Meeting of the Parliament (Hybrid)

Meeting date: Thursday, December 3, 2020

Official Report 993KB pdf

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Covid-19 (Vaccine Delivery)

The next item of business is a statement by Jeane Freeman, the Cabinet Secretary for Health and Sport, on the delivery of the Covid-19 vaccine. The cabinet secretary will take questions at the end of her statement.

Yesterday was the day that we have all been hoping and waiting for. I am pleased to return to the chamber to update Parliament on the deployment of the Pfizer Covid-19 vaccine, which is the first such vaccine to receive authorisation to supply from the United Kingdom regulatory body, the Medicines and Healthcare products Regulatory Agency.

I have previously set out the advance planning that we have undertaken so that we could be confident that, as soon as the first vaccine supplies arrived, we were ready to begin. Today, I can confirm that we will begin vaccinating from Tuesday 8 December, along with our counterparts across the four nations of the UK.

I also previously set out a number of areas in which we could not finalise our planning because we did not have the final and detailed information. Some of the issues remain, but the authorisation to supply that was received from the MHRA overnight on the 1 December and advised to me in the early morning of 2 December, alongside the final advice from the Joint Committee on Vaccination and Immunisation on the Pfizer vaccine that it published yesterday, provides some of that important information.

First, on the overall age range to be vaccinated, the JCVI has asked that we include 16 and 17-year-olds who have underlying health conditions. We will do that and factor those young people into our delivery. Secondly, the MHRA has been clear that we should retain 50 per cent of the supplies that are arriving in December, so that we can provide the second dose to those who have received their first dose in the timeframe advised. Finally, we have detailed information on those for whom the Pfizer vaccine is not advised: women who are pregnant or who plan to become pregnant in the next three months. Those are all vital pieces of information—it might be different for each of the Covid-19 vaccines that the MHRA authorises—which allow us to complete the patients leaflet to support informed patient consent, and the necessary clinical governance protocols and advice to clinical teams.

As I have said throughout, we have worked on a four-nations basis. Yesterday morning, I agreed with my colleague health ministers that, subject to the first batch of approved supplies arriving in time, we will begin the vaccination programme on Tuesday 8 December. On the evening of Monday 7 December, I will discuss with those colleagues where we then are with that process.

Following yesterday’s announcement, between now and next Tuesday, detailed work and discussions will take place on a number of issues, including completion of patient consent work, clinical governance arrangement protocols, safe transportation and storage guidance, data collection and an iterative training process for the clinically accredited staff who will carry out vaccinations. As I speak, the training materials are being finalised by NHS Education for Scotland, using the detail that is now available from the MHRA and the JCVI. The first training sessions are scheduled for tomorrow and Monday, and we will then repeat the process throughout the entire vaccination programme.

As members will know, we will follow the JCVI advice and guidance on priority delivery of the vaccine. The vaccine aims to reduce mortality and morbidity from Covid-19. The guidance prioritises, according to their age, those who are most at risk from harm, and asks us to work our way through to the youngest adults and to take account of those who are clinically vulnerable. The only sectoral exception to that approach is for the health and social care workforce, who are in the first priority group alongside those aged 80 and over and care home residents. Professor Wei Shen Lim, chair of the JCVI’s Covid vaccine sub-group, has said that the aim of vaccinating care home residents and staff, others in order of age from the oldest to the youngest, and healthcare workers is to cover almost 99 per cent of vaccine-preventable deaths from Covid-19, so that is clearly exactly the right approach for us to take.

Members will know that the Pfizer vaccine has specific storage and transportation requirements, which include exceptionally low temperatures and limited transportation times once it has been taken out of a low-temperature environment. It will also come to us in pack sizes of 997 doses. That all poses particular logistical challenges in vaccinating individuals close to their homes, so it will clearly present a challenge in vaccinating our care home residents and our elderly citizens who live in their own homes.

I am pleased to say that, over lunch time today, following detailed discussions led by our chief pharmaceutical officer, we now have confirmation, on the basis of the stability data, that the Pfizer vaccine can be transported in an unfrozen state for up to 12 hours and can be stored undiluted for up to five days. I am also pleased to confirm that, under certain conditions, we will be able to pack supplies down into smaller pack sizes. Both those steps will make the vaccine more usable, with minimum wastage, for care home residents and our older citizens. It means that we will be able to take the vaccine to them, or close to them, and we will begin that exercise from 14 December. From next Tuesday, 8 December, we will begin vaccinating first the vaccinators themselves and then work our way through the first cohorts of health and social care workers.

When the first delivery is received in Scotland, it will go straight to our 23 commercial freezers, which can store the vaccine at the required temperature of -70° and are located across Scotland, including in our important island authority areas.

In the first week of the vaccination programme, we will deliver to priority group individuals who can go to vaccination storage areas. I am delighted that our local authority colleagues will work with us to ensure access to transport for staff who need it. Working in this way in the first week of administration of a new vaccine will also allow our key pharmacy staff to be on hand as we run the process to make up the vials into doses and then vaccinate, as we test out the data recording and clinical governance protocols and work through the pack-down process for the following weeks.

We are therefore ready to implement the national plan that I set out two weeks ago, which sets out the overall policy direction and guidance; provides a delivery framework and service delivery guide; develops and delivers a national workforce model; provides national training; covers procurement and logistics; and provides national information and advice, and the tools to record data about vaccinations when they take place.

Locally, national health service boards’ own delivery planning is well under way. It is putting in place local recruitment and deployment of staff, with boards’ local authority partners identifying locations that are as accessible and local as possible and securing the support that they need—including the national support that we are receiving from the armed services—to set up and manage local centres in a Covid-safe way.

As other vaccines come through the MHRA authorisation and JCVI guidance process, we will flex our planning and delivery to take account of any necessary changes. However, on the basis that we receive the vaccine supply that we expect when we expect it, we should be able to vaccinate the first phase of people by spring next year. The rest of the adult population will follow as quickly as possible thereafter.

Our workforce planning and recruitment is on track to secure the 2,000 vaccinators and support staff we will need by the end of January. An existing core of trained and experienced vaccinators from the flu programme will transition to the Covid vaccination during this month and next, we are actively recruiting from the emergency registers and NHS Scotland’s accelerated recruitment portal, and we are drawing from the wider clinical workforce of general practitioners, pharmacists, dentists and optometrists. From Tuesday next week, we will need 160 whole-time equivalent vaccinators per day to begin delivery—and we have them.

All that work for next week and the weeks beyond that will be overseen by me and senior officials. I am delighted that Councillor Stuart Currie will join us from Convention of Scottish Local Authorities to ensure that we can maximise the input and expertise that our local authority colleagues will bring to the nationwide exercise.

As we progress in what will be a fast-paced exercise, we will, as the First Minister said, make every effort to keep members updated on both the national picture and their local arrangements, making initial information available from next week. My colleague Joe FitzPatrick as public health minister will oversee that and take on the additional work of responding to any local issues that members raise.

A significant part of that information will be on the safety and efficacy of this vaccine and the others that will follow. However, let me be clear that, in the MHRA authorising the vaccine for supply, no corners have been cut. The process has been as rigorous and robust as it always is and as we would expect it to be. Over the coming weeks, we will be issuing clear information to the public, not only on the safety and efficacy of the vaccine but on our delivery plans nationally and, importantly, locally. We need—as best we can, given the caveats that I have set out on delivery and vaccine properties—to be clear in our plans so that everyone knows what to expect and when they are likely to receive their invitation to be vaccinated.

A vaccination programme of this scale is a significant logistical challenge and it requires a major nationwide effort, but we undertake it with optimism and a determination to succeed. I have no doubt that there will be glitches on the way and unexpected difficulties to overcome, but science has excelled yet again to give us hope. Now we will get on to deliver on that. I look forward to working with members across the chamber in that work.

We have a great deal of interest from members who wish to ask questions. I hope that we can make progress through all the questions.

I thank the cabinet secretary for advance sight of her statement. Yesterday’s announcement was groundbreaking, and it gives millions of people across our country hope that we will soon return to some semblance of normality. However, we still have a long way to go and it is vital that we get the roll-out of this and future vaccines right. For instance, we would welcome the Government publishing a full list of venues across the country that will administer the vaccine, and which venues will open this month.

First, on the workforce, can the cabinet secretary tell us how many of the 2,000 vaccinators and support staff who are required to deliver the first phase are in place in each health board? Of those 2,000, how many will be vaccinators and how many will be support staff?

Secondly, given the particular storage needs of the Pfizer/BioNTech vaccine, how many freezers are currently in each health board area and what is their capacity, and does the Government have orders out for any more?

As the First Minister said, we will publish a full list of venues as soon as we have confirmed all the venues that are in place across all the health board areas. I expect that we will be able to do that before the Christmas recess—I remind the member that the first priority groups are health and social care workers and care home residents.

I am delighted that the agreements that were reached over lunch time mean that we can take the vaccine to care home residents and to those who are over 80—we will want to be able to take the vaccine to some of them in their own homes, because that is much more person centred for them.

Twenty-three commercial freezers have been purchased, and they are located across all our health board areas, including in island authority areas. I would like to advise members on where they are, but I have to say—although this is not a reason for not doing that—that national security, which is part of MI5, is very unsure about the wisdom of making public where our storage is of what is a very precious vaccine. We continue to talk with it on a four-nation basis because, obviously and evidently, people want to know that their area is covered.

However, I can and will advise members of how many freezers each board area has, so that members can, I hope, see that we are ensuring proper coverage. The freezers are there and are being tested, and they are all of a size that can accommodate the vaccine supplies that we expect as they come through.

On the workforce, my statement made clear the number of whole-time equivalent vaccinators that we will need for the first week or so. We use a model to estimate the number of people within the 2,000 that we will need at various stages in the programme. That is currently being prepared and written so that I can advise Ms Lennon, who asked me a question about it previously. I am happy to ensure that Mr Cameron and the other health spokespeople also see what the model is and therefore how we flex and plan the recruitment of individuals and where we need them to be. That includes how we bring in additional people from the clinical workforce on a sessional basis as and when we need them, as we do with pharmacists, dentists and optometrists.

I thank the cabinet secretary for the advance sight of her statement.

The roll-out of the first vaccines in just five days’ time really is the best early Christmas present that people in Scotland could have dreamed of, and I welcome the really good news for care homes. Will all care home residents be vaccinated during the first phase? When does the cabinet secretary expect all care home vaccinations to be complete?

I welcome the commitment to keep MSPs and the public updated. Will the provision of public information include a helpline that people can access for advice and confidential guidance? If so, when might the details of that become available?

I, too, am absolutely delighted with the progress that was made over lunch time that will allow us to take the vaccine to care homes. That is one of the most critical issues, and it was one of the most challenging things about the Pfizer vaccine. Our senior officials, along with the MHRA and Pfizer, deserve our congratulations and thanks for getting us to this place.

On care homes, one reason why I made a point of pulling out the changes that have appeared since I last spoke in the chamber about the vaccine programme was to highlight the clear advice that we need to hold 50 per cent of the supplies of the vaccine that we receive in December so that the people who are vaccinated in December can get their second vaccination in January. That is not quite what we expected, and it means that, for example, in the first of the batches that have passed testing, we expect 65,500 doses but, instead of vaccinating 65,500 people, we will vaccinate half that number and hold the other half of the doses so that we can do them again within the time period allowed.

We expect more supplies to arrive during December and, as those are confirmed and we are clearer about that, that will let us know how many people we can vaccinate in December and then be ready to redo in January. That has an implication for whether we can vaccinate all the residents in all our care homes.

Therefore, I have asked our clinical advisers—who will also have a connection directly to the JCVI—how, if we have to, we should prioritise our care homes, given that, although we will get through them all, we will not necessarily do so in the month of December. As soon as I have that information, I will be sure to let members know. I hope that, as I get that information, I will also get confirmation of the delivery dates of other supplies, which might ease that pressure.

We are giving active consideration to putting a helpline in place. There will be a national phone line, which, in the first phase, will be able to provide information. In the second phase, it will also be able to book people in for appointments in their local area. In the first phase, the line will provide information and will then put people through to local call handlers, who will be able to offer information on their specific local area. In the second phase, when the rest of the adult population will be dealt with, it will also be able to book appointments for people.

That will be in place from the start of next year. In addition to everything else, in January there will be a national household door drop that will provide information on the vaccine, its safety, what we expect it to do, when people can expect to be seen and the local plans in their area.

I encourage the cabinet secretary to give shorter answers, as 15 more members have questions, and we have 10 minutes left.

I thank the cabinet secretary for providing an advance copy of her very welcome statement. However, concerns have been raised by clinicians, including the head of the Royal College of General Practitioners, about the fact that black and minority ethnic people do not feature in the JCVI’s priority list. The guidance states that there should be

“flexibility in vaccine deployment at a local level”.

We know, for example, that deaths among Scots from south Asian backgrounds are twice as likely to involve Covid-19 as deaths among those from white backgrounds. Will that be factored into the Scottish Government’s prioritisation process?

I completely understand Mr Ruskell’s question and what prompted it. The JCVI looked very carefully at all the evidence and data that is available from across the UK on the impact of the virus on the BAME community, and it concluded that although people’s background was relevant, age was more relevant to the impact of the virus on the whole community, including the BAME community. In following the JCVI guidance, we must obviously take that into account.

However, our chief medical officer, along with colleagues, continues to consider where we might add in flexibility to our delivery. At this point, I cannot confirm one way or the other whether we will be able to do that. It is extremely important that we follow clinical advice in everything that we do and ensure that access to the vaccine is in proper order of priority and is equitable. However, if that position changes in any respect at all, I will be happy to make sure that members are updated.

The biggest scientific effort in history has helped to find a vaccine; now, the biggest public health exercise in history is needed to distribute it.

It is, of course, essential that islanders are offered equal access to the vaccine and that the priority groups who live in remote parts of Scotland are fully included in the first and subsequent waves of the roll-out. Can the cabinet secretary therefore give my Orkney constituents a categoric assurance that that will indeed happen, particularly given the welcome clarification that she has provided on the way in which the vaccine can now be delivered, and confirmation that freezer storage will be available in our islands?

Freezer storage is available in all our island authorities—that is, in Orkney, Shetland and the Western Isles.

Mr McArthur is absolutely right. The development in how we can store and transport the Pfizer vaccine will make a significant difference not only to our care homes, but to our island communities and our remote areas. That means that we can make good—as we always intended to—on our commitment to equitable distribution of and access to the vaccine.

The news of the vaccine is very welcome, and I thank all the scientists and clinicians who have worked tirelessly to assess the quality, safety and effectiveness of the various vaccines. In the interests of transparency, I inform the chamber that the NHS has contacted me to ask me to participate in the vaccination process as a vaccinator.

I ask the cabinet secretary to expand on the regulatory process. When can we expect the Pfizer vaccine to get full licensing approval, beyond the welcome approval to supply?

I will be really quick, but we will set this out in more detail. There are a couple of principal reasons why we have got so quickly to the authorisation to supply the vaccine, compared with previous experiences and, if you like, normal practice. One of those is the fact that just about the entire global scientific and research community has been focused on the matter for many months. As we know, with the AstraZeneca/Oxford vaccine, the researchers had a bit of a template to start from on coronaviruses, although not specifically on Covid-19, and I think that they would say that it gave them a bit of a head start.

The other main element is the significant focus on the funding of all that research and work from Governments across the UK, as well as globally.

In addition, the regulatory authority has run a parallel process, so it looked at the data from the phase 1 clinical trials as they happened and then at phases 2 and 3 as they happened, so it has been able to review the data almost in parallel with the clinical trials as they have occurred. All of that has concertinaed the process that led up to the stage that we are now at.

Of course, work continues, and it will continue, as we vaccinate across the UK and elsewhere, to see how effective the vaccine is—for example, in preventing transmission. The MHRA continues its process in order to move from authorisation to supply and full licence, which Ms Harper asked about.

I will be happy to set out the full detail of that and will ensure that, in the first piece of information that Mr FitzPatrick circulates to MSPs, we set out in more detail and with greater expertise than I have offered exactly how that whole process has worked.

What will be the role of GP surgeries in the vaccination process? What consideration has been given to the impact on their day-to-day working?

We have reached a particular agreement with GPs and we are in discussions with other independent contractors to the NHS, such as pharmacists, dentists and optometrists, in order to secure what I would describe as their sessional time—their time in local vaccination centres. They are a critical part of the vaccination process.

Where GP surgeries can accommodate particular individuals in their patient list for whom going to the GP practice is much easier and more convenient than going elsewhere, they will do that. However, the overall intent is to allow the continuation of the vaccination programme while not interfering in the important day-to-day business of the GP community and their practice staff. That is the agreement that we have reached with them, which will allow both to continue. I am really pleased that we have reached that agreement, and, as I say, discussion is now under way with other independent contractors to the health service.

Will the cabinet secretary outline how the vaccine delivery programme will ensure that those who live in more rural communities, such as Lochwinnoch in my Renfrewshire South constituency, will be able to receive the vaccine if they do not have access to a car or are unable or reluctant to use public transport?

There are two ways in which we are looking to make sure that that can happen. The first is the work with our local authority colleagues in particular to identify any local premises that they have in a village or a nearby town that we can make Covid safe and use as a local vaccination centre for small numbers of people.

The second way, which will probably be very effective in constituencies such as Mr Arthur’s and indeed mine, is using mobile vaccination units. The ambulance service will be actively involved in providing those and in undertaking vaccinations, given its clinical experience. Both ways will ensure that we can cover those communities and take the vaccination to them.

On the international day of people with disabilities, we should remember that people with learning disabilities are particularly vulnerable to coronavirus, as their death rate is more than six times higher than that of the population as a whole. The JCVI gives some priority to adults with Down’s syndrome, but not to children. Can the CMO consider whether we should also give priority to parents and carers of children with Down’s syndrome and other disabilities, given the inevitable and daily contact involved in care, and their anxiety that they will bring infection into the home?

That is a really important question, for which I am grateful to Mr Gray. He will know that children are not in this programme, because the clinical trials for the Covid vaccine have not been completed for that age group.

We have extended our interpretation of the first priority group to include carers—not just carers of adults, but carers of children. I am happy to undertake to look at whether we need to do more regarding the groups that Mr Gray is thinking about, or whether they are already covered in what we are going to do to widen, to some degree, the definition—it includes personal assistants and others—of those whom we think should be in the first overall wave between now and the spring.

I call Alasdair Allan, to be followed by Rachael Hamilton.

It looks as though Dr Allan’s connection has been lost. We will move on to Rachael Hamilton, and we will try to come back to Dr Allan later.

How many vaccines does the Scottish Government believe it has the capacity to deliver in the initial weeks of the programme? Will the Parliament be advised of how many doses of the vaccine each health board will receive?

As I said at the outset, the UK Government has secured 800,000 doses, and our 8.2 per cent share of that is 65,600 doses. That is what we are assured will be delivered. I cannot give other numbers, because we do not have definite delivery dates for the rest of December, so it is not possible for me to answer the second part of Ms Hamilton’s question.

I am happy to ensure that members are advised of information on the supply and the likely delivery dates as we get it. Doses will be distributed between our health boards according to population share, so that access is equitable. We have, for example, a breakdown of the number of care home residents in each of our health board areas, so we know what we need to distribute to those boards so that they can vaccinate all their care home residents. We have similar distribution allocation numbers for health and social care workers, and, indeed, for various age groups.

However, we need to remember that we are strongly advised by the MHRA—in fact, it is a requirement—to keep 50 per cent of all doses that we receive, in order to vaccinate for a second time those who receive the first vaccination. I understand that members are looking for definite numbers, but giving those numbers is not always as straightforward as one might think. We will do our very best to make sure that members have as much confirmed information that they can rely on as possible, as quickly as we can give it to them.

I, too, welcome the news that the vaccine can be transported unfrozen for up to 12 hours. Given the rurality of my constituency, Midlothian South, Tweeddale and Lauderdale, that is very important. Is there a role for communities in identifying local sites where vaccinations can take place? If so, whom should they contact—the NHS or their local authority?

There is absolutely a role for that. Ms Grahame has already suggested a couple of possibilities to me. The best people to contact are in the local authority, and I would suggest going straight to the chief executive. The Society of Local Authority Chief Executives and Senior Managers—which, as Ms Grahame knows, is the chief executives collective body—is actively engaged with us on all of this. The local authority is the best place to go to, because authorities are a huge part of the schedule of work that I am very pleased to say they have agreed to do alongside us, to make sure that we can deliver the programme.

How will the Government ensure that as many of our older citizens as possible are vaccinated and that their human rights are respected? I am referring in particular to those who cannot give consent to vaccination.

In circumstances in which informed consent cannot be given—some older citizens will be in that situation, but other fellow citizens will be in it, too—it should be sought from the designated member of the person’s family, if such a person exists. That person may have power of attorney or another role in that regard. There are well-known processes in healthcare for going through that exercise. The appropriate route to secure consent needs to be taken in order to ensure that people are not vaccinated without informed consent.

We will try to get Dr Allan again.

I was pleased to hear the cabinet secretary confirm that the initial vaccine is more transportable than was initially thought. That has clear benefits for island areas such as mine. Will the cabinet secretary say more about the publicity campaign and the engagement that there will be for the first eligible groups to ensure maximum take-up?

Over this month and into January, we will issue a number of pieces of public information about the safety of vaccines, how they work, what to expect from the national delivery programme, the priority groups, and why they have been set out in that way. The rough timeframe that we expect for all those things is an estimated one, because it is, of course, dependent on supplies arriving and other vaccines being authorised and approved. As I have said, we will do a national household door drop in January. There will be direct information to every household in Scotland that covers all of that, the local plans in the area, what people should expect to receive through the post or by whatever other means as their personal invitation, and why we encourage people to accept that invitation and be vaccinated. We will keep that approach going all the way through until we reach the end of the programme.

I apologise to the half a dozen members whom I was not able to reach, but we have to end there, as we have quite a few items of business to get through.

15:32 Meeting suspended.