I welcome the opportunity to provide an update to Parliament on the winter vaccination programme for 2022. This winter’s vaccinations for the most vulnerable began on Monday, so this week marks another key milestone in our continued effort to protect people against Covid-19 and to provide resilience for the national health service this winter.
As a nation, we have faced enormous challenges since the start of the pandemic, stretching beyond the initial and serious health impacts of the virus. However, it is important to recognise how far we have come. For many of us—although I accept that it is not true for all of us—life feels as if it has largely returned to normal. We have lifted all legal restrictions and protective measures. That was possible only because of the game-changing Covid-19 vaccination, the high level of uptake among the Scottish public who have come forward to receive it and the army of vaccinators up and down the country to whom we are all eternally grateful.
More than 12 million Covid-19 vaccine doses have now been administered in Scotland. In fact, we have among the highest rates of uptake of first, second and third doses of the Covid-19 vaccine anywhere in the United Kingdom. At one point during last winter’s vaccination programme we had one of the fastest vaccination roll-outs in the world, which was a fantastic achievement in protecting the most vulnerable in our society against serious illness and death. The European Centre for Disease Prevention and Control estimates that Scotland’s vaccination programme has averted around 28,000 deaths among those aged 60 and over. Due to the vaccine, Scotland had an estimated total reduction of 86 per cent in fatalities, which is the highest percentage in Europe after Iceland. Every single one of those saved lives is someone’s family member and someone’s friend, so it cannot be stated enough that our health service and everyone involved in the vaccination programme are owed a huge debt of gratitude by all of us.
This autumn and winter, we will build on the success of our previous programmes, including of the spring and summer programme that has just drawn to a close. As with previous rounds of vaccination, Scotland’s spring booster programme enjoyed tremendous uptake: as of 5 September, 70 per cent of those with suppressed immune systems, 86 per cent of elderly care-home residents and 92 per cent of those aged 75 and over had received a spring booster dose. That represents 87 per cent of all those eligible for a fourth dose, and has exceeded our expectations and planning assumptions. I express my sincere thanks to all those who came forward and to those who made that immense effort possible.
Advancing our continued offer of vaccines and boosters will ensure as much protection as possible for those who are most at risk. So, we are today publishing the deployment plan for the winter 2022 vaccinations, which sets out the detail of how we will administer vaccines to those who are in most need here, in Scotland.
Although this year’s deployment plan still has at its heart the aim of tackling Covid-19, it recognises that there are other challenges that put pressure on the NHS and endanger the health of some of the most vulnerable members of society.
Seasonal flu is a key risk as we move into the winter. As Cabinet Secretary for Health and Social Care, I am acutely aware of the pressures that flu and Covid-19 combined place both on the NHS and on people’s personal health. That is why I am pleased that we will, where possible, offer Covid-19 and flu vaccinations in the same appointment to those who are eligible.
As part of our approach to tackling winter pressures head on, we are aiming to vaccinate as many people as possible against flu and Covid by the beginning of December while ensuring that we have the necessary capacity in the system to achieve that. I am all too aware of the strain that the NHS is under and, in order to achieve the pace that we need, we need to accept that there may well be some overlaps of cohorts receiving their vaccines and some small and, I hope, limited geographical variation, as we do not want to hold any one area back, particularly later in the programme. That will not be unique to Scotland, I suspect. However, against that challenging backdrop, the goal remains to vaccinate those who are most vulnerable as soon as possible.
As ever, our decisions on who to vaccinate and when are guided by the clinical expertise of those on the Joint Committee on Vaccination and Immunisation. In line with the committee’s recommendations, this winter, a Covid-19 booster will be offered to residents and staff in care homes for older adults; front-line health and social care workers; all adults aged 50 and over; those aged 5 to 49 who are in a clinical risk group, including those who are pregnant; those aged 5 to 49 years who are household contacts of people with immunosuppression; and carers aged 16 to 49.
Everyone who is eligible for a Covid-19 vaccination will also be invited for a flu vaccine, and they can safely receive both vaccines at the same appointment. That is why, this winter, as I mentioned, we will aim to administer the Covid-19 and the flu vaccines at the same time where possible. That will save time, it avoids the need for repeat journeys to vaccination centres, and we hope that it will protect as many people as possible against the serious health risks that are posed by both Covid-19 and seasonal flu. That final point is particularly important as we know that, this year, seasonal flu arrived in the Southern hemisphere much earlier than was expected.
In addition to setting out those who are eligible for a Covid-19 winter vaccination, the deployment plan sets out a range of other groups who will be offered the flu vaccine.
Prioritising those who are most at risk has been our approach from day 1. In accordance with the advice from the JCVI, the winter vaccination programme started on Monday with care home residents. Many care home staff are being offered their vaccines at the same time. Alternatively, they, along with health and social care workers, can book their appointment through the online portal, which has been open since 22 August.
Alongside care home residents and staff, health and social care workers and individuals who are housebound are being vaccinated from Monday, too, ensuring that we protect the most vulnerable first, as I said.
We have already scheduled more than 800,000 winter vaccination appointments for those aged 65 and over, with hundreds of thousands more being scheduled this week. I urge all those who are eligible to please wait until they are contacted. Anyone who is in any doubt about whether they will receive an appointment should visit the NHS Inform website for more information.
Given that the immunity that is conferred by vaccination can wane over time, it is important that we maximise protection for the most vulnerable ahead of winter, when the threat from Covid-19 and flu is likely to be at its greatest. By prioritising those who are most at risk, we can also limit strain on our NHS as it recovers from the worst effects of the pandemic.
On 15 August and 3 September, the Medicines and Healthcare products Regulatory Agency granted regulatory approval to two updated bivalent vaccines. Because of their dual aspect, they target both the original strain of Covid-19 and the omicron variant. Bivalent vaccines have been deployed as part of our winter vaccination programme from the start of this week.
The vaccine that is used will depend on clinical eligibility, but also, crucially, on vaccine availability. I reassure the public that both the existing and the new bivalent vaccines provide excellent protection from severe illness and hospitalisation, and I urge all those who are eligible to take up the offer of a vaccination when they are called forward.
The vaccination programme is a vital step in our plans to address as many of the winter pressures as possible. We are also well aware of the bigger picture. We cannot fail to acknowledge the cost of living crisis and all that it entails; the potential for industrial action, although we will work hard to ensure that that does not happen; and the inevitable bad winter weather. All those issues and more may well make it more difficult to travel to large-scale vaccination centres than it was previously. Also, the fact that legal restrictions have been lifted means that those large-scale venues are, quite understandably and rightly, going back to their original purposes.
For those reasons, we are instead offering smaller, local clinics to facilitate access for those who need it most. Across Scotland, more than 440 clinics are available during the programme, as of 6 September. We are also taking steps to ensure that people who may experience barriers, or who feel less confident, are able to come forward for vaccination.
Although we have a general level of assurance on vaccine supply and delivery, that may be impacted by extreme adverse weather or disruption to transport routes. We will do all that we can to overcome those challenges.
This year’s winter vaccination programme will, no doubt, confront serious challenges. Our NHS is still in the middle of a period of recovery, which involves sustained and significant challenge as we work towards ambitious targets in bringing down the backlog that has been left by the Covid-19 pandemic. Nevertheless, I am confident that the programme will be delivered in line with current JCVI planning, with the most vulnerable being vaccinated by the beginning of December, and that it will achieve a high rate of uptake, as previous rounds of vaccination did.
I say again to the Parliament and to the public: the vaccines provide excellent protection from severe illness that could otherwise strike at the worst time of year. I strongly encourage everybody who is eligible to take up the offer of vaccination. I look forward to providing a further update to the Parliament in the coming months, detailing our progression through the programme.
The Presiding Officer:
The cabinet secretary will take questions on the issues that were raised in his statement. I intend to allow around 20 minutes for that, after which we will move to the next item of business. I would be grateful if members who wish to ask a question were to press their request-to-speak buttons now.
I welcome the roll-out of the winter flu and Covid vaccination programme. This is the first bivalent vaccine for targeting both the omicron and the original strain of Covid-19. As has been seen throughout the pandemic, working together as the United Kingdom, we are able to swiftly get jabs into arms, and early procurement of the bivalent vaccine is only possible because of the broad shoulders of our United Kingdom. As a general practitioner, I urge everyone who is eligible to please get vaccinated, as that will save their life.
With the best will in the world, some people will not receive their letter, through error, and some eligible people—for example, unpaid carers—may also not be lettered, through not being known about. How does somebody book an appointment who feels that they are eligible but has not received a letter?
I thank Dr Gulhane for his comments, and I reiterate that, if people are eligible, they should please come forward.
When it comes to those who are eligible, various cohorts will sometimes be contacted differently, depending on the local structures. For example, the way of contacting household contacts of those with immunosuppression might be different in Orkney from how it is done in Glasgow. However, if people have any doubt about their eligibility, we can direct them towards NHS Inform. If they are digitally excluded or unsure, they can call the vaccination helpline for confirmation about whether they are eligible and how they will be invited.
Dr Gulhane is aware that this is our second winter vaccination programme. For many people, it may well be the fifth dose of the vaccine. I therefore suspect that people are now in the rhythm of knowing whether they are eligible. Some may not be in that rhythm; if they have any doubt, they should not hesitate to call the vaccination helpline for further information.
I thank in advance those who will be involved in running the winter vaccination programme. We are grateful for their efforts.
We know that the Covid vaccine lessens the impact of Covid; however, we also know that it does not stop people from getting Covid in the first place. That remains a significant concern. Some people have underlying health conditions, were originally on the shielding list and were told to stay at home. Not all of them are eligible for the antiviral medication, and we have yet to see the use of prophylactics to prevent those who are most at risk from getting Covid in the first place. When will the cabinet secretary extend the eligibility for antivirals to all those who were on the shielding list, and when will access to prophylactics be given, so that we can protect the very vulnerable from getting Covid in the first place?
First, I point out that I forgot to say in my response to Dr Gulhane that I am writing an update—it should have landed in most MSPs’ inboxes—on the winter vaccination programme. That will include details of who is eligible. As Cabinet Secretary for Health and Social Care, I have a leadership role and, of course, I hope that all MSPs will cascade that information locally. If they hear of any individuals who have any doubt about whether they are eligible or who think that they are eligible but are not getting any further information, I am more than happy for them to contact me.
I recognise what Jackie Baillie says. I recognise that there are people who, for whatever clinical reason, might not be suitable to receive a vaccine. Although the vaccine remains the best protection against the serious effects of Covid, some people might just not be able to exhibit an immune response due to a clinical condition that they have.
A clinical discussion is taking place on widening access to antivirals. I have been contacted by the likes of Parkinson’s UK, which is very keen for its members and the people with Parkinson’s disease whom it represents to be eligible for certain antivirals. I understand that one of the clinical trials that is under way is in discussion with people with Parkinson’s to gather clinical data. The evolution of eligibility for the antivirals is an on-going process.
On prophylaxis, Jackie Baillie will be aware, but I am happy to give her more detail in writing, that a particular prophylactic, Evusheld, is of interest to many people. It has received a conditional marketing authorisation from the MHRA. However, that authorisation was given before Evusheld was tested against omicron, so there is insufficient data to give us any credible evidence that it is effective against that variant.
I understand that the UK Department of Health and Social Care has offered to explore the possibility of a clinical trial for Evusheld. I am very supportive of that and will make it clear when I meet with the UK Secretary of State for Health and Social Care that I expect that Scottish patients would also take part in that clinical trial.
As a nurse, I, too, encourage everyone who is eligible to take up the vaccine offer. Many of those who are eligible for vaccines will face accessibility requirements, particularly those who are housebound. Accessibility should never be an obstacle to people receiving healthcare. With that in mind, what arrangements have been considered in the roll-out of the next round of vaccinations for people with accessibility needs?
That issue has been well rehearsed in previous iterations of the vaccination programme, but it is absolutely right that Emma Harper raises it. There might be people who are now housebound who were not housebound in previous iterations of the programme. I give an absolute assurance that they have not only been thought of in the programme but given real priority.
Housebound patients will be offered flu and Covid vaccinations within their homes and at the same appointment where appropriate. Those who are eligible will be contacted by their local boards. Much like anybody who feels that they should be eligible but has not been contacted, whom Dr Gulhane asked me about, people who are housebound who have not been contacted should call the national helpline. The number for that is 0800 030 8013.
The deployment plan highlights the fact that many health boards are using the Scottish Ambulance Service to reach deprived or rural communities. We know that the service is already under pressure. How will it be adequately resourced to ensure that those communities are not overlooked?
I pay tribute to the work that the Scottish Ambulance Service has done. I think that many members have visited its mobile units up and down the country. Tess White is right that some of those units have been in remote and rural areas but some of them have been in urban areas. However, they have been a great asset to us in the vaccination programme.
The planning for the winter vaccination programme has been done hand in glove with the Scottish Ambulance Service. In remote and rural parts and island communities in Scotland, there is still largely a reliance on those hyperlocal vaccination centres. As I said in my statement, there are around 440 vaccination centres. I hope that that will give some level of confidence to Tess White that remote rural and island coverage is very good indeed in terms of the vaccination centres, let alone the additional complementary assistance that the Scottish Ambulance Service can provide through its mobile units.
The cabinet secretary may be aware that West Lothian has a bigger population than the city of Dundee and that my constituency of Linlithgow has the most constituents in Scotland, with a significantly disproportionate number of over-50s residing in it. The Pyramids facility in Bathgate provided the space for the very welcome more than one third of a million Covid vaccinations but, like other mass vaccination centres, it is now understandably closed. What assurances can the cabinet secretary give me that, if vaccinations are to be based in GP surgeries in my constituency, and across the country, staffing levels and venues will have the capacity and support that they need to ensure that demand from the large number of people who will be eligible to have their winter Covid booster will be met?
I agree with everything that Fiona Hyslop has just said. For various reasons, those large mass vaccination centres are no longer available to us. They are being used for their original purposes and some may have closed down, but there are still large centres in some parts of the country. However, I am reassured by the plans that I have seen made by local health boards up and down the country that by using those local sites with high volume they hope to provide that reach right across the country.
Fiona Hyslop is absolutely right about staffing. The very constrained timetable that the JCVI is asking us to work to means that we will have to hit a run rate every single week that is near the record run rate that we hit last winter, when we had the boosted by the bells campaign, if members remember that. That is on top of the usual winter pressures that we may well face. If there is another wave of Covid, for example, that will undoubtedly have an impact on staffing, so those things are being monitored. Contingency plans are absolutely being put in place, but it is fair to say that this is a really ambitious programme and the impact and pressures on staffing are significant. However, we all know the importance of the vaccination programme. That is why I am so grateful to every single member of the vaccination programme who is helping us with the winter programme.
I note what the cabinet secretary said about vaccination services being as local as possible, but we know that the rhetoric does not always match reality. There have been numerous examples of NHS Highland patients being made to make 100-mile round trips, and in Inverclyde there have been numerous examples of people with respiratory illness being instructed to travel to Glasgow. In terms of delivery, it is also critical to recognise that the Royal College of Nursing is balloting for strike action, with more than 90 per cent of nurses having rejected the Scottish Government’s pay offer. What specific actions are being taken to ensure that vaccination centres will be as close to people as possible, and what further action is the Scottish Government taking to resolve the pay dispute and ensure that nurses are paid a fair wage, including those who provide vital vaccination roles?
I am satisfied that the number of venues that we have is sufficient for the ambitions of the winter vaccination programme. If, for example, there is a need for more vaccination centres, I would expect local health boards to adjust their programme accordingly. Paul O’Kane mentioned NHS Highland, which alone has 121 vaccination centres. I hope that gives some level of assurance to him about its coverage.
On the second part of his question, we are in regular dialogue with the trade unions. I want to see a fair settlement. I understand why the RCN is asking for an above-inflation increase but, of course, as John Swinney has said in the past couple of days in the chamber, our public finances are constrained. Nonetheless, while I am disappointed that 5 per cent has been rejected, I completely respect the mandate that trade unions have been given and, therefore, we are getting back around the table with them to get, I hope, to a fair deal for our NHS staff up and down the country.
As Scotland has rightly opened its doors to refugees in the past few years, most recently to those fleeing from the war in Ukraine, what steps will be taken to ensure that all refugees, who may not be registered with a GP, can be made aware of the vaccine programme and access appointments?
Gillian Martin raises an important point. That has been part of winter planning for this vaccination programme, and materials have been translated into Ukrainian and Russian. Of course, we know where those Ukrainian refugees are and, therefore, there is a targeted effort to ensure that the material gets to them directly. They do not have to be registered to a GP in order to get the vaccination.
We will continue with those efforts and we are also talking to a number of community and third sector organisations that can assist us with that communication.
Good work is going on. I have said to the health boards that cover areas that are hosting Ukrainian refugees, which is a suitable portion of them, that we will work with them to be as proactive in this endeavour as we possibly can be.
Vaccine hesitancy will be as big an issue in this roll-out as it has been in previous roll-outs, particularly because people believe that we are now living with Covid and that it is just a way of life. What additional messages can the Government give to people who are sceptical about the efficacy of vaccines in order to ensure that they understand how important it is to get the new booster jab?
Mr Cole-Hamilton is absolutely right. I have been concerned about the fact that Covid is perhaps not as prominent on the agenda as it was during previous iterations of the programme, and I do not want any complacency to set in. The indications thus far from the portal that has been opened for health and social care workers and the work that has been done in care homes do not suggest that the uptake has been affected, but we will not be complacent about that.
All of us—primarily me, given the role that I hold—have a responsibility to continue to communicate the benefits of the vaccine. I urge everyone to do that, and I will certainly do that in my position.
The issue is not just to do with vaccine hesitancy. We know that there are certain groups in the population among whom the uptake has been lower. Going back to Tess White’s point, that is where our mobile units can be effective if they are deployed outside particular community facilities. Previously, they have been deployed outside the Glasgow gurdwara, mosques and areas of high deprivation, where they have proved to be a fantastic resource.
I can give Alex Cole-Hamilton an absolute assurance that nobody in the Government is being complacent, and I urge everyone present to communicate the benefits of taking up the vaccine.
The COVID-19 Recovery Committee has been told that, worldwide, some 20 million lives have been saved by the vaccines, yet there is a lot of misinformation and disinformation about them on social media. Can the cabinet secretary confirm that 20 million is roughly the number of lives that have been saved, and can he reassure people who have been made nervous by social media?
John Mason is referring to a study that was conducted by Imperial College London, and he is right to say that the number of lives saved is around 20 million—it is 19.8 million. As I referenced in my comments, we know that, in Scotland, 28,000 lives have been saved by the vaccine.
There is a lot of disinformation, and we are doing our best to counter it by promoting the benefits of the vaccine on social media platforms, where we can reach a far wider audience than—I say this with no disrespect—the people who are watching our proceedings in the chamber.
We will continue with our efforts to counter that disinformation. As I said to Alex Cole-Hamilton, every one of us—not only me—has responsibility to do that.
We are in a cost of living crisis and I am sure that the cabinet secretary would not want anyone to be unable to make their appointment due to not being able to afford to get there. Has the Scottish Government had any conversations with health boards about what support might be offered in those circumstances?
Again, we have told health boards that we have to factor the cost of living crisis into our planning, and they have been willing to do that. We know that the cost of living crisis is a public health crisis.
That planning is well under way. If people feel that they cannot leave the house because they cannot afford to do so, they should, of course, contact the national vaccination helpline or the health board. My absolute expectation—I will reiterate this to health boards—is that we will do everything in our power to get to those people or, indeed, get them to us at no cost to themselves if the cost of travelling to a vaccination centre is prohibitive for them.
Centralised vaccination centres simply do not work in rural areas. One house-bound and vulnerable elderly couple in Strathspey have been given their appointments on two different days in two different locations, with one being asked to make an eight-hour round trip of 70 miles to Inverness. That does not fit in with the cabinet secretary’s statement to provide more local centres. I favour GPs in rural areas rolling out vaccines, as they did earlier in the pandemic. If GPs are willing to do that, is the cabinet secretary willing to support them?
In short, yes—absolutely. If Mr Mountain wants to furnish me with specific details about that matter, I would be happy to follow it up with the appropriate health boards. I have given details of the local arrangements and how many local centres there are. If there has been an issue with scheduling, that is, of course, regrettable.
My colleague Fergus Ewing and I had a meeting with a local GP. If local GPs in north Highland, for example, are keen to be part of the vaccination programme and they are needed, there should be no restriction on behalf of Government, for example. We know that GPs have been used—in fact, I visited a GP in Rothesay on the island of Bute who was administering vaccinations. There is not a legal restriction in that sense if GPs are willing to do that, although we know that that is not part of their contract.
I am happy to delve further into Mr Mountain’s specific point about his constituents, if he is able to provide the details.
Clearly, we want vaccination centres to be as accessible as possible and to minimise—again, as far as possible—lengthy travel to get vaccinations, especially for people who are reliant on public transport. Will the number of venues for vaccination be kept under review?
In short, that absolutely will be kept under review. I expect that, if there is a need to adjust, health boards will adjust accordingly. They will absolutely do that. I have seen that happen in previous iterations of the vaccination effort.
I will make the point that I made in response to Gillian Mackay’s question. If anybody is concerned about the cost of travel or their ability to travel and arranging transport to and from vaccination appointments because of mobility issues or other issues, support is available from each board. People can go to the NHS Inform website for the details of that, or they can call their local health board, the vaccination helpline or, indeed, the national helpline, which can direct them to the right place. We want no barriers to anybody coming forward for the vaccination. Again, I urge anybody who is eligible to come forward to protect themselves and others and, of course, our NHS, please.