Chamber and committees

Our second petition, for which we will be joined by witnesses remotely, is PE1950, on ensuring that immunosuppressed people in Scotland can access the Evusheld antibody treatment. The petition, which was lodged by Alex Marshall, calls on the Scottish Parliament to urge the Scottish Government to enable access, via the national health service, to the Evusheld prophylactic treatment for people who have a zero or weak response to the Covid-19 vaccines.

We previously considered the petition at our meeting on 9 November, when we agreed to write to various organisations and to invite the petitioner and representatives from the patient campaign group, Evusheld for the UK, to provide evidence to the committee. Members will have noted in our papers for today’s meeting that the petitioner, Alex Marshall, has declined the opportunity to provide evidence or pursue the petition further, as he feels that the emergence of new Covid-19 variants has rendered the Evusheld treatment ineffective.

I note that the committee has now received responses from the Scottish Medicines Consortium, Immunodeficiency UK, Blood Cancer UK and Kidney Research UK.

Despite the unusual circumstances in which we find ourselves and the fact that the pandemic has moved on, there are issues that the committee wishes to explore. I am pleased to welcome Mark Oakley and Nikola Brigden, who are from Evusheld for the UK. Good morning to you both.

We move straight to questions. Please raise a hand or put an R in the chat function—that is the usual way. The clerks are monitoring that and will ensure that we know when you would like to come in and contribute. I move straight to my colleague David Torrance.

I assume that that is to suggest that they are hard copies, but I do not like to presume. If you could pass the photographs to the clerks, that would be helpful. We had a recent inquiry into natural woodlands, and photographs were very helpful to the committee in understanding the issue. Of course, sadly, we have all from time to time had to visit cemeteries, so we are from our own experience, aware of some of the issues.

I will ask a question to try to set the discussion in context. As I said, in the past few years we will all probably have had occasion to visit a cemetery, and not necessarily one with which we would be familiar. That said, I am familiar with the cemetery with which you are concerned. The natural question that occurred to me in visiting it on my own account is this: has this started to happen recently? I presume that maintenance of cemeteries and graveyards will historically have been an issue that has had to be handled and progressed. Is it the case that the golden age of established upright headstones was so long ago that the infrastructure of those headstones is now showing its age, and the headstones are sinking or falling? What do you think has happened, in this context, to make the issue of greater public concern now than it has been?

Are those steel rods?

I thank both witnesses very much for taking the time to join us this morning. Your evidence has been very helpful for our consideration of the petition. I also thank Paul O’Kane for joining us.

Given your experience—I now have some direct experience, as well—in what way did you find that the inability to access this particular treatment resulted in a different pathway through and out of the pandemic to that of other people? Clearly, bigger concerns still rested with people who are immunosuppressed, even as they saw everybody else acting more normally.

I am grateful for that. Implicit in what you are saying is a sense among the community of those who are affected in this way that the lighthouse of public attention has maybe swung away and people who are in this position are left to cope on their own, without the same attention that there was when this was a much more general and widespread affliction that was being felt by a much wider community across the country. I appreciate and understand that.

To move away from anything that is so personal to you, do you have any knowledge of whether immunosuppressed people have disproportionately experienced morbidity as a result of the pandemic, or does the exceptional care that they are having to take make it difficult to draw any statistical conclusion or evidence in that regard?

Various members of the committee have at different times served on the Parliament’s health committee, so we are familiar with the commissioning process and the way in which these things progress. From time to time, we have all lodged questions to ministers about the availability of product and, of course, they have always deferred to NICE, the Scottish Medicines Consortium and the processes that are at play in that regard.

I suppose that ministers’ argument would be that, were they to act by exception, that would be at the cost of diverting resource away from treatments that have been through the commissioning process and been recommended to them. What would you say to them, as ministers who have to come to decisions in relation to the commissioning authorities, in the face of that conundrum?

I understand. Essentially, you feel that Evusheld should be the subject of the same emergency provisions as applied at the height of the pandemic, in order to accelerate consideration.

Given that this is very much in connection with a petition that is open and under consideration, it is perfectly in order for the committee to actively promote that event. There will be an opportunity for committee members to drop in to meet Mary Ramsay and, in the first instance, to engage with that drop-in event, which I think would be a productive thing to do.

In your evidence, Rhoda, I think that you have taken us slightly further forward. Did I hear you say that an application has now been lodged—you assume—by NHS Tayside?

I acknowledge that many other countries moved very quickly at a point when the drug could have been introduced and we did not. I understand that NICE and the SMC were participants in a meeting that took place a fortnight ago, and that they are now talking about final guidance being produced in April. I suspect that there is not a lot that the committee will be able to do that will accelerate the process, but I understand everything that you are saying as to why the petition is there and why you think it should succeed.

The petition also brings home lessons that could be learned, because who knows what situation we might face again? It seems that, at one point, there was a process. That process has been normalised back to existing practice and, therefore, people are struggling. This session has been very helpful to us in understanding the issues.