Coronavirus (COVID-19): Strategic Framework update - February 2021

Vaccine deployment plan roll-out

Our Vaccine Deployment Plan details how the largest peacetime vaccination plan in Scotland’s history is being delivered. The Plan sets out how we will work as fast as supplies allow to vaccinate everyone in Scotland over the age of 18 and those aged 16 and 17 who are frontline health and social care workers, young carers or have underlying health conditions, a total of 4.5 million people. Around 1.5 million have already received a first dose of vaccine.

Vaccines are a critical part of suppressing the virus to the lowest possible level, both in order to save lives and also to allow us to gradually ease restrictions and return to a more normal life. There is also a vital interplay between vaccines, testing, and non-pharmaceutical interventions (NPIs).

As additional data around the overall efficacy of the vaccines become available we will learn more about:

• for how long vaccines can protect an individual
• if that protection includes protection against emerging variants
• the impact the vaccines have on transmission
• whether people’s willingness to adhere to restrictions and NPIs declines following vaccination

Our immunisation policy in Scotland is determined by Scottish Ministers and follows advice from the Joint Committee on Vaccination and Immunisation (JCVI) and other appropriate bodies. The JCVI has advised that the first priorities for the COVID-19 Deployment Plan should be the prevention of mortality and the protection of health and social care systems. As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age.

There are nine priority groups, comprising 3.4 million people, which when taken together, are estimated to represent approximately 99% of preventable mortality from COVID-19. Based on our current projections of vaccine supply, we are likely to complete the JCVI priority list by early May 2021. However, assuming revised projections of supply allow, we will aim to bring this forward to mid-April.

We will then move to vaccinate the remaining population – 1.1 million in the under 50 cohort (excluding children) – as quickly as supply allows. We hope - supplies permitting - that this will be possible by the end of July.

In determining our approach to the rest of the population, we will aim to coordinate with the UK Government and other Devolved Administrations, and take account of any updated JCVI advice.

We have put in place financial and practical support to ensure all parts of our community have the knowledge and confidence to participate in the vaccination programme and that any practical barriers are removed. Faith, third sector and community groups continue to be important partners in getting messages across to the communities they represent, encouraging participation and working alongside Scottish Government and health boards to remove practical barriers to participation. Examples of this are targeted marketing and surveys conducted through trusted partners like BEMIS, the national umbrella body supporting the development of the Ethnic Minorities Voluntary Sector in Scotland. This work will continue to adapt throughout the vaccination programme as we move through the priority groups and learn more about what works.

To save lives, particularly in the face of such an infectious new strain, the priority is to vaccinate as many people as quickly as possible. Our vaccination programme is proceeding at pace and we are increasing the capacity through utilisation of large vaccination centres to accelerate vaccination appointment invitations to JCVI priority groups. It is important that we do everything we can to ensure delivery matches supply and by implication not doing anything that would put the speed of delivery at risk.

The Pfizer-BioNTech and Oxford-AstraZeneca vaccines are currently being administered within Scotland. The Moderna vaccine has also been approved and we expect to be able to start deploying it in April 2021. We are continuing to work closely with Health Boards to assess likely available vaccine supply and associated implications for the vaccination workforce. The locations for vaccinations have been chosen to maximise throughput while making them as accessible as possible, including for those ineligible for the current ones.

We have now vaccinated more than 31% of the adult population with a first dose. The roll‑out of vaccines against COVID-19 offers the prospect of lowering the prevalence of coronavirus, helping us to ease restrictions gradually. However, it is essential that people and organisations continue to adhere and comply with the rules and guidance, even after they have been vaccinated. This is because we do not know to what degree being vaccinated prevents either catching or transmitting the virus. So, as the vaccination programme progresses and as more of us are vaccinated, clear, consistent public messages will be vital, including on a Four Nations basis.

We will inform people, organisations and communities of the evidence and the reasons we are asking them to continue a restricted lifestyle until such time as we are able to return normality into our daily lives and routines.

We have commissioned research to examine the likely implications for adherence to guidance and restrictions in post-vaccine Scotland. Polling conducted in Scotland indicates that the majority of people are knowledgeable about remaining virus transmission risks post-vaccination and are prepared to continue to live with restrictions even after being vaccinated, in order to protect others.

There are already a number of coronavirus Variants of Concern and we are likely to continue to find new ones as the virus mutates in order to survive. Further mutations, which might increase mortality, may be harder to detect or may present with different symptoms. As a consequence, we will continue to use the other levers at our disposal to suppress the virus to the lowest possible level whilst proceeding at full speed with the vaccination programme.

We publish daily updates of the cumulative number of people receiving their vaccination. 

In addition, weekly updates providing a more detailed breakdown by priority groups vaccinated and geography are published by Public Health Scotland. 

Going forward, a vaccine certificate programme may have the potential at the right time to support other non-pharmaceutical interventions in the opening up of international travel and the domestic economy in line with work being carried out as part of the World Health Organisation Safer Vaccinations Programme. However, more information is needed on vaccine efficacy and how long immunity lasts before it is possible to assess whether such a programme will be appropriate in Scotland. There are also a number of issues relating to data security and equality and ethical issues that need to be addressed. This includes taking into account the fact that the vaccines are not currently licensed for under 16s or people with certain medical conditions as well as considering possible equalities issues in relation to sectors of the population who are more vaccine hesitant or who find it more difficult to engage with services.

We are working on certification issues on a Four Nations basis and are contributing to the WHO Safer Vaccinations Programme, sitting on three working groups covering data quality, standards and equality issues to support the reopening of international travel once it is safe to do so. This includes further exploration of what a certificate could and could not be used for and work on standards, which will guide our next steps both internationally and domestically.

As a first step, work has started to scope and develop a technical solution to allow authenticated electronic storage of status. This is to ensure technology is not the limiting factor should the scoping work underway indicate it would be appropriate to pursue certification at the right time.

While our first duty is to protect the health of people in Scotland, this is a global pandemic requiring a global response. Co-ordinated international action is essential to deliver vaccines to the populations of all countries. The Scottish Government therefore strongly supports COVAX, the vaccines pillar of the Access to COVID-19 Tools Accelerator (ACT), co-led by the WHO, GAVI and the Coalition for Epidemic Preparedness Innovation, as well as the UK’s substantial financial contribution to COVAX. Through our International Development Fund we are supporting our partner countries in Malawi, Rwanda and Zambia on vaccine preparedness.

The quickest practical roll-out of vaccination

We are:

• continuing the roll-out of our vaccination programme at pace, in line with advice from the Joint Committee on Vaccination and Immunisation (JCVI)
• prioritising second dose for our most vulnerable and moving on to vaccinating Cohort 6 - all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality and unpaid carers. We will move quickly to bring forward Cohorts 7, 8 and 9 in line with our Vaccine Deployment Plan.
• taking a strategic approach to how under-50s will be vaccinated, potentially on a Four Nations basis
• progressing work to encourage high uptake amongst all these groups, building on the strong support for vaccination shown by older age groups
• working to ensure vaccine uptake amongst hard-to-reach groups
• continuing to issue clear public health messaging around the benefits of vaccination
• developing plans for on-going seasonal vaccination, if required
• maintaining and developing robust surveillance of emerging variants/mutations and the likely effectiveness of vaccines against them
• monitoring data in relation to the vaccinated population over time, to consider immune responses and the potential for re-infection
• maintaining reliable vaccine supply chains and developing mechanisms for delivering large-scale vaccination programmes in future.
• contributing to the World Health Organisation Safer Vaccination programme which is examining the technical details, ethical and equality issues, and privacy standards of vaccine certification
• keeping vaccines under review as more clinical and scientific information on new variants emerges

A message of thanks

The Scottish Government would like to take this opportunity to recognise the very many NHS staff, armed forces personnel, Local Authority colleagues, third sector partners and many others involved at every stage from vaccine production, to procurement, to delivery and all those coming forward to volunteer their help. This programme to vaccinate 4.5 million people in Scotland is a national effort, and each one of you is playing a vital part in the largest mass vaccination programme we have ever undertaken. Its importance to the future of each one of us cannot be overstated.