Dr. David Nabarro:

I will answer as best I can. The WHO has had a number of exchanges with the manufacturers of the Russian vaccine, the Gamaleya company, and it is continuing to seek from the very co-operative Russian manufacturers all the data that are needed for an emergency use authorisation. It is complex. For this process to go through, first one has to look at the vaccine and the results of the phase 1, 2 and 3 trials of the vaccine. Second, under the WHO rules that have been approved and requested by the national Governments of the member states of the WHO, a certificate of good manufacturing practice is requested from the manufacturer. All of these issues are being looked at. In regard to other vaccines that are going through this system, I cannot tell the committee when the effort will be completed. In regard to Gamaleya and Sputnik V, this is a work in progress that is being done with the greatest possible speed while at the same time maintaining the requirements for quality assurance, safety and efficacy.

Senator Joe O'Reilly asked about ensuring access for refugees and other disadvantaged people. It is important to stress that the COVAX scheme has been designed such that it includes capacity to ensure that when vaccines are available they get to disadvantaged and refugee communities. Deputy Berry asked about the situation where patents have been waived, to which I think Dr. McMahon gave a pretty good answer. I do not want to add to it. In 2002, I was working with the director general WHO and the Secretary General of the UN. The key issue is that company CEOs came to us. As a result of an environment which created some pressure, they came to us and I recall that eight of them said they were going to find a way to reduce their prices and to deal with the various concerns raised previously around doing so. The rest is history. What a transformative change.

On the question regarding whether pharma companies have agreed to voluntary licensing in regard to Covid vaccines, the answer is that they have. The agreement between AstraZeneca and Serum Institute of India or between Sanofi and BioNTech are examples of where this is happening. The key question that we all need to ask is what can be done to speed up things and make sure that the right amount of vaccines are available.

That brings me to Deputy Gannon's questions. He asked if wealthy countries were hoarding vaccines. I checked that with people who have the answers when I was getting briefed for today's meeting. It is not that wealthy countries have got a lot of vaccine. In fact, each of the wealthy countries that has a mass vaccination programme under way, including the United Kingdom and countries in the European Union, are short of vaccine. They are worried about supplies because they have made advance purchase commitments, which means they got an option on vaccine with the manufacturers but there is such competition for supplies among governments that have made pledges to vaccinate large proportions of their population as well as those who have made pledges to support COVAX. There is a terrible competition under way and I cannot underestimate the severity of this competition. One just has to look at newspapers in European countries right now to see, for example, the frustration being expressed towards European leaders that there is not more vaccine becoming available. That is creating a competition with COVAX. Quite simply, that is what is happening now. It is because the countries that are committed to vaccinating all their populations for the very good reason that they see this as the best way out of the pandemic are putting such huge pressure on the very limited supply that availability of COVAX is always in question. That is our difficulty.

Deputy Gannon brought up this point by asking if wealthy countries are hoarding. I do not want to use the term "hoarding" but they are certainly putting immense demands on the manufacturers in the current vaccine shortage to take vaccines away from COVAX so that they can fulfil pledges they have made to their citizens for widespread vaccination. This situation is very difficult. If a political leader has said his or her people will be vaccinated and after they have done the people most at risk - the health workers - they will go to teachers, then first-line responders like ambulance workers and then essential personnel like security guards, who have a lot of contact with people and we know have a higher incidence, it can be seen that the political pressure in Europe is huge, yet at the same time here are we, with COVAX, saying, as we have heard even in what has been going on here today, that the situation for health workers in poor countries is desperate. Thousands of health workers have died as a result of Covid-19 in the past year. Yes, we want to protect these health workers but there is this terrible conundrum, and I believe everybody sees it. Unfortunately, increasing the licensing and using the Medicines Patent Pool and C-TAP will not deal with the acute problem right now. The problem right now is that there is limited capacity. We are in a shortage situation. It should get better in the coming weeks and months but the competition for this small amount of vaccine right now is huge.

Deputy Gannon's question, and I do not want to answer it exactly as written, was how to get Pfizer to fulfil its responsibilities to COVAX. Pfizer has got responsibilities to a number of different groups which have made advance purchase agreements. It has also got shortages of production because, when vaccines are being produced, things do not work smoothly. Batches go wrong. Whole batches have to be thrown away. Pfizer has licensed the Serum Institute of India, a Korean company. It has also got its own plants in Europe and they are not all able to produce what is needed. Given the demand that is coming, often backed by lawyers from European governments and from the European Union as well as from the UK and, I am sure, from other countries in the world, and it is building up, it is super hard to understand precisely what is going on.

One concern is that COVAX works if there is transparency about pricing, delivery dates and to what degree the company is able to say that it did its best but could not deliver. Right now, we do not have full transparency, which makes life difficult.

In response to Deputy Gannon, the lack of transparency makes this difficult. What steps should the Government take to support the matters we are talking about? Everything that has been said in the chamber is right. This requires political action, not just within the nation but also across Europe and through the UN Security Council. There is a core question that comes back to members here, representing the Irish people, which is what the Irish people want. My colleague, Dr. Mike Ryan, who is the greatest Irishman working on infectious diseases, works as head of emergencies at the WHO. He talked to me last weekend as I was preparing and said that it is difficult because politicians believe that it is their job to always fight for the interests of their constituents, which, right now, is for as many people as possible to be vaccinated with a safe, effective and functional vaccine as quickly as possible.

Is there any way that we can get a message to politicians that perhaps the population of Ireland is prepared to look at an alternative proposition, which is for high-risk people in Ireland to be vaccinated now with whatever spare vaccines are available being shared with other countries in the world so that they can vaccinate their high-risk population? Once we have all high-risk populations vaccinated, then we can complete the vaccination of the adult population. This is a political dilemma. I do not know how one gets to know the mood of the population but there surely needs to be a test of what the people of Ireland and other European countries want right now, whether it is fairness for the world or trying to get as much vaccine as possible for people in the country.