Skip to main content
Normal View

Joint Committee on Transport and Communications Networks debate -
Wednesday, 5 May 2021

Report of the Covid-19 Rapid Testing Group: Discussion with Science Foundation Ireland

I welcome Professor Mark Ferguson, director general, Science Foundation Ireland, and thank him for coming. We appreciate him taking the time as this is a very important issue. The purpose of the first part of today's meeting is consideration of the report of the Covid-19 rapid testing group, of which Professor Ferguson is chair. This is related to the resumption of our aviation hearings, which we believe are critical in terms of the reopening not only of the aviation sector but also Ireland Inc., tourism and business. On behalf of the committee, I reiterate our welcome to Professor Mark Ferguson, director general of Science Foundation Ireland, chief scientific adviser to the Government and chair of the Covid-19 rapid testing group, whose report we will deal with today. We are grateful that he was able to attend at such short notice.

This first part of our meeting will last one hour. We will then suspend before recommencing with our second set of witnesses from the Irish Travel Agents Association for the second hour.

All witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if witnesses' statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that witnesses comply with any such direction.

For witnesses attending remotely from outside of the Leinster House campus, there are some limitations to parliamentary privilege and, as such, they may not benefit from the same level of immunity from legal proceedings as a witness physically present does. Witnesses participating in this committee session from a jurisdiction outside the State are advised that they should also be mindful of their domestic law and how it may apply to the evidence they give.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind members of the constitutional requirement that members must be physically present within the confines of the place where Parliament has chosen to sit, namely, Leinster House or the Convention Centre Dublin, in order to participate in public meetings. With regret, I will not permit a member to participate where they do not adhere to this constitutional requirement to be physically within the precincts. Therefore, any member who attempts to participate from outside the precincts will, reluctantly, be asked to leave the meeting. In this regard, I ask any members participating via Microsoft Teams to confirm that they are on the grounds of the Leinster House campus prior to making their contributions to the meeting.

I ask Professor Ferguson to make his opening statement.

Professor Mark Ferguson

I thank the Chairman and members of the committee for inviting me. I was asked to chair a group of experts to advise the Minister for Health on rapid testing. Our report has been published and is available to the committee. It has a number of recommendations and there is also a body of evidence and references within the report.

By way of an opening statement, I will just say that this is a very important and rapidly moving field. Many new tests are being developed, with 1,000 or more under development, and many tests are being approved by regulatory authorities around the world. Many countries have adopted rapid testing as part of their strategy and the evidence base for rapid testing is also developing very rapidly.

Probably the most efficient thing is for me to turn this over to questions from the members and I will do my best to answer those.

I call Deputy Joe Carey.

I thank Professor Ferguson for appearing before the committee. I read the report and I am very encouraged by its findings and recommendations. If we look to other jurisdictions, we see that Ireland is behind the curve. I strongly believe we need to embrace this as a way to reopen our economy and society and to keep it open. That is the main point. If we look across to the UK, we can see that households there can apply for two test kits a week and millions of these test kits have been brought into the UK. We need to do the same in Ireland. Professor Ferguson has recommended that we move at pace on this. I strongly endorse that recommendation and call on the Government to do just that, and to make arrangements to put these recommendations into place.

Obviously, there is movement in terms of rolling out pilots here and the Minister, Deputy Harris, has moved on this in the higher education sector. I see a real opportunity for Shannon Airport as a distribution and logistical hub for the delivery of test kits and their distribution across the country. The UK used Bournemouth Airport to do that and I think Shannon is very well placed to play a leading role in the distribution of these kits.

What is the difference between antigen testing and LAMP testing? I see there are differences between them in the report so Professor Ferguson might explain that.

Professor Mark Ferguson

I will do my best to explain the differences. A rapid antigen test detects a protein on the virus and it works where, in the test kit, there is an antibody that binds to that protein, and that is then linked to some sort of marker, whether it is a fluorescent marker or a gold marker, and it reads out as a little line. In simple terms, it is a lateral flow antigen test and it is predominantly detecting the presence of live virus of proteins that are in the intact virus. That is the basis of most pregnancy tests so, for many years, people have been able to walk into a chemist shop and buy a pregnancy test, which is a lateral flow test that works in that way.

What is great about this is it does not require a laboratory or any special equipment. It is a kit which anybody can use on their own or under supervision. By contrast, LAMP testing requires a laboratory, but unlike PCR, it does not require very sophisticated equipment or chemicals. It only requires an oven. For LAMP testing, one mixes the reagents and then tests the sample and it reads out, but this has to be done in a laboratory. It is slightly more accurate than a lateral flow antigen test and it might be suitable, for example, for a large company with, say, 2,000 employees or for those with access to a basic laboratory facility. LAMP testing is being used in some of the universities, such as Trinity College Dublin, for testing students. It is faster than PCR and slightly more accurate than lateral flow antigen testing, but in simple terms, it requires a dedicated person and a laboratory.

Our report focuses on the lateral flow antigen testing because ultimately, as rightly stated by the Deputy, people can do the test themselves. People can be trained to do it at home and, where a test is positive, the person would not go to work, but would have a confirmatory PCR test from the HSE. That is very much the strategy that the UK and other countries such as Austria, are pursuing. In the United States, there are big programmes under way as well and other countries such as the Czech Republic, Slovakia and so on are empowering their citizens to take ownership of their health and test themselves and, if they test positive, to go for a confirmatory PCR test. These tests are not quite as accurate as PCR. The false positive rate is approximately 1 in 1,000, which means that from every 1,000 tests carried out there will be a positive that is actually a negative. The order of accuracy in regard to the negative results, in other words where the test reads negative but a person is actually positive, is between 50% to 80%.

A really important point made in the report is that validated tests only should be used, a list of which are available on the EU Joint Research Centre website. Those are tests that have been validated by at least one member state and in use by at least more two member states and they meet certain minimum specificities. There are certain commercial tests that do not work nearly as well as I have articulated. They should not be used. People should use only those tests on the validated list.

I thank Professor Ferguson. I have a lengthy list of members who wish to ask questions and they will have an allocated time of, roughly, three to four minutes each. I am conscious of time and the need for the committee to get maximum information today so I will move on now to Deputy O'Rourke.

I thank Professor Ferguson the report. I will be brief. Professor Ferguson mentioned that things are moving rapidly. I refer to the reports from HIQA of 21 October, the European Centre for Disease Prevention and Control, ECDC, of 19 November and the Centers for Disease Control and Prevention, CDC, of 16 December. It would appear that the technology might be moving but policy and Government response is static. I would welcome Professor Ferguson's opinion on the delay in moving on antigen testing and if he believes now is the time to act and to do so immediately. I am interested in hearing his perspective on how this technology could be used in the aviation sector. Is it an option for airline and airport workers in the first instance?

Recommendation B1.9(b)(ii) deals with programmes of repeated rapid testing of essential workers who travel into the country. I ask Professor Ferguson to focus on the following question. Is that a realistic possibility, complementary to PCR or in addition to PCR? There are a lot of people travelling into this country who are subject to a pre-departure PCR test within 72 hours and no post-arrival PCR test. Does Professor Ferguson believe there is need for a pre-departure antigen test and post-arrival serial antigen testing that might meet the same quality standard? In other words, antigen versus PCR serial testing versus one-off testing.

Professor Mark Ferguson

I thank the Deputy. The answer is "Yes, we should act immediately." In regard to the Deputy's other question, in the United Kingdom the Scientific Advisory Group for Emergencies, SAGE, group produced a paper, which is available on the gov.uk website at SAGE minutes, in which it modelled the effects of serial testing of travellers coming into the country and showed that that was as effective as quarantine. What does this mean? It means that when a traveller comes into a country, he or she is issued with a barcoded rapid antigen test. The barcoding is unique and there will be a record of to whom, say, ten tests are given. Those individuals test themselves daily, take a photograph of the barcode and the test result and then upload it to an IT system, which records that a person has done a test and it is negative. That person can then go about his or her business. If a person does not turn in a test - a person might forget to do it or deliberately not do it - he or she is issued with an automated reminder to do it. If the person repeatedly does not do the test, as the IT system has recorded when that person entered the country, as well as his or her telephone number, contact details and so on, somebody will pay him or her a visit to find out what is going on. That was modelled for SAGE and shown to be as effective in isolating infectious individuals as quarantine, either at home or in a hotel situation. It is my understanding that the UK is now piloting that at present.

Our recommendation was about essential workers coming into the country. These would be people coming in to fix a piece of equipment, to carry out a specific operation on a patient or to treat somebody. It would also include people coming here to attend a funeral. These are all situations in which it would difficult to quarantine people because they have to act immediately. We are suggesting that in those situations, serial rapid testing could be used but tests would need to be barcoded and an IT system is required as well. This could then used in the longer term. This is contained in the body of the report, not the recommendations. In the longer term, when more people are vaccinated in, maybe, a few months' time, this might be something for a number of people coming into the country. Consideration could be given to giving it to everybody on an aeroplane. The most important thing to remember is that numbers become important. If most people do it, we are far better off than having a small number of people doing something else.

I thank Professor Ferguson. I ask members to follow on with questions. This is about extracting the maximum amount of information from the research carried out by Professor Ferguson. The next speaker is Senator Dooley.

I thank Professor Ferguson for his comprehensive report. On the wider use of antigen testing, I have been contacted by individuals who believe there is an opportunity to carry out antigen testing within the hotel experience. There is concern that some people will be hesitant to visit hotels when they open next month owing to the mixing that takes place within a hotel environment. Based on Professor Ferguson's experience and understanding of antigen testing, does he see a role for it in the hotel environment? Could it form part of a building of confidence in people to visit hotels and participate in activities that happen in that environment? In light of Professor Ferguson's experience around testing and the quality and improvement of antigen tests generally, does he believe we can get to a point pretty quickly at which we can dispense with mandatory quarantine?

Does he believe that, as a result of using antigen testing as a component of our overall testing system in conjunction with the roll-out of the vaccine in other countries and the existing PCR testing, we could get to a point at which mandatory hotel quarantine would not be required, because it greatly inhibits us in getting the aviation sector back on track?

Professor Mark Ferguson

I thank the Senator very much. In answer to his question, yes, I do believe rapid testing will be very important in instilling confidence in people who may wish to go to hotels, restaurants and so on. It may very well be the case that the owners of hotels or restaurants will do this voluntarily. Speaking personally, I would feel a lot more confident about going to a hotel or restaurant if I knew that everyone there had been rapidly tested or tested previously. It is not perfect. There will be some mistakes but it is an awful lot better than doing nothing. It is important in restoring confidence. I am not sure I would make it mandatory but there is a role there for business owners.

In terms of mandatory hotel quarantine, this situation will become really interesting as travel begins to open up. It is really important that we do these pilots soon and quickly. The report talked about moving at pace. If we start with the essential workers, we can find out what compliance is like, what the IT systems are like and how easy it is to do. We would then be in a very good position to think about whether this could be rolled out more widely and whether we could potentially dispense with mandatory quarantine, as the Senator mentioned. Variants are going to become very important. They come from other countries but also develop in our own country. They generate spontaneously. Therefore, widespread testing both of visitors and the indigenous population is important to keep a handle on those variants.

How confident is Professor Ferguson that the existing tests will be sensitive to the variants? How quickly can the sensitivity of the kits be changed? Obviously, a great deal has been learned over recent months, but how quickly can testing be adapted to identify the variants that now exist?

Professor Mark Ferguson

The existing tests detect all variants but they do not distinguish between them. The reason for this is that the antibodies are detected at what is called the nucleocapsid of the virus. This is the bit that does not change much. The good news is that the test will tell one whether the virus is present, but it will not tell one if it is a variant. The strategy would be for those who tested positive on an antigen test to take a confirmatory PCR test, from which the virus would be sequenced, allowing us to know what variant, if any, was present. The trick behind the testing is twofold. First, it will allow an awful lot of people to be screened very quickly and cheaply. Second, it will allow those who test positive to be isolated very quickly. That is the most important thing if this system is to substitute for hotel quarantine. One gets the result within approximately 30 minutes. People who test positive should isolate until they get a confirmatory PCR, after which they may need to continue to isolate. Rapid isolation is the trick. That will allow this system to be substituted for quarantine. Of course, compliance will be important. That is why I really believe that we need to do these pilots at scale so we can get the data, see what they look like and see if this could be deployed more widely.

I will ask a final question if I may.

We have to move on. The Senator has had nearly six minutes. I will allow him in at the end.

Are all antigen tests the same? Is there a standard?

I ask Professor Ferguson to give us a "Yes" or "No" answer as I am conscious of other members.

Professor Mark Ferguson

No, they are not. The best ones are on the Joint Research Centre list.

Following on from that, how long would it take to get a pilot scheme up and running? Has Professor Ferguson had interaction with the Government about setting up such a pilot scheme? If there was a pilot scheme up and running and the barcode system was in place, coupled with the vaccination programme now under way nationwide, including here, and with the digital green pass now being considered by the European Commission, how quickly could antigen testing become the standard test for pre and post-departure testing of those travelling into and out of Ireland?

Professor Mark Ferguson

The testing pilots of which I am aware are in the further and higher education sector and in the universities. The Minister, Deputy Harris, is moving. I am well aware of those schemes. I am also aware of developments taking place with employers in the general employment sector.

My question is-----

Professor Mark Ferguson

I am not aware of anything in the aviation sector in Ireland. I know a little about the pilots going on in the UK but I do not know of anything like that in Ireland.

How quickly could a pilot be set up and the results concluded?

Professor Mark Ferguson

It could be done very quickly. The obvious thing to do is to learn from the experience of the UK. There may be other countries doing such pilots as well.

Could it be done in a month?

Professor Mark Ferguson

I would think so, yes.

Has Professor Ferguson had interaction with the Government regarding the recommendations in his report? I refer specifically to interaction with the Department of Transport in respect of aviation. The vaccination programme is very much under way in different countries. How does that feed into the professor's thinking around pre and post-departure antigen testing for air travel, linked with quarantine, so that we can get the aviation sector back up and running in a way that is safe for people's health?

Professor Mark Ferguson

No, I have not had any interaction with the Department of Transport in this regard, although I would be very happy to help if the Department is interested.

We will follow up with the Department and ask it to interact with Professor Ferguson immediately with regard to a pilot scheme for antigen testing in the aviation sector. We can do it in the essential worker space, as Professor Ferguson recommended in his report. Will he comment on the vaccination programme that is under way and the digital green pass being proposed by the European Commission? How does he believe these matters will feed into antigen testing becoming the benchmark test for air travel? Obviously, positive antigen tests would have to be followed up with a PCR test. That is a given. Will Professor Ferguson make his final comments in that area?

Professor Mark Ferguson

Let me speak specifically about testing and then about antigen testing. I believe that, if an individual had been vaccinated, had taken a pre-departure PCR or antigen test, had a follow-on test on arrival followed by serial testing either every day or every two days------

Professor Ferguson is referring to antigen testing.

Professor Mark Ferguson

Yes. What I have described would be a pretty good sign that such a person was relatively safe. What do I mean by that? The antigen test determines whether one is infectious and may pass on the virus. One is much less likely to pass on the virus if one is vaccinated. If one is in the category of those who may pass on the virus despite being vaccinated, which is rare, that should be picked up with an antigen test. When those two things are combined, it is fairly safe to say that most infectious people would be caught and that it would be a satisfactory regime. I emphasise that no regime is perfect. There will always be one or two things, even with PCR testing, that allow people to slip through. That is not the game we are in. We are in a numbers game. It is a matter of trying to prevent most people passing on the virus and trying to allow them to be safe. The combination of vaccination and rapid testing will allow that to be done. If this was to be combined with people wearing masks on aeroplanes, I would feel very confident.

I thank Professor Ferguson. This engagement is informative and necessary. I agree that we need a pilot scheme as soon as possible so that this can be brought into operation in respect of aviation. Professor Ferguson spoke about how PCR testing is more accurate. This issue can be dealt with by having more rapid antigen testing. How many such tests are needed to make up for this deficiency? What is the false positive rate? Is it one in 1,000? What would be necessary? Does Professor Ferguson have any indication of the cost of those better quality tests? Obviously, the system would be a lot less costly if mandatory hotel quarantining and so on were to be dispensed with.

Professor Mark Ferguson

I will explain the difference between the two tests in some detail at the end but, in simple terms, one can increase the accuracy of a rapid antigen test in the following ways. The first is training.

There are many videos on YouTube but, in my opinion, the best ones come from the National Health Service, NHS, in the UK. They teach people how to take the sample because that is where there is quite a lot of inaccuracy. It is about training people on how to take the sample, by self-training and so on. As regards the accuracy of the test itself, as I said, the Joint Research Centre in the EU has a list of very good tests. The accuracy with which the result is read is a simple matter. For some tests it is necessary to wait 30 minutes. If one tries to read them after five minutes one might not get the right result. Again, that is about training. That is the first thing.

In terms of deploying tests, serial testing really improves accuracy. In the workplace, we recommend testing every two to three days. It is better to test every day, which is why we recommend that a test is done every day for people coming in on an aeroplane. That is an antigen test.

For how many days would the test be done?

Professor Mark Ferguson

That is a good question. It would be for the ten days that are currently done in quarantine. It would be the same length of time but instead of being in quarantine there would just be a test every day. Clearly, if people tested positive, they would isolate. If they tested negative, they could continue around their business.

If there is a positive or a negative test and a need to be sure, just immediately do another test. The first thing is, if a test is positive and someone thinks, "I am not really positive", do another test and if that is positive, one can be pretty sure the person is positive. He or she can go for a confirmatory PCR. These are very straightforward matters.

The cost of tests varies. The UK procurement document, which is a public document, states that each individual barcoded test must cost less than £5. The UK is paying less than £5 but how much less I do not know. It may be £3; I do not know. In normal pricing, the tests cost somewhere between €5 to €9. It would depend on how many are bought and how they are bought and so on, but the cost is of that order. The cost is very low by comparison with PCR, mandatory quarantining or anything like that. They are relatively cheap.

I ask Deputy Ó Murchú for his concluding remarks.

We are looking at something that could be €50 or €60, which would obviously make up for the deficiency in antigen testing because it will be done very often. It would give us a roadmap with which we could operate. We need to look into this and a pilot needs to be set up as soon as possible regarding aviation. That is just it.

We now move to the Fine Gael slot. Deputy Crowe has three to four minutes.

I have not joined the Chairman's party but I presume he is speaking of a Fianna Fáil slot.

What did I say?

The Chairman said Fine Gael. We are in coalition of course.

I am obviously moving ahead of the trend. I apologise; it was a Freudian slip.

The Tánaiste is often mistaken for the Taoiseach so I suppose it all balances out. I thank Professor Ferguson for joining us this afternoon. There are a number of very compelling benefits and arguments to rapid antigen testing. First, the cost factor. It is approximately €5 per antigen test versus a huge variance of anywhere from €30 in North Macedonia, to approximately €150 in Dublin Airport at the moment, for a PCR test. There is a huge price variance. The speed at which results come back is also an issue. All of that has to be juxtaposed with the accuracy of the testing that is coming back.

Over the last number of weeks, I have looked in depth at the digital green certificate. When this was first mooted, many people expected it would absolutely nail down that PCR tests were the only method of certification. When the technical specification was issued last week, lo and behold, it mentioned certification of antigen testing. It paves the way in the months ahead, as aviation gets back to some normality, that it will not always be just PCR testing. There is some space in the room for rapid antigen testing and that needs to be looked at.

I come to Professor Ferguson with a proposal to see what he would think of it. Perhaps our committee could then take action on it. There is obviously a space here at the moment, with five or six lead-in weeks before the digital green certificate is operational throughout the EU. Right now, each member state is working pretty much off its own rules, for better or worse. A logical way of trialling this could be to pick one route in and out of Ireland with very few passengers, maybe a dozen or two dozen, where it is known who is on the aeroplane. To entice passengers, they would not have to get a PCR test; they would be antigen tested and we will see how that would go. The route could be Heathrow to Dublin as we unfortunately do not have Shannon routes at the moment, but it would be an in and out service. That could be trialled over these few weeks until we have a European-wide regime. What does Professor Ferguson think of that as a pathway to getting some normality back to aviation without breaking the bank for the passenger?

Professor Mark Ferguson

That is a very good idea. The Deputy's suggestion of doing it on an Ireland-UK route is particularly helpful, because as I said previously, the UK is piloting these things and has got the IT systems in place. If an airline on that route is picked, such as CityJet, Ryanair, Aer Lingus or whatever, this system could be used as a substitute for home self-quarantining, for example. The data would need to be collected, it would need to be seen that people did the test, reported the results and information was received on how many people did that and so on. The Deputy's idea is a very good one. If that was done, there are quite a lot of businesspeople travelling at the present time, and others who, I suspect, would volunteer to participate, particularly if they did not have to home isolate but would be allowed to go about their business. This is unless, of course, there was a positive test, in which case it would be necessary to isolate and get a confirmatory PCR. The Deputy's idea is a good one.

I formally propose, out of today's meeting, that this proposal go forward to the Departments of Health and Transport on a trial basis for the next few weeks. I watched a Sky News report the other night in which people were filmed coming in and out of a disco in Manchester, which was trialled using a sample of the population. We are talking about sampling, potentially, people going to concerts, matches, etc. Why not look specifically at, and this is probably one of the best ways to test it, a flight that has a very low carry load, maybe ten or 12 passengers, in and out of Ireland to the UK. Let the HSE trial this and monitor its efficacy. This could very well be a pathway forward for Ireland, using the building blocks of the digital green certificate. I formally propose that, out of today's committee meeting, if there is no dissent, this become a recommendation now, not next month.

We already agreed to write to the Department of Transport to ask that it engages with Professor Ferguson to set up a pilot scheme. The Deputy has put forward the construct of what that pilot scheme should look like. We will include that in the recommendation. Other matters may come up in the course of the meeting. We have already taken a decision today. We will write to the Department immediately, asking it to set up a pilot scheme. Clearly, the construct of looking at a particular flight over and back to the UK where, as Professor Ferguson said, it already has the structures in place, absolutely needs to be done immediately. We have Professor Ferguson before us today and there has been no interaction with the Department of Transport on a report that is groundbreaking but very straightforward. The report is now a month old. This testing should have been going on for the last number of weeks. We still have sufficient time so, certainly, the construct around such a pilot scheme should be included in our recommendation.

We will move on to the Green Party slot. Deputy Matthews has four minutes.

I want to go back to what Professor Ferguson said at the outset about the SAGE report and the testing being carried out in the UK. Is the UK carrying out that testing at the moment and could we learn from any mistakes, or what it is doing at the moment, rather than proceeding straightaway to a pilot? Is that a more effective way of assessing whether serial testing would work? Is Professor Ferguson aware of a pilot scheme operating in the UK, and has been operating for some time, which would allow us to make an assessment on that? Can we get a report on that or would it be for the committee to follow that line of inquiry, to learn from any mistakes being made in the UK? I thank Professor Ferguson.

Professor Mark Ferguson

It is necessary to do both. One can definitely learn from the experience of other people and what they will say about matters I have already told the committee about, such as serial testing. It is also necessary to do the pilot because the logistics and IT system need to be in place, as well as the people within the Health Service Executive or on the ground in whatever airport is chosen in Ireland and so on. There are two parts to it. The logistics part needs to be done and there is a need to learn from other people.

I am not certain about what I am about to say, but as far as I know the UK has commenced those studies.

I am aware of the modelling work done for SAGE and have read the report, which is in the public domain. My understanding is that the UK pilots have just started so this would be a very opportune moment to take part in those, for example, in the way suggested by the previous Deputy in the context of a UK-to-Ireland flight. That is the answer. It involves logistics and learning.

The committee should try to pursue the matter of the authorities here working in tandem with their UK counterparts. I do not imagine things would be that different, logistically or behaviourally.

When we write to the Department, we will implicitly ask it to link up with the UK. It should be an integrated approach between ourselves and the UK. There are benefits in terms of the North-South angle. It is a collaborative process. We will include that in our request to the Department of Transport.

I do not have much to add and nor to I have questions beyond those that have been asked already. What Professor Ferguson has delivered in terms of his 50-plus page report is something this country had needed for a number of months. It is a rigorous and strong academic paper on the advantages of rapid mass antigen testing. Professor Ferguson is chief scientific adviser to the Government of Ireland and the Government needs to take this on board. Our aviation industry needs a pathway out of where it is at the moment. It needed action months ago. The initial report on aviation recovery was published last summer. We have always been behind the eight ball on this. We were told that antigen testing was not the gold standard. Unfortunately, PCR testing was the enemy of the good for so long in terms of Government policy but Professor Ferguson has set out in detail how this can be ameliorated and managed and why there are such advantages to antigen testing.

I thank Professor Ferguson for his report, which needs to be taken on board. I commend the Chairman on the urgency with which he has set out how the committee will deal with this matter. Deputy Cathal Crowe's suggestion is very good. I support it and am glad it will be included.

A few airports, such as those in Rome and Istanbul, have used antigen testing. Representatives from Rome Airport appeared before the committee a number of months ago. Did Professor Ferguson look at any further evidence of how their testing has continued over the past number of months, particularly through the winter wave, or did that fall outside the scope of his report? I again thank him. I cannot emphasise how important this is for our aviation industry.

Professor Mark Ferguson

Unfortunately, we did not look in any more detail at those airports. This is something that someone else could do but we did not do it.

I have nothing more to add other than to heap further plaudits on the report and give a boost to how much we need to implement this recommendation.

I have been raising the necessity of rapid antigen testing at a political level since last January. To be honest, I have been baffled by the sluggish response from the HSE and NPHET. It is very regrettable that such a valuable tool in our battle against Covid has not been advanced. Hopefully, the work of the committee today can help to facilitate matters in that regard.

Can Professor Ferguson confirm whether an antigen test detects both symptomatic and asymptomatic carriers? My position on this is very simple. The test is easy to perform, generates rapid results and is relatively cheap. It should be used in the construction industry, the hospitality and retail sectors and schools. I am aware that a pilot project is under way in the context of construction. Many private companies are using antigen testing very effectively. Such testing is widely accepted across Europe. It is advanced in the UK, Germany, France and Italy. All across Europe, huge orders are being placed with companies manufacturing antigen tests. My concern is that we will end up like we did with PPE at the start of the pandemic and manufacturing capacity will be full by the time we make a decision.

I am not happy about the delays in respect of this matter. I raised it with the Tánaiste and Minister for Enterprise, Trade and Employment last week. As part of his response, he stated that the Government endorsed Professor Ferguson's report and that there were differences of opinion between scientists and public health doctors. Could Professor Ferguson explain what these differences are and whether we can overcome them? The political will to roll out antigen testing is there but there is resistance within NPHET and at senior level in the medical profession to this being deployed.

Professor Mark Ferguson

Antigen testing does detect symptomatic and asymptomatic individuals. It is really useful in mass testing for asymptomatic individuals because if someone feels perfectly well, he or she may not be motivated to roll up for a test so that is really part of the advantage.

I cannot really tell the Deputy why people are resistant. He would need to speak to those individuals but if we look at the data, we need to understand that a PCR test and an antigen test are about different things. Since this is a transport committee, people often talk about the PCR test as being the Rolls Royce test. According to this analogy, if one cannot have a Rolls Royce, one should not have any car but that is nonsense. If I wanted to travel through Africa, I would not use a Rolls Royce, I would choose a Land Rover. If I wanted to be green and save the planet, I would choose an electric car not a Rolls Royce that burns so much petrol per gallon. What that tells us is that it depends on the question one is asking. An antigen test basically detects infectious people. It detects an individual who has a viral load and is likely to have live virus and transmit it to other people. This is what we want to do. We want to remove those infectious people from the workforce, the aeroplane or general society and get them to isolate until they are not infectious. One then stops the spread of the virus. A PCR test detects the nucleic acid of a virus and that tells a person when he or she has a very small amount of virus that is not infectious, tells him or her when he or she is infectious and tells him or her when he or she is post-infectious - in other words, he or she is way over having had the symptoms but still has some traces of the nucleic acid. These tests are detecting different things. An antigen test will not tell a person whether he or she has ever had Covid or whether he or she is over the virus, it just tells someone whether he or she is infectious at that stage. The mentality that equates a PCR test with an antigen test is unhelpful. They are detecting different things.

By definition, any self-administered test is less accurate than a professional test but there is plenty of precedent for this. A woman can walk into a chemist shop, buy a pregnancy test and carry out that test and when she goes to the doctor, the doctor carries out another one so this is known. As already stated, training is very important. There are plenty of good videos. Taking the sample is very easy to do. Reading the test is very important and that can be aided with a photograph. Selecting the right commercial test kit is also important. Of course, no test is infallible. There are about one in 1,000 false positives with an antigen test while there are false negatives as well and people need to be educated about that. They need to be told that the test is not perfect but that is true of almost any test. We just need to think about the different contexts of the test.

I thank Professor Ferguson for being here today. The scientific dogs in the street have been screaming about antigen testing for some time. Noted broadcasters have been screaming about it.

We have raised it in this committee and I have raised it in the Seanad. There has been antigen testing throughout Europe for several months. There has to be a gate blocker; there must be somebody here who is preventing this moving forward. We appear to be constantly behind the curve on matters such as antigen testing. Has Professor Ferguson encountered resistance to the committee as it tried to progress this study?

I fully support the option put forward by Deputy Cathal Crowe. However, given the Schengen travel area throughout Europe, there will clearly be an integrated travel scheme in Europe. The Minister for Defence spoke yesterday about a mobile phone app whereby I would be able to bring it to the airport, show it to a card reader and it would declare I had taken my test and am free to travel. Is Professor Ferguson aware of how far advanced we are in the development of that app?

That is all I have to say. I thank Professor Ferguson for his time. My colleagues have had many questions for him.

Professor Mark Ferguson

Indeed, there are people who worry about the accuracy of a rapid-flow antigen test. I guess it is the difference between a diagnostic for an individual patient and a screening device for the population. A screening device for the population has to be easy to use, cheap, very straightforward and have a good degree of accuracy. In my opinion, one in 1,000 is an acceptable level for a false test. In the opinion of some other people, it is not. They would want it to be one in 100,000 or whatever. That is just a matter of opinion. I think much of the worry is about the accuracy of the test. Another worry is people misunderstanding the test, so they believe if they get a negative test they can go crazy. This is what is called a risk transfer type of argument. The same argument was made about condoms, seat belts and so forth, that people were going to misbehave. That is not the way to look at it.

I view antigen testing in the context in which we are discussing it as a health and safety measure. If one wears a bicycle helmet, does one ride the bicycle more dangerously than if one did not wear the helmet? I do not think so. It is the same type of argument here. The people who are worried about testing worry partly about the accuracy per se and they worry about the potential behavioural changes that may occur after that. My personal view is that the public are very well educated. They know the challenges of Covid-19, and it is a terrible disease. They are aware of the problems of severe lockdown and restriction of economic and social activity. I believe that one should explain to people that this is a screening tool, a way of trying to increase the safety of the population and, as a Deputy said earlier, to give people confidence to go back onto an aeroplane or to go to a restaurant, hotel or to work. Yes, there will be some cases where it is inaccurate and one may be one of the unfortunate people who get an inaccurate test but, by and large, it is much better than doing nothing and much better than having a complete lockdown. Most people will understand that. I have a great deal more faith in human nature, that most people will not misbehave and that they will do the test and comply. We cannot devise a system for a very small number of people who are obviously not going to work it the way we would want. The vast number of people would, because they are keen to get back to their lives.

That is clearly an opinion, and there are different opinions. I have tried to summarise what I see as the opinion in this area. I must say that the tests are getting more accurate and the weight of evidence behind using them is becoming ever more compelling.

I have a final brief question. The issue of pilot testing arose here this morning. Pilot testing has taken place in most European countries and in the UK at this stage. Can we not just bite the bullet now and go for it? Pilot testing will only delay us even further.

Professor Mark Ferguson

Yes, we should move very quickly. The only reason that I would recommend pilots at scale and at pace, which is what is in the report, is in order to get the logistics right. That is all.

It runs in parallel with establishing a system to operate it.

Professor Mark Ferguson

Yes, exactly.

Senator Buttimer has four minutes.

I thank Professor Ferguson for attending the meeting. Professor Ferguson is the chief scientific officer for the Government. His report was published in April, but it was submitted on 19 March. What has been his engagement with the Government since then?

Professor Mark Ferguson

I have had fairly extensive engagement across the higher and further education sector with the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, and officials of that Department and I have been involved in discussions about extensive pilots which are under way or are planned.

That is just in education. Is that correct?

Professor Mark Ferguson

It is in higher and further education.

Has NPHET, the chief medical officer and Dr. Glynn engaged with Professor Ferguson? Has there been interaction with the Minister for Transport and the Minister of State with responsibility for aviation?

Professor Mark Ferguson

In the case of transport and aviation, no. In terms of NPHET and Dr. Glynn, yes, they have read the report and I have talked to them about it. I have also had interaction with the commercial sector, the Tánaiste, IBEC and commercial employers and companies.

What has been the view of NPHET and the Government regarding a pilot, which we all support?

Professor Mark Ferguson

My understanding is that the Government has endorsed the report. It is up to individual Departments to roll out parts of that report. Clearly, I have made recommendations and I am very happy to help or engage in any way I can be helpful. It is down to the individual Departments to roll out any recommendations.

Should Professor Ferguson be involved in putting together a pilot? Who should be involved in putting that pilot together, be it in respect of a flight, a sporting event or a nightclub, as in the case of the UK? Has Professor Ferguson or the Government had any engagement with the NHS regarding the pilot scheme?

Professor Mark Ferguson

In terms of a pilot scheme, one would want to have engagement with the relevant actors. In aviation one would want the airline company, the airport staff and the HSE involved. If anybody wishes to ask me or any other member of the expert group - remember I only chaired that group - about the knowledge, we would be very willing to help. Incidentally, we did recommend setting up an expert group for the knowledge.

As regards the NHS, I had very extensive interaction with colleagues there, as did the expert group, in the context of taking evidence and learning from their experience of the widespread rolling out of rapid antigen testing. We have certainly done that in terms of gathering the evidence and support for the report.

Hopefully, we will set up the EU digital green certificate or green passport. Would Professor Ferguson be of the view that Ireland should have a pilot in place before we do that? Is he supportive of the EU passport?

Professor Mark Ferguson

Yes, I am supportive of putting a pilot in place immediately. The report said we should carry out pilots at scale and as quickly as possible. As I explained previously, that is mostly related to logistics. It is a little related to learning, but it is also about logistics and getting the right people involved. I am fully supportive of that. In addition, I am fully supportive of some form of digital passport that could incorporate the vaccination status and testing. That has been tried in Israel and in a number of other places. It is going to be a way of understanding how to engage safely in activities that people want for the sustainable reopening of the economy and society.

I thank Professor Ferguson for his contribution and for his work.

Professor Ferguson, if the Government were to ask you to head such a pilot programme, particularly in the context of aviation, for example, is it a position you would be willing to take? You recommended in your report that an expert group be established. If the Government approached you to lead such a group in a pilot programme, would you be willing to undertake that task?

Professor Mark Ferguson

That would not be appropriate. I would be very happy to help in any way possible, and I am sure any member of the expert group would be capable of doing that. I have the job of running Science Foundation Ireland, and it is important for the people involved either in aviation or in the hotel business for the HSE and the Department of Health to be involved. I am not shirking a responsibility. I am simply saying there are not enough hours in the day, and it is not my job. However, I am very happy to help or advise in any way that could assist the setting up of such a pilot.

Professor Ferguson's report on the aviation sector is great work. It has been idle for too long, for the last month. I note that on page 47 he makes a specific recommendation about a test to release, to reduce harms from unnecessary quarantine, for example of asymptomatic contacts, critical workers and international travellers. It is a recommendation. We will write to the Department of Transport, which is the principal Department for aviation, and we will also write to NPHET, the Department of Health, the Minister for Health, the Department of the Taoiseach and the Tánaiste to raise the urgency to set up such a pilot programme with immediate effect. It is a pilot and roll-out since ultimately they would happen in parallel to get the logistics in place.

What reaction did Professor Ferguson get from Dr. Holohan and Dr. Glynn and what is NPHET's view on the report? He did not get a chance to answer that direct question. He might elaborate on it.

Professor Mark Ferguson

As far as I am aware, the report has not been officially discussed at NPHET, although I have discussed it, especially with Dr. Glynn, before Dr. Holohan returned to work. They see it as complementary. Their view is also that it is up to line Departments other than the Department of Health to implement some of the recommendations. One can see a flavour of that in the recommendations in the report. The Department of Health is focused on rolling out the vaccination programme while looking at hospitals, general practitioners and so on. It is for other the Departments, including Education, Transport and Enterprise, Trade and Employment, to take the lead and to involve the HSE where appropriate. The HSE is involved in the confirmatory PCR test. One of the interesting things about our recommendations is that one can do the antigen test and then, if one tests positive, the confirmatory PCR test is not just about a confirmation of the test but bringing a person within the governance of the HSE, since he or she is now within that system. If one makes that link, that is how one will get the Department of Health on board. It becomes involved at that point.

In summary, any pilot programme, with the Department of Transport as the principal Department, will involve NPHET, the Department of Health and the HSE. We thank Professor Ferguson for coming in at short notice. This has been a most informative session and he has given of his valuable time. We will write to the Department of Transport and the Minister. We will also write to the various other bodies that we named, including the Department of Health, the Minister for Health, NPHET, the HSE and the Department of the Taoiseach, which is co-ordinating all matters regarding Covid. We want to see a pilot programme established with immediate effect which would look at specific routes vis-à-vis the UK and work with the UK on its pilot scheme so that when the green certificate is up and running we, as a country, are not left on the runway but are flying with the other countries.

Is the SAGE material that Professor Ferguson spoke about earlier all available online? I know there are a number of papers. If it is not, we would need that extra information and also the detail about the IT systems etc. If we could get that as a committee, that would be brilliant, or do we need to go and seek that?

Professor Mark Ferguson

It is online and I will send the reference to the clerk.

Professor Ferguson works with our committee in any way necessary. We see him as a valuable asset in dealing with Covid and reopening the aviation sector and the economy. I thank him.

Sitting suspended at 1.34 p.m. and resumed at 1.41 p.m.
Top
Share