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Publication - Research and analysis

Coronavirus (COVID-19) vaccine certification: evidence paper

Published
29 September 2021
From
Deputy First Minister and Cabinet Secretary for Economy and Gaelic
Directorate
Performance, Delivery and Resilience Directorate
Topic
Coronavirus (COVID-19) in Scotland, Health and social care, Public safety and emergencies
ISBN
9781802014495

This paper summarises the range of evidence available on vaccination certification schemes. Evidence is drawn from clinical and scientific literature, from public opinion and from international experience.

View supporting documents Supporting documents

2. The current state of the epidemic.

2.1 Cases, hospitalisations and deaths

In late August 2021, COVID-19 cases reached a higher peak than the last wave of cases in July 2021. Cases are currently decreasing but remain high across most local authorities[1]. Case rates are lower in fully vaccinated individuals, than unvaccinated and partially vaccinated individuals (Figure 1).

Figure 1: COVID-19 rate per 100,000 individuals eligible for vaccination by vaccination status, 7-day rolling average from 10 May 2021 to 17 September.
The chart shows the COVID-19 case numbers for unvaccinated, 1 Dose and 2 Dose individuals were at a very low level of under 10 per 100,000 on the 10 May. All showed an increase with a peak in early July, before dipping back down at the beginning of August and then increasing to a greater level than before in late August/early September. Unvaccinated and 1 dose cases per 100,000 are higher than 2 dose cases per 100,000 throughout. Unvaccinated peak at around 90 positive PCR tests per 100,000 in July and 180 per 100,000 in early September. 2 dose peak at around 25 per 100,000 in July and 70 per 100,000 in September. 1 dose peak at around 65 per 100,000 in July and 180 per 100,000 in September.

Source: Public Health Scotland COVID-19 Statistical Report 22 September 2021

COVID-19 related acute hospital admissions have also increased over the past month but are now decreasing[2]. Hospitalisation rates are higher among unvaccinated individuals (Figure 2).

Figure 2: Rate of acute hospital admissions where individual had a COVID-19 positive PCR test 14 days prior, on admission or during their stay in hospital, per 100,000 individuals eligible for COVID-19 vaccination by vaccination status, seven-day rolling average from 01 September 2020 to 17 September 2021.
The chart shows the COVID-19 acute hospital admissions for unvaccinated, 1 Dose and 2 Dose individuals were at a very low level of around 0.2 per 100,000 on the 10 May. All showed an increase with a peak in mid-July, followed by decrease and an increase to a greater level in early September. Unvaccinated levels are higher than 1 and 2 dose cases levels throughout. 1 dose levels are the lowest through the majority of the timescale shown. Unvaccinated individuals’ hospital admission peaks at around 1.9 per 100,000 in July and 2.8 per 100,000 in September. 1 dose peak at around 0.8 per 100,000 in July and around 1.9 per 100,000 in September. 2 dose peak at around 1.4 per 100,000 in July and around 2.4 per 100,000 in September.

Source: Public Health Scotland COVID-19 Statistical Report 22 September 2021

Of those individuals that have been fully vaccinated, from 29 December to 10 September, 0.01% have died with COVID-19 recorded as an underlying or contributory cause of death[3].

More information on the current situation as of 24th September in Scotland can be found in the State of the Epidemic report which is updated and published on a weekly basis[4].

2.2 Forecasts for the medium term

Predictions of the impact of COVID-19, in terms of estimated number of infections, hospitalisations and ICU, on the NHS over the coming weeks are modelled by Scottish Government analysts (Figures 3, 4 & 5) and show two projections over the three weeks to 10th October. 'Central' assumes that infections have plateaued. 'Better' assumes that infections continue to fall[5].

Figure 3: Medium term projections of modelled total new daily infections, adjusting positive tests [6] to account for asymptomatic and undetected infections, from Scottish Government modelling, based on positive test data reported up to 20th September.
Modelled projections of daily infections show the actual data decreasing since the beginning of September with a recent levelling off at around 7000 daily infections. The ‘central’ projections looking to mid-October have a large range from around 7000 up to over 20000 indicating the high uncertainty. The ‘better case scenario’ projection decreases throughout the same time scale with a range of around 2000-4000.

Source: Coronavirus (COVID-19): modelling the epidemic (issue no. 70) - gov.scot (www.gov.scot)

There is uncertainty as to how much infections will increase or decrease in coming weeks.

Figure 4 shows the impact of the projections on the number of people in hospital. The modelling includes all hospital stays, whereas the actuals only include stays up to 28 days duration that are linked to COVID-19. Hospital and ICU occupancies have plateaued. The scale of any future increase or decrease in hospital occupancy and intensive care use is highly uncertain, and depends on the number of infections.

Figure 4: Medium term projections of modelled hospital bed demand, from Scottish Government modelling, based on positive test data reported up to 20th September.
Modelled projections of hospital bed demand show the actual data increasing from mid-August until mid-September where it reaches 1000 beds and levels off. Central projections have a wide range from a slight decrease to a rise to around 1800 over the next month. Projections in a better scenario suggest that bed demand could decrease to around 400 beds.

Source: Coronavirus (COVID-19): modelling the epidemic (issue no. 70) - gov.scot (www.gov.scot)

Figure 5: Medium term projections of modelled ICU bed demand, from Scottish Government modelling [7], based on positive test data reported up to 20th September.
Modelled projections of ICU bed demand show the actual data increasing from around 50 in August until reaching 100 beds mid-September. Central projections then have a wide range, rising to between 100 and 225 beds at the end of October. Projections for ‘better’ scenarios peak and then drop to between around 70-130 beds.

Source: Coronavirus (COVID-19): modelling the epidemic (issue no. 70) - gov.scot (www.gov.scot)

More information on Scottish Government modelling can be found in the Coronavirus (COVID-19): modelling the epidemic in Scotland report which is updated and published on a weekly basis[8].

What the above predictions tell us is that there is still a degree of uncertainty about the future and we cannot be assured that the current positive position will continue.

2.3 Vaccination progress

Vaccine uptake has progressed extremely well in the Scottish adult population with approximately 76% of 18 to 29 year olds and 71% of 16 to 17 year olds having received the first dose of the vaccine. Around 96% of people aged 40 and over have received two doses of the vaccine[9] [10], see Figure 6. This puts Scotland in a different position to a number of other countries where vaccination rates were much lower on the introduction of certification, see section 5.3.

Figure 6: Total % coverage by age group and sex in Scotland
The chart shows the different vaccine levels separated by age and gender. The vaccination coverage increases with age and in the under 40’s is slightly higher for females compared to males. For 16-17, female dose 1 = 73.5%, dose 2 = 10.8%; male dose 1 = 68.4%, dose 2 = 9.5%. For 18-29, female dose 1 = 78.4%, dose 2 = 66.3%; male dose 1 = 74.5%, dose 2 = 59.6%. For 30-39, female dose 1 = 83.9%, dose 2 = 76.1%; male dose 1 = 82.9%, dose 2 = 73.0%. For 40-49, female dose 1 = 91.1%, dose 2 = 86.9%; male dose 1 = 91.9%, dose 2 = 85.7%. For 50-54, female dose 1 = 94.9%, dose 2 = 92.4%; male dose 1 = 98.1%, dose 2 = 94.6%. For 55-59, female dose 1 = 98.0%, dose 2 = 95.9%; male dose 1 = 100%, dose 2 = 97.8%. For 60-64, female dose 1 = 100%, dose 2 = 99.0%; male dose 1 = 100%, dose 2 = 100%. For 65-69, female dose 1 = 100%, dose 2 = 98.8%; male dose 1 = 100%, dose 2 = 100%. For 70-74, female dose 1 = 100%, dose 2 = 98.8%; male dose 1 = 100%, dose 2 = 99.9%. For 75-79, female dose 1 = 100%, dose 2 = 100%; male dose 1 = 100%, dose 2 = 100%. For 80+, female dose 1 = 100%, dose 2 = 100%; male dose 1 = 100%, dose 2 = 100%.

Source: COVID-19 Daily Dashboard | Tableau Public. Updated 27th September 2021, data related to 26th Sept

In recent months the rate of first doses of vaccination has been slowing, see Figure 7. On 26 September 91.3% of those aged 16+ had received a first dose of the vaccination, there has been an increase of 1.2 percentage points in the latest 4 weeks compared to an increase of 11.1 percentage points in the 4 weeks leading up to 1 July. In recent weeks the rate of second doses of vaccination has been slowing, on 26 September 84.2% of those aged 16+ had received a second dose of the vaccination, there has been an increase of 3.5 percentage points in the latest 4 weeks compared to 12.4 percentage points in the 4 weeks leading up to 1 July[11].

It was announced on 4 August that 16-17 year olds would be offered the vaccine from 6 August. The proportion of people aged over 16+ that had received a first dose increased from 72.4% to 81.6% in the first four weeks of 16-17 years olds being offered the vaccine.

Figure 7: Cumulative total number of vaccinations by dose in Scotland
The chart shows the cumulative vaccine uptake for dose 1 and dose 2 increasing rapidly for Dose 1 from January 2021 to July 2021 then increasing at a slower rate since. Dose 2 increases rapidly between April 2021 and August 2021 before levelling off. Dose 1 is currently at around 4.1 million vaccines and Dose 2 around 3.8 million.

Source: COVID-19 Daily Dashboard | Tableau Public. Updated 27th September 2021, data related to 26th Sept

Forecasting suggests a second dose coverage of the 16+ population of between 83.9% and 86%, with a central estimate of 84.3% by 30 September. Trend analysis suggests that first dose coverage of 16 and 17 year olds may reach between 73.1% and 78% (central estimate: 76.1%) by 30 September. Applying forecasting to 18 to 29 year olds indicates a second dose coverage of between 62.6% and 66.4% by 30 September. Similarly, for 30 to 39 year olds, second dose coverage is estimated to reach between 74.6% and 76.2% by 30 September.

2.4 The impact on the Health service

The COVID-19 pandemic is having an impact on our health and social care in Scotland in a number of ways. This includes the impact on our health and social care services, how people are using those services, and how this impacts on health. As we prepare for autumn and winter our primary and secondary health and social care services face significant and increasing pressures and demands. The rapid rise in COVID-19 cases and hospitalisations in Scotland over recent weeks illustrates the need to take action to reduce transmission in high risk settings in order to reduce the risk of serious illness and death and alleviate pressures on the NHS.

For example, elective inpatient and day case activity reduced by 46.8% during April 20 - June 21(circa 164,000 surgical procedures), compared to pre-pandemic (April 18 – June 19). Elective inpatient and day case activity for quarter ending June 2020 was at 20.7% of pre-COVID-19 activity when compared to June 2019. For quarter ending June 2021, inpatient and day case activity was at 72.8% of pre-COVID-19 activity (June 2019).

There is uncertainty as to how much infections will increase or decrease in coming weeks. Hospital and ICU occupancies appear to be plateauing but the scale of any future change in hospital occupancy and intensive care use is highly uncertain, and depends on the number of infections[12].

Contact

Email: Covid19OutbreakManagement@gov.scot

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