Meeting of the Parliament

Meeting date: Thursday, November 19, 2020

Official Report 1200KB pdf

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Covid Vaccine

The next item of business is a statement by Jeane Freeman on a Covid vaccine. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:23  

I am grateful for the opportunity to set out our current plans to deliver a programme of Covid-19 vaccination to everyone in Scotland who is over 18. As I will cover shortly, there remain some key areas where we have still to receive or confirm information, and I will continue to update members as information becomes available and our plan develops.

Last week, we all had the good news from Pfizer, and this week we had more good news from Moderna, as they both announced over 90 per cent effectiveness in phase 3 clinical trials of their vaccines. Those are just two of 12 vaccines that are undergoing phase 3 trials worldwide, including three involving clinical trials here in Scotland. Pfizer and Moderna will now share evidence from their trials with the regulatory and advisory bodies to allow clinical and scientific review, with advice then to each United Kingdom health department to determine on safety and effectiveness.

That is a critical point. I want to be clear to members and to people around Scotland that the safety of the Covid-19 vaccine is paramount to us. The global scientific, research and pharmaceutical communities have come together and worked as never before. We have seen unprecedented investment worldwide in research, development and manufacture, volunteers around the world—including here in Scotland—taking part in clinical trials, and driven and dedicated research teams. That is why we are seeing the front-running vaccines delivered in months, rather than in the many years that vaccine development can sometimes take. It is impressive, but it is not at the expense of safety.

Each vaccine goes through a rigorous and independent three-phase testing process long before it can be licensed as safe and effective for use. Regulators such as the European Medicines Agency and the UK’s Medicines and Healthcare products Regulatory Agency review trial results and decide whether to approve the vaccine. During a pandemic, the timeframes can be compressed, but never at the expense of safety.

Vaccinating the adult population—everyone aged over 18—in Scotland means vaccinating 4.4 million people. We have, rightly, worked across the four nations to secure the vaccines and secure agreement on the population share of the purchased doses for each of the UK nations.

From December, we expect to have the first delivery of vaccines to Scotland. We are planning on the basis both that the Joint Committee on Vaccination and Immunisation is able to review the clinical evidence and provide Governments with a recommendation, and that the vaccine receives a licence.

As I said, we are hopeful that, over the coming weeks into 2021, we will have more than one vaccine available to us, so that we can, with minimum delay, vaccinate as many people as possible as quickly as possible. However, I must be clear that there are a number of challenges and, at this point, unknowns to our delivery programme, which we hope will take from December to spring next year to complete in full.

The first of the unknowns is obviously the start date. We are ready for December, but the first available vaccine has yet to be approved, and supplies have yet to arrive. Thereafter, we need more vaccines to become available and we need to understand the delivery schedule for each.

The Pfizer vaccine has specific requirements in terms of transportation, storage and accessibility for use in certain settings. Other vaccines will have their own requirements, which might be similar to those of the Pfizer vaccine or might be different. It will be important to understand the differences to inform clinical advice about deployment. Our national plan has to be able to adapt to accommodate different requirements.

A vaccine must be used in a way that ensures that those who are most in need of protection receive that protection first, so our planning will be informed by the independent scientific and clinical advice of the Joint Committee on Vaccination and Immunisation. The JCVI has already offered interim advice on prioritisation, which we have used in our planning for the early but limited vaccine supply that we expect to receive.

In the first wave of our plan, from December through to February, we will vaccinate front-line health and social care staff; older residents in care homes and care home staff; all those aged 80 and over; unpaid carers and personal assistants; and those who will be delivering the vaccination programme. The current interim advice from the JCVI is that we then work through those aged over 65 and those aged under 65 who are at additional clinical risk, followed by the wider population.

This is a national vaccination programme that sets out clearly the parameters within which our national health service boards will lead local delivery. Nationally, we will set out the policy direction and the delivery framework, accompanied by guidance and information for those at the front line. We will develop and deploy a national workforce model; provide national training; undertake procurement and logistics work; provide national information and advice; create tools to record data about vaccinations, so that they are on people’s medical records; and, from phase 2, provide a national booking service.

National health service boards will then lead local delivery, identifying acceptable and accessible locations both for mass vaccination and for local access, taking population and geography into account. They will undertake recruitment and deployment of staff and the management of local vaccination clinics.

Over the coming weeks and months, we will be sending information to everyone across Scotland explaining what the vaccine is, how we are prioritising who gets it, what to expect when vaccinated and so on. Those in the first wave of the programme will be contacted during December and January either by mail or, for health and social care workers, by their employer. They will be told where they will receive their vaccine, how to make an appointment and what they need to know.

In truth, the programme is a major public service exercise. We need the expertise and resources that our local authorities, community planning partnerships and the third sector can bring, and we need locations—both fixed and mobile—so that we can make the mass vaccination programme as accessible as possible wherever someone lives in Scotland and whatever their circumstances.

We need a workforce that is diverse in its skills and availability. Our planning assumption is that we will need over 2,000 vaccinators and support staff by the end of January, so that—vaccine availability and delivery schedules yet to be confirmed—we will be able to vaccinate around 1 million people by that time.

We need registered clinicians to vaccinate and to supervise vaccinations, as well as nurses and doctors, but also the wider clinical workforce such as pharmacists, dentists and optometrists. We have now concluded an agreement with the British Medical Association on terms and conditions for general practitioners’ involvement in the programme and are working through agreements with other independent NHS contractors.

However, we also need a workforce that understands the importance of logistics, minute planning for delivery, location set-up and building, and Covid-safe locations, as well as the importance of data collection and performance management. Scotland has an excellent track record on vaccinations, but this will be one of the biggest civilian logistical challenges in our lifetime, so we have strengthened our NHS planning teams, engaging with local authorities, local resilience partnerships and the military.

We know from the beginning of the pandemic, when the military assisted in the delivery of NHS Louisa Jordan and the deployment of testing sites, that they bring real value to supporting our efforts. With so many vaccines in phase 3 clinical trials, there is the potential for multiple vaccines to be available over the next 12 months and it is possible that those will have different characteristics that impact on how they are stored, handled and delivered. That requires real logistical expertise from one organisation that can cover the whole country, so I am grateful that the military have responded once again and stand ready to bolster our planning, bringing with them a wealth of logistical and operational expertise.

It is important to be clear about what we do not yet know. We do not know which vaccines will be approved for use and when doses of those vaccines will reach us. We do not yet have information about all the vaccine characteristics; for instance, we do not yet know whether the Pfizer vaccine will be approved for transportation beyond the ultra-cold temperature that is currently being used, in order to allow us to vaccinate in multiple smaller locations such as GP practices and care homes. Although we have some welcome news on the efficacy of the Pfizer vaccine from the trials, we do not know whether it will stop a person from getting the virus, from passing it on or will prevent the virus from causing serious harm.

It may take many months before we fully understand the level of protection on transmission and the impact on reducing the severity of the illness that is caused by the virus. We know that the first vaccines will require two doses, three to four weeks apart. It is possible that further booster doses, and even an annual programme, may be required, given that we do not know how long any protection will last. For now, the important thing is that, when we start to deliver the first vaccines, it will be on the basis that they offer some form of protection, even if we do not know at this stage how much protection that is.

It will be safe, so when we get in touch, please go for the vaccine. It offers you a level of protection that we do not have through any other means. If you are not in the first group that is called, you should please be patient. I know that you will understand how important it is that we protect first those who are most vulnerable to serious illness and death.

A safe and effective vaccine brings hope. It gives us all encouragement that where we are now will end. However, right now, we all have to keep following the necessary restrictions, tough though I know they are, and keep washing our hands, wearing face coverings and keeping a 2m distance. That is how we protect ourselves, our loved ones and our NHS, while science brings us hope.

The cabinet secretary will take questions on the issues raised in her statement. I will allow around 20 minutes for that. Members who wish to ask a question should press their request-to-speak button.

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

The recent news that various vaccines are proving effective during clinical trials is very welcome, as is news that the UK Government has now added some 355 million doses from seven different developers, which is more per head than almost any other country. Given that problems are being encountered with this year’s flu vaccinations, it is understandable that there is concern about how the Government will manage the roll-out of a Covid-19 vaccination programme in such a way that the public have full confidence in it.

With that in mind, I find that the statement lacks many details on the practical aspects of delivering a vaccine. Further clarity would be welcome on the exact make-up of the dedicated workforce and how the Government will address issues with delivering vaccines to, for example, care homes that are in higher tiers.

Will the cabinet secretary confirm how Covid-19 vaccines will be delivered to the public, taking into account Scotland’s unique geography of high-density urban areas and sparsely populated rural areas? Can she confirm how vaccines will be safely transported to delivery points once they are in the possession of health boards?

I am grateful to Mr Cameron for his questions. I am sure that, having listened to the statement, he understands that there are some parts of his questions that I cannot confirm.

I cannot confirm the details of transportation because, for example, with regard to the first vaccine that has come successfully through stage 3 trials and is now being considered by the regulatory bodies, we do not know all of its components, which will determine the nature of transportation and the vaccine’s stability through that. That is part of what I meant when I talked about “unknowns”.

That information is coming through to us on a regular basis. My officials are involved in all those discussions at the UK level, including those with the Joint Committee on Vaccines and Immunisation. Later today there will be another four-nations health ministers call in which all of us—because we are all grappling with the same unknowns—will work through how much more we know at this point. That is why I have committed today to updating members on that information regularly.

That applies to answering Donald Cameron’s question about exactly how we will deliver the vaccine in care homes. We intend to take the vaccine to care homes and to vaccinate in each care home both the staff and the residents. Necessary elements of doing that are being dealt with, such as gaining appropriate permissions from people to be vaccinated. However, we need to know the properties of the vaccine, the packaging that it will come to us in and whether we can transport it. For example, can we transport the Pfizer vaccine from its very-low-temperature storage facility to individual care homes? If we can, given the package sizes, do we need more than the 22 commercial storage freezers that we currently have? Do we need those in smaller sizes in more locations around the country?

Our outline plan has options relating to such unknown elements, but we cannot firm up those options until we have detail on the exact properties of each of the vaccines that come through successfully.

My final point about delivery is that our boards are doing two things. They are using some of the existing flu infrastructure, in the larger walk-through and drive-through flu vaccination centres. Those are more appropriate for urban areas and for certain cohorts of our population.

We will also use mobile vaccination units. We will use more local high street vaccination centres, which is where our partnerships with local authorities will come into their own. We will make sure that the vaccination programme is accessible to people the length and breadth of Scotland, taking account of the geography and circumstances in which people do not have private transport or their age means that they have mobility issues.

The final point that I want to make is that, depending on the vaccine’s properties, we will look to use the health service resource to vaccinate some people at home because it will be easier for them to receive the vaccine in those circumstances.

From the cabinet secretary’s statement, it is clear that the workforce will be crucial to the success and speed of the vaccination programme. With that in mind, I have a few questions; the cabinet secretary might have to follow up some of the answers in writing for brevity’s sake.

When the first delivery of vaccines arrives in Scotland, how soon after that does the cabinet secretary expect the first vaccinations to be administered? Of the 2,000 vaccinators and support staff that will be needed by the end of January, what proportion will be vaccinators? Will there be any additional recruitment? Will non-registered clinicians receive training to become vaccinators?

The cabinet secretary also mentioned the role that general practitioners will play, which is clearly welcome. What additional support will be in place to ensure that GPs will continue to be able to do their day jobs and see patients on a timely basis?

There are a lot of questions there, as Ms Lennon rightly said. I will write to Ms Lennon on some of those, as I will to other members, because there is a lot of detail.

We are ready. We hope that we will receive the first of the 320,000 doses that we expect in December in the first week of December, and we will be ready to begin the vaccination programme in that week.

National training is under way. We are already deploying some of the cohort of our flu vaccinators to this work because the flu programme is well under way. Some will deploy over and the rest will be deployed further once the flu programme is completed.

We are recruiting, but our clinical expertise extends beyond the medical and nursing professions into dentistry, optometry, and pharmacy. We have already had positive discussions with those professions about their members wanting to be part of this national exercise, and looking at the shifts that they can sign up for—we do not expect this to be a nine-to-five operation or a Monday-to-Friday operation—so that they can continue to deliver their core service and undertake vaccinations in addition. That is why we are in discussions about terms and conditions for that extra work.

The armed forces will do a great deal of the logistical work but, again, our partnership with local authorities and local resilience partners will help us to identify locations and to ensure that they are Covid-safe. Our national procurement service on personal protective equipment will ensure delivery of the right level of PPE to all locations, and that the mobile units carry it with them.

We move to open questions. I allowed a bit of extra time for the opening questions because of the subject matter, but I ask everyone else to be succinct with their questions, and, as far as possible, with their answers.

Parts of the Maryhill and Springburn constituency have had lower uptake of the flu vaccine historically, although I know that it has been stronger this year. Will the cabinet secretary ensure that NHS Greater Glasgow and Clyde works to deliver an uptake of any new Covid-19 vaccine that is high in all parts of Glasgow, as we want it to be right across Scotland?

Yes, I will. I will just make one quick point. Those mobile units and local high street centres that we have talked about are to be used precisely so that we can reach people who we have not been able to reach in the past.

In a call last week, the cabinet secretary and I discussed the practicalities of delivering a population-wide vaccine. I know that she recognises the need to ensure that the public understand the realities of the vaccination process. What consideration has the cabinet secretary and her team given to the impact of restrictions on the programme for those awaiting their turn for vaccination when others have already been vaccinated?

I assume that Mr Whittle is talking about the strategic framework level of restrictions. In the first wave, we would ideally like to deliver the vaccine to those individuals who are 80 and over and not in residential care, in their own homes. That is partly to take account of any mobility issues that they might have, but also to ensure that it is as safe as we can possibly make it. That depends on the properties of the vaccine and the degree to which it is stable if it is moved any distance at all. We will know that very shortly. All that work is happening at pace, not just here in the Scottish Government and with our partners, but in the JCVI, the regulators and companies such as Pfizer and others, who are producing the information as quickly as they can so that we know what the delivery schedule will be.

Elsewhere, we are trying to ensure that we have what I am calling “high street locations”, so that people do not have to travel far in order to receive the vaccine. The location will be Covid-safe in the way in which it is organised and people move through it, the timetabling of their appointments and all the other measures, including PPE and hand sanitisers. We have seen our health boards deliver that in the flu vaccination programme.

The cabinet secretary touched on the issue of public locations. Local authorities own and run many community centres and sports centres. In some areas, particularly in Greenock and Inverclyde, the utilisation of such venues will be extremely important and useful, particularly for the older members of the community who are often spread out, but also for those areas in which there are pockets of the population where there are many older people.

Those are precisely the kind of discussions that we are having to enable us to access those locations in partnership with local authorities.

Last night, I was contacted by home care staff, a community nurse and two ward staff members, all of whom are in contact with Covid patients and all of whom told me that they had not been tested, eight months down the line—not even once. Given that shameful situation, what confidence can they have that they will be near the front of the queue when the vaccine comes? What is meant by front-line health and social care staff? Those people do not appear to be regarded as front-line staff just now. Finally, will designated family members be vaccinated to ensure that they can visit care homes?

As I have just set out, front-line care staff— and by front-line, I mean patient-facing NHS and social care staff, including social care staff who work in care homes and home care staff—will be in that very first wave. Over December and January, they will be offered the opportunity to be vaccinated. As the member knows, I will set out in the Parliament next week the plans for the roll-out of routine asymptomatic testing.

On designated visitors, the JCVI information and advice is that we should work through age cohorts. The only sectoral exemption to that is NHS and social care staff. We have extended that definition ourselves to take account of unpaid carers and personal assistants. However, the JCVI has said that the clinical evidence is crystal clear that we must work through the age cohorts because they are the most vulnerable to serious harm from the virus, including death. That is the basis on which we will deliver the vaccine.

The statement is very welcome and shows that there is light at the end of the tunnel, but there is still a huge amount of work to be done to get there.

I want to ask about the extended flu vaccine programme, with which there were major logistical problems in some health board areas, including NHS Fife. What has the Government learned from that experience? Is there a case for specific support to individual health boards that may struggle with capacity and other problems?

We have learned at least two lessons, and we are now implementing them. The first is the importance of a national plan. It is delivered locally, but that is very different from having 14 territorial health plans. The national plan is clear and sets out the parameters within which a health board has to organise its local delivery—it should have the widest possible range of delivery locations and it should think about the kind of staff that it needs to recruit and how it will support and train those staff using the national training programme.

The two main lessons that we have learned are the importance of a national plan, coupled with local delivery because local boards know the geography much better at their level, and the importance of maximising the number of locations, including mobile locations, where people can be vaccinated.

The large mass vaccination centres work well, but only for a particular cohort of the population. For the population group that we need to get to first, mass vaccination centres are not the right places. We need to do things differently, which includes vaccinating people at home, provided that the vaccine’s properties allow us to transport it in small doses.

The cabinet secretary’s statement is very welcome and offers much-needed hope. However, although the statement was 1,700 words long, only four of those words covered the national booking service that will administer delivery to everyone from phase 2. That will be utterly crucial in the delivery of the vaccine. I would like some additional detail on that service. First, will it be automated or staffed? Secondly, is it ready to go or is it still to be designed?

Mr Cole-Hamilton should never judge the amount of work that we are doing on the basis of the number of words that I use.

As I said, the national booking service will be ready from phase 2, which kicks in at the end of February and takes us through another couple of months thereafter. The service has been designed, but the detail of it is not yet finalised, because it is for phase 2.

I will undertake to ensure that every member knows the detail of what that national booking service is, including whether it is automated, how people can get advice, what someone should do if they get an appointment time that they cannot make and so on, and how that connects up with the local delivery areas. I will do that as soon as all the details are finalised.

I too very much welcome the news about the vaccine, as will all my constituents in Cowdenbeath. Can the cabinet secretary advise what the current thinking is, and what we know at this point, about how the information will be disseminated in Fife so that people know what is to happen and when? Can she confirm that those in my Cowdenbeath constituency and elsewhere in Fife who may struggle to get to a central location from their village or town will be able to get the vaccine where they live, and that that will be an automatic entitlement rather than something that involves people having to get into a big argument and harangue?

With regard to information, we will—as I said in my statement—write to those in the first cohort over the coming weeks to ensure that they know what the arrangements will be for them. We will write to those individuals either directly or, in the case of health and social care staff, through their employer.

Thereafter, we currently have in train the planning for, and content of, a national door drop that will provide every household in Scotland with detailed information on the vaccines, their safety, how we are going to deliver them, what to expect and so on.

In addition, I will write to every member of the Parliament with the same level of detail that I gave on the flu vaccine programme so that they know about both the national and local arrangements and have a named local contact to whom they can go to directly as an MSP with individual constituent inquiries. Of course, members can always come to me with such inquiries too.

On local access, we are putting in place every possible step that we can so as to minimise any travel that anyone has to undertake in order to be vaccinated. In some instances, that may not be possible in a particular village, for example—and I am thinking of my own constituency here. It may be really difficult for people to travel to the village next door or the nearest town. We are therefore deploying that huge clinical workforce so that, in some cases, we can deliver the vaccine directly to someone in their own home. As I have said many times, however, that is dependent on the properties of the vaccine and on how stable it is the more it is transported.

I am going to let these questions run on for a little while.

The cabinet secretary will be aware of particular issues facing remote and rural areas of the Highlands and Islands and of the additional challenges that many communities already face in delivering a winter flu programme. Can she comment on what planning is under way to support the roll-out of a Covid vaccine in our rural and island communities? That will be vital in ensuring that as many people as possible have access to vaccination and that no one is left out.

Mr Halcro Johnston is very right. My own constituency is largely rural and, for many people, particularly in the most southern and eastern parts of that constituency, local towns are not as accessible as people might think they are.

Discussions are under way in individual health boards about what makes most sense in their areas. How many mobile vaccination units do they need? Where are we using local authority property and facilities—large or small? How are we working with the third sector, and indeed with faith groups, which may also have locations that we can rent and turn into Covid-safe vaccination centres for small numbers of people? All of that consideration is under way.

For some parts of our country, mobile units will be more effective than that. That may be the case in some of our island communities; for other areas, it will be a matter of using local community centres, church halls or other properties, including local authority sport and leisure facilities, which we can access and make use of.

It does not involve GP surgeries so much because, as was covered in Ms Lennon’s question, we want to ensure that they can continue to deliver healthcare. There are possibilities for clustering with some of that.

Every individual health board is in discussions with the national team to consider what they are doing individually and what makes sense, and I can assure the member that I look across all those 14 local plans to ensure that they are as comprehensive and assured as I need them to be.

As the cabinet secretary has recognised, the very welcome roll-out of a Covid vaccine will present logistical challenges, especially given that one of the more likely vaccines needs to be stored at -70°C. Can the cabinet secretary confirm that some thought will be given to the needs of island communities in case storage requirements of that kind apply, and can she explain how patient transport to centres will be organised in areas with very scattered populations?

We are giving that a lot of consideration. The matter is particularly relevant to island and other communities in and around Scotland. There are many such comparable considerations north and south of the central belt. The Pfizer vaccine does indeed need to be stored at the temperature that Mr Allan mentioned. As yet, the number of what are called transportation steps before it absolutely has to be used is to be confirmed. The vaccine cannot be moved around any more than that.

That has implications for where it is taken to be distributed from in the first instance. We have 22 commercial-sized freezers that will be deposited around the country. We are considering whether we need more of them or more of the same standard of commercial freezer but smaller, which we might need to take to other parts of Scotland to ensure that we can distribute the vaccine as widely as possible before we get to the point at which we actually have to use it. That is about reducing waste of the vaccine and maximising the amount that we can use to vaccinate individuals.

If members have particular knowledge about their constituency areas, I would welcome hearing it from them. Dr Allan has done that very helpfully for me in the past, in pointing out the nature of the Western Isles community and telling me things that I, as someone who does not live there, would not immediately understand. I would welcome any particular constituency information to which any member wants us to pay attention.

The cabinet secretary will be aware that many of my constituents cannot access Covid-19 testing because of where they live. Will she reassure them that they will receive the vaccine regardless of where they live? As she is not planning to use GPs, and as some of those people will need to be vaccinated at home, they must be reassured that they will not be left behind.

I apologise to Ms Grant if she has picked me up wrongly. I will be using GPs, although it is entirely for GPs to volunteer, as it will be for pharmacists, dentists and others.

GPs, practice nurses and other clinical staff in GP practices are welcome to be involved in the programme. We have reached an agreement with the British Medical Association on financial reimbursement for them. GPs might well be involved in Ms Grant’s area, as might district nurses, family nurse practitioners, local pharmacists and so on.

I assure members that we will do all that we can to ensure that every Scottish citizen who is eligible for the vaccine—all adults over 18—can access it and can be vaccinated, whether we take the vaccine to their home or to one of the many locations that we are looking to set up with our partners in local authorities and others. There will also be mobile units, which might be particularly relevant to Highlands and Islands communities.

Ms Grant will know that additional local testing centres are about to be set up in the Highlands. I hope those will assist her constituents to access testing.

Will the cabinet secretary provide an update on the phase 3 Covid-19 clinical trial that is currently under way across NHS Tayside? How will that inform national roll-out of a vaccine when one is available? Will the national door-drop information be available in an easily accessible format for people who have additional support needs?

I apologise to Ms Robison, because I do not have the detail of the Tayside trial with me. I am happy to send that to her later.

The national door-drop information will be available in a number of languages, as is usual with our communications. We will pay close attention to other forms of communication to ensure that all our citizens have, understand and can make use of the information that we provide, either through the national door drop or the many other channels that we will use.

That concludes questions on the statement about the Covid vaccine. I remind members about the social distancing measures that are in place as they enter and leave the chamber