This week I spoke with a community nurse manager who works for a private company contracted to care for HSE patients. She co-ordinates a large team of nurses and carers. The professional services they provide make it possible for elderly and often terminally ill patients to remain in their homes rather than being admitted to hospital or to a nursing home. These community-based workers carry out their work alone, without the assistance of other professionals. Not only do they care for patients, but they also provide support and guidance to family members. Their work is invaluable but these highly committed workers feel totally abandoned. The nature of their everyday work takes them from house to house. Increasingly they are faced with cases of Covid-19. Numerous times each day nurses and carers have to put on PPE gear in their cars or in house porches. It has become impossible for them to get back-up support from other medical services. If a housebound patient displays Covid-19 symptoms and requires a test, it can take up to seven days for paramedics to arrive to carry out that test. Family members are instantly quarantined in the house or forbidden to enter if they live elsewhere, yet the community nurses and carers must continue to visit, provide care to the patient and support their families. As it stands, these private-company nurses and carers have not been notified of when they will be vaccinated and neither have the hundreds of family carers in every county across the country. These are front-line workers in every sense, except when it comes to vaccination. Community healthcare would collapse without these people and they must be protected as a matter of urgency. Older people living at home are terrified. They have heard nothing from their doctors about when they will be vaccinated. Family carers and those who provide home help feel forgotten. Residents in sheltered housing at Sue Ryder House in Holycross and Nenagh remain vulnerable. It is imperative that these people be given the same level of priority as those living in nursing homes.

To counteract this destructive virus, which has caused havoc, we need a deliberate, calculated and co-ordinated plan to vaccinate as much of the population as possible in the shortest possible timeframe. This is the most urgent and crucial task to be undertaken since the foundation of the State. It is a major project but the roll-out of the vaccine lacks scale and ambition. We are in the midst of a national crisis or emergency which is having a disastrous effect on our society and economy. Restrictions and lockdowns give only temporary relief. The policy of suppressing and containing the virus has failed in Ireland and across Europe. We need to break the cycle of opening and closing and the only lasting solution is inoculation. However, there are already serious doubts and reservations about our vaccine roll-out programme. Many people are concerned that the vaccine programme is sluggish. While we can now be more confident about vaccine supply, big questions remain around the number of vaccinators available. The projected time it will take to vaccinate 70% of the population is deeply disturbing to many people.

I thank the Deputy for raising this issue but I assure him that there is no need for people not to have confidence in the vaccination programme. It will be very comprehensive and will be ramped up as further vaccines are authorised and made available to us. The only limiting factor at the moment is the supply of vaccines. The only significant volumes we have received to date are from Pfizer BioNTech, which have enabled us to prioritise front-line healthcare workers and residents and staff of long-term care facilities. That will be the priority up to the weekend. By Sunday, all staff and residents in nursing homes and long-term care facilities will have been vaccinated with their first dose, as well as potentially up to 70,000 front-line healthcare workers. My understanding is that we have received approximately 152,000 vaccines and by next Sunday, 142,000 of those will have been administered. We are literally getting the vaccines out as we get them in to the country.

We have a much more comprehensive and detailed plan for ramping up the volume of vaccinations in the next phase, particularly after the authorisation by the European Medicines Agency of the AstraZeneca vaccine which, all going well, should be on 29 January, with delivery expected in mid-February.

This will be followed by the Janssen vaccine, which we expect to be authorised a month later. We will also be getting more supplies from Pfizer-BioNTech and Moderna. There will, therefore, be a very significant ramping-up. The Deputy has correctly identified the workforce issues. GPs and pharmacies are now ready to distribute the AstraZeneca vaccine and others. We are also working to expand that workforce so there can be a full national campaign to vaccinate the nation as soon as possible. The Deputy should be in no doubt about that. The workers he has represented and whose concerns he has articulated are on the front line, particularly in home care settings. I will feed his comments back to the national task force. We take advice on clinical priorities from the National Immunisation Advisory Committee, which is headed by Dr. Karina Butler, and from the National Public Health Emergency Team, NPHET. It is on the basis of this advice that we decide the sequencing and priority of those who are to get the vaccine. The evidence base suggests that the existing vaccines reduce illness and mortality. It is necessary to vaccinate the eldest and most vulnerable in our society, as well as those on the front line. If we do that, we will reduce mortality, risk and illness. I will take on board the representations the Deputy has made.

My concern is the number of vaccinators we have. HSE services are already overwhelmed. Some 6,500 healthcare staff are out of work due to Covid. We simply cannot divert further front-line staff for the purpose of acting as vaccinators. We need to assemble a task force of vaccinators. We need to recruit outside the obvious circle and build a national team to dispense the vaccine. We need a battalion of vaccinators working around the clock. We need to utilise community centres in every town and parish as vaccination centres. If people are asked to turn up for appointments during the night, so be it. They should get the jab and get the job done. This has to be our mentality and approach.

At present we have 1,700 people administering the vaccine and they are doing an excellent job. To be effective and to expedite the roll-out, we will require 5,000 to 6,000. I welcome the engagement of GPs but we must realise that they are already overworked and snowed under. We therefore have to ask whether they have time to be central to the campaign. I welcome the agreement reached with the pharmacists. Has the Government considered using the resources of the Army, particularly its medical resources? Has it considered inviting all retired doctors and nurses to answer the call? Should we consider enlisting medical students or even using dental practices or skilled scientific laboratory technicians? We have to think outside of the box and to be creative. This is a once-in-a-lifetime emergency and our response has to be bold, brave and imaginative.

I agree. Every category the Deputy has just enumerated is not only being looked at, but worked on. A vaccinator workforce of scale, over and above existing hospital vaccinators, GPs and pharmacists, is needed. We need to draw upon resources. Some who are retired will be able to come forward, for example. There will be vaccination centres in different communities across the country. The national task force is working on this right now. We will be in a position to give a more comprehensive account in the future. The key game changer with regard to the availability of vaccines will be the authorisation of the AstraZeneca vaccine. We envisage a significant ramping-up across February, March and April. May and June will also be significant because we will have very significant amounts of vaccine. It will no longer be an issue of the supply of vaccines but a workforce issue, as the Deputy has identified. That work is well advanced. A lot of work is going on in that regard.