Coronavirus (COVID-19): Scotland's Strategic Framework update - November 2021

Future strategy

In our management of the pandemic, we need to be alert to the possibilities of different futures given inherent uncertainties about the virus. Our expectation is that COVID-19 will now become endemic and that we have a difficult winter to plan for. The current resurgence of COVID-19 across Europe underlines the risk that the virus continues to pose, with a number of countries now reintroducing legal measures to reduce transmission. Factors such as vaccine take up and vaccine waning, levels of adherence to COVID-19 rules and guidance, and the risk of new variants can all combine in different ways to produce very different outcomes requiring different responses.

Currently we consider that we are in a situation in which vaccination, supported by the booster programme, remains effective and adherence to proportionate protective measures remains sufficiently high to keep the virus at manageable levels. However, we recognise the risk of moving – potentially rapidly – into other, more challenging scenarios with varying impacts on health, the economy and society and each requiring a different mix of interventions in response. For example, weakening adherence to the rules and guidance in place would likely increase future COVID-19 cases and require further intervention.

Known events may also have a bearing on which future scenario transpires. For example, the COP26 international climate change conference in Glasgow posed a number of risks around increased travel and social contact, particularly amongst those attending outwith the 'Blue Zone'.^[8] And we have learned from past experience that the festive period may present risks of heightened transmission due to the increased social interaction that tends to occur around that time.

This underscores the need to maintain and develop strategies to control and mitigate the different harms of the pandemic and these elements of our Strategic Framework are set out in the various sections below, following consideration of our overall strategic intent.

In light of the current state of the epidemic and our consideration of future potential scenarios, we judge that the current strategic intent guiding our COVID-19 response remains appropriate:

"to suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future."

In practice, this means that, because of both the success of the vaccination programme and continued adherence to COVID-19 protective measures by individuals and organisations, we can tolerate a level of COVID-19 circulating in society. We do not do this lightly – other things being equal, it would of course be preferable to be free of COVID-19. However, we judge that the restrictions required to eliminate the virus (or to keep it suppressed at the lowest possible level) and the resulting interference in our daily lives and livelihoods and fundamental, protected rights that pursuit of such elimination would cause, likely on a repeat cycle, would be disproportionate and inconsistent with our intent to alleviate the broader harms of the pandemic.

We can only tolerate transmission of COVID-19 up to a point. Too high a level of the virus would cause intolerable health harms – both directly and indirectly because of the wider pressure it would place on our already stretched health services. Therefore we must continue to be alert for the virus spreading to an unacceptable level, where what is judged acceptable takes all factors (including the broader harms caused by restrictions) into account.

This is why we continue to apply our 'four harms' approach^[9] in weighing up decisions about the imposition or easing of protective measures. We regularly review the COVID-19 legal measures in Scotland to ensure their ongoing necessity and proportionality and that they remain reasonable in order to achieve our strategic intent. Following this approach means that measures will remain lawful under relevant COVID-19 legislation.^[10] We also subject regulations to impact assessments, including to assess the impact on businesses and on equalities, as we know that the harms of the virus do not fall evenly across the population but are felt particularly acutely by particular people, groups and sectors.

As noted, on top of case levels that are still relatively high, we face the significant risk of increased circulation of the virus throughout the winter period. For that reason, we believe that retention of a number of baseline measures to reduce and prevent transmission and the attendant health harms is both necessary and proportionate. And continued strong adherence to these measures remains essential. We will continue to review such measures to ensure that they remain necessary and proportionate as epidemiological conditions evolve. We cannot rule out the possibility that further legal measures will be required as a proportionate, preventative intervention to tackle the pressures we face this winter: we do not want to impose such measures but have learned that early intervention can reduce future harm and the need for tougher measures later.

We believe that by seeking to ensure that our interventions alleviate the various harms of the pandemic and remain necessary and proportionate, we will enable Scotland to emerge from the acute phase of the pandemic in a position to recover and rebuild for a better, fairer and greener future.

The various interventions that we have in place to tackle the epidemic are set out in the six elements of our Strategic Framework below.

• Vaccination
• Test and Protect
• Protective measures
• Managing the risk of importation
• Supporting adherence
• Providing care and support to mitigate the harms of the crisis