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Joint Committee on Health díospóireacht -
Tuesday, 20 Apr 2021

Covid-19 Vaccination Roll-out: Update

I welcome our witnesses from the Health Service Executive, HSE, and the national immunisation advisory committee, NIAC. They are presenting virtually to our meeting and will provide us with an update on the roll-out of the Covid-19 vaccination programme.

From the HSE, we have Dr. Colm Henry, chief clinical officer, Mr. Damien McCallion, national lead for the Covid-19 vaccination programme, Professor Martin Cormican, chairperson of the clinical support group and Dr. Lucy Jessop, director of public health, national immunisation office, NIO. From NIAC, we have Professor Karina Butler, chair, and Dr. Brenda Corcoran, scientific adviser.

The witnesses are all very welcome to our meeting. Before we hear the opening statements, I point out to the witnesses that there is uncertainty as to whether parliamentary privilege applies to evidence given from a location outside the parliamentary precincts of Leinster House. Therefore, if witnesses are directed by me to cease giving evidence in relation to a particular matter, they must respect that direction.

I call Dr. Henry to make his opening remarks. He has five minutes.

Dr. Colm Henry

I thank the members of the committee for the invitation to update them on the HSE’s vaccination programme. Joining me today are Mr. Damien McCallion, national lead for Covid-19 vaccinations, Dr. Lucy Jessop, director of public health, national immunisation office, and Professor Martin Cormican, chairperson, clinical support group.

I will make a brief opening statement on the current situation with the vaccination programme. Regarding our overall objectives, it is important to restate our objectives for the programme, which are to reduce hospitalisations and mortality through vaccination of the most vulnerable groups and to vaccinate the largest number of people possible in the general population.

Significant achievements have been made by the HSE. As of this week, more than 1.2 million vaccines have been administered, comprising the administration of 850,000 first dose vaccines and 350,000 second dose vaccines. I am delighted to report that the majority of residents in long-term residential care facilities have substantially completed their vaccination. In addition, front-line healthcare workers and people over 70 years of age have largely received their first dose or are due to do so this week. We are also well advanced with the vaccination of the very high-risk patients in our hospitals, with over 90,000 vaccinations completed, and we will commence the vaccination of the remainder of those high-risk patients in the community from next week. Vaccinators in this phase have included those in hospital vaccination teams, community vaccination teams, vaccination centres, the National Ambulance Service and general practice. I acknowledge the work of all these staff and those supporting them in the background for their efforts during what have been challenging times.

On supply, we are continuously adjusting our integrated operational plans to align with the updated allocation sequencing and confirmation of supply schedules. Despite many challenges, the HSE has adhered to the Government’s principle of ensuring all available vaccine supplies are administered. We are regularly administering 95% of available vaccine within seven days of delivery. There has been variability between manufacturers, which can cause complications to our operations team. We have faced continual challenges, with changes in supply volumes and delivery dates, but we continue to work to meet our targets in this regard.

On the vaccination plan, clinical oversight and guidance are at the centre of directing the roll-out of the vaccination programme to ensure vaccines can be administered safely, efficiently and effectively. Our ongoing planning and roll-out includes operating models for general practitioners, GPs, hospitals, community vaccination teams, the National Ambulance Service, pharmacies and vaccination centres, alongside the corresponding ICT, infrastructure and recruitment mobilisation. We have faced many planning challenges with changes in supply, cohort definitions and clinical guidance in relation to specific vaccines. Last week, we also had to readjust due to the decision by Janssen to pause delivery of its vaccine product. We are also about to enter another planning cycle this week with the more positive news on increased supply of the Pfizer-BioNTech vaccine.

Regarding vaccination centres, 37 such centres have been agreed and the infrastructure is in place for these centres. More than 19 of these centres are already operating for specific patient cohorts, and this will increase to 26 over the remainder of this week. Staffing is in place and those centres already operating have been working well and with good feedback from the public. The remaining centres will open over the coming weeks as the necessary supply and demand processes are put in place. Online registration opened last week for those aged between 65 and 69 years who will have their vaccine administered through the vaccination centres using the AstraZeneca vaccine and that process has gone very smoothly to date. The first appointments have already been offered to those who registered.

We have seen early evidence of the positive impact of the vaccination programme. This is illustrated through reduced mortality, reduced incidence of the disease and reduced hospitalisations. This is particularly evident in the most vulnerable groups who are the initial priority for the programme. The virus and its impacts on society remain largely unpredictable and, as such, the need for proactive monitoring and flexible planning will always be a feature of our response. We continue to adjust our vaccination plan every time a change is required and we will continue to be as agile as possible.

I thank Dr. Henry. I call Professor Butler to make her opening remarks. She also has five minutes.

Professor Karina Butler

I thank the committee for providing the national immunisation advisory committee with the opportunity to explain its work in providing evidence-based advice on immunisation to the Chief Medical Officer, CMO. NIAC was established in 1995 at the request of the Department of Health as a voluntary committee within the Royal College of Physicians of Ireland, RCPI. It has provided advice on immunisation across the ages from infancy to adulthood, on matters such as the human papillomavirus, HPV, vaccination programme and the meningitis and influenza vaccines. NIAC also develops and publishes guidelines for immunisations in Ireland, which are implemented by the HSE and co-ordinated by the national immunisation office. NIAC also advocates for best immunisation practices through the widespread dissemination of information to healthcare providers and other stakeholders, including the public.

The 22-member committee is made up of a wide range of experts, including representatives from the RCPI, its faculties and institutes, the Royal College of Surgeons in Ireland, RCSI, the Irish College of General Practitioners, ICGP, the national immunisation office, the Nursing and Midwifery Board of Ireland, NMBI, the Infectious Disease Society of Ireland, IDSI, the Travel Medicine Society of Ireland, TMSI, the National Virus Reference Laboratory, NVRL, and lay members. Meetings are also attended by representatives from the Department of Health, the HSE and the Health Products Regulatory Authority, HPRA. NIAC members regularly participate in meetings of the World Health Organization, WHO, and European advisory bodies on immunisation.

It may be helpful to outline the process through which NIAC considers new evidence and provides recommendations. The Chief Medical Officer of the Department of Health formally asks the committee to consider a question about immunisation. Since the start of the pandemic, NIAC has considered numerous questions and issued advice to the CMO to inform the Department of Health’s immunisation policy, which is then implemented by the HSE. I have provided a background document detailing the processes that NIAC undertakes, such as reviewing emerging evidence and seeking additional input from a wide range of stakeholders, including medical experts in specialist areas, the Health Information and Quality Authority, HIQA, and the vaccine task force. Thus, all relevant considerations are taken into account, together with the scientific evidence on which recommendations are based. Safety is always a priority.

This workload has been significant in recent months. There has been some concern when new recommendations are made or changed. It is important to remember that we are dealing with a disease that is only just one year old and, amazingly, we have highly effective vaccines to provide protection against Covid-19. New evidence about these vaccines is being published almost daily. As vaccine development and roll-out have been more rapid than ever previously experienced, it is to be expected that there would be many changes to any recommendations, similar to what was seen during the 2009 pandemic. Then, however, we had only two new vaccines to combat that outbreak.

In 2021, with an infection of even greater consequence, greater understanding, adaptability and agility are required to ensure that the safest, most effective course is steered. The goal is to safely protect our population from hospitalisation and death. We need to balance the known very significant risks of Covid-19 against any vaccine safety concerns that may emerge, while weighing in how other measures can reduce the risk of Covid-19, including the use of alternate vaccines.

The guidelines are amended to give the best possible advice on all available evidence at the time, while bearing in mind the safety and well-being of the individual and the population. I reiterate that NIAC is not involved in the implementation of the vaccination policy or in the roll-out of the vaccines. It is an independent advisory committee, which provides advice to the Chief Medical Officer on immunisation.

Final decisions on the prioritisation groups and other aspects of the vaccination programme lie with the Department of Health and the Government.

NIAC acknowledges the significant support of our voluntary members and the collaborations with and by all involved in the vaccination programme in pursuing a common goal of reducing deaths and severe illness from Covid-19. Through maintaining confidence in a high-quality vaccination programme, we can maximise vaccine uptake and reap societal benefits.

I thank members for their attention. My colleague, Dr. Corcoran, who is with me today, and I are happy to take any questions.

I thank Professor Butler. As members are also attending the meeting virtually from their offices and therefore cannot see the clock to monitor speaking time, I will try to advise them when they have a minute remaining. I ask again that speakers stick to their time allocation to facilitate all members participating in today's meeting. Our first questioner is Deputy Colm Burke.

I thank Dr. Henry and Professor Butler. I very much appreciate the work that is being done by them and all their back-up support teams and the progress that has been made to date.

I will raise a number of issues, the first of which is with regard to the roll-out of the vaccine and the approach now being adopted in Denmark in administering the vaccine. My understanding, and I may not have the correct medical terms, is that vaccinators are drawing back the syringe to make sure they have not hit a blood supply vessel. I was recently asked to deal with it on 96FM in Cork, where Dr. John Campbell was maintaining, or made a suggestion, that if a vaccine hits a blood supply or goes into a vein directly it can contribute to clotting.

With regard to the vaccination in Ireland, while I know the vaccine is supposed to be administered into the muscle, is there a mechanism similar to what Denmark now has? It has changed its policy to deal with this issue. Is that being reviewed in Ireland as regards how we roll out the vaccine?

Dr. Colm Henry

I thank Deputy Burke. To clarify one point of the Deputy's question, any inference of clotting in a process of hitting a blood vessel is completely unrelated to the rare clotting that has already been reported with the AstraZeneca vaccine. The vaccines we give come from multi-dose vials and are intramuscular injections. Our vaccinators are trained. They are all healthcare professionals who are trained in the administration of intramuscular injection and how to give it appropriately, correctly and safely. I will ask Dr. Lucy Jessop to comment on the Deputy's question.

Dr. Lucy Jessop

Yes, absolutely. Our training is based on the NIAC guidelines in terms of how to give an intramuscular injection. We have done some extra training for all vaccinators in terms of how to recognise the muscle at the top of the shoulder to make sure we do not give it too high with shoulder injury, and as the Deputy said, give it appropriately into the muscle. We have, therefore, done additional training for vaccinators and are reminding them how to find the muscle when they are injecting. The advice, however, is not to draw back on the syringe to see if one has hit a blood vessel, as the Deputy was talking about in Denmark. It is not something that I am aware has been recommended. We would again look to our colleagues in NIAC if there were any changes in how a vaccine should be administered. It is not how we would recommend giving the vaccine, however.

The suggestion made by Dr. John Campbell, one of the people on the radio show on which I appeared - I am not a medical expert so I am not holding myself out as such - was that his experience was if there is a connection to a vein, the vaccine then reacts to something which may then contribute to the clotting mechanism. This is what was suggested by him. I am not sure what the witnesses' reaction to that is but this is what was put out to the public when Dr. Campbell was being interviewed. I know that might only happen in one in 1,000 or one in 10,000 cases but in view of the fact that Denmark has now adopted a different process, should we now be looking at that in Ireland as well?

Dr. Colm Henry

To reiterate, there is no link between the rare venous clotting syndromes that have been reported. These vaccines are immune-mediated, and as such, and are not linked to this injection technique, which is intramuscular. As Dr. Jessop said, at this point we do not see any reason to change the advice and training we give to people on intramuscular injection, a procedure with which most healthcare professional are very familiar.

Does Dr. Henry believe that Denmark is overreacting on this issue? This is the approach now in Denmark.

Dr. Colm Henry

I could not comment on what Denmark have chosen to do. All I can do is reiterate that we train all vaccinators, many of whom are experienced vaccinators in intramuscular injection. The main change for them in this particular exercise is that they are dealing with multi-dose vials and that is slightly trickier than the more common single-dose vials we deal with in vaccination programmes. I could not comment on what happens in Denmark.

As I understand it, the only way of indicating whether a person has hit a vein is by drawing back on the syringe.

Professor Karina Butler

This subject has actually been discussed at EU level. That has been considered and it is felt that is in no way related to the development of these clots. Dr. Brenda Corcoran may want to comment further on that.

Dr. Brenda Corcoran

The issue in Europe was examined by the European Medicines Agency, EMA, as to whether there was any link between the vaccine going into a vein, as the Deputy has suggested, and the possibility of these very rare clotting events. All the evidence from the EMA and our colleagues in the Health Products Regulatory Authority, HPRA, is that there has been no association with this. As outlined by Dr. Jessop from the national immunisation office, if the vaccine is given correctly into the muscle, there is no need to aspirate, that is, take back the needle to see if there is any blood coming out. That is not what is recommended by NIAC because if one gives the vaccine into the correct site it is not necessary to do that. There is no evidence, even if that was done, that it links in any way with these rare events.

I will move on to another issue regarding the roll-out of the vaccine for people who cannot access a GP because they are bed-bound. I am aware of a number of cases and know of one man, for instance, who is 90 years old. My understanding is that his GP has notified the HSE and to date, there has been no return contact.

Is there a particular problem with the roll-out of the vaccine for people who are confined to bed and cannot go to their GP? How do we intend to fast-track this? Do we need, for instance, to get the assistance of the Defence Forces together with the National Ambulance Service? I know the ambulance service is responsible for it but it has a huge workload. How are we going to fast-track that element of the vaccination for people who are very vulnerable?

Dr. Colm Henry

I will pass over to Mr. McCallion in a second. To start, however, we have been aware of this problem from the beginning and have been working closely with the general practice community in primary care to identify those who are housebound for one reason or another. We have a specific bespoke model of care for these people, which involves the National Ambulance Service. Because we are administering a vaccine that is in a multi-dose vial and has particular transport and storage requirements that make it quite difficult to transfer, it must, by necessity, be pre-planned in terms of the number of patients corresponding to a vial in any one region. As I said, we are working with the National Ambulance Service. I will pass over to my colleague, Mr. McCallion to update the Deputy on where we are with this cohort now, which is a stand-alone exercise within the programme.

Mr. Damien McCallion

Essentially, as Dr. Henry said, the National Ambulance Service said it will go out to people so, obviously, it is a slow enough process in the sense that it is going all over the country to rural areas. Approximately 1,600 people have been vaccinated through this process and we estimate the referrals have slowed down. There are very few left, if any. We are down to approximately 300 people remaining, who are all being scheduled and will probably all be completed over the next three weeks or so. The programme is, therefore, fairly well advanced. Much has been done and the second doses have actually commenced already. Somewhere in the region of approximately 200 to 300 people have already started their dose 2 as well.

The families are not getting any feedback from anyone. I know they are contacting the GP directly, who then contacts the HSE. There is, however, no feedback directly to the families and there is huge anxiety. This 90-year-old person is bed-bound and has carers who come to him. His family feel he is very exposed in the sense that he has not been vaccinated and still needs that level of care.

Mr. Damien McCallion

Sure. They are clearly some of the most vulnerable people that we need to get to. The ambulance service is working through those and if there is an individual case that has been escalated, we are happy to close that out. They respond to people and as I have said, there is probably no more than approximately three weeks or 300 people left. There are already 1,600 people done. The referral goes from the GP through to the ambulance service and they work right around the country to visit these people and vaccinate them. If there are individual cases where people feel they have not had contact but have been referred for some time already, the assurance we give in general terms is that we are completing the process over the coming weeks. If there is a specific case, people have put forward such cases in the past and we have ensured contact was made to give some comfort and reassurance that they have not been forgotten in the process.

Deputy Colm Burke's time is up.

I have a final question that will only take a few seconds. It relates to maternity hospitals. My understanding is that the Rotunda has introduced a new system for visits. Would it be possible to have one policy for all maternity units across the country? There is a big concern that partners or husbands are not being allowed into maternity hospitals. Is the policy going to be reviewed?

Dr. Colm Henry

We have a national policy but it is subject to local interpretation based on local outbreak data and epidemiology. Professor Cormican might comment briefly on the policy.

Professor Martin Cormican

The national guidance is that while there is control over visiting, people who have given birth should normally expect to have visits from a partner and pregnant people should expect to be accompanied during labour. People should be accompanied for the 20-week scan. The qualification put around that is that individual hospitals may have to exercise a degree of discretion following a documented risk assessment. For example, if there is a particular problem in a hospital at a particular time with an outbreak or some other problem, the hospital might have to deviate from national guidance. This guidance indicates that should be done after a detailed assessment of risks, for a defined period and with clear communication with everybody involved. The norm is that people can expect to be able to have somebody with them during labour and for the 20-week scan.

I commend Dr. Henry and Professor Butler on the work they have done. Notwithstanding any questions we put or any concerns we have raised in the past about the roll-out, I genuinely commend all of those involved in the process. It is a major undertaking and it is also very important in the context of us fighting back against Covid-19. People can see there is real progress to be made and maybe the finishing line and we need competent management now in a number of areas. I assume Dr. Henry agrees that these areas would include contact tracing, travel checks, quarantine and the vaccine roll-out. It is all really important.

We had breaking news from the EMA on the Johnson & Johnson vaccine. The position in respect of it seems to be a bit like that relating to the AstraZeneca vaccine in that the EMA is recommending that a warning be attached. The agency has said that the benefits outweigh the risk and it is not, as far as I can see, indicating that it should be limited to any age cohort. It indicates that the incidence of blood clots was mainly in those under 60 years of age. Is it not the case that the recommendation for the authorised use of the AstraZeneca vaccine from the EMA is that it is suitable for all age cohorts over 18? We in this State, following the recommendations from the NIAC, took a decision from an abundance of caution to limit the AstraZeneca vaccine to people over 60. Is that correct?

Professor Karina Butler

Yes, that is absolutely correct. The AstraZeneca vaccine is authorised for use across all ages from 18. It was also noted by the EMA, as the Deputy states, that there was a warning with regard to its use and the risk of these very rare, atypical clotting incidents that are quite severe and carry approximately a 22% to 30% mortality rate. They are a side-effect of very high consequence. It was also noted by the EMA that each country would make their own guidance, taking into account the local pandemic position and the availability of other mitigating strategies, including alternate vaccines.

I was just looking for clarity on that. The committee will have to study the recommendations or report that will come from the EMA but given that it seems to be very similar to the AstraZeneca vaccine in its warning and authorised use for all people over 18, with the benefits outweighing the risk, is it possible we will see a similar recommendation coming from NIAC on the Johnson & Johnson vaccine that we have with AstraZeneca? It seems to be exactly the same position. There is a warning but the EMA is saying that it is suitable for everybody over 18. Will we be looking at a similar recommendation for the Johnson & Johnson vaccine?

Professor Karina Butler

As the Deputy said, this is breaking news and there is no doubt we will look at the detail of it over the next day or so. There is additional information we anticipate will come out this week. At the request of the European Commission, the EMA is looking at these events and trying to refine the information given to us to contextualise them, perhaps with more detail on age-related risk. Taking all those factors into account, we will look at the best recommendations at that time.

I have some questions for Dr. Henry on the roll-out, which has had some benefits for healthcare, including what is happening in care homes. We all recognise this and accept it as progress. With respect to roll-out targets, how many inoculations happened up to yesterday for this month? What was the figure up to April so far?

Dr. Colm Henry

I thank the Deputy for his kind remarks. Credit is due to the vaccination delivery teams throughout the country who have delivered this vaccine under very challenging circumstances. Mr. McCallion will update the Deputy on those figures.

I am looking for a number of figures and I do not need context. I just need the figures. I am seeking the number for April so far and estimated delivery and inoculation figures for the complete months of April, May and June. How many vaccines are we expecting to get this month and in May and June? How many inoculations are expected?

Mr. Damien McCallion

There are two aspects to those questions. On the supply side, we are down under 800,000 for available vaccines. There were changes in the past week so I can reflect that. Last week alone, of the projected deliveries for the next four weeks for the four vaccines, we have 12 changes in either dates of delivery or volumes. The Deputy is aware of the AstraZeneca change, including its usage, and the Deputy also referred to Janssen's decision last week. We have additional vaccine from Pfizer but we also have changes from AstraZeneca in the past 48 hours that will reduce our capacity in the coming weeks as well.

I know caveats will be put on all of this but, with respect, I asked a specific question on the numbers. It can be very difficult to get those numbers.

Mr. Damien McCallion

Sure.

I know we must take the numbers given with caveats but I am asking how many vaccines we are expecting for the months of April, May and June, and how many inoculations are expected to happen.

Mr. Damien McCallion

For April we hope to get somewhere close to 800,000 but there may be some variation in that in light of changes again over the past 48 hours. There have been some very specific changes.

Mr. Damien McCallion

For May, the expectation, with Janssen out of the equation, is to get somewhere in the region of 1.4 million vaccines.

What about June?

Mr. Damien McCallion

For June, currently, the number is probably somewhere around 1.6 million. Again, there is a number of caveats, with active discussions ongoing with suppliers.

Does that put us on course to meet the target of all adults having received at least the first dose by the end of June?

Mr. Damien McCallion

With what has happened in the past week, we are not in a position to answer that directly. There is a question of supply and I mentioned those changes. We had further changes from AstraZeneca in its profiling. There will be an immediate effect from that in the next couple of weeks. We are not in a position to say that is there.

The Government is.

Mr. Damien McCallion

It is clearly something we are working towards.

Can I ask if that is a Government target or a HSE target? We hear all the time about this target of all adults receiving their first dose at least by the end of June. Is that a Government target, a HSE target or both?

Mr. Damien McCallion

My understanding is that targets are set by the Government and we also have targets within the programme. We are working towards that target as best we can, but it is very much led by supply. Supplies are constrained at the moment. As I mentioned previously, we are already experiencing a shortfall with AstraZeneca, which will limit the number of vaccines we can administer, the utilisation of our centres and our current plans. We are replanning again, and having just replanned last week, we are continuing to add changes to that.

In respect of the overall target, we are continuing to work towards that but there are significant supply challenges. The Deputy himself will be aware of such challenges over the past 14 days. As I mentioned, in the next four weeks alone, of the four vaccines of which we have supply, excepting Janssen which is currently off the table pending the EMA decision, 12 of the profiles have either changed in respect of volume or of dates, which affects delivery.

In terms of the overall target, we are continuing to work towards it, but there are very significant supply challenges. The Deputy will be aware of the challenges we have experienced in the last 14 days. As I mentioned, in the next four weeks alone, of the four vaccines of which we have supply, excepting Jansen which is currently off the table pending the EMA announcement, 12 of the delivery profiles have either changed in respect of volume or delivery dates, which affects delivery.

I have one more question. It concerns pregnant women, which is an issue that arises regularly. There are pregnant women who would argue that if there is any potential complication in the pregnancy, they should be vaccinated. Is that something that is being looked at?

Second, senior trade union representatives have been in contact with me in relation to prison officers who are escorting prisoners to hospital. They see themselves as working in a patient-facing role, yet they do not seem to be recognised. Is that area being looked into?

My final question is for Dr. Henry. Are we still going to see weekly reporting on the vaccine roll-out? It does not seem to be the case. I have been informed informally that we could be moving towards biweekly updates, which I do not believe is acceptable. We need weekly updates. Perhaps that question could be addressed. I will leave it at that.

Dr. Colm Henry

I will go through the Deputy's questions as quickly as I can.

I will take the second issue first, in respect of prison officers. We are now going through aged-based cohorts based on the NIAC advice and on the principle of reducing harm. The greatest harm is associated with age, which trumps any differential between professions. Of course, healthcare workers within prisons have been vaccinated, as have prisoners who have special conditions or those who qualify by age or through having underlying conditions. As for prison officers, they will be vaccinated if they come within age cohorts or underlying illness cohorts, as with members of any other profession.

I might ask Dr. Jessop to comment on the issue of pregnant women and vaccination.

Dr. Lucy Jessop

Pregnant women are eligible for the vaccine in terms of their cohort, in a similar way to prison officers, as Dr. Henry described. We have been vaccinating pregnant healthcare workers. We will vaccinate pregnant women with high-risk medical conditions, then those within the age cohorts going down. I do not believe there are current recommendations to place pregnant women in a high-risk condition, but as with the whole programme, NIAC is looking at any available evidence. If that is something that needs to be prioritised over and above a person's age cohort or his or her other medical conditions, that is something that can be looked at.

I also asked about the weekly versus the biweekly reporting. Dr. Henry might answer that question.

Mr. Damien McCallion

Basically, we report the figures daily and we hold a weekly press conference. I am not aware of any plans to change that, if that is the context of the question. Was there something more specific? We do daily reporting----

So, updates will still be given on a weekly basis?

Mr. Damien McCallion

To the best of my knowledge. I am not aware of any plans at the moment to change that. We publish the figures every day for the last 24 hours. We have shortened it from 48 hours to 24 hours.

I thank the witnesses.

I wish to extend my thanks to NIAC and the HSE.

Can Dr. Henry indicate when will pharmacists join the vaccination programme?

Dr. Colm Henry

The recent changes in the relative allocation of vaccines to different groups-----

Can Dr. Henry tell me when pharmacists will join the programme?

Dr. Colm Henry

I will refer that question to Mr. McCallion. I just wanted to set the context in that we-----

I do not really need the context. I just wish to know when they will join the programme.

Mr. Damien McCallion

We have been working with pharmacists for some time, and with the Irish Pharmacy Union, IPU, and the Pharmaceutical Society of Ireland, PSI. There are a number of steps that we had to go through with them. First, we had to reach an agreement. Second, we needed to put in place an operational framework as to how they would operate as vaccinators. Third, we needed to put in a technology solution that would allow them to function. We will have provided some of that information in the briefing note. We plan to trial that solution. It will be a cold trial. In other words, pharmacists will not actually be vaccinating people during the trial; they will just be trialling the system to make sure that it all functions properly.

The issue from there is partially supply-driven, so the point at when we take them on-----

When it is hoped that this will happen?

Mr. Damien McCallion

At the moment, we are not in a position to do this. We want to get to the point where we have everything sorted and vaccinations in pharmacies can begin this process.

Mr. Damien McCallion

These are important points. There are two factors that will determine it. One relates to when we have supply of the vaccine, the other is the vaccine mix. Pharmacy vaccination will lend itself better to some vaccinations than others, so the decision around the use of the Janssen vaccine and so on will affect that.

Second, will the vaccines be administered in the context of a pharmacy, or will pharmacists join mass vaccination teams?

Mr. Damien McCallion

Both. At the moment, pharmacists have two roles in the vaccination centres - one is managing the supply of the vaccines into the centres and the other is as vaccinators. The community pharmacy process that I just talked about is the process that we are working through separately with the community pharmacy sector. We have put out a request for expressions of interest and responses are coming through at the moment. The signs are reasonably positive on the numbers of those who will be interested.

I only have ten minutes and l hope I do not come across as being rude.

Mr. Damien McCallion

I understand.

Perhaps when we have Mr. McCallion back before the committee in a month's time, he will be in a better position to answer that question.

I wish to say to the witnesses from NIAC and the HSE that they have nothing to fear in giving us, as politicians, direct answers. I have noticed that there is a little bit of PR creeping into some of the contributions, perhaps unintentionally and unconsciously. For example, Dr. Henry stated that "we regularly hit 95%". How often, as a percentage of vaccine doses, is that target of 95% output hit in terms of the supply received?

Mr. Damien McCallion

I can take that question.

Basically, across the vaccines, we measure from when they are available to be administered and try to hit that target within seven days. We have been operating at between 90% and 100% pretty much every week. There may have been some weeks when it dipped. If I could also comment on a factor that is most important in context. When there is a delay, as there was with the AstraZeneca vaccine last week, clearly we cannot administer the vaccine-----

Mr. Damien McCallion

-----so immediately, that rolls out to seven, ten, or 24 days.

Is that information available on websites?

Mr. Damien McCallion

It is reported every week.

Daily, perhaps?

Mr. Damien McCallion

No, we do not measure it daily. It would not make any sense to do so. We look at the previous seven days, the output, and the relevant factors that are present in respect of the vaccine. We provide the information in the press briefing every week in terms of what is there around it. The other thing I would say is that as we move forward, there will be fluctuations in that, as we move into vaccine centres.

I accept that. As a member of the Oireachtas committee, I am of the view that we are non-partisan here. We are trying to find the truth of the matter between targets set by politicians and realistic targets.

It was mentioned previously that it was hoped that 800,000 vaccines would arrive in April. It is now 20 April. How many vaccines have arrived?

Mr. Damien McCallion

In terms of the actual delivery, we still have deliveries to come in. I would not have the exact numbers to hand.

Roughly, how many have come in to date, namely, 20 April?

Mr. Damien McCallion

I have learned not to give rough figures, if the Deputy will forgive me, because-----

How many had arrived by 15 April?

Mr. Damien McCallion

Broadly speaking, there are still deliveries due week on week. We will be due to receive more than 200,000 for the remaining weeks in April, namely, this week and next week. It will probably be higher than that.

Is that 200,000 for each week?

Mr. Damien McCallion

Per week, yes. We are looking at 200,000 coming in this week and around 200,000 to 250,000 coming in the following week, in indicative numbers.

So, there are roughly 400,000 vaccines left to arrive out of the 800,000 that are expected this month? Is that correct?

Mr. Damien McCallion

Yes, there is a higher number of delivery. It is an important point----

Okay. Go ahead.

Mr. Damien McCallion

Sorry, it is. In respect of the number of vaccines that arrive, we have to hold back a buffer stock-----

Yes, to use for the second dose.

Mr. Damien McCallion

There is a figure in respect of the total amount received and then there is a figure for the total vaccines available to be administered. The figure for the total vaccines available to be administered is that 800,000 figure. The figure in respect of vaccines delivered will be higher than that. In respect of the Moderna vaccine, for example, we hold back 50% of the stock. In the case of the Pfizer and AstraZeneca vaccines, we hold back stock relative to the second dose, which must be administered in the weeks following the first dose.

Published figures for vaccine deliveries into Ireland show that 1.187 million - almost 1.2 million - doses were received up to the end of March. Is that correct?

Mr. Damien McCallion

I will have to check that, but the figure in respect of vaccines administered is in that ballpark.

As of Friday, April 16, which was last Friday, 1.18 million doses had been administered into people's arms. That is almost three weeks later. That figure is only about 1,000 more than the figure for the vaccines that was publicised as being received into the country up to the end of March.

Mr. Damien McCallion

I would say that there are timing issues there in respect of the information that the Deputy has. On the supply side-----

No, I got this information from the app.

Mr. Damien McCallion

Is the Deputy referring to the Covid-19 app?

Yes, it updates, not daily. It is approximately two or three days behind.

Mr. Damien McCallion

The report that we produce every day is the reliable source of data on the number vaccinated.

How many doses have been administered?

Mr. Damien McCallion

We have administered more than 1.2 million doses.

The HSE has administered 1.2 million doses up to today, 20 April, but on 31 March 1.187 million doses had been received, which is a tiny bit shy of 1.2 million.

Mr. Damien McCallion

There will be a difference even over the normal.

I know about the buffer and all the rest. For six weeks the HSE and others have talked about administering 0.25 million doses per week in April. I forgave that for the first and second weeks of April. Then we had the AstraZeneca thing but remember AstraZeneca only accounts for 25%. So, at 31 March we had received a ballpark figure of 1.2 million doses and as of today we have administered 1.2 million doses.

Mr. Damien McCallion

There are a couple of factors. The end of March figures will clearly have increased and we have a buffer that we maintain that is 50% of Moderna, and for Pfizer and AstraZeneca-----

Moderna is a tiny amount of only 50,000 doses.

Mr. Damien McCallion

Also, for Pfizer, we hold dose for dose 2. Separately from that, in recent weeks we had to pause the administration of AstraZeneca and hence we have built up stock.

Targets were set not by the HSE although Paul Reid talked on radio about 0.25 million vaccines per week. As many as 1.2 million vaccines have been administered up to today and we are to get to 4 million vaccines by the end of June. The target is not a big deal to me but it is what missing the targets implies, and they are not the HSE's target necessarily. Right now, 27% of Irish people are unemployed. So, a quarter of the Irish population do not have jobs and the vaccination programme is so critical to mobilising those people back to their jobs and opening up the economy. There are people surviving on €350 a week so that is why targets are important for planning purposes.

We have 1.2 million vaccines, which means we need 2.8 million vaccines to reach the target set by the Government, that all adults in the country would have received at least one dose by the end of June. I see that 1.2 million vaccines were received up to 31 March and, as of today, in and around 1.2 vaccines have been administered. That does not add up.

Mr. Damien McCallion

There is a timing issue in terms of the difference in date between the supply and administrative figures. From the numbers that we have, other than the impact of AstraZeneca in the past week, we know that we are achieving the vaccination numbers, the administrative numbers, within that 90% to 100% in terms of the target.

Again, we are not going to hold the HSE to this, but there are ten days left in April, about 400,000 vaccines are due to come in, 1.2 million vaccines have been administered up to today, and if everything went okay, where might we be at the end of April?

Mr. Damien McCallion

What we declared is that our target for this week is between 140,000 and 160,000 vaccines based on the issues that occurred last week. We have got information from Pfizer, as of yesterday, which we are now building into our plan, with additional supply that will allow us to do more vaccines, hopefully, next week. As I said, in the past 24 hours we have had a reduction in the supply of AstraZeneca.

We are at 1.2 million doses today. Where would we be if those figures come through by 30 April?

Mr. Damien McCallion

For this week, our aim is to do another 140,000 to 160,000 vaccines.

So that is 1.46 million vaccines.

Mr. Damien McCallion

For the following week, the team is working through the additional numbers from Pfizer that we are getting and we are also dealing now with a shortfall in AstraZeneca. When we complete that we will have a number for next week. Our aim, for next week, would be to increase the numbers that we are doing.

For six weeks, we have been promised that there would be 0.25 million vaccines done next week. Does the HSE have the capacity to reach 0.25 million vaccines if all of the winds blew in its direction, and pharmacists and dentists were on board?

Mr. Damien McCallion

To get over that 250,000 over the coming weeks we certainly could achieve that with the workforce that we have and the vaccination through general practice, vaccination centres, our hospitals and community vaccination teams.

So, hiccups have held up progress.

Mr. Damien McCallion

There are two factors; one is predominantly supply. We do not have the vaccine to run through.

Second, as we mentioned in our briefing note to the committee, as the vaccination centres settle in they will generate a lot more additional capacity. As we have talked earlier about, other vaccinators will come on board such as the pharmacies at a later point, which will increase capacity further.

Can the vaccination programme reach 0.25 million vaccines a week?

Mr. Damien McCallion

We will get to those figures. We will need to get to those figures. At the moment, our constraint is that we do not have the supply that would allow us to test the system to get there. We hoped to get over the 200,000 mark in the coming weeks but we just will not have the supply to achieve that at the moment.

I apologise to the Chair if I came across as blunt but I had just ten minutes and it would be great if we had an hour. Finally, I appreciate the detailed answers.

I thank all our guests and thank them for their work. The last speaker has indicated how frustrating it is to get one's hands on basic figures and I do not know why we have to battle for that. We did submit questions before this meeting, which was helpful and worked well. Can we get an undertaking that we can submit questions and receive written replies on a regular basis? We should not have to battle to get basic data.

The figure for the weekly number of vaccines given, the highest weekly number was 129,000 vaccines administered, which is a very long way short of 0.25 million. We have not got today's figures yet so we do not know what the figure is for the last week. Can it be made available to us either now or as soon as possible? The data is hours later than normal today for some unknown reason. We need to keep track so can the figure be made available?

The weekly supply projection figure has also not been made available. We were promised a weekly figure but we have not had an official supply projection figure since 7 April so there are two weeks outstanding. Can the figure be updated quickly? Can we have the figures today?

I would like Professor Butler to respond to my questions on pregnant women. It has been reported that three pregnant women with Covid were in intensive care units, ICUs, last weekend. I am sure Professor Butler knows of those reports about a risk of miscarriage and stillbirth in pregnant women as a result of Covid. Does she believe that all pregnant women should be regarded as a priority group for the vaccines or is she satisfied to continue with the suggestion that they are dealt with on an age basis or relevant cohort, irrespective of their pregnancy status?

Professor Karina Butler

I thank the Deputy for bringing up this very important issue. Yes, women who are pregnant are not at more increased risk of getting an infection but they are at increased risk of adverse outcomes. There are particular circumstances related to pregnancy in the sense that there is a limited amount of time when one can vaccinate them or when it is best to vaccinate them.

The problem in the beginning was, as we know, pregnant women were excluded from the clinical trials so there is always a vaccine and a risk-benefit analysis. What has happened over time is, particularly for the ribonucleic acid, RNA, vaccines, there have been increasing use of those vaccines in pregnancy such that now there is an accumulating amount of information on them and on their safety in pregnancy related to that, insofar as they still rely on a passive reporting system. In the US, where they have been used quite widely, the data coming from there is very reassuring. This is something that is very important. We are actively considering it at the moment and we will prepare some advices for submission to the Department of Health on this aspect.

Is that in respect of the priority that would be awarded to pregnant women?

Professor Karina Butler

At present, the recommendations for pregnancy are that vaccination would be offered to those with high-risk conditions after a discussion with the obstetrician on risk and benefit. There has not been a general recommendation on vaccination in pregnancy although there is a statement not to withhold it from a pregnant woman. If it is recommended in pregnancy it is not so much that pregnant women require a specific prioritisation as such but as pregnancy is time-limited it may be that giving it to them might need to be facilitated in some way.

Does this mean a recommendation will be made in this regard?

Professor Karina Butler

Work is ongoing and, with the greatest respect, it will be coming out very soon. We are just finalising what will be coming from that.

As Professor Butler has said, pregnancy is time-limited but clearly given the current concerns and anxiety, it is important that we get the advice as soon as possible.

Professor Karina Butler

Absolutely.

I want to raise with Professor Butler the decision of NIAC on AstraZeneca. When the advice was given the understanding was we would continue to get Janssen supplies.. Given that there are issues with Janssen, although they may be resolved today, has NIAC considered revisiting the advice?

Professor Karina Butler

We revisit advice all of the time as evidence and the various factors that go into the generation of any advice come on board. Of course, safety is paramount. It is always a risk balance in terms of the very real threats of Covid and what Covid does, the benefits of the vaccine, what the alternative mitigating strategies are and what the alternate vaccine availability is. It very much depends on what else is in the mix. For example, if there were no Pfizer and no mRNA vaccines-----

I appreciate that. It is just the timing of these two decisions.

Professor Karina Butler

All of these things have to be taken into account.

In light of the EMA's decision today, how quickly does NIAC expect to be in a position to give advice on the use of Janssen?

Professor Karina Butler

Other advice will be coming from the EMA this week that may help inform on whether there is a specific age profile that might help define the risk more clearly. The other factors that go into this include what the overall impact on the programme is. Of course, we have heard from Dr. Henry and Mr. McCallion today that there may be more Pfizer supplies. The questions include what will be the overall impact on the programme and where Janssen is needed or might not be needed. Everything has to be taken in the round before a decision can be made.

At present, what is the expected-----

Deputy Shortall is out of time.

Professor Karina Butler

Dr. Corcoran wants to comment on this.

Dr. Brenda Corcoran

The other aspect is that we will be linking with our colleagues in the EU. They are struggling with similar queries. Many of them have issued similar advice. We link together and take into account our situation in terms of where we are in the pandemic and the other available vaccine supply. These are all factors that will help us make our decision.

I take it the number for Janssen, which was to be approximately 600,000 doses for this quarter, will remain the same. Perhaps the HSE will respond to this.

Mr. Damien McCallion

At present the plan is to have 600,000 Janssen vaccines for the second quarter.

And that is expected to remain the same.

Mr. Damien McCallion

Hopefully, given the changes we have seen, but the current plan is for 600,000 Janssen vaccines.

I thank Deputy Shortall.

When will the projected supply line be updated?

Mr. Damien McCallion

The supply line is updated through the Department on a regular basis rather than through the HSE. We take the supply in terms of operationalising it. The Department looks at it almost weekly. At present, it is daily in terms of what has happened over recent weeks. We will look at what advice comes through from NIAC to the Department, which will look at the supply profile for us relative to what the advice is on usage of Janssen. The Deputy is asking when Janssen will potentially come back into the equation.

I am asking overall, given all of the moving parts. It is up to the Department to provide those data.

Mr. Damien McCallion

The data are looked at weekly through the Department and the task force.

We have not been given them for two weeks. I thank the witnesses.

I thank the witnesses for being here this afternoon and for all of their incredibly hard work over the past year. One of my first questions is on when we expect to have all 38 vaccination centres open. Having listened to the other contributions, I expect that the answer will be that we just do not have the supply to do so at present. Is this correct?

Dr. Colm Henry

The opening of the centres correlates with the supply line. We will have 27 open this week for those aged between 60 and 69. It is dependent on the supply line.

Considering what we know about the supply line, when is it expected that all of the centres will be open?

Mr. Damien McCallion

It will be phased over the coming weeks. A total of 19 have operated already and the centre in the Fairways Hotel in Dundalk opened this morning. Unfortunately, with some of the changes, some of these centres may have to step up and down over the coming weeks. The others will come in over-----

Sorry to cut across but it is expected that, as supplies vary, we might have vaccination centres open and then perhaps shut for a week and then open again.

Mr. Damien McCallion

We will have to vary the opening hours. They are appointment based and it is important to remember this. It is not a case of turning up. People will be called in as we have supply and appointments to give them. Our aim is to get to either a five-day or seven-day service depending on the centre. Some centres will have the volumes to support seven days and others will be five days. We will have 26 centres open over the coming week and 19 have already functioned. Those opening this week will get a bedding-in period and, depending on the supply, the hours and days may have to vary. We must bear in mind they are appointment based and not walk-in so the public impact is less. The balance of the centres will open over other weeks. Some are also satellites of major centres so they will not be open every day in any case. The modelling for the centres is based on population and ensuring good coverage so people have a minimum journey time to get to the centre.

I attended a meeting of the Joint Committee on Disability Matters this morning. One of the chief concerns of Inclusion Ireland, the Disability Federation of Ireland and a number of other organisations is the vaccination of personal assistants and those providing home supports to people with disabilities. Will the witnesses outline the plan for this?

Dr. Colm Henry

As we have heard, we are approaching it on the basis of age and risk from underlying illness. Anybody who is an assistant to somebody who is disabled will get the vaccination based on age or underlying condition as with any other profession.

One of the briefings we received today mentioned the HPV vaccine, which is a completely different area but it has been disrupted by the roll-out of this vaccine and the pandemic. Previous contributors have spoken about the utilisation of pharmacies in the roll-out of the Covid vaccine. Perhaps this is a question for NIAC. Does anybody have information on the HPV vaccine catch-up? Could pharmacies be utilised?

Dr. Colm Henry

I will ask Dr. Jessop of the national immunisation office to address this matter.

Dr. Lucy Jessop

The HPV vaccine is one of a number of vaccines we provide in second level schools. We also provide some vaccinations in primary schools. Early in the pandemic last year, school buildings were closed for quite a number of months so the vaccination programmes had to be paused. However, the school teams worked very hard to catch up on the programmes over the summer through special clinics, and our uptake was very good in the previous academic year. Something similar is likely to happen this academic year. The teams did vaccinations in the first term of this academic year and we have had uptake of the HPV vaccine and the Tdap vaccine given at the same time. We are now looking to restart these clinics, either through going into schools or mass vaccination clinics to catch up. This is likely to be the model in terms of catching up and making sure the programmes are finished before the start of the next academic year.

At present, the uptake level is 65%. I accept that a point was made in the briefing that it may be about data and data input. If we are looking at low rates of take-up of the HPV vaccine, are we sticking with the provision of the vaccine through the school model? Is there an option to increase availability through a walk-in scenario in pharmacies?

Dr. Lucy Jessop

The school model is the one we would like to stick with, if at all possible. The way we record the data is on a database to which the school teams have access. The problem with going into a pharmacy is that we would not necessarily know whether a girl had been vaccinated already or where she was on her course. There is also the fact that pharmacists are only allowed to give certain vaccines by law at present and HPV is not one of the vaccines that are allowed.

They would need a change in the law and specific training for that so it is not something we need in the short term because I believe we can catch up over the next few months.

I will turn to AstraZeneca if I have time. Last week, when the committee discussed matters, the changes in the advice around the AstraZeneca vaccine had come through. As I understand it, the current advice is that we will continue with AstraZeneca with the older cohort and those in a vulnerable position or at high risk but as in other EU countries, those who are not in those cohorts and have received their first dose may begin a new course or receive a new vaccine or at least wait 16 weeks before they go ahead. Could somebody outline that in greater detail? What percentage of people are in that cohort and might have their second dose disrupted or might be looking at a different vaccine?

Dr. Colm Henry

We are giving the AstraZeneca vaccine to those aged 60 to 69 with or without underlying medical conditions and mRNA vaccines to those aged below 60 with or without underlying medical conditions. For those who have had a first dose, the advice from NIAC was that if they are over 60, they will proceed to having the second dose within 12 weeks, which is the usual schedule. If they are aged below 60 and have one of those defined medical conditions, again, it is in their interest based on their level of risk to proceed and have the second dose within 12 weeks. If they are aged below 60 and do not have an underlying medical condition, NIAC advises a protracted gap of up to 16 weeks to allow it to appraise the evidence of the timing of a second dose. That second cohort of people aged below 60 with no underlying conditions more or less corresponds to healthcare workers because that is where we were directing the AstraZeneca vaccine.

How many people out of the 200,000 or so people who received that first dose are we talking about?

Dr. Colm Henry

About 130,000 healthcare workers have received a first dose of the AstraZeneca vaccine. We have performed about 90,000 of those in respect of those in cohort 4, which comprises a very high-risk group with a variety of medical conditions between community vaccination teams and hospitals. We are due to begin with GPs shortly. Not all of the 90,000 received the AstraZeneca vaccine. Some received the mRNA vaccine before the AstraZeneca vaccine was advised for those in cohort 4.

I thank the representatives from the HSE and NIAC. How concerned is Dr. Henry about variants of concern and variants of interest, particularly the B1617 variant coming from India? How concerned are the HSE and NIAC about the sequencing of particular variants that could mutate and cause significant difficulties for any public health service?

Dr. Colm Henry

I will ask Professor Cormican, who is a viral expert, to comment on the second question. Variants of concern have a very particular definition. Mutations happen all the time in the world of virology. Many have no consequences while some do. We define variants of concern as those mutations that are associated with either increased transmissibility of the virus, increased aggressive ability to cause illness or virus resistance - a decrease in the effectiveness of public health measures, including vaccination. Of the two variants in question at this point in time, P1 and B1351 from South Africa, there is some evidence of reduced neutralising antibody response when people have been vaccinated but the vaccines are still effective to a large degree against serious illness and hospitalisation, so it is a mixed story of immunological response and ability to prevent serious illness.

Professor Martin Cormican

As the Deputy noted, variants do come along from time to time. It is often difficult to predict exactly how a variant will respond to the vaccine but it is a concern. The HSE agrees that it is important to have an emphasis on reducing the chance of variants that might escape from the vaccination being introduced. We are very much more comfortable that there are better controls on that in place than was the case previously. The risk of that in some respects becomes greater because as more of the population is vaccinated, the advantage that a variant which could escape the vaccine has becomes greater, so it is really important that we are in a position to control that.

The other point that is important in respect of variants is that variants do not just happen in other countries. They can happen anywhere so the continued work of our public health colleagues and all of the initiatives the public is supporting to keep the number of cases down are also important in reducing the risk that a virus variant might start here. Every time the virus copies itself, there is some level of risk that it will change so if we have thousands of people here getting infected every day, there is a greater chance that a variant that will cause us trouble will arise here but if we keep the number of people who are getting infected here lower, the chance of us getting a variant arising here that will cause us concern is lower. It involve two parts. One is trying to reduce the risk of it coming in and there are controls in place around that. The other thing that remains important is keeping the number of infections in this country as low as we can reasonably and practicably manage because it could start here just as it could start in any other country.

My second question concerns extending the period between administering vaccines. Obviously, the temporary suspension of the AstraZeneca and the Janssen vaccines has slightly skewed vaccine roll-out. It seems that the Pfizer vaccine has been and will be the dominant vaccine for those who choose to be inoculated. With regard to the Pfizer vaccine, it is recommended that there should be 21 days between the first and second doses. What is NIAC's recommendation if it goes beyond 21 days? Other countries have done this, in particular Britain, which has extended the period up to ten weeks. It looks like this Government could probably do something similar with regard to the Pfizer vaccine. What are NIAC's recommendations regarding the time space between the first and second doses? Pfizer says it should be 21 days but there is a possibility that this could be doubled or tripled.

Professor Karina Butler

This is, again, a very important question because we want to know the most effective way to use our vaccines in the community. The vaccine is authorised for an interval of up to six days. The initial recommended schedule was 21 days. It is currently being used on a 28-day schedule. If we extend the interval, the potential benefit is that one gets some vaccine into more people. We have seen that in the UK, that has contributed significantly to the reduction in hospitalisation and its overall early effectiveness rate has been around 70%. What is the downside to doing that? The downside is that one is not getting the maximum protection and a situation might arise where there is a level of partial immunity that might favour the emergence of resistant mutants, particularly if one has got ones that need the highest level of immunity. It is about trying to balance those competing benefits and risks to see what is the best schedule. The question is also whether we need to think about it depending on what the overall supplies of the Pfizer vaccine might be and what the impact on the programme will be because, again, any stretching out of those intervals will necessarily lengthen the time to get everyone fully vaccinated but there may be a point that is reasonable that gives a benefit without compromise. It is an important question. Where do we get the data from? Most of the early studies involved looking at the efficacy of a single dose. It was done at that very short interval before a second dose was given with the exception of the UK because that was really the only place that went to the 12-week interval. They have updated on a monthly basis their effectiveness data. It was still rather short-term but a report should come out at the end of this month - it usually comes out at about the 22nd or 23rd day of the month - to see if there are any problems with extending that interval or if it is something that is safe and might be beneficial.

Again, it depends on the level of supplies and the overall need. We know that two doses of the vaccine give people the best protection and the best response.

What is NIAC recommending?

Professor Karina Butler

We are looking at all the evidence and waiting for that information in order to give a recommendation.

I thank Dr. Henry, Professor Butler and their teams for the amazing work they have been doing on behalf of our country over the past 12 months. Of the 105,000 in cohort 1, how many now have been fully vaccinated with the first and second jab?

Dr. Colm Henry

They are more or less fully vaccinated.

Mr. Damien McCallion

There are a small number left, which is partly related to issues like outbreaks in certain settings and our ability to go back. We will be continuing through April. Some of those could probably take a little bit of time to wrap up. Essentially, all dose 1 and the majority of dose 2 are done, with a percentage left to be done going back through outbreaks. That work will continue but it is a timing issue.

Dr. Colm Henry

There is a continuous programme to vaccinate people at point of entry to nursing homes too.

Of the 482,387 people in cohort 3, how many have received their first jab?

Mr. Damien McCallion

By the end of this week, we will have over 95% of those complete and a small percentage left for next week. That is attributable to some early problems with Moderna in the cycle. Essentially, all of the over-70s, by the end of this week, will be substantially completed and we will have a small number to complete next week - less than 5%. This is attributable to issues in the early part of the programme for the over-70s.

This still involves 25,000 people in the over-70s group who have not received their first jab yet. Is there any regional breakdown of this? I am getting information that in some urban areas, such as Kildare, people have not even got appointments yet. Is there a situation where the over-70s in large populated towns are still waiting, whereas in rural areas they have received their first jab?

Mr. Damien McCallion

There is no split between urban and rural. GPs are on a schedule on a two-week rota and they get their vaccines in that two-week cycle. Where one person in one area is getting the vaccine, it might be because they are in the delivery cycle in the first week and then the remainder will be picked up in the second week. To give assurance to those people, we expect to be at over 95%, with a small percentage to be completed. That is largely attributable to the Moderna issues at the start of the process. By the end of next week, essentially that small balance will also be administered.

Is there a dedicated telephone line for the over-70s? I know they are told to go to their GPs but there are always exceptions in these situations. Is there a phone line run by the HSE which people can ring in order to get information if they are concerned that they are not getting their appointment? If there is not, will one be set up? There should be in my view.

Mr. Damien McCallion

In fairness, general practice has done phenomenal work in the administration of the vaccine to the over-70s.

Mr. Damien McCallion

The point is that we give the GPs seven-day notice of vaccine supply. Sometimes the appointments cannot be given out that far in advance. That is why people may perhaps have some uncertainty. We have HSELive which supports it but which does not have access to individual information relating to general practice. As we move through the next two weeks, if there are people who feel they have not been picked up in the process, we will be able to ensure they get their vaccine, whether that is through their GP or through HSELive. There is no value in someone ringing HSELive now because it will not know whether a person is in a particular practice. As we conclude dose 1, if there are people left, we will be able to pick them up then.

How many of the 250,000 people in cohort 2 have received their first jab?

Mr. Damien McCallion

Cohort 2 - front-line healthcare workers - is substantially completed. There will be an ongoing requirement to vaccinate new front-line healthcare workers, new medical students and new placements. We have over 5,000 student placements a year. The HSE has a turnover rate of 4%. It is an equal rate in the private sector. There will be a separate ongoing process with a pathway set out for new healthcare workers to come in. The original cohort definition is now substantially complete.

Of those 250,000, how many are administration staff and people in the healthcare sector who are working remotely?

Mr. Damien McCallion

The model is that local service managers made decisions, be they in the public, private or voluntary sector. We would not have that level of breakdown. The number of administrative staff would be consistent with what we have in the entire healthcare system. We would not have the details, however. The model used meant that, initially, staff in hospitals and such like were vaccinated directly. There was huge pressure in the early part of the vaccination programme when there were high prevalence rates of the disease among hospital staff, hospitalisation among healthcare staff and so on. As we moved through, we introduced a portal for healthcare workers. For individual providers, be they public or private, responsibility was placed on them to ensure they identified people. It did not necessarily look-----

Does Mr. McCallion believe that was a mistake?

Mr. Damien McCallion

No. At that time, when one looks at what it was trying to address, one could have been overly administrative and that would have had an impact in terms of provision. Dr. Henry will comment on the circumstances of the time. However, the sequencing worked out by Professor Cormican and others clearly set out the process. We believe, in the main, that it was followed.

Dr. Colm Henry

To put a context to this, we rolled out the programme on the cusp of the worst surge of this pandemic. January alone saw almost half the total number of cases we had since the beginning of the pandemic. We certainly do not have any regrets about the way we asked hospital, nursing home and community teams to vaccinate as quickly as possible. We had multiple outbreaks that were a real threat to residents and staff alike in both settings.

In the context of the back-up lists GPs are working from, is it correct that nobody between 60 and 70 can be on those?

Dr. Colm Henry

For the over-70s, it is the mRNA vaccine. For the latest iteration, we are giving the AstraZeneca alone to the 60 to 69 age group. Our back-up list in the first instance should be from within the same cohort, that is 70 plus.

Has that been exhausted?

Dr. Colm Henry

If that has been exhausted, we would ask him to go to the next cohort list which, in this case, would be eligible groups less than 60 years of age.

There could be a situation where somebody between 60 and 69 would be in a position to respond at short notice to a phone call to get a vaccination. Is it correct that they might not be able to and could end up waiting several weeks, even though the structure is age-based and the younger one is, the less likely one will suffer the effects of Covid?

Dr. Colm Henry

We have started off the programme for 60-year-olds to 69-year-olds. As we explained earlier, we opened the portal since last week. We have started mass vaccination centres with 27 open by the end week, administering the AstraZeneca vaccine first dose in descending order from 69-years-old to 60-years-old. That will proceed for 65-year-olds to 69-year-olds over the next three weeks. We will progress seamlessly to 60-year-olds to 65-year-olds thereafter. That programme is up and running now.

It will be 27 centres open at the end of this week, not 28 as the Minister for Health, Deputy Stephen Donnelly, stated in briefing material he made available.

Mr. Damien McCallion

There are two others due in next week which will take it up to 28. We said earlier it is 26 with two more coming through. The balance will follow over the coming weeks with demand and supply. In the short term, we do not have the supply to maintain them at the level we need.

I have had the issue of housebound people in rural communities, as well as their carers, who cannot get information as to when they are due to be vaccinated, raised with me by many across the country. I have one case of a woman in Meath who is trying to find out when her husband, who is 70 and is PEG-fed, will be vaccinated. I have a case of a 97-year-old man in rural Galway who is yet to be offered vaccine but his daughter who is in her late 50s and who cares for him was offered one.

There is an issue of people falling through the cracks, particularly vulnerable individuals who have not yet been seen to and who will likely need to have their vaccines administered at home. It was stated that these people will be picked up by the system over the next two weeks. Is it reasonable for us to say to those people that in the next few weeks they will be seen to and that NIAC and the HSE are very confident of that?

Dr. Colm Henry

We will reach everybody. I reiterate how difficult this is. I do not want to overemphasise this but it needs to be said again. The vaccine is extremely difficult to administer, particularly as it comes in a multi-dose vial that has very definitive storage and transport requirements which are time limited. It must be planned with the National Ambulance Service, NAS, to deliver the vaccine and once a vial is reconstituted it must be used within six hours. We must plan the administration of the number of doses coming out of a vial in quick order between different households. It is not simply a matter of NAS personnel administering the vaccine and leaving the house. These are frail individuals and having been administered the vaccine at home, they must be observed for at least 15 minutes. It is a considerable undertaking. We heard earlier that, to date, 1,500 or 1,600 of this cohort have been vaccinated. We have a few hundred people yet to vaccinate and we are committed to reaching everybody. Some people are concerned. We have identified all this cohort through working with general practitioners who are best placed to identify those who cannot travel to vaccination centres or general practice surgeries.

Mr. Damien McCallion

In terms of when we hope to finish, it is a three-week window. Approximately 300 people have yet to be vaccinated. We have faced certain challenges in the sense that some people will have been hospitalised in light of the nature of the conditions they may have. These are the most vulnerable people and some of them may have been transferred to residential care. The ambulance service is working through this cohort and that is window of time involved. If a person is concerned, we can pick up on that. We hope to get through the balance of those 300 people in that time. Some 1,600 people have been vaccinated. The administration of the second dose of the vaccine is being planned and scheduled at the same time by the ambulance service.

That is great. They will be seen to in three weeks.

A decision was taken to effectively privatise the employment of vaccinators through CPL. Dr. Henry may not have the answer to this question but he might come back to us on it. How much money does CPL make from each vaccine one of its employees administers? This might be of great public interest. How much is being made by a private company in administering these vaccines? This is a matter of great interest in the context of public health.

Dr. Colm Henry

They are not paid in terms of the number of vaccines as such, but we can certainly revert with details. There may be some commercial issues involved but I am sure we can revert to the Senator with details around the nature of the contract. CPL is recruiting people into the centres and they are managed by our people in the HSE within the centres. CPL is supporting the recruitment process into the centres. As I stated in the briefing that was provided to the committee, it has produced good numbers so far and we are continuing to recruit on that basis.

Deputy Shortall spoke about pregnancy and there is the concern of the risk of stillbirths from Covid-19 infection. The UK has recommended that pregnant women should get either the Pfizer or Moderna vaccine on the basis of on their age and clinical risk. Forgive me if this question has already been answered - I was attending a media committee meeting and I came in at the end of Deputy Shortall's questions on the guidance for Irish women - but is there any prospect of the vaccine roll-out being re-examined to recognise the vulnerability of pregnant women?

Dr. Colm Henry

I suggest that this question be passed to Professor Butler because she commented on the matter earlier.

Professor Karina Butler

I reassure the Senator that this is a topic which is under active review and that all those considerations are well taken on board.

I thank the witnesses. Those are all my questions.

The next speaker is Deputy Cathal Crowe.

I confirm I am within the Leinster House campus. I thank the witnesses from NIAC for being with us today and, more importantly, for all the work they have been undertaking for the last number of months. I wish to put a number of points to Dr. Colm Henry and he decide to re-assign some of those. I represent County Clare and many people in the county are being vaccinated at the Radisson Hotel, which is located on the Clare-Limerick border. The mid-west vaccination team has been sending text messages out to people notifying them that it is their turn to get the all-important jab. I hope Dr. Henry can see the message - I have printed out what the text message states because it is extremely casual. It comes from an 086 number. It asks the people to please reply "Yes" or "No" as to whether they can attend. They are also asked to bring ID along with the text on their phone as proof of appointment and to ring the number between 9 a.m. and 6 p.m. with any queries. The message is very casual. Many people believe it to be phoney, a fake text or a scam and they are not replying to it, which means they are losing out on key appointments. This is happening repeatedly at the local vaccination centre. The message lacks all formality. I explained to some HSE staff that in this day and age people receive text messages from their banks, supermarkets and all sorts of companies and entities that look more formal. There is such important work going on at the Radisson Hotel and it is wonderful. We thank those involved for what they are doing, but this text message lacks all formality. As a result of the latter, hundreds of people are not opting to text back and are losing out on their appointments. It is a basic issue to which I would draw Dr. Henry's attention if he is not already aware of it. I ask that he examine regularising the position in this regard as a matter of urgency and ensure that there is some structure put onto that message. Is he aware of the matter already?

Dr. Colm Henry

No, but we will certainly pass on the Deputy's concerns to the University Limerick Hospitals Group. I would echo the Deputy's acknowledgement of the huge work they have done throughout the month of January and onwards in vaccinating large numbers of people. They use the Radisson Hotel in order to be able to take the vaccination programme out of the hospital site and we will certainly pass on the Deputy's concerns.

Mr. Damien McCallion

I would add that currently the centres are working off local scheduling systems and that will be strengthened up as we move forward. As a result, that issue will be addressed. I take on board the immediate point and we will bring that back to UL and ensure there are similar standards with respect to other centres.

I appreciate that. People are very savvy these days. If they have a sniff of a scam coming their way, they avoid it. Unfortunately, that is what is happening here. It is quite a serious problem.

My next question is also directed at Dr. Henry. We are hearing that in the next few day the whole regime around mandatory hotel quarantine is going to change. Those who are coming into Ireland vaccinated will be allowed to go to their home environment and probably quarantine there for a few days. An issue has been brought to my attention by a constituent who is now domiciled in the United Arab Emirates. She was vaccinated with the Sinopharm vaccine in February but has been told that vaccine will not be recognised in Ireland. When she arrives as a passenger into Dublin Airport with the Sinopharm vaccine in her system, that fact will not be recognised. The authorities only recognise the headline vaccines that have been given in other jurisdictions. Has NIAC provided advice to the Minister for Health on which vaccines are acceptable and which are not? If it has done so, why would it make distinctions in that regard?

Dr. Colm Henry

I am not sure if the Deputy is directing that question to me, the HSE or NIAC. People coming into the country who have been vaccinated in other countries is an issue. First, there is the matter of the evidence of vaccination, second, partial vaccination and, third, the type of vaccination involved. It is something we are considering. I will ask Dr. Jessop of NIAC to comment on the ongoing work in this regard.

Dr. Lucy Jessop

On the vaccines we have in the EU and equivalent vaccines, for example, the AstraZeneca vaccine being used in India, there is published data relating to their effectiveness. The Sinopharm vaccine is not seen to be as effective as some of the other vaccines we are using in Europe. The matter the Deputy raised may well be related to that. I am sure, as with all these things, these matters are being reviewed with respect to which of the vaccines should be taken into account in the context of mandatory quarantine or people being able to quarantine at home instead.

I appreciate that. This is an important week, with an big decision to be taken, probably on Friday, in respect of allowing those people who have been vaccinated to enter the airports and disperse around the country. It is important that we nail down which vaccines are acceptable and which are not. Regardless of which vaccine one is talking about, they all have high efficacy rates. They may not all have an efficacy rate of 98% or 99% but they certainly provide a high degree of protection. That needs to be factored in.

My final question is also for Dr. Henry. We heard the Tánaiste say last week, in the vacuum that existed while the EMA was undertaking a number of reviews, that those who refused vaccines would end up at the back of the queue. Operationally, has that been the case? Have people who telephoned clinics and stated they were not sure if a particular vaccine was right for them and that they would wait to hear what the scientific experts had to say ended up being at the back of the queue? Will those people have to wait a number of months to be vaccinated? All things being equal and everything moving at the current momentum, when will the last eligible adult in Ireland be vaccinated?

When does Dr. Henry envisage the last vial will be taken from a shelf and jabbed into someone's arm? This is a very important vaccine. There must be, provisionally, an endpoint to this. Does he know what it is, has the HSE planned for it and could he guesstimate when it might be?

Dr. Colm Henry

I thank the Deputy. I would strongly advise anybody listening in the 60 to 69-year age group to take the AstraZeneca vaccine because of the considerable protection it gives them from serious illness, hospitalisation, admission to intensive therapy units, ITU, and death. They have much more to fear from the virus, and its side effects and complications, than they have from a vaccine which has a very rare side effect that has been largely noted in people under 60 years of age.

At this point in time, we are in the position that AstraZeneca is the only vaccine we can offer those over 60 years of age. As the Deputy has heard, this is because of our programme of completing the over-70s and our need to use the mRNA vaccine in those under 60 years of age, as per advice. AstraZeneca is one vaccine we can give. It is a very effective and safe vaccine and will protect people between 60 and 69 from the worst effects of this virus.

Regarding the Deputy's second-----

May I ask, operationally, is the 60 to 69 age group ending up at the back of the queue? If members of this group have reservations, are they ending up at the back of the queue, operationally, or is that a political statement? I am just trying to ascertain that.

Dr. Colm Henry

I would not use that language. I would much prefer to describe to people the benefits of this vaccine and what they have to gain from it. I hope they can be persuaded by the evidence, which is very strong, particularly from the UK, to which Professor Butler and others have referred, that this vaccine is very effective at preventing those serious consequences of this virus which are very definitively age related. People aged from 60 to 69 have everything to gain from that.

On when the last eligible adult will be vaccinated, as we work through age groups there are greater volumes of people in their 50s, 40s, 30s and 20s. Certainly, as we said previously, this is dependent on supplies. We expect to continue this programme throughout the summer. Of course, it will be an ongoing programme because there will be more people coming into it from those age groups. There may be evidence to come yet, which Professor Butler could talk about, on vaccination of younger age groups including those under 16 years of age. An unresolved question is also emerging as to whether people will receive annual or biannual doses. We do not know.

As of now, at this phase of the programme, we are trying to reach every eligible adult as quickly as possible and that is supply dependent. What the future holds for the vaccination programme in terms of ongoing entry and the requirement for booster doses is as yet uncertain.

I thank Dr Henry. Keep up the good work everyone, we really appreciate it.

I thank all involved for the work they are doing and have done in the course of the past year. I hope that their hard work will pay dividends. Can the witnesses emphatically state that all vaccines currently available, in use and approved throughout the country, are equally safe and effective regardless of where they are manufactured?

Dr. Colm Henry

I will take that question first and then ask Professor Cormican or Dr. Jessop to comment. All the vaccines available are safe and effective. The recent reframing of the NIAC advice has indicated that we should use one in a particular age group and mRNA vaccines in another age group. The vaccines we are using have an emerging, strong efficacy record from clinical trials and are very effective in real world evidence, as is emerging from those countries further along in their vaccination programmes. The evidence coming through from real-life experience is that they are delivering benefits, more than we expected even from the evidence in phase 3 trials, in preventing serious illness. Does Dr. Jessop want to comment on the country of origin?

Dr. Lucy Jessop

Regarding where they are manufactured, all the vaccines we have are from EMA-approved manufacturing sites. They are manufactured in several different countries but they go through very rigorous procedures to recognise those sites as able to produce vaccines. Each of the vaccines has lots of batch checking to make sure that all the vaccines in each batch that comes out are of equal effectiveness. If there are any batch problems then, obviously, those batches are held back or additional tests are done. In terms of the batches we get, I do not think it makes any difference which country they come from. All of the batches from that manufacturer have gone through the same rigorous testing.

Since availability of supply is a major contributor to the speed with which the vaccinations take place, how is the full extent of the requirement in a particular area determined?

Mr. Damien McCallion

As the Deputy knows, some of the cohorts are not area based. Nursing homes, healthcare workers and the over-70s were modelled up based on GP numbers for the over-70s. We were able to look at each area in the country and see how many over-70s were registered with each practice. That served as a reasonable basis for the number of people in each area and hence the distribution model to GPs for the over-70 population was built up on that.

The medical, high-risk and very high-risk groups have proved more challenging in that we had to work through our hospitals and with general practice to try to identify those people. Again, that is through all the individual hospitals throughout the country and also trying to work with general practice, which is just commencing for those groups. We do not have national disease registries so, essentially, we just pick those numbers up hospital by hospital and through practices.

For future age cohorts, as in those aged 70 and downwards, with 65 to 70 being the first group, we have numbers from the Central Statistics Office, CSO, for the total population. We are also able to see some of the regional numbers for populations around each geography and how that works. That will continue through all the age groups right down to the completion of the programme.

Is there any basis for concern among the various cohorts at the present time about the safety of the vaccines as it applies to them personally, given that there have been changes in recent times that shifted the emphasis from one group to another depending on the age and medical condition of the people concerned?

Mr. Damien McCallion

I will ask Professor Cormican to answer that.

Professor Martin Cormican

When anybody takes a medicine or injection of any kind it is understandable that they will have questions and concerns about it. That is perfectly natural. It is part of the training for people involved in healthcare to deal with those questions and answer them. Of course, it is understandable that people have concerns. When advice changes, and changes for very good reasons because of changing evidence, it is understandable that creates concerns for people as well.

However, we can reassure people that the vaccines in use have been through a very rigorous process. We have good evidence about how they perform. We have seen that the benefits are huge in reducing the risk. People do, of course, have questions. The vaccinators, doctors and nurses, will be able to answer those questions and give them the information they want. It is understandable that people are concerned but they can usually be given the answers they need and, overwhelmingly, the answers make it clear to them that the benefits hugely outweigh any risks.

Professor Karina Butler

I would like to come in on that. I can understand why the Deputy is asking that question. The 60s to 70s age cohort, particularly, has concerns and feel they are singled out for what they might perceive as a less safe vaccine. Part of that has arisen from a misunderstanding of the messaging when AstraZeneca was first restricted from the over-70s. The reason it was held at that stage in the beginning did not arise from any safety concerns whatsoever. It was simply that there had been a very small number in that age group in the original trials of AstraZeneca. In the phase 2, 3 and 4 trials there were only about 222 individuals over 70 years of age. It was for that reason, while waiting for more information to come out, that in the beginning it was recommended that the mRNA vaccines be given preferentially to the over-70s.

This was coupled with the fact that as we get older our immune systems do not always respond so well. We wanted to make sure that the vaccines were equally effective in older age groups. That data then came out from Scotland and the UK. Thus, the advice from NIAC was revised to state that these vaccines could be used across all age groups. There are no concerns about the safety of AstraZeneca in those older age groups.

However, somehow that has not translated into common public knowledge. It was felt there was a danger at the older ages and now we are saying that perhaps they are less safe in the lower age group, so that middle age group is feeling a little squeezed. It is about trying to get that information out and realising that there were never any safety concerns there. In fact, we have said, in terms of the 60 year age group and even, perhaps, the 50 year group, that really has been redirected out of an abundance of caution, a phrase that has become hackneyed in a way, but that is what it is. What one wanted to see was that a very wide safety margin was being maintained. We know that the risk of Covid-19 for somebody aged 60 years is 84 times the risk of anything associated with the vaccine. That is not just the risk of Covid-19 in somebody who contracts it, that is the risk for somebody who is of that age in the population taking into account the risk of acquiring it and the risk of what happens after one gets it.

I understand where people are coming from, but it is about trying to inform them so they may feel confident in that. We are aligned with many other countries in Europe in taking those age cut-offs, be they around 60 years of age. We know the UK has taken a much lower age cut-off, but it must be said that it was at a different stage in its pandemic as well. We also have to take into account the availability of alternative vaccines. All of those factors came into play.

We are pressed for time, so I will leave it at that. I thank the witnesses for that comprehensive answer. We have received a large number of inquiries which are based on misinformation, but understandable information as well. We must recognise the effect of social media in transmitting information that is both helpful and unhelpful in certain circumstances.

I welcome the expert witnesses. My question is similar to Deputy Durkan's. I was contacted by a lady this morning who knows I am a member of this committee. She asked me to ask a question on behalf of her husband who is younger than 60 years and is part of the vulnerable cohort. He received the first dose of AstraZeneca and she made it quite clear that he will not take the second dose. Can he get another vaccine? I explained in the best way I could, as a layperson, the evidence relating to clotting, that there were very small numbers and a small percentage and the facts about the people who got the first dose. Her reply was that she knows the science, but that he is not taking the second dose of AstraZeneca. That is my first question.

Professor Karina Butler

First, I should point out that even after one dose of AstraZeneca vaccine, once about 21 days have elapsed, people are very well protected for at least a few months and probably longer. That is why we had the confidence in being able, for some, to stretch out that interval from 12 to 16 weeks while we got more information and protected against the severest forms of disease and hospitalisation. The good part is that the lady's husband has already had a dose of vaccine. That is very helpful. For someone in his position in terms of his high-risk status, the risk from Covid-19 many times outweighs any potential risk associated with the vaccine. Even given his age, he is at the lower end of whatever small risk there might be.

Regarding other vaccines, there simply are no data yet, although they will be coming out, as to whether what is called a mix-match or using a different vaccine is effective or even, perhaps, advantageous. Quite simply, we do not have that data at present. Studies are taking place in the UK which are likely to report over the next month. Similarly, France and Germany, which decided to go that route, will be getting information. That information will be emerging over time. Now, however, the best advice for somebody such as that man is that he would get his second dose of AstraZeneca. He would not be scheduled yet because the second doses are not scheduled until the first week in May or so. His risk from Covid-19 far exceeds any risk related to the vaccine. All we can do is inform and try to share the information with people, but we must respect the fact that they ultimately can make decisions for themselves.

I thank Professor Butler. I will certainly pass on that message. My second question is for Dr. Henry or his team. Island residents received their first vaccination on the islands. The vaccine was delivered professionally. It was excellently co-ordinated by the Air Corps to drop vaccines to the offshore islands. People over 70 years and in some cases younger people, depending on the number of residents, were vaccinated. Will all other island residents be vaccinated in a similar manner? Will the vaccines be delivered to the islands rather than people having to come to vaccination centres on the mainland?

Dr. Colm Henry

We will be going through all other residents, as was said in previous replies, based on age cohort or underlying risk profile. We have not yet determined specific modes of administration to the offshore islands, but I can revert to the Deputy with a more definitive response on that.

The system of administering the vaccine or delivering it directly to the islands worked well and saved people who would not have transport having to come to the mainland. Perhaps Dr. Henry will revert to the committee's secretariat with information on that.

Dr. Colm Henry

Yes.

My third question is on a matter that was touched on earlier. I have come across a 96-year-old lady who lives in sheltered housing in my constituency. There are ten others over 60 years old who are in similar accommodation. I have contacted the National Ambulance Service to try to get them vaccinated. Unfortunately, these people are falling through the cracks. They are at an age where they should have been vaccinated very early, but have not been. I am not sure where or how they are falling through the cracks. If there are other people who are housebound, is it their GPs or their families who should be making the calls to the National Ambulance Service in this case to get the vaccination?

Finally, I presume that for pharmacists and dentists who get the call to be part of the vaccination team that it would be through the portal as well. Somebody would be sent to Joe Bloggs, pharmacist, at 11 o'clock Wednesday week, for example. It will be the same type of procedure and it will be done through the portal. Similar to the vaccination centre or GPs, one would be invited to go to a certain location to receive the vaccine.

Dr. Colm Henry

I will respond briefly to the first question. As I explained earlier, for the housebound the system is working closely with the GP community, which is best placed to identify the people who cannot travel to a GP surgery for the over 70 years vaccine scheme. We have not been able to approach it with the same strict age-based incremental approach as we did with those who go to the GP surgery simply because the vaccine is a multi-dose vial. The National Ambulance Service has to deliver it and the vaccine, once reconstituted, must be used within five or six hours. Some of it is somewhat geographically based in the sense that the National Ambulance Service has to assess who needs it in a particular area and schedule the vaccinations on a particular day. It must factor into this not just the administration but also the lifespan of the vaccine after it has been reconstituted and the need to monitor the patient for at least 15 minutes after the vaccine. We urge anybody who has not yet heard to inform his or her GP. The GPs are informing us in turn of those patients who cannot go to their primary care centres for vaccination. We will leave nobody behind, and that has been our commitment from the beginning.

Mr. Damien McCallion

On the second part of the question, GPs are currently involved in vaccinating the over 70 year olds and moving on to the second dose. We have worked out agreements with the GP leadership on GPs also assisting us with regard to very high-risk and high-risk patients. As I said, we do not have national disease registries so most people with the majority of conditions, although not all of them, are known to general practice. That scheduling is done locally and through GPs. If people are in doubt about that, the HSE website gives details of the criteria for inclusion in both the very high-risk and high-risk categories. People will be called. They do not need to contact their general practitioner or hospital as they will be called through that process.

We are still working through the model of how people will be assigned to pharmacists. As stated earlier, the model for pharmacies is still being developed in the context of the technology and the operating framework. We will also have to take into consideration the vaccine types that may be available because some of those could be challenging for pharmacists. We have done an expression of interest for pharmacies in the context of the numbers involved. That will be closing out soon.. We will be running a trial over the coming weeks to see how that will work in terms of the technological solution involved and to make sure that there will be a clear framework for operating. We will make a decision on what is the best time to activate pharmacies as a channel. At the moment, we clearly do not have the supply. Some of the decisions relating to the Janssen vaccine could influence thinking as well.

Does Professor Butler think there will be a requirement for booster doses later in the year or early next year or is it too early to provide an answer in that regard in the absence of sufficient data?

Professor Karina Butler

There are probably not enough data but there is a general feeling that the need for booster doses or a further dose similar to the flu vaccine is quite likely. It may not be every year. It might be every couple of years. Work is ongoing to develop a pancoronavirus vaccine, which would not be as changeable and might have a broader range of cover. It is too early to say but it is certainly possible that there might be a need for additional vaccine doses.

Dr. Henry referred earlier to over-70s being largely vaccinated. There have been a number of questions today. The difficulty for some people who have contacted us, as public representatives, is that the HSE has been running an advertisement for a number of weeks which states that the over-70s have been largely vaccinated and that it will be moving on to others. This is causing problems for many GP surgeries. Children of elderly parents are contacting their GPs, annoyed and angry, asking why their father or mother has not been vaccinated. They have listened to the advertisements on radio or seen them on television and are asking why their parents are being left behind. There seems to be a difficulty with this. The witnesses may need to tweak the advertisement. A number of GPs have been really upset about this. They tell people that the reason a person's father or mother has not been vaccinated is that the GP did not get the vaccine, which has been a problem.

Advertising has been touched on today. With regard to vaccine hesitancy, are the witnesses talking about some sort of programme? Some of the information imparted today is really useful. Will there be a campaign through the media about vaccine hesitancy? Will there be a plan regarding those staff who may be hesitant, for whatever reason, within the HSE or long-term residential homes? What about the part of our population who do not have email addresses? Believe it or not, there is a small cohort of people who do not have such addresses. What about people who do not have smartphones? Have the witnesses come across difficulties with this?

A number of people have contacted us to say that they did not understand why someone from Donegal or Clare would have to travel to Dublin to get the vaccine. Have those difficulties with the roll-out been resolved?

I listened to what the witnesses said about rare clotting incidents. Many people have questions about this matter. It is atypical and affects a tiny cohort. We are talking about possibly four people out of 1 million. What is the recommendation? A GP has been in touch with me about the issue. What is the recommendation where there have been difficulties with clotting in a family?

Deputy Shortall wants to come in for a couple of questions but maybe the witnesses could address some of my questions first.

Dr. Colm Henry

Regarding hesitancy, we have an active campaign. We brought in specialists in the field and in other fields, including cancer, renal, etc., to promote the message, especially for vulnerable groups, that it is much more in their interest to get the vaccine because of the dangers of the virus. The more difficult challenge would be with younger age groups who perhaps feel that they have less to fear from the virus. Once we get past the primary objective of reducing harm, we will want to expand the vaccine to the greatest number of people possible to reduce transmission. As we explained earlier, it is not finished for the over-70s. It is almost finished but it is an ongoing programme. Some people may be excluded because of active illness or recovery. We certainly do not want to give a message that somebody has missed the boat. We will certainly take on board the Chairman's comments.

Regarding travel from Donegal to Dublin, we have ample facilities for all the vaccinations in Donegal, Kerry or Cork. It may have been early on when some of the hospital specialists were identifying patients in particular cohorts who felt they had to go to Dublin to be vaccinated. This should not happen. We are well able. I ask Professor Cormican to cover clotting and those with a history of clotting disease.

Professor Martin Cormican

One thing that is important to say about this is that it is an unusual pattern of disease. The HSE has been working on getting information out throughout its structures and to the general practice community about what to watch out for in the event that this rare event happens. It is important that if people have symptoms such as severe headaches, visual disturbances or abdominal pain, they go to see their doctors. We have worked with general practice and with emergency departments to make sure that if patients get those symptoms, if they go to get attention, there is a pathway in place to make sure that there is care. There are two parts to that. It is a rare complication but it is important and we have worked with colleagues to make sure that we have a process in place to try to fast-track those who get this complication to get treatment which improves their chances of doing well. It is a rare complication.

The fact that somebody has had a clot in the past is a common source of questions. This is a different pattern of disease. It is not more likely to occur in somebody who had a clot in his or her leg in the past. It is a specific type of condition. It is important for people to be aware that although it is rare, if they get those symptoms, they should go to their doctor. We have worked to make sure that care is provided to them as quickly as possible, for hopefully a very small number of people.

Mr. Damien McCallion

The Chair also mentioned people who might not be technology literate. For the elderly population in long-term residential care, there was no requirement for people to use technology to get the vaccine. It was brought to them. For the other age groups, HSELive is there to support people to help them to register, or to register for them where needed. Approximately 10% of people have availed of that in the last week in the 65 to 69 group. That service is there and we have bolstered it to more than 500 agents who can support people. For the reasons the Chair has pointed out, not everyone will be familiar with the technology, or may have problems accessing it.

I want to go back to Professor Butler about the issues I raised earlier. Given the public interest in the availability of vaccines, with the momentum that is there now, how much of life and the economy is riding on the vaccine programme? Will she give an indication as to when they are likely to be able to give advice about the Janssen vaccine and also about stretching out the interval between vaccines?

Will Dr. Henry comment on the report on Dealgan House nursing home and the fact that two staff members who were vaccinated have now been diagnosed with Covid? Has that happened before? What are the implications?

If Professor Butler could reply first, I would appreciate it.

Professor Karina Butler

Certainly. I might address the Deputy's second question first if that is okay. I, too, saw that two healthcare workers had tested positive. That will happen because none of these vaccines is 100% effective for 100% of the population. If we look at different healthcare workers, the SIREN study in the UK found that they were 85%, and possibly up to 90%, effective at preventing infection. I do not know about these individual cases so I will not comment on them but the important point in that study is that the healthcare workers who did become infected were picked up through serial testing. They were not necessarily symptomatic and therefore they had mild infections. The corollary of that is that they will be less likely to pass on the infection. I noticed on a Twitter feed that these cases were picked up in serial testing as opposed to the workers presenting as ill. That is one of the reasons we say that, notwithstanding vaccination, we still need to employ public health measures such as masking and social distancing until we get the levels of virus down in the community. That goes to address some of the earlier questions, including how we manage people coming into the country, particularly if they have been vaccinated with vaccines that have not been authorised in the EU and where we do not have all that detail. However, even in the case of those who have been vaccinated, no vaccine is 100% effective for 100% of the population. The Deputy may have directed that question elsewhere but I thought I might fill her in on that.

In terms of NIAC, when we have been asked questions we have turned around advice and answers as rapidly as possible but we want to make sure we have the evidence needed to give the best answers. We know there are a couple of important pieces coming out. The first part is whether, when there is more detail on age-related risk, we will still need such broad brush strokes in the recommendations for the age cut-off. The second part is looking to get more granular detail. If we go with a one-dose strategy that stretches out vaccination for longer, is there a compromise that will be a problem in the future? We have to take those two issues into consideration. As soon as we have as much evidence as we can get to make a recommendation, that will be transmitted as fast as possible.

I appreciate that.

Professor Karina Butler

In other words, it is not about giving a firm date.

Does Professor Butler hope it will be some time next week or is she talking about a month?

Professor Karina Butler

I am definitely not talking about a month. We need these answers but I am not saying it will be tomorrow or the next day.

Would next week be a reasonable date?

Professor Karina Butler

We are hoping that the information from the UK will come on 22 or 23 April. We are looking at other evidence but we must bear in mind that there will be chops and changes along the way. There have been many turns. It would be wrong to have just one fixed course that does not flex with the evidence as it comes out. That causes uncertainty and living with uncertainty is hard. All of us would like a black and white answer to go forward and just do this. That would make it much easier for all of us but it would not be the right course. We will come back with advice as soon as we are asked and have the evidence. We know it is an important issue but it will not be before that.

I thank Professor Butler for that.

That concludes our business for today. This has been a very useful meeting, not only for the committee but for people watching the proceedings at home. I thank all the contributors.

The select committee will meet at 3.30 p.m. on Thursday, 27 April, to consider the Revised Estimates for Public Services 2021 for the Department of Health, which the Minister for Health, Deputy Stephen Donnelly, will present to the committee.

The joint committee adjourned at 5.35 p.m. sine die.
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