Emer Higgins (Dublin Mid West, Fine Gael)
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There are 170 people in Irish intensive care units at this time. Fortunately, that number is reducing by the day but, right now, 170 people are critically ill with Covid-19 in Ireland. That is 170 people whose families are crippled with fear. I ask the House to imagine for just a second if we could change that. I ask colleagues to consider that we could introduce a simple and cheap intervention that could decrease the number of people fighting for their life in ICUs. I ask the Government to imagine what might happen if it were brave enough to take a bold decision instead of waiting for additional evidence that may come too late. What if, by taking that decisive action, we saved hundreds of lives across Ireland?

That is what I am asking of the Minister for Health. I am asking him to be brave enough to make a decision that could change the trajectory of this pandemic and potentially save hundreds of lives. I am asking him to provide free vitamin D supplements to people who present at Covid test centres and free activated vitamin D to people on admission to hospital. I am asking that he advise our general population to start purchasing and taking these affordable, readily available supplements as part of our response to the pandemic.

All the decisions we have made during this pandemic have been rooted in science and this would be no different. The positive effects of vitamin D are widely known. Studies in the UK, France and, in particular, Spain show a direct correlation between high levels of vitamin D and enhanced immunocompetence against Covid-19. In Spain, 50 out of 76 patients admitted to hospital with Covid-19 received activated vitamin D. All of them were discharged without complications. Of the 26 patients in the study who did not receive vitamin D, half of them ended up critically ill in ICU and, sadly, two of them passed away. In Connolly Hospital in Blanchardstown, our medics have seen at first hand that patients with low levels of vitamin D are more likely to require admission to ICU and three times more likely to require a ventilator. The evidence exists and the studies are being done. There is no risk in advising our general population to take vitamin D at high dosage. The Food Safety Authority of Ireland and European studies have confirmed that.

Despite this evidence, here we are, with a Government approach that is at a do-nothing level of caution. If we continue on this path, it may be too late for the people in ICU. That is not me being dramatic. That is me paraphrasing The Lancetmedical journal, which published an article last month warning us that additional evidence on the correlation of Covid-19 and vitamin D may come too late. What is taking the Minister so long to act on the evidence that exists? We already know that half of all Irish people have insufficient levels of vitamin D. We already know from the Irish Longitudinal Study on Ageing, TILDA, that the populations for whom Covid-19 is most deadly, including older people, have an 80% vitamin D deficiency. These are the cohorts that account for 50% of our fatalities. It is not just older people. A staggering 94% of black, Asian and ethnic minority people here in Dublin have vitamin D levels below the threshold for enhanced immunocompetence.

What is stopping the Minister from recommending that people start taking vitamin D to help protect themselves from ending up on a ventilator? I have tabled tens of parliamentary questions on this issue and asked for meetings between the Minister and the Covit-D Consortium, which specialises in this research. That group of experts was not even consulted by HIQA ahead of its recommendations to the National Public Health Emergency Team, NPHET. There is negligible risk in this strategy and potentially a massive gain. I am asking the Minister to include recommendations around vitamin D supplementation in the living with Covid plan. That simple act could save lives.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I invite the brave Minister of State from Waterford, Deputy Butler, to address Deputy Higgins's questions.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Higgins for raising this important matter. Vitamin D is essential for bone and muscle health and to support the normal functioning of the immune system. Vitamin D can be found in a variety of foods, including in fortified cereal and dairy products, and humans can also absorb it from the sun. I take this opportunity to highlight the importance of a balanced diet that not only supports overall health but can also help to increase vitamin D intake. This is particularly important for vulnerable populations. I ask that nursing homes and all service providers continue to ensure suitable food offerings and outdoor activities are provided, as appropriate, to further maximise vitamin D intake.

Department of Health guidelines on vitamin D, which were updated in November 2020, advise adults aged 65 and older to take a daily vitamin D supplement of 15 micrograms to support bone and muscle health. In the context of Covid-19, it is currently advised that those who are self-isolating or are unable to go outside, including adults and children over the age of one, should consider taking a daily supplement containing 15 micrograms of vitamin D to ensure a healthy vitamin D status.

The role of vitamin D supplementation in the prevention or treatment of Covid-19 has not been definitively established. NPHET considered an evidence synthesis paper on the role of vitamin D in the prevention and treatment of the virus on 28 January 2021. The paper examined available research evidence up to January 2021, including recent rapid reviews, randomised controlled trial evidence, observational studies and laboratory studies. A recently updated rapid review conducted by the National Institute for Health and Care Excellence in the UK concluded that there is currently a lack of evidence linking vitamin D and the incidence and severity of Covid-19. The report advised increasing awareness of existing recommendations relating to vitamin D supplementation. Results from a randomised control trial reported reduced admission to ICU and reduced mortality in patients with Covid-19 receiving standard care plus vitamin D compared with standard care alone. However, this trial was noted to have significant methodological limitations, including low participant numbers and a serious risk of bias. Collectively, other evidence provides conflicting reports of an association between vitamin D supplementation and a reduced risk of poorer outcomes from Covid-19 infection.

NPHET agreed that, at present, there is insufficient high-quality evidence with respect to vitamin D in the prevention and treatment of Covid-19. NPHET also agreed that efforts should be made to increase awareness of existing guidance. Adults spending increased time indoors, those who are housebound or in long-term residential care and people with dark skin pigmentation are recommended to take a daily vitamin D supplement. NPHET's recommendations for the use of vitamin D are being incorporated into wider messaging and, additionally, are being communicated across the health service, including in nursing homes and social care settings as necessary. The Department of Health has recently written to the HSE and Nursing Homes Ireland to encourage implementation of guidance on vitamin D supplementation in nursing homes. In the coming weeks, a presentation will also be delivered to GPs through the Irish College of General Practitioners on the importance of vitamin D and it is expected that this will reach upwards of 3,000 GPs.

NPHET will continue to monitor ongoing developments and research in this area, particularly randomised control trials, and will review guidance accordingly. The Government will continue to look to NPHET to provide recommendations with regard to vitamin D supplementation and Covid-19. The Government remains united in its resolve to tackle the spread of the virus.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Minister of State for her reply. However, all she has done is reiterate what we already know. I do not mean to be disrespectful to her when I say that I am frustrated that the Minister, Deputy Stephen Donnelly, is not here to participate in the debate. He seems to be avoiding this issue entirely. He is giving me evasive replies to parliamentary questions and promising updates on my meeting requests which never arrive. His role is not to sit back and blindly do what he is told to do by cautious, anonymous public servants. His role is to question, probe and, above all else, act. He is not a passenger in the car; he is the person driving the car for us during a pandemic. He is choosing our course and our speed of acceleration.

I believe, as do the scientists and academics I am working with, that we cannot afford to wait any longer for action on vitamin D. We are not alone. People like Professor Luke O'Neill are flying this flag too. The Minister must make vitamin D supplementation part of the Government's new plan for living with Covid. We can look across the water for inspiration in this regard. Finland, with a higher population than us, has buried 3,000 fewer people than we have during this pandemic. For almost two decades, Finland has been fortifying its food with vitamin D.

Apart from the remote island of Iceland, the people of Finland have the lowest death rate from Covid-19 in Europe, and because of vitamin D they had a head start when it came to Covid-19.

Let us look closer to home. Right now in England - the Minister of State referenced the report - a four-month supply of vitamin D supplements is being given to those who are medically vulnerable. Those responsible have not said this new measure is a direct response to Covid-19. I imagine this is why they have not advised to go with a higher dosage, which is what the covit-D consortium are recommending. Is that because they do not have evidence to categorically and definitively say so? Instead of waiting for additional evidence that may come too late, they are acting on what they already know. As we know, in a pandemic speed trumps perfection.

Mary Butler (Waterford, Fianna Fail)
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It would be remiss of me not to say that the Minister for Health, Deputy Donnelly, was here this afternoon speaking on the Covid-19 vaccines question-and-answer session. I believe the Minister had another appointment.

I thank Deputy Higgins for raising this important matter. An evidence synthesis paper on vitamin D and Covid-19 prepared for national public health emergency team was discussed at its meeting on 28 January 2021. The paper examined available research evidence up to that date, including recent rapid reviews, randomised controlled trial evidence, observational studies and laboratory studies. NPHET agreed that at present there is insufficient high-quality evidence with respect to vitamin D in the prevention and treatment of Covid-19. NPHET agreed however that efforts should be made to increase awareness of existing guidance on vitamin D.

As I have said, a number of groups should take a daily vitamin D supplement, including adults spending increased time indoors, those who are housebound, those in long-term residential care and those with dark skin pigmentation. Measures are now being taken to communicate these recommendations for the use of vitamin D. Communication has been already issued to nursing homes and a presentation will be made to GPs. I encourage everyone to note the guidance from the Department of Health advising adults aged 65 years and older to take a daily vitamin D supplement of 15 µg to support bone and muscle health.

While the role of vitamin D supplementation in the prevention or treatment of Covid-19 has not been definitively established, I wish to assure the Deputy that NPHET will continue to monitor ongoing developments and research, especially randomised control trials, in this area and will review guidance accordingly. The Government will continue to look to NPHET to provide recommendations with regard to vitamin D and Covid-19.

Once again, I thank Deputy Higgins for her interest in this subject. I will certainly pass on her thoughts to the Minister, Deputy Donnelly.