Flu and COVID-19 vaccination programme 2023-2024: child rights and wellbeing impact assessment

CRWIA Stage 1 – Screening

1. Brief Summary (Guidance Section 2.1)

Since December 2020, Scotland’s Flu and COVID-19 Vaccination Programme (FVCV) has been guided by expert advice from the Medicines and Healthcare products Regulatory Agency (MHRA), the Joint Committee on Vaccination and Immunisation (JCVI), and the UK Chief Medical Officers (CMOs).

2023 has seen the JCVI, and therefore Scottish Government, move away from a pandemic emergency towards pandemic recovery. The main aim of the programme is to stop severe illness, hospitalisations and deaths. During this phase, whilst the virus continues to circulate and cause illness, our focus is to offer vaccination to those at most risk of serious disease and who are most likely to benefit from getting a vaccine.

Between 2 December 2020 and 15 September 2023, lots of COVID-19 vaccines were authorised by the MHRA for use in children and young people from the age of 6 months and over.

Following these authorisations, the JCVI gave advice on how these vaccines should be given to children and young people. This has continued in 2023:

• 07 March 2023: The JCVI advised a spring booster for those aged 5 to 17 who have a weakened immune system.

06 April 2023: The JCVI advised 2 vaccines for those aged 6 months to 4 years who have particular illnesses or conditions that make them more at risk of getting ill with COVID-19 . Some people who have a severely weakened immune system could also get a third vaccine.

• 30 June 2023: Up until 2023, people could come forward to any clinic in Scotland, at any time, and get the COVID-19 vaccines they were eligible for. In 2023 this stopped, so that all healthy people 5 to 64, who don’t have any health problems that make COVID-19 serious for them, can’t get a COVID-19 vaccine any more.
• 08 August 2023 (statement dated 26 May 2023): The JCVI advise a winter dose for anyone aged 6 months and over who have particular illnesses or conditions that make them more at risk of getting ill with COVID-19 , frontline health and social care workers, people aged 12 and over who live people with weakened immune system, people aged 16 and over who are carers and staff working in care homes for older people.

For 2023, the MHRA and JCVI have also authorised the use of new vaccines:

Those aged 12-17 who could not receive a Pfizer or Moderna mRNA vaccine, due to having allergies or a bad reaction, were able to get another vaccine called Novavax Nuvaxovid up until 31 May 2023. Between 1 June 2023 and the end of September 2023, there was no non-mRNA COVID-19 vaccine available in Scotland for the very small number of people who needed it. From late September 2023 another vaccine (non mRNA ) called Sanofi Vidprevtyn became available. This is approved for use for those aged 18 and over. For use in those under the age of 18, a clinical assessment has to be made and if the clinician thinks it is appropriate to give the vaccine, it is given under a ‘Patient Specific Direction’ (PSD).

In winter 2022 we updated our online booking portal, so that people over the age of 12 could book or reschedule an appointment online. This continues for 2023. Those under the age of 12 can’t use the online system due to information governance concerns, so have to call the National Vaccination Helpline to book their appointments.

A vaccine called LAIV, or Live Attenuated Influenza Vaccine, is the recommended vaccine for children and young people to protect against flu. This is given as a nasal spray up the nose, and not as an injection. For those who cannot receive LAIV, there is another option available called QIVc or ‘Cell-based Quadrivalent Influenza Vaccine’. This is given as an injection.

Flu vaccines for 2023/24

The flu child and school vaccination programme has been running since 2014, and secondary school pupils were included in the eligible cohorts from 2021-22. This was because it was agreed it was sensible to protect children during the Covid pandemic. Every year the JCVI publishes information on which flu vaccines should be used for the next winter. The JCVI also recommends who they think should be given the free flu vaccine. Scotland’s Chief Medical Officer (CMO) then publishes a CMO letter that lets the NHS know what the flu programme looks like for the coming winter.

2. Which aspects of the relevant proposal currently affects or will affect children and young people up to the age of 18?

This CRWIA is about COVID-19 and flu vaccination policy for 2023-24, for all children and young people (under 18 years of age) in Scotland.

The offer of COVID-19 and flu vaccination for children and young people depends on the advice received from the JCVI. The type of vaccine a young person will be offered and the number of vaccine doses they receive will depend on their age and if they have a health condition. Our vaccination policy affects all children aged 6 months to 17 years.

Changes to the vaccination policy in 2023

In 2023, the main aim of the FVCV vaccination programme is still the prevention of severe illness, hospitalisation and death. During the current phase of pandemic recovery, the aim is to focus on offering to those at greatest risk of serious illness, who are therefore most likely to benefit from vaccination.

Although the at risk groups and age of children recommended to be vaccinated has largely stayed the same in 2023, the JCVI have lowered the age of children to be vaccinated to 6 months and over from the previous age of 5 years and over.

This covers a larger age group of those children and young people who are identified as being at clinical risk or who have a weakened immune system.

In addition, as of 30 June 2023, the “rolling offer” of COVID-19 vaccination will end. Up until this point, any child or young person could come forward to a clinic, at any point in the year, and request as many vaccines as they were cumulatively eligible for since the start of the programme. This is no longer the case and those aged 5-17 who do not have any clinical conditions that make them vulnerable to COVID-19, will no longer be able to access any COVID-19 vaccination. As uptake has traditionally been lower for the younger age groups, and lower still in areas of high Scottish Index of Multiple Deprivation (SIMD)and in particular minority ethnic communities, this means that children in communities that are already disadvantaged in terms of public health, will have less vaccine-based immunity to COVID-19. However, this is offset by the fact that studies have shown that children are much less likely to develop severe COVID-19 disease than adults and for the vast majority of children, COVID-19 infection is associated with no, or mild symptoms and many children will also have some sort of infection-based immunity to the virus. The clinical risk is therefore greatly reduced.

3. Which groups of children and young people are currently or will be affected by the relevant proposal?

Our vaccination policy this year affects all children aged 6 months to 17 years who are identified within a clinical risk or immunosuppressed group and those that work in a care position or in the care sector.

Clinical risk groups include those with:

• Severe or profound or multiple learning disabilities,
• Downs Syndrome
• Teenage pregnancy
• All refugee children who fall under the eligibility criteria for flu and / or Covid
• Those on the learning disability register

Although Scotland doesn't have a learning disability register, we try to identify all those who would be eligible to be on the English equivalent.

Further information on clinical health conditions that are considered eligible can be found in the Green book chapter 14a found here: COVID-19 Greenbook chapter 14a (publishing.service.gov.uk).

In addition in 2023, the following young people were considered at higher risk and were offered COVID-19 vaccination:

Spring booster

• Those aged 5 to 17 who are immunosuppressed

Primary course

• Those aged 6 months to 4 years in a clinical risk group: 2 doses
• Those aged 6 months to 4 years who are severely immunosuppressed: 3 doses

Winter booster

• Persons aged 6 months to 17 years in a clinical risk group
• Frontline health and social care workers
• Persons aged 12 to 17 years who are household contacts of people with immunosuppression
• Persons aged 16 to 17 years who are carers or who are staff working in care homes for older adults

The Scottish Government continues to keep the programme under review to ensure that is remains relevant, inclusive and reflects current lifestyle choices where appropriate, including offering vaccines suitable for vegetarians and vegans. Where possible alternative vaccines are provided to accommodate religious beliefs.

The JCVI continue to review their advice in relation to the vaccination of children and young people, taking into account new data and information that becomes available, including the timing of flu season (see the graph demonstrating this at Annex 6).

Declaration

4. Is a Stage 2 Children’s Rights and Wellbeing Impact Assessment required? (Tick relevant requirement)

CRWIA required - X - No explanation required, please complete questions 5 and 6

CRWIA not required - Please explain why below and contact the children’s rights unit to discuss this decision crwia@gov.scot

Explanation why CRWIA is not required:

5. Sign & Date

Policy Lead Signature & Date of Sign Off:

Peggy Winford Seasonal Vaccination, Strategy and Transition Unit Head: 4^th April 2024

CRWIA author, if different from policy lead, Signature & Date of Sign Off:

Lynsey McGilvary, Senior Policy Officer, 3^rd April 2024

Deputy Director Signature & Date of Sign Off:

Dr ST Cuthbert-Kerr, Deputy Director for Public Health Capabilities, 4^th April 2024