for five days a week, we could open it initially two or three days a week and move from there. We are working very hard on this issue at the moment. I thank the Deputy for his question and the work he does with his own day care centre.

Deputy Frankie Feighan

I am happy to inform the Deputy that the Janssen single-shot vaccine was administered today to prioritised groups of medically vulnerable people living in homelessness services in Dublin. This group includes people with specific underlying conditions. There are more than 700 medically vulnerable people in homelessness services, and approximately 350 of them are due to receive the vaccine this week alone. The Janssen vaccine is very appropriate because it is a one-shot vaccine. It was incredible to see all the stakeholders and very vulnerable people who cocooned and made huge sacrifices over the past year. It was wonderful to see that single-shot Janssen being administered. That will be a huge game changer in the coming weeks and months.

Deputy Cormac Devlin

I thank the Ministers of State for those updates. The news about the day care centres is particularly welcome. Many people and staff do not know when they will be reopening so it will be great to get that information as soon as that subcommittee reports.

I thank the Minister of State, Deputy Feighan, for that update. No doubt it is very welcome that cohort is being vaccinated. There was a slight delay in starting that programme for the most vulnerable and it is important it continues.

I ask the Minister to come back to me on the question of pharmacists. I just want to get clarity on this matter. I know the vaccines are coming in next week, but when will the vaccinations in pharmacies start? Many pharmacists have completed the documentation that was required and sent it back to the HSE. Not all pharmacies are suitable as vaccination centres due to their size, but if we could get a bit more information I would be very grateful.

Deputy Stephen Donnelly

A pilot scheme is being rolled out for the ICT system and portal for pharmacists. I have taken this up with the HSE on numerous occasions, including this week. I believe there is a role for pharmacists to play in the vaccination roll-out. That is why we put a deal in place with the Irish Pharmacy Union, IPU, at the start of this process. To date, the people running the programme have said that the capacity has not yet been needed. Between the GPs, the vaccine centres and the HSE vaccination teams, there has been sufficient capacity. We know this is correct because we have been getting the vaccines out, with the vast majority of them - around 95% - being administered within seven days of arriving into the country. However, volumes are going to increase substantially and, as the Deputy rightly says, the Janssen vaccine in particular would be very suitable for pharmacists to give out. That is something we will continue to pursue.

Regarding SNAs and teachers, the same question could be asked by many very worthy groups, which we would dearly love to see vaccinated as quickly as possible. At the moment, there are excess waiting lists in order that vaccine doses are not wasted if people do not turn up. However, that protocol is carried out according to the NIAC recommendation on the cohorts and that is how we are proceeding. It should be noted this issue will diminish very quickly in the coming weeks because, as the volumes increase significantly, which is beginning to happen, more and more SNAs, teachers and our phenomenal front-line workers, whom we want to vaccinate as quickly as possible, will be getting vaccinated anyway through the cohort system.

Deputy Mattie McGrath

I would like written answers from the Minister. Why are the HSE and the Department of Health not collating figures on the numbers of people with delayed diagnoses of cancer or misdiagnoses? There are 38,000 people waiting for colonoscopies alone and many of their diagnoses have been delayed.

Student nurses were forced to take the AstraZeneca vaccine. The Taoiseach told the Dáil they had to take it or they would forfeit their careers. Now we know it is not suitable for under-60s. What redress is there for those student nurses and young people? It is shocking.

There is a cohort of teachers from Ireland working in the United Arab Emirates, UAE, who have been vaccinated. The summer holidays are coming up and they dearly want to come home. Many of them have children who want to see their grandparents. However, their vaccinations are not EU approved. Will they be forced to quarantine or can we get some forbearance for those people who have been vaccinated?

I return to the issue of St. Brigid's Hospital in Carrick-on-Suir. I want to know why it was closed in the middle of a pandemic. Why did the Minister of State, Deputy Butler, the Minister for Health and the Taoiseach refuse to meet with Councillors Kieran Bourke and David Dunne and the action committee of doctors and nurses? They point-blank refused to meet them. Why? How was the hospital deemed suitable for treating Covid patients when it is now deemed unsuitable for treating patients who are convalescing? Why is that? It was deemed suitable for Covid patients last March. Why did HIQA deem it suitable for step-down patients during the Covid pandemic and then decide it was no longer suitable in November? We need answers to those questions. I represent the people and am entitled to answers. I have not got one answer in writing from the Minister since he took up office. I expect to get them. I do not think paper is that scarce that he cannot give me a written answer. It is outrageous that the Minister of State, Deputy Butler, turned her back on her own community and her own colleagues, including Councillors Burke and Dunne and others. To turn her back on her own community as regards that hospital is shocking.

Deputy Michael Collins

I have been asking these questions for the past three weeks and I have not got any answers. The Minister promised me two weeks ago he would furnish me with answers. People over 65 who have a family history of clotting are worried about taking the AstraZeneca vaccine. Some tell me they are so worried they cannot even sleep. They are worried because the Tánaiste said that anyone who refused the vaccine would be put at the bottom of the pile. These are people who have genuine concerns.

I also mentioned Parkinson's disease sufferers last week. They have been in contact with me and I presume they have been in contact with the Minister as well. They are worried they have been dropped down the list due to the age categories and they are very worried about their own health issues. Does the Minister have a timeline as to when Parkinson's sufferers will be vaccinated?

The Minister of State, Deputy Butler, might be able to answer my third question, which relates to Clonakilty Community Hospital. It is not up to HIQA standards. I had a meeting with the HSE the other day and my impression was that it is not on the list to be upgraded at all. It is a hospital of excellence and the staff have worked so hard on it but it is not up to standard, and if it is not up to standard, there is an issue. Why is it not on the list to be brought up to standard? Clonakilty hospital serves a huge, vast area. I ask the Minister of State to come back to me on that.

I always go outside the line with these questions. I will probably run out of time so I may as well leave it to the Minister to reply to me in writing. The Minister said he would have a follow-up meeting with Vera Twomey. I respect that this does not relate to Covid but it is a Covid year and this is a very urgent issue. Much of the issue has been resolved - credit where credit is due - but there is a part that is not resolved. I would appreciate if we could have a follow-up meeting with the Minister as soon as possible.

Deputy Richard O'Donoghue

I am still baffled that there is no Limerick venue for the roll-out of the vaccine. We heard today about the Radisson hotel and how dangerous it is for people who do not have transport to cross that motorway to get to it. I highlighted this concern months ago. There are people travelling from Limerick to Clonmel, Mallow, Cork, Clare and Kerry for vaccines. We offered the Government Limerick Racecourse, the University of Limerick, UL, and other venues these people could have gone to and now they are travelling to different counties to get vaccinated. A couple on "Morning Ireland" last week talked about how difficult it was for them to get to a vaccination centre.

I highlighted this months ago. I was on Live 95 FM with Deputy Kieran O'Donnell and Councillor Liam Galvin, and they were happy enough with the venue at the time. Now, it has been proven it is not a good venue. I ask the Minister to please give us a venue in Limerick so our people can get their vaccines in their own county.

Deputy Stephen Donnelly

I thank the Deputy for the question, and we were discussing that vaccination centre earlier. The issues raised regarding access to public transport are ones I have committed to taking back to the HSE. It is imperative that everyone can access these vaccine centres. Not everybody has access to a car, of course, so people must be able to access these centres using public transport. I will take this issue back to the HSE. One suggestion made earlier was that a shuttle bus service might help a lot with the situation. We must ensure everyone has appropriate and as easy as possible access to all these centres.

Deputy Catherine Connolly

I am going back to the issue of day care centres and respite care, and this matter is for the Minister of State, Deputy Butler. I welcome that progress is being made on this issue, but I cannot understand how quicker progress cannot be made a year and two months after a pandemic was declared. The Minister of State knows the facts and figures on the ground. The vaccination programme has been rolled out. Can we have more specifics regarding day centres and particularly regarding respite care? I reiterate that I do not think it is my role to go to a Minister about a specific case but I will have to, even though I do not want to, because everyone should be treated the same. People are going under in caring roles with no respite. Briefly, when is it envisaged that we will have respite care and day centres restored?

Deputy Mary Butler

Regarding respite, and the Deputy raised this issue with me last week, I have sought a comprehensive report on this issue in the Galway area. Respite is happening in other areas and I will furnish that information to the Deputy as soon as I get it. I have answered the question regarding the day care centres. Work is under way and the task force is in place, but it must be safe to do so. There were 393 cases of Covid-19 today, so we are trying to take a cautious approach in this regard. We want to open these day care centres and not to close them again.

Deputy Catherine Connolly

I understand that, and I understand that the Minister of State is doing her best. We are, however, talking here about minimum prices for alcohol and other things that are irrelevant now. Government effort should be going into identifying vulnerable groups and essential services and restoring them as a matter of priority. That is what I am asking the Minister of State. I welcome the fact she followed up on it, but before I came in here I checked at 5 p.m. and Merlin Park Hospital has stopped respite care. Day care centres are not functioning in Galway, so we need clarification on this issue. I thank the Minister of State for that.

Turning to the roll-out of the vaccination programme, I believe the Minister has been put in a position where information is being segmented. I am not happy with that, and I do not blame the Minister for it. He is doing his best in this limited role. I think we need an overall discussion on this aspect. I was called disingenuous by the Taoiseach when I said this was not happening. I am repeating it is not happening. There are so many elements we cannot even get to discuss here. Vaccination is only part of it. Trust is an essential element, and I think that trust has been broken. I pay tribute to the people who nevertheless persist in believing in a system as best they can.

Regarding the age group from 60 years old to 69 years old, I have heard no apology from anybody. This issue has been raised by other Deputies today. For people to be told they are going to the bottom of the list is simply appalling and unacceptable. I use those words again and I hope I am using them with sufficient force so that the Minister might look at them. Regarding this age group, Professor Kingston Mills, at the end of April, pointed out, among many other things, that, "The Medical Council guidelines make it clear that recipients of medicines (including vaccines) have a right to make an informed choice and should be provided with all the information necessary for decision-making, including details on possible adverse reactions, efficacy and alternatives."

I am in a position as a Deputy where I am making representations to the HSE regarding a people having contacted me and wanting to be vaccinated but not wanting to have the AstraZeneca vaccine for very good reasons. Those people have nobody to discuss this issue with. I will not say they are at the mercy of their general practitioner. Some GPs are very good, but other GPs do a sales pitch for AstraZeneca and say there is no choice. That is unacceptable and it is no way to build confidence in the roll-out of the vaccination programme.

I have two other points to raise. One concerns temporary accommodation for healthcare workers. An issue has again arisen in Galway. It arose before, and RTÉ has raised the issue as well as Deputies. I refer to healthcare workers coming from direct provision centres, who are in temporary accommodation, and now they have been told they have to get out of that temporary accommodation. In fact, in Galway, in two cases, letters were received telling the people involved to get out by the end of July. They have not got out because they have no place to go. On the one hand, therefore, we are saying temporary accommodation is there for the duration of Covid-19 as long we have it and yet this aspect is being interpreted in a manner that is completely inconsistent and unfair when we really need healthcare workers.

The final matter I raise concerns the waiver of intellectual property rights in respect of vaccines. The Biden Administration has, finally, shown the way and that is very welcome. Our own President Michael D. Higgins has said that, "This decision marks a moment of immense moral significance in international policy, putting global need ahead of any narrow considerations." The Minister has said he is looking at this issue, and I welcome that. However, we are now a year and three months into the pandemic and this was something we should have looked at in the very beginning. Ireland should have been leading in this regard because, given our background, we knew we were all in this together. That is what we were told. Now, however, we have very upsetting scenes from India, which is producing and exporting vaccines while people are dying in the manner we are witnessing. My colleague, Deputy Joan Collins, raised this issue, I raised it and other colleagues have also raised it. We were laughed at regarding waiving intellectual property rights.

The point of the TRIPS Agreement waiver was to fill a gap in the market and encourage innovation. It is not possible to encourage innovation where there is too much risk and no demand. However, all those risks have been taken away. Why? It was because indemnity has been provided to all the pharmaceutical companies. We have taken away the risk factor and there is absolute demand. We are in a situation now where we are bolstering those companies' profits at the expense of human beings dying on the street. That is totally unacceptable. We should be leading the way. Our voice from this small country should be leading the way to say we should look at this issue. It is not good enough to tell us today it is not a panacea. I do not want a panacea. I do not want perfection. I want a country that is leading with a voice of humanity and not for profit. If we are putting all our eggs in the one basket, which I disagree with because I think we need a multifaceted approach, then at the very least remove the profit element.

In my last six seconds, we had a very interesting Zoom meeting with representatives of the Cuban Government recently, which is in the process of producing five vaccines. This is my third time raising this issue with the Government. There is an embargo on Cuba. Can we imagine that, under an embargo and in a non-profit situation, five vaccines are being worked on in Cuba and one has come to fruition. There is a very low death rate in Cuba, and while any death is unacceptable, those deaths only happened when the country opened, foolishly and prematurely, as has been admitted.