Coronavirus (COVID-19) domestic vaccine certification: equality impact assessment

The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No.4) Regulations 2021

Legislative Background

The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No.4) Regulations 2021(the 'Regulations') are made under powers to make provision for the purpose of preventing, protecting against, controlling or providing a public health response to the incidence or spread of infection, conferred on the Scottish Ministers by schedule 19 of the Coronavirus Act 2020. These Regulations, which amend the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021 ("the principal Regulations"), will come in to force on 6 December 2021.

Introduction

The aim of this Equality Impact Assessment (EQIA) is to analyse the potential impacts for each protected characteristic under the Equality Act 2010, both positive and negative, of expanding the domestic Covid Status Certification to accept a negative test (either lateral flow device (LFD) or polymerase chain reaction test (PCR)) as an alternative to proof of vaccination. Where there are potential negative impacts, mitigating actions have been identified. The use of Covid Status Certification for international travel is beyond the scope of this impact assessment. A separate EQIA on this policy can be found here.

The Scottish Government is mindful of the three aims of the Public Sector Equality Duty (PSED): eliminate unlawful discrimination, harassment and victimisation; advance equality of opportunity between people who share a protected characteristic and those who do not; and foster good relations between people who share a protected characteristic and those who do not. We are also mindful that the equality duty is not just about negating or mitigating negative impacts as we also have a positive duty to promote equality. We have therefore sought to promote equality through both the policy itself and supporting guidance.

While it is the view of the Scottish Government that any negative impacts of Covid Status Certification are currently justified and are a proportionate means of helping to achieve the goals set out by the Policy Objectives, we also recognise that these measures are only required to respond to the current set of circumstances, and are only necessary as long as the potential public health benefits can justify any negative impacts caused.

International evidence suggests that crises responses often inadvertently discriminate. The Equality and Human Rights Commission, the Scottish Human Rights Commission and the Children's Commissioner for Scotland stated in April 2020 they had already found increasing evidence that some groups are experiencing disproportionately negative impacts from the virus and some of the responses to it.

The Scottish Government are committed to ensuring that human rights, children's rights and equality are embedded in everything we do, and are central to our response to the pandemic. The Scottish Government's Framework for Decision Making recognises that harms caused by the pandemic do not impact everyone equally, and that we must work to advance equality and protect human rights.

Policy proposal

Covid Status Certification will require certain premises and settings to ensure that there is a reasonable system in operation for establishing that all people in the premises can demonstrate that they are fully vaccinated, they have received a negative test result (LFD or PCR), or they are exempt, and to refuse access to or remove anyone who is neither fully vaccinated, nor has received a negative test result, nor is exempt. "Fully vaccinated" means that a person has completed a full course of a Medicines and Healthcare products Regulatory Agency (MHRA) authorised vaccine, with the final dose having been received 14 days before the date on which they seek to enter the premises or event. A negative test result means that a person has received a negative Lateral Flow Device test (LFD) or Polymerase Chain Reaction (PCR) test in the last 24 hours.

Initially, the scheme did not include a negative test result as an alternative to proof of vaccination as we did not consider that it would be appropriate and believed it could undermine one of the policy aims of the scheme: to increase vaccine uptake. Based on the latest evidence, and a balance of harms, the Covid Certification scheme will include the option of providing a negative test, instead of proof of vaccination. This means that individuals can provide either proof of vaccination or record of a negative test to gain entry to the settings in scope.

This change makes it possible for more people to make use of the scheme, such as those who are not yet fully vaccinated. It also means that individuals who received a vaccine not recognised by the MHRA, or who have experienced difficulty accessing their vaccination record, will be able to attend venues covered by the scheme. We hope that the inclusion of testing will encourage the greater use of regular testing and will still support us to achieve our policy objective of reducing the risk of transmission of Coronavirus.

The scheme will apply in the following higher risk settings:

• late night premises with music, which serve alcohol after midnight and have a designated place for dancing for customers
• indoor events (unseated) planned for 500 or more people at any one time
• outdoor events (unseated) planned for 4,000 or more people at any one time
• any event planned for more than 10,000 people at any one time

The following will not qualify as events for the purposes of the scheme:

• a funeral, marriage ceremony, civil partnership registration, or a reception or gathering which relates to a funeral, marriage ceremony or civil partnership registration
• a mass participation event such as a marathon, triathlon or charity walk
• an event designated by the Scottish Ministers as a flagship event according to criteria, and in a list published by the Scottish Ministers
• a drive-in event
• an organised picket
• a protest or demonstration
• a public or street market
• an illuminated trail
• a work or business conference (not including any peripheral reception or function outside the core hours of the conference, whether or not alcohol is served)
• a business or trade event which is not open to the public for leisure purposes
• communal religious worship
• an un-ticketed event held at an outdoor public place with no fixed entry points

Ministers have been clear that Certification will not be a requirement for public services or other settings that many people have no option but to attend, such as public transport, health services and education.

The following people will be exempt:

• under 18s
• people who for medical reasons cannot be fully vaccinated and cannot undertake a qualifying Covid-19 test
• people taking part (or who have taken part) in vaccine trials
• the person responsible for the premises
• workers and volunteers at the premises or event
• emergency services responders and regulators carrying out their work

The regulations will require the persons responsible for a setting to ensure there is a reasonable system in operation for checking that people seeking to enter the premises are fully vaccinated, can provide record of a negative test result (either LFD or PCR), or are exempt, and to have in place a compliance plan for the system.

The amendments to the scheme will come into force on 6 December. Ministers must review the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021 (which include Certification) at least every 3 weeks to assess whether any requirement in the regulations is still necessary to prevent, protect against or provide a public health response to the incidence or spread of infection in Scotland. We will continue to assess whether any less intrusive measures could be introduced to achieve the same combination of policy objectives in respect of the higher risk sectors concerned; if so, the policy will be immediately reviewed.

Sectoral Guidance is published on the Scottish Government website here. Guidance for the wider public is published on the Scottish Government website here.

Policy Objectives

In line with our strategic intent to 'suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future', the policy objectives of Covid Status Certification are to:

• Reduce the risk of transmission of Coronavirus, by ensuring that specified indoor public spaces where transmission risks are higher are used only by those who are vaccinated or can provide a record of a negative test within the previous 24 hours (or exempt): vaccination or a negative test within the previous 24 hours reduces (but does not entirely eliminate) the risk of being infected, the risk of serious illness and death if infected, and the risk of infecting others;
• Reduce the risk of serious illness and death thereby alleviating current and future pressure on the National Health Service, by reducing transmission in specified settings where transmission risks are higher;
• Reduce the risk of settings specified in the scheme being required to operate under more restrictive protections, or to close, by ensuring that the risk of transmission in these settings is reduced; and
• Increase the protection enjoyed by those using settings covered by the scheme and their contacts, by incentivising those using the settings to take up the vaccine and/or to test regularly and self-isolate if positive.

An evidence paper summarising the range of evidence available on Certification schemes was published here. A follow up evidence paper which sets out the evidence on Certification since the original paper was published is available here. Consistent with our approach throughout the pandemic, the paper adopts a four harms approach covering the direct health harms of Covid-19, the indirect health harms, the social and the economic harms. Evidence is drawn from clinical and scientific literature, from public opinion and from international experience. This impact assessment should also be considered alongside the latestState of the Epidemic report.

Public health rationale

The COVID-19 epidemic continues to pose considerable challenges, with new case rates currently averaging around 3,000 per day, an increase from October. COVID-19 related acute hospital admissions have fluctuated over the past month but have recently started to decrease. Case rates and age standardised hospital admissions are considerably lower in vaccinated versus unvaccinated individuals. Modelling indicates uncertainty over hospital occupancy and intensive care in the next four weeks. Hospitals are currently at, or very close to, capacity and have been in this position for many weeks now with several Health Boards operating within an environment of unprecedented pressure and heightened risk, plus a requirement for military support. This is likely to be driven by Covid-19 cases and delayed discharges but also may reflect that patients with higher acuity are now requiring admission.

As we prepare for winter, our primary and secondary health and social care services are facing arguably the most significant and increasing pressures and demands in the history of the NHS. The winter period will also pose significant challenges of increased transmission and related pressure on the National Health Service. We remain of the view that action is therefore needed across all sectors to ensure adherence to baseline measures. Drawing on the evidence so far available, we consider that Covid Status Certification has a vital role to play as one such measure.

While no vaccine is 100% effective at preventing infection, disease and transmission, and they do not completely break the link between a high volume of positive cases and serious pressure on healthcare services, they are our best route out of the pandemic. Vaccines help prevent transmission of the virus as vaccinated people are less likely to become infected and ill than unvaccinated people (and only infected people can transmit the virus). The UK Vaccine Effectiveness Expert Panel (VEEP) is a group of scientific and analytical specialists from academia and government in the UK who provide a consensus view on vaccine effectiveness, split by variant, vaccine and dose. They have published estimates for vaccine effectiveness based on an assessment of the evidence at the time of writing and as new evidence or data emerges, SAGE will update its advice. A summary published on 24^th September can be found here.

More analysis can be found in a number of large studies including EAVE-II (Early Pandemic Evaluation and Enhanced Surveillance of Covid-19) in Scotland, Real-time Assessment of Community Transmission (REACT-1) in England and the Office for National Statistics (ONS) Covid-19 Infection Survey ONS study. Therefore, we have strong evidence that vaccines are effective at preventing disease, hospitalisations and deaths. In September 2021, COVID-19 cases increased and surpassed the peak that was seen in early July 2021 but have since declined and remained steady through October and November. The rate of increase in cases was less among fully vaccinated individuals compared to partially or unvaccinated individual. As of 25 November, 82.4% of the eligible population (12+) were fully vaccinated, and in the week 13-19 November 38.6% of positive cases were in unvaccinated individuals. However, effectiveness decreases over time for both Pfizer-BioNTech and Oxford-AstraZeneca vaccines due to waning immunity. In the week 13-19^th November in an age-standardised population, individuals were 3.3 times more likely to be in hospital with COVID-19 if they were unvaccinated compared to individuals that had received two or more doses of vaccine.

Vaccine uptake has progressed extremely well in the Scottish adult population with approximately 79% of 18 to 29 year olds and 77% of 16 to 17 year olds having received the first dose of the vaccine as of 24 November. Around 96% of people aged 40 and over have received two doses, but uptake of a second dose remains lower in people in their 30s (77.9%) and the 18-29 age group (69.4%) as of 24 November. Vaccine uptake has slightly increased since the scheme was announced, although it is not possible to directly attribute rises to the introduction of Certification. The proportion of those aged 12+ with a first dose rose from 86.0% to 90.5%. The proportion of those aged 12+ with a second dose rose from 77.6% to 82.2%.

Two main testing methods exist for detection of SARS-CoV-2: LFDs (lateral flow tests or devices) or PCR ( Polymerase Chain Reaction). PCR is the recommended testing method if you have COVID-19 symptoms while LFDs are recommended only for people who do not have symptoms. PCR is a highly sensitive and specific technique to detect SARS-CoV-2 and is a recommended diagnostic testing method by the WHO. Specificity and sensitivity levels of >95% have been reported by SAGE for PCR testing.

LFD testing is effective at identifying people with the virus when they are at their most infectious and have high viral loads. A peer-reviewed study on sensitivity of the LFDs carried out by the University College London found that LFDs are more than 80% effective at detecting any level of COVID-19 infection and, therefore, can be an effective tool in reducing transmission. Another study showed that LFDs are 95% effective and 89.1% specific at detecting COVID-19 when used at the onset of symptoms.

SAGE endorsed the benefits that rapid antigen testing (such as LFD testing) could have on reducing transmission when discussing the UK Government Plan B options; "Other measures are available which, if introduced, could also make Plan B (or more stringent measures) less likely (and could potentially offer better efficiency or effectiveness) for example encouraging wider use of rapid antigen testing in workplaces and the community, and ensuring self-isolation of those who test positive by providing sufficient support".

It is recommended to test twice weekly, which will almost always identify Covid during early stages of infection and thus significantly reduce disease transmission. The optimal testing strategy in order to gain access to a high risk setting would be to take the test as close as practically possible to the time of entry. LFDs are less sensitive than PCR but have the advantage of providing rapid results, and SAGE has endorsed the benefits that rapid antigen testing (such as LFDs) could have on reducing transmission.

Higher-risk settings tend to have the following characteristics: close proximity with people from other households; settings where individuals stay for prolonged periods of time; high frequency of contacts; confined shared environments, and poor ventilation. Settings identified by SPI-B as high risk include public transport; places of worship; restaurants, shops, malls and markets; parties; cinemas; theatres; planes; large family gatherings; religious, cultural, sporting and political events; crowds; pubs and clubs; restaurants and cafes; hotels, cruise ships, hospitals and care homes

By restricting access to customers who are fully vaccinated or who can provide a record of a negative test, it is less likely that infection will take place in these settings, and it is less likely that infections within them will lead to illness. Consequently, we can reduce the risk of transmission of the virus and help reduce pressure on health services, while also allowing settings to operate as an alternative to closure or more restrictive measures. As such, we consider Certification, as part of a package of measures such as improved ventilation, to be a necessary and proportionate public health measure.

NHS Scotland Covid App and Paper Certificate

On 30 September we launched the NHS Scotland Covid Status App (the "App") for international use. This contains two unique QR codes, one for each dose of the vaccine. This product has been designed for use for international travel and so it is necessary to include full name, date of birth and details of vaccination to meet EU standards. This version of App can be used to demonstrate vaccine status in the settings in scope.

On 20 October, the NHS Scotland Covid Check App, which is used by venues to check QR codes, was updated so that when an international QR code is scanned for domestic purposes only a green tick or 'Certificate not valid' is displayed, rather than a person's name, date of birth and vaccination details.

In order to further minimise data display, on 21 October, the Covid Status App was updated to include a domestic page. This option simply shows the person's name and a QR code. When the QR code is scanned by the NHS Scotland Covid Check App it shows either a green tick or 'Certificate not valid' representing someone's vaccination status. The domestic App has functionality to hide or display a person's name. The Privacy Notice can be found on NHS Inform: Personal information we process, How we use your data, Your Rights.

The latest PHS report, published on Wednesday 22 November, showed that the Covid Status App has been downloaded over 1.7 million times up to midnight on 20 November and we continue to monitor user activity. Up to midnight on 20 November, more than 1.2 million PDFs have been downloaded since QR codes were introduced on 3 Sept, with over 516,100 printed versions requested.

For those who do not have digital access or would prefer a paper copy, a record of vaccination can still be requested by phoning the Covid-19 Status Helpline on 0808 196 8565. The paper record of vaccination will then be posted to the address that is on the individual's GP records and held on the National Vaccination Service System (NVSS).

When registering an account on the App the user needs to verify their identity. This is for privacy protection as health data is special category data and protected by GDPR and human rights legislation (Article 8 right to respect for private and family life) and so additional safeguards and security measures are required to verify a person's identity before they are given access to their health records.This means users are asked to scan a photo of their passport or driving licence and then to take a live photo of themselves. The software then uses their live photo to compare likeness with the photo in their ID and confirm their identity. There is manual verification for the small number of cases which fail the automatic process. For the limited number of cases where a person's identity cannot be verified in the App, individuals can call the Covid-19 Status Helpline, or use NHS Inform to request a paper Certificate, which will be posted to them.

Identity verification is an important safeguard for people using the App to ensure that only the person themselves is able to access their vaccination record which is part of their medical record. This ensures public trust in the App. We carried out an options appraisal which concluded that facial recognition was the option that provided the highest degree of security. This information is only used to identify the person and ensure the requester of the Certificate is actually the person holding the device/phone. This data is not retained. Due to the need to develop the NHS Scotland Covid Status App quickly for international travel purposes and against a backdrop of rising cases and pending winter pressures on the NHS in Scotland, which meant the introduction of a domestic Certification scheme was likely, it was not possible to develop more than one IDV (Identity Verification) route for the App's introduction. Work is underway to add other forms of identity to the IDV scheme as well as to identify options for alternatives to non-biometric digital identity verification.

In addition the paper and PDF versions of the Certificate were already available for people to use, either if they are unable or unwilling to use the IDV route so people are not excluded from accessing their medical data. The user pathway for these products is different for these routes including using information in relation to the person's vaccination that it would not have been easily possible to replicate for the App. In addition paper Certificates are sent to the address the person is registered with at their GP.

Many countries accept negative PCR tests or recovery status as an alternative to vaccination, and we expect both of these functions, alongside booster vaccines, to be available in the NHS Scotland Covid Status App for international use by mid- December. Further development work will be required to extend this for domestic use. Further information, such as LFD negative test status, will be added in a future release of the App. In the meantime, customers can display an SMS (text) or email showing they have registered a negative test. There is no QR code within SMS or emails and so they do not need to be scanned by the NHS Scotland Covid Check App. Venues will instead perform a visual check and no data will be retained. Individuals can get an SMS or email by registering the result of their negative test on the GOV.UK website here.

The testing option requires people to have access to a standard mobile phone or mobile device. This does not need to be a 'smart phone' and any mobile phone that can receive text messages or has access to email is sufficient. Test results can be displayed on a mobile phone, tablet or other device, or a paper copy can be printed by the individual. In Scotland, it is estimated that 88% of households had internet access in 2019, however this varied by household net income and deprivation. The proportion of internet users reporting that they access the internet using a smartphone increased from 81 per cent in 2018 to 86 per cent in 2019.

Exemptions

There are medical exemptions for domestic Certification for the very limited number of people who can neither be safely vaccinated and tested. In the vast majority of cases, a successful route to safe vaccination or testing can be found. Local vaccination centres can help to answer questions about the vaccine and can advise what arrangements may be put in place to enable safe vaccination. In the rare cases where that support does not lead to vaccination, an exemption is offered to the individual which can be used for international use. If the individual cannot be tested, they will be advised to obtain proof of evidence from their primary or secondary care clinician in the form of a letter. This evidence will then be assessed by a Scottish Government clinician who will work with the Resolver Group to provide the necessary support on a case-by-case basis to determine whether the individual is exempt from testing.

For more information on exemptions see the NHS Inform website here, call the Covid-19 Status Helpline on 0808 196 8565 or visit your local vaccination centre. Medically exempt individuals are provided with paper Certificates which have enhanced security features. Medical exemptions cannot be displayed on the international section of the App due to EU specifications. They are under consideration for a future release of the domestic section of the App. We continue to engage across the four nations to ensure that work around exemptions is taken forward collectively.

All clinical trial participants have received a letter from their Principal Investigator which can be used for proof of their trial status. Clinical trials participants are encouraged to undertake testing and provide a record of a negative test, as they may have received a placebo dose.

While children are exempt from the requirement to Certification for domestic purposes, 12- 17 year olds who have been vaccinated may choose to download a PDF via NHS Inform, or they may choose to request a paper Certificate by calling the Covid-19 Status Helpline.

The paper Certificates are in English. Information about what information the Certificates contain can be requested in other languages and alternative formats including Easy Read, audio and Braille. Information can be found on NHS Inform here, or when people request their Certificate.

For more information on the Covid Status Certificate see the Scottish Government website here.

Age: Young people (18-39)

Background

A full Children's Rights and Wellbeing Impact Assessment (CRWIA) on the use of Certification for international travel has been carried out and can be found on the Legislation.gov.uk website here. The CRWIA considers the impact of Certification on children – all those under 18 – and so this age group will not be considered in the EQIA.

Young people in the age cohort 18-39 have taken up vaccination at lower rates than the rest of the population. As of 24 November 2021, 78.9% of young adults aged 18-29 had received one dose, with 69.4% having received their second; 84.8% of adults aged 30-39 had received one dose, and 77.9% had received their second. UK-wide research suggests that, while general willingness to get vaccinated is high, vaccine hesitancy (the "reluctance or refusal to vaccinate despite the availability of vaccines") is inversely related to age, as 16–24 year olds are 1.48 more likely to be vaccine hesitant than those aged 45–54 years. Recent Scottish polling conducted in October 2021 found that, among those awaiting their first, second or booster vaccination, 72% of 18-34 year olds were 'likely' to take it, compared to 89% of those aged 50 and over.

Recent UK-wide analysis also shows that vaccine hesitancy has decreased slightly among younger age groups. The latest Opinions and Lifestyle Survey (ONS) conducted in June-July 2021 found vaccine hesitancy was:

• 11% among those aged 16 to 17 years (14% previously in the ONS survey conducted January-February 2021),
• 5% among those aged 18 to 21 years (9% previously)
• 9% among those aged 22 to 25 years (10% previously).

Connected with this lower vaccination uptake among younger cohorts, Public Health Scotland data shows that, in the four weeks up to 30 August 2021, 40.1% of Covid-19 related acute hospital admissions were unvaccinated individuals, of which 56.2% were in the under-40s age group.

Even before the pandemic, young people already reported higher levels of loneliness than the general population. The Scottish Household Survey of 2018 showed that 21% of the general population reported feeling lonely "some, most, almost all or all of the time" in the last week, but this percentage rose to 24% for people aged 16-24.

Evidence collected through the longitudinal Scottish COVID-19 Mental Health Tracker Study run during the pandemic further suggests higher levels of loneliness among young people. The most recent analysis (on data collected in February and March 2021) found those aged 18-29 reported more loneliness than older age groups.

The Tracker Survey has also shown young people have experienced mental health issues disproportionately. In particular:

• 18-29 year olds were more likely to report depressive symptoms (35.8%) than those aged 30-59 years (25.3%) and 60+ years (11.9%).
• 18-29 year olds (28.8%) were more likely to report anxiety symptoms than 30-59 year olds (15.5%), and 60+ year olds (8.2%).
• 18-29 year olds (28.8%) were more likely to report anxiety symptoms than 30- 59 year olds (15.5%), and 60+ year olds (8.2%).

Half of 18-29 year olds (50.2%) reported psychological distress compared to 31.4% of 30-59 year olds and 20.5% of 60+ year olds.

During the pandemic, evidence suggests that young people's mental health has suffered disproportionately from restrictions. In the first wave, 18-29 year-olds reported 1.7 times more depression, 1.6 times more anxiety, and almost twice as many suicidal thoughts than the overall sample. In the second wave, levels of anxiety for that age group increased further.

Differential impacts

Positive Impacts

For adults (18+), the 18-39 age cohort have the lowest level of vaccination.

All 16 and 17 year olds were invited to come forward for vaccination from 6 August. All 16 and 17 year olds will be offered a second dose from 12 weeks or more after their first dose and those who are at increased risk from COVID-19 due to underlying health conditions, those who live with someone who is immunosuppressed, those who are an unpaid carer, a frontline health or social care worker, or those who are within three months of their 18th birthday, will be offered the second dose eight weeks after their first dose. As of the 24 November 2021, 77.1% of 16-17 year olds have had one dose and 19.6% have had 2 doses of the vaccine.

For those young people who have just turned 18 years old and have not had the opportunity to be doubled vaccinated, plus two weeks, for example if they have recently tested positive for Covid and have had to wait 4 weeks before getting their vaccination, they will be able to show record of a negative test as an alternative to vaccination.

A study comparing six countries has found that Certification increased vaccinations 20 days prior to implementation, with a lasting effect up to 40 days after. The uptake was higher for <20 years and 20-29 years when restricted to settings such as nightclubs and events. When expanded to a greater range, a high uptake was also seen in 30-49 age groups. A greater change was seen in countries with lower starting levels of vaccination. It is important to note these schemes were not vaccine only, like Scotland, and had a different scope.

If vaccine and testing uptake increases among this age group, this would positively impact them as increased vaccination will reduce the direct health harms from Covid-19 and increased testing will enable us to identify the virus and reduce transmission.

There are some young people, such as some care experienced people, who may find it more challenging to access and maintain Certification due to their life experiences and circumstances. For example, a care experienced person may change their address frequently, and may not have their current address registered at their GP. Including testing as an alternative to vaccination could have positive impacts for these younger people, as this may avoid difficulties with changing addresses and maintaining paper documents. However, we know that digital exclusion affects care experienced young people and so they may not have a phone to receive or display SMS and email test results.

Socialisation is key in supporting and maintaining relationships, mental health and wellbeing. Evidence shows that the mental health of this age group declined during lockdowns, and then gradually increased as settings re-opened. The settings in scope are often frequented by young people and play an important role in facilitating socialisation. Therefore, if the policy objective is achieved and the risk of transmission is reduced, which in turn allows higher risk settings to continue to operate as an alternative to closure or more restrictive measures, the policy could positively impact young people as it facilitates their ability to socialise.

Negative Impacts

Stakeholders noted the reduction in mass vaccination centres and that some remaining sites could be more difficult, expensive, or time-consuming to access. This, coupled with the later offer of the vaccine to younger people, may make vaccination less accessible for this age group. The introduction of testing as an alternative to vaccination would mean that those who are not yet fully vaccinated would be able to access the regulated spaces.

We want visitors coming to Scotland to be able to access events and venues. For domestic Certification purposes, only MHRA-authorised vaccines are accepted and this does not include the World Health Organisation (WHO) list vaccines, such as the Chinese vaccines Sinopharm and Sinovac and the Indian vaccine Covaxin. While students can be any age, they are far more likely to be younger and between the ages of 18-25. Many students travel internationally to attend Scottish universities and of these many have received a vaccine which is not authorised by the MHRA. Stakeholders have informed us that an estimated 23,000 international students could have received an alternative vaccine. This could impact their ability to socialise with other students, such as going to nightclubs or sporting events. For those whose vaccine is not recognised by the MHRA, testing would be an alternative option and would mitigate against the negative impacts.

Test results are valid for 24 hours and so for those who do not have a MHRA vaccine, testing could have an impact on spontaneous attendance at events. LFD tests can be ordered online on picked up from a local pharmacy and, dependant on the test used, takes approximately 30 minutes to process the result. Registering the results of the LFD test on the GOV.UK website here takes a short period of time and the SMS and email confirmation are generally issued very quickly.

There is a possibility that Certification could be used beyond the intended purposes, and that employers could require proof of vaccination as a condition of employment. Employees within the regulated settings are generally younger. Evidence from the Institute for Fiscal Studies showed that young people (under 25s) in the UK were 2.5 times as likely to work in a sector that has been 'shut down' during the pandemic, such as leisure and entertainment. Therefore, if employers use Certification beyond the policy intention, it is more likely to impact on younger people. This age group has been already impacted financially by the pandemic, so if people are not able to maintain or gain employment due to their Certification status this may exacerbate pre-existing impacts. The inclusion of testing will act as a mitigation against this, however as LFD test results are only valid for 24 hours, daily testing may be inconvenient and burdensome.

Age: Older People

Background

Older people have been particularly impacted by the health harms of the virus. As seen in Figure 1, death rates calculated with data throughout the pandemic increase exponentially with age.

Source: Public Health Scotland: https://www.opendata.nhs.scot/dataset/covid-19-in-scotland

Source: Public Health Scotland: https://www.opendata.nhs.scot/dataset/covid-19-in-scotland

Social isolation and loneliness has been exacerbated by Covid restrictions and a key group affected are those aged over 75. A report from Age UK, 6 months into the pandemic suggests that the pandemic has had a damaging effect on older people's mental health: 34% of those surveyed agreed that their anxiety was worse or much worse than before the start of the pandemic. Of those surveyed aged over 70, 31% reported feeling unsafe or very unsafe, and 45% uncomfortable or very uncomfortable when outside of their home due to the pandemic. More recent Scottish polling conducted in October 2021 also found 68% of respondents aged 75 or over felt 'worried about the Coronavirus situation' compared to 53% of all respondents (although small base size is noted for the over 75 group).

In February 2021 Age UK conducted a survey on those aged 60+ showing that: 36% feel more anxious since the start of the pandemic and 43% feel less motivated do the things they enjoy since the start of the pandemic. Older people have reported losing confidence in their ability to take part in

activities which were previously routine before the pandemic. In addition the prolonged periods of isolation, reduced social contact, and limited mental stimulation has led to 22% of older people finding it harder to remember things since the start of the pandemic.

There have been significant wider impacts on older people. In March 2020, about 180,000 individuals (3% of the Scottish population) who were clinically extremely vulnerable (CEV) were asked to shield. CEV individuals are more likely to be female, older, and live in more deprived areas of Scotland than the population at large. A study on the experience of those shielding found that 87% reported a negative impact to their quality of life, 85% a negative impact on physical activity and 72% a negative impact on their mental health. A further Scottish survey conducted on the impacts of the second lockdown on those aged over 50 found 48% of respondents who had shielded 'felt more anxious' as we entered lockdown in January 2021, compared to 39% of all respondents.

Differential impacts

Positive impacts

If the policy objective to reduce the risk of transmission are achieved this would positively impact older people, as any reduction in transmission of the virus will positively impact this group who are at a far higher risk of poorer health outcomes if they contract the virus.

Age Scotland suggested that Certification could play a positive role in supporting older people to feel safer and more confident in society if they know that those around them are vaccinated or tested. This is particularly the case for those older people who are clinically extremely vulnerable. Age Scotland also felt that the introduction of testing was a positive addition to the Scheme.

Lockdowns and restrictions have negatively impacted older people's mental health and wellbeing. If the policy objective is achieved and higher risk settings continue to operate as an alternative to closure or more restrictive measures, this could positively impact older people if, for example, they are still able to attend the settings in scope with family, friends and support groups and services.

Negative impacts

Digital access reduces with age. As of 2019, 20% of over-55s in the UK do not own a smartphone and only 47% of adults aged 75+ use a smartphone to access the internet, compared to 98% of 16-24 year olds.

Vaccine Certification is available both digitally (via an App) and as a paper document. Stakeholders have highlighted that although paper Certification would mitigate against digital exclusion, it may still present challenges depending on how easy it is to update (for instance if data is incorrect or out of date, such as QR codes expiring) and on what happens when a Certificate is lost, stolen or destroyed. Age Scotland noted that not all smart phones or camera phones can host the App. They also encouraged continued communications with business to ensure that the sector are aware of and accept paper Certificates.

People do not need to have a 'smart phone' or 'camera phone' to display their negative test result. Any mobile phone that can receive text messages or access emails is sufficient. At this point in time, a paper testing Certificate is not available.

When registering on the App for the first time, the user needs to verify their identity before they can access their health records. This will done using biometric identity verification: a facial recognition software which will compare the photo in a person's ID with a live photo or video. Stakeholders raised this as a potential issue, as some older people have never had ID, or it has expired and not been renewed. Stakeholders cited research commissioned by the Cabinet Office for the introduction of mandatory photo ID at polling stations, which suggests that 2% of people aged over 70 in Great Britain do not have any form of ID.

However, those who cannot verify their identity on the App can call the free national helpline and request a paper copy of their Certification, or use the Covid Vaccination and Scheduling Portal. The Covid-19 Status Helpline is free and open every day from 10:00-18:00. A Resolver Group has also been established to resolve any reported inaccuracies in vaccination records and wider issues relating to acquiring Covid Vaccination Certification.

Stakeholders have also raised that clear, accessible communications are required as some older people may not be aware that a venue or event requires Certification, which may result in them being denied entry. Documents explaining what is shown on your Certificate have been translated into 19 different languages, and is also available in audio format, Easy Read, and Braille, all of which can be found here.

As Certification is required to access some settings, it could potentially be used as a method of coercive control, for example by taking a phone or paper Certificate from the victim. Although older people have historically been a 'hidden' group in domestic abuse statistics, UK research from 2016 suggests that victims aged 61+ are much more likely to experience abuse from a family member, much more likely to suffer abuse from a current intimate partner and more likely to keep living with the perpetrator after getting support.

Lastly, some older people rely on carers and others, including family members, for everyday living. If someone who cares for an older person does not have Certification, this could negatively impact on the older person if they are not able to access the setting in scope due to not having support from their carer. The inclusion of testing will act as a mitigation against this. While this is unlikely, the carer may also choose not to be tested.

Disability

Background

According to the 2019 Scottish Health Survey, 32% of men and 37% of women in Scotland reported living with a limiting long-term condition. For people aged 75 and over, 58% had a limiting long-term condition. 1 in 5 Scots identify as disabled, and more than a quarter of working age people have an acquired impairment.

Covid has had a disproportionate impact on the health of disabled people: 93% of people who died from Covid-19 up until April 2021 had at least one pre-existing condition. Research by National Records of Scotland with deaths data until January 2021 found that, after adjusting for age, disabled people were between 1.8 to 3.2 (women) and 1.8 to 3 (men) times more likely to die with Covid-19 than non-disabled people, depending on the extent to which disability limited their daily activities. Similarly, research in England which analysed data from up to February 2021 estimated that, after adjusting for age, sex, ethnicity, and geographical location, adults on the learning disability register were 5.3 times more likely to be hospitalised in relation to Covid-19, and 8.2 times more likely to die due to Covid-19.

Covid-19 restrictions have impacted disabled people particularly hard. Evidence has highlighted how, for wheelchair users, their main option to meet others was indoors, whilst others with dementia or learning disabilities struggled to understand the rapidly changing restrictions. Other evidence suggests that people with pre-existing mental or physical conditions feel negatively affected by the fact that others seem to now be living more normally than they do, and those with physical health conditions are among the sub-groups with the highest level of concern about the occurrence of another wave of Covid-19.³⁵

Differential impacts

Positive impacts

If the policy objectives to reduce the risk of transmission is achieved, this would positively impact those disabled people who are at a far higher risk of poorer health outcomes if they contract the virus.

Some disabled people who are clinically extremely vulnerable were asked to shield at the start of the pandemic. Anecdotal evidence suggests that while shielding officially ended on 26 April 2021, concerns about contracting the virus have remained, and many individuals have continued to behave as if they are still shielding, leading to an adverse impact on their lives and quality of life.

Stakeholders have suggested that Covid restrictions and protective measures can support disabled people to feel safer when in public and participating in society. A recent poll conducted by Disability Equality Scotland found that 82% of respondents had no concern about the Certification scheme. Views on the scheme were mixed however some respondents perceived it as reassuring and a way to improve participation in society for those at risk. Some respondents would like to see Certification extended to more settings. Inclusion Scotland also noted anecdotal evidence that some carers would like to see Certification extended to more settings as they felt the risk of attending settings where Certification is not in place is too high and as a result the people they care for have been acting as if still shielding. Certification could therefore provide reassurance for these people and support them to feel safer and more confident in society.

Additionally, if the policy objective to allow higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, Certification could benefit disabled people as socialisation plays a key role in disabled people's wellbeing. Therefore, if Certification supports settings to remain open and facilitates socialisation, such as the ability to attending the settings in scope with family, friends and support groups and services, this would have positive impacts on disabled people.

Negative impacts

As with age, digital exclusion is a key consideration for disabled people. Glasgow Disability Alliance reports that 60% of their members feel digitally excluded and that, while disabled people may have a smartphone, it may be too old to support certain apps. Some disabled people may use an older model of a mobile phone as it meets their accessibility needs and so may not want to upgrade their phone to a new model which can support the NHS Scotland Covid Check App.

In response to a recent poll conducted by Disability Equality Scotland, respondents suggested that the NHS Scotland Covid App was not accessible as it requires an email address and a driving license or passport to register and verify the user's identity. In addition, there could be some accessibility issues for blind or people with visual impairments, as the App does not contain audio prompts. Stakeholders encouraged further user testing to ensure the App is accessible for all users. Documents explaining what is shown on your Certificate have been translated into 19 different languages, and is also available in audio format, Easy Read, and Braille, all of which can be found here. There were also reports of people in rural areas being unable to download the App due to a lack of phone signal.

A paper vaccine Certificate can be requested by phoning the free Covid-19 Status Helpline which is open every day from 10:00-18:00. Additionally, people do not need to have a 'smart phone' or 'camera phone' to display their negative test result any mobile phone that can receive text messages or access emails is sufficient.

Stakeholders also felt that clearer communications were needed on Certification and other baseline measures. They also felt that, while the inclusion of LFD testing was generally positive, there is the possibility that people could fraudulently use the system.

As with many other products which are part of everyday life, such as bus passes, there may be limited circumstances where a disabled person finds it challenging to maintain either a digital or paper Certificate. According to the latest statistics, in 2019 there were 23,584 adults in the autistic spectrum or with learning disabilities known to local authorities in Scotland. Some of these people may find it more challenging to maintain Certification, which could lead to negative impacts if it results in them not being able to access a setting in scope. They may also find the experience of being turned away confusing and distressing. In these circumstances, the individual can call the Covid-19 Status Helpline and request a paper copy of Certification. A carer or relevant adult can also call the helpline and request a paper copy of Certification on behalf of the person they are caring for. If the individual is time limited and cannot wait for a paper Certificate to arrive, they can take an LFD test and register the result on the GOV.UK website. They can then use the SMS or email confirmation of a negative test to enter a regulated setting.

There are exemptions in the regulations for the very small percentage of the population who cannot be vaccinated and tested for medical reasons. Some people who are exempt from vaccination and testing may have a condition which would constitute a disability under the Equality Act.

While the details of a person's exemption will not be displayed on their exemption Certificate – it will simply say 'Exempt' – stakeholders have nonetheless raised concerns about data protection, as health data is special category data and protected under human rights legislation (Article 8 right to respect for private and family life). Stakeholders have also raised concerns that, for the very small proportion of disabled people who are exempt, some may be denied access to the regulated settings, even though they have an exemption, as has been experienced with face covering exemptions. Medical exemptions cannot be displayed on the international section of the App due to EU specifications. They are under consideration for a future release of the domestic section of the App.We continue to engage across the four nations to ensure that work around exemptions is taken forward collectively.

As with younger people and other groups (such as those living in poverty), disabled people may also have difficulty accessing the vaccine if they are unable to access vaccination sites. Disabled people may have less access to transport than non-disabled people if public transport is inaccessible or not suitable for them, and if other forms of transport (such as taxis) are prohibitively expensive. While we are committed to an inclusive vaccination programme, record of a negative test can be used as an alternative to access the regulated spaces until people have been fully vaccinated.

Stakeholders also highlighted that disabled people are more at risk of becoming victims of a variety of scams, and this is substantiated by an information briefing from Citizens Advice in June 2018. Certification may then provide "phishing" opportunities for scammers, which may impact disabled people more than non-disabled people.

Certification may negatively impact disabled people if their carer has a different status to themselves. Data from England shows that 91% of carers known to local authorities care for someone with a physical disability or a long-standing illness and 31.3% of Scottish adults with a learning disability live with a family carer.

As with older people, there is the potential for a Covid vaccine certificate to be used as a tool to exert coercive control. A report from Public Health England in 2015 indicated that disabled people experience higher rates of domestic abuse and suffer it for longer periods of time, more severely and more frequently. Data from Glasgow over 2018-20 shows that 12% and 22% of Adult Support and Protection investigations involved someone with a physical or a learning disability, respectively.

Gender Re-assignment

Background

As of May 2018, around 0.5% of the population of Scotland (24,000 people) were estimated to be transgender.

Trans people suffer disproportionately from mental health conditions. A systematic review concluded that they were twice as likely as the general population to take their own lives and that a lack of access to health care places particular pressure on trans communities. A 2020 review of literature on trans people and loneliness found that trans people often report higher levels of loneliness than the general population. It also found that belonging to communities of people who face similar challenges has a positive psychological impact on trans people's wellbeing.

Differential impacts

Positive impacts

Socialisation is important for many trans people and is essential in maintaining their mental health and wellbeing. Therefore, if the policy objective is achieved and the risk of transmission is reduced, which in turn allows higher risk settings to continue to operate as an alternative to closure or more restrictive measures, Certification could positively impact trans people as it supports their ability to socialise.

Negative impacts

Many trans people may be known by different names, pronouns, and genders by different people, institutions, and databases at various points in their lives. If name changes have not carried across all data sets, people may have different names and genders on different healthcare databases, which stakeholders have advised can cause data flow and interoperability issues. Stakeholders have also informed us that in a few circumstances entire health care records have been deleted and a new profile created when an individual has asked for their name or gender to be changed.

When registering on the App for the first time, the user needs to verify their identity before they can access their health records. This is done using biometric identity verification in the form of facial recognition software which compares the photo in a person's ID with a live photo or video.

This could present a number of problems for trans people. We know that LGBT people are less likely to have valid ID and may therefore find it more difficult to verify their identity on the App. Unpublished interim findings from a joint survey run by Stonewall and LGBT Foundation found that: nearly one in four respondents (23%) had experienced problems having ID accepted in the past; just under three quarters of respondents (73%) owned a usable UK passport, and just over two thirds of respondents (68%) owned a usable driving license ('usable' = where the photo looks like them and the personal data matches their name and gender. Out of date ID is still 'usable' for the purposes of the survey). The top five most common barriers or concerns cited in relation to obtaining ID were: receiving intrusive questions from other people when applying for or presenting ID (38%); obtaining ID taking more energy than they have available (37%); being unable to easily print documents (32%); being 'outed' as trans when applying for or presenting ID (31%) and obtaining ID taking more time than they have available (26%). For those who have no ID and are therefore unable to register with the App, they will still have access to the paper alternative, as this can be posted to the address held on health databases. In addition, ID is not required to register a negative test result and so proof of a negative test – either an SMS or email – could also be used.

If they do have ID, trans people may then encounter other issues relating to the verification process. The biometric identification software will compare the photo on the ID with a real time photo or video of the individual. For some trans people their photo could look different to their current appearance for a number of reasons, including that they are wearing make-up, they have taken hormones or undergone facial surgery. This may mean that the software is not able to automatically verify the person's identify. Gender and racial biases within facial recognition software are known in the technology industry and stakeholders highlighted that minority ethnic (ME) communities and trans people often have lower rates of automatic verification with this type of software, and stated that this could be particularly true for trans ME people. Jumio, the company providing the software, works to minimise demographic bias in their AI algorithms by using large and representative data sets and training its AI on real-word production data.

After the biometric verification check, a last barrier for trans people is that if the individual's details on their ID differs from those on their medical records, they might not be able to register their account. Stakeholders have informed us that trans people often have turbulent interactions and relationships with health care services, so if Certification creates the need for increased interactions then it could potentially cause additional anxiety and distress.

Once an account has been created, stakeholders have highlighted the risk that Certification could lead to discrimination and distress if a user's name is displayed on the App or Certificate. For example, if someone's name on their medical records – and therefore their Certificate – is different to the name that they use with their friends, family and others, this could lead to their transgender identity being unintentionally disclosed.

If a trans person cannot verify their identity on the App, requests a paper Certificate, and the document is posted to their family home, this could unintentionally reveal their trans status to family members. LGBT young people are already fearful of disclosing their identity – 'coming out' – and 77% of young people believed their sexual/gender identity was a causal factor in their rejection from home.

The domestic App has functionality to hide and display a person's name. Individuals can create separate profiles for international and domestic use using different email addresses. If an individual wishes to use a different name domestically, and has photo ID in that name, they can create one account for international travel, which aligns with the details on their passport, and one account for domestic use, which aligns with their preferred name. The App can only host one account at a time so the individual will have to log in and out to use the different accounts.

The inclusion of testing as an alternative to vaccination reduces the risk that a person's transgender identity is unintentionally disclosed as any name can be registered with the testing portal and there is no verification of name or identity so an individual can use their chosen name.

Marriage & Civil Partnership^[1]

Background

During the pandemic there has been a reduction in the number of new marriages and civil partnerships: there were 5,545 marriages registered in Scotland between 1 April and 30 June 2021, 30% lower than the average number on a second quarter over the five years 2015-19, but a large increase on the number of marriages in the same period in 2020 following the easing of Covid-19 restrictions. This was mainly as Registration Offices were closed from mid-March and most marriages scheduled after the closure could not take place. From June 2020 onwards marriages and civil partnerships were resumed but with very strict limits on the number of attendees.

In 2020, over 264,000 weddings were postponed in the UK. UK polling data gives us further indications of the extent to which couples who wanted to get married or registered as a civil partnership have been impacted by the pandemic. A poll of more than 400 couples with weddings planned between September 2020 and January 2021 revealed that, while 95% are not planning to cancel their wedding, 71% were choosing to postpone to later in the year or into 2022. This is corroborated by a survey of 1,449 people who had planned to marry during the first lockdown in summer 2020 in England and Wales: 625 (43%) of respondents had been unable to marry on their intended wedding date, with the majority of them having to postpone their plans. YouGov polling data from June 2021, which covered more than 3,200 adults in Great Britain, reveals that 91% of respondents have not attended a wedding in the last year or so, under Covid-19 restrictions. Of the very small number of respondents who have (6%), half of them (3%) said that the experience had not been as good as it could have been without Covid-19 restrictions.

Differential impacts

Positive impacts

There is an exception for funerals, marriage ceremonies or civil partnerships and related post ceremony gatherings from the requirement for Certification.

Negative impacts

If partners or spouses have differing Certification status then this could potentially have negative impacts if one person is not able to enter a setting in scope while the other is. The inclusion of testing will act as a mitigation against this. While this is unlikely, a partner or spouse may also choose not to be tested.

Pregnancy and Maternity

Background

Current evidence, focusing on the delta variant, suggests that pregnant women are no more likely to get Covid-19 than adults without health conditions, but that they may be at increased risk of becoming severely unwell compared to women who are not pregnant, particularly in the third trimester.

Though evidence surrounding whether COVID during pregnancy increases the risk of still birth is conflicting, recent evidence suggests an increased risk . A study from the American Journal of Obstetrics and Gynaecology that studied more than 340,000 births in England up to January 2021 found that women who tested positive for Covid-19 around the time of birth were twice as likely to have a stillbirth, and were more likely to have an emergency caesarean birth compared with those who didn't have Covid-19 when giving birth. Another global study of 2,100 pregnant women across 18 countries found that women who contracted Covid-19 during pregnancy were over 50% more likely to experience pregnancy complications, and that their risk of dying during pregnancy and in the postnatal period was 22 times higher than in the non-infected pregnant women. Babies born to mothers who have Covid are also more likely to be born pre term . Although there was less evidence earlier in the pandemic, pregnant women had been included in the list of people at moderate risk if they contracted the virus as a precaution, and a small number were asked to shield during the pandemic if they had congenital or acquired heart disease.

The Royal College of Obstetricians and Gynaecologist provide weekly updates and have said that vaccination in pregnancy against COVID-19 is strongly recommended and should be offered at the same time as the rest of the population based on age and clinical risk. JCVI and the NHS also recommend pregnant women are offered the vaccine as well encouraging them to get the second dose while pregnant, if not pregnant at the time of their first dose .

The virus has also impacted pregnant women's wellbeing and economic prospects. A survey of almost 20,000 mothers and pregnant women, conducted after the first wave by Pregnant Then Screwed, showed that 15% of mothers surveyed were either made redundant or expected to be made redundant. 72% of mothers reported needing to work fewer hours because of childcare issues, and 65% of mothers who were furloughed said a lack of childcare was the reason.

Differential impacts

Positive impacts

Public insights polling has found that 53% of those surveyed agreed that the high level of people with two doses of the vaccine in Scotland gives them more confidence to go out and about and 62% of respondents agreed that, it they wanted to go to premises or an event, having a Covid Status Certification scheme in place would make them feel more comfortable doing this. This was particularly true of women, who were 7 percentage points more likely to agree that it would make them feel more comfortable (women 65% vs men 58%).

Therefore Certification could add a layer of reassurance to pregnant women and support them to feel safer and more confident participating in society. More recent polling of 9,000 pregnant women by Pregnant Then Screwed showed that three quarters of respondents said they feel anxious about the easing of Covid-19 restrictions.

If the policy objectives to reduce the risk of transmission is achieved, Certification could benefit pregnant women as they are at a higher risk of poorer health outcomes if they contract the virus.

Stakeholders highlighted that, if the policy objective to allow higher risk settings continue to operate as an alternative to closure or more restrictive measures is achieved, Certification would be welcomed by many pregnant women as they have been negatively and sharply impacted by the economic burden of restrictions and lockdowns.

Negative impacts

We know that vaccine hesitancy is higher in women, particularly younger women, in part due to fears related to fertility. Stakeholders have highlighted anecdotal evidence that women who conceived through IVF are particularly vaccine hesitant. Whilst direct comparisons are not currently available, the data on Covid-19 vaccination in pregnancy shows that, to date, vaccination rates have been lower in pregnant women compared to non-pregnant women in the same age groups. Public Health Scotland data shows that 30% of women aged 35-39 who delivered their baby in July 2021 had received a Covid-19 vaccination by the time of delivery. By contrast, data available for the general population shows that by the end of July 2021, 81% of adults aged 30-39 years in the general population had received at least one dose vaccine. Pregnant women could be impacted by Certification if they are not vaccinated and are denied access to the settings in scope. However, adding testing to the Certification scheme would mitigate against this as pregnant women or those breastfeeding who choose not to be vaccinated can provide a record of a negative test in order to access a regulated setting.

There are very few circumstances where pregnant women are advised against vaccination due to pregnancy related complications. In these circumstances record of a negative test can be provided as an alternative to proof of vaccination.

If Certification exceeds the policy intention and is used by private businesses or third parties as a condition or employment, then this could negatively impact on pregnant women if they have not been vaccinated. A negative test could be used as an alternative to proof of vaccination, however as a LFD test result is only valid for 24 hours, testing every day could be burdensome. Businesses which are not covered by the Government's scheme are required to meet their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.

Race

Background

Minority ethnic people in Scotland experience significant health inequalities. Prevalence of some health conditions are higher for some ethnic groups, such as Type 2 diabetes and coronary heart/cardiovascular disease among people of South Asian and African descent. In 2011, despite having a much younger age profile, 37% of Gypsy/Travellers reported having long-term health conditions compared to 30% of the population as a whole.

Inequalities are also socioeconomic. Relative poverty, which affected 23% of households in Scotland in 2019, rose to 38% and 39% in Black and Asian households respectively. The gap in employment rates for working age minority ethnic people, relative to the white population, was 22% for women and 9.5% in men, and Pakistani and Bangladeshi workers had the lowest median hourly pay and were also the least likely to work from home in the UK.

The pandemic has exacerbated existing health and wider inequalities. Analysis of hospitalisations and more severe outcomes due to COVID-19 up to 30 September 2021 point to continued evidence of increased risks in most ethnic minority groups relative to the White group. White Scottish, rates of hospitalisation or death were estimated to be around 4-fold higher in Pakistani and Mixed groups, and around 2-fold higher in Indian, Other Asian, Caribbean or Black, and African groups. Deaths amongst people in the South Asian ethnic group during wave 1 were almost twice as likely to involve COVID-19 as deaths in the White ethnic group, after accounting for age group, sex, area-level deprivation and urban rural classifications. This increased to 3.78 times and 3.55 times more likely for wave 2 and wave 3 respectively. A similar pattern was seen for the Black/Caribbean/African group compared to the white group with an increased risk of 1.47 times, 2.03 times and 3.33 times more likely to die of COVID-19 for wave 1, 2 and 3 respectively. Estimates show that low earners were 7 times more likely than high earners to have worked in a sector that has shut down as a result of the lockdown, and those with customer facing roles are likely to have seen reductions in earnings or face job losses as they are less able to work from home.

Differential impacts

Positive impacts

If the policy objective to reduce the risk of transmission is achieved, Certification could benefit minority ethnic communities, as they are at a higher risk of poorer health outcomes if they contract the virus.

A panel study with more than 70,000 participants across the UK undertaken by University College London suggests that minority ethnic people describe higher levels of loneliness than their White counterparts. Therefore, if the policy objective to allow higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, Certification could benefit minority ethnic groups by facilitating socialisation.

People from certain ethnicities, for many different complex and nuanced reasons, are less likely to take up the vaccine. Testing will act as a mitigation and will allow those who have not been fully vaccinated to access the regulated settings.

Negative impacts

Lower vaccine uptake among ME communities is a result of a combination of factors including misinformation, mistrust, socioeconomic barriers, and delivery that does not meet accessibility needs. For example, some Gypsy/Travellers are often not in an area long enough to engage with health services to be fully vaccinated. In this circumstance testing could act as a mitigation for Gypsy/Travellers, who are more likely to have an address on their GP records (where paper vaccine Certification is sent to) to the one where they currently reside. A test result could be registered on the GOV.UK website and the SMS or email used to access a regulated setting.

Looking at ethnicity, the uptake of the first dose by most ethnic groups is lower than the White group for all age cohorts.

Survey data from UK-wide research suggests that, in comparison to White British and White Irish participants, Black African and Mixed Black African health and social care workers were less likely to have been offered a vaccine, and much more likely to have declined vaccination if offered. Reasons for doing so among Black African participants included distrust in Covid-19 vaccinations, healthcare providers and policymakers. Uptake by the White Polish community is also comparatively much lower. Therefore Certification could negatively impact ME communities if they are denied access to the regulated settings due as they have not been vaccinated.

As at 28 September 2021, in those aged 18 and over, dose 1 vaccine uptake is highest in White ethnic groups (89%) and lowest in the Caribbean or Black ethnic groups (68%). For dose 2 this is 84% and 60% respectively. For dose 2 the lowest uptake is in African ethnic groups (59%).

SAGE have reported, with high confidence, that Black African and Black Caribbean groups are less likely to be vaccinated (50%) compared to White groups (70%). Survey data from the UK Household Longitudinal study shows overall high levels of willingness (82%) to take up the COVID-19 vaccine. However, marked differences existed by ethnicity, with Black ethnic groups the most likely to be COVID-19 vaccine hesitant followed by the Pakistani/Bangladeshi group. Other White ethnic groups (which includes Eastern European communities) also had higher levels of COVID-19 vaccine hesitancy than White UK/White Irish ethnicity.

Stakeholders raised concerns that the introduction of Certification could exacerbate vaccine hesitancy and thus undermine one of our initial policy objectives. They felt that Certification is unlikely to incentivise asylum seekers, refugees or migrants to take up the vaccine as they do not often frequent the settings in scope. Stakeholders also felt that as parents and guardians are influential figures in children's lives, children may hold the same sentiments as their parents, and may also become less likely to take up the vaccine.

Certification could also impact migrants. Research suggests that the majority of documented migrants that are recent entrants to the UK do not register with a GP, despite relatively easy access to primary healthcare. Undocumented migrants, refugees and asylum seekers are even less likely to register in primary care services. Stakeholders identified that a reason for this is fear that their data will be shared with the Home Office, which could impact on their migration status. This is based on prior experience of health data being shared by the NHS with the Home Office.

We know people from lower socio-economic backgrounds are more likely to be digitally excluded. For example, 82% of households in the 20% most deprived areas in Scotland had internet access at home compared with 96% of households in the 20% least deprived areas. We also know that relative poverty impacts ME people far more than White people and so minority ethnic communities are more likely to be digitally excluded. Paper certificates are available as an alternative, together with support and guidance. Whilst this is a sound option, it may still present some challenges. For example, as a security measure, the paper Certificate is posted to the address held by the GP. This could impact some groups, such as some Gypsy/Travellers, who may not have a fixed address.

Those in Scotland who have been vaccinated abroad with a vaccine that has not been approved by the MHRA may be negatively impacted by the scheme if they are unable to access spaces were Certification is required. This may include those visiting Scotland, or residents, such as international students. Stakeholders have informed us that an estimated 23,000 international students, including 13,000 Chinese students, could have had an alternative vaccine. This could impact on people's ability to participate in society. For those whose vaccine is not recognised by the MHRA, testing would be an alternative option which would allow them to access the regulated settings.

In terms of the App, as previously explained under the Gender Reassignment section, facial recognition software has been found to contain racial and gender biases. This may mean that a higher number of minority ethnic people, especially women, registering for the App could encounter more difficulties verifying their identity than white people. Stakeholders also highlighted that migrants, asylum seekers and refugees, are less likely to have ID, and as such may be unable to use the App. ID is not needed to register a test result and so an SMS or email confirmation could be used to access the regulated setting.

There is also the possibility that Certification could be used beyond the intended purposes and employers could require proof of vaccination as a condition of employment. People from ethnic minorities are disproportionately represented in industries where working from home is not feasible, and may therefore be more impacted if employers enforce this requirement. A negative test could be used as an alternative to proof of vaccination, however as a LFD test result is only valid for 24 hours, testing every day could be burdensome. Businesses which are not covered by the Government's scheme are required to meet their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.

As with anything where documentation affords access to certain spaces, services or products, there is the potential that unconscious bias could cause enforcement of Covid Status Certificate to be administered in a discriminatory manner. There are more subtle ways that unconscious bias could be enacted, as for example while taking all reasonable measures to enforce Certification, employees may spot check people from minority ethnic groups far more than white people. While people may still ultimately gain access to the setting if they have Certification, the experience of feeling singled out could still cause distress, a loss of time, distrust in the scheme, and anxiety about future use.

Concerns regarding discrimination are apparent in public polling: minority ethnic people report 18% more concern than White respondents that they would be discriminated against through vaccine passports, and 54% of all surveyed people think it is likely that vaccine passports would lead to discrimination against marginalised groups. There is also anecdotal evidence that this has occurred and that ME attendees have been asked for proof of Certification more frequently than white attendees.

Religion or belief

Background

Attending a place of worship is for many an important role in promoting their spiritual wellbeing and mental health, as well as contributing to a reduction in social isolation and loneliness.

Limitations on attending places of worship (including closure of in person worship) has impacted on people's ability to practice certain aspects of their faith, such as to congregate for worship in line with their Article 9 (freedom of thought, belief and religion) rights under human rights legislation.

Differential impacts

Positive impacts

There is an exception within the regulation for certain purposes, including communal religious worship. Certification would therefore not impact on freedom of religion (Article 9).

Negative impacts

People of certain religions may choose not to be vaccinated because it goes (or is perceived to go) against their beliefs. Examples include Muslim or Jewish people if a vaccine contains, or is believed to contain, pork cells, or Orthodox people if a vaccine contains, or is perceived to contain, embryonic cells. An interfaith statement, which urged people to come forward for vaccination, was issued by faith leaders. The Muslim Council also issued a statement encouraging people to be vaccinated and ran a vaccination campaign.

There are also other beliefs and convictions, such as veganism, which may result in a person choosing not to be vaccinated, as it has been tested on animals.

While we encourage everyone to come forward for vaccination, in these circumstances, testing can be used as an alternative to vaccination and mitigates against people being denied access to the regulated spaces.

Sex

Background

As can be seen in Figure 5, more women tested positive than men during lockdown periods (March-June 2020, December-March 2020-21). This is partly due to the fact that women are more likely to work as a key workers and in people-facing roles that carry greater risk of infection.

Despite testing positive more often than men, data from up to September 2020 showed that, after adjusting for age, males were 1.4 times more likely to die from Covid than females. However, there is emerging evidence that women may be more affected by long Covid.

Scottish research into mental health impacts during the first wave of the pandemic shows that women reported higher levels of psychological distress than men across all ages, as well as symptoms of depression and anxiety.³⁴ This is consistent with UK-wide research on the mental health gender gap which, looking at data from the first wave, found that having a larger social network before the pandemic was strongly associated with larger declines in well-being after the onset of the pandemic: women reported more close friends before the pandemic than men, and higher loneliness than men after the pandemic started.

The pandemic has increased socio-economic inequalities for women and they are overly represented in many 'shut down' sectors, such as retail, accommodation and food and beverage service activities.

Domestic abuse is highly gendered: in the period 2018/20 16.5% of adults had experienced at least one incident of partner abuse since the age of 16; higher in women (21.2%) than men (11.2%). Out of the 60,641 incidents police recorded in 2018-19, four of every five incidents where gender had been recorded had a female victim and a male accused. Throughout the pandemic rates of domestic abuse have increased: the domestic abuse and forced marriage helpline received 95% more calls in the period April-June 2020 than in the same period the previous year, and a 27% increase for the 2020-2021 year overall compared to the previous.

Differential impacts

Positive impacts

If the policy objective to reduce the risk of transmission is achieved, Certification could positively impact men, as they are at a slightly higher risk of poorer health outcomes if they contract the virus.

British data from 2015 suggests that, although men spend on average more time than women on leisure activities in general, women spend on average more time socialising. Therefore if the policy objective of allowing higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, Certification could benefit women as it facilitates their ability to socialise.

As previously stated, public insights polling found that women were 7 percentage points more likely than men (women 65% vs men 58%) to agree that, it they wanted to go to premises or an event, having a Covid Status Certification scheme in place would make them feel more comfortable doing this. Certification could add a layer of reassurance to women and support them to feel safer and more confident participating in society.

Additionally, stakeholders stated that any measure that avoids future restrictions or closure would be welcomed by women in abusive relationships, who have suffered disproportionately during lockdowns, and by women more generally, who are more likely to be working in the sectors that Certification may allow to remain open.

Negative Impacts

A study that uses the UK Household Longitudinal Study, a nationally representative panel, found 21% of surveyed women indicated vaccine hesitancy compared to 14.7% of men, with women estimated to be around 1.55 times more likely to be vaccine hesitant than men. The study also highlights that women were more likely than men to state that their main reason for vaccine hesitancy was concern about side effects, and that they do not trust vaccines. A negative test could be used as an alternative to proof of vaccination, however as a LFD test result is only valid for 24 hours, testing every day could be burdensome.

Studies have found that facial recognition software has gendered and racial bias and "generally work best on middle-aged white men's faces, and not so well for people of colour, women, children, or the elderly". Therefore when registering for the App it is possible that a slightly higher proportion of women may not be able to have their identity automatically verified.

Stakeholders informed us that women are more likely to share their phones with family members, such as their children. As the App can only log into one person's profile at time, women may be more likely to apply for a paper Certification for themselves or family members.

There is the possibility that Certification could be used beyond the intended purposes by private businesses and third parties as a condition of employment. As women are more likely to be vaccine hesitant than men this could impact women more than men. The pandemic has already exacerbated socio-economic and workplace inequalities for women, so if the policy intention was exceeded there is the possibility this could be aggravated. A negative test could be used as an alternative to proof of vaccination, however as a LFD test result is only valid for 24 hours, testing every day could be burdensome. Businesses which are not covered by the Government's scheme are required to meet their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.

Finally, as with older or disabled people, there is the risk that Certification could be used as a tool to enact coercive control. This would likely impact women far more than men as evidence shows domestic abuse is highly gendered.

Sexual Orientation

Background

In 2018, 2% of people in Scotland identified as lesbian, gay, or bisexual (LGB).

During the pandemic, loneliness and isolation has strongly impacted LGB people of all ages. A survey of 2,934 secondary school pupils (1,140 of whom identified as LGBT+) by Just Like Us found that LGBT+ young people are twice as likely as their non-LGBT peers (52% vs 27%) to have felt lonely and separated from the people they are closest to on a daily basis during lockdown. 68% of LGBT+ young people survey also reported their mental health has worsened since the pandemic began, compared with half (49%) of non-LGBT+ young people. Age UK also reported that older LGBT people are especially at risk of loneliness, as they are more likely to be single, live alone, and have less contact with relatives.

While data from 2019 suggests that only 0.3% more men in the UK contracted HIV through sex with other men than with women, HIV still has a strong historical and cultural connection with the LGB community. A study from England in December 2020 showed that the risk of dying from Covid-19 for people with HIV was more than double that of the rest of the population, even after adjusting for factors such as deprivation, ethnicity, smoking and obesity. In comparison, a systematic review found those living with well-controlled HIV were are no greater risk of poorer COVID-19 disease outcomes than the general population. A note in the Lancet stated that, while clinicians should treat the findings as important, conclusions should be taken with caution until we have more specific controlled data to assess the effects of HIV on Covid-19 outcomes.

Differential impacts

Positive impacts

If the policy objective to reduce the risk of transmission is achieved, Certification could positively impact people living with HIV, as they are at a higher risk of poorer health outcomes if they contract the virus. It may also support them to feel safer and more confident participating in society if they know that those around them have been vaccinated.

If the policy objective of allowing higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, Certification could positively impact LGB people as it facilitates their ability to socialise. This is particularly important for older people within the gay community who report higher rates of loneliness.

Negative impacts

Despite their higher risk of death from Covid-19, stakeholders have informed us that some HIV positive people feel hesitant about the vaccine due to fears about side effects and that it may interact poorly with their HIV medication. Therefore, if HIV positive people are less likely to be vaccinated, Certification could have a negative impact if they are denied access to the settings in scope. This will be mitigated by the addition of testing as a negative test results can be used as an alternative to proof of vaccination

As detailed in the Gender Reassignment section, LGBT people are less likely to have ID than the general population, and so they may be slightly more likely to face difficulties registering for the App and more likely to use the paper Certificate.

Mitigating actions

The Scottish Government considers that, subject to the below mitigations being implemented, where Certification does engage rights, it does so in a proportionate way in order to protect public health.

Recognising not everyone has or can be vaccinated

Inclusive vaccination programme: our aim is to deliver our vaccination programmes in a way that ensures no-one is excluded, in particular those most at risk from COVID-19. The offer of COVID-19 vaccination will remain open to those newly eligible, or those who have not yet taken up the offer of a vaccine for the initial programme and the booster programme. The Inclusive Vaccine Programme includes targeted outreach and tailored communications e.g. Public Health Scotland and third sector partners have ensured the provision of a range of translated materials, British Sign Language (BSL) versions and other resources, such as the Covid-19 vaccine NHS Scotland explainer video, to ensure that everyone is able to access this information. The National Vaccine Inclusive Steering Group meets monthly and provides information and support to a wide range of organisations across the third sector. Engagement with stakeholders is ongoing, including through individual meetings, to ensure opportunities to raise issues of concern. More information on the Inclusive Vaccination Programme and the National Inclusive Steering Group for Covid-19 Vaccinations can be found here.

Testing: we know that some people cannot be vaccinated for legitimate reasons or have not yet taken up the vaccine. Initially, the Certification scheme did not include a negative test result as an alternative to proof of vaccination as we considered that it would not be appropriate and could undermine one of the initial policy aims of the scheme: to increase vaccine uptake. Based on the latest evidence, and a balance of harms, the Covid Certification scheme will include the option of providing a record of a negative test, with test results valid for 24 hours, as an alternative to proof of vaccination.

Exemptions: there are limited circumstances where a person may not yet have been vaccinated or may be unable to be both vaccinated and tested for legitimate reasons. For this reason, there are exemptions in the regulations for under 18s, those who cannot be both vaccinated and tested, and those participating in vaccine trials. Incorporating exemptions into the domestic App so that they appear as a green tick is under consideration for a future release.

Increasing accessibility

Paper Certification: in order to ensure Certification is accessible to all and to mitigate against digital exclusion, which is higher among older people, disabled people and some minority ethnic groups. We have translated documents that explain what is shown on your Certificate into different languages and formats, including Easy Read, audio and Braille.

The Covid-19 Status Helpline: to ensure that those who do not have digital access have a route to request their vaccination record. The helpline is also be available for people who cannot verify their identity on the App. The Covid-19 Status Helpline is free and open every day from 10:00-18:00 on 0808 196 8565.

A Resolver Group: has been established by NHS National Services Scotland to resolve any reported inaccuracies in vaccination records and wider issues relating to acquiring Covid Vaccine Certificate. Any requests for support can be escalated through the Covid-19 Status Helpline.

Communications and marketing: the implementation of Certification is being supported by a range of communications and marketing resources and activity to help people understand where the scheme has been introduced, for what purpose and how to gain certification. This will provide information about identifying and avoiding scams and phishing attempts, and will take the opportunity to reinforce messaging that vaccination data will not be shared with the Home Office or impact on immigration status, unless shared by the data subject themselves (e.g. when they go on holiday) or in exceptional circumstances when required by law. It will also provide information on and raise awareness of schemes like the Proof of Age Standards Scheme (PASS) and the Young Scot National Entitlement card.

We are building on learning across other materials, such as the Covid-19 Vaccine Explainer animations, and are currently developing a Covid Certification Summary Information Sheet which will include key messages and guidance on how to access translated information about Covid Certification. This Summary Sheet takes into account conversations with minority ethnic and seldom heard audiences and will address their specific concerns, such as data collection, usage and privacy. The Summary Information Sheet will be created in multiple languages and accessible formats.

Data protection and privacy

Data Protection Impact Assessment (DPIA) and Privacy Notice (PN): these are created to ensure that all data is managed, handled, processed and destroyed in line with UK GDPR legislation, data protection laws and data ethics best practice as well as human rights legislation. The PN will support users to understand how their data is being used throughout these processes, emphasising protection of their data and ensuring government is being open and transparent. The Privacy Notice is already online and can be found on NHS Inform: Personal information we process, How we use your data, Your Rights. The Easy Read Version can be found here.

Domestic App: within the NHS Scotland Covid Status App there is the function to access Certification for domestic use. This only shows the QR code and the user's name can be hidden. When the QR code is read by the NHS Scotland Covid Check App it simply shows a green tick or 'Certificate not valid'. This mitigates against disproportionally engaging an individual's right to privacy (Article 8 ECHR: right to respect for private and family life). Individuals can create separate profiles for international and domestic use using different email addresses. If an individual wishes to use a different name domestically, and has photo ID in that name, they can create one account for international travel, which aligns with the details on their passport, and one account for domestic use, which aligns with their preferred name. The App can only host one account at a time, so if the user has two accounts under different names they will need to log in and log out to access the desired account.

Biometric identification software: Jumio,the company providing the software, state that their software has equal rates of success across all demographics with a matching rate of over 95%. For the other 5% there will be a manual check by Jumio staff to verify the user's identity. Work is underway to provide an alternative to biometric identification to register for the app. Work is also underway to add other forms of identity to the IDV scheme.

Supporting implementation in line with our policy aims

Sectoral guidance: to support effective implementation consistent with our policy aim, we have provided information to the sectors where Certification is mandated on the policy and regulations, and the appropriate implementation, enforcement and handling of exemptions. Updated guidance can be found on the Scottish Government website here.

Ministers have been clear that Certification will not be a requirement for public services or other settings that many people have no option but to attend such as retail, public transport, health services and education. We recognise that some businesses, outside the regulated settings, are asking people for evidence they have been fully vaccinated as a condition of entry or as a condition of employment. We have emphasised in our guidance that businesses which are not covered by the Government's scheme would need to consider carefully their approach, in accordance with obligations under all relevant laws including data protection, the Equality Act 2010 and human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.

Public guidance: we have also updated guidance for the wider public to provide information on what Certification is, the policy objectives, where it is regulated and why, and the steps to attain Certification. This guidance can be found on the Scottish Government website here. Our Guidance is clear about the settings where the use of Certification is appropriate as a public health mitigation. It explains that the scope of the Regulations has been carefully and deliberately limited to activities where the balance of public health risk clearly outweighs other rights considerations, and is designed to respect the rights of individuals. Specific protections, applicable within the limits of the statutory scheme, have been put in place to ensure the scheme operates in a lawful manner.

Ongoing stakeholder engagement: following the implementation of Covid Certification we have continued to engage with stakeholders to gather intelligence on the impact of Certification. We will continue to engage with stakeholders and we will create feedback loops, building this evidence into the policy.

Exceptions: There are exceptions for premises being used for certain purposes, including worship, un-ticketed events held at an outdoor public place with no fixed entry points and certain business events that individuals are required to attend for work purposes.

Monitoring and evaluation

Any policy that engages human rights needs to meet the test of necessity and proportionality at any given time, and should be immediately removed if it is found to no longer meet that test.

The Scottish Government is responsible for monitoring and evaluating the policy. As the regulations have been laid under the Coronavirus Act 2020 there is a requirement to review the regulations every 21 days. The extent to which the policy (Covid Status Certification) is achieving the policy objectives (reduce the risk of transmission of Coronavirus; reduce the risk of serious illness and death; reduce the risk of settings specified in the scheme being required to operate under more restrictive protections, or to close; and increase the protection enjoyed by those using settings covered by the scheme and their contacts) is being monitored and evaluated in line with this requirement. Monitoring and evaluation will also provide us with further information about other positive and negative effects of the introduction of the policy. We will also continue to assess whether any less intrusive measures could be introduced to achieve the same combination of policy objectives in respect of the higher risk sectors concerned; if so, the policy will be immediately reviewed.

An overview of the range of information being used to monitor Certification is detailed at Annex B and C.

The Covid Status Certificate provisions will expire on 28 February 2022, as with all other Covid measures under the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021. Parliamentary approval would be required to extend them further.

To that end, we will continue to consider the impact of Certification on protected characteristics and our obligations under the public sector equality duty. This will include engaging with relevant stakeholders and we will publish further equality impact assessments (EQIA) if needed.

Assessing the impacts and identifying opportunities to promote equality

Do you think that the policy impacts on people because of their age?

Age	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative differential impacts identified at this time. There is the potential for indirect discrimination of young people due to lower vaccination uptake and higher rates of vaccine hesitancy. Ensuring that vaccinations are accessible, through the Inclusive Vaccination Programme, and the addition of testing will help mitigate this risk. There is the potential for indirect discrimination of older people and care leavers (up to the age of 26) due to higher rates of digital exclusion and lack of photo ID within this demographic. The paper Certificate and helpline and addition of testing will mitigate against this. Due to lower vaccination uptake among younger people, even though the policy does not apply to employment, there is a risk that Certification could be used as a condition of employment. This may have differential impacts on younger people. We have published sectoral guidance to support effective implementation consistent with our policy aim, which can be found on the Scottish Government website here. We recognise that some businesses, outside the regulated settings, are asking people for evidence they have been fully vaccinated as a condition of entry or as a condition of employment. We emphasised in our guidance that businesses which are not covered by the Government's scheme need to consider carefully their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here. Certification may present practical problems for care leavers due to frequent changes in of postal address. We have set up a Resolver Team to resolve any issues relating to inaccuracies in vaccination records. Testing acts as a mitigation to this.
Advancing equality of opportunity	X			There is some evidence of a positive differential impact identified at this time. If the policy objective is achieved and the risk of transmission is reduced, this will positively impact older people who have poorer health outcomes if they contract the virus. Certification may support older people, who are more at risk if they contract the virus, to feel safer and more confident in society. This is important for wellbeing, mental health and maintaining relationships.
Promoting good relations among and between different age groups	X			As above, Certification may support older people, who are more at risk if they contract the virus, to feel safer and more confident in society. This is important for wellbeing, mental health and maintaining relationships.

Do you think that the policy impacts disabled people?

Disability	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative differential impacts identified at this time. There is the potential for indirect discrimination of disabled people due to higher rates of digital exclusion within this demographic. The paper Certificate and helpline and addition of testing will mitigate against this. There will be exemptions to prevent indirect discrimination of people who may be medically unable to be vaccinated. The expectation is these numbers will be very small, for almost all disabled people or people with other medical conditions safe completion of immunisation, with support if required, is achievable.
Advancing equality of opportunity	X			There is some evidence of positive differential impacts identified at this time. If the policy objective is achieved and the risk of transmission is reduced, this will positively impact disabled people who have poorer health outcomes if they contract the virus.
Promoting good relations among and between disabled and non-disabled people	X			There is some evidence of positive differential impacts identified at this time. Certification may support disabled people, who are more at risk if they contract the virus, to feel safer and more confident in society. This is important for wellbeing, mental health and maintaining relationships.

Do you think your policy impacts on people proposing to undergo, undergoing, or who have undergone a process for the purpose of reassigning their sex?

Gender reassignment	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative differential impacts identified at this time. Without mitigations, Certification could present practical barriers for some trans people due to data flow and interoperability issues. Individuals can create separate profiles on the App for international and domestic use by using different email addresses. If an individual wishes to use a different name domestically, and has photo ID in that name, they can create one account for international travel, which aligns with the details on their passport, and one account for domestic use, which aligns with their preferred name. We have established a Resolver Team to resolve any issues relating to inaccuracies in vaccination records. Trans people are less likely to have ID and stakeholders have raised concerns that some biometric identification software contains gendered and racial biases. Jumio, the company providing the software, state that their software has equal rates of success across all demographics with a matching rate of over 95%. For the other 5% there will be a manual check by Jumio staff to verify the user's identity. For the limited number of people who cannot register using the App, they can access a paper copy of their Certificate by calling the helpline. People can also choose to provide a record of their test result
Advancing equality of opportunity			X	There is no evidence of a differential impact identified at this time.
Promoting good relations	X			There is some evidence of a positive differential impact identified at this time. If the policy objective is achieved and higher risk settings are allowed to continue to operate as an alternative to closure or more restrictive measures, this will facilitate socialisation and help to reduce feelings of isolation, which is important to trans people's mental health and wellbeing.

Do you think the policy impacts on people because of their marriage or civil partnership? ^[2]

Marriage and Civil Partnership	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation			X	There is no evidence of a differential impact identified at this time. There will be an exception within the regulations for marriages and civil partnerships and associated celebrations.
Advancing equality of opportunity			X	There is no evidence of a differential impact identified at this time.
Promoting good relations			X	There is no evidence of a differential impact identified at this time.

Do you think that the policy impacts on women because of pregnancy and maternity?

Pregnancy and Maternity	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative differential impacts identified at this time. Together with the addition of testing, the Inclusive Vaccinations Programme, which includes targeted outreach for pregnant women, will help mitigate any risks that Certification indirectly discriminates pregnant women, who may be more inclined to be vaccine-hesitant. Due to higher levels of vaccine hesitancy among pregnant women, even though the policy does not apply to employment, there is a risk that Certification could be used as a condition of employment. This may have differential impacts on pregnant women. We have published sectoral guidance to support effective implementation consistent with our policy aim, which can be found on the Scottish Government website here. We recognise that some businesses, outside the regulated settings, are asking people for evidence they have been fully vaccinated as a condition of entry or as a condition of employment. We emphasised in our guidance that businesses which are not covered by the Government's scheme need to consider carefully their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.
Advancing equality of opportunity	X			There is some evidence of positive differential impact identified at this time. If the policy objective to reduce transmission and increase vaccine and testing uptake is achieved, this could positively impact pregnant women, as there is evidence that they may be at an increased risk of becoming severely unwell compared to women who are not pregnant, particularly pregnant women in the third trimester.
Promoting good relations	X			There is some evidence of a differential positive impact identified at this time. Evidence indicates women would feel more comfortable if Certification was in place in certain settings, and so Certification may support pregnant women to feel safer and more confident in society. This is important for wellbeing, mental health and maintaining relationships.

Do you think the policy impacts on people on the grounds of their race?

Race	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative impacts identified at this time. Lower levels of vaccination uptake are evident in minority ethnic groups. Together with the addition of testing, the Inclusive Vaccinations Programme, which includes targeted outreach for ME groups, will help mitigate any risks that Certification indirectly discriminates ME people who may be more inclined to be vaccine hesitant. Evidence suggests that biometric identity software often contains gendered and racial biases. Jumio, the company providing the software, state that their software has equal rates of success across all demographics with a matching rate of over 95%. For the other 5% there will be a manual check by Jumio staff to verify the user's identity. For the limited of number of people who cannot register using the App, they can access a paper copy of their Certificate by calling the helpline. People can also choose to provide a record of a negative test. ME groups are more likely to face digital exclusion. The paper Certificate and helpline and the addition of testing mitigate against this. Due to lower vaccination uptake among ME groups, even though the policy does not apply to employment, there is a risk that Certification could be used as a condition of employment which may have differential impacts on ME people. We have published sectoral guidance to support effective implementation consistent with our policy aim, which can be found on the Scottish Government website here. We recognise that some businesses, outside the regulated settings, are asking people for evidence they have been fully vaccinated as a condition of entry or as a condition of employment. We emphasised in our guidance that businesses which are not covered by the Government's scheme need to consider carefully their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.
Advancing equality of opportunity	X			There is some evidence of positive differential impact identified at this time. If the policy objective to reduce transmission is achieved, this will positively impact ME communities, who have poorer health outcomes if they contract the virus.
Promoting good race relations			X	There is some evidence of positive differential impact identified at this time. If the policy objective is achieved and higher risk settings continuing to operate as an alternative to closure or more restrictive measures, this will facilitate socialisation and could support mental health and wellbeing, which has been negatively impacted during the pandemic.

Do you think the policy impacts on people because of their religion or belief?

Religion or belief	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative impacts identified at this time. There may be some people who do not want to be vaccinated for reasons related to their religion or beliefs. The addition of testing and the Inclusive Vaccinations Programme, which includes targeted outreach, will help mitigate any risks that Certification indirectly discriminates people who may be more inclined to be vaccine-hesitant based on their religion or beliefs.
Advancing equality of opportunity			X	There is no evidence of a differential impact identified at this time. There will be exceptions for premises being used for certain purposes, including worship.
Promoting good relations			X	There is no evidence of a differential impact identified at this time. There will be exceptions for premises being used for certain purposes, including worship.

Do you think that the policy impacts on men and women in different ways?

Sex	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative differential impacts identified at this time. Women have higher rates of vaccine hesitancy than men. Together with the addition of testing, the Inclusive Vaccinations Programme, which includes targeted outreach to women, will help mitigate any risks that Certification indirectly discriminates women who are more likely to be vaccine hesitant. Lower levels of vaccination uptake are evident among women. Even though the policy does not apply to employment, there is a risk that Certification could be used as a condition of employment which may have differential impacts on women. We have published sectoral guidance to support effective implementation consistent with our policy aim, which can be found on the Scottish Government website here. We recognise that some businesses, outside the regulated settings, are asking people for evidence they have been fully vaccinated as a condition of entry or as a condition of employment. We emphasised in our guidance that businesses which are not covered by the Government's scheme need to consider carefully their obligations under all relevant law including data protection, the Equality Act and Human rights. For more information see the Equality and Human Rights Commission Guidance for Employers here.
Advancing equality of opportunity	X			There is some evidence of positive differential impact identified at this time. If the policy objective is achieved and the risk of transmission is reduced, this will positively impact men, who have poorer health outcomes if they contract the virus. Evidence indicates women would feel more comfortable if Certification was in place in certain settings and so Certification may support women to feel safer and more confident in society. This is important for wellbeing, mental health and maintaining relationships.
Promoting good relations between men and women	X			There is some evidence of positive differential impact identified at this time. If the policy objective is achieved and higher risk settings can to continue to operate as an alternative to closure or more restrictive measures, this will facilitate socialisation and could support mental health and wellbeing of both sexes.

Do you think that the policy impacts on people because of their sexual orientation?

Sexual orientation	Positive	Negative	None	Reasons for your decision
Eliminating unlawful discrimination, harassment and victimisation		X		There is some evidence of negative impacts identified at this time. LGBT people are less likely to have ID and stakeholders have raised concerns that some biometric identification software contains gendered and racial biases. Jumio, the company providing the software, state that their software has equal rates of success across all demographics with a matching rate of over 95%. For the other 5% there will be a manual check by Jumio staff to verify the user's identity. For the limited of number of people who cannot register using the App, they can access a paper copy of their Certificate by calling the helpline. People can also choose to provide a record of a negative test. There is anecdotal evidence that people living with HIV may be slightly vaccine hesitant than the general population. Together with the addition of testing, the Inclusive Vaccinations Programme, which includes targeted outreach to people living with HIV, will help mitigate any risks that Certification indirectly discriminates people living with HIV who may be more likely to be vaccine hesitant.
Advancing equality of opportunity	X			There is some evidence of positive differential impacts identified at this time. If the policy objective is achieved and the risk of transmission is reduced, this would benefit people living with HIV as they are more likely to have poorer outcomes if they contract Covid.
Promoting good relations	X			There is some evidence of a differential positive impact identified at this time. If the policy objective is achieved and higher risk settings can to continue to operate as an alternative to closure or more restrictive measures, this will facilitate socialisation and could support mental health and wellbeing, which is particularly important for LGB older people, who report higher levels of loneliness.