Coronavirus (COVID-19): Scotland's autumn/winter vaccination strategy 2021

9. Our inclusive approach to vaccination

Our COVID-19 vaccinations programme has operated at pace since it first began in December 2020. The challenge, that we still face is ensuring a balance is struck between pace and ensuring no one is left unprotected, in particular those most at risk from the virus.

In response to impact assessments, emerging insights, research and data we have worked with Health Boards to engage with under-served communities in new and creative ways, including through:

• the National Vaccine Inclusive Steering Group which supports and advises the programme;
• translated information and resources, and focused Q&A sessions for population groups, including a podcast in Barlinnie prison, a radio session for Black, African and Caribbean communities and a web session with the Polish community;
• assertive outreach at community venues and sites to reach groups that are unlikely to be contactable by letters or attend vaccine clinics - for example, Gypsy/Travellers, people experiencing homelessness and rough sleepers, asylum seekers, refugees and migrant workers;
• collaboration with faith groups and representatives and offering vaccinations in places of worship, including Mosques, African and Polish Churches and Gurdwaras; and
• mobile units taken to areas of deprivation with low vaccine uptake rates.

All of these approaches have worked particularly well when planned and delivered in partnership with these communities.

Flexible delivery models were also adopted for the following groups and settings:

• In line with the JCVI advice on prioritisation and operational flexibility, Boards vaccinated groups of unvaccinated prisoners aged 18 and over. As well as being more efficient, it also allowed for ease of vaccine deployment and minimised the potential for vaccine wastage.
• People arriving as part of the Afghan relocation policy have been offered vaccinations depending on their vaccine status.
• Seafarers have also been accepted for vaccination via drop-in clinics or pre-arranged appointments. Many Health Boards have actively promoted this through engagement with harbour staff and Fisherman's missions, with some deploying mobile vaccination units to these sites.
• People entering drug and alcohol rehabilitation facilities have been offered second dose vaccinations ahead of the recommended 8-weeks schedule when clinicians consider there is a risk that the person may not return at the recommended time for a second dose. This is in recognition that there can be a heightened risk given many can lead transient, complex, risk burdened lives, which increases their risk of catching and or transmitting COVID-19. In the Mapping Survey reported in December 2020 it was noted that the minimum duration for rehab in Scotland is five weeks.

Whilst the vaccination programme has been a huge success, delivering at a pace and scale never thought possible, we have been keen to learn lessons. Some of these include:

• timely accessible information in a range of languages and formats including easy read and British Sign Language (BSL) and multiple platform for example paper leaflets, websites and social media posts.
• recognising diversity and the range of needs of people eligible for vaccination, for example a quiet vaccination centre, interpreter, access to affordable transport, the opportunity to discuss concerns.
• flexible delivery models including digital and non-digital appointment services, community vaccination location, outreach work and mobile units.
• working in partnership with specialised services, local authorities and community groups like housing support workers, the Refugee Council and GP practices that specialise in supporting people experiencing homelessness, drug or alcohol additions.
• appropriate data and evidence.
• equality of access.

Populations which experience barriers will often require greater resource to promote and support vaccination uptake. For example outreach clinics require additional time and resources to delivery but reach people who may otherwise not attend a clinic.

Working with partners we will continue to embed this learning and improve our data and evidence base to better understand the barriers to vaccination and how we can overcome them. Taking an inclusive approach is built into national and local vaccination planning and delivery.