Flu and COVID-19 vaccination programme 2023-2024: equality impact assessment

Eligibility for vaccination in 2023-24

20. The spring campaign focused on those at highest risk, namely residents in care homes for older adults, all those aged 75 and over and those with a weakened immune system aged 5 to 74.

21. We also introduced a new programme for those at clinical risk of Covid-19 aged 6 months to 4 years.

22. As confirmed by the JCVI on 8 August 2023, winter 2023-24 will see a focus on those at higher risk, but unlike previous seasons, those in the 50-64 age group will be offered a flu vaccine, but not Covid-19. The groups eligible for both vaccines are:

• Residents in care homes for older adults
• All adults aged 65 years and over
• Persons aged 6 months to 64 years in a clinical risk group
• Frontline health and social care workers
• Persons aged 12 to 64 years who are household contacts of people with immunosuppression
• Persons aged 16 to 64 years who are carers and staff working in care homes for older adults

23. The CMO letter of 18 April 2023 confirmed Scotland’s flu cohorts for winter 2023-24. Flu vaccination is being offered to the same extended cohorts that were agreed in 2022-23:

• Frontline Health and Social Care Workers
• Non-frontline NHS staff (occupational health offer)
• Residents & Staff in care homes for older adults
• Persons aged 50 and above
• Person aged 5-49 in a clinical risk group
• Persons aged 5-49 who are household contacts of the immunosuppressed
• Carers & young carers
• Children aged 6 months to 2 years with an eligible health condition
• All children aged 2 to 5 years (not yet at school)
• All primary and secondary school pupils
• Nursery, primary and secondary school teachers and pupil-facing support staff in local authority or independent settings
• prison population, prison officers and support staff who deliver direct front-facing detention services

24. Prioritisation in the childhood programme in 2023 will see children aged 2 to 5 years be offered flu vaccination from the outset of the programme, and a request to complete early, to ensure the best protection in that age group is achieved well in advance of the onset of flu activity. This in turn affords indirect protection to the older population, by helping to prevent transmission of the virus.

25. 2023-24 sees a continuation of the extended flu programme, to include all those aged 50 and over. The rationale for expanding the flu programme is to maintain the resilience of services and help reduce winter pressures on health and social care services.

26. The vaccination of frontline health and social care workers (HSCWs) is still advised for winter 2023-24, but the rationale on inclusion has shifted. During the pandemic emergency phase, frontline HSCWs were prioritised for COVID-19 vaccination in order to protect them against severe disease, to protect the resilience of health services, and to reduce the risk of transmission from HSCWs to vulnerable persons under their care. Currently, most HSCWs are no longer at much greater risk of severe COVID-19 compared to the rest of the population and vaccination is of limited benefit in protecting against transmission. There remains potential benefit in offering vaccination to frontline HSCWs in order to protect health and social care services from staff absences due to COVID-19 during the winter months. Similar considerations apply to unpaid carers and young carers in terms of supporting them to continue to care.

27. 2023-24 will also see a shift away from a universal offer of vaccination, referred to as “the rolling offer” in Scotland. Up until this point, any individual 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 5-64 who do not fall into any of the other eligible categories will no longer be able to access any COVID-19 vaccination as of 01 July 2023.

28. Although the COVID-19 programme is contracting in terms of its size and eligibility, our aim remains to deliver our vaccination programmes in a way that ensures no-one who is eligible is excluded, in particular those most at risk from COVID-19 and flu. The offer of COVID-19 vaccination will remain open to those eligible as per JCVI advice and is reviewed regularly in line with JCVI guidance and the COVID-19 Green Book Chapter. The COVID-19 and flu winter vaccination offer will end on 31 March 2024.