Covid-19 Vaccination Programme: Statements

I will be sharing time with the Minister of State, Deputy Butler. It has been 44 days since the first Covid-19 vaccine was administered in Ireland. Since Annie Lynch received her vaccine on 29 December, more than 240,000 vaccines have been administered. The programme is a significant logistical challenge and the focus of thousands of people, who are transporting and administering the vaccines and managing the programme. They have built a new vaccine infrastructure involving physical infrastructure, a workforce and IT resources. While there have been bumps along the way and will be more, this should not detract from the progress made so far. Thanks to the efforts of vaccination teams in every county, Ireland has one of the highest per capita rates of vaccine administration in the European Union. This is a good performance and one which should give confidence in the capacity and determination of the Government, the Department of Health, the HSE and the many partner agencies working with us to deliver this critical vaccination programme.

We are still in the early stages but things will move quickly as supplies coming into the country increase. There is optimism about the authorisation of additional vaccines, including one which can be administered with just one dose. People's hopes for safety and protection from Covid-19 and, ultimately, for a return to a more normal life are wrapped up in this vaccination programme. The relief and joy reported when front-line healthcare teams or nursing homes residents are vaccinated is testament to the fear, anxiety and stress many have been carrying for the past year.

Our ambition for Ireland and our strategy for the vaccine programme is that supply will be the only constraint. The principle behind the programme is that the roll-out is to be fair, safe and effective. The implementation plans have already changed and will change again as new vaccines are authorised, as supplies are updated and as new information becomes available. The principles and ambition, however, remain the same. Our national solidarity with those most at risk is really strong. When asked, most people say that they want those who need the vaccine most to get it first. These principles are why we accelerated vaccination in the nearly 600 nursing homes from Inishowen to Mizen and from Achill to Dublin city. It is why we are starting to vaccinate those aged 85 and older from next week with the most effective vaccines available.

We are securing our supply through advance purchase agreements made by the European Union. What we are trying to achieve, a mass vaccination programme of this scale, is challenging. There is no point in pretending otherwise. Just yesterday, the President of the European Commission said that the EU had made mistakes, for example, when it came to Article 16 and Northern Ireland. She also urged the bloc to stick with the current strategy saying that she could not imagine what would have happened if a handful of the bigger European countries had outbid the smaller European countries. The EU-27 approach is right for Ireland and for Europe as a whole. Without it, smaller countries like Ireland would have struggled to secure contracted supply. By working as part of the EU, we now have advance purchase agreements in place for almost 16 million vaccine doses.

We now have three highly effective and safe vaccines authorised for use for all adults. The next phase of our vaccination programme is scheduled to begin this coming Monday. GPs are inviting those aged 85 and older to be vaccinated. The view of the Chief Medical Officer echoed that of the national immunisation advisory committee. Dr. Holohan's advice to me, which I accepted, is that the superior efficacy demonstrated by mRNA vaccines, including in older people, and the particular vulnerability of members of this group should they get Covid-19 indicated that mRNA vaccines should be administered to all of those aged 70 years and older, where practicable. This advice is based on the validated clinical data available. Any new information on the effectiveness of the different vaccines will, of course, be reviewed as it becomes available.

The decision regarding the mRNA vaccines presented some pretty big logistical challenges for the HSE and for our GPs, given the need to store the Pfizer and Moderna vaccines at such low temperatures. I acknowledge the work done by the HSE to adjust in a very short time. I also acknowledge the superb response of GPs right across the country and of the Irish Medical Organisation, IMO, in stepping up to this challenge. Approximately seven in every ten GP practices will be able to administer the Pfizer and Moderna vaccines in their clinics. The HSE and the IMO are working with approximately 400 other smaller practices to implement local solutions. These include smaller GP practices coming together in hubs or joining up with larger GP practices. The plan is to distribute approximately 20,000 mRNA vaccines to the GP network next week specifically for those aged 85 and older. This will comprise approximately 8,000 doses of the Moderna vaccine and 12,000 doses of the Pfizer vaccine. The following week, we plan to increase that figure to approximately 50,000 vaccine doses. The plan is to increase the figure again the week after that. As with all vaccine forecasts, these plans are entirely dependent on supplies arriving into Ireland.

There will be people who cannot make the journey to a GP. Local solutions are being put in place for them. The important thing is that no one will be left behind. A solution will be found for everyone who cannot make it to the GP. There are also people who do not have a GP. They, or their families, can contact the HSE helpline on 1850 24 1850.

One implication of using the mRNA vaccines for those aged 70 and older is that the vaccination of other cohorts can start earlier. On Monday of this week, we started to administer the first dose of vaccine for the remaining front-line workers. Next week, approximately 21,600 vaccine doses for this group will be distributed. Our plan is to have this group fully covered with its first dose this month. As with all vaccine forecasts, these plans are entirely dependent on supplies arriving into Ireland.

We are also working through the timing and sequencing of the fourth and later cohorts in the context of the decision on the mRNA vaccines. We can begin vaccinating these cohorts a little earlier as well. I hope to be in a position to update colleagues in the House in this regard next week.

In preparing for the ramping up of the vaccination programme, 5,800 vaccinators have been trained to date and we are adding to that on an ongoing basis. In time, we will need many more and detailed planning is being undertaken to that end.

Communications are, of course, essential to the vaccine programme and I am delighted to be able to share with the House the latest information we have that 85% of people surveyed now say that they will definitely, or probably, seek a vaccine. This figure has been moving steadily upwards. My view, and I believe the view of colleagues in the House, is that the more information we can provide publicly the better. To that end, two weeks ago I committed to colleagues that daily vaccine figures would be made available. These went online on the data hub last week and they were added to the Covid-19 tracker app yesterday. If people click on to their app, they will be asked to update the app and when that happens, they will now see the daily vaccine figures coming in on that also.

I also committed to ensuring that all Deputies and Senators received a daily briefing on the vaccine programme. That started this week, I believe on Tuesday, and I hope that colleagues will find this useful. If there is additional information that colleagues would like that would be useful to get on a daily or weekly basis, please just let me know and I will endeavour to get out all the information that they would find useful.

I finish by expressing my sincere thanks to colleagues in the Dáil and Seanad Éireann for their efforts in supporting the vaccine programme. While we will, of course, debate many of the operational aspects, as we should, Deputies and Senators right across the Oireachtas have shown invaluable solidarity in backing the safety and importance of the vaccine programme which is quite literally the light at the end of the tunnel. I thank the Ceann Comhairle.

Gabhaim buíochas leis an gCeann Comhairle. Ireland’s vaccination programme against Covid-19 has been designed to ensure that those who are most vulnerable to the disease are the first to be protected. This, alongside the vaccination of health care workers, is to be welcomed.

On 24 January, the HSE completed roll-out of the first vaccine dose to the majority of residents and staff in nursing homes. Administration of the second vaccine dose is nearing completion. Those who were unable to receive the vaccine due to their Covid-19 status will be included once it is safe to do so.

Vaccinations in residential-congregated settings that were not included in the first series of the vaccine programme, such as unregistered voluntary and religious order service providers, commenced this week.

First doses have been completed in congregated disability and mental health settings for over-65s.

The vaccination programme has already served to be sufficiently adaptable in responding to delivery shortages and change. The vaccines that have been administered have undergone rigorous testing and review prior to their receiving conditional market authorisation from the European Commission. These measures ensure that the vaccines currently being administered to the most vulnerable of our citizens, as well as those who care for them, are both safe and effective. The expert views of the national immunisation advisory committee on which vaccines, AstraZeneca's or the two mRNA vaccines, should be administered to older people, is in line with this core principle of protecting those who are most vulnerable.

Subject to ensuring availability of a second dose of vaccine for all those to whom they are currently being administered, Ireland’s strategy is to distribute all of the vaccines that we receive. The only limitation to the vaccination programme is the supply of vaccines.

The initial vaccine roll-out is focused on vaccinating those in the highest priority groups so that those at greatest risk of serious adverse consequences from Covid-19 are protected from it. The strategy is underpinned by ethical principles, with a strong focus on equitable access and prioritising those most in need. As the Minister of State charged with responsibility for older people, I welcome that the vaccine allocation strategy prioritises those over the age of 65 living in long-term residential care facilities, front-line healthcare workers who are in direct patient contact and those aged 70 and over. The HSE, in conjunction with immunisation experts, is evaluating the further stratification and sequencing of cohorts for vaccination.

I am pleased to note that HSE disability operations has recently briefed disability umbrella organisations on the vaccination of disability service staff. Disability services have continued to operate during the current restrictions, providing an essential service to individuals and their families. Vaccination of these important service providers will, in line with vaccination plans for front-line healthcare workers, commence in the coming weeks. Registration online for this cohort commenced on Tuesday, 9 February. I encourage all staff to register as soon as possible.

Front-line mental health workers will also be included in this vaccination plan for front-line healthcare workers. Specialist mental health services continue to operate and provide supports to children, young people and adults across the country in line with public health guidance.

The roll-out of Ireland’s largest ever vaccination programme, less than one year after Covid-19 was declared a public health emergency of international concern, is a huge achievement. The availability of three authorised vaccines within this timeframe, and the promise of others on the way, is unprecedented. I wish to acknowledge, with thanks, the efforts of all involved in bringing us to this important stage. The initial focus of the programme on those in the older age groups and healthcare workers highlights our commitment to a fair and equitable distribution of vaccines. As more vaccines become available, we will continue to ensure that they are distributed fairly and to those most in need until sufficient vaccines become available for everyone who wants to receive the vaccine.

I wish to use my ten minutes for over and back exchanges with the Minister on questions rather than by making a statement.

My first question is on older people. Over the past number of weeks, we have been given different timeframes as to when those aged over 70 will be inoculated. It was March when we expected the AstraZeneca vaccine would be used for the over-70s. Obviously, we all expect the timeframe to change now but we have been told that it could be April, May or June. Can the Minister confirm, for the purposes of clarity and on the basis of the information that he has, what is the estimated timeframe for fully inoculating all the over-70s?

I thank the Deputy for his question. As he will be aware, we will start on Monday with those aged 85 and older and then we are going from 80 to 84, 75 to 79, and then 70 to 74. These are the tiers within which we are doing this. This starts on Monday and the schedule I have suggests that the group will have finished its second doses by mid-May, but, as always, these things are dependent upon the supplies arriving. If we get the supplies that are forecast, and as we all now know these go up and down, it would be mid-May when the second dose has been completed.

I accept that there are supply issues but the middle of May for all of the over-70s to be inoculated is a long time for those most at risk to wait. This will cause concern for many older people. I know that the GPs are ready to play their part as, we are told, are pharmacists. There are community vaccinators I am sure who can also play their part. It is very difficult when we hear that we were hoping that it would be the end of March and now it is the middle of May, and may be longer.

My second question, which I raised with the Minister last week and which I have to raise again, is on the issue of family carers. I have spoken to hundreds of family carers since he responded to me last week in the Chamber. He said that family carers are not being seen as a distinct cohort of people, in and of themselves, who will be vaccinated. They are very angry and sore about that. His response was that carers who work for the HSE and for private providers are seen as a priority and will be in priority 2 but family carers are not. We are talking here about people who care for very vulnerable children and there are many such people.

I will relay one of hundreds of messages which I have received, this one from someone called Geraldine. She is caring for her son full time, who has profound disabilities and is non-verbal. He has been informed that he will be in the Covid-19 vaccination group 7. He needs care 24-7, his parents are 66 years old and 68 years old, and they are worried what will happen to him if they get Covid-19. The question has been asked about who cares for the carers.

In the spirit of what has been said to us in the past concerning it being possible for the allocation groups for vaccination to be looked at again and revisited, and given that family carers feel very sore and not very valued in this context when they hear the responses they have been given, can the Minister re-examine this situation and ask the national immunisation advisory committee, NIAC, to re-examine it as well? I ask that because this is a cohort of people, in and of themselves, who need to be valued, respected and listened to when they are telling us of their experiences in the way in which they have.

If the Deputy does not mind, I will briefly return to those aged over 70 years and older. The timelines we were discussing before the decision on the mRNA vaccines had the end of March as the date when the administration of the first doses would have been complete, but because we are using the Pfizer-BioNTech and Moderna vaccines, and the supplies are different, that process has lengthened by about two weeks. It is not a shift from March to May. March was the completion time for the first dose and that has now shifted by about two weeks because we are using the mRNA vaccines.

Turning to the specific issue of carers, I hear what the Deputy is saying loud and clear. The Minister of State, Deputy Butler, and I had a meeting yesterday with many groups representing older people, and carers' groups were represented at that meeting as well. I have had many representations on this matter, as we all have. There is nothing that I and the rest of us would like more than to have no supply constraints now and to be able to vaccinate all these groups that do such incredible work. I state that because the cases and associated fears raised by the Deputy are similar to ones of which we are all aware. These are real concerns and worries.

I asked the HSE specifically about this point and about a clinical judgment in this regard, because we have debated it several times here in the House. We must remember that the decisions being made by the HSE on a clinical basis derive from the principle of using the vaccines to protect those people who are most vulnerable. Hence, we have started with those in long-term residential care settings and those aged 70 years and over because the information we have is that they are the highest risk categories. As more vaccine becomes available, we will of course be moving on to people who are family carers as quickly as we can. The clinical judgment which we got in respect of protecting those who are directly most at risk themselves was as we laid out here before. That is in no way to talk down the incredibly valuable work those carers do, and the real concerns being articulated by the Deputy.

The Minister's response does not answer the question at all. The question I posed concerned whether these people are going to be considered as a distinct cohort in their own right. I think they should be. The Minister has obviously looked for a clinical assessment. I do not know what that assessment has been. While it does have to be underpinned medically, these are people who we all recognise are doing a lot of work. The people they are caring for need to be vaccinated of course, but those people also cannot be cared for if the carers themselves get sick with Covid-19. That is the point. The other point is that we draw, or at least the Minister and Government for whatever reason draw, a distinction that sees carers working for the HSE and private providers being treated differently from family carers. I do not accept that is the right course of action.

I have another question that has come up a great deal. I refer to people with medical conditions who need treatment and in many cases that is life-saving treatment. Those people's consultants and health specialists are telling them that they cannot or will not proceed with the treatment because of the risk of contracting Covid-19. One individual with whom I am dealing has multiple cancerous lumps, and he needs a mix of chemotherapy and radiotherapy. I have received many more representations, as I am sure has the Minister and other Deputies.

I spoke to Dr. Colm Henry of the HSE directly about this issue. He said he had made a recommendation to the national immunisation advisory committee. There are also patients who need kidney dialysis and that issue is also coming up regularly. These are people who need live-saving treatments, interventions and supports, and yet their clinicians are telling them that they are fearful about going ahead with such treatments if those patients are not vaccinated. Can the Minister confirm whether this issue has been resolved? It would be absolutely unacceptable if people were not able to get life-saving treatments and needed interventions because they cannot be vaccinated.

It is one of the most important questions with which we are dealing in the vaccination programme at present. I have asked the Department of Health and NIAC to take a look at the prioritisation. Given what we know now about the vaccines and that the programme is under way, I do not think we can often make changes to the prioritisation list. If we are making changes, I think we will probably do that once. I have great sympathy with the position of those people to whom the Deputy referred. I have made my view on that issue clear to the Department of Health.

NIAC is now doing detailed work regarding exactly the group about which the Deputy just spoke. Those people are currently in cohort 7, and that is a large group comprising people with underlying conditions. To address the Deputy's specific point, a group within that cohort is really high-risk and that is an urgent situation. Over the next few days, therefore, NIAC will report back and we will be looking at that information, and that was what I was referencing in my opening statement. I refer to wanting to be able to report back to the House, ideally next week, on that exact point the Deputy has raised.

I hope we will get progress on this issue, and I think everybody accepts it is an urgent issue. My final question concerns category 6 key workers. The decision to not use the AstraZeneca vaccine for those aged over 65 years means that the people in this key worker group will be the second next category to be inoculated with the AstraZeneca vaccine. There is still no definition of who is a key worker. Has that work been done? I ask this question because we are being asked about this issue. We have many key workers, or people who see themselves as key workers, who are asking us where they sit and what is the definition and when are we going to see the detail in this respect. We have not seen it, and yet this category is going to be quickly part of the roll-out of the vaccination process. Can the Minister briefly explain where we are with that process?

I ask the Minister to be very brief.

Very briefly, as part of that same exercise I just referred to involving those with underlying medical conditions, we are looking at this exact issue as well. I refer to key workers, essential workers and so forth.

We now move to speakers from the Labour Party, and I call Deputy Kelly.

We know the number of people vaccinated as of today. The Minister has given us those figures. As of today, though, how many vaccines have we got from each of the three suppliers, respectively? Can the Minister give me the figures as of today for AstraZeneca, Pfizer-BioNTech and Moderna, respectively?

What I can give the Deputy is the delivery schedule, which I asked for just before we came in. As of Sunday, the total number of vaccine doses which have come in is 272,000, and I will get a breakdown for the Deputy concerning those three vaccines which have come in so far.

I thank the Minister. If he could do that, it would be helpful so that we can deduce one from the other. The Minister can appreciate where I am going with this. On the AstraZeneca vaccine, I understand that the Government was very much taken aback, as we were, by the recommendation that came in regard to that vaccine. If there are situations where speed will trump perfection in getting the vaccine out to those who are very isolated, will consideration be given to using the AstraZeneca vaccine for those people? I am thinking of the purely practical issue concerning storage. Equally, if data are acquired in the coming weeks showing that the AstraZeneca vaccine is of use and is safe for those aged over 70 years of age, will he change back the criteria and speed of the roll-out? The Minister has outlined mid-May previously as the date in responses to me, but will he bring that forward by the two weeks that are being lost, or by as much as is possible?

On the first question from Deputy Kelly, I will be led by the clinical advice on that issue but I am certainly very open to doing just what the Deputy has suggested. The transport of the Pfizer and Moderna vaccines must be done in a very precise way. It is not possible, for example, to have a GP put those vaccines in the back of his or her car and drive around the hills of Tipperary or Wicklow. It may be the case, therefore, and we will be led by the clinicians on this issue, that in some isolated circumstances the AstraZeneca vaccine is the right one to use. As we know, it has been cleared as safe and effective for all age groups.

Will Deputy Kelly remind me of his second question, please?

My second question concerned changes in the data regarding the AstraZeneca vaccine.

If the data changes will the Minister bring forward the timelines? The Minister has said mid-May but could that potentially come forward if the data change on the use of that vaccine for people over the age of 70?

Yes, absolutely. The validated data show an efficacy of 58% or 59%. The Oxford trials, for example, have that figure as a little bit higher. I believe the UK is about to publish field data, which may be higher again. We must keep all of that under review. If we find out that the effectiveness changes, which is updated based on more and more information, then we absolutely have to update the delivery plan accordingly.

Hopefully those data will come in. That would help with the whole roll-out. I have further questions and I will put them to the Minister together because of time limitations. While I do not want to stick the Minister to anything, I want to be realistic. I presume the timeline for everybody resident in Ireland to be vaccinated by September is a date that is out the window. Will the Minister confirm this either way?

Have the people who live in assisted living facilities, such as in Sue Ryder accommodation, been vaccinated? What is the plan there? They are different age cohorts but the mix is the important thing in that regard.

GPs will get a dose of vaccines and will go through their patient list of people over the age of 85. We are all aware of situations where they may have some vials left over. If the doctors drift into the 80- to 84-year-olds will there be an issue? I presume that common sense for GPs will be at play here.

I will ask the Minister of State, Deputy Butler, to answer Deputy Kelly's question on those who live in assisted living.

With regard to GPs, the answer is "Yes". One of the principles is that we do not waste any doses. If a GP has 20 doses available and has 16 people who are 85 years old or over, it would make sense for the GP to bring in some of the next group for exactly that reason.

On the September timeline I will again caveat the reply, as I have tried to do many times, by saying that it is all highly provisional. It was construed publicly as making promises. These are not promises. Based on the highly conditional forecasts it would still be possible to meet the September date. Again, this is highly dependent on supply.

I thank the Deputy for the question. For those people in assisted living facilities that are not registered with HIQA, mostly religious organisations, vaccination commenced on Monday, 8 February for people over the age of 65. It is for those people living in accommodation such as the Matthew Shea Home, the Sue Ryder homes, and the non-registered facilities that are, as I said, run by religious organisations. These vaccinations were brought ahead to the beginning of this week because there are fears around the weather at the end of the week. We expect to have 9,000 people in those settings vaccinated this week.

A great book by the author Dr. Ida Milne is a treatise on the Spanish flu. Dr. Milne tells the story of a battalion of US soldiers who arrived at the Western Front in France in September 1918, who fought on the front in October, with the war ending in November. Some 440 of that battalion succumbed to the Spanish flu and only a small fraction succumbed in action. The metaphor is not lost in our time now. I think of those constituents such as the kidney dialysis patients in particular. One driver, who brings this particular constituent to hospital for dialysis, tested positive for Covid. The patient then had to undergo ten tests. Having listened to the Minister and the Minister of State on the agility and flexibility of the vaccination programme I ask them to be conscious of that situation. I hope an abundance of supply will assist us in that flexibility.

What can the Minister say, in the remaining minute and a half of my time, for those people who are availing of home care packages, as they are essentially in hospital but at home?

People who might currently be in hospital but also avail of home care packages will receive the vaccine when they return home. A person must be in the same setting between 22 and 28 days in order to receive the second dose of the vaccine. An older person who is in hospital today, for example, but due to be released at the end of the week, will not receive the vaccine in the hospital setting. He or she will receive it while in their home setting.

What if the person is at home now but availing of a home care package?

The person will receive the vaccine when the GP surgery calls them, starting next Monday. The second vaccine will be administered through the GP also.

Is that chronological also? Is it according to the age of the person? Must a person aged 62 with a home care package wait his or her turn? It will not be up to the GP to say a patient is more in need because his or her situation is particularly fragile.

At the moment it will be determined purely by age.

I have written to the HSE seeking details of the allocation of vaccines to all hospitals in the State. I was waiting for two weeks and got a very general and meandering response back from the HSE that basically said it was allocated based on various criteria. Will the Minister confirm this?

The HSE said the criteria were given to hospital groups in the first week in January in a pilot scheme to level 4 hospitals: St. James's Hospital, Beaumont, Cork and Galway. There was no mention of Limerick. University Hospital Limerick, UHL, is a level 4 hospital. We were also told that it was not allocated to UHL in the mid-west in Limerick because the HSE had put out requests and none was forthcoming from UHL. What is the correct position?

Will the Minister ensure that I get details on the actual roll-out of the vaccine? All I want is transparency and that each area is treated equitably. I believe that Limerick and the mid-west is behind, but the people who do the vaccinations are doing incredible work. I ask the Minister to reply to these questions first and then I will have one final question for him.

The Deputy's statement on the roll-out is correct. For the first few days it was based on the four pilots. That was done in response to very clear advice from NIAC as to how it wanted it rolled out for the first week or so. Then the HSE contacted the various hospital groups and distributed vaccine based initially on their capacity to distribute it to the correct groups. The prioritisation was done based on the published prioritisation list from the chief clinical officer.

On the Deputy's second question, he will have to get that detail. I agree that there must be transparency on the distribution around the country. I will certainly ask the HSE to provide that information to the Deputy.

I have two final questions. Will the Minister follow up? I believe that when the vaccines are being allocated we need to get a disproportionate number of vaccines to catch up with the other agencies.

I will conclude on a more general question. What will the situation be when people get the first and second dose of vaccine? Where does the Minister see it playing out over the next 12 months? How long does the vaccination last? Will we be into a cycle of the vaccine being rolled out every year? What is the plan for rolling it out every year to people?

It is a really good question. The scientific and medical community cannot answer it yet because the vaccines are being administered for the very first time. There are several unknowns at the moment including the impact on transmissibility, more detail on the effectiveness and the duration of protection, as referred to by Deputy O'Donnell. Those things are not known right now. It could be an annual situation like the flu vaccine, or maybe people will get protection for several years as with other vaccines. We do not know yet.

I am increasingly concerned about the plight of family carers. I was contacted recently by one such carer who was especially keen that I would outline her case to the Minister to give some context to the challenges she faces. In essence, this Drumlish mother is the carer to three people. She cares for her elderly mother who lives a short distance away but is isolating and is totally dependent on her daughter. She also cares for her son who is in his 20s and is autistic. Unfortunately he has been hospitalised no fewer than seven times since October and has undergone emergency surgery on four occasions.

She also has a second son who is a chronic diabetic. Across the family unit, in two homes, she is caring for three people. Obviously, she has support from her husband, but the reality is that this carer has spent the best part of a year isolating herself, afraid to go out and mix with people. Effectively her life has been put on hold. She has no issue with this; she loves her family dearly. Her mother will get vaccinated quite soon and hopefully her son, who is at high risk, will also be vaccinated. Many of us believe that when those people are vaccinated, she should also be vaccinated.

On behalf of the Longford branch of the Irish Kidney Association, I raise the issue of dialysis. At the end of last year, the national renal office urged that the 2,000 dialysis patients be prioritised at the same level as people aged over 65. Several of my colleagues have already outlined the situation of dialysis patients. I take on board what the Minister said earlier in offering his personal views on it. Hopefully, there can be some movement on that.

I welcome that the roll-out of the vaccine for the elderly through GPs will start next week. However, I wish to highlight two examples. I know a couple in Ballymahon; the husband is 88 and the wife is 84. Hopefully, she will drive him to get his vaccine. Surely in such cases there should be some discretion for a GP to make some change to the criteria. I know a man aged 81 living in Granard who has Parkinson's disease and is at high risk. I hope there is some discretion for GPs in such cases.

The national immunisation advisory committee is looking very closely at people who are undergoing dialysis along with many other vulnerable people with underlying conditions. It will report back to the Department of Health, and the Chief Medical Officer and his team will consider that. We will decide if it is appropriate at that stage to make some changes.

Regarding carers, there is no question but that the lady the Deputy mentioned deserves a vaccine. We would like nothing more than to go into that household with four vaccines. However, because we have limited supply, we need to make some hard choices. The first thing we want to do is vaccinate the three people she is caring for and then vaccinate her as quickly as possible.

A few weeks ago, in response to a parliamentary question I submitted, the Department confirmed that the HSE database for vaccinations for healthcare workers is live and managing all vaccinations for healthcare workers. What percentage of healthcare professionals have been vaccinated, by grade, group and category, and how many have received one dose and two doses? I ask the Minister to confirm that the figure includes contract staff, including contract cleaners, agency nurses and people who may not be part of the HSE whole-time equivalent staff but are very definitely front-line workers working in our hospitals. If he cannot give that information now, he can give it to me in writing.

My understanding is that the contractors who are working in the HSE are included. For example, we are not differentiating between a doctor or a nurse who works in a HSE hospital and those working in a private hospital or a nursing home, the vast majority of which are private. To the best of my knowledge, no distinction has been made between public and private, which is the right thing to do.

I will need to provide the Deputy with a written response containing the breakdown between the different grades and so forth because it will depend on exactly what information is being recorded by the system.

I ask for that to include contract cleaners. There is a very specific issue - I can talk to the Minister about it afterwards - with contract cleaners not necessarily being included, even though we all agree they should be.

I wish to ask about an issue relating to procurement. The HSE paid Roqu Media International €10 million to import ventilators from China which were never used. Roqu Media is a festival management company. I suppose we can all roll our eyes collectively over why we were getting ventilators from such a company. What is the dispute between Roqu Media and the HSE that has resulted in the HSE denying journalists freedom of information requests due to commercial sensitivity? How advanced is this dispute given that the transactions happened ten months ago? Where do things stand given that Roqu Media claims there is no dispute? How many suppliers supplied the 465 ventilators? Who are they? Where are the machines now? Have the quality issues with the ventilators been addressed by the Department to the extent that the Minister would be confident that there will not be a recurrence of the situation that arose?

I will get the Deputy a written reply to the specific case she mentioned.

I will make two quick points on the ventilators. The Deputy and I, along with other Deputies in the Chamber, were very much involved in asking the HSE to do at the time whatever it took to get these ventilators in. We all remember the enormous pressure for PPE, ventilators and so forth. I have no doubt that there will be a review. In any such review we need to bear in mind the context in which that was done. Shortly after coming into office last June, I wrote to the HSE board and asked for an audit of the full amount because hundreds off millions of euro were spent in a time of emergency. I asked for an audit of that to answer exactly some of the questions the Deputy very reasonably asked. That work is ongoing. When we have the results of that audit, obviously, I will be very happy to share them.

Everybody appreciates the significant logistical challenges involved in the vaccine roll-out programme. It is important to have transparency and for the Minister to share as much information as possible. Obviously, it is subject to change and that is fully appreciated. It is good to receive the daily figures for the number of vaccines given. The other side of that is obviously the plan we have for the vaccines that have arrived in the country. People appreciate that is subject to change. However, the Minister should at least give us the breakdown of the people who have received the vaccine. It would be worthwhile to have other information that would let people know exactly what is going on so that we do not need to drag it out of the Minister every week here. Much more could be done in that regard.

We can all make cases for different groups of people who should have a higher priority. I reiterate the point about people who have serious underlying life-threatening health conditions, including transplant recipients. These are people who have similar mortality rates to the over-70s in long-term care facilities. They are aged under 70 and go right down to teenagers with serious underlying life-threatening conditions. Over the past year, cocooning has had an impact on these individuals and their wider families who, in many cases, need to move out of the family home. That is a very distinct group. They are clinically identifiable. It is very important that consideration be given to that group whose lives are in danger and who must have a high priority as a result. I again stress the importance of that bearing in mind that there are also teenagers in that group who need consideration. I note what the Minister said earlier.

The next issue relates to the number of residents and staff in nursing homes who have yet to receive their first dose of the vaccine. I have been looking for that information for the past two weeks. Can the Minister provide it now? What is the estimated date for completion of all vaccinations in nursing homes and long-term care facilities?

What is the up-to-date position on the efficacy of current vaccines in dealing with the known variants, specifically the South African and Brazilian variants?

What is the up-to-date advice on the impact of transmissibility on the three vaccines currently in use?

My next question relates to the gap between the first and second doses of a vaccine. Firefighters were recently told, when they got their first dose, that it would be 12 weeks until they got their second dose. Why is that?

I thank the Deputy for her question on nursing homes. Residents in the initial 27 nursing homes that were done the first week have received their second dose. For the next two weeks, starting next Monday, all nursing homes will get their second dose and they have received their date for that. As regards the people who have-----

With all due respect, I asked how many residents and staff in nursing homes have yet to receive their first dose-----

I was just going to answer that.

-----and what the estimated date is for completing the second dose.

It is hard to give an estimated date because those who missed out have to be 28 days clear of Covid to get the vaccine. These vaccinations will be conducted, where possible, alongside delivery of the second dose, which will happen in the next two weeks. At CHO level, targeted clinics-----

What is the number?

My understanding is that it is approximately 3,000 people.

I thank the Minister of State.

With regard to the gap between doses, there are different gaps. The clinical advice for the Pfizer and Moderna vaccines is 28 days. With Pfizer, there was a range of between 21 and 28 days and the HSE has chosen 28. The gap between the first and second doses for all age groups is 28 days for that vaccine. AstraZeneca is different. For those above the age of 65, the advice is to leave a gap of four to six weeks and that is what the HSE is going with. For those under 65, the advice is four to 12 weeks and the HSE is going with 12 weeks. That is what the UK went with and the preliminary evidence from the UK suggests that the greatest immune response occurs with a 12-week gap.

As regards the efficacy of the different vaccines on the variants, that work is still under way and our expert group is waiting for some results. The scientific community has not yet produced the results on transmissibility. That is one of the big questions, which has strategic implications for the vaccination programme.

I fully agree with the Deputy's point on serious underlying conditions and we are looking at that issue right now.

Does that include teenagers?

Yes, but there is an added complication in that the clinical trial data on under 18s are not back yet.

The Minister had suggested that 16- to 18-year-olds-----

We are out of time, Deputy. I am sorry but we are taking other people's time.

Will the Minister clarify that?

I ask the Minister to write to Deputy Shortall and update her on that matter. I call Deputy Niamh Smyth.

As the delivery of the vaccine progresses, I ask that front-line staff like paramedics be urgently vaccinated, as they are in many cases on the front line and working in uncontrolled environments. Paramedics come upon car accidents, go into people's homes and deal with various situations, often going into unknown circumstances. Paramedics in Cavan-Monaghan have been in contact with me and they were frustrated, annoyed and concerned that they were being sent to St. Mary's Hospital in the Phoenix Park for their vaccinations and were not being vaccinated locally like other front-line staff. That may have changed in recent days and some of them may be being vaccinated closer to home but given that we are all trying to do our bit in restricting travel, the idea of them travelling to the Phoenix Park for a vaccination does not make much sense. I would like the Minister to keep an eye on that, to ensure that is not the case and that they are looked after in their own local area.

Like many other Deputies, I have received numerous pleas to bring vulnerable kidney patients, especially those on dialysis, to the forefront of the vaccination programme. These patients must attend hospital care facilities for treatment at least three times a week and for a minimum of three hours at a time. Despite strict protocols to minimise infections, such patients remain at risk of transmission between patients and staff and are in hospital often. Most organ transplant recipients, including over 2,600 kidney transplant recipients, have suppressed immune systems, which add to their high risk of infection and inability to fight the virus. Many of my colleagues in the Chamber have made the same case to the Minister. These people should certainly be moved up much higher as regards priority in the roll-out of the vaccine.

The Government will be announcing mass vaccination centres over the coming days. In my constituency of Cavan-Monaghan, numerous hoteliers such as the Hotel Kilmore in Cavan and the Hillgrove Hotel in Monaghan have contacted me, as have local football clubs. The GAA has been four-square behind communities in protecting, helping and enabling people during this difficult time. These places have excellent facilities that allow space, capacity, footfall and all the things I am sure the Minister and the HSE take into consideration when planning the mass vaccination centres. I ask the Minister to look at clubs like Mullahoran in County Cavan or Bailieborough Shamrocks, as well as the hotels I have mentioned. These places have the facilities and they are available and ready to go. Will the Minister respond to my request?

How long do I have?

If there is not time, I ask the Minister to respond in writing.

Maybe we will hear from the other two contributors before the Minister responds. I call Deputy O'Sullivan.

I will try to be brief and allow the Minister to come back in. I welcome his comments regarding kidney and dialysis patients. I also raise the case of sufferers of cystic fibrosis. Approximately 1,300 adults and children in this country suffer from that disease. Being in here talking about vaccines and trying to get them out to people quickly reminds me of the parable of the loaves and the fishes. It is difficult and there are stresses on the system. We are doing our best to prioritise those who need the vaccine most. I ask the Minister to take cystic fibrosis sufferers into consideration.

I refer to pharmacies and the vaccination process for over-70s in particular. I ask the Minister to clarify the reasons pharmacists cannot vaccinate the over-70s. Is there a clinical reason? Will the Minister elaborate on that? Pharmacists and their staff have the training and safeguards in place to deal with any adverse event that may arise from the vaccination process. We understand that there will be problems with the delivery of the vaccine and that supply will peak and trough but assigning the vaccination of over-70s solely to GPs is likely to cause further unnecessary delays in the administration of the vaccine. I ask the Minister to provide clarity on the pharmacy issue.

I will keep my question short in order to allow the Minister to respond. Other Deputies have raised concerns around the lack of clarity regarding timelines, logistics and people's places in the vaccine allocation groups. I also raise the issue of kidney patients, particularly those on dialysis, and cystic fibrosis patients, who require additional clinical preparation. I have also heard from different GPs and staff in their surgeries about the lack of clarity around the allocation of vaccines. They have registered on the portal and they are inundated with requests and messages. The same is true of pharmacists and pharmacy staff. More information is required. I am conscious that timelines are subject to supply being available but it is much better to avoid an information vacuum, which will only generate speculation and anxiety among the public.

I ask the Minister to deal with as many questions from the three Deputies as possible and correspond with them on the others.

Absolutely. I thank all three Deputies for their questions. On Deputy Niamh Smyth's questions, paramedics are included in the first group and are being vaccinated now as front-line healthcare workers. All three Deputies asked about people with underlying conditions. As we discussed earlier, very detailed work is being done by the national immunisation advisory committee to look at that issue. We are all agreed on the matter of people within the group with underlying conditions who are very high-risk. That is being looked at right now and I have asked the Department to do a review of it.

I hope to be able to report to colleagues on that next week.

In terms of the vaccination centres, the situation is as follows. There are 34 vaccination centres being worked on by the HSE. The aim is to have these ready by mid-March. They will be needed in quarter 2. Some of them may be used by GPs before they are used for the next phase, when there will be much higher volumes. On the questions regarding pharmacies, the two issues are related. An operational decision was taken by the HSE to use the GP network to vaccinate those who are 70 and older. Critically, that is not forecast to cause any delays. Again, the principle that is being used is that the only constraint on administering the vaccines is the supply of vaccines into the country. I can commit to colleagues that if it was the case that the GP network was not capable of handling the volume coming through, we would immediately look to expand upon that. The thinking is that the pharmacists will be essential to this programme. We have the deal in place for the pharmacists. If we get the supply in, the volumes will increase considerably. This is where the pharmacists will come in.

I want to raise the issue of the roll-out of vaccines for community-based services such as homeless services, community drugs teams, counselling services and services for children with autism and other disability services. Many workers in these services were seconded to the HSE during the first wave and were valued members of the HSE during that very difficult time. At this stage, many or all of them have returned to work in their services and they are dealing again with vulnerable service users. This is important work but, unfortunately, much of it is taking place via Zoom or through phone calls. There is no one-on-one interaction in terms of the delivery of these services, which is a critical piece of their service delivery.

Earlier, reference was made to the loaves and fishes in terms of trying to get the vaccine to as many people as quickly as possible. We all acknowledge that the pandemic has taken a serious toll on the mental and physical health of people in our communities, particularly the most vulnerable in our communities. It is vital that services are up and running again as quickly as possible. There is an enormous challenge facing us into the future because of the restrictions under which many of these services have been operating up to now.

I want to speak about a particular service in which I am involved. There are four front-line workers, an administration staff member and a co-ordinator involved in this project, which works with vulnerable people within our community. The four front-line workers have been asked to register for their vaccination, and have done so, but the other two staff have not been asked to register despite that they are a critical piece of this service. There are so many services across the State that similarly are small compact services in which staff work closely. It is important that administrative and other staff be given the vaccine at the same time as the front-line workers. In my opinion, and that of the staff about whom I am speaking, they are front-line workers in terms of the workings of these services.

The sentiments expressed by the Deputy are shared across the House. These staff provide critical services. I will ask my officials to email to the Deputy a link to the HSE's document published on 5 February, which contains guidelines for sequencing and registration for healthcare workers and seeks to answer the questions the Deputy has raised. For example, sequence group 2d relates to healthcare workers who deal with unscheduled care patients in a controlled environment on a daily basis, for example, patient-facing staff who work in inpatient residential care areas that provide care for unscheduled care service users and community settings providing walk-in access for patients and service users, such as walk-in community services, addiction services, homelessness services and walk-in mental health facilities. It may not respond exactly to what the Deputy has articulated in terms of all the different groups within those vital services, but it at least provides a clear prioritisation in terms of how we get to all of the people we need to vaccinate as quickly as possible.

I am sharing time with Deputy Paul Murphy. I have one very specific question which the Minister probably will not have an answer for today so I ask him to bank it and come back to me on it. The Minister will be aware of the concern expressed by the South African Government in regard to the efficacy of the AstraZeneca vaccine in terms of the variant in that country. I have been contacted by at least two healthcare workers here who are working with people who are quarantining following their arrival into this country and who are concerned they may come into contact with that variant and will be offered the AstraZeneca vaccine rather than the Pfizer or Moderna vaccines. I ask the Minister to respond as to whether that is a just concern.

The following is the main point I want to make. The problem in this country and across the world is there is not enough vaccine. People need to know that a significant contributory factor in that regard is the greed of the vaccine producers in terms of profit and their refusal, as is being demanded by the People's Vaccine Alliance, to share the formula and intellectual property that would allow other vaccine producers to produce vaccine in large quantities. Pfizer, Moderna and AstraZeneca are only planning to produce enough vaccine for one third of the world's population between them, most of which is being sold to the rich countries. The biggest manufacturers of vaccines in the world are barely producing any, either because they do not want to or because they are not being given the mechanisms to do it. According to UNICEF, only 46% of global capacity to produce Covid-19 vaccines is being utilised because of problems around intellectual property rights. This is a disgrace and it threatens to undermine the vaccine effort on a global level.

The three largest vaccine producers in the world have bases in this country and could produce vaccines but they are not doing so. That is an outrage. As the Minister is aware, there is a global campaign, supported by Oxfam, UNICEF, and many others calling for the Agreement on Trade-Related Aspects of Intellectual Property Rights, TRIPS, to be suspended at the World Trade Organization meeting in March, which would allow for a dramatic ramping up of vaccine production. Does the Minister support the People's Vaccine Alliance campaign and will he call for the suspension of the intellectual property rights of monopolies over the right to produce these vaccines at the WTO meeting? I would like a direct answer to that question.

Let us hear from Deputy Paul Murphy and then we will get answers to both Deputies' questions.

My question relates to Deputy Boyd Barrett's question so I would like to hear the Minister's response before I come in.

We need a global solution to this issue for all sorts of reasons. We need it for ethical and moral reasons. We also need it for reasons of self-interest. There is no point in Ireland fully vaccinating its people when we live in a globalised world. We need a global solution. Given that we need a global solution for ethical and moral reasons and for our own self-interest, is the solution the suspension of intellectual property? Maybe it is but I would be concerned about that as the solution and I will state why. These pharmaceutical companies, against which the Deputy rails, have produced, in an unprecedented short timeframe, an array of vaccines that are highly effective and we are now using. Only a few months ago, eminent experts were telling me that it could be years, if ever, before we had vaccines for Covid-19.

If this were the only virus of its type that we were ever going to see, then maybe that could be something. However, I will tell the Deputies what my concern would be. It is that if there were a move to say we are suspending intellectual property, in the case of the next virus or variant that arrives, those very same companies that we need to produce the vaccines would ask why should they.

The time for the Minister to ask questions about whether this is something we should do, or to say that we could do it or not do it but he has concerns, is over. He has responsibility in this matter as Minister. The EU is blocking the suspension of the waiver. The EU, by refusing to take on the big pharmaceutical companies, is blocking the vaccine from being used across the globe. It might be 2024 or later by the time we have global vaccination. These vaccines were developed in large part through more than €5 billion of public money. Ms Winnie Byanyima of the UN told an Oireachtas committee this week that big pharma is protecting its monopolies, technology and intellectual property and thus restricting production of Covid vaccines. That is criminal. It is immoral and it is also a health danger to people in this country as well as around the world. Has the Minister discussed this with the other health ministers? Has he raised it at all with his EU counterparts? As things stand, the EU is going to stand with some other major countries in blocking the waiver and blocking access to the vaccine for most people in the world.

The next speaker is Deputy Brendan Smith and he is sharing time with Deputies O'Connor and Richmond.

I welcome the comments today by the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler, in regard to the vaccination programme. Both have consistently indicated that they want the programme to be rolled out fairly and that those most in need will be prioritised. That has to be the basis for rolling out the largest ever vaccination programme in the history of our country.

I welcome the Minister's confirmation that 85% of the public have indicated that they want to have the vaccine made available to them. The vaccination programme already involves additional partnerships with GPs, pharmacists and other healthcare professionals. I welcome their determination and interest in ensuring the programme is rolled out as rapidly as possible. I am also glad that GPs at local level will share facilities where necessary to ensure the vaccination programme is administered as locally as possible. For some weeks, I have been contacting the HSE at local level to give the names and details of various community and sporting organisations that want to make their facilities available should they be of particular use.

I had the opportunity earlier today to discuss with the Minister the very strong requests made by kidney patients in respect of the vaccination programme. They have outlined to all of us very clearly the need to reassess the programme in terms of when they will get their vaccine. They highlight very strongly that domestic and international expert medical opinion makes a strong case on both medical and ethical grounds for the need for all kidney patients to be vaccinated earlier than currently planned. I sincerely hope the Minister can give that particular request detailed and urgent consideration.

The Minister will recall that I have raised on numerous occasions the need to ensure the strict implementation of restrictions on travel, both for people within this State and people visiting the State. I very much welcome the new restrictions that came into place earlier this week. I genuinely believe that people visiting the State should be subject to the same travel restrictions as are people ordinarily resident here. It is a welcome move. I also welcome the Government's commitment to impose harsher penalties on people travelling outside the State and coming back here on non-essential travel.

I thank the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler, for being here today. The Minister spoke earlier about the need for a global solution to the Covid-19 crisis and he is right about that. I have put questions to him multiple times in the House and made statements on matters pertaining to Covid. An issue with which I am quite disappointed at a European level is the EU's attitude to a multilateral approach to research in the area of antigen testing and having a set antigen strategy across the Union. We know we are going to be in a situation where we cannot get our entire population inoculated during 2021. There is a significant risk that this entire year will be lost because of the Covid-19 pandemic. That is neither the Minister's fault nor that of any Minister in the Government. However, we should be trying to invest in research into ways in which we can give people the ability to live alongside this virus to some degree.

Antigen testing offers a channel to do that. I cannot understand why it is not being done at a European level. When the Minister is at the next meeting of the Council of Europe with his health ministerial colleagues, will he put that point to them? I also ask that he feed back the disappointment I have as a parliamentarian, which I am sure others in this House share, regarding the EU's performance in the area of Covid. It has not been up to scratch and the Commission has let us down quite badly. I say that as somebody who is a proud European and very much in favour of the European project. We need to feed the message back that the EU has not lived up to our expectations and it must do more.

I thank the Minister for coming to the House for this debate. I welcome his announcement that there is to be a review of the vaccination schedule for chronically ill people such as the 1,400 sufferers of cystic fibrosis and those requiring kidney treatment, whether dialysis or otherwise. I ask that he expand on his answer about when that review might be completed. We need to provide some element of hope and succour to the very many patients around the country, and their families, who are very worried and have been really struggling with the cocooning process.

The other issue I wish to raise is slightly wider and ties in a little to what Deputy O'Connor mentioned. It relates to vaccine supply. I raised this issue the last time we had an opportunity to ask the Minister about the European procurement process. Can he provide any detail on the reports that both AstraZeneca and Pfizer-BioNTech will be able to scale up the production of their vaccines and what that might mean for Ireland's allocation of vaccines? I will finish there to allow the Minister time to respond.

I thank the Deputies for their questions. The question on rapid testing is a very good and pertinent one. I have raised with the Commission and the other health ministers that there should be a centralised clearing house and some sort of co-ordination in terms of the ability to validate and then deploy antigen testing and also to share information across the EU. I can say to the Deputy that I think there is a bigger opportunity to use antigen and rapid testing in this country. I have set up an expert group chaired by Professor Mark Ferguson, who is director of Science Foundation Ireland and the Government's chief scientific adviser. He is looking at a quick review to see what are the appropriate tests to use, where are the appropriate settings to use them and how they should be used. I know he is doing very good work. In fact, I had to miss, with much regret, a meeting as part of his work that he set up with a Nobel laureate on exactly this issue last Friday.

In regard to underlying conditions, I ask that we pause here for a second. We have talked about this several times today. What I do not want to do is send out a message of false hope for any particular group. I am very aware that there will be people who are very sick, people who are dealing with very serious conditions and people who, quite understandably, very badly want to get vaccinated. They want to see where they are at. I do not want to give any false impressions. I ask that we be very clear on this because various groups have been raised today, including people with cystic fibrosis and those dealing with kidney issues, be it kidney transplant, dialysis and so forth. What I am saying is that I have asked the Department to review the situation specifically with regards to those who are very vulnerable to Covid because of underlying conditions. They will be a subset of what is currently cohort 7. There are many hundreds of thousands in that cohort because it covers everyone with an underlying condition. There is a smaller group within that who are really very susceptible. NIAC is doing some very detailed analysis on that now and I am expecting it to report back to the Department next week. The Chief Medical Officer and the Department of Health will be scrutinising that in great detail and I hope to be able to report to colleagues next week. I may not have all of the information and I may not have fully agreed answers for colleagues next week but I certainly want to be able to report back because I share the very serious concerns that have been raised.

I am out of time but I will answer the final point briefly, which was about the vaccine manufacturers scaling up production.

If they do scale up and if further options become available, we will look into buying or opting in to them. What I can say now is that we have advance purchase agreements in place for almost 16 million doses across the various vaccines.

There is growing concern from community sector pharmacists on the timeframe for them to receive the vaccine. In recent months they have seen more and more patients referred to community pharmacies for what would have been standard procedures in any general practitioner practice, including blood pressure and supervised methadone checks. Their face-to-face contact with patients has dramatically increased to allow for the reduction in face-to-face contact for patients with local GPs. They have shouldered their fair share in this pandemic. In keeping the pressure off local GPs as much as possible, the risk to them has dramatically increased but the protections have not. If a pharmacist in the HSE becomes pregnant, she is given the maximum protection possible. She works remotely from home for the full duration of the pregnancy. However, if a pharmacist in a community pharmacy becomes pregnant, she shows up to work every day as normal right up to the weeks before she gives birth, despite the significant increase in risk for her and her unborn child.

Pharmacists will be needed for an effective mass roll-out of these vaccines. This will have to involve not only those working for the HSE but the thousands throughout the State working in local community pharmacies. When will community pharmacists be vaccinated? I have one more question that I will come back to.

I will ask that the Deputy is sent a link to the relevant paper. It was issued on 5 February to answer exactly these kinds of reasonable questions. This circular gives a description of who is included in cohort 2, that is, front-line healthcare workers. Group 2(g) covers all other healthcare workers without direct patient care but who are working in a healthcare facility with the potential to meet patients who are not captured in any of the earlier categories. Examples include laboratory staff, pharmacists, catering etc. I will ask that the Deputy is sent exactly this circular. The second part of the answer relates to front-line healthcare workers. We started the vaccination of the second group on Monday this week with the AstraZeneca vaccine.

Many Deputies have already raised the question of kidney transplant patients. Kidney patients have a high mortality rate. They have major concerns. What hope can the Minister give to them? Will the Minister consider adding them to group 1?

I have asked the Department to do a detailed review of cohort 7, which includes those with underlying health conditions. The current size of that cohort is especially large because it is an estimate of everyone in the country with an underlying condition. The view expressed consistently in the House - it is one I share - is that there is a smaller group within that cohort who are particularly vulnerable to Covid-19 and who might get ill or die if they were to contract Covid-19. The national immunisation advisory committee is doing a detailed review of that full list to see what a subgroup might be to ensure they are prioritised.

Our next contributor is Deputy Verona Murphy with the view from the lovely south east.

I was to share with my colleague, Deputy Lowry, but I do not know whether he is here. I will keep going and we will see.

I wish to raise an issue relevant to several of my constituents. Many Deputies in the House have similar constituency issues. I heard the Minister relay that cohort 7 would be revised. I am somewhat concerned about who is actually putting the list together. The reason is that I have a great many constituents with serious underlying conditions making representations to me and asking me to represent their views to the Minister. I have been unable to secure any form of clarification.

I will tell the Minister about Enda. Enda is 16 years old but is severely autistic. He has three siblings. They all live in the same house with his mother and father. They have not had one night's sleep in this year. Enda normally remains awake for the whole of the night-time period. He has had his whole world turned upside down because he does not see his carer and does not go to his facility. They have no respite. Effectively, a whole family and the boy's carer are being discommoded. They have absolutely no clarity on whether, as a 16-year-old, Enda will be vaccinated given that it has been said that there will not be vaccinations for those under 18 years. The fact that he has a severe intellectual autistic condition means that he needs the interaction of his carer and special needs assistants. Where will that leave this family?

In another example, Walter is 40 years old and lives on his own. He has had two kidney transplants. Walter drives himself for dialysis three days per week. He does not see his parents or brother. He cannot go to the shop, especially since the RTÉ programme the other night broadcast interviews with Covid-19 sufferers who told us that they could only point to the fact that they picked it up in the shop. Walter's life is severely limited. He needs clarity. At 40 years of age his whole life has been surrounded by limitations, but this is a particularly terrible time in that he cannot even see his family.

I have also heard from the mental health services in Wexford. The Westlands unit is a residential unit that takes care of five adults. The people there have no clue. I asked as late as last night if they had been notified. I received an email this morning. There has been no notification for the front-line health workers in Westlands in respect of whether or when they will be vaccinated.

Leah is 26 years old and has Down's syndrome. Sometimes she suffers with different things that may put her in hospital but ultimately she is at home with her family, who are her primary carers. None of the family members is eligible for a vaccine based on the roll-out or the age profile. I am asking about Leah. Can we have some clarity?

Above all, I am asking about family carers. I heard Jane Johnston this morning. Her son has returned every second week on a rota basis to his services. It is of the utmost relief. Jane was in tears this morning. She was worried about how he would get along and because she has no way of knowing when he or those around him will be vaccinated. I appeal for these people, who are suffering psychologically. When will they have some form of relative normality? It is normally a difficult situation for these families in any case. I call for some clarity on the roll-out.

I am unsure whether my colleague, Deputy Lowry, has arrived. The Minister can answer. I do not think the Deputy is here.

I will answer the question on mental health. All residents aged 65 years and older within registered nursing homes, disability residential care facilities and mental health residential care facilities have been offered vaccination. Some mental health staff came under cohort 2 but the AstraZeneca roll-out now includes all mental health staff. Everyone is encouraged to apply on the portal.

My thanks to the Deputy for her question. There is nothing I would like more - there is nothing any of us would like more - than to have all of the supply here now, because then we could vaccinate all the people the Deputy is talking about at the same time. That is what we would like to be able to do. However, because of the limited supplies, at least in the initial months, we need prioritisation. The prioritisation came from the national immunisation committee and was agreed by the National Public Health Emergency Team, NPHET. As I said earlier, there is a review going on by NIAC at the moment with regard to those with underlying conditions.

The number of people in the country with underlying conditions is very large and some of them are highly vulnerable to Covid-19. I have asked for a review to specifically identify that group of people because the principle of the vaccination programme is that it is safe, fair and effective. In other words, we must vaccinate the most vulnerable first. We are therefore doing a review of that. Family carers have been asked about specifically many times and that is very reasonable. The Deputy and I, as well as everyone in this House, recognise the invaluable work family carers do. The Deputy has given several examples of families where the work done is just above and beyond and it is done every day. All I want is to be able to give them a date. I would love to be able to tell them to go down to their GP on Monday alongside the people aged 85 years and over. However, there must be a sequence. Those who are being cared for, who would be most vulnerable were they to get this awful virus, must be vaccinated first and then we will move on as quickly as possible to those caring for them.

I will take four minutes and leave some time at the end for the Minister's answer. Although I have raised many of these issues with him privately, I will do so here, on record. I put up a post today welcoming the Helix centre in DCU being used as one of the community vaccination hubs in my area. I was inundated by requests from people asking when they might be vaccinated. It is worth saying that in the context of a vaccination programme about which we thought there might be some hesitancy, we should be delighted that people are willing to take this vaccine and want to do so.

My second point is that we are not rolling out the vaccine programme - we are rationing the vaccines we currently have. Listening to many of the contributions made by Members backs this up. This is cruel and sad but it is the reality of where we are. In making the case for each group, the national immunisation advisory committee has done a good job in outlining that many of the criteria are based on protecting the people who will suffer most by suffering illness rather than those who are in most contact with it. That is a difficult thing for people to understand sometimes but we know the vaccine is most effective at stopping people from dying. I did an interesting analysis among my own family group, from whom I was getting questions in our WhatsApp group. I applied the NIAC criteria to the 20 people in that WhatsApp group and by and large everybody was very happy with giving priority to those who were older in the group, those who had most contact in a healthcare scenario and so on. I ask people to do the same, to look at the priority list and ask themselves if they believe that it is a fair allocation of a very restricted supply. That is what the NIAC has done and that is what the Government is doing.

There are two categories where we will get more questions as supply increases. I welcome the Minister's announcement today on those people in that broad group of people with underlying conditions who perhaps would have a very severe impact with Covid. I am thinking in particular of people with rare diseases impacting their lungs and in particular of those with cystic fibrosis. I would think a case could be made for them. I am not a medic but I would appreciate it were the Minister, in his contact with the NIAC, to ask those questions and get those answers for us.

That broader group of key workers also needs to be defined. People are, on balance, very fair. They appreciate there are people ahead of them who might need this vaccine more but they want to know the basis on which those decisions are being made and the people who are making them. I have had the experience of having worked with people on the NIAC in the past in a different light and they have done a good job here. However, perhaps we need some more lay voices communicating NIAC's decision and explaining some of the decisions the medics have made. I thank the Minister for his work in this area. On the roll-out and specifically the logistics, there is no spare vaccine sitting in a warehouse not being injected in Ireland and that is something of which we should be appreciative. I am not referring to the Minister's work, although that has been done, but we should be appreciative of all the people who are injecting those vaccines, to the healthcare workers who are involved in that and all the HSE staff.

The Minister has been left 20 seconds. I can move to the next speaker if he likes.

I am not sure there was a question but if there was I am more than happy to pick it up. It was more of a statement, if that is fair.

The Minister says the system of distribution for vaccines must be seen to be fair, safe and effective. What is he doing about the fact, as published by The Irish Times, that 800 people have been vaccinated outside of priority groups 1 and 2? Can he account for that fact? They are the most vulnerable and the sickest or potentially those who are most likely to suffer serious illness. How can 800 other people be vaccinated outside that cohort? What audit is the Department or the HSE carrying out to ensure there is fair and equitable distribution and that family members or other people who are not in categories 1 or 2 are excluded? It is hugely important, particularly in view of the cases being made here today about people with serious kidney disease and other very serious and chronic illnesses.

I note "The Michael Reade Show" on LMFM has identified that at least two workers in a nursing home who tested positive for Covid were placed in a private hotel for accommodation without the HSE or indeed anybody in the hotel being advised that they were sick. That is a very serious issue. Is the Minister aware of this and can he or will he carry out an investigation into it?

Several Members have raised the issue of people who are receiving dialysis or cancer treatment. In particular, people under 18 years of age who are on dialysis are down in vaccination category 15. While the Minister has outlined that he expects to revert within the next week, can we have an answer on this point because it has been raised consistently for the past four to five weeks? Will the Minister give us a straight answer in order that people will know what is planned over the next few weeks and months?

The second issue is having a clear plan set out for the next six weeks. Can the number of vaccines coming into the country every week be set out publically, in particular those for the next six weeks? We would then have a clear view of what is coming in.

Finally, on the Johnson & Johnson vaccine, although I acknowledge it has not been approved by the European Medicines Agency yet, I understand that more than 400,000 doses of that vaccine will be available in mid-April if approval is granted by the end of February. As this is a single-dose vaccine, we can get through a far greater number of people in a faster time. Can we increase that level of vaccine and can we have it delivered early, once it is approved by the European Medicines Agency?

In response to Deputy O'Dowd, I will have to take a look at the report he referenced about the 800 people. It does not sound like something that should have happened but without being able to look at the specifics, it is very hard for me to comment. Certainly, the isolated instances we have discussed in the House previously in respect of family members were not acceptable and under no circumstances should that have happened. I am happy to look into the referenced report.

Similarly, the issue regarding the hotel in the Deputy's constituency has been raised. I thank him for raising it. It is something we are currently looking into with the HSE.

I have two and a half minutes. At the end I will have a few questions to which the Minister might reply in writing. The HSE has confirmed that Ireland will slow down its vaccine roll-out this week. The revised plan means only 29,000 vaccinations will be given out this week.

That is a staggering 17,000 fewer than planned. The number under the original plan was 46,000. Surely a better plan should be put in place. It is obvious to the dog on the street that the Government does not have any type of grasp on the roll-out.

Much has been said in recent days about the vaccine roll-out to the over 70s. This cohort of 480,000 people will now receive the Pfizer or Moderna vaccines. The Oxford-AstraZeneca vaccine will not be given to those aged over 70 in Ireland in spite of the EU drugs regulator approving the AstraZeneca vaccine for all age groups. It seems that the elderly in this country are getting the worst deal in the context of Covid-19. They were left to die in nursing homes when Covid originally hit. When a social welfare payment was given out, the elderly were not included. Now there has been another mix-up in terms of what vaccines they can be given. The Minister stated that the roll-out of the vaccine would not be politicised and that it would be more a decision made for others. He was correct. However, two weeks ago I was privately told in west Cork that the vaccine centres would be rolled out in Clonakilty and Bantry. I was told not to pass on that information, which is fair enough. I respect the person who said that to me. My office then phoned the Minister's office last Monday and asked his secretary for the locations of the vaccination centres in south-west Cork. People are asking where they will be located and that is why I wanted an answer from the Minister. We were not given an answer. We received a bland email with no details. Surely, if every person on the street knows where the centres will be located, Deputies should have been given the same information as everybody else. The secrecy attached to the locations makes the Government look highly suspect and lacking in leadership.

I have been made aware that some people in west Cork have been given the vaccine but should not have received it. At the same time, there are doctors, nurses and home helps in west Cork who have not been offered the vaccine. It is high time the Government woke up and dealt with this issue. On Tuesday, the Irish Nurses and Midwives Organisation, INMO, informed the Oireachtas Joint Committee on Health that the Irish vaccine roll-out started in a haphazard manner and was not focused on the locations or workplaces with the highest rate of infections. In other words, the Irish vaccine strategy was deeply flawed from the outset. If the Minister cannot answer my questions today, I would appreciate if he were to answer them at a later date.

On the issue of home helps, for three weeks I have been asking the Minister when home helps in west Cork will be vaccinated. It is a black and white question. Why are pharmacists not being allowed to roll out the vaccines? I would appreciate if the Minister were to come back to me on those issues.

Several months ago, I asked the Minister about the roll-out of the flu vaccine. I put it to him that 2 million doses had been supplied but the Government could only account for 1.4 million of them. I ask him to provide me with an answer in writing, stating whether that was right or wrong. I asked how we were going to be prepared to roll out the Covid vaccine, given the number of vaccines involved, when the HSE and the Department are totally unfit and not accountable to anybody, not even the Minister. When will carers, home helps and gardaí get the vaccines? They are front-line workers. They could not be more on the front line. I do not have a big issue if five or six leftover vaccines are administered to people. Surely it is better than wasting them. The vaccines should not be wasted.

Valerie is a middle-aged woman who had a serious accident when she was a young girl and got an award. An exceptional care team was put in place by her father and mother. Her care and support team comes into the house to care for her. The family lives in Carrick-on-Suir, quite close to where the Minister of State, Deputy Butler, lives. Valerie's carers are waiting to be given the vaccine but they are given a lower priority because they have been employed privately by her father on her behalf. They are frightened and worried. They have been watching RTÉ, the bad news channel. The RTÉ reporter who is a former Deputy found his vocation at long last and frightened the life out of everyone. He was here with us in the Parliament for a while. A fear factor is being instilled, while the roll-out is not fit for purpose. Those carers who are employed privately need the vaccine as much as anyone. Will they be given any idea when they will get it?

The Minister stated that there is a list, but that list is going backwards because of the lack of supply. In the United Kingdom, 12.8 million vaccines have been administered, but only 230,766 have been administered in Ireland. Maybe we should have left the EU as well and we would have got the vaccines. The EU is not looking after us. It never did. The Government is unable to get the vaccines. The Minister was asked by Deputy MacSharry to contact the CEO of the companies involved to see whether Ireland could get the vaccines by itself.

The roll-out is frighteningly slow and it is a damn fine mess. When the Government could not look after the roll-out of 2 million doses of the flu vaccine, I asked how they were going to roll out the Covid vaccine. The HSE is not fit for purpose. It has not been fit for purpose for decades. Its management was appointed by the Minister's great leader, the Taoiseach, who set up the HSE. It is not fit for purpose, full stop.

Deputy Michael Collins stated that those in nursing homes were left to die. I think that is a very unfair comment. It is scaremongering. To date, 1,734 people have died in nursing homes, but the nurses, staff and carers have worked their fingers to the bone to try to ensure that these people were not left to die. It is unfair of the Deputy to say that.

I would like the Minister of State to come down to some of the hospitals and nursing homes where the standards that she and her Government colleagues apply have not been applied and the Government has not-----

(Interruptions).

I am going to move on.

(Interruptions).

Deputy, thank you. I ask for your co-operation. This is one of the reasons I stick to the time. I let the Minister of State in but there is a time limit and I do my best to stick to it. I will go back to sticking to the time.

I first record my thanks to all those who have been involved in the very effective roll-out of the Covid vaccine up to now. I suspect that vaccine centres are happy places in which to work at the moment.

The Minister of State, Deputy Butler, told the House that those most vulnerable to Covid-19 would be the first to be protected, along with healthcare staff. In that context, I make a strong case, as have other Deputies, for kidney patients. Many such patients in my constituency have contacted me. We now know that their mortality rates from Covid-19 are similar to those for over-70s in residential care. Patients who are receiving or awaiting dialysis treatment are especially vulnerable. They have to attend hospital three times a week for three hours per visit. As the Minister is aware, they cannot cocoon and, as such, are at a higher risk of infection. Those who have had kidney transplants are in the same vulnerable position. I believe their position in the vaccination categories must be reconsidered as a matter of urgency.

The position of those with cystic fibrosis and those whose life-saving treatments or surgeries have been delayed because they have not been vaccinated also needs to be reconsidered.

I am not asking the Minister to play God. To do so would be unfair to him and to everybody else. However, I am asking that the groups I have mentioned would be central in the consideration of the national immunisation advisory committee to which the Minister referred.

I refer to front-line workers in congregated settings or residential homes for adults with disabilities. I am asking that these workers be made part of category 2 simply because they are part of category 2.

Nothing has changed since the last time I spoke to the Minister. Effectively, he is still trying to perform a loaves and fishes operation and make the small number of vaccines he has received stretch as far as possible. I think most people understand that. On the last occasion, the one question I asked was about people who have had Covid-19. There are studies from Public Health England and research institutes in the United States and elsewhere that indicate such people have at least a degree of immunity for an undefined period. Are those who have had Covid-19 still receiving the vaccine according to their place on the priority list or is it deemed that because they have a degree of immunity, they do not need to be afforded the same degree of priority?

I endorse what has been said regarding people with underlying conditions in category 7. I do not envy the Minister or NIAC. I acknowledge it will be NIAC that will have to prioritise among various cohorts. Once that prioritisation is done, will that include minors or just people in that age cohort?

If the Minister or the Minister of State could clarify those points, I would appreciate it.

I refer to the comments of Deputy Harkin regarding those with disabilities and front-line workers. The Minister of State, Deputy Rabbitte, confirmed this week that disability service staff are included in vaccination plans for front-line healthcare workers in the coming weeks.

I know this was a significant concern for front-line disability service workers and it has been welcomed.

The Deputy asked if we are vaccinating those who have had Covid-19 in order and the answer is, "Yes". As he and I have talked about previously, there is interesting evidence and data from the UK, which the Deputy referenced. I have requested that NPHET comes back to me with a view on that but the current position is regardless of whether or not one has had Covid-19, one will be vaccinated.

Both Deputies asked understandable questions about those with underlying conditions. As the Deputies acknowledged, there will not be political involvement in who may be deemed to be in the particularly high-risk group. NIAC will give a view on that, as will NPHET and the Chief Medical Officer. The Department of Health will then come to me with a view. My role was to pose the question and to say I would like this looked at because it has, rightly, been raised by many Deputies over many weeks. It is a detailed and sensitive piece of work, as the Deputies have acknowledged. I hope to be able to discuss it in detail next week with colleagues in the House. However, we obviously need to leave space for the various groups to come to conclusions.