Covid-19 Vaccination Programme: Statements

I am sharing time with the Minister of State, Deputy Butler.

I believe we would all agree that Ireland’s Covid-19 vaccination programme is the most ambitious public health initiative ever undertaken by the State. Following the considerable sacrifices made by everyone in taking action to minimise the risk of spreading the disease, the availability of safe and effective vaccines provides a beacon of hope for a return to some normality. The vaccines protect the lives of those most vulnerable to Covid and will allow us to enjoy again and see the value of things we once took for granted.

By the end of last week, over 500,000 doses of vaccines had been administered. This is a significant milestone and a reflection of the hard work undertaken by the thousands of women and men across Ireland who are working very hard to implement the programme.

The focus to date has necessarily been on older people and healthcare workers. There are strong indicators that the vaccination of this cohort is having very positive benefits. Covid infection rates for hospital workers have fallen by approximately 95%. The number of staff in the nursing home sector absent for reasons related to Covid has fallen from several thousand to several hundred and continues to fall. The latest serial testing results from the nursing home sector showed a positivity rate of just 0.2%, which we can all welcome. Thanks to this, the National Public Health Emergency Team, NPHET, is today giving consideration to protocols on visitation. I know this is tremendously important to residents, families and staff. The Minister of State, Deputy Butler, and I have been working closely together on this issue and we are looking forward to discussing the situation with the acting chief medical officer later today.

The next phase of the programme, which started this week, sees vaccines being made available to those with underlying medical conditions which place them at very high risk from Covid. In addition, the programme this week is focused on second doses in nursing homes; a small final group of those aged 85 and older, including those who are housebound; healthcare workers, for whom the administration of the first dose will be finished next week; and some initial roll-out to those aged 80 to 84. There is, therefore, a lot of activity ongoing around the country.

There is, understandably, a lot of focus on vaccine supply. Ambitious targets and optimism with regard to the pace of regulatory approval of candidate vaccines have come up against the realities of vaccine production and supply. This can make us lose sight of the merits of Ireland’s engagement with the EU’s procurement process. Ireland has opted into advance purchase agreements negotiated by the European Commission on behalf of member states. Through this mechanism, we have advance purchase agreements in place for seven different vaccines. These include the three vaccines currently being administered in Ireland, a fourth, the Janssen vaccine, which we hope will be authorised by the European Medicines Agency, EMA, later today, and three others which are currently being reviewed by the EMA. We have pre-ordered a little under 18.5 million doses of vaccine. This is enough to vaccinate every man, woman and child in the country twice. We are looking at options to increase this amount via the EU. Just yesterday, an additional delivery of the Pfizer vaccine was secured by the commission, with Ireland due to receive an additional 46,500 vaccine doses this month. This is obviously very welcome.

The terms and conditions of these agreements include a requirement that vaccine doses will not be made available for use until the relevant vaccines have received regulatory authorisation. It has always been an underlying principle of the EU’s procurement process that, prior to administration of any given vaccine, assurances should be obtained as to its safety and effectiveness.

Some have argued that Ireland should be seeking additional vaccine supplies outside of the EU process, which is a very reasonable argument to make. I assure Deputies that Ireland is in regular contact with pharmaceutical companies, the commission and other countries. It will come as no surprise to my colleagues that other countries are not interested in giving up their own vaccine supplies while they are vaccinating their own people, particularly their most vulnerable. Ireland is in the same position. It will also come as no surprise that the pharmaceutical companies themselves do not have as yet undeclared supplies not being procured by the EU or other regions or countries around the world.

The third argument put forward by some is that we should use vaccines that have not been authorised by our own regulator. The Russian vaccine, Sputnik V, has been mentioned in the House on several occasions. The EMA is conducting a review of the Sputnik V vaccine but it is interesting to note the comments of The Irish Times Europe correspondent, Naomi O’Leary, who said yesterday that “The Italian factory announced as the production site for Russia's Sputnik vaccine for overseas orders is a small business that has never made vaccines and is not authorised by the Italian Medicines Agency.”

On the reliability of supply, Moderna and Pfizer have performed well thus far. AstraZeneca has not. It is repeatedly changing its delivery schedules, often at the last minute, and revising down the volumes it will deliver. This is happening right across Europe. It is deeply frustrating for everybody, with so many people looking to get vaccinated as quickly as possible. We are acutely aware of the anxiety caused when these delivery schedules are not met. It should be noted that the Commission and member states, including Ireland, are proactively engaging with the vaccine manufacturers to impress upon them our legitimate expectations that agreed allocations will be met and the need for them to increase supply accordingly.

Some have characterised these shortfalls by AstraZeneca as the HSE missing its targets. This is incorrect; AstraZeneca is missing its targets. The HSE’s target is to get people vaccinated as vaccines arrive, a target which it is consistently hitting. Some 95% of vaccines are being administered within seven days of arriving in the country. The HSE set out to vaccinate those aged 85 and older over a three-week period. The roll-out was not flawless and there were GPs who did not get supplies on the days they were originally told they would. However, the vast majority did and approximately 99% of those in this cohort were indeed vaccinated during the allocated three-week period.

As I said, the roll-out was not perfect, and it is important we learn from this.

I would like to share with Deputies the additional measures that have now been put in place by the HSE to support GPs. A call centre has been established. Dedicated relationship managers have been put in place. A regular GP bulletin outlining available vaccines is being produced. Updates have been made to the order management systems. Distribution process improvements have been made and the distribution ramp-up model has been updated based on learnings over that initial three-week period.

As of 7 March, 165,000 doses, of which over 65,000 were second doses, have been administered to residents and staff in long-term residential care facilities. A total of 262,000 doses, of which over 84,000 were second doses, were administered to front-line healthcare workers. The estimated number of people over 70 to be vaccinated is approximately 480,000. It is expected, subject to availability of vaccine supply as always, that everyone in this cohort will be vaccinated by mid-May.

The impact of the vaccines so far is extremely positive. The evidence from Ireland and from around the world is beyond the most optimistic expectations that were being put to me a few months ago. As more groups are vaccinated, options will become available to modify or lift the existing restrictions, which are having such an impact on people across the country. While there has been, and will continue to be, uncertainty and fluctuations in delivery schedules, we have purchased more than enough vaccines to vaccinate our entire population. Supply will ramp up, we will vaccinate those who are most vulnerable and then move on to the wider population. We will, in time, see a return to a more normal way of life.

Ireland’s vaccination programme is designed to protect the most vulnerable in society, beginning with older residents of long-term care facilities and front-line workers, before rolling out to the wider community. We are continuing to prioritise those who are most vulnerable to Covid-19 infection, and front-line healthcare workers who care for them come first in the priority list for vaccination.

Some long-term residential care facilities have experienced significant outbreaks over the course of the pandemic, leading to loss of life. As a result, residents over the age of 65 were given the highest priority in the vaccine allocation strategy. The overwhelming majority of first doses in long-term care facilities are expected to have been completed by the end of this week. Roll-out of the second vaccine dose to the majority of residents and staff in nursing homes is progressing. These are the residents of nursing homes who were unable to receive the vaccine initially due to the fact that there were major outbreaks of Covid in their nursing homes or due to the fact that they were recovering from Covid.

On 15 February, we began the process of vaccinating the approximately 482,000 people over the age of 70 in Ireland, beginning with those aged 85 and older. I am pleased to inform the Dáil that we have been able vaccinate the overwhelming majority of those aged 85 and older by the end of last week. I wish to reiterate my thanks to the GPs, their staff and representative bodies for their ongoing efforts, which have facilitated the expansion of our programme into the community.

There is a direct correlation between a person’s age and his or her risk of developing severe disease and potential death due to Covid. Some 88% of all deaths over the course of the pandemic have occurred in those aged 70 and older. The vast majority of GPs have been vaccinating their patients in the over-85 age group without any issue. The national vaccination programme is not adopting a one-size-fits-all approach. I wish to reiterate that no one will be left behind and that solutions will be found for all who wish to receive a vaccination. A variety of solutions are being put in place to vaccinate those aged 85 and older who have not already received their first dose. This week will see the programme begin the process of delivering vaccines to those who are housebound. Vaccination will also be provided to people who are currently hospitalised on an ongoing basis. Some 65 smaller GP practices, with a combined total of approximately 800 patients, will receive delivery of the vaccine this week. The vaccination programme continues to progress and those aged between 80 and 84 have now begun to receive vaccinations.

The majority of residents of long-term residential mental healthcare units over the age of 65 have now received a vaccination. Most of the eligible staff at these facilities have also received at least one dose. The process of administering second doses to service users and staff has already begun. The remaining sites will be covered as the roll-out progresses. I am pleased to inform the Dáil that Covid cases in residential mental healthcare settings are continuing to fall, with 30 cases reported this week. The majority of cases that are being reported in these settings relate to staff rather than residents. The pandemic has been a profoundly difficult period for so many in society. The continued operation of mental health services has been of paramount importance during this immensely unsettling time.

This will be the largest vaccination programme in the history of the State. Huge progress has been made in a relatively short period of time. The immediate priority of the programme is to protect the most vulnerable among us and our front-line healthcare workers, who have been front and centre in the fight against Covid. Truly remarkable progress has already been made with regards to protecting our older citizens. The vaccination programme is less than three months in operation and we are vaccinating people as quickly as possible. Vaccine supply remains the only limiting factor. I wish to thank all of those involved for their hard work which has brought us to this point, and which will, in time, result in the reopening of our country and the full resumption of our lives.

There is a real frustration out there with the roll-out of the vaccine. The Minister has accepted and acknowledged some of that frustration. That frustration is understandable. Nobody in this Chamber can say that the roll-out so far has been as efficient as we would have wanted it to be. It is falling short of people's reasonable expectations.

We have had real problems on the supply side and the head of the HSE said that it is the responsibility of the Department of Health and the Minister for Health to sort out problems on the supply side and to bolster supply. Time and again we have been left short by AstraZeneca and it simply is not good enough. We are not being given reasonable answers as to why that is happening on an ongoing basis and it is completely unacceptable. We had a target set for 1.7 million doses to arrive in the first quarter of this year. That target was reduced down to 1.4 million, then 1.25 million and now it has been reduced to 1.1 million. That is hundreds of thousands of doses of vaccines which have not arrived. If they had, people would have been vaccinated at the end of this month or at least have got their first shot but now they will not. Problems on the supply side have consequences for the roll-out of the vaccine and for citizens of this State.

We also have problems on the administration side, which is the direct responsibility of the HSE and which falls under the Minister's purview. We saw problems last week where some GPs did not get their vaccines on time and some did not get them at all. We have also had cases where some GPs have not got equipment and one surgery got a box of leaflets rather than a box of vaccines. We have had multiple examples in recent days of surgeries being left short in their supply, ranging from 15% to 50% of a shortfall, and having to call elderly patients and tell them that their vaccine is not there and they cannot be vaccinated. It is heartbreaking for the GPs and for the people who are expecting to be vaccinated.

I appeal to the Minister to do more to fix the problems, bolster supply and learn the lessons that should have been learned when we saw the problems that have materialised in recent weeks. People expect better and they want a more efficient roll-out. They want a safe, speedy and efficient roll-out of the vaccine and they simply do not see it happening. I appeal to the Minister to fix those problems that are under his control as quickly as he can.

I want to put a number of questions to the Minister. He said in his opening statement that the missing of targets is the responsibility of AstraZeneca and that it has left us short.

I ask the Minister to be as brief as he can on this and answer the question directly. How many times has AstraZeneca left us short? What is the total amount we expected from AstraZeneca and what did we get? He said that on numerous occasions, very often at the last minute, it has left us short. How many times? What reasons is it giving? We are being asked why this is happening time and again. What reasons has AstraZeneca given the Minister for the shortfall?

I thank the Deputy. I will get him a detailed note on the number of corrections or revisions from AstraZeneca. Last week over a seven-day period, it revised down its deliveries at the very last minute three times. The reasons are down to production. It is not my area of expertise but we are told that the production of these compounds is very complex and things can go wrong. However, I agree with the Deputy; what is happening with AstraZeneca is not good enough. Ultimately the people it is causing anxiety for, the only people who matter in any of this, are the public. Vulnerable people are waiting and it is not good enough.

As the Minister for Health, has he been in direct contact with AstraZeneca? Has he spoken to the company? What response did he receive? These are agreements reached through the European Commission with this company. People want to know if the Minister is being hands-on. Has he spoken directly to the company? Has he spoken directly to the European Commission to express the frustration of people that this simply is not good enough?

I thank the Deputy. I am in regular contact with other EU ministers. There are meetings of EU ministers on a regular basis and exactly these issues are being aired by me and by others. The negotiation over supply sits with the Commission. The contracting relationship is with the Commission. On top of that I can assure the Deputy that the task force which has taken on this relationship is in very regular contact not just with AstraZeneca but also with the others.

Before the Deputy comes back, may I make one brief point?

With respect, I asked if the Minister for Health has contacted AstraZeneca directly. He has acknowledged that there is frustration. He has acknowledged the missed targets. In his view it is the responsibility of AstraZeneca. I accept that the agreement is through the European Commission, but the Minister for Health has responsibility for the supply side. I am asking him a straight question. Has he directly contacted AstraZeneca at a senior level to express the frustration of people in this State who are being left short time and again by that company?

I thank the Deputy. I have not because the contracting relationship in the first instance is with the Commission and in Ireland, the task force is taking the lead on that. AstraZeneca has appointed a more senior person in recent times as the relationship manager with Ireland.

May I just make one quick point? I know it is the Deputy's time so I will make it very quickly. Regarding the efficiency of the roll-out, in defence of the HSE it is getting 95% of the vaccines that arrive here out within seven days. By any reasonable measure, that is efficient work by it.

I ask the Minister about family carers. He knows I feel very strongly about this. I have met hundreds of them and will meet hundreds more today because they are really concerned that they are being left behind. They are really concerned that they are not being valued and respected. They have said time and again they are not looking to take vaccines from anybody else. They are supporting and looking after very vulnerable children with complex needs in many instances. In the past the Minister has said that he has engaged with the national immunisation advisory committee, NIAC, and is awaiting a response from it. What has that response been? How close are we to getting a resolution to this issue? It needs to be done. I appeal to the Minister to sort this issue out once and for all. I ask him to explain to carers who will be listening if there has been any movement in their just demand to be treated as a distinct cohort given the work they do.

I thank the Deputy. I can confirm that considerable work is going on. It is being run from the Department of Health in connection obviously with NPHET and NIAC. It is looking broadly at the rest of the population. We all know that NIAC initially established a very detailed prioritisation. Now that we know more about the vaccines and their distribution, work is going on to establish what happens after cohort 4. I am very sympathetic to the points that have been raised by the carers. I am acutely aware of the value of what they provide. When Professor Butler, who chairs NIAC, was asked exactly this, the question she asked back was, given that we have a finite supply of vaccines for any group, be it family carers, teachers, gardaí or any other group, if a person is at lower risk of contracting the virus and we vaccinate them first, are we moving somebody who is at higher risk lower down the list? All of that needs to be considered.

I am particularly concerned about one group of carers, namely, carers for children. They are falling between two stools because-----

I have given the Minister a good run to respond.

-----neither they nor the people they are caring for are currently being prioritised.

In fairness, we have a very short time, as the Minister knows.

Are family carers being considered for cohort 6? I ask the Minister to give a "Yes" or "No" answer to that.

It is not really a "Yes" or "No" because right now, what we have are cohorts 1 to 4.

A colleague of the Minister's, a Fianna Fáil Deputy, responded to a family carer saying that she had a meeting with him and he had informed her, subject to a recommendation coming from the NIAC, that family carers would be in category 6 and that carers should not be as concerned as that particular carer was because there would be movement. Either that is right or it is wrong. We need to be honest with carers about what is being considered.

I also have a question about pharmacists. They are very frustrated about their role. They are very frustrated that they are not part of this roll-out and they are not getting answers to questions they are asking. Those on the front line in pharmacies, those who work in the shops, have not yet been vaccinated. Pharmacists have been, but those who work on the front line have not been. They have not been given any answers on their role. Is that Fianna Fáil Deputy correct that the Minister had said to her that family carers would be considered for category 6?

I thank the Deputy. There are two pieces of good news for pharmacists. One is that the pharmacists themselves are being vaccinated as front-line healthcare staff. The second is that as we move past cohort 4 and start vaccinating, for example, people aged from 65 to 69, the current thinking is that pharmacists will be able to be involved there because it is a lower-complexity and lower-risk group of people.

Regarding category 6, a Fianna Fáil Deputy-----

I saw the claim being made. It does not reflect what was said.

That is unacceptable. I asked about-----

I have been very lenient with the Deputy. We have gone over the time. I move on to Deputy Kelly.

Hopefully, the Johnson & Johnson vaccine will be approved today. Is the Minister aware of any of the other EU countries doing deals with the four companies that are producing vaccines? Are any EU countries doing deals? I am not talking about Germany and Denmark, which have bought surplus vaccines that were not being used by other countries. Is the Minister or anyone else in government aware of our colleagues in European countries doing deals with the four companies already approved or due to be approved by the end of today for producing vaccines, separate from the EU agreement?

I thank the Deputy. Various stories are circulating. One which I believe is real is that Denmark and some other country are looking at a strategic partnership with Israel. However, when we look into them, what we find is that these relate to quarter 4 of this year or possibly into next year. What is important to us is vaccine in the short term. We are not aware of European countries working with pharmaceutical companies to secure additional vaccine beyond the EU process in the short term.

Following on from what the previous speaker said, I appreciate that there is a group at European level that is working on the relationship and contracts with these companies. How many times has the Minister or anyone else in government spoken to AstraZeneca, Moderna, Pfizer, or Johnson & Johnson?

I will ask the task force to produce a note. The task force is our lead group on this on behalf of the Government.

It is in regular contact with all of the pharma companies. I will ask that a note be sent to the Deputy on the level of contact.

For the record, the Government has been in touch with all four companies.

The task force, on behalf of the Government, is in regular contact with those companies.

Who are the members of that task force?

The task force is chaired by Professor Brian MacCraith and the full membership is available online.

How many times has the Government and the task force, individually, met or spoken to all four companies? This is critical information, of which, respectfully, I think the Minister should be aware.

I have two more questions, which I will ask together. Last week, I asked the Minister if he would consider doing the following for one week. This is about transparency. Transparency is the Minister's friend. Can we get, on a weekly basis, in tabular form and in respect of each of the four companies, the projected or expected contractual delivery to our country; the actual contracted delivery; the number of doses delivered; and the number administered? That would of benefit to the Minister because it would provide transparency. I do not understand why the Minister will not do this. There is a great deal of innuendo and commentary, ifs and buts and, dare I say it, at times, unfortunately, and, probably accidentally, Ministers are making statements that are not accurate. Consequently, transparency would be the Minister's friend. Why will he not do as I have asked and set out the information across three columns in respect of the four companies?

My final question is in regard to the dates, which I have asked numerous times but I have never been fully satisfied with the answer. We know that Germany and Denmark bought up excess vaccines. The Taoiseach told me yesterday that Ireland always tried to buy any vaccines available. I have asked that question of others and the response was the same. On what dates did Ireland try to buy the excess vaccines that Denmark and Germany bought that were not being used in other countries?

With regard to transparency of supply, we are largely in agreement. The Deputy suggested I provide information in relation to three areas, namely, forecast, delivery and administration. In regard to the administration, we can all accept there is daily information released in that regard. It is available on the tracker App and online. There is full transparency in terms of what is administered. In regard to delivery, I listened carefully to Deputy Kelly and others last week and I have instructed the Department to publish the deliveries on a weekly basis. That happened, first, while we were in the Chamber last week and it happened again yesterday. I have asked that it happen on a weekly basis so that, too, is happening. With regard to the forecasts, it is not as simple. We are all acutely aware of the anxiety that is being caused by these movements in supply forecasts. Deputy Cullinane referenced it earlier. These forecasts are changing, sometimes several times a week, and this is causing huge anxiety for people throughout the country.

We have gone way over time and must move on.

Will the Minister answer my other questions?

The next slot is being shared by Deputies Haughey, Eoghan Murphy and Durkan.

It is fair to say that Irish people are very anxious at this time. Tolerance levels are low. Since the pandemic was declared and the first death in Ireland was declared this day last year, like many other Deputies, I have received many queries in regard to Covid-19, most of which related to financial supports for individuals and businesses but also in regard to the reopening of schools and childcare and, in particular, the leaving certificate examination. It is clear there is huge interest in the vaccines issue among the public. Clear communication on the matter is important. The tendency to catastrophise even minor problems is not helpful at this time. It is a hugely logistical operation to put in place the infrastructure to vaccinate our citizens. In addition, sometimes certainty and clarity are not possible given the unpredictability of the virus, among other things.

There is an obvious issue concerning the supply of vaccines, as we have discussed this morning. I firmly believe that Ireland was right to go the EU route even though some are now questioning this approach. It was not an option for Ireland as a small country to go it alone in a dog-eat-dog global vaccine market, where we would end up accepting lower standards, paying more and with delivery being even more unreliable. That said, many want to know the position on doing bilateral deals. Is this an option? How credible are assertions that one or two EU states are doing better by going outside of the EU? Can Ireland do separate deals with Russia, the UK, China or the US or go directly to the pharmaceutical companies to get additional supplies? I have my doubts on that.

I want to ask about the vaccine bonus. What has been happening in regard to nursing homes is cruel, where residents have not received face-to-face visitors for many months. I hope that NPHET will make a positive decision in that regard. A comment from the Minister in that regard would be useful. On logistical problems, there have been issues in my constituency in terms of vaccines not arriving on time and appointments for elderly people being cancelled. I appreciate that a decision has been made that the National Ambulance Service will deliver the vaccine to those confined to the home. Is Dublin Fire Brigade involved in the administration of vaccines in the Dublin area?

On cohort 4, vulnerable people, will they be contacted by their GP or will the vaccine be administered to them in a hospital setting?

I remind Deputies there is a three-minute time limit.

With the permission of the Leas-Cheann Comhairle, I will use my three minutes for a questions-and-answers session with the Minister, as was the practice last week.

I know the Minister is frustrated about the delay in the vaccine roll-out and he is being unfairly criticised for some of that delay. I know, too, that he and other colleagues in the Government have been engaging with companies and other countries about other avenues to secure additional vaccine supply and that this has been happening since last week. That proactivity is welcome. It is prudent though to hedge against further delays. The Russian vaccine, Sputnik V, if submitted for approval is likely to be approved by the European Medicines Agency, EMA. The Germany authorities have spoken tacitly in favour of it, studies in medical journals show it is very effective and some EU countries are already using it. In advance of a potential or likely approval by the EMA of Sputnik V, are we do anything ourselves or with the EU in terms of putting in place advanced manufacturing agreements or advanced procurement agreements, as we did with regard to other vaccines? If not, is this something the Minister would suggest be done?

I would like to bring to the attention of the Minister that Senator Buttimer and I have proposed that the European Ombudsman appear before the new ombudsman and petitions committee to answer in regard to her work and investigation into how the EU has handled the Covid pandemic and vaccine roll-out to date.

How much time do I have?

The Minister has one minute.

I thank Deputy Eoghan Murphy for his questions. As he will be aware, the European Medicines Agency is looking at Sputnik V and is conducting a rolling review. What is normal practice then is that the advance purchase agreements, APAs, can be put in place. For example, we have seven APAs in place, three for authorised vaccines, one for a vaccine we hope will be authorised today and three for vaccines that have not yet been authorised. The same process can be put in place for Sputnik V. I would draw the Deputy's attention to the comment from the European correspondent of The Irish Times yesterday, in which she noted that the Italian factory announced for the production site for Russia's Sputnik V vaccine for overseas orders is a small business that has never made vaccines and is not authorised by the Italian Medicines Agency. We need to be convinced, via the European Medicines Agency and our own regulatory authorities, that if we do enter into these APAs, all vaccines meet the same very high safety and efficacy standards.

Would the Minister propose that we do that work? Obviously, we would not use a vaccine unless it had been approved by the EMA. I agree with the Minister's point in that regard, which he made well last week, but we might make that proposal.

The Minister may have time to respond to that point later.

I commend the Irish people on the progress that has been made in this crisis. The number of cases since the peak is down 90%. The hospitalisation numbers are down more than 75% and ICU admissions are down more than 50%. That is the result of people up and down the country observing the obligations that arise during this crisis. Despite the frustration with the stop-go progress on vaccines, as of five days ago, 523,000 vaccines has been given. That number is probably at 600,000 now. This is an increase of 20% in a week in the number of people who have been vaccinated. By the middle of next week, all of the over-80s will be vaccinated. That will take out 63% of the risk of fatalities from the virus. It is a very significant group to have been vaccinated. As we move to the group with high-risk conditions, we will take even more of the risk out, particularly the risk of people being admitted to ICU.

I have two questions for the Minister. First, should we not now be considering extending the gap between doses of the vaccine? We could increase the number reached by 40% if we had a longer delay between doses. From what we hear, 80% of the impact is delivered through the first jab, with the second jab adding only another 10% to 15% in terms of effectiveness. We would be better moving more quickly down through the priority groups in terms of impact on the risk of the virus.

Second, I would like to ask the Minister how this dramatic de-risking of the virus will change the trigger points that will be determined for decisions on reopening the economy. Clearly, the risk associated with, say, 300 cases per day is very different if 80% of the risk has been removed. I can understand concerns about anticipatory behaviour, but we need to level with people if we are to sustain their support.

I thank the Deputy for his acknowledgment of the huge work that is being done, not by any of us here but by the Irish people in sticking with a very hard regimen of measures. It is working. Even with this awful B117 variant and its significant contagion, we are still, week by week, steadily reducing the number of cases. I believe we are now about the fourth lowest in Europe. We just need to keep going.

The Deputy's point on the interval between doses is an excellent question and one that NIAC has been looking at and will continue to look at. Some concerns have been raised in terms of a fall-off in effectiveness or levels of protection if the interval is too long. That is something NIAC is paying attention to and if it makes any recommendations to us, whether on the mRNA vaccines or in regard to AstraZeneca, that is something we certainly will look at.

Will the Minister provide a written answer to my second question?

I am afraid the time is up. There might be a spare minute later to allow the Minister to come back on Deputy Bruton's question.

It is reported that 10,000 people have been trained to administer vaccines, yet the Government's target, at peak, is to vaccinate 250,000 people per week. This means that in an average working week for those 10,000 trained vaccinators, each of them will vaccinate only five people per day, according to those figures. Why is the target so low? There are 800 vaccination booths across 37 vaccination clinics and each of those booths has a capacity to vaccinate 100 people per day, on the basis of a 12-hour day, five days a week. That gives capacity of 400,000, not including GPs, pharmacists and other people who might administer vaccines. Why then is the Government's projected figure for maximum vaccinations per week set at 250,000? The figures do not add up and I cannot make sense of why the Government is taking this approach.

I represent Cork North-Central. There are three vaccination centres in Cork city, two on the south side and one in the city centre, but none on the north side. From the north side to Glanmire to Togher to Blarney, there is nothing. This will result in some people having to travel up to an hour to get vaccinated. If there are so many people trained in giving vaccines, why did the Minister not look at having mobile vaccination booths that would be accessible to people at churches, community centres and GAA clubs? How were the vaccination plans developed? If the EU vaccines deal meant that the most we could expect to vaccinate in a week is 250,000 people and the Government knew our capacity was closer to 400,000, if not 500,000, per week, why did it not look at sourcing more vaccines? If we have the capacity, why are we not using it?

People are fed up. They have put their faith in the vaccinations and they see them as the light at the end of the tunnel. They are now angry because they see delays and crises. People want to return to their normal lives. At this moment in time, is the Government being truthful with them about when that will happen? I hope the Minister can give me answers in the time remaining.

I thank the Deputy. I believe the number of trained vaccinators is at approximately 9,700 right now. The question is which comes first. Do we train up our vaccinators and then ask for as much vaccine as can be produced? That would be a fantastic position to be in and we would train a lot more vaccinators in that scenario. However, what comes first is the supply of vaccine. As we are all aware, the limiting factor is the supply. Based on the forecast we have for what the pharmaceutical companies have agreed to deliver here, we have trained up a workforce and we are continuing to expand that workforce to be able to do significantly in excess of what we are expecting.

The Government plan said there would be 1 million vaccines given per month over three months, which is 250,000 per week. Why do we have capacity for 500,000 when the very best-case scenario, which we will not even reach, is that 250,000 does can be given? It just does not add up.

There is no time remaining for the Minister to respond. As a general point, if Deputies want the Minister to reply, I ask that they leave time for him to do so. Otherwise, their contributions are statements.

Sometimes I question the value of these sessions because we do not get any new information. We frequently ask for information and the Minister promises to send us notes, but the notes do not arrive. For example, last week, I asked about the Moderna vaccine and the fact that, at that point, less than a quarter of Moderna deliveries to this country had been administered. I never got an answer on that. I appeal to the Minister to be much more forthcoming in giving information and data generally. All of this should be open-source information. There is no reason that the Minister should be hiding any of it. It is in everybody's interest that he is absolutely clear about the numbers that have been delivered here and the numbers that have been administered. It is only through that kind of levelling with people that they will have confidence in the programme.

It took the Minister a very long time to commit to publishing the daily figures for vaccines administered. It took a long time to get him to tell us how many are arriving here on a weekly basis. That information is coming now by way of press statement but it needs to go up on the data hub. I ask the Minister just to be clear and open about this. There has been a mishandling of the information coming out in regard to the different cohorts. Three weeks ago, the Minister announced that over-70s would be vaccinated. Three weeks later, the administration of vaccines to the over-85s is only just finishing. There is a whole cohort of people who expected to have got their vaccination by now. By not providing clear information and schedules, the Minister is raising people's expectations.

I want him to try to be clearer about the scheduling of vaccines for the two cohorts in respect of which he has given a commitment, namely, cohorts 3 and 4. Cohort 3 is people aged between 70 and 85 and there are 407,500 of them. Can the Minister set out a schedule for when the different subgroups within that age cohort will be vaccinated, showing, as of now, what the expectation is in this regard? The other very important cohort is cohort 4, which comprises the 160,000 people with underlying conditions that carry a very high risk in regard to Covid infection. We were told that 10,000 of them will be vaccinated in the first week. When are the other 150,000 going to be done? Again, we need a schedule for that. The over-70s and those with serious conditions are waiting very anxiously to find out when they will be vaccinated.

The generic messaging from the Minister is only raising people's expectations. He needs to be clearer on when people are likely to be vaccinated.

I wish to ask the Minister about what we have seen between the first and second doses in the past ten days. The ratio is 9:1 and that is a change. Is that a change in policy or is it a result of timing?

The Minister promised mass vaccination in the second quarter. That means increasing from the current average of 12,000 a day, although it has to be said that for the last day reported, which was 7 March, the figure was only 2,699, which is abysmally low. The average is 12,000 a day now. The programme will have to ramp up to between 35,000 and 40,000 per day. We have not yet seen the plan for that for the second quarter. Will the Minister commit to publishing that plan?

My thanks to Deputy Shortall. There are more questions there than I will be able to answer in 50 seconds, so let me try to move quickly. The Deputy should have received an answer on Moderna. I have intervened previously to ensure she got answers and I will chase that up. That should not happen. If I give a commitment to any Deputy that he or she will get an answer from me, that should happen.

Deputy Shortall's critique on data is unfair, to be honest. There are daily figures up on the app. Only last week, the Deputy and others asked for the supply data. We put the data up the same day and put them up again yesterday. The Deputy is saying it took too long but we will simply have to agree to disagree on that.

The Deputy asked about the first dose versus the second dose and the ratio changing. I presume that is because of adding AstraZeneca, and the longer time between the mRNA vaccines and AstraZeneca will change that because of the longer period. In fairness, the Deputy asked last week for a plan on how we will scale up in the second quarter. The Deputy should have received the answer and I will chase that up as well.

As we are one year into the pandemic, I take the opportunity to compliment all our front-line workers and all workers providing different services for us through challenging times. I highlight again the particular role of our healthcare workers. They have spent a difficult year dealing with a deadly virus. We all know they have been working in highly challenging circumstances, oftentimes with a reduced staff complement because of colleagues being out sick, etc. They continue to do a marvellous job in what are still difficult circumstances.

The Government and the National Public Health Emergency Team made the right decision to prioritise front-line healthcare workers for vaccination in the first cohort along with long-term residents of nursing homes. That was the right decision. The over-85s were prioritised after that. Unfortunately, some practices have not yet received their vaccines for those aged over 85. I appeal to the Minister to insist to the HSE that these practices get the vaccines this week. I believe it is only a small number. I have heard from constituents who are concerned that they have not yet been called for the vaccine because the GP practice has not yet received it.

I represent Cavan and Monaghan. Many of our neighbours in Fermanagh, Armagh and Tyrone have, thankfully, got the vaccine. We know those responsible are providing the vaccine in Northern Ireland to a far younger age cohort while we have older people who have not yet got their vaccines. Their neighbours, cousins and relations are getting vaccines north of the Border, and the best of luck to them. I appeal to the Minister to ensure that, where this exists, the particular difficulties are ironed out. We can all make cases for different categories of people, including people with underlying health conditions and those working in different areas.

I am amazed that members of An Garda Síochána have not been given a higher prioritisation in the roll-out of the vaccination programme. Along with other front-line workers, members of the force have done exceptionally good work over the past 12 months in dealing with this pandemic. I appeal to the Minister and whomever makes the recommendation to review the placing of An Garda Síochána in the particular category.

Until now, there has been a problem internally in the HSE communicating with GPs. I know from speaking with GPs that there was utter frustration at times with making calls and calls not being returned. Those who called never got to speak to the same person a second time. When there is a dedicated helpline, there should be identified officials to deal with particular counties. If a general practitioner from Cavan rings, that GP should be able to talk to a small team of people rather than someone with whom he or she has not spoken previously or someone who claims to have no knowledge of the particular queries. GPs and other clinicians in practices have too much to do. They are under too much pressure to be wasting time making needless telephone calls because previous calls have not been returned. This should not arise in the first place. They should not have to speak to different people to outline the same query on numerous occasions. This has to be streamlined. Unfortunately, there is a tendency nowadays not to return calls. This applies is in some parts of the public service and the private sector as well. People bang off an email that says nothing. There is nothing like picking up the telephone and talking to the clinician who has concerns.

This morning, I spoke to a GP in a small practice who was starting to make calls to some patients to whom he had arranged to administer vaccines tomorrow. Unfortunately, he does not have enough vaccine to administer to all of them. That is a source of great disappointment for those people. I appeal to the Minister to ensure that such administrative difficulties are resolved.

I fully acknowledge that the only way we are truly going to beat Covid-19 as a society and country is through the effective roll-out of the vaccine. Thankfully, we are already starting to see that the vaccine is highly effective in preventing the spread of this deadly disease among those already inoculated. As those most at risk of contracting Covid-19 and falling seriously ill from it are vaccinated, the risk and threat of the disease naturally starts to reduce. However, it is vital that complacency does not set in before the vaccine has been fully rolled out. For this reason, we must look at all options open to us to ensure that when the time comes we have the safest possible reopening of our country, society and economy. We must put checks in place to ensure that happens. It is only by doing this as safely and effectively as possible that we can save lives and, most important, prevent another wave and further economic restrictions that close businesses and cause job losses.

One option available to us is the widespread introduction of rapid antigen testing in areas of large population and in schools and workplaces. I know some firms are already doing this and have prevented the spread of clusters in their workplaces. The test takes between 15 and 30 minutes to produce a result, which is indicated on the testing strip. It tells people whether they are positive. The test is not 100% accurate and only delivers a positive result when a person is most infectious, which is for up to eight days in the infection cycle. It might produce some false negatives. However, it still finds positive results. Where the individual is asymptomatic, this is an obvious step that can help to identify more cases of Covid-19 in the community and prevent its spread. It is essential to use all methods at our disposal for a safe reopening.

Only by preventing the spread of Covid-19 in the community can we avoid another wave occurring. I suggest that leaving certificate students and teachers attending school daily be tested with antigen tests regularly. Nursing homes and day care centres could test too. I have made the point to the Minister of State at the Department of Health, Deputy Butler, that nursing home residents and users of day care centres have now received vaccination in the vast majority of cases. We could use antigen testing to help to restore normality or near normality to their lives. These people have had a torrid year. People using day care centres have been unable to avail of those services. Antigen testing is a weapon in our armoury that we can use for a safe reopening and to try to bring some normality back to people's lives.

I raised with the Minister of State, Deputy Butler, the issue of people who are housebound. In my constituency of Tipperary, I know of cases where people who are housebound have not yet received the vaccine.

Obviously, they have serious health conditions. The Minister of State is working on this matter, but these people should be prioritised so that they are vaccinated as quickly as possible.

I support Deputy Brendan Smith's comments about An Garda Síochána. Gardaí are disappointed by their place on the list for the vaccine roll-out. They are an essential cog in our battle against the virus. We saw the work they did during the protests of recent weeks. Will the Minister see whether gardaí can get a higher priority?

If the Minister does not mind, I will go off track for a second to discuss diabetes services at Mullingar regional hospital. He has been in touch about this matter. In recent days, Professor Michael O'Grady confirmed to parents that the hospital's plans to recruit a temporary nurse had failed to materialise and that, even if a temporary nurse was available, the only way the service could resume would be with appropriate permanent resources. The service cannot resume based on promises. All March appointments were cancelled in mid-February and cancellations for April appointments will issue next week. Will the Minister of State liaise with Professor O'Grady, who goes above and beyond for the 130 children and adolescents affected, and intervene to sort out this issue?

I compliment and thank all front-line workers. The day before yesterday, I received a letter from a GP in my area who wrote seeking my support in respect of a matter of great urgency. The GP in question has worked in County Meath for the past eight years and this was to be a momentous week for that individual's practice and patients in that, after weeks of planning, the practice was due to receive delivery of its first batch of Covid-19 vaccines for administration the following day to patients aged 85 years and over. Unfortunately, the practice did not receive its batch despite confirmation over the phone the day before and a practice at the opposite end of the car park receiving its batch. The GP is extremely disappointed, to say the least. The previous few days had been spent contacting patients and arranging appointments only to have to cancel everything that afternoon. The cohort of patients in question are the GP's most elderly and vulnerable. In the main, they have not left their homes for the past 12 months and were mostly reliant on family members to transport them to the clinic the next day, many of whom had made special arrangements to facilitate that. As is always the way with this group of patients, they were understanding and supportive and did not complain when they received news that afternoon of the cancellations. The GP says that this situation is not good enough, though. The GP would be the first to say that, in the past 12 months, the HSE had been largely supportive of general practice and worked excellently with the practice in question to try to get through the pandemic. Unfortunately, the lack of communication in recent weeks regarding the vaccination roll-out has disappointed the GP, culminating in significant frustration the morning the letter was written.

Will the Minister of State let me know what is happening with the paediatric clinic in Mullingar? I thank her for her engagement in the matter.

I thank the Deputy for his questions. I will try to respond to his question about the paediatric diabetes clinic in Mullingar regional hospital, a matter on which I recently answered a question from another Deputy from the area. Indeed, quite a few Deputies from the area have raised it with me. I acknowledge the work that Professor O'Grady has been doing. The post has been filled, but it will not be taken up for another few months. The Minister and I will work with the HSE to see whether we can expedite that.

Deputy Brendan Smith mentioned that some elderly people had not received vaccines. Three weeks ago, we started the roll-out to the over-70s, but there does not need to be any ambiguity about this. We have always stated clearly that the roll-out to the over-70s would commence with the over-85s. Some 99% of those have been vaccinated to date. There have been a couple of issues, but I am led to believe that the majority of those will be sorted by this week.

Vaccinations for those who are housebound are commencing today. The National Ambulance Service will be travelling the length and breadth of the country to look after them. There is a small cohort of people who cannot leave their homes in order to get vaccinated. Those vaccinations will start today in the greater Dublin area.

I am sharing time with Deputy Barry. I will take three minutes and he will take two.

Today marks one year since the WHO declared the coronavirus a global pandemic. Since then, 6,500 people on this island and 2.5 million across the world have lost their lives. The pandemic has caused devastation for many people on the planet, as well as economic turmoil. We have seen the best of humanity and solidarity. We have witnessed the wonders of science and research and development and a vaccine that will protect the whole of humanity.

The global crisis warrants a global response. A very important vote will take place today at the WTO requesting that intellectual property rights be waived to give poorer countries across the world access to vaccines. In light of the vast amounts of money - up to €8 billion - that have been given to pharmaceutical companies, they should show altruism. According to an Oxfam survey published yesterday, 62% of people in Ireland want the Government to ensure that pharmaceutical companies share Covid vaccine science and technology with other approved companies globally. Has the Government used its influence with the European Commission as regards today's vote on intellectual property rights? Has it requested pharmaceutical companies in Ireland, which have significant capacities, to increase production of the vaccine not only in Ireland, but across the world? No one is safe until everyone is safe. That is an important point to remember on the day that is in it.

I acknowledge the Deputy's ongoing advocacy on this issue. I share his desired end goal, that being, a global and just vaccination programme. It cannot be a vaccine for the West or wealthier countries. As the Deputy rightly stated, it has to be a vaccine for all of humanity. The only question is how to do that. As variants emerge or new diseases arrive and vaccines must be adjusted or created anew, how do we achieve a model that responds not just to the current strains of the coronavirus, but to future strains and diseases?

As I told the Deputy previously, I have a slight concern. Oxfam is looking for what the Deputy has advocated, but I am concerned that, were we to do this once, we could unintentionally undermine the companies' ability or willingness to do what we need them to do in future. However, I assure the Deputy that I share his goal for a global and just vaccination programme.

My first question is for the Minister of State. She just stated that 99% of over-85s had been vaccinated. Will she clarify? Is she using that figure as a general way of saying that most have been vaccinated or is she saying that it is actually 99%?

My next questions are for the Minister. Pfizer and Merck were contacted by the Government about producing vaccines in Ireland. The State offered to assist with the cost of reconfiguring plants in Cork and Carlow, but the companies said "No". Some questions arise. Did the Taoiseach intervene with the companies? Was the exchange by phone, email or both? Was the recent exchange the first such exchange or did the Government show foresight and arrange this conversation for last year? Apart from the carrot that we have been told about, was any stick used? There are a large number of drug companies in Ireland with significant premises and there is no shortage of labour that could be trained. I am for nationalisation and switching to production for society rather than for profit, but one does not need to be a socialist to use some stick on this issue. In the US, the Biden Administration has used the wartime Defense Production Act to compel companies to prioritise manufacturing for national security purposes. Was it just a carrot used in the Irish exchange or was there any stick?

The figure of 99% is arrived at as follows. The estimate is that there are in excess of 72,000 people over the age of 85 years. They were being vaccinated in several different ways. One was through nursing homes and other long-term residential care facilities, an area that has largely been covered. The second way was through the roll-out in the community.

A small number of those aged 85 or older had not been vaccinated as of last Sunday, which was the end of the three-week period. The information the Minister of State and I have is that number is a few hundred. Based on that calculation, the HSE vaccinated in excess of 99% in the three-week period.

I welcome the announcement this morning by the HSE that it has acquired a hotel in Blarney to convert into a 60-bed community nursing home. This is a very welcome decision and I very much support it.

On the issue of the Johnson & Johnson vaccine, I refer to the commitment given at the health committee several weeks ago that more than 400,000 doses of the vaccine would be made available by mid-April. Can the Minister clarify in writing how many doses of the Johnson & Johnson vaccine will be made available in the next three months? When are they likely to be delivered once the vaccine is approved today by the EMA?

Many medical procedures in hospitals have been cancelled in recent months. What percentage of procedures have been resumed? Are we at 60%, 70% or 80%? What are the targets over the next three months? This is very important information for people who are awaiting medical procedures.

I thank the Deputy for his questions. With regard to the Johnson & Johnson vaccine for which authorisation is being sought today, I can confirm that we have advance purchased 2.19 million doses. Its great advantage is that it is a single-dose vaccine and so that amount on its own would vaccinate almost half the population. There is very strong procurement in place. However, the Deputy asked the second relevant question, that is, when the vaccine will be delivered. On the basis of how unreliable one of the pharmaceutical companies has been, I want to wait and see in that regard. Obviously, we have month-by-month agreements in place. I think we need to make sure these agreements come in on target before we get into too much detail.

Deputy MacSharry will not be here to take his time, so he asked my colleagues and I to share it among us. I have four brief questions for the Minister and the Minister of State.

On the issue of those in at-risk groups who it is hoped will be vaccinated in the coming weeks and months, if there a requirement for them to be vaccinated at home or in a safe environment, will provision made in that regard rather than these people having to travel to a vaccination centre or a local GP?

Deputy Cahill raised the issue of the review being conducted by Professor Ferguson in respect of rapid antigen testing. What is the status of the report in that regard? When we are likely to see a review of the decision in respect of rapid antigen testing?

I understand the national immunisation advisory committee, NIAC, is keeping the priority list for vaccination under constant review. Has there been any movement in respect of carers in the context of the list? When are we likely to hear about any such movement?

On the issue of prison officers, other Deputies made the case for prioritisation of members of An Garda Síochána. Could prison officers, who are obviously in close proximity to people every day, also be considered for prioritisation if there is a review?

I welcome the Minister and the Minister of State and thank them for their time and for taking questions this morning. The general indicators seem to be going well. The Minister and Minister of State outlined some of the indicators in terms of vaccinations. I note that the numbers in respect of one of the cohorts, that of front-line hospital staff, have gone from 16% to 4%, which is extremely welcome. Case numbers and hospitalisations are going in the right direction, which highlights that vaccination and restrictions are working.

I welcome the fact that NPHET is expected to announce its recommendations on nursing homes later today. It is commendable that 72,000 of those over 85 have already been vaccinated. I think the Minister of State highlighted a figure of 99% in that regard.

I ask the Minister of State to outline the process for those who are housebound. She may have stated that the National Ambulance Service is carrying out that work. I ask her to outline the position in that regard a little further.

I share the Minister's frustration regarding the supply of vaccines. I am sure that many of his European counterparts share that same concern, as do members of the public. All Deputies are being contacted by people who are frustrated by the lack of supply and the figures that are presented but then have to be scaled down simply because of issues relating to manufacturing supply. I note that vaccinations of a cohort comprising those who are high risk and aged between 16 and 69 will begin this week. How many people fall into that category?

When are certain categories of workers going to know into which cohort they actually fall? As previous speakers stated, such workers include members of An Garda Síochána, special needs assistants and public-facing workers such as those who work in GP surgeries, pharmacies or shops, for example. Carers have also been mentioned. The Minister and I have spoken about this issue previously.

On the issue of mass vaccination centres, can NIAC examine the usage of sub-centres such as parish centres or community halls as has been done in Israel and the United Arab Emirates? Using such premises has been very effective in those countries and has brought the vaccination programme right into the heart of communities. GPs and pharmacists would play a key role in that regard.

Finally, I have received reports in respect of essential retailers that are bringing in non-essential items to sell in their shops. I refer to Dunnes Stores in particular and its shop in Cornelscourt in my constituency. There have been reports regarding retailers in counties Clare and Limerick. Non-essential retailers find this extremely disturbing because they just cannot compete. There does not seem to be any problem for the retailers that continue to engage in such practices. It does have an impact. If people are not all in this together, as the phrase goes, then it is not fair. I ask the Minister to please follow up on that issue.

I thank the Deputy for his question. As I identified earlier, to date, 99% of those aged over 85 who wanted the vaccine have received it. I compliment our older generation, who have been so stoic in the past 12 months. They have done everything that has been asked of them and they have been front and centre when taking on board the vaccine.

On the issue of the small number of people who are housebound, the HSE was in contact with every GP practice and got a list. I met representatives from the HSE yesterday afternoon and was informed that the National Ambulance Service will deliver the vaccine to persons throughout the country who are housebound. That roll-out is starting today in the greater Dublin area.

I thank the Minister of State. I understand the Minister will have to absent himself briefly from the Chamber. I will give him a few minutes to respond to the questions that have been asked.

I will try to respond to the questions in 30 seconds. The fourth cohort will be done both in hospitals and GP clinics. If certain people cannot make either of those trips and are essentially housebound, arrangements will be made accordingly.

The report in respect of rapid testing is currently being finalised. NIAC prioritisation is ongoing. It is considering all of the groups that have been referenced here today, as well as many others.

The use of community halls can be considered. It was deemed not to be the way to go in the context of the initial roll-out, which involved more complex cases and more vulnerable people, but that is a decision that we should keep under review.

I thank Deputy Devlin for raising the issue relating to non-essential retail. There must be enforcement for the very reasons he laid out.

Before I put a question to the Minister, I wish to take the opportunity to recognise the great work and sacrifices made by all front-line workers. As one who has recovered from the Covid virus, I can fully appreciate how difficult it is for those who are suffering from it. I offer condolences to the families of those who have died as a consequence of this pandemic.

My concern is with the sequencing and pace of the vaccination roll-out and how those who are to be vaccinated are prioritised. One group of healthcare workers who deal with some of the most vulnerable in our community are agency workers employed as carers. The use of agency workers is problematic, in that they move between many vulnerable people and their families within the community. There is real potential for such individuals to be carriers of the virus because, as all Deputies know, one can be a carrier of the virus without knowing one has it.

Has the Department of Health a comprehensive list of such agencies? Has it engaged with those agencies to put in place a vaccination schedule for their employees? Will the Minister of State clarify the timeline for when those staff members will be vaccinated? Into which cohort do those people fall?

Will the Deputy have more questions?

The Deputy asked about sequencing and prioritisation. When the national immunisation advisory committee, NIAC, initially looked at the list, the decision was taken to vaccinate the most vulnerable and those most at risk of a bad outcome from Covid, including death. I will ask the HSE to come back on the Deputy's question about agency workers and to state whether it has a comprehensive list of the sequence of vaccination for the different agencies. My understanding is that any paid healthcare worker on the ground has received the vaccine or can apply to receive it through the portal. The majority of front-line healthcare workers have received at least one vaccine to date.

I specifically asked about agency workers and the Minister of State did not give me an answer. Those workers are carers and, as far as I am concerned, are at the front line.

As the vaccination programme progresses, does the Minister of State anticipate that families will be able to visit their loved ones in nursing homes, contingent on all parties concerned being vaccinated? This matter has been raised several times and I know that the National Public Health Emergency Team, NPHET, will make a decision on the issue. It is extremely important. My mother is in a nursing home and not being able to visit her has been an absolute calamity. Many people have not seen their mothers or fathers for months on end. We need clarity on that matter.

Other vaccines are available in China, Russia and Brazil. Is there an ideological problem in dealing with this issue? The European Medicines Agency, EMA, can approve vaccines in the West but when it comes to other areas of the world, it seems to be very slow in clearing vaccines for use. Will the Minister of State answer that question?

I will answer the Deputy's question about nursing homes. The Deputy is right that the past 12 months have been very difficult for anyone with a family member in a nursing home. As we know, the pandemic has borne down hard on the nursing home sector. Christmas week was the most recent time that anybody was able to visit a loved one in a nursing home, other than on compassionate or critical grounds. The preceding opportunity to visit was a couple of months earlier. I accept and acknowledge that it has been difficult. The HSE will report to NPHET today on a loosening of restrictions. I urge caution because, as of yesterday, we still have 104 nursing homes out of 580 with an outbreak. Admittedly, the scale of the outbreaks is smaller and many of the nursing homes are coming out of significant outbreaks that occurred over the past few months. We will have to urge caution but the Minister and I would love to see movement on this issue.

I call Deputy Canney. Is he looking for responses or just making a statement?

I will be looking for some responses, if I can get them.

I thank the Minister and the Minister of State for being here. Good work has been done by everybody in Ireland over the past year to make sure that we try to master the virus and take back charge of our lives. Vaccination has been the one great hope and will sort out our problems. I hope we will get back to some sort of normality in the coming months. I must, however, raise some concerns about the roll-out of the vaccination programme. I have said repeatedly that the public needs to see more information about the projected supplies that will come into the country. We seem to be getting a daily report of what has been done but large cohorts of people are looking for timelines for their vaccination and whether it will happen in March, April, May, June, July, August or September. We do not have that. We have a plan but not a programme to show the supply chain for the vaccination coming into this country on a weekly basis and to indicate the quantity we will get. Front-line workers, nurses working in the Irish Blood Transfusion Service, have asked me when they will be vaccinated. People are wondering when their children, who are in their 20s and 30s and suffering from cystic fibrosis, will be vaccinated. Can the Government produce a programme, rather than a plan? The programme would show indicatively the supply and how it will be sent out.

In my home town of Tuam, a GP did not get a supply of vaccine. The communication with the HSE was very poor. The staff in the GP's practice had to talk to the families of older patients on the morning of their appointments and explain why the patients could not come in. The practice gratefully received the Moderna vaccine this week and the doctor said it was the first time people had laughed on the way in and out of the surgery because they had got something they had been waiting for. There is a huge problem with communication between the HSE and GPs. We cannot rely on emails. How can a GP practice plan when it gets two conflicting emails in one hour as to what type of vaccine it will get? How can it manage that? GPs do not know when they will get a second batch of vaccine and cannot plan around it. That is not fair to the people who are waiting and wanting to know what is going to happen.

Parents of children with special needs have been on to me and want to know when vaccines will be available. They do not want to know that they are in level A, B, C, D, E or F. They want to know, within reason, when they are going to get their vaccination. They want to get some sort of communication and speak to people who know when it is going to happen. We do not know all the answers but one thing that is coming back to me clearly from people in my constituency is that the communication is very poor. We cannot rely on a daily report stating how many people have been vaccinated because it does nothing to help or reassure the people who are not vaccinated. How can we set up better communication? How is the Minister going to deal with the staff in the blood transfusion service? When might they be vaccinated?

I thank the Deputy for the questions. The Deputy's question about projected supply and whether we can publish the amount expected to come in, week by week, is reasonable. The problem is that the amount expected to come in, week by week, is being changed, largely by AstraZeneca, and sometimes several times a week. That is causing untold anxiety in the community. It is eclipsing the good news that we are rolling out astonishingly effective vaccines to the most vulnerable groups of people and healthcare workers and that process is going well. The Deputy rightly referenced a GP clinic where the process has not worked perfectly and appointments had to be rescheduled for a week later. That should not happen but it did and similar problems affected approximately 65 of the 1,300 practices in the country. Those practices had much smaller groups of people to vaccinate. That should not have happened. The HSE has tried to learn from that and put in extra supports for GPs. What happened at the same time was that in the three-week period when the target was to vaccinate those aged 85 and older, 99% of that target group were vaccinated in that period. That is not a message that got out. The message that got out, understandably, was the number of examples in which the process did not work perfectly. We need it to work as perfectly as possible. The roll-out has not been flawless and lessons are being learned.

On the Deputy's suggestion that we state the amount of vaccines we will get, week by week, we know with absolute certainty that the amount will change regularly. We also know that is causing a lot of anxiety for people. We probably need to focus on the Deputy's related question about whether we can have indicative timelines, even the months when different groups of people will be vaccinated so that they know whether they will be vaccinated in April, May or June.

We will endeavour to do more on that to try to provide some certainty for people in order that, armed with that information, they can begin to plan and think about the rest of the year and the future.

I welcome the Government's announcement in recent days regarding its attempts to secure a supply of vaccinations. I made a rough calculation. The WHO says 315 million people on the planet have been vaccinated out of an available population of 5.2 billion. This means that 4.8 billion individuals have yet to be vaccinated. In the early phases of the pandemic, we saw a great deal of amateur virology and at times we have seen some amateur procurement as well. The idea that we can easily access vaccines somewhere on the planet when 4.8 billion people are yet to be vaccinated is difficult to comprehend. It should not mean that we do not try, but we should outline exactly how difficult that is going to be.

I am always reluctant to give advice on NIAC's prioritisation unless I see a gap. The gap I see is that relating to people who are aged over 65 and who are being admitted to hospital. Hospitals are high-risk environments for Covid, but people are not being vaccinated. It would be worth looking at that matter because I know of a number of cases where people have contracted Covid after being admitted to hospital. It might seem some time off, but has NIAC given any thought to the idea of prioritising those areas that are hotspots geographically for the final cohort of the vaccination roll-out? Unfortunately, my electoral district, the Ballymun-Finglas ward, has one of the highest rates of Covid in the country. To my mind it would make sense to start in those hotspots.

Carers are very much on the front line, working up close and personal with people. Many of the people they are caring for will be getting the vaccine, but to set the minds of carers at ease, could the Minister outline the plans to ensure that they will be vaccinated quickly? Carers need to get a clear indication in that regard. I know steps have been taken, but could he indicate the plans for advancing their vaccination to set the minds of carers at ease?

Pharmacists are a cohort of people who could be involved in the roll-out of the vaccine. GPs are fairly busy administering the vaccine already, but if pharmacists were engaged, they could back them up and almost double the number of vaccinators. Could the Minister outline how quickly pharmacists will be engaged in getting vaccines rolled out? They would genuinely add so much to the pace. The pace of the roll-out is a significant issue for many, especially vulnerable people. The reprioritisation was a very positive move for cohorts 4, 5 and 7, which are people with various conditions. I imagine it is not going to be that straightforward to identify a large number of them but many vulnerable people already have a relationship with pharmacists, hospitals and so on. Could the Minister outline how people will be identified? Will they have to engage with pharmacists, consultants or hospitals? I know he will not have a quick answer on that so he might be able to send me a note on it in order that I can outline the information to people and set their minds at ease as to how those in vulnerable groups will be identified.

I thank the Minister for his time in facilitating questions. I am not having a go at the Department or the hard work undertaken by the HSE, I am trying to help. We simply need more information on the supply of vaccines, the logistics involved and where they are going. While older people and front-line staff continue to be vaccinated, I receive daily reports of situations causing public distress and concern. In addition, it is increasingly difficult to get official information and a meaningful response. Last Thursday, I was contacted about queues for up to three hours of front-line workers at Mayo University Hospital where more than 100 people were congregated. Last Friday, I was advised of an error regarding a vaccine delivery to a GP centre in Bangor that should have gone to Belmullet. This resulted in one practice receiving large quantities of vaccine and the other being left short. On Monday, I was contacted by a family who were really concerned about their 95-year-old mother who was just holding on and had yet to receive information about her vaccine. I understand that no one will be left behind, but one can understand the stress this is causing.

I have contacted various GP surgeries and the current barriers encountered by medical centres are mainly administrative, with duplication of paperwork, cumbersome ordering and ongoing uncertainty on the volume of vaccines GPs will receive. Local media reports yesterday indicated that some surgeries did not receive vaccines despite promises of delivery. Public representatives need more information about the vaccines coming on stream. I am fully conscious that the timeline will not be perfect, but GP surgeries and pharmacies need transparency on this.

Two thirds of intern doctors at Mayo University Hospital have been offered contracts in July. Where are the remaining five contracts? This matter must be addressed.

I will opt for a back-and-forth exchange with the Minister. Supply is the issue at the moment. If we had a supply of vaccines a lot of the issues that are arising would not arise. I want straightforward answers. We talk about what is happening outside the EU, but I want to talk about within the Union because that is the procurement process we signed up to. Is the issue with the European Commission and the manufacturers and suppliers of the vaccine or is it with how Ireland is dealing with the suppliers of the vaccine? Could the Minister answer "Yes" or "No"? I have another question for him.

It depends on what the Deputy means by the term "the issue". Certainly, Ireland has opted into its full pro rata amounts. We have opted in to the options on all of the top-ups and as a result of that we pre-ordered enough vaccine to vaccinate every man, woman and child in the country twice.

My question for the Minister is whether the issue is with us. If the issue at the moment is that we are not getting our pro rata share from the manufacturers of the vaccine a couple of things need to happen. The Minister must have a direct meeting with the suppliers of the vaccine. There must be a meeting with the European health ministers on the issue and there is also a need for a collective meeting of those Ministers with the suppliers and manufacturers of the vaccine. Could the Minister give those commitments? He put out a statement that he is looking at working with other countries to ensure the most efficient use of vaccines within the European Union. Will that happen?

To be absolutely clear: Ireland is getting its pro rata amount. That is why we consistently have had one of the fastest roll-outs in the EU. I assure the Deputy that there is ongoing work with member states-----

-----and with the Commission on the points the Deputy raised.

We will move on to the Rural Independent Group.

I will concentrate my efforts on the Garda. I will be making statements and I would appreciate it if the Minister would give me a written reply. I have asked a lot of fair questions about the vaccines and I have never got a reply. Shop assistants are asking me when they will be considered. They have been on the front line for quite some time. Many people on islands off west Cork are infirm and are not able to leave the island. Will a doctor travel to the islands to look after them?

I encourage the Minister to increase the number of people allowed at weddings and funerals in the upcoming announcement because people are trying to get married but not in an unsafe way.

I wish to speak on behalf of the 300 Garda members in the Cork west division and their families. What is their priority for vaccination? Since the beginning of the pandemic, gardaí in west Cork and throughout the country have stepped up to the plate when called upon. They have put up with changes to their working lives and conditions and changes to work patterns, and they have policed checkpoints and enforced all Covid restrictions they have been asked to enforce. That is despite being poorly equipped from the outset with PPE gear that could only be called second rate at best. In most cases they were among the last to receive Covid equipment as it came on stream.

Gardaí got on with the job while working in deplorable conditions, even taking Covid into account. We are all aware that the stations in which they work in west Cork are cramped and there is no hope of social distancing. Each day they provide the quality policing service needed in west Cork which, despite all the odds, they have managed to do through goodwill. They did so in the belief that by putting themselves and, indirectly, their families in harm's way their endeavours would have been acknowledged and their health and safety taken into account when the vaccine roll-out took place.

I am cutting into my colleague's time. I would appreciate if they were seriously considered for vaccination.

The clock started wrong.

I have the time in my head.

I have a question for the Acting Chairman. I have never received a written answer to my questions from the Minister for Health or his colleagues, despite having asked for them since last September. We ask for answers and do not get them. It is an abdication of his duty. We are elected by the people to ask questions.

I want to speak about An Garda Síochána. Members of the Garda are front-line workers who must deal with every situation and have done so gallantly. Community gardaí have stepped up to the plate. They are losing numbers and cars. We need a definite date for the vaccination of members of the Garda. Thomas Finnan, a Garda Representative Association, GRA, representative, and his colleagues in Tipperary contacted me. They do a sterling job and have to get a date for vaccination.

Other speakers have referred to front-line carers. They are in a very vulnerable situation and are looking after the most vulnerable people. We need a date for vaccination for them. We have not received reassurance from the statements and the feeble effort to roll out and procure vaccines. It is shocking.

I want to ask the Minister about the loss of ten intern doctors. There have been 19 in Clonmel since last July, the middle of the pandemic. This July, no new doctors will be appointed. They will all have to emigrate. We cannot afford to lose more than half of our doctors. Many people in the Minister of State's constituency go to Clonmel hospital. This is shocking.

I refer to the children's hospital. I have been contacted by Jonathan Irwin, a renowned businessman who cares about the children's hospital and is involved in the Jack and Jill Children's Foundation. Has the hospital been completely forgotten about in the quagmire, bog and dark black hole? Will the cost be €2 billion or €3 billion? Can we get any update on the current situation? I know where the site is. There have been cost overruns. Will it be finished? We know from social media that there was a major fistfight among employees some time ago. Things could go wrong. There is some kind of a curse on it. Why would there not be, with the blackguarding that is going on?

I do not know what time is left on the clock today, but I want answers in writing from the Minister. I do not want to have to come back here next week or the week after and ask the Minister for answers. He has a duty to reply to the questions we ask and he cannot evade our questions. He has evaded them assiduously since he was appointed, which is shocking. St. Brigid's hospital in Carrick-on-Suir was closed in the middle of a pandemic. The Minister of State, Deputy Butler, should be ashamed of herself. The Minister and Minister of State will not meet the residents, staff or councillors in Carrick-on-Suir.

I am glad the Minister has acknowledged that there was not a perfect roll-out. I acknowledge the enormity of the task of trying to vaccinate the whole country. Let me say that publicly. I also want to repeat that it is simply part of an overall approach. My worry is that we are now focusing entirely on the vaccination programme, which I understand, but there is a much bigger issue, namely, how we deal with the pandemic.

Let me finish on the practical side. Last week the Minister got a little excited about what I pointed out. Today many other colleagues have pointed out the difficulties faced by GPs. We contacted GPs in Barna, Spiddal, Carraroe and the Aran Islands. There were significant difficulties in the vaccination operation, which were not caused by the pharmaceutical companies but rather the operation of the HSE in its failure to communicate and deliver vaccines. It treated three islands as one unit, which highlights the importance of having a policy for the islands.

I will leave that aside for the moment. The Minister has acknowledged that and has said there is a call centre. He might come back and clarify the nature of the call centre. Has it been privatised or is it is within the HSE? What is the cost of it?

Today is 11 March. I am sure that has not been lost on the Minister, but he did not state in his speech that on this very day a year ago a pandemic was declared. When the World Health Organization declared that pandemic, it said it did not use the word "pandemic" lightly or carelessly. It said it had rung the alarm bells loud and clear. It went on to state that all countries could still change the course of the pandemic. It was a very strong and positive message from the World Health Organization. At that stage, 81 countries had no cases and 57 had fewer than ten. What was the WHO message? It was to detect, test, treat, isolate, trace and mobilise. The WHO representative said that was doable. He said countries should prepare and be ready, and to detect, protect and treat, reduce transmission, innovate and learn. I would love an opportunity to be part of a debate in the House on that message from the WHO a year ago, and our utter failure, along with a lot of other countries, to embrace the message, realise where we were and take appropriate treatment.

I can forgive any Government for what was done in February, March and April, because it was caught on the hop, but it had the whole summer to prepare for vaccination and how we could finally open up our country in a safe manner. I was always a proponent of an approach to zero Covid. The current lockdown was totally avoidable had we dealt with this in the beginning instead of getting caught up with what was or was not a substantial meal in a pub and dividing one pub from another, as opposed to acknowledging that we were facing into a pandemic with an utterly starved public health system, a public hospital system that was at crisis point and so on.

I need to repeat this because in the middle of all of this, while focusing on numbers in respect of the vaccination programme, we are forgetting how the pandemic arose. I do not have time to go into that, but we know the connection between what we are doing to nature and the natural environment and the rise of pandemics. There was a failure in our public services.

Having put that in context, I have left the Minister very little time. I am simply raising these matters with him. On the practical side, he said 99% of the problems on the ground had been sorted out. I do not believe that. I believe the figure is over 90%. Can the Minister of State confirm that everybody over 85 years of age will be completely vaccinated? The word "some" has been used for a few weeks. I also ask for clarification on the call centre.

I thank the Deputy for her questions. I cannot answer the question on the call centre but I am sure we can get her a written reply on that. On where we started, on 15 February we commenced vaccination of those aged over 85.

The roll-out started with those aged over 85 years. Have they all been vaccinated? Will they be by the end of the week? I ask the Minister to answer my question on the call centre.

Of those aged over 85 who wanted to receive the vaccine, 99% have received it to date. We are starting the roll-out for those who are housebound today.

Perhaps the Minister could answer my question on the call centre.

I thank the Deputy. I will get her a detailed note on that. It is one of several measures the HSE has put in place in response.

I want to begin by focusing on the positives. There has been a huge reduction in the number of cases in nursing homes and among front-line workers. That is fantastic and is proof that the vaccines are working. The fact that 99% of those aged over 85 years have been vaccinated is something we have to welcome. It is good news. The fact that we have conducted a review of the NIAC priority list and have been able to accommodate people with chronic kidney disease and transplantees is good news. It means that we are listening. The fact that two mass vaccination centres will be opened in Cork South-West is good news for the people of my constituency.

I have to take this opportunity to speak on behalf of sections of society that feel they are being overlooked. Like most Deputies here today, I want to speak up on behalf of carers. Family carers are frozen and petrified with fear that they will bring the virus into places where they are looking after their vulnerable loved ones. We have to look at that.

I want to take this opportunity to acknowledge the phenomenal work of An Garda Síochána throughout the country. Its members have provided amazing service during the pandemic. Most Deputies make daily or weekly trips to and from Leinster House. I meet the same gardaí at the same checkpoints every week when I make that trip.

Hail, rain or shine, they are there. They are in Ballinascarty, Bandon, Innishannon and in The Viaduct. No matter what the weather, they are there and they are there to protect us. The work they are doing is phenomenal. We have to acknowledge that. They are so accommodating and they are friendly in how they do their job and they are doing it right. They face extraordinary circumstances. We saw what they faced on the streets of Dublin and they faced similar scenes on the streets of Cork. When they are called out to an incident, they have no idea of what circumstances they are being called out to or whether there is Covid present there. Like other Deputies, I received a letter from the Garda Representative Association. All it seeks is that consideration be given to members of An Garda Síochána being vaccinated after the medically vulnerable. I would love a comment on that. For the extraordinary work they are doing, they deserve more.

I seek a clarification from the Acting Chairman. To date, there has not been a closing statement at these sessions. Should I respond to Deputy Christopher O'Sullivan's questions or what point are we at now?

In the debate notes I have, it is called a wrap-up. The Minister may interpret that. He has seven minutes.

Okay, I thank the Acting Chairman. I will begin by addressing Deputy O'Sullivan's question. I wholeheartedly agree with him about the Garda. From day one, members of the Garda have done an extraordinary job. They have put themselves in harm's way, both in terms of the virus and in some of the activities that we have seen, particularly the protest in Dublin and the disgraceful behaviour with direct attacks on gardaí. They have done an extraordinary job. They have been involved in a very hands-on and co-operative approach to enforcement. They do not come the heavy, lots of options are available to them. Ultimately, if they need to fine people, they will and many fines have now issued. Ultimately, if they need to prosecute people, they can and some prosecutions are under way. I think they have done a superb job.

Family carers do invaluable work, which is incredibly difficult, every day. Their contribution is hugely appreciated by the people they care for, their families and by all of us. That is to be acknowledged. The Deputy is asking whether, given that both these groups are doing such important work, they can be prioritised. A similar question has been asked about teachers, for obvious reasons, and funeral directors and those working in that sector because they are coming in contact with people who have died of Covid-19, as well as a wide variety of other groups. I, and all of us here, would like nothing more than to have sufficient supply to be able to simply roll it out at scale, at a rate of several hundred thousand per week, and we would move through all these very worthy groups at pace. We are working with all the supply we have. As the Deputy has acknowledged, it is right and proper that we prioritise those at highest risk first and our healthcare workers. As mentioned earlier, the impact the vaccine is having on the cohorts that have been vaccinated is nothing short of astonishing, with a 95% reduction in Covid infection rates for hospital workers. We should remember that not all hospital workers have received their two doses yet. The reduction is in part based on partial vaccination and partly down to a very welcome reduction in community transmission, which has come at a very high cost to and sacrifice by the Irish people. As the Minister of State, Deputy Butler, said earlier, the impact in nursing homes has been radical. The numbers of staff out of work because of Covid, directly or indirectly, was several thousands in January. It is now in the low hundreds and continues to fall. We fully expect a similar boon for those getting the vaccine based on age.

At present, several cohorts have been agreed in the prioritisation. Cohort 1 comprises those in long-term residential care, cohort 2 comprises healthcare workers, cohort 3 is based on age, namely those aged 70 years and older and cohort 4 now includes those identified as being at very high risk due to underlying conditions. Then there are two other cohorts, namely, those involved in the vaccination programme, those aged 65 to 69 years and then people with underlying conditions which puts them at high risk but not very high risk. When all those cohorts are added up, it amounts to a very sizeable group of people. For instance, there are believed to be in excess of half a million people with underlying conditions, and then there are those aged 65 to 69 years. A very large group of people already has been prioritised and I think there is pretty much universal support for the approach taken to date. Understandably, the question being raised across the House is, what happens after that? Can family carers, members of the Garda, teachers, funeral directors and a variety of very worthy and important groups come next? The national immunisation advisory committee and the Department of Health, in conjunction with other Departments, are doing a full review of the population to be vaccinated after the groups we have just talked about. NIAC considers the risk profile, because we always want to prioritise those most at risk from Covid, as well as the likelihood of people getting infected. The work is ongoing. I know the House wants the detail and to know broadly when people can expect to get their first dose, because the second is pinned to that, depending on the vaccine, or if it is the Janssen vaccine, it is just one dose. It would be useful, and has been discussed at length here today, that when that group is agreed and we look at our provisional supplies, which have moved in a way that caused a great deal of anxiety, that we would be able to provide indicative time lines for the remaining cohorts, perhaps by month.

It is one of the rare times the Minister had another minute or two left.