Scotland's autumn and winter vaccination strategy: progress report and accelerated delivery plans - December 2021

6. Creating additional capacity

We have also taken a number of steps to increase our national vaccination capacity so we can administer as many COVID-19 vaccinations as possible, and as quickly as possible. Our decisions have been informed by clinical and operational delivery advice at all times.

Prioritisation of COVID-19 boosters over flu vaccination

Given the vital importance of vaccinating the population rapidly against Omicron, we will prioritise the COVID-19 booster programme over the remainder of the flu vaccination programme over the next few weeks of 2021. This will allow many more COVID-19 booster appointments to be made available to eligible individuals. This is in recognition of the fact that the uptake of flu vaccine for those aged 65 and over is 89% as at 12 December, according to Public Health Scotland’s most recent weekly national seasonal respiratory report. This is higher than the final uptake achieved at the end of the flu season last year. In addition, the current level of seasonal flu in Scotland is below the baseline expected for this time of the year.

Flu vaccination for the 50 to 64 year old age group was similarly ceased during the 2020-21 winter programme to support COVID-19 vaccination efforts, with no detrimental impact in subsequent flu prevalence.

Measures including physical distancing, hand washing ventilation and face coverings will continue to have an ongoing protective effect against seasonal flu and other respiratory illnesses. However, Health Boards will continue to offer the flu vaccine to those most at risk who were routinely offered it prior to the pandemic. These include:

• Pregnant women;
• Those over 65 years of age; and
• Those aged 16-64 years with underlying health conditions.

Temporary reduction in the time required for post-vaccination observation

The UK Chief Medical Officers recently issued advice in response to the Omicron variant that recommends temporarily suspending the requirement for people to wait in a vaccine centre for 15 minutes after they receive a COVID-19 vaccine. The Chief Medical Officers have suggested that there is a need to boost as much of the population as possible before the peak of the Omicron wave, and/or provide a first vaccination to those with no prior protection. Their advice is that it is likely this temporary measure will increase vaccination capacity and hence significantly reduce the number of people becoming ill, hospitalised and dying from COVID-19. The Chief Medical Officers also recommended that this temporary measure should be operationalised in line with the needs of each of the four UK nations. The Scottish Flu and COVID-19 Vaccination Clinical Governance Group has considered this advice in the context of the vaccination programme in Scotland and recommended that the post vaccination observation time is reduced to a minimum of 5 minutes for all COVID-19 vaccination events where the individual does not have a history of allergic reactions. This will speed up vaccination times and enable many more appointments to take place.

The Clinical Governance Group will continue to review the overall safety and efficacy of arrangements for the vaccination programme in Scotland on an ongoing basis. All currently deployed vaccines have been shown to be safe with low rates of severe side effects, but as with all vaccines, occasional cases of anaphylaxis have been reported. The rates are slightly higher in the case of mRNA vaccines from Pfizer/BioNTech and Moderna but overall they are still extremely rare. This position will be kept under review.

It is however important to note that those with a history of allergic reactions will be managed in line with Green Book advice and everyone who is vaccinated will be provided with verbal and written advice on allergic reactions including what actions to take if they become unwell.

Prioritisation of COVID-19 boosters above primary courses for 12 to 15 year olds

The JCVI have recommended that our immediate measures within the COVID-19 vaccine programme focus on the delivery of the booster vaccine to those who are eligible, as these are the individuals who are most at risk of severe disease and death from SARS-CoV-2. Whilst they have advised that all children and young people aged 12 to 15 who are not at additional risk from a severe COVID-19 infection be offered a second dose of the Pfizer-BioNTech vaccine, they have noted that this is to be a secondary measure, subject to appropriate consideration by deployment teams regarding feasibility in terms of timing.

As such we shall continue to follow the advice of the JCVI and will prioritise the administration of booster vaccines first for those most at risk. We therefore anticipate that we shall commence the delivery of second doses for non-at risk 12 to 15 year olds from early January 2022.

However, Health Boards will continue to offer the vaccine to 16 and 17 year olds given deployment for second doses in this age group is already well underway.

Increasing the number of drop-in clinics

Based on what we have learnt from the early stages of the vaccination programme about people’s desire to have choice in terms of the time and location of their vaccination appointments, the preference remains for people to book and attend a scheduled appointment. As well as providing individuals with clarity on when they will receive their vaccine, it enables the programme to plan more effectively for the workforce and vaccine volumes required on an ongoing basis.

Drop-in vaccination clinics will continue to play an important complementary role in the delivery of the programme. However, due to the unpredictability of the number of people who will attend these clinics on any given day or time, we cannot remove the possibility of some queuing and we ask people to be mindful this might be the case if they elect to use this option. There remains the option for anyone who wishes to do so to book an appointment (either via the online portal or the vaccination helpline) if they would prefer not to queue at a drop-in clinic.

We continue to be mindful of the need to balance wider acceleration of the number of boosters administered with the need to ensure equity and that those most in need are supported to be vaccinated. We know for example that the uptake of the booster is higher among those in the least deprived areas of the country for all age groups compared to the most deprived areas. That is why we will use the latest evidence we have to support Boards to ensure there is a sharp focus on communities and to prevent people from being left behind.

Workforce

The vaccination workforce continue to deliver an exceptional programme rapidly, safely and efficiently. Vaccinators and many other staff are working tirelessly behind the scenes to plan and deliver this programme and save lives. We will never be able to thank them enough for what they have done and continue to do.

We continue to work with Health Boards to maintain and build the workforce to meet the demands of the COVID-19 vaccination programme. As at 17 December 2021, over 18,000 vaccinators had administered a vaccination during the programme. Additional funding has been released to enable Health Boards to recruit permanent vaccination staff, and we will release further financial support as required, to meet any change in clinical guidance which affects the programme requirements.

To enable this recruitment drive, we have promoted uptake of vaccination workforce positions through national messaging and a call to arms to all healthcare staff. This has increased our Health Board staff banks with many individuals from retirees to pre-registration healthcare students taking up shifts. Primary care colleagues continue to support the programme and National Health Boards have also responded by offering mutual aid, encouraging staff members who are registered health care professionals and others to support Health Board vaccination clinics. In addition, we are grateful to the military, who have provided significant support through a Military Aid to the Civil Authorities agreement, helping to accelerate the vaccination effort at a crucial time in the pandemic.

Health Boards continue to recruit and train additional members of the vaccination workforce with more than 1,000 people recruited to provide additional resource to the vaccination programme. This equates to around 300 extra full time staff and we also continue to engage with the National Volunteer Co-ordination Hub to increase the number of non-clinical staff who can support the programme.

Facilities/Venues

In the early stages of the vaccination programme a wider range of facilities were available for use as vaccination clinics. Now that many venues including sports and cultural facilities have reopened to the public, we continue to work to establish long-term suitable options for vaccination clinics.

In response to the emergence of the Omicron variant and the resultant drive to increase booster uptake, we are working closely with our partners in COSLA and Local Authorities to explore what additional support could be provided to secure additional facilities. We are grateful to Local Government Chief Executives and others who have agreed to help and support this national effort.

Health Boards are continuing to add capacity to meet local population needs in line with our accelerated ask. This includes Greater Glasgow and Clyde extending Hampden as a venue for vaccination clinics from next week and Lothian adding the Corn Exchange this week and the Edinburgh International Conference Centre (EICC) next week. We will continue to work with all Health Boards to ensure that our vaccine clinics are fully accessible and that, where possible, they are located within community settings, or where there is low uptake to avoid widening health inequalities, for example, locating clinics in more deprived areas.

Information is also now also available through NHS Inform on how to access support with transport to clinics if needed, or to request an interpreter at appointments.