Coronavirus (COVID-19): vaccine deployment plan: update - July 2021

Where we have got to so far

Our COVID-19 vaccine deployment plan

We published our COVID-19 Vaccine Deployment Plan in January 2021. This set out our COVID-19 vaccination plans for 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, unpaid carers or have particular underlying health conditions. In total, this equates to just under 4.5 million people across Scotland[1].

Our updated plan published in March 2021 outlined plans for Phase 1 of the programme which focuses on vaccinating priority groups 1 to 9 as identified by the Joint Committee on Vaccination and Immunisation (JCVI). The plan also set out our plans for Phase 2 to vaccinate all remaining adults (those between the ages of 18 to 49) who had not already been offered a vaccination in Phase 1.

This update aims to reflect on the progress against our March Plan for Phases 1 and 2 and looks ahead to operationalising recent advice from the JCVI on vaccination of those under 18 years old, and the potential COVID-19 booster vaccination programme this autumn.

The offer of a COVID-19 vaccination remains open for all those who are eligible, as supplies allow. In addition to scheduled appointments, on the 28 June 2021 we opened the self-registration system to all adults. Currently, anyone over the age of 18, who has not yet had their first dose – for whatever reason – can also attend a drop-in clinic without an appointment. People who are waiting for their second dose can turn up as long as they received their first dose of the COVID-19 vaccine at least eight weeks before.

How we have prioritised

Phase 1

Our March update outlined the latest advice from the JCVI on who should be initially prioritised for vaccination, as part of Phase 1 of the vaccination programme. The JCVI concluded that evidence strongly indicated the single greatest risk of death from COVID-19 is increasing age. Additionally, the JCVI highlighted that frontline health and social care workers who provide care to vulnerable people are a high priority for initial vaccination. More details about this are set out in the JCVI’s advice on who should be initially prioritised for vaccination.

The groups identified by the JCVI as part of Phase 1 are set out below in order of priority:

1. residents in care homes for older adults and their carers

2. all those 80 years of age and over and frontline health and social care workers

3. all those 75 years of age and over

4. all those 70 years of age and over and clinically extremely vulnerable individuals

5. all those 65 years of age and over

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

7. all those 60 years of age and over

8. all those 55 years of age and over

9. all those 50 years of age and over

This approach to prioritisation in the first phase of the vaccination programme was supported by all four UK Nation Chief Medical Officers. This is in line with the advice from the JCVI, which agreed this approach was most likely to achieve the initial aims of reducing mortality from COVID-19 and maintaining our health and social care systems.

The JCVI advised that people experiencing homelessness and rough sleeping should be offered vaccination alongside group 6. We followed JCVI advice and included this cohort within group 6.

Phase 2

On 13 April 2021, the JCVI provided advice for Phase 2 of the vaccination programme, focussing on the vaccination of adults under the age of 50 not already vaccinated as part of priority groups 1 to 9 during Phase 1. This advice reaffirmed that there was good evidence that the risks of hospitalisation and critical care admission from COVID-19 increase with age and that rapid vaccine deployment is the most important way to maximise public health benefits against severe adverse outcomes from COVID-19.

As with earlier stages of the programme, JCVI advice continues to focus on reducing severe illness, hospitalisation and death associated with COVID-19. The prioritisation to date, has been supported by evidence that the risk of hospitalisation and critical care admission with COVID-19 increases with age. In considering the best approach to vaccinating those aged under 50 without underlying health conditions, it reflected on calls for targeting particular sectors, occupations or those who may face additional risk. However, on the basis of the available evidence, JCVI recommended an age-based programme starting with those aged 40-49 years would be the optimal way to protect individuals working in jobs with a potentially high risk of exposure to COVID-19 from severe disease related to COVID-19. The JCVI advised that, operationally, simple and easy-to-deliver programmes are critical for rapid deployment and high vaccine uptake.

Vaccination prioritisation under Phase 2 therefore continued to be age-based, starting with the oldest adults and continuing in the following order:

• all those aged 40 to 49 years
• all those aged 30 to 39 years
• all those aged 18 to 29 years

In line with JCVI advice, we recognise the need for operational flexibility to maximise uptake. Our deployment teams utilise their understanding of local health systems and demographics to provide clear communication and outreach activity, promoting vaccination within identified groups where uptake has been lower. See section 3 for further information.

From focus group discussions with younger people we identified that messaging from experts rather than peers was regarded as more important with that audience and has greater credibility than, for example, celebrities. We worked with Professor Nicola Steedman, Deputy Chief Medical Officer, to develop a short video on the importance of vaccination and where to find accurate information – on NHS Inform – to inform their decision on vaccination.

Advice from the JCVI also guided our approach to respond to emerging evidence about the vaccines themselves and also variants of concern. During Phase 2, JCVI updated its advice to set out that, where possible, an alternative to the AstraZeneca vaccine should be preferentially offered to those under 40. For those aged 30-39, the advice also recommends this should only be where no substantial delay or barrier in access to vaccination would arise. In addition, the emergence of the Delta variant and evidence about vaccine efficacy following one and two doses, led to a change to the recommended dose interval from 12 to 8 weeks, where vaccine supply permits. These major changes to the programme and delivery systems were rapidly operationalised. 

We have included the advice within our national policy, and the Chief Medical Officer has communicated this to Health Boards, recognising the dynamic approach to deploying the vaccine in Scotland.

Four UK nations approach

We continue to deliver the COVID-19 vaccination programme, informed by the advice received from the JCVI, maintaining a consistent approach wherever it is appropriate to do so across the four UK nations. Scotland’s Health Boards follow the nationally agreed prioritisation schedule to vaccinate Scotland’s population as quickly as possible.

Although our approach to cohorts has been consistent with the four nations approach, we have sought to clarify our definitions to reflect Scottish circumstances. For example, we expanded our definition of unpaid carers within priority group 6 to ensure all those over the age of 16 who provide vital support to those they care for were able to access the vaccine at an early stage.

Our progress

In our March Deployment Plan, we said we would aim to offer everyone in JCVI priority groups 1 to 9 a first dose of vaccine by early May 2021. We went beyond offering the vaccine and vaccinated 98% of those aged over 50 as at Friday 7 May 2021, with their first dose.

The vaccination programme has been – thanks to the dedication of staff and volunteers – an enormous success, exceeding expectations. Since it began on 8 December 2020, and as at 7:30 am on 23 July, the programme has delivered:

 

• 3,992,327 people protected through their first dose of the COVID-19 vaccination; 3,966,384 of these are aged 18 and over, which represents 89%.
• 3,044,903 people provided with maximum protection by receiving their second dose; of these, 3,034,636 are aged 18 and over which is 68% of all adults.
• given we know that risk increases with age, 2,787,450 people aged 40 have received their first dose vaccination which equates to 97% of this cohort. 2,606,112 (91%) of this group have now received their second dose vaccination.

Latest progress by age on first doses

(this includes everyone in the selected age group):

• 266,611 people aged 80 or over
• 198,317 people aged 75-79
• 284,999 people aged 70-74
• 300,270 people aged 65-69
• 354,436 people aged 60-64
• 393,376 people aged 55-59
• 378,584 people aged 50-54
• 610,857 people aged 40-49
• 584,912 people aged 30-39
• 594,022 people aged 18-29

Latest progress by age on second doses

(this includes everyone in the selected age group):

• 257,719 people aged 80 or over
• 194,711 people aged 75-79
• 280,507 people aged 70-74
• 294,663 people aged 65-69
• 345,596 people aged 60-64
• 379,542 people aged 55-59
• 360,036 people aged 50-54
• 493,338 people aged 40-49
• 250,656 people aged 30-39
• 177,868 people aged 18-29

Figure 1 shows the cumulative doses of COVID-19 vaccine – both first and second doses – administered in Scotland as at 23 July 2021.

As part of our commitment to ensure administration of the programme is fully transparent, Public Health Scotland (PHS) publishes uptake figures (both first and second dose) every day on its website.

In order to operationalise the latest advice from JCVI, we have changed the second dose schedule from 12 to 8 weeks. From 21 June, all mainland health boards scheduled future second dose appointments at 8 weeks and are continuing to actively encourage people to come forward for their second dose if they have waited more than 8 weeks since their first dose. This is in direct response to the Delta variant.  It is important to note the JCVI does not recommend further reducing of this dose schedule, as this would shorten the duration of the protection provided by the vaccine.

Figure 1 – cumulative doses in Scotland by day, as at 23 July 2021 

Going beyond our original plans

In our March Deployment Plan, we confirmed our planning assumption of 80% vaccination uptake by those in JCVI priority groups 1 to 9. This means we were planning for around 80% of people who were offered vaccination to take up the invitation. Latest progress as at 23 July 2021 shows we have now provided first dose vaccinations far in excess of our original aim of 80% for these priority age groups. 

Progress for age based JCVI priority groups shows we have provided first dose vaccinations for:

(this includes everyone in the selected age group)

• 98% of people aged 80 or over
• (complete) people aged 75-79*
• 99.7% people aged 70-74
• 99.9% people aged 65-69
• (complete) people aged 60-64*
• 99% of people aged 55-59
• 96% of people aged 50-54
• 91% of people aged 40-49
• 80% of people aged 30-39
• 71% of people aged 18-29

*Vaccination uptake for groups marked complete are considered complete based on the estimated eligible population at a set point in time.

Progress for age-based JCVI priority groups shows we have provided second dose vaccinations for:

(this includes everyone in the selected age group)

• 95% of people aged 80 or over
• 98% of people aged 75-79
• 98% of people aged 70-74
• 98% of people aged 65-69
• 98% of people aged 60-64
• 95% of people aged 55-59
• 92% of people aged 50-54
• 73% of people aged 40-49
• 34% of people aged 30-39
• 21% of people aged 18-29

Progress for the non-age based JCVI priority groups shows we have provided first dose vaccinations for:

• 98% of current residents of care homes for older adults with 94.5% having received both doses
• we have vaccinated in excess of the initial target population estimate of staff working in all care homes for both first and second doses.
• 96% of those who were advised to shield, part of the clinically extremely vulnerable group
• 90% of people aged 16-64 with underlying health conditions
• 94.5% of people in specified frontline healthcare roles have received their first dose and 89.8% have had both doses*

• 88.8% of people in specified frontline social care roles have received their first dose and 81% have had both doses*

*Specified frontline health care workers and specified frontline social care workers figures provide a more precise measure of vaccine uptake in key frontline roles including registered NHS staff within the job family nursing/midwifery, medical and dental, ambulance services, Allied Health Professions and registered GPs; and registered Scottish Social Services Council staff.

These percentages include all people in the selected age group/JCVI priority group.

Figure 2 shows as at 23 July 2021 the percentage of people vaccinated in the age groups prioritised in phase 1, based on the latest available mid-2019 population estimates published by National Records of Scotland. The initial estimate of 80% vaccination take up by those in JCVI priority groups 1 to 9 is shown by a red line.

Figure 2 – coverage by age group as at 23 July 2021 (percentage vaccinated)

There are a number of reasons we have been able to continue to move more quickly through the programme than originally planned. The huge support and responsiveness from the people of Scotland, who have come forward when invited to be vaccinated, has been incredible. We have also seen a monumental response from the dedicated staff and volunteers in the NHS and wider partners, including local authorities and the third sector including the Red Cross. This has been an inspiring example of the flexibility and professionalism demonstrated in the excellent working practices by Health Boards and other partners, to respond to this unprecedented health challenge to safeguard lives and public health.

The programme has been delivered with less vaccine wastage than estimated, with a clear focus on protecting as many people as quickly as possible. The pace and effectiveness of the vaccination programme is a tribute to the monumental efforts of every single person involved.

Importantly, health boards have ensured their approach is fully inclusive by embedding inclusion throughout the programme to ensure the programme has a wide reach into all communities. This is another important factor in why we have been able to reach more people than we originally planned.

PHS now includes vaccinations data on its COVID-19 dashboard, which is updated every day with the latest available figures including those related to the vaccination programme. This includes daily vaccination figures by sex, age, location (NHS Health Board and local authority) and JCVI priority group. This includes both first dose and second dose vaccinations. PHS has also published data on those who Did Not Attend (DNA) a scheduled appointment and on COVID-19 vaccine uptake by ethnicity and deprivation. However, it should be noted DNAs do not equate to building up stock levels or an increased risk of wastage. NHS Boards take account of the potential for these in planning clinics and have been overbooking appointments and using drop-ins to use up any free capacity. Read more about DNAs. 

Impact of the vaccination programme

Emerging evidence demonstrates the effectiveness of vaccination against hospitalisation from COVID-19. A Public Health England study published in June showed two vaccine doses are highly effective at preventing hospitalisation from the Delta variant (96% and 92% effective for Pfizer and AstraZeneca respectively). PHS is also conducting analysis to estimate vaccine effectiveness in preventing COVID-19 infection in Scotland.

The vaccination programme is helping to weaken the link between new cases and serious health harms. For example, the proportion of people who get COVID-19 and require hospital treatment fell from around 13% in January, to 2% in the most recent week commencing 28 June 2021. Further information is available in the PHS COVID-19 weekly report published on 21 July 2021.

PHS has recently published analysis on COVID-19 related hospital admissions by vaccine status, to help understand the characteristics of those being admitted to hospital. In the period 19 June to 16 July 2021, there has been an increase in the overall number of COVID-19 related acute hospital admissions, with the largest number among unvaccinated individuals, providing further evidence that vaccination is weakening the link between the rise in new cases and a rise in hospitalisations and serious illness. Over the same period, 49% of COVID-19 related acute hospital admissions were in unvaccinated individuals, of which 68% were in the under 40s age group, highlighting that the people who require hospital care are – on average – younger than during previous stages of the pandemic. Further information is available in the PHS COVID-19 weekly report published on 21 July 2021.