Covid-19 Pandemic

Questions (692, 828, 928)

Seán Haughey

Question:

692. Deputy Seán Haughey asked the Minister for Health if a person in any category who has a conscientious objection to receiving one particular type of Covid-19 vaccine can opt instead for a different vaccine; and if he will make a statement on the matter. [7597/21]

View answer

Paul Kehoe

Question:

828. Deputy Paul Kehoe asked the Minister for Health if there will be a choice or options provided with regard to Covd-19 vaccines; and if he will make a statement on the matter. [6856/21]

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Denise Mitchell

Question:

928. Deputy Denise Mitchell asked the Minister for Health if there is a provision for persons to choose which vaccine they receive if they are unwilling to take one on religious or moral grounds. [7314/21]

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Written answers (Question to Health)

I propose to take Questions Nos. 692, 828 and 928 together.

The European Commission has to date authorised the use of three COVID-19 vaccines in Ireland following recommendation by the European Medicines Agency (EMA). All of the approved vaccines comply with all the requirements of quality, safety and efficacy set out in the EU pharmaceutical legislation. In addition, authorised vaccines are subject to ongoing monitoring in Ireland by the Health Product Regulatory Authority (HPRA).

It is recommended that you accept the COVID-19 vaccine when it is offered to you. It is not intended that a choice of vaccine will be provided.

Further information on COVID-19 vaccines can be found here:

https://www2.hse.ie/screening-and-vaccinations/covid-19-vaccine/getting-covid-19-vaccine.html

Vaccination Programme

Questions (693)

Sorca Clarke

Question:

693. Deputy Sorca Clarke asked the Minister for Health the most recent medical advice regarding pharmacists providing Covid-19 vaccinations. [6328/21]

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Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Ministerial Correspondence

Questions (694)

Niall Collins

Question:

694. Deputy Niall Collins asked the Minister for Health if he will address issues raised in correspondence (details supplied); and if he will make a statement on the matter. [6337/21]

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Written answers (Question to Health)

The HSE has adopted RNA PCR as the gold standard test for diagnosing Covid-19. This is consistent with international best practice.

The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) recommend that nucleic acid amplification tests, such as RT-PCR, should be used to detect suspected, active SARS-CoV-2 infection. The advice of the WHO and the ECDC is available on their websites. For example, in its Technical Report “Options for the use of rapid antigen tests for COVID-19 in the EU/EEA and the UK”, published on 19 November 2020, the ECDC confirmed that “To date, testing for SARS-CoV-2 infection mostly relies on reverse transcription polymerase chain reaction (RT-PCR) performed on a nasopharyngeal specimen. This testing method remains the gold standard for detecting SARS-CoV-2 and is characterised by both high sensitivity and specificity in detecting viral ribonucleic acid (RNA).”

SARS-CoV-2 PCR assays in Ireland are operated in accordance with the manufacturers' instructions, and the CE marking for the assay. It is the manufacturer that decides the optimal number of cycles for the assay, not the testing laboratory. For commercial assays, the manufacturer chooses the PCR parameters including the amplification cycles. Intentionally moving away from the manufacturer's instruction would invalidate the CE mark.

This position remains unchanged and the WHO Information Notice simply reminds the professionals involved in the analysis of samples using the rRT-PCR to follow manufacturer instructions. SARS-CoV-2 PCR assays in Ireland in use by the HSE and laboratories operating on behalf of the HSE are operated in accordance with the manufacturers' instructions and the CE marking for the assay.

Higher Cycle threshold values typically indicate a lower amount of virus in the sample. However, the CT value alone does not indicate whether the virus load is increasing or decreasing, it does not indicate whether the individual is infectious or not, and it does not provide an indication of the specimen quality (i.e. how closely the specimen mirrors what is actually happening in the patient's respiratory tract).

In the Irish context, specificity (or false positive) data are not collated centrally. However, based on the data we do have available, and based on our growing level of experience with the SARS-CoV-2 assays in use in Ireland, the false positive rate is estimated to be somewhere between 0.1% and 0.2% (suggesting a specificity of around 99.8-99.9%). This does mean that for every 10,000 tests performed, there will potentially be 10-20 false positives, although this number can be reduced by repeat testing of some low level (or weak) positives. However, it is often not possible to distinguish between true positives and false positives.

Considerable work has been undertaken to date to evaluate the use of Antigen Detection Tests (ADTs) in an Irish context and this will continue on an ongoing basis due to the role they can have in the national testing strategy. In particular, further setting-specific ADT validation work continues to be undertaken by the HSE. Antigen testing will not, however, replace the requirement for large scale PCR testing which remains the gold standard for community testing

The HSE continues to monitor the evidence for other testing types in conjunction with other public bodies, such as the Health and Information Quality Authority (HIQA), and having regard to best international evidence and advice. On an ongoing basis, the National Public Health Emergency Team considers and reviews, based on public health risk assessments, how best to target testing to detect, and mitigate the impact of, the virus across the population. This includes keeping Ireland’s national testing policy under continuing review.

Covid-19 Tests

Questions (695)

Denis Naughten

Question:

695. Deputy Denis Naughten asked the Minister for Health the waiting time for a PCR test for a person with symptoms of Covid-19; the waiting time for a PCR test for an asymptomatic close contact of a confirmed case of Covid-19; the waiting time for a PCR test for a symptomatic close contact of a confirmed case of Covid-19; if there is a difference in waiting times for close contacts who are symptomatic and those who are asymptomatic; if so, the reason for same; and if he will make a statement on the matter. [6338/21]

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Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Vaccination Programme

Question No. 697 answered with Question No. 690.

Questions (696)

James Lawless

Question:

696. Deputy James Lawless asked the Minister for Health the logistics and distribution experts that have been consulted in developing the roll-out processes for the vaccine programme; and if he will make a statement on the matter. [6344/21]

View answer

Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Question No. 697 answered with Question No. 690.

Vaccination Programme

Questions (698)

James Lawless

Question:

698. Deputy James Lawless asked the Minister for Health the current listed position regarding family carers to receive the vaccine; and if he will make a statement on the matter. [6346/21]

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Written answers (Question to Health)

The COVID-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department , endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.

Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.

The rollout of the COVID-19 vaccination programme is the responsibility of the HSE.

The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.

The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus.

The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.

The next group to be vaccinated are those aged 70 and older in the following order: 85 and older, 80-84, 75-79, and 70-74. Vaccination of this group will begin this month.

All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.

The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.

Family carers are a diverse group, therefore, each individual will be vaccinated in the group thatis appropriate to them.

Vaccination Programme

Questions (699)

James Lawless

Question:

699. Deputy James Lawless asked the Minister for Health the position on the list for members of the dentistry profession and primary healthcare staff to receive the vaccine; and if he will make a statement on the matter. [6347/21]

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Written answers (Question to Health)

The COVID-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department , endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.

Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.

The rollout of the COVID-19 vaccination programme is the responsibility of the HSE.

The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.

The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus.

The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.

The next group to be vaccinated (group 3) are those aged 70 and older in the following order: 85 and older, 80-84, 75-79, and 70-74. Vaccination of this group will begin this month.

All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.

The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.

Frontline healthcare workers (HCWs) in direct patient contact roles will be vaccinated in Group 2. This includes HCWs working in public, private, and voluntary settings. Other HCWs, not in direct patient contact, will be vaccinated in Group 4.

Vaccination Programme

Questions (700)

James Lawless

Question:

700. Deputy James Lawless asked the Minister for Health if his Department will provide a clear dashboard of information regarding the scheduling as to the way that persons will receive the vaccine in order to provide and easy to understand information source as to when persons are to receive the vaccine; and if he will make a statement on the matter. [6348/21]

View answer

Written answers (Question to Health)

The Government is committed to the timely implementation of a COVID-19 immunisation programme.

The National COVID-19 Vaccination Strategy, which was prepared by the High-Level Task Force on COVID-19 Vaccination, was signed off by Cabinet on 15 December 2020.

The vaccines will be rolled out in three phases - the initial roll out, a mass ramp-up and open access. The highest priority groups, those over the age of 65 living in long-term care facilities and frontline healthcare workers in direct patient contact, will receive the vaccine first.

The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.

The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus. The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.

The next group to be vaccinated are those aged 70 and older in the following order: 85 and older, 80-84, 75-79, and 70-74. Vaccination of this group will begin this month.

All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.

The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.

Vaccine allocation is a matter for the Department of Health and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.

The rollout of the COVID-19 vaccination programme is the responsibility of the HSE.

Further information on the COVID-19 vaccination programme can be found at:

https://www2.hse.ie/screening-and-vaccinations/covid-19-vaccine/covid-19-vaccine.html

Vaccination Programme

Questions (701)

James Lawless

Question:

701. Deputy James Lawless asked the Minister for Health if clarity will be provided regarding the suggestion that the EU allocated vaccines according to how well placed member states are to administer same; if Ireland can receive additional doses of the vaccine if the country was in a position to administer them more quickly; and if he will make a statement on the matter. [6349/21]

View answer

Written answers (Question to Health)

Ireland is participating in a Procurement Exercise being operated by the European Commission on behalf of Member States to procure suitable, safe and effective vaccines, in sufficient quantities, to combat COVID-19. Six Advanced Procurement Agreements (APAs) have been negotiated by the Commission under this process to date.

Ireland has agreed to procure five of these vaccine candidates under of the terms of the APAs; government approval has been obtained to opt-into a sixth, but this is conditional on certain trial progression criteria being met.

The basic principle for the allocation of the doses to the Member States is the population-based distribution key. This is a pro rata key on the basis of population numbers and ensures a fair distribution. Delivery of vaccines to each country is concurrent.

Ireland has signalled its solidarity with the EU approach and has, through its participation, gained access to a broad range of vaccines that it might not otherwise have access to, and at the cost agreed collectively by the EU.

Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated a national allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first. Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.

Hospital Data

Questions (702)

Mark Ward

Question:

702. Deputy Mark Ward asked the Minister for Health the number of persons that have presented for self-harm to accident and emergency departments by CHO area and month in 2020 to the latest date in 2021; and if he will make a statement on the matter. [6365/21]

View answer

Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Hospital Data

Questions (703)

Mark Ward

Question:

703. Deputy Mark Ward asked the Minister for Health the number of persons that presented for self-harm to accident and emergency departments; the number that were referred for psychiatric evaluation; the number of persons that received a biopsychosocial assessment, by CHO area and month in 2020 to the latest date in 2021; and if he will make a statement on the matter. [6366/21]

View answer

Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Home Care Packages

Questions (704)

Pádraig O'Sullivan

Question:

704. Deputy Pádraig O'Sullivan asked the Minister for Health if additional resources will be made available to the public health system and in particular home support services; and if he will make a statement on the matter. [6367/21]

View answer

Written answers (Question to Health)

Homecare is an essential service to support people to live in their own homes and their own communities for as long as possible. The allocation of funding for home supports across the system, though significant, is finite and services must be delivered within the funding available. The 2020 National Service Plan provides for 18.9m home support hours to be delivered to 53,700 people and Intensive Home Care Packages delivered to approximately 235 people with approximately 360,000 hours delivered in the full year.

An additional €150 million is being provided for home support in 2021. The very significant additional funding will provide a further 5 million hours over this year’ target aimed at keeping older people healthy and happy, in their community, for as long as possible. This represents about a 26% increase in home support hours over the 2020 NSP target.

The Programme for Government (2020) commits to the introduction of “a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care.” In this regard, the Department is in the process of developing a statutory scheme for the financing and regulation of home-support. It is intended that the new scheme will provide equitable and transparent access to high-quality services based on a person’s assessed care-needs, and that it will also provide transparency about service-allocation while ensuring that the scheme operates consistently and fairly across the country.

Work is on-going within the Department to determine the optimal approach to the development of the new scheme within the broader context of the on-going reform of Ireland’s health and social care system, as envisaged in the Sláintecare Report. This work encompasses the development of the regulatory framework for the new scheme; the examination of the options for the financing model for the scheme; and the development of a reformed model of service-delivery.

The Sláintecare Implementation Plan commits to the establishment of the statutory scheme for the financing and regulation of home support services by the end of 2021. Work planned in 2020, including the planned testing of a reformed model of service delivery, was adversely affected due to the impact of COVID-19 on delivery mechanisms for home support and the requirement for the diversion of resources to deal with COVID-19. This has had an impact on the final timeline.

The successful development of this scheme is an ambitious programme of reform and is a key priority for me, and the Minister for Health. In order to accelerate this work, the Department is working closely with the HSE to ensure that the required resourcing including personnel, governance structures and other requisite resources are scaled up to ensure that significant progress is achieved by the end of 2021.

Within this context funding was secured in 2021 for the HSE to progress the roll out of InterRAI as the standard assessment for care needs in the community, the testing of a reformed model of service delivery for home support services and the establishment of a National Office for Home Support Services. All of this work throughout 2021 will progress the development of a reformed model of service delivery to underpin the statutory scheme.

In parallel, the increased investment in home support services in 2021 will contribute to meeting the Programme for Government commitment to providing equitable access to home care.

Covid-19 Pandemic

Questions (705)

Neale Richmond

Question:

705. Deputy Neale Richmond asked the Minister for Health if he has considered introducing documentation for those medically exempt from wearing face coverings to ensure that all those who do not wear masks in retail settings are truly exempt from doing so; and if he will make a statement on the matter. [6368/21]

View answer

Written answers (Question to Health)

The public health advice relating to COVID-19 is kept under continuous review by the National Public Health Emergency Team (NPHET), by my Department and the Government. The NPHET reviews international developments as a component of their overall examination of the evolving epidemiology of Covid-19 and are informed by the international scientific evidence, and guidance by international bodies including the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). WHO and ECDC guidance is formulated in the context of considered appraisal of the international experience and accumulating scientific evidence in relation to COVID-19.

As the Deputy is aware, a person, without reasonable excuse, must wear a face covering when using public transport, in retail outlets, shops and shopping centres, in other indoor spaces such as libraries, cinemas and cinema complexes, theatres, concert halls, bingo halls, museums, businesses carrying out cosmetic nail care or nail styling, hair care or hair styling, tattoo and piercing services, travel agents and tour operators, laundries and dry cleaners and licensed bookmakers. The regulations relating to face coverings have recently been amended to include post offices, credit unions and banks.

Face coverings are also recommended in situations where physical distancing may not be possible, in busy or crowded outdoor spaces where there is significant congregation.

My Department appreciates the challenges experienced by those with medical difficulties during Covid-19. However, there are no plans, at this time, to introduce documentation for those deemed medically exempt from wearing face coverings, in the manner proposed by the Deputy.

The relevant Regulations in relation to face coverings which remain in place until 9 June, 2021 can be found at: https://www.gov.ie/en/collection/1f150-view-statutory-instruments-related-to-the-covid-19-pandemic/

The current advice in relation to face coverings is available at https://www2.hse.ie/conditions/coronavirus/face-masks-disposable-gloves.html and http://www.gov.ie/facecoverings/.

Mental Health Services

Questions (706)

David Stanton

Question:

706. Deputy David Stanton asked the Minister for Health his plans for the reopening of mental health day care centres such as the Owenacurra mental health centre in Midleton, County Cork; and if he will make a statement on the matter. [6370/21]

View answer

Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Primary Care Services

Questions (707)

Dara Calleary

Question:

707. Deputy Dara Calleary asked the Minister for Health when approval will be sanctioned for a medical hub (details supplied) in County Mayo; the reason for the delay in signing off on the approval; and if he will make a statement on the matter. [6375/21]

View answer

Written answers (Question to Health)

As the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care facilities, the Executive has been asked to reply directly to the Deputy.

Vaccination Programme

Questions (708)

Emer Higgins

Question:

708. Deputy Emer Higgins asked the Minister for Health if he will discuss with the National Immunisation Advisory Committee when persons with cystic fibrosis should receive their vaccination and to determine if they and other vulnerable groups should be included in category 3. [6378/21]

View answer

Written answers (Question to Health)

The COVID-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department, endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.

Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.

The rollout of the COVID-19 vaccination programme is the responsibility of the HSE.

The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.

The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus.

The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.

The next group to be vaccinated are those aged 70 and older in the following order: 85 and older, 80-84, 75-79, and 70-74. Vaccination of this group will begin this month.

All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.

The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.

Long-Term Illness Scheme

Questions (709, 737, 751)

Seán Haughey

Question:

709. Deputy Seán Haughey asked the Minister for Health if he will designate classical homocystinuria as a long-term illness given that a similar condition known as phenylketonuria is classified as such; and if he will make a statement on the matter. [6386/21]

View answer

Richard Bruton

Question:

737. Deputy Richard Bruton asked the Minister for Health if he will consider extending long-term illness cover to HCU, that is, homocystinuria. [6469/21]

View answer

Aodhán Ó Ríordáin

Question:

751. Deputy Aodhán Ó Ríordáin asked the Minister for Health if classical homocystinuria can be added to the list of conditions covered by the long-term illness scheme in view of the fact of its similarity to phenylketonuria a disease already on the list. [6550/21]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 709, 737 and 751 together.

The Long Term Illness Scheme was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. Under the scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.

There are no plans to extend the list of conditions covered by the scheme at this time. However, a review of the current eligibility framework, including the basis for existing hospital and medication charges, will be carried out under commitments given in the Sláintecare Implementation Strategy.

For people who are not eligible for the LTI Scheme, there are other arrangements which protect them from excessive medicine costs.

Under the Drug Payment Scheme, no individual or family pays more than €114 a month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.

People who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.

Vaccination Programme

Questions (710, 711, 903)

Duncan Smith

Question:

710. Deputy Duncan Smith asked the Minister for Health the number of healthcare workers that received their first jab for the Covid-19 vaccine in the period 28 December 2020 to 1 February 2021; the results by week and by healthcare worker subset as per the vaccination sequencing document; and if he will make a statement on the matter. [6390/21]

View answer

Duncan Smith

Question:

711. Deputy Duncan Smith asked the Minister for Health the number of healthcare workers that received their second jab for the Covid-19 vaccine in the period 28 December 2020 to 1 February 2021; the results by week and by healthcare worker subset as per the vaccination sequencing document; and if he will make a statement on the matter. [6391/21]

View answer

Louise O'Reilly

Question:

903. Deputy Louise O'Reilly asked the Minister for Health further to Parliamentary Question No. 179 of 14 January 2021, the number of healthcare professionals vaccinated by grade, group and category in percentage terms and in tabular form. [7187/21]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 710, 711 and 903 together.

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.