James Reilly (Dublin North, Fine Gael)
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Question 78: To ask the Minister for Health and Children the location of the 45 Health Service Executive swine flu vaccination clinics; the persons who will man them; the opening times of the clinics; the number of patients they will see per day; the number of vaccinations they will administer per day; and if she will make a statement on the matter. [39588/09]

Jan O'Sullivan (Limerick East, Labour)
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Question 81: To ask the Minister for Health and Children the number of recorded cases of H1N1 flu to date in 2009; the number of recorded deaths; when she expects the H1N1 vaccination programme to be delivered to the general population; the categories of staff who will administer the H1N1 vaccine to the general population; if they will be replaced in their regular role; and if she will make a statement on the matter. [39514/09]

Mary Harney (Dublin Mid West, Independent)
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I propose to take Questions Nos. 78 and 81 together. The incidence of influenza-like illnesses, ILI, reported on 25 October last is at a rate of 210.9 per 100,000 population. This is the highest ILI rate reported since sentinel influenza surveillance began in 2000. There were 2,727 laboratory confirmed cases of H1N1 on that date. It is not necessary for swabs to be taken by GPs to make a clinical diagnosis. The majority of cases are now diagnosed clinically. At 29 October, 492 cases of confirmed pandemic H1N1 2009 had been hospitalised and sadly ten deaths have occurred.

Vaccination is a key strategy being used to mitigate the effects of the pandemic. Every person in the country will be offered the vaccine. However, initially the vaccine is arriving in small quantities due to the demand for the vaccine worldwide. Ireland is not unique in the difficulties we have been experiencing in sourcing the vaccine in the quantities we would require. Obviously, therefore, vaccination will be prioritised to ensure those who require it most will be first to receive it. The national immunisation advisory committee and the pandemic influenza expert group have advised that the vaccine should be given to the population in the following order of priority: people with long term medical conditions aged between six months and 65 years and all pregnant women of more than 14 weeks gestation and for women six weeks post partum, - the "clinically at risk" groups; health care workers; children between six months and 18 years of age; adults over 65 years of age; and the rest of the population.

It is generally agreed that the preferred option for the administration of the pandemic vaccine to people under 65 in the "clinically at risk" groups is through general practice. GPs hold their medical records and are in a position to identify patients with underlying medical conditions for vaccination. It is estimated that there are approximately 410,000 people in this category. GPs have been receiving vaccine over the past two weeks and many patients have already been vaccinated. However, not all GPs are in a position to participate in the vaccination programme and the HSE has set up special vaccination clinics to vaccinate the "clinically at risk" patients of such GPs.

A full list of the locations and opening times of these clinics has been provided via the national and local media and is available on the swine flu website at www.swineflu.ie. I have arranged for a copy of this list to be circulated to Deputies. A typical HSE vaccination clinic will comprise at least one doctor, six nurses and appropriate support staff. It will have the capacity to vaccinate up to 500 people a day, but the numbers vaccinated at the clinics will clearly depend on the demand from the public for the service. Staff being assigned to the vaccination clinics will not be replaced and the vaccination programme will, therefore, mean that some other services have to be delayed or curtailed. The HSE has drawn up plans to prioritise services during the period of the vaccination programme, but the impact on particular services will only become clear as the programme is rolled out. The intention is to start vaccinating other priority groups, like health care workers and children, as soon as possible. However, depending on uptake, vaccine supplies and other factors, it could take from six to eight months to vaccinate the entire population.

The House will appreciate that this pandemic is one of the biggest public health challenges this country has faced. The logistics of undertaking such a mass vaccination programme are challenging. I am confident, however, that the extensive preparation plans which we have in place will assist in meeting this challenge.

James Reilly (Dublin North, Fine Gael)
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If we extrapolate the figures from the sentinel surveillance, we see that almost 10,000 people contract the swine flu per week. However, these figures do not take into account the people who do not attend their GP and, therefore, the figure may be more like 30,000. We have a serious situation on our hands. Some GPs have opted out of the vaccination programme because they believe that even if they do not sign a contract but accept and administer it, there is an inferred contract that makes them liable in law to somebody at risk whom they failed to contact. Will the Minister comment on that and reassure GPs that will not be the case so that more people can avail of vaccination through their GPs?

Hundreds of at risk patients have had to be turned away because supplies have run out or were not delivered. One-third of the HSE vaccine clinics remain unopened and some at risk patients face up to a 250 km round trip to their nearest HSE clinic. Some practices filled out the necessary forms last month, but only received syringes and needles. Practices that received doses of vaccine expect it to run out soon and that has already happened in some cases. One GP in Edenderry received enough vaccine for only 30 patients and had to use his entire supply by lunch time yesterday. Another doctor in County Laois only received enough for 60 patients and used that allocation up yesterday. The list goes on.

The HSE has a very poor strategy in place for implementation. Will the Minister confirm how many HSE vaccine clinics remain unopened? When will all the clinics be open and what are their opening times? Will opening times be extended? Is the Minister satisfied there are sufficient vaccines available to cover at risk patients? I accept what she said about the supply issue, but what action will she take to speed up the implementation of the programme?

Mary Harney (Dublin Mid West, Independent)
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It is a pandemic and every country faces the same logistical challenges. Our experience is very much in keeping with our counterparts in Europe and we have had close contacts with many colleagues, particularly those in Northern Ireland and the United Kingdom.

There is no issue with regard to indemnity and this has been made clear to general practitioners, both individually and on the websites of the three insurance companies. They, Medisec, MPS and MDU have all given assurances that this is normal in general practice and that the doctors are indemnified. The producers of the vaccine have been indemnified by every country as for obvious reasons they cannot go through the normal processes. An information leaflet and documentation was sent out to all GPs last month. This is clear and easy to understand and has been translated into eight languages so that patients from countries where people do not normally speak English can easily understand the what the vaccination programme is about and the possible side effects.

We now have 615,000 doses of vaccine in the country. There is a two-week lag from the time it comes to the port to when it can be got to either a clinic or GP, because of the manner in which it arrives. It does not come like the traditional vaccine because the manufacturers are trying to get the vaccine to countries as quickly as possible and when it arrives we have to do a considerable amount of work to get it out in ten-pack vials.

There are 45 HSE clinics and 32 teams, so some teams will cover more than one clinic. We hope to have 60 teams in place in approximately two weeks. On average, each team consists of seven vaccinators, one doctor and six nurses. Some have more and some less, depending on the arrangements necessary. Some 83% of general practitioners have agreed to participate, but 17% have not. I accept there are logistical issues, but there are such issues in every country. I have spoken to many colleagues who face the same logistical challenges.

I appeal to everybody, particularly members of the medical profession, Members of the House, the regulatory body of the Medical Council, all the training bodies, the College of Obstetricians and many other bodies to follow the advice given for all health care workers, doctors and others to accept this vaccination. I am not a clinician, but I am of the same view. Significant work has been put into this programme over the summer, led by the chief medical officer and the expert group. They have done considerable work and have won public confidence. They have been involved in many public debates on the airwaves, reassuring and informing people. That will continue to be the case.

We anticipate that some 415,000 people are at risk and general practices will get approximately 415,000 vaccines to administer to their patients. I am aware some doctors have an issue with regard to identifying those patients, but the majority know who they are.

Jan O'Sullivan (Limerick East, Labour)
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I acknowledge the work that has been done by people such as Dr. Holohan, Dr. Kelleher, Dr. Doorley and others. By and large they have done a good job. There are still some GPs who have signed up but who have not receive the vaccine, I spoke to one about half an hour ago. Can the Minister tell us when all GPs who have signed up to the programme will receive their vaccines? Those doctors who do not have it yet are getting numerous phone calls and are finding it difficult to say no to people.

What is the advice for pregnant women who want to get the mercury-free vaccine? I understand it is available in the clinics but not with the GPs.

I asked about people being replaced in their regular role when asked to work in these teams. They are taken from their regular work and that is causing problems in some areas. I was talking to a voluntary organisation that administers some of the home care packages and was told nurses are being taken from those packages. Is there a system where those people can be replaced if necessary?

The Minister said there is a two week lag for the extra supplies once the boat comes in. Can we get more information about future supplies and when we can expect all of the population to be vaccinated.

Mary Harney (Dublin Mid West, Independent)
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We have 615,000 vaccines at present and from their arrival at the port until we can get them to the HSE clinic or to general practice takes about two weeks. From next week it is hoped to start with infants between six months and four years, preschool children and health care workers. After that the focus will be on the over 65s and school children, with the rest of the population coming after that. It could be up to eight months before we get to everyone. It depends on the take up and the speed with which we get stocks of vaccine.

The vaccine is being delivered by United Drug Distributors cold store, which has huge experience of delivering to pharmacies. There might be issues about when people signed up. Initially the date was 9 October, extended to 14 October. Vaccines have gone to 1,500 sites, covering more than 2,000 GPs. I met the team last night and I understand some doctors will get vaccines today and tomorrow and as quickly as they can physically get out them out, they will do so.

I am not in a position to advise pregnant women because I am not a clinician. The College of Obstetrics has advised on the matter but I would advice pregnant women to consult their GPs for advice.

James Reilly (Dublin North, Fine Gael)
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I wish to clarify something for the Minister. There is no issue around the medical or legal situation as regards what happens if there are side effects from the vaccine for someone. The medical, legal problem is that if I as a GP accept these vaccines and vaccinate patients, there is an inferred contract between the HSE, me and the people at risk. If I fail to contact all those at risk, which I may not be in a position to do, I could be sued by one of those individuals for failure to contact him of her if he or she gets swine flu and develops serious complications. That is the consideration and doctors wish to be reassured on that point.

There was no contact between one of the main GP organisations, the IMO, and the HSE from July until late September. That is extraordinary, given that GPs were supposed to deliver this. The Irish College of General Practitioners are acknowledged as the group to speak to about standards and quality but the IMO deals with this sort of logistical problem. Can the Minister confirm if there was an internal memo from her Department to the HSE not to engage with the IMO? Can she also confirm that an offer was made privately to the HSE that GPs would vaccinate free of charge if the HSE would organise the clinics and that this offer was not taken up?

Mary Harney (Dublin Mid West, Independent)
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The onus is on the individual to come forward to the general practitioner, not on the GP to find the patient. There is a good relationship between GPs and their patients, although I have heard some general practitioners say they are not in a position to identify the at-risk patients. That surprises me because we hope that under the new contract for general practice that we will be able to manage chronic illness at general practice level. The onus is on the patient to come forward.

The Department advised the HSE because, given the volume of vaccine that was coming, and the advice of the expert group in August and early September, it had not been decided whether to involve general practice at that point. That advice was from the chief medical officer and those involved in the arrangements in the Department. The advice was to engage with the ICGP because it is the standards body while the IMO is the representative organisation and, generally, in matters to do with clinical issues, training and education, the college is involved.

We are in a pandemic and the onus is on all of us to work together. This is a small country and the State has arrangements to procure the vaccine for every citizen in the State free of charge. If GPs want to administer it free of charge I would be happy to hear it. If that is also the case for other vaccines we want to introduce, I will be the first to jump on the offer. The onus is on the patient to come forward, lest there be any doubt.

Jan O'Sullivan (Limerick East, Labour)
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I am alarmed and surprised that it could take up to eight months to vaccinate the entire population. That is a long time during a pandemic. Is there no way to do it quicker? What about replacing staff? If the same person is taken from his or her job for that length of time, assuming the HSE clinics will be consistently open, it will have an impact. In my area there was a suggestion that they would rotate staff and take people from different areas at different times so no area would be short-staffed for a long time.

Mary Harney (Dublin Mid West, Independent)
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Vaccination of the entire population depends on the availability of the vaccine, it is not the logistical issue. We cannot say with certainty when we will have the 7 million doses we have ordered. The other issue that is emerging is if it will be necessary to have a second dose of one of the vaccines. If that is not necessary, that will speed the process. We are in the same situation as virtually every other country in the European Union.

Staff will be rotated but when there is an emergency, there must be all hands on deck, as we all appreciate. I have asked the experts from the HSE and the CMO if they will provide a briefing for Oireachtas Members because many people are contacting me for information and I know they want a briefing session, perhaps early next week.