Oireachtas Joint and Select Committees
Friday, 29 January 2021
Joint Oireachtas Committee on Health
Covid-19 Vaccination Programme: Update
Today's witnesses will provide us with an update on the roll-out of the Covid-19 vaccination. I welcome from the high-level task force on Covid-19 vaccination, Professor Brian MacCraith, chair; from the Department of Health, Mr. Fergal Goodman, assistant secretary, health protection division, and Ms. Elizabeth Headon, vaccine communications co-ordination; and from the HSE, Mr. David Walsh, work stream lead of the vaccination process and workforce, Dr. Lucy Jessop, director of public health in the national immunisation office, and Mr. Fran Thompson, chief information officer.
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.
Whatever the difficulties of rolling out the vaccine in Ireland, we should be mindful of the situation in the rest of the world, which the head of the WHO has said is on the brink of catastrophe. There are also concerns over what the German medical authorities have said about one of the vaccines. It is important for us to meet today and put some questions to the witnesses.
I call Professor MacCraith to make his opening remarks.
Professor Brian MacCraith:
I am grateful for the invitation. As I have sent in my statement, I will aim to be very brief.
I have been asked to comment specifically on the role of the high-level task force so I will make just a small number of points on that.
The overall objective of the task force is to support the Department of Health and the HSE in developing a strategy and implementation plan and to monitor the roll-out of, and provide strategic inputs to, an efficient and agile national Covid-19 immunisation programme. As the committee will be aware, the Covid-19 vaccination programme strategy and implementation plan were launched and published on 15 December. The programme has now moved into a live HSE operation with the commencement of the roll-out. The ongoing role of the task force is now to support the HSE and the Department of Health in planning amid uncertainty and in developing and testing scenarios that enable the vaccination programme to be adapted to a very fluid external environment. I do not need to elaborate on the issues surrounding vaccine supply. The task force itself has no executive authority or direct responsibility for the roll-out. The Minister and the Department of Health are responsible for policy matters, regulatory matters and funding. The operational delivery of the programme is the responsibility of the HSE under the leadership of its chief clinical officer, Dr. Colm Henry.
There are two main areas on which the task force delivers. First, the weekly task force meetings draw together expertise and inputs from the Department of Health; the HSE; the Department of the Taoiseach; the Chief Medical Officer; the National Immunisation Advisory Committee, NIAC; the HPRA, which is the regulatory body; the Irish College of General Practitioners; and others. This creates a very valuable forum for addressing all elements of the programme and ensuring full awareness of key risks and issues, which can then be addressed by the appropriate departments or agencies.
The second element is of ongoing importance. The task force is supported by a programme management office, PMO, led by a programme director, Mr. Derek Tierney. A key piece of work developed through the PMO is the programme planning roadmap. This is an integrated design tool which supports adaptive planning of the programme, for example planning for scenarios such as reductions in early deliveries of AstraZeneca vaccines and dealing earlier with the reduction in the number of Pfizer vaccines.
A key operating principle of the programme is that the administration of vaccines will be limited only by supply. The committee will be aware that there have been some challenges in this regard. Supply uncertainty remains one of the biggest challenges to the programme. Supplies continue to arrive, however, and we anticipate continuing to scale up the vaccination programme over the coming weeks and months. The programme is now firmly in operational mode, and a number of the programme's work stream leads are represented here today. The task force continues to meet weekly in its role as support to the Department of Health and the HSE, to monitor the progress of the programme and to ensure a strategic and co-ordinated response to any issues that arise.
I will now hand the committee over to my colleagues to discuss the details of the programme.
Mr. Fergal Goodman:
I am conscious of the committee's time constraints so I will perhaps keep to just a few brief remarks in order that we do not go over old ground all the time. As Professor MacCraith said, we are just four weeks into the programme now, and for very understandable reasons there is intense interest in it nationally and internationally. It has become a rolling story in some ways, and that probably makes it additionally difficult to continue in a straightforward way to plan and progress the programme under that spotlight. Operationally, for the HSE and for the Department, we want the focus to be very much on working through this programme and dealing with the evolving events. I think Dr. Colm Henry on the radio this morning - I do not know if anyone heard him - noted the constantly evolving nature of everything to do with the pandemic, and the vaccination programme, to an extent, is beset by the same challenges.
The priority from the start of the programme has been, first, to vaccinate and protect those who are at greatest risk from Covid-19 in terms of morbidity and mortality. They are, as we know, predominantly older people in residential settings in the first place, and we will shortly move on to older persons in the community as well.
As members will be aware, front-line healthcare workers, on whom the country has been, and will remain, so dependent, have comprised a group that has been addressed early. That work is in progress.
Regarding the challenges around authorisation of the AstraZeneca vaccine, we will hear from the European Medicines Agency, EMA, by early this afternoon. That will provide a point of certainty from which we can move forward with greater clarity about supply and deliveries. It will be another tool in our armoury, so to speak, with the Pfizer and Moderna vaccines already in use.
My colleague, Ms Elizabeth Headon, is with me today. The committee has identified communications and the communication strategy as an area of particular interest. The Department works closely with the HSE on the communications aspect of the programme. Work on it has been in train for several months. It plays out in phases as the programme progresses. It is crucial for the public to have confidence in, and understanding of, the vaccines; to be able to access accurate information easily; to receive relevant details at the level of the individual about when, where and how someone will receive his or her vaccination; and to feel confident in the administration of the programme. The Department has provided the committee an ancillary report outlining the press and broadcast advertising to date as well as social media and news coverage, which we hope members will find useful. There are high levels of public engagement with the communications channel, with 860,000 visits to the gov.ievaccine site and 414,000 visits to the hse.ievaccine site. Social media engagement has reached a figure of 2.5 million.
Fortunately, research carried out weekly for the Department has demonstrated growing public confidence in and demand for Covid-19 vaccination. In the early stages, there were questions about whether sufficient numbers in the population woulne, a number well up on what we saw last year.
There is a great interest in and demand for information. At times, it could be said that there is a frenzy of information. It is important that there be clear communication from all arms of the State regarding the importance of the programme and the fact that it is complex and being run and planned on a clear basis, as set out in the strategy and initial implementation plan. That plan is a living document and will continue to evolve as we get additional products, the quantity being received comes on stream and we learn more in Ireland and internationally about how the vaccines work in practice. It will be an evolving programme and will be a big job for most of the year ahead, albeit fortunately one with extremely positive prospects for the country as we vaccinate more of the population.
Mr. David Walsh:
I am joined today by my colleagues, Dr. Lucy Jessop, director of public health in the HSE's national immunisation office, and Mr. Fran Thompson, the HSE's chief information officer. Since the committee has my written statement, I will not go through all of it.
Vaccines are highly regulated products and the systems and processes put in place to distribute, administer and record their roll-out reflect this. As Mr. Goodman alluded, each vaccine is considered by the EMA, which then issues a conditional marketing authorization, CMA. This information is considered in Ireland by the national immunisation advisory committee, NIAC, which makes recommendations on the use of the vaccines to the Department of Health. The HSE is then asked to implement those recommendations.
The Pfizer vaccine comes in multi-dose vials with specific time constraints and cold chain storage conditions.
The national immunisation advisory committee provides the scientific and other advice regarding the management of the vaccine and this advice is updated regularly as more evidence emerges both locally and internationally about the vaccine. Each change in advice is rapidly acted on and updated guidance is issued to vaccinators.
The national immunisation office, NIO, leads on vaccine supply and distribution. In addition, the NIO develops and delivers training programmes for already experienced vaccinators via a range of channels including live webinars and the HSE's training portal, HSELanD. The NIO produces training and information material and distributes that material as well as providing ongoing support to the process.
Digital enablement of the programme is vital to its success. The vision is to have a fully digitally supported process from end to end covering all aspects of the vaccine programme. This is a challenging programme given the scope and timeframe for the roll-out. We are attempting to deliver a national digital programme, which would normally take approximately six months, within three weeks.
The three main processes that must be digitally enabled to have a successful overall offering include the pre-vaccination process, with a citizen registration portal to enable registration, scheduling and consent. Another is vaccine administration, including validation of citizens' identity, clinical workflow, recording of the vaccine, recording of adverse reactions, scheduling follow-up appointments and the production of a vaccine certificate. Another process is reporting and monitoring, which is critical and includes reporting and management of data, adverse reaction tracking etc. This delivery of the system and functionality is being undertaken in stages utilising an agile methodology. The process involves constant collaboration with the stakeholders and continuous improvement and iteration at every stage of the project. Integration of the individual health identifier, IHI, is critical to enable the HSE to safely administer the vaccine. IHI integration is now live on the system.
The core element for records about the vaccine has been operational since 29 December 2020. The system is operational across 680 healthcare facilities and is being used by 3,600 healthcare staff who are licensed users of the system. The general practitioner element of the portal is now live, which allows GPs to register to receive the Covid-19 vaccine. Once a person presents for vaccination, he or she is validated by an administrative staff member and then the person who is administering the vaccine records the details of the vaccination. The data are stored on the Salesforce system.
Progress to date includes integration of the system to the HSE service directory entries for more than 2,500 facilities including healthcare sites and new clinic locations. IHI integration is available, enabling access to real-time GP tables, professional ID validation and Eircode validation. The teams are working towards integration with GP systems to receive vaccine records. By Wednesday, 27 January, the HSE had administered a total of 161,500 vaccines across a variety of settings including long-term care and healthcare workers. The HSE will continue to roll out the vaccine programme in line with the Government strategy over the coming months in line with vaccine supply. The HSE works in an integrated way with the high-level task force on Covid-19 vaccination, as Professor MacCraith stated, and colleagues in the Department of Health, other Departments and a range of State, voluntary and private agencies to ensure that this programme is successfully delivered.
I thank Mr. Walsh. Members are attending virtually from their offices and cannot see the clock. They have ten minutes for the first group and seven minutes for the second. I will say when they have a minute left. We are learning as we go.
I welcome the witnesses. We acknowledge all the work done so far, particularly with regard to the front-line workers. We recognise the job they are doing at great personal risk to themselves and their families and hope this can continue.
We have come to a crucial stage in the fight against the virus. We need to keep public confidence on our side. The public needs to have absolute confidence in the ability of the system to tackle and deal with the virus. One way in which that will be achieved is by ensuring there is confidence in regard to supply chains of the vaccines. It would be very beneficial to have daily and weekly updates on the number of days or weeks of supply still available in the system and to relate that to the number of vaccinations taking place daily. That would reassure the public and it is a very necessary part of the process at this stage.
We need to be able to indicate progress in slowing down the virus, that is, the acceleration of the vaccination programme, while at the same time identifying the period, between the roll-out of the vaccination programme and the introduction of restrictions, by which it is presumed the virus is being curtailed. I acknowledge that we are gaining ground at present, as the recent figures indicate, but we had a problem over the past five or six weeks and we do not want to lose that progress.
Professor Brian MacCraith:
There is a twice-weekly announcement at the moment of vaccination figures and of the numbers of vaccines arriving and we are happy to share those figures regularly. The plan from the HSE is that once the IT system is fully up and running, there can be daily updates on the vaccinations. The whole system is driven by supply and it varies often. Since I started in this role, there have been up to ten changes in the information on the supplies of the various vaccines. We have a level of confidence for this quarter, although it was dented in recent days by the AstraZeneca issue and we are awaiting clarity on that.
We are sticking to the principle of administering vaccines as soon as they arrive. We work right to the edge of the supply that is available. No vaccines are resting in the fridges or freezers in any given week and I can share those figures with the committee. We have been adhering to that. As an example, in the three weeks up to Sunday last, the average number of vaccines administered per week was 48,000, which equates approximately with the volume of supply. We are adhering to the level of supply, therefore, and trying to manage the situation to keep a supply available for the second dose. As the committee will be aware, the three vaccines we are considering at the moment are dual-dose vaccines. I am happy to share the figures with the committee, and I agree with the Deputy about the public confidence issue and ensuring the vaccination rate adheres to the principle we set out.
Dr. Lucy Jessop:
As Professor MacCraith stated, we are closely controlling the vaccines but also sending them out as fast as possible. There have been times where we have got close to requiring the deliveries to be coming in for the next lot of vaccines, but we are trying to titrate the vaccines we send out and to ensure we can fulfil our obligations. Obviously, there were plans for the long-term care facilities to be vaccinated, so we ensured there was vaccine for all of them and for the second doses. It is a complex process to ensure we can meet all those commitments at the correct time.
We need to remember that vaccines are very complex and sensitive biological products.
The storage and distribution even when bringing them into Ireland can be difficult. Obviously, if there is a problem on a ferry or a difficult shipping crossing, the vaccines may not be able to get to Ireland on a particular day. It is, therefore, something we are always aware of and we are always watching to make sure we know what is happening with our supplies.
Mr. David Walsh:
I refer to the Deputy's question about daily reporting because I know that is a matter of great concern, not only to him but all Oireachtas Members. We are working towards that and it is our desire to do it. Obviously, the CEO of the HSE, Mr. Reid, is anxious to be able to meet the requirements around that so we are working through it.
As Dr. Henry said this morning on radio, we started the process because we had the vaccine and there was a requirement to commence vaccinating rather than wait for the system to be 100% ready. Therefore, we went with the functionality regarding being able to record the actual vaccination itself. We have, however, been working in quite a difficult environment across long-term care and hospital settings, which were not set up for system. We are still trying to catch up with that element of it. Perhaps Mr. Thompson might clarify exactly where we are with that at this point, which I believe would be helpful to all the members.
Mr. Fran Thompson:
As Mr. Walsh said, there were a significant number of issues around that and how we made sure it was recorded, especially in some of the long-term care homes. There are a wide number of sites across Ireland and many of them have little or no infrastructure for us to utilise.
There were also some challenges in loading some of the data because they are held by the nursing homes and some were a bit slow in providing us with them. We have the self-registration portal now working for healthcare staff. In the next week or two, we hope to be a position where will we have the solution and system in real time, or close to being real time, and, therefore, will be able to provide those figures to people on a daily basis.
When would it be possible to give a daily or evening news bulletin update on the extent of the vaccinations taking place and the percentage of the population being vaccinated? A daily or nightly update like that could be hugely important in reassuring the people. In the event of extra vaccines becoming available, the witnesses might consider providing daily information on news bulletins on the use of mass vaccination centres where it might be possible to accelerate progress, which is hugely important in reassuring the people.
Mr. David Walsh:
I will respond to those two questions. We are under significant pressure from our CEO and the Minister to achieve daily reporting as quickly as possible. Both operational staff and staff from Mr. Thompson's division are working hard to achieve that and are currently working through backlogs of data uploads.
To take members quickly through mass vaccination centres, our next targets are to finish off any residual vaccinations required in long-term care to go back to complete category 2 in the Government strategy, which is front-line healthcare workers. Given the numbers, that will be a precursor for mass vaccinations with mass vaccinations sites to follow as soon as supply allows, which I believe the Minister said is in March.
I thank the Chairman and welcome all our witnesses. I wish everybody well in the roll-out of the vaccine programme, including Mr. Walsh and his team, Mr. McCraith and Dr. Colm Henry, who is not on the call. Obviously, it is a difficult and challenging job. It is demand-led and supply-led in terms of the number of vaccines that come in.
I want to make one observation, first, if I can, picking up on some comments that were made in the opening statements. It is important, from our perspective, that we do not over-promise and that there is a clear link and connection between what is being said by those rolling the vaccine out on the ground and what is being said at a political level. I want to make that point first so that we do not overpromise in any of this.
It was stated by Mr. Goodman that there is a lot of intense interest in the vaccine, and, obviously, there is. I see that as important, something that we should value and something that we should seize upon because ever before a vaccine was approved or a dose came onto this island, the debate and question was whether people would take the vaccine. That question has been answered by the huge demand right across society for the vaccine. That is important. It needs to be recognised and valued and then we have a responsibility to deliver.
Professor MacCraith stated either in his opening statement or in response to a question that the supply depends on what we get from the various different pharmaceutical companies. There has been, the professor stated, ten different changes. We accept that as well. Obviously, to some degree the task force is at the mercy of the providers of the vaccine, but Professor MacCraith stated that there was reasonable confidence for the first quarter of this year in terms of supply. How does that measure with the Minister's assertions over the past number of weeks? The Minister was making these assumptions based on the AstraZeneca vaccine arriving. There has been a revision of that because of the dispute between the European Commission and the company. The intention was for 700,000 people to be vaccinated by the end of March. Is that still the case?
Professor Brian MacCraith:
The assurances we had received indicated 1.4 million doses across AstraZeneca, Pfizer and Moderna. Naturally, the simple calculation is to say they are all due to those vaccines and that leads to 700,000 people being vaccinated. However, as we have learned in recent days, AstraZeneca has indicated a significant drop at this stage. Currently, that 1.4 million doses has reduced to just above 1.1 million doses while we await the outcome of the negotiations between AstraZeneca and the European Commission.
Professor Brian MacCraith:
That is by March. If I could clarify, there is due to be a second delivery in March from Moderna which the company will not clarify until the outcome of the negotiations, and we just do not know what the total will be. The current confirmed total up to the end of quarter 1 is 1.1 million doses now but that may change today. It may change tomorrow.
I want to put a number of question, if I can, to Mr. Walsh. I thank Professor MacCraith for that. I will focus, first of all, on the information technology, IT, system. I note in the opening statement there is still some work to be done for this to be a fully operational and fully live system.
I refer to the first and obvious question that is being asked of us. When we get to the third allocation group, which is the over-70s, starting with the over-85s, questions will be asked as to how the system will work and how people will be contacted. Is it the case that the person, for example, let us start with the over-85s, has to contact his or her GP or the system, or does the system contact the individual? Could that be answered first by Mr. Walsh?
Mr. David Walsh:
The over-85s are a particular group that needs to be given all due consideration. They place their trust in their GPs and, as have seen through the flu vaccination programme, what worked successfully was where GPs contacted their over-85s and called them in for vaccination. The intention is the same process will apply in relation to Covid-19 vaccination.
Mr. David Walsh:
Yes. As one works one's way down that list, there are many people well over the age of 70 who are very active and very mobile, and, indeed, in their 80s and 90s as well.
The intention is to use the GP network and that bond of trust to maximise the uptake in the older age groups, and that is our absolute target.
I get that. For the over 70s, the GPs will contact the people themselves and that is how that will work out. For the general population, there was a promise of 15 mass vaccination centres or pop-up centres. Have we locations identified for those sites? When we get to that point, how will the IT system work? Is it at that point that people will have to contact the system because, obviously, that will be more problematic or difficult? Again, how will the system work? Will people have to contact the vaccination centres and make appointments? That is the first question.
The second question is in regard to staffing. How many people have come through the training process for vaccinators and support staff who will be in place for the mass vaccination centres? Are we looking at Army personnel with medical backgrounds? What is the capacity we are looking at?
Again, in regard to site identification, is that in train and what timeframe are we looking at for these vaccination centres to be in place?
Mr. David Walsh:
I will answer those questions in sequence and I might ask Mr. Thompson to help me with some of them. The critical functionality, not only for mass vaccination centres but for the broader staff vaccination process, is to finalise the online portal so people can go on and register on the system, giving the relevant details required for the process. Second, the system will then schedule someone for a vaccination once they have been registered appropriately, and then, third, schedule them for a second vaccination because we are still dealing with multi-dose vaccines. The same will apply for mass vaccination centres or more local centres, when they are open.
In terms of training, and I will seek clarification on this, the last figure I saw was that in excess of 5,000 people have completed the top-up modules in regard to the Pfizer vaccine vaccinator training.
That is welcome and it is a lot of staff. However, there are questions being asked in regard to the role of pharmacists. There are 2,500 pharmacists, who, obviously, can play a crucial role. The Minister said yesterday in the Dáil that dentists will also play a role, which is great, and it is all hands to the pump as far as I am concerned. However, the Irish Pharmacy Union is concerned that pharmacists have not had any assurances in regard to when their staff will be vaccinated and when they will be part of the vaccination process. My understanding is that, from what they have been told, pharmacists may not be part of the roll-out for the over 70s, and there is a concern that GPs will be part of it but not pharmacists. I ask Mr. Walsh to give clarity in regard to the role of pharmacists, first, in regard to when they will be vaccinated, and, second, on their role in regard to the vaccination programme. Third, if pharmacies are not going to play a role until we get beyond the over-70s, when the Minister says dentists will play a role, at what point will they come into the equation as well?
Mr. David Walsh:
I may ask Mr. Goodman to comment on some of the issues in regard to who can act as a vaccinator and the regulatory environment around that. Pharmacists potentially have two critical roles within the overall process. One is that, for larger-scale clinics, pharmacists can add immensely to the efficiency of the operation of those clinics through their participation in the cold chain and, also, in the reconstitution of the vaccines prior to administration. Second, community pharmacy will definitely have a very large role in the overall roll-out of this programme. When we consider the numbers, although I do not have them in front of me, if there are nearly 500,000 people over the age of 70 in the country and our target for vaccination is ten times that figure, I think community pharmacy will have a huge role.
I have started my timer, which is set for ten minutes. Before I go into the preliminaries, rather than get a written answer I will reiterate the question Mr. Walsh did not completely answer on the role of pharmacists in the roll-out of vaccines to the over-70s.
Mr. David Walsh:
We started off with the over-85s. The clear relationship there is between the GP and the older person. There is potential for people over the age of 70 to access the pharmacy line once that is set up, but from my own experience, in particular for the older group, the GP option is the one that they seek.
Deputy Cullinane also asked about the vaccination of pharmacists. It is a priority that people who act as vaccinators are offered the vaccine. Prior to commencing as vaccinators, GPs are currently being offered vaccination, as are their practice nurses, and the same will apply to pharmacists prior to them being asked to act as vaccinators. They are also front-line healthcare workers in their own right, so as part of the second category in the Government's strategy, they will be offered vaccination in the coming weeks.
I welcome the witnesses and thank them for their public service and dedication in recent months and the work they are doing. Generally, the debate and discussion on the issue needs to calm down a little bit. This committee meeting could serve a useful purpose for a resetting of the clock. It is not useful or helpful to talk about overpromising. What was said was based on figures that were available to us at the time. We are all disappointed about AstraZeneca. It is 29 January and I suspect by 27 or 28 February we may be in a different position given forecasting about other vaccines.
I am very grateful to Professor MacCraith for the clarification of his role. From a communications point of view, between the high-level task force, NPHET and all the other bodies, one voice would be great. Professor MacCraith has the co-ordinating role, so he has the benefit of having all the knowledge and information from the various inputting bodies. We could use today as a reset. We had expectations because of circumstances beyond the control of everybody. Those expectations are not going to be met, certainly by AstraZeneca. We should not be afraid of overpromising. There is really good news about Novavax. I would welcome any news Professor MacCraith has on Johnson & Johnson and its vaccine in terms of timelines.
Professor Brian MacCraith:
I thank Deputy Lahart for his comments. I spoke to the European lead of Johnson & Johnson. The name of its vaccine is Janssen. It is expecting to announce the clinical trial results in the coming days and to submit to the Food & Drug Administration, FDA, in the first instance in early February. What normally happens is that the submissions to the European Medicines Agency, EMA, would happen not too long after that. We are hopeful of a positive outcome for Janssen. It is very attractive because it is a single dose vaccine. We hope there will be a positive outcome some time in March but these things remain uncertain.
I accept that. I had questions on pharmacists and dentists. Again, there was a big frenzy. I have had emails. All of the questions have been answered very calmly. There is an answer to all these questions. Media abhor a vacuum.
One of my key messages today is that everyone should just calm down. The questions get answered. The questions the pharmacists have had have been answered reasonably cogently this morning. Politicians have a role in this. Everyone is anxious to receive the vaccine. I wish to clarify and confirm that the deadlines for the vaccine commitments up to the end of February will be met. It is my understanding that up until the end of March there is an issue but that up until the end of February the task force is on target, supply-wise.
Mr. Fergal Goodman:
I want to come in on a point which might help to round out that issue about the role of pharmacists,. The arrangements we have come to between the State and general practitioners and pharmacists on fee arrangements provide for two scenarios. One is where the professional is providing the service in his or her own premises, in other words, a GP surgery or community pharmacy. There is also an arrangement whereby the HSE takes on vaccinators or brings people in to do sessional work in a mass vaccination centre. General practitioners and pharmacists can both fulfil that role as well so we have an arrangement in place that covered both options. It provides flexibility and reflects the fact that we cannot predict exactly what the balance we will need will be as the programme develops.
I thank Mr. Goodman. There has been talk about overpromising and people being overly critical. I want to emphasise the message that the system needs to be given an opportunity and time to respond. I am satisfied so far with the answers we have received this morning. On the roll-out by GPs and pharmacists, does it apply to the AstraZeneca vaccine only? What other vaccines that may come on stream might be administered by GPs and pharmacists? To clarify, I take it dentists may assist those teams in the mass vaccination scenario so I am inquiring about GP roll-out for other vaccines.
Professor Brian MacCraith:
Maybe I will start with that and ask Dr. Jessop to give further detail. Obviously, an awful lot depends on what we hear today about the AstraZeneca vaccine and whatever determination the European Medicines Agency comes to in that regard and also whether it makes any comment on the age dimension, a bit like what we have heard from Germany. Absent that, the original plan was certainly that the AstraZeneca vaccine would be used, through the GP network, to address cohort no. 3, which is the over-70s. If for any reason that does not happen, the contingency plan at this stage is to use the Pfizer-BioNTech and Moderna vaccines for that cohort.
Professor Brian MacCraith:
Depending on the scenario that emerges today from the European Medicines Agency, we were looking at mid-February for both scenarios but that could shift forwards or back by a week. There are other factors which might emerge today in terms of the dosage interval as well. All of these factors add to the uncertainty. Part of the work the task force is doing is to model through those very scenarios and then give advice to the various aspects of the structure the committee heard about earlier on. Perhaps Dr. Jessop can add a bit more-----
I am coming to the end of my time. The key issues that have concentrated the minds of people are the roles of GPs, pharmacists, dentists and others and questions about the establishment of mass vaccination centres. We have confirmation, insofar as it is possible, of the continuation of supply, as promised until the end of February, and we have also learned that the best approach is to take this day by day.
Admittedly, there has been an interruption in the supply of AstraZeneca vaccine that was committed to but there is good, positive news on Novavax and Johnson & Johnson, which may bring us better news in March. There have been too many voices in this debate. The information we have just received is excellent. I look forward to the witnesses appearing before the committee again. If we have learned any lesson since the vaccination news was launched, it is that we must take it day by day. Every question that stakeholders and other vested interests, including the community and individuals, have had gets answered. The answers may not be the answers people want but the questions are answered. I thank the witnesses for the work they are doing and all the agencies they co-ordinate in the teeth of the most challenging of circumstances. It is very much appreciated.
I thank all the witnesses for attending this morning. At the outset, Professor MacCraith pointed out how uncertain the situation is. We all appreciate that. It is very fluid and it is changing by the day, if not by the hour. There has been news today that could be quite a game-changer, depending on how it goes. We all accept that, and it is important that people be reassured, but the best way to give people reassurance is to provide up-to-date, factual information because the goalposts are changing quite a bit. It is important that we do not raise people's expectations unrealistically. That is where accurate information comes in. It is really important that it be provided to the public generally and also to us. As health spokespersons and as a committee, we have really struggled to get our hands on up-to-date, accurate information. There is the weekly session in the Dáil but we have not got too much information from that. What is the basis on which we are approaching this? We need to be absolutely up-front with people and provide up-to-date, timely information.
This raises again the question of whom we must contact when we want to get information about vaccines. That is a genuine difficulty. I appreciate the attendance of all the witnesses this morning, but the reality is that the lead person in this area is not present today. There is something wrong with that. I accept that the lead person is very busy, was on the radio this morning and has a huge amount to do — too much, in my view — but, again, I return to the issue of governance and the question of whom the buck stops with. While it stops with the Minister politically, whom does it stop with in terms of the operations? There is a problem in that regard.
With regard to accurate and up-to-date information, we are now getting figures twice weekly on the numbers of people vaccinated. Professor MacCraith said we have the figures on the numbers of vaccines delivered to the country or in the country at any one time. It is important that we get that information and that it be put on the website of the Health Protection Surveillance Centre, HPSC. It would be great if it could done daily. I refer to the number of vaccines we have received in the country and how many have actually been administered. It would be great to get figures daily but even twice weekly would be a big improvement. Professor MacCraith has said he has those data and is happy to share them. Will he share them publicly on the HPSC website?
My second question relates to AstraZeneca. Obviously, there are major concerns over the reliability of the delivery. If the vaccine is approved by the European Medicines Agency today, is there an expected delivery schedule? Can it be provided to us in the quantities expected?
Professor Brian MacCraith:
Perhaps I can take some of those questions. My understanding is that Dr. Henry did not get a formal invitation to attend. In any event, I had asked whether he might be able to join me here but he had another major commitment. I believe that is the reason he is not here.
In response to the Deputy's question about up-to-date, factual information, I will set out the current position in respect of the regularity of vaccine supplies. Vaccines come in from Pfizer once a week; from Moderna they come in approximately fortnightly. I say "approximately" because in both cases we get confirmation, typically 48 hours in advance. Mr. Paul Reid, CEO of the HSE, has been announcing those numbers at least weekly at his press conferences. I imagine the HSE would have no problem in sharing those numbers. Sometimes the way the system works, in terms of the buffer we try to maintain to cover the second dose, is not fully appreciated by everyone. One has to explain the difference between the number of vaccines that have arrived and those that have been administered at a given point. I am pretty certain the HSE will have no problem in sharing those figures.
Professor Brian MacCraith:
The total expected delivery for AstraZeneca for the month of February is 190,000 doses, split over three deliveries. We do not have absolute certainty on those deliveries yet. I spoke to AstraZeneca's country lead as late as yesterday evening. We expect to have a delivery in mid-February and one in late February. The totality has been confirmed twice this week and comes in at 191,000 doses, which is approximately what we were led to believe anyway. That does not affect our planning. The issue is the uncertainty from March onwards.
Professor Brian MacCraith:
The only figure we have been given is 95,000 for March but that is one of two or three deliveries. They will only confirm at this stage the 95,000, which is the first delivery. As the Deputy will understand, it is all tied up with the negotiations and the potential reductions. The totality for quarter 1 now is 286,000, where we had been planning and expecting 600,000. That gives the approximate 50% reduction.
Okay. Maybe the Chairman will not include the time he has spent speaking to me.
How many residents and staff in nursing homes are yet to receive their first dose? What is the estimated timescale for completion of both doses to residents and staff in nursing homes? Are there contingency plans in the event that the EMA today recommends that AstraZeneca is not given to over-65s and will Mr. Walsh share those contingency plans?
Mr. David Walsh:
I will start with the question on residents and staff in long-term care. Taking it in chunks, there are four HIQA-registered nursing homes which have not been vaccinated yet on public health advice due to the scale of their outbreaks. That includes both staff and residents - approximately 400 in total. There are probably slightly more staff than residents in that, given the staffing ratios.
There are 117 nursing homes where substantial numbers of staff and residents who could not be vaccinated because they were either actively ill or within four weeks of having been ill. Some of those facilities are emerging from that period so our next task is to plot how we will go back and catch up on all those missed people. I do not have the total figures from those 117 homes but I will seek them.
This week, we are working through psychiatry of later life services, vaccinating those over 65 years of age, and disability facilities. We will have completed all residents over 65 years in those settings this week but we will still have a substantial number of staff to vaccinate in those settings and we will commence doing so of the coming week. I can get more specific figures and send them to the Deputy directly.
I have three questions. I will run through them in order to give the witnesses as much time as possible for answers. The first relates to priority for people who may be under 65 years, those with heart conditions, respiratory illnesses and so on to receive the vaccine. I am trying to understand how vaccines will be administered to these people. It seems that GPs will recommend them to be vaccinated, but we do not have full GP coverage throughout the country. In addition, there will be many who will be in contact with consultants and might not be in regular communication with GPs. Is it the case that GPs must trawl through their own files and then contact people or should those who do not have a GP find one? Should people contact GPs themselves? What is the capacity among GPs in terms of making contact with people? Some have huge numbers of patients in their practice who the may not see that often as those patients mainly deal with consultants. We may not have talked much about the IT system this morning, but I am thinking of GPs' practices and trying to understand the IT set-up, whether the GPs are administering the vaccines themselves or referring patients on.
Also on priority groups, the list puts an order with healthcare workers, front-line workers, special needs assistants, those over 70 years of age and those over 85. There will be thousands of people in some of those groups. Will there be prioritising of vaccinating within those groups, say a healthcare worker with an illness or who is particularly vulnerable? If that is happening, how is it going?
Finally, I have been trying to understand how the IT system will work. From the early system I saw, it seems that people will be required to create a new account for the vaccination process. The MyGovID system is intended to be used for exactly this kind of purpose. In order to avoid the creation and maintenance of yet another single-purpose database containing millions of citizens IDs, will the HSE use the existing MyGovID system as the means to login to the vaccination management system?
Mr. David Walsh:
I will comment first on people with chronic illnesses - Mr. Goodman may assist on this - and the system in place for GPs to take on a lot more of the care burden in respect of certain chronic diseases.
With regard to GPs, I accept there may be exceptions but, in general, GPs keep a very close eye on their more vulnerable patients and are probably the best source of data and information in terms of joined-up registers of who is within their locality. The Deputy is correct, however, in that if people are falling through the cracks, we need a means of making sure they are brought back into the system. The same applies to people who are housebound and may not be able to attend their GP clinic. We need to run through a range of scenarios to make sure that people are not excluded by virtue of their condition when, on the face of it, there is all the more reason there should be-----
Mr. David Walsh:
Not currently, but there will be a mechanism to ensure that no one falls through those cracks.
I will answer the Deputy's third question in terms of prioritising within healthcare workers. There are senior occupational health and public health staff within the HSE working on an orderly prioritisation of healthcare workers based not on their grade but on their risk of exposure to Covid-19. That would apply regardless of their setting or employer, whether they are public, private or voluntary, self-employed or part of an organisation.
Mr. Fran Thompson:
Yes. I will go to the GP solutions first. We have been working with the GP vendors to make sure that their solutions can accommodate the vaccine. The GP vendors and the solutions today are very good at managing the influenza vaccine and the cohorts. They have functionality within the system to allow them to call in and manage the cohort. We are working very closely with them. In round figures, there are approximately 2,700 GPs for whom the system will have to be updated and rolled out to those people, and the GP vendors are in the process of doing that.
The Deputy also asked about the use of MyGovID. We have been in discussions with the Government Chief Information Officer, CIO, on the best way to do that. On our side, we took a decision that it is something we would like to do in the future, but for simplicity and speed we said we would allow people to register using their own email address and their own password, because in terms of trying to link that into MyGovID, and not everybody today has a MyGovID, we reckoned we were trying to make it as frictionless as possible for people to do that registration.
We are also very keen to make full use of the individual health identifier, IHI, and that, when we are registering people, we are assigning their IHI into the vaccination system to ensure we can uniquely track and trace them all the way through. It is a very good use of the IHI in this instance.
My first question is to Mr. Walsh. At any given time there is a certain amount of vaccine in the State. What is the situation with surplus vaccines? On any particular day is there a surplus available if there is an issue with either transportation or the roll-out? If there is a surplus of vaccine per week or per day, how can it be sourced?
Mr. David Walsh:
It is fair enough to say that there is not a surplus as such. Every vaccine we currently have in the State is assigned against a day's vaccinations. The National Immunisation Office has a very difficult job in managing that to ensure that on a given day sufficient vaccine is deployed to vaccinate those people we have committed to vaccinate. On occasion, because of the success in getting a sixth or seventh dose out of vials, there may be a very small local surplus after a day's vaccinations. Guidance has been given out to the system because this has to be used or discarded once it has been reconstituted. Very clear guidance has been given on how that is to be used to vaccinate priority front-line healthcare workers. That is quite small-scale. The National Immunisation Office and the suppliers do a great job in trying to juggle from day to day, especially at this time while vaccine supplies are so tight, to try to meet the commitments we have made. It is very tight.
My second question is to Professor MacCraith. I say very sincerely to him that Ireland obviously as a vast pharmaceutical industry. We have one of the most advanced pharmaceutical sectors in the European Union. If patents and intellectual property were not in the way, could the production of vaccines be ramped up in any way by our pharmaceutical industry, given that thus far €5 billion in public money has been spent on the three vaccines - those produced by Pfizer, Moderna and AstraZeneca - that will be available to the majority of people in the EU and beyond? Can Professor MacCraith see any way that the pharmaceutical companies in Ireland and other countries could, particularly in view of the fact that €5 billion has already been given to them, ramp up production to give us more vaccines to roll out as quickly as possible?
Professor Brian MacCraith:
That is a real and interesting question and it is already out there. The Deputy may have seen the announcement earlier this week that Sanofi has agreed to take on the manufacture of extra vaccine supplies for Pfizer. This is highly unusual in a highly competitive industry. In anticipation of this question, I have spoken with IDA Ireland, which is in regular contact with all the pharmaceutical companies here. Ireland has benefited from the fact that some of the pharmaceutical companies have shifted the manufacture of other elements to plants here to make way for a focus on the vaccine in other locations. The key issue is that IDA Ireland is in direct and regular contact with all the relevant pharma companies in relation to the totality of their global supply chains, and to see if an opportunity exists. That dialogue is ongoing but there is nothing to report in actual developments on that matter at this time.
There is capacity and this scenario could apply to the pharmaceutical industry in Ireland, particularly in view of what Professor MacCraith just said in the context of what is being done with the Pfizer vaccine.
Professor Brian MacCraith:
My knowledge is that the pharmaceutical companies here have benefited from the fact that the global network of the pharmaceutical companies, the headquarters of which the Deputy will be aware would be in other countries, have taken on extra activity here to allow those companies in other locations to upscale and focus on their activities. IDA Ireland is in regular daily contact with these companies to explore opportunities as they might arise. I cannot say any further than that in regard to IDA Ireland, but I did raise the question.
I thank all of our guests for the work they have done and continue to do. I also thank all of our front-line staff throughout the country, be they in GP practices or in hospitals or public health nurses.
I would like to touch on one or two issues. The first issue is the people who have a particular illness, which has been touched on already by Deputy Hourigan. I refer in particular to people who are on dialysis. Yesterday, I met a parent whose son is 33 years old and has lung cancer for which he is receiving chemotherapy. People in receipt of such treatments and those on dialysis, for which they are required regularly to attend hospitals, are very concerned about their access to the vaccines. Are there plans to co-ordinate with the hospitals in regard to vaccination for people who are at-risk patients? Many of these people are not necessarily attending their GP and as such their vaccination will need to be co-ordinated through the hospitals.
My second question is in regard to Johnson & Johnson and the roll-out of its vaccine, if approved. The advantage of this vaccine is that is given in one dose rather than two. Its approval and availability would greatly fast-track the vaccination programme, but I understand the earliest it will be available is some time in May. How many people could benefit if that vaccine were made available and in what timescale, on the basis that it is a one dose vaccination?
Mr. David Walsh:
I will take the first question. On vulnerable patients, there is a considerable amount of correspondence from various senior clinical people across the system to Dr. Henry in regard to the issue. It is important to understand how the current schedule came about, which, as I understand it, was on the basis of a recommendation from the national immunisation advisory committee, NIAC, to the Department and onwards to Government. This is where the current scheduling came from. With regard to when the particular cohort mentioned by the Deputy will be reached, as I said earlier, if we can capture the majority of people through GPs or pharmacies, that is the way to go, but we need to make sure people do not fall through the cracks. I recognise that there are a significant number of groups that may not agree with the current scheduling and have written to us in that regard. I am not aware of any process of review or anything like that.
We will continue to follow the current schedule and maximise the number of vaccines we have to deploy in order to get to those groups as quickly as possible, recognising that where there are exceptional circumstances we will have to put in exceptional measures to make sure that those people can get their vaccination.
The Johnson & Johnson question might pass on to Professor MacCraith.
Professor Brian MacCraith:
I thank Deputy Burke for his question. We would be slightly more hopeful than the Deputy that it might happen in April, even, at best, perhaps late March. These things are not predictable. The key point relates to the early results that we expect to hear in the next ten days or so in terms of their clinical trials.
Ireland, through the advance purchase agreement, has signed up at this stage to 2.2 million doses and they will be distributed across quarters 2, 3 and 4 of this year with the estimated peak in quarter 3, but we would expect, perhaps, in quarter 2, to have many hundreds of thousands. Again, these things are uncertain. That would be good news and all of those single doses would be single individuals not having to come back for a second dose.
I refer to people on dialysis. I am not taking away from people who are in nursing homes as they are an extremely important group but people on dialysis are also a very vulnerable group, in particular, because many of them attend hospital three days a week and have someone collecting them and someone dropping them home. I wonder if that would be looked at and if they would be included at a very early stage rather, as is now planned, in group 7 of the programme.
Mr. Fergal Goodman:
I will not talk about the dialysis group per sebecause that, as Mr. Walsh has said, is probably reflective of many groups of patients with one condition or more and cases continue to be made that they should be selected out and given an earlier access to the vaccine. As colleagues have made clear in the discussion so far, we are dealing with an extremely limited supply confidence and for the next small number of months we hope we will be concentrating on the initial groups. As we get supply, quarter 2 will look very different from quarter 1. I am not referring to any patient group here but trying to paint a picture of how we see things playing out. As we get to have a greater range of products and much more quantity to work with, we will quickly go down this list. These are not all large groups in the Government table of allocation strategy. It is only when one gets down towards the bottom part of that that one is into what my might call the other 4 million of the population. Probably the first million is encompassed within the first ten or so groups. We will make our way through those as rapidly as we can subject to supply. The difficulty, when supply is so limited, is selecting out groups on an ad hocbasis.
On the sequencing, as colleagues have said, this was developed through a process with the advisory committee. An ethnical framework is also applied to ensure it is appropriately balanced. The Government signed off on this. As everyone appreciates, we needed a framework like this because if we had not had it, it would have been an untidy position to manage. It is, should the Government decide to do so, open to be reviewed, probably through the same type of process through which it was developed, but it is not something that the Government sees as being reviewed regularly on the basis that one has to let it run out. As we learn and have more options available, we may be able to take a look at it again. The essential prioritisation, as we know, was based on the risk profile for groups of people.
I have a few quick questions for Professor MacCraith, after which I will ask some general questions. When did the Minister for Health tell Professor MacCraith that he was accelerating the nursing home vaccine roll-out that he announced on 8 January?
Professor Brian MacCraith:
The dialogue regarding the decision involved the Minister talking to the HSE so we learned of the process through that. We think everyone recognised the interest in addressing residents in long-term care facilities as quickly as possible given the external situation. As regards an exact date, I do not have that information but I am sure we can come back to the Senator, through the HSE, on when that initial dialogue took place.
Yes. It would be great if Professor MacCraith could come back to me on that because in a briefing to Oireachtas Members and journalists he indicated that it would be prudent to keep a buffer of vaccines. Obviously, when there was a change of tack that buffer was used up quickly. The timeline from when Professor MacCraith said it would be prudent to have a buffer and the Minister changing tack and using up the buffer seems to have been quite tight.
Professor Brian MacCraith:
I will certainly come back to the Senator. The buffer was there for a reason. In terms of the risk of the situation we are dealing with, the decision was taken to move forward and compress what was, essentially, three weeks of vaccinations in long-term care facilities into two weeks. That has worked well, even in the light of all the outbreaks. I can come back to the Senator on those issues.
That would be great. Front-line workers around the country were told that their vaccination appointments were cancelled on the day the acceleration was announced. In Our Lady of Lourdes Hospital, Drogheda, they were told on 11 January and the Dublin Fire Brigade and paramedics were told on 13 January. The reason was the nursing home acceleration. Was it a good idea for the plan to change so suddenly and create a sense of disarray among front-line workers?
Mr. David Walsh:
It is an important issue. The nursing home vaccines were always allocated. We knew we were going to use them and we just drew the timeframe forward by one week.
On front-line healthcare workers being vaccinated through hospitals, there was one extremely busy week. I do not have a calendar in front of me to allow me to specify which week that was. Many hospitals had arranged clinics in the expectation that they would continue to receive supplies at the same level. That was never going to be possible given our supply constraints. A number of the clinics that the hospitals had prospectively arranged were then deferred. We are now planning for the recommencement of those once we get through the second doses that are already scheduled for the big first group. By the middle of February, we will be flat out again vaccinating priority front-line healthcare workers.
Mr. David Walsh:
No, I do not think so. As I said, there was one big week of hospital delivered healthcare worker vaccinations. Similar to the nursing home vaccinations and our acceleration of those, the number of healthcare workers vaccinated that week was actually ahead of what was planned. I cannot recall the exact number but it was close to 40,000, which is a significant number. That was done because of the amount of pressure in the hospitals, the amount of disease they were facing and to get that programme under way.
We were always doing the nursing homes. I do not believe it is true to say that a vaccine that was going to go to a healthcare worker went to a nursing home resident instead. It is also important to remember that of all the vaccinations done in long-term care, in excess of 50% went to front-line healthcare workers in those homes.
That is interesting because only a week ago Mr. Paul Reid spoke about this at the HSE briefing. When asked if the nursing home acceleration had led to the cancellation of front-line staff vaccinations he said that was practically what happened. It is interesting to hear the two different perspectives.
Looking back, what if the HSE and hospitals had known what they know now about the shift that was going to happen and the acceleration? This is not a debate about who should or should not get it. Decisions are made and that is fine. Do the HSE officials believe that those hospitals would have been stricter in ensuring that the most at-risk healthcare workers got the vaccine if they had known their supply was going to be changed? We know of some of the scandalous stories about hospitals giving vaccinations to people who were not necessarily on the list first. Do the HSE officials believe that if they had known that it would have been somewhat stricter?
Mr. David Walsh:
First, I echo what Dr. Henry and Mr. Reid said in respect of cases where non-priority healthcare workers were vaccinated. That simply should not have happened. I think what hospitals did, quite rightly, was maximise the opportunity they had. There were some errors made and they cannot be repeated. Anyway, from the middle of February or earlier we will be back vaccinating those workers in big numbers and in strict adherence to the categories as set out in the Government strategy.
I warmly welcome all our witnesses today and thank them for all their hard work at this extremely challenging and stressful time.
I welcome that the HSE, along with other agencies and bodies, has created a strategy to promote accurate information around vaccinations nationwide. However, I am concerned and I believe we cannot ignore the fact that there is a need for a public health strategy in marginalised communities. We all know that marginalised communities can be bombarded with false information and scaremongering when it comes to vaccines. It is important that we develop a clear pathway to positive factual information and access to the vaccine.
I imagine the witnesses are aware of Safetynet, which is a primary care facility for marginalised people in society who do not have access to healthcare. They have reconfigured to respond specifically to the coronavirus pandemic. The facility has created a mobile health unit. Those involved have built strong relations with the homeless, migrant and Traveller communities in recent years. The services they offer are more important than ever now.
We know poor health rates are high in marginalised communities. We need to come up with a good proactive strategy to combat this with the help, hopefully, of Safetynet and more mobile health sites. Can we plan to strategise with Safetynet in the coming weeks to promote access to information on these vaccines within these communities? What are the thoughts of the witnesses on that? I believe those involved provide an important service. I have one more question after the response, if that is okay.
Mr. David Walsh:
I smile when I hear Senator Black refer to Safetynet and I think of all the people involved, including Dr. O'Carroll and all his colleagues who work in that service.
I would also add Dr. Margaret Fitzgerald from our public health department who works very closely with them on those very vulnerable groups. She is working hard to put together the strategy the Senator spoke about.
Regarding priorities and vulnerable groups, homeless people and other marginalised communities are a very clear consideration and form part of our current thinking. People living often in congregated settings, including hostels, are incredibly vulnerable. We are trying to put together a plan to address that specific need, working clearly with Safetynet Primary Care and other similar smaller providers throughout the country.
Deputy Hourigan touched on this and I want to express my anxiety on it. We know of the Government's categorisation of key workers under its roll-out plan. However, SNAs are not considered key workers. UK research shows that SNAs cannot socially distance and have increased risk of contracting Covid-19. Will SNAs be included with healthcare workers for vaccination? Similarly, will personal assistants for people with disabilities, whose work by its nature requires close contact, be vaccinated under the front-line healthcare worker category?
Mr. Fergal Goodman:
I do not have anything to add. The SNAs are in group 9 or group 10. I am not aware that any formal proposition has been put for consideration. As we are all aware, there is much discussion about what would be involved in restarting education. There has been no discussion or proposal on whether vaccination would be part of that. It is not being considered as far as I am aware.
I have been following the debate all morning. I reiterate what my colleague, Deputy Lahart, said. It is very important to bring some calmness to this debate and certainly in this forum. Terms such as "overpromising" and "kicking a political football about" do not help when many people are on oxygen support this morning and are battling Covid. I hope we will see AstraZeneca and all the other vaccines we need come through the supply chains right down to community level in the country in the quickest possible time.
I thank those who have joined us from the HSE. They are doing a very difficult job. Many of the difficulties that have presented in the past three or four days are not of their creation. It is a supply chain issue, which will largely need to be hammered out at European level in the coming days. As we have done at each meeting of the joint committee, I acknowledge the immense work by our front-line health service staff.
Mr. Goodman might be in the best position to answer my first question.
In the context of the roll-out, from national level right down to county and local health level, I am very concerned that a large cohort of the mental health staff in County Clare and in the University Limerick Hospitals Group have not yet been vaccinated. We are seeing around the country various news bulletins to the effect that everyone from administrative staff, people who may have the protection of a Perspex screen, to some outdoor staff in hospitals have been vaccinated, yet the mental health staff in Ennis and around Clare have not been vaccinated. Many of them continue to circulate in the community and call to people's homes and they have not been given that all-important jab yet. This is very important. I have raised it with Colette Cowan of the University Limerick Hospitals Group, but still we have no certainty as to when they will get vaccinated. Elsewhere in the country, I saw the other evening that Bantry hospital in Cork vaccinated everyone. They have now moved on to vaccinating local GPs, bringing them in very successfully, so there is not parity right throughout the community. I know a devolved responsibility has been given to each hospital group, but there is a need for co-ordination here as well, ensuring that some rungs of the ladder have not been missed. In County Clare, they certainly have been missed.
If I may, I will also put the next point to Mr. Goodman. It relates to GPs being vaccinated. A number of GPs have been in contact with me. In the early days of the registration portal there were some technological glitches which meant that as they put in their data those data were wiped, as I understand it, and they had to re-engage with the process again and again, meaning many of them did not register successfully. It is only in the past day or so that they have been able to do so. They are wondering whether that technical glitch will delay their vaccination. That is what I would like to ask.
I have a number of further questions to come in on, but perhaps Mr. Goodman could respond to those two initial ones.
Mr. David Walsh:
I think they are for me rather than Mr. Goodman. I am happy to answer them.
Regarding mental health staff in Ennis, and, indeed, elsewhere, and other front-line staff right across both acute and community services, at this point in time I know the numbers look big but we have completed a very small proportion of the total number. Starting by mid-February, using the portal, which we will talk about again in a minute, and following the prioritisation document based on the relative risk of exposure of all those workers, they will be invited for vaccination and, based on our projected supplies, we should be able to ensure that all those priority healthcare workers will be vaccinated. The first doses will be administered in February and the second doses, where appropriate, in February as well, with the tail-end of the second doses happening in March. People have been very patient. I have seen correspondence from the executive clinical director for that service, which has been very constructive in how it deals with the issues. I assure the Deputy that they will be dealt with over the coming weeks.
Regarding GP vaccinations, GPs are about to become part of our critical vaccinator workforce as well as being critical front-line healthcare workers in their own right. A significant number of them have had their first vaccinations through three channels. One has been through some of the acute hospitals; the second has been through nursing homes, where they have attended on the day when they have patients during vaccination; and the third has been through clinics set up specifically to help with the vaccination of GPs and practice nurses. That will be repeated and they will have access to those vaccinations.
Yes, I do. I wish to make a few brief points. It is my understanding - I am open to correction - that many of the child and adult mental health service, CAMHS, personnel have been vaccinated yet they are not offering any programme to the special needs children who are at home.
There is a whole other debate to be had about how their teachers are engaging with them online. Many CAMHS personnel have been vaccinated, but from what I can see, CAMHS is not out delivering a service. The HSE needs to consider this matter. It is frustrating for mental health staff and GPs to see others passing them out on the ladder. It is also frustrating for teachers and special needs assistants, SNAs, to see HSE personnel who ordinarily engage directly with children daily not engaging with those children anymore but nonetheless being vaccinated.
I hope that Professor MacCraith can consider having ambassadorial roles for people. In County Clare, Mr. Anthony Daly, our famous hurler, has an ambassadorial role with Covid response teams. It would instil great confidence in the nation and reassure the public that this process was safe if, as they were vaccinated, people like Ms Katie Taylor, Mr. Brian O'Driscoll and others with a high profile were used in an ambassadorial role. There is also an onus on Members of Dáil Éireann to do so. It is okay to have concerns, but it is not okay for a small number of Deputies to spread false truths. There is a great deal of fake news still circulating. This issue needs to be addressed.
I welcome the witnesses and acknowledge the work being done in the vaccination programme's roll-out, including trying to make it as fair as possible. Nothing frustrates people more than others skipping the queue or, rather, being perceived as skipping the queue.
I feel let down by AstraZeneca and the issues surrounding it. I hope that a solution can be arrived at quickly. It smacks of big business taking advantage of a difficult situation, particularly given the €336 million investment made by the EU and, by extension, the taxpayers of Europe.
The witnesses have answered many questions about pharmacists. Pharmacists are at the heart of many communities and play a key role in administering vaccines. They have the skills and training and are trusted. Every year, they administer the flu vaccine. They do a good job. Their potential to support communities and provide services has not been realised across a range of areas.
I will ask a couple of questions. Deputy Crowe mentioned GPs. What percentage of GPs have been vaccinated?
I have been approached by chartered physiotherapists, who literally play a hands-on role dealing with clients, be they people with bad backs, bad necks or whatever else. In terms of placement on the list, they are not regarded as being front-line workers who engage with people despite the fact that they have very close contacts.
The situation regarding pregnant women is being reviewed. Currently, they are at the bottom of the list alongside children and adults. According to this document, that is to be refined. Presumably, we are awaiting data from other countries. What is the rationale? When will their placement be refined or reviewed?
I hope that only a small number of people have received their first doses out of sequence. When will they be receiving their second doses? People have asked me that question.
Many people believe that, if they get vaccinated, they will be cleared to go and will not have to be restricted. For example, if foreign holidays were permitted, they believe they could go and return. Some clarity is needed. Actually, not clarity, rather, it should be communicated that the vaccines do not stop people from transmitting the virus, only from getting ill. This shows why everyone must keeping doing the things we have been trained to do over the past year and following the habits we have developed and why everyone who is willing needs to be vaccinated.
Mr. David Walsh:
I do not have a figure for the percentage of GPs vaccinated, but they have been vaccinated through a number of channels, as have their practice nurses. I will try to draw that information together. There will be another sweep to pick up GPs and practice nurses who have not yet been vaccinated.
It is clearly critical as they become vaccinators for the third cohort.
Regarding chartered physiotherapists, it depends on the setting that they are working in and their level of exposure. They could be priority healthcare workers. We have engaged with a number of the professional bodies about their members, especially those in private practice who may feel excluded. If a chartered physiotherapist is working in an environment where he or she is exposed to Covid-19, he or she is the same as anyone else working in a hospital or other healthcare environment and needs to access the vaccine in line with peers with a similar risk of exposure. I am happy to clarify that.
I ask Dr. Jessop to talk about the vaccine-specific issues that were raised.
Dr. Lucy Jessop:
Regarding pregnant women being of the lowest priority for the vaccine, that was written at a time when we were not quite so clear about some of the issues with the vaccine. Pregnant healthcare workers are now being vaccinated. We know that they are at great risk of Covid-19 and are exposed as front-line healthcare workers, so they are being offered the vaccine. There are some clear guidelines about that and information has been provided by obstetricians and gynaecologists, and answers to frequently asked questions from pregnant women who are concerned about the vaccine are freely available so that they have that information. Women who are between 14 and 33 weeks of pregnancy are able to get the vaccine if they are front-line healthcare workers. That has carried on for the last several weeks of the programme.
There was a question about a possible misunderstanding about what the vaccine does. It is clear in the leaflets that one receives before and after receiving the vaccine that it protects one from Covid-19 and its severe effects but it does not stop transmission as far as we know. The leaflets and the information that people are getting are clear that one must still obey all the guidelines that every other citizen is following. We and our colleagues involved in communication will continue to reiterate that information to make sure that people are clear that they must follow guidelines even though they are vaccinated.
I welcome our guests and commend them on the great work that they are doing. We had examples of where family members ended up getting vaccinated at the end of a day in order not to waste the vaccines. Will they receive a second dose as the other front-line workers will?
On the sequencing, I have no doubt that much time and effort went in to ensuring the most appropriate people were lined up first. Have the witnesses had any political lobbying to alter the sequencing or move specific groups up for various reasons? Has any intense pressure been brought to make any changes to the sequencing?
Mr. David Walsh:
There is no doubt that I personally and many other officials in the HSE get much correspondence from people with genuine cases for why they want the vaccine now for themselves or their child.
Personally, however, I have certainly not had political pressure to act outside of the sequence.
That is very encouraging because the political system needs to sell the message that the sequencing has been done in an appropriate way and we need to defend it.
When the officials from the HSE appeared in front of the committee before Christmas, they expressed confidence that the ICT system would be up and running prior to the vaccination process beginning. Clearly, that did not happen. Were deadlines in respect of the ICT system missed? Will further deadlines be missed or is the HSE confident that the ICT system will be robust and on time and will not compromise the roll-out of the programme in any way?
Mr. Fran Thompson:
The ICT system went live on 29 December and, as I articulated earlier, some of the challenges we had were with some of the infrastructure on the sites. We are live on almost 800 sites today and it is a challenge to deal with them all. We have also had to train almost 3,600 users, who were not always familiar with the vaccination process. We took the decision that we needed to get the vaccine out fast and let the ICT system catch up. It was much more important to get the vaccine out and to get it working for all those vulnerable groups, rather than to get all the processes and procedures working 100%, as we normally would.
Is Mr. Thompson is confident that the ICT system having to catch up will not compromise the data or create any errors? Is he confident that everything is in sync, to the greatest extent possible, in respect of the safety of patients' records?
Professor Brian MacCraith:
Ms Headon might come in on the collaboration between the Department of Health and the HSE.
Ms Elizabeth Headon:
It has been great to hear the focus on communications and the recognition of the importance of it, which we take very seriously. It is a reassurance that everybody has a great thirst or demand for information about the vaccine. My role is to co-ordinate the expert teams, the Department of Health and the HSE. The HSE, in particular, has produced extensive patient information and an advertising campaign will begin this weekend. It has found that what people want is factual information that is relevant to them. We will roll that out cohort-by-cohort-----
My point is that there needs to be one person dealing with the communication, who would become the public face of the vaccination programme and who would go before the media, daily if necessary. Ms Headon is correct that the information has to be accurate but, unfortunately, we live in a world of social media, where information has to be provided quickly as well.
We need to put all of this into perspective. Forty days ago, we did not have a single vaccine dose available, but in forty days' time, we will have four different vaccines. I have a couple of specific questions. On front-line healthcare workers, a category that includes home help, there seems to be a differentiation between HSE employees and private employees contracted with the HSE.
Can Mr. Walsh clarify that they will all be treated the same?
Mr. Walsh might highlight what is happening with the availability of the vaccine for carers. Can Dr. Jessop confirm if there is any up-to-date information available with regard to a vaccinated person being able to transmit the virus? Have we any new evidence as of yet?
Mr. David Walsh:
I thank the Deputy. With regard to home help or home support workers, as far as I am concerned it includes HSE direct employees, contracted employees through the various agencies and people working entirely in the private sector. This is about a population vaccination programme and about front-line healthcare workers. It does not matter who their employer is. I am clear on that. It adds significantly to the figures of front-line healthcare workers. The various representative bodies write to me regularly about it.
Carers, by which I mean family carers, are currently not encompassed within that. I know it is a source of unease among that group. Dr. Jessop might respond.
Dr. Lucy Jessop:
In terms of reduction of transmission, as far as I am aware there is not any new data as yet so we will be keeping a close watch on that. There were tens of thousands of people in the studies, obviously, but that would not have been enough to be able to pick up whether it reduced transmission now that several countries are quite far on with their vaccination programmes. Some of that data will be becoming available and we will be updating our information as soon as we have more data around that.
I thank the Chairman. I have one quick question for HSE. Mr. Walsh mentioned earlier that residents aged over 65 in disability and long-term care facilities have been vaccinated. That is great. Why have the staff not been vaccinated? It is similar to staff in nursing homes. There is much concern about this. Can Mr. Walsh clarify when they will be vaccinated?
Mr. David Walsh:
I thank the Deputy. They are due to be vaccinated. The latest they will be vaccinated will be as part of the recommenced front-line healthcare worker programme. What we wanted to do across disability facilities was impacted by the supply glitches over the last couple of weeks, which reduced the supply available for that. We would have liked to do all residents and staff in those congregated settings. It is still our intention to do so.
I am afraid we have come to the end of the session. Could the witness come back to us on that whole process regarding healthcare workers at risk and how he can reconfigure and reprioritise that area? Mr. Walsh mentioned the 117 nursing homes and the staff who are ill. Perhaps he could give us an update on that and the up-to-date IT systems for 2,700 GPs at some stage in the future. Perhaps he could reassure people that none of this vaccine is going to waste and it is not being dumped at the end of the day. That is a reassurance we can take as read here today. We look forward to hearing from Mr. Walsh again in the next couple of weeks. A huge responsibility is on him and all his colleagues. We wish them well. If we talk about a shining light, the vaccine has that potential . We are hoping it is a game-changer. There is still much concern about the efficacy of the various vaccines. Mr. Walsh has clarified many of the concerns today, however. I believe it is the start of a conversation we need to continue. I wish him well in his work.
The committee will meet again in public session next Tuesday, 2 February at 10 a.m. when we will get an update on addressing how nursing homes are coping with Covid-19 issues with representatives from the Department of Health, the HSE and Nursing Homes Ireland presenting to the committee.