Mark Daly (Fianna Fail)
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I thank the Minister of State at the Department of Health, Deputy Mary Butler, for coming to the House. Half of the matters relate to health, as they would in the middle of a global pandemic.

Pat Casey (Fianna Fail)
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I also welcome the Minister of State back to the House and thank her for her commitment to it. She has always made herself available to answer our queries and I know of her personal commitment to the role she has taken on as Minister of State.

My question is for the Minister for Health, Deputy Stephen Donnelly, and it is to ensure dialysis patients are given the same priority in the allocation of Covid-19 vaccine as nursing home residents and staff, given their similar mortality levels. Everyone in this House is conflicted because different cohorts are making representations to us that they should be ahead of others. Even in my small village of Laragh, we have different cohorts of people. I am reminded of an email I received from a very close friend last week putting the case for her brother, who has a neurological condition and is living in a residential care unit with three other clients and who has not seen his 82-year-old mother for nearly a year.

In addition, two very good friends in the same village are now on dialysis, one for three years and the other for two years. I had the pleasure of playing football with Thomas and Michael for nearly 15 years.We have mixed emotions when trying to make these decisions. The decision has to be based on facts and evidence. That is the priority when the decisions have to be made. I am aware the issue of people who are going through dialysis or have been recipients of a kidney transplant was raised on a number of occasions yesterday in the Dáil. There is international evidence that backs up their case that they should be moved up to the same level as nursing homes. There is evidence that there is a 25% mortality rate among renal patients who become infected with Covid-19. I am not just saying this; it is backed up by science.

In the Dáil debate yesterday, the Minister for Health, Deputy Donnelly, referred to a review of all people with disabilities and how we will administer the vaccine, and not just the cohort I am talking about but other cohorts. However, I am focusing on this today and there is evidence to prove the mortality rates. The second issue is the inconsistencies within the age groups. One is at seven if over 65 and 15 if under 65.

I ask the Minister of State for a reply on the review process. Does she know how the Minister for Health, Deputy Donnelly, intends carrying it out? When will the review process be finished and published? Can the Minister of State see any way of getting this cohort of people up to the same level as nursing home residents?

Mary Butler (Waterford, Fianna Fail)
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I thank the Cathaoirleach for the warm welcome and Senator Casey for the very important issue he has raised.

He is quite right; it was raised several times yesterday in the Dáil when Minister for Health, Deputy Donnelly, and I were answering questions on the Covid-19 vaccine. The only limit to the vaccine is supply. That is where our main issue is. For example, we got 21,600 doses of the AstraZeneca vaccine this week. Those are being distributed to front-line workers because a decision was taken that it was no suitable for those over 65. The issue we currently have is supply. We would love to have a huge supply of the vaccine. There are no vaccine supplies sitting in storage not being administered. I want to put it on the record.

The Covid-19 vaccine allocation strategy sets out a provisional list of groups for vaccination. The strategy was developed by the national immunisation advisory committee, NIAC, and the Department of Health, endorsed by the National Public Health Emergency Team, NPHET, and approved by the Government on 8 December 2020. Vaccine allocation is a matter for the Department of Health. The roll out of the Covid-19 vaccination programme is the responsibility of the HSE. The aim of the Covid-19 vaccination programme is to ensure, over time, the vaccine becomes available to all individuals for whom it is indicated.

Given there are currently limited vaccines available, it will take some time for everyone to receive the vaccine, necessitating an allocation strategy. This will ensure that the most at risk of death and serious illness receive the vaccine first. The priority is to first vaccinate and protect the most vulnerable among us, that is, the most likely to have a poor outcome if they contract the virus. The priority is to use vaccines to save lives and reduce serious illness. Hence, the focus on the over 65 year cohort in long-term residential care facilities and health care workers in front-line services often caring for the most vulnerable.

As we have seen, the roll out has been to nursing homes. I am delighted to say the uptake from residents is close to 99%, which is absolutely phenomenal. Vaccine 2 is being rolled out to the nursing home settings. During the week commencing 8 February, the vaccination programme is continuing. It is entering its conclusion phase with a continued prioritisation of staff within disability and mental health settings who are managing the care of those over 65 in residential settings. Residents over 65 in non-registered long-term residential care, LTRC, settings, such as religious orders, are also being prioritised for vaccination. I will be dealing with that issue in the next Commencement matter. In line with vaccine supply, each community healthcare organisation, CHO, commenced vaccination within these settings on 8 February, which was Monday of this week. The next group to be vaccinated is group 3, which will start next Monday. It includes those aged 70 and older in the following order: 85 and older; 80 to 84; 75 to 79; and 70 to 74. Vaccination of this group will commence on Monday, 15 February. People with chronic kidney disease are included in group 5 or group 7, which include people aged 65 to 69, with priority for certain medical conditions, and people aged 18 to 64 with certain medical conditions. Of course people with chronic kidney disease are not an homogenous group and may be included in other priority groups, such as groups 1 and 2.

In response to the Senator's direct question, the Minister for Health stated yesterday that he asked the HSE to examine the issue raised in relation to the various groups. I expect this review to conclude quickly.

Pat Casey (Fianna Fail)
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I thank the Minister of State for her reply. I acknowledge that the limited amount of vaccine received is being rolled out and administered, and that the issue is about supply. That is why I put down the Commencement matter today. There is clear evidence in relation to the cohort I am referring to that there is a 25% mortality rate, and it should be at the same level as nursing home residents.

I know it is not within the remit of the Minister of State to tell me how quickly a review can be done. We would all love to know what "quickly" means. All I ask the Minister of State to do is to raise our concerns about this cohort with the Minister. It is not that they should receive preferential treatment but that they should receive a fair treatment based on science and fact, which the Department is aware of. We should try to get them up to whatever level we can. We should see if the distinction between age groups within that cohort can be removed.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Casey for advocating on behalf of kidney and dialysis patients, and highlighting the challenges they face. As he said quite rightly, this will be determined from a scientific, medical, and clinical point of view. That is the only way we can look at this issue. On the decision by the Government, the national immunisation advisory committee, NIAC, and the National Public Health Emergency Team, NPHET, to immunise those in nursing home settings first, we must be conscious of the fact that in the first wave, 56% of all deaths were in nursing homes. As of early this week, unfortunately 1,739 of our beloved residents lost their lives in nursing homes, either with Covid or because of Covid, and I suppose that is something we will probably never know for sure. That is why the priority has been determined in this way. Those next in priority are patient-facing front-line workers who are doing an exceptional job on a daily basis. The next in priority are our most vulnerable cohort, those over 70 years.

I certainly take on board the point made by Senator Casey. It has been made to me several times. The priority is for those who are at most risk of death or serious illness to receive the vaccine first. As the Senator quite rightly pointed out, the Minister said yesterday this issue would be looked at. Different cohorts were mentioned. For example, the situation of many very ill people who are waiting for serious operations and who need to be vaccinated in advance was mentioned yesterday. The only thing preventing vaccination is supply. In quarter 2, starting in April, I hope we will receive 250,000 vaccines per week, whereas this week we only received 21,600 vaccines. Gabhaim buíochas leis an Seanadóir and I will communicate his thoughts to the Minister.

Mark Daly (Fianna Fail)
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I thank the Minister of State for her response and Senator Casey for raising this issue which is a concern of every public representative. The Irish Kidney Association has done much work advocating for its members, many of whom have no choice but to go into hospital every week. As they cannot delay their dialysis they need to be protected as much as they can be when going into hospital. I thank the Minister of State for coming in. I know the Minister of State will welcome the Member who will take over as Acting Chairperson from me, Senator Hoey, who has chaired many meetings as president of the Union of Students in Ireland. That organisation represents hundreds of thousands of students and I have no doubt that Senator Hoey will do an excellent job in chairing the Seanad for the first time. I welcome Senator Hoey in taking over the Chair and I thank the Minister of State.