Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 30, 2021

Official Report 1028KB pdf

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Covid-19

The next item of business is a statement by Nicola Sturgeon, who will give a Covid-19 update. The First Minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:21  

Today, as well as giving an update on the general Covid situation, I will share the latest information that we have on the recently detected omicron variant. I will outline the steps that we are taking to slow its spread and to curb transmission of the virus more generally.

First, however, I will set out today’s statistics. Yesterday, 2,569 positive cases were reported, which is 11.5 per cent of all tests. Currently, 706 people are in hospital with Covid, which is nine fewer than yesterday, and 54 people are in intensive care, which is two more than yesterday. Sadly, a further 10 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,572. Once again, I convey my condolences to everyone who has lost a loved one.

More positively, the progress and pace of the vaccination programme continues to be very good: 4,346,736 people have now had a first dose and 3,949,736 have had two doses. In total, 88 per cent of all those over 18 are now double-vaccinated, and 77 per cent of 16 and 17-year-olds and 59 per cent of 12 to 15-year-olds have had a first dose. From today, 16 and 17-year-olds can book their second dose of the vaccine online, and I encourage them to do so.

On first, second, third and booster doses, we remain the most vaccinated part of the United Kingdom. That matters because, as we know, vaccines save lives. According to a study that the World Health Organization published last week, there might be more than 27,000 people in Scotland who are alive today only because of vaccines. I again record my thanks to everyone involved in organising and delivering the vaccine programme.

In last week’s statement, I expressed the view that our overall situation was much stronger than I had dared hope. Case numbers, although still too high, had stabilized and, indeed, had started to decline. Since then, the data has become, if anything, even more encouraging. However, although case numbers here have continued to fall, the world has, of course, received the deeply worrying news of the new omicron variant.

I will say more shortly about our current understanding of the new variant. Before doing so, I will give a bit more detail of the current overall trends in infection levels.

In the past week, the average number of new cases that are being recorded each day has fallen from just under 3,000 to just over 2,500, which is a reduction of 15 per cent. As in the past few weeks, the biggest decline has been in older age groups, with cases in the over-60s having fallen by 27 per cent. That is very likely to reflect the on-going success of the booster programme.

Encouragingly, cases in the under-60 age cohorts, which account for the significant majority of cases in Scotland just now, have also fallen in the past week, by 13 per cent. In fact, during the past week, cases have fallen in all age groups. The number of people in hospital with Covid has also fallen, from 743 to 706, as has the number in intensive care, from 60 to 54.

All of that is really positive news, which indicates that vaccination, together with continued compliance with the protections that are still in place, is applying a firm downward pressure on transmission, and therefore helping to reduce the overall health harms that the virus causes.

All of that said, the national health service is still under significant and very severe pressure. Although case numbers are falling, they remain very high, and higher than we would want them to be going into the winter period. We know that a combination of factors poses a real risk that transmission will increase again through December and into the new year, as colder weather forces us indoors more and festive socialising gets under way. That risk remains very real and, if it materialises, it would put significant additional pressure on the NHS. Of course, the risk has now been significantly increased—at least, potentially—by the emergence of the omicron variant.

I turn to what we currently know about the new variant. Perhaps the most important point to make at this stage is that most of the key questions about the impact and implications of it have not yet been answered. However, the number of mutations that it has and the nature of those, together with some of the very early indications from southern Africa, have raised the concern that it might be more transmissible than the delta variant, which is currently the dominant variant in Scotland and many other parts of the world. Further data and analysis are needed to confirm that, and to assess what impact, if any, the new variant might have on the effectiveness of vaccines and on the risk of reinfection.

It is worth stressing that there is no evidence at this stage to suggest that the disease that is caused by the omicron variant is more severe than that which is caused by other variants but, again, further analysis is required before we can be certain of that.

Thanks to the work of the global scientific community, we will find out much more about omicron in the days and weeks ahead. As our knowledge and understanding expand, we will be able to assess with much more certainty the implications for our response to the pandemic. I very much hope that, as we learn more, our level of concern will diminish rather than increase.

However, while hoping very much for the best, it is prudent at this stage to contemplate and prepare for something less positive than that. The fact is that any variant that might be more transmissible than the delta variant—which, in turn, was more transmissible than any variant that came before it—and which could, even if to a limited extent, evade vaccine or natural immunity, must be taken very seriously. That is why we have responded, and will continue for now to respond, in a way that is proportionate but also highly precautionary.

I turn to our current understanding of the presence of the omicron variant here in Scotland. I can confirm that, as of 5 pm yesterday, there are nine confirmed cases in Scotland: five in Lanarkshire and four in Greater Glasgow and Clyde. We have preliminary information on all nine of those cases, which is the basis of the information that I am about to share with the Parliament. However, I stress that health protection teams are continuing their investigations.

None of the people who have tested positive for the new variant has so far required hospital care. All nine were tested on or around 23 November and, because they had tested positive, they have all been self-isolating. A surveillance look-back exercise had identified that the polymerase chain reaction test results in those cases showed what is called the S-gene dropout. That is not conclusive evidence of the omicron variant, but it is indicative of it. However, whole genome sequencing of those positive samples has now confirmed that they are indeed the omicron variant.

As far as we know, none of the individuals concerned has any recent travel history to, or known links with others who have travelled to, the countries in southern Africa where the variant was originally detected. However, while the contact tracing exercise is still on-going, health protection teams have established that all nine cases are linked. They all trace back to a single private event on 20 November. Indeed, over the coming days, we fully expect that more cases will be identified that are also linked to that event.

In summary, the lack of any known travel or overseas connection to the cases suggests that some community transmission of omicron is already happening in Scotland. However, the fact that all known cases so far are linked to a single event suggests that community transmission might still be limited. Indeed, so far, there is nothing in the wider look-back exercise that Public Health Scotland has undertaken to suggest that community transmission of the new variant is either sustained or widespread.

The look-back exercise has examined PCR test samples dating back to 1 November to identify any that have the S gene dropout. A number have been identified and, where the sample makes it possible, subjected to whole-genome sequencing. The exercise has resulted in the nine cases that we have reported.

Given the nature and scale of the 26th United Nations climate change conference of the parties—COP26—the surveillance work that Public Health Scotland is doing is also looking at any potential links to it. At this stage, however, there is no evidence whatsoever of any such link. Although it is not impossible that one will emerge, the timelines that are involved make it improbable.

In short, Public Health Scotland is working hard to identify any and all cases of omicron in Scotland as quickly as possible. I am very grateful to PHS for its efforts.

Given the nature of transmission, I consider it highly likely—indeed, almost certain—that more cases, perhaps many more cases, will emerge. However, the enhanced surveillance gives us the best possible chance of identifying cases quickly and then, through the isolation of index cases and close contacts and targeted testing, of breaking transmission chains and containing spread while we learn more about the variant. That is key. While so much about the new variant is unknown, it is important that we act on a highly precautionary basis.

That is certainly true for the steps that Government must take, and it is equally true for all of us as citizens. We all have a part to play—this has been true throughout the pandemic—in stemming transmission of the virus in general. Let us not forget that, although we are talking right now about nine cases of a new variant, 2,500 cases of the delta variant are still being recorded each day. Suppressing the transmission of delta remains important, and it is now important to suppress and contain transmission of the new variant, in particular.

Some of the protections that the UK Government announced at the weekend in relation to England, for example a requirement to wear face coverings in some settings, are already in place and more extensive here in Scotland. Therefore, at this stage, rather than introducing new protections, we are asking people to significantly step up and increase compliance with existing protections such as face coverings, hygiene, home working, ventilation, vaccination and regular testing.

Enhanced domestic compliance will complement the UK-wide travel restrictions that were confirmed over the weekend, which aim to reduce the risk of additional cases of the new variant entering the country. Ten countries in southern Africa have been added to the travel red list so far. Anyone travelling back to Scotland from any of those 10 countries must enter managed quarantine for 10 days on their arrival. In addition, anyone arriving in Scotland from anywhere outside the common travel area is now required to take a PCR Covid test on or before the second day of their arrival—we advise that that should be on the second day—and to self-isolate until they get the result of that test back.

Given the incubation period of the virus, the Scottish Government’s judgment is that it would be sensible on a precautionary basis for the travel rules to be tightened further on a four-nations basis. Yesterday, the First Minister of Wales and I suggested to the Prime Minister that, until we know more about omicron, people arriving in the UK from overseas should be asked to self-isolate for eight days and to take a PCR test on day 8 after their arrival, as well as on day 2. We look forward to discussing that further. We suggested to the Prime Minister that the convening in early course of a COBR meeting to discuss that and other issues would be appropriate.

Although certainty is not possible at this stage and will not be possible until we know much more about the new variant, my strong hope is that, beyond temporary travel measures, no additional restrictions will be required. However, that will depend partly on what information emerges about omicron in the days to come. It will also depend, significantly, on all of us complying rigorously with all the protections that are currently in place to stem transmission.

Of course, it remains the case that our first and most important line of defence against the virus is vaccination. Yesterday, we received updated advice from the Joint Committee on Vaccination and Immunisation. Its recommendations are as follows: all adults over the age of 18 should be eligible for a booster; the gap between second doses and boosters should be reduced from six months to three months; people who are immunosuppressed and who have already had three doses should also now be eligible for a booster; those who are immunosuppressed and have not yet had a third jag should get that now, regardless of when their second dose was administered; and, finally, 12 to 15-year-olds should now be offered a second dose. The JCVI had, of course, already recommended second doses for 16 and 17-year-olds and, as I said, from today, anyone in that age group can book an appointment online for their second dose.

The Scottish Government has accepted the JCVI’s updated recommendations and we will now put its advice into operation as soon as possible. Urgent modelling work is being done to inform the operational response—for example, that involves assessing the additional capacity that will be needed in terms of workforce and facilities. As the JCVI has advised, we will continue to prioritise booster jags on an age and clinical risk basis. However, the bottom line is that many more people than was the case last week—at least 1 million more—are now eligible for a booster, and that is good news in our fight against the virus.

Information will be provided as soon as possible for those who have become newly eligible. However, I say to those who are already eligible that, if you have not had your booster yet, please book to get it as soon as possible. Uptake in the over-60s is now at 84 per cent, which is high, but we want to get it higher still so, if you have yet to get your booster, please do so now. Similarly, if you are aged between 40 and 59, please book online at NHS inform.

I know that there is a concern that the vaccines will be less effective against the new variant. I stress that we do not yet know whether that is the case but, even if it is, vaccination will still matter. Less effective does not mean ineffective. Of course, the vaccines will remain just as effective as they are now against the delta variant, which is still the dominant one circulating in Scotland. A booster will significantly improve our protection against all variants. It really is the most important thing that any of us can do to protect ourselves and our loved ones. Similarly, if you still have not yet had your first or second dose, please arrange to get that. It is now more important than ever to get an appointment and to get the protection that vaccination will offer you.

In addition to getting vaccinated, as I said, all of us should now step up and significantly increase our compliance with existing protections such as face coverings, ventilation and hand hygiene. We are also strongly encouraging everyone who can work from home to do so. We are asking everyone, from now through the festive season, to do lateral flow device tests on any and all occasions before mixing with people from other households, whether that is in a pub, restaurant, house or shopping centre.

From Monday, subject to Parliament’s approval this week, proof of a recent negative lateral flow test or vaccination will be accepted by venues and events that are covered by the Covid certification scheme. It is already very easy, and free, to get lateral flow tests. They can be ordered online or collected from pharmacies and test centres. For secondary school pupils or members of staff at schools or early learning centres, test kits are available free of charge from schools and early years centres. I can confirm today that, in the run-up to the festive period, local authorities will make lateral flow tests available in many more locations. Obviously, the locations will vary in different parts of the country, but they will include shopping centres and supermarkets, garden centres, sports grounds and Christmas markets. We are also working with transport partners to provide access to tests in transport hubs.

Although it is already easy to get lateral flow tests, we are taking steps to make it easier still. Please make sure that you get a supply, keep it topped up and use it. It is worth mentioning that the newer devices are much easier to use than the older ones, as they require nasal swabs only rather than nasal and throat swabs. Therefore, if you have previously tried lateral flow tests and given up because you found them too uncomfortable to use, please try again now. Remember also to report the result of tests online and, if a test shows positive, isolate at home until you have had a confirmatory PCR test and got the result of that.

If we all do that over the next few weeks, it will make a big difference, because we will all massively reduce the risk of infecting others, particularly if we have the virus but would not otherwise know about it because we do not have symptoms. Please test yourself before mixing with others and on every occasion when you intend to mix with others.

There is no doubt that the emergence of the new variant is a blow, or certainly a potential blow. It is potentially the most concerning development in the pandemic in recent months. However, even if our developing knowledge about the variant confirms some of our worries—let us hope that it does not—we are still in a much better position than we were in this time last year, thanks to the vaccines. We know what we need to do to stem transmission, because we have done it before and we know that it works. It is down to all of us to make sure that we do it.

If, in recent weeks, we have been sticking a bit less strictly to the public health advice, now is the time to follow it rigorously again. First, get vaccinated. That is the single most important thing that we can do. Secondly, test regularly and before any occasion when you will be socialising or mixing with other households. Finally, comply with all existing protections. Please wear face coverings on public transport, in shops and when moving about in hospitality settings. Keep windows open to improve ventilation. Follow all advice on hygiene. Wash hands and surfaces. Work from home if you can.

The discovery of the new variant makes those measures more important than ever before. If we treat the news of the new variant as an opportunity to raise our guard again, I hope that we will protect the progress that we have made in recent weeks, and we will give ourselves the best possible chance of enjoying not just a more normal Christmas, which we all want, but a safer Christmas too, and of avoiding any tighter restrictions in the weeks ahead.

Please get vaccinated, get tested and comply with all the protections that are in place. If we all do that, we will play our part in slowing the spread of the virus generally and the new variant in particular.

The First Minister will now take questions on the issues that have been raised in her statement. I intend to allow about 40 minutes for questions.

Last week, the First Minister came to the chamber and was upbeat in her assessment of the Covid outlook, saying that the situation was

“more positive than we might have expected it to be”.—[Official Report, 23 November 2021; c 12.]

At the same time last week, my party was calling for the easing of some restrictions. However, as we have seen time and again with the virus, a lot can change in just a week. The situation has shifted, so our approach must adapt as well.

The UK and Scottish Governments’ responses to the emergence of the new variant in recent days have been swift. Nobody wants restrictions to return. We are all completely fed up with the virus and the limits that it has placed on our lives for nearly two years now. However, we have to be realistic and sensible. We must evaluate the situation fully as we learn more about the new variant.

Nevertheless, while we wait for more information, we are not defenceless against the virus. The vaccination programme has always been our best weapon against Covid-19. As the First Minister noted in her statement, experts estimate that more than 27,000 lives have been saved in Scotland as a result of our vaccines.

The booster programme across the UK is going well, but there is no doubt that there could be even more urgency in delivering it. For weeks, now, we have been calling for the reopening of mass vaccination centres in order to speed up the roll-out. Those centres were incredibly effective in the roll-out of the initial doses of the Covid vaccines, yet, this morning, the First Minister’s health secretary dismissed our proposal. Humza Yousaf suggested that the hold-up in reopening those centres is due to a shortage of staff. Can the First Minister confirm whether that is the case? What is being done to resolve those issues?

Finally, after the JCVI’s decision, almost 2 million people in Scotland are now waiting to get their vaccine. Considering how crucial it is for as many people as possible to get that booster jag, will the First Minister tell us what additional measures she is taking to accelerate the vital booster programme?

I remain more positive about the situation than I was a few weeks ago, notwithstanding the emergence of the new variant. As I have set out today, the overall trend of infections in Scotland is downwards. A few weeks ago, I would not have dared hope that that would be the case. We know that there are risks in the weeks ahead—I said that last week—in socialising around the festive period and in colder weather pushing us all indoors more. There is an additional risk now, potentially, in the form of the new variant. However, we are in a stronger position to confront all of that than would have been the case at this time last year or even a few weeks ago.

Vaccination is the best line of defence, which is why there is no lack of urgency on the part of the Scottish Government. Nor do we rule out any options. We discuss, on an on-going basis, appropriate ways in which we can accelerate the progress of the vaccination programme. We have had questions—and I would always expect such questions—about the deployment route that we chose for 12 to 15-year-olds, for example, and on the deployment routes that we have chosen for the first stages of the booster campaign. The routes that we have chosen have taken us to where we are today, as the most vaccinated part of the UK. On booster vaccination, so far, we are quite a way ahead of any other nation in the UK.

Of course, we want to go further. That was true before the JCVI updated its advice, yesterday, on those who are eligible. It is even more true now, when so many more people are eligible. We are currently considering all possible options for doing that, and we are not alone in that. The UK Government, the Welsh Government and the Northern Irish Government are having to do the same.

There is no shortage of staff. We have in place staff to do the roll-out that we had planned on the basis of the old advice. However, given that, as of today, more than a million people are eligible who were not eligible at this time yesterday, we clearly have to find more staff and more facilities in order to speed things up. That work is under way right now. We will focus ourselves, get our shoulders to the wheel and work with health boards—whose shoulders are also to the wheel—to get that to happen as quickly as possible. All four UK nations are going to be doing that.

The good news is that we have adequate supplies of vaccines, although developments in the past few days remind us all that we need to get vaccines distributed more equitably across the whole world, because—as we are being reminded right now—until the whole world is vaccinated, none of us is out of danger. The vaccination programme is the most important thing that the Government is doing right now, and we will continue to push it forward as fast as we can.

I send my condolences to those who have lost a loved one.

Yesterday, we had confirmation that patients in Scotland had tested positive for the omicron variant. Perhaps most troubling was the news that none of the cases that had been identified had a travel history, meaning that they had caught the variant in the community. Obviously, that is causing anxiety and concern.

The tools to protect us from the virus remain the same: vaccination, testing and contact tracing. The JCVI has now recommended that the booster jag be made available to all who are aged over 18 and that the gap between the doses be reduced to three months. Before that change, more than 800,000 people were eligible for a booster. The change means that more than 2 million people are eligible for their booster dose. The Government previously set a target of 400,000 Covid vaccinations a week. Does that remain the target? Last week, there were just under 240,000 vaccinations.

I note what the First Minister has said about supply chains and storage. Given that we are expected to ramp up the number of vaccinations, are we confident of those supply chains in the coming weeks and months?

Currently, just two health boards—in Tayside and the Western Isles—are running drop-in sessions for boosters. Will that be extended to all health boards in order to demonstrate the urgency, especially given that much higher numbers of people will be expected to get their booster vaccination? We cannot rely simply on a phone line or on a booking system to meet that demand.

Finally, there will be additional pressure on test and protect. What additional resources will be made available to ensure that cases of the new variant, in particular, can be properly tracked so that transmission can be reduced?

As I said yesterday, when I addressed those issues, the fact that, as far as we know, none of the cases that has been identified so far has a travel history involving, or a connection to anybody who has recently travelled from, the African countries where the variant was first identified is a cause for concern because it is indicative of community transmission. That is still the case.

However, today, the work that health protection teams have done through test and protect—identifying that all those cases are linked and are linked to one event—slightly reduces that anxiety, because it gives us assurance that community transmission is not widespread. We are also not picking up any evidence of its being more widespread in the quite extensive look back that Public Health Scotland has been doing. To be clear, it has been looking at all PCR samples that have been taken from 1 November to identify any that have that S-gene dropout, which used to be indicative of the alpha variant—which has more or less disappeared—and which is generally not indicative of the delta variant. Therefore, if it has been appearing recently, the suspicion is that the variant is omicron. So far, that exercise has identified only those nine cases.

I expect that we will have more cases associated with that event and more generally. However, the fact that we are in the position whereby I can say all of that is a huge credit to the work that is being done by Public Health Scotland, health protection teams and test and protect, for which I thank them.

I will not repeat everything that I said to Douglas Ross on vaccinations. We will accelerate the programme as far and as fast as we can. It is important to clarify that the 400,000-a-week target was for Covid and flu vaccinations—[Interruption.] Anas Sarwar says that it was not, but it was, and that target is being exceeded. We will have to increase the weekly number of vaccinations.

It is important to note that the JCVI, along with everybody else, recognises that not everybody can be vaccinated on a single day or immediately. The order of priority in which we do it is therefore important, and that also has a bearing on how we choose to do it. Drop-in centres are important when we get to certain stages of a vaccination programme, but we have to be careful not to use them inappropriately. If we do it only through drop-in clinics, Anas Sarwar—who is considerably younger than I am—could get ahead of me for vaccination although my risk is higher because I am older. I use that only as an example. Obviously, there are more extreme examples, because he is not that much younger than me, but the general point that I am making is understood. I am trying to say that we are doing all those things in a way that gets us through it as quickly as possible but that also follows proper and sensible clinical risk considerations.

We will keep Parliament updated on the roll-out of the vaccination programme and how we are increasing capacity and planning to speed up that roll-out as much as possible. I am not complacent about that, and I will be held very strongly to account in the weeks to come, as is right and proper. However, our progress so far suggests that the way in which we have been deploying the vaccinations is the best, and we will continue to learn from past experience.

Finally, we will continue the efforts that have got us to the point of identifying those nine cases in order to identify further cases as quickly as possible. The advantage of the S-gene dropout in this variant compared to the delta variant is that it allows the presence of the variant to be identified through PCR testing, although genomic sequencing is then required to confirm it. All that work will be on-going while we learn more about the variant in the days to come.

The emergence of new variants will always be a source of real concern as we try to navigate our way out of this crisis. We have learned to expect the unexpected, and, for as long as the global south remains largely unvaccinated, this will keep happening. Right now, richer countries such as Great Britain are stockpiling vaccines far in excess of what we will ever need. Many will go to waste when they could have gone to developing countries. I reflect the First Minister’s remarks in my own and say that that needs to change.

We need to stop omicron in its tracks—or, at the very least, buy ourselves enough time to learn more about its effects and get more boosters into arms. We know that the contact tracing system is already under immense strain. Will the First Minister consider instructing a programme of door-to-door surge PCR testing in communities around affected areas?

I will not. I do not think that, at this stage, instructing that on a blanket basis would be right or appropriate—or the best use of resources that are under pressure, although they are coping very well. Today, of all days, I am not very sympathetic to any criticisms of our contact tracing teams, who are doing heroic work right now to identify and understand the transmission patterns of those cases.

We can use—and are using—targeted enhanced testing where cases are identified. That will start with the testing of close contacts of those cases, because we want close contacts to isolate as well. It is important to note that health protection teams are best placed to understand and judge where enhanced testing should be used.

There might be instances in which door-to-door testing is appropriate, as was the case earlier this year in the south side of Glasgow, but that has to be driven by the assessment of health protection teams. In relation to the nine cases and the look-back surveillance that is being done, door-to-door testing would not necessarily be the right use of resources at this point. However, if health protection teams think otherwise, they have the ability and the resources to get on and do that.

I will briefly pick up on a point that has been raised. It is important for people—certainly in Fife—to be aware that NHS Fife is offering booster drop-in clinics from 5 pm this evening. It is important to put that on the record.

Given the emphasis on working from home wherever possible and the continuing importance of wearing a face covering, can the First Minister reassure my Cowdenbeath constituents that those key protection measures will be the subject of extensive public health information and awareness-raising campaigns and will be enforced?

Annabelle Ewing’s first point is important. There is no absolute one-size-fits-all approach to how health boards are delivering vaccinations; some are, at different stages, using drop-in clinics, and that is appropriate. It is about getting to people as quickly as possible through a variety of routes, and that will continue to be the approach.

On public awareness, we already have television, radio, digital and outdoor campaigns to remind the public of the key protections that are in place and the need to comply with them. We will intensify those campaigns over the winter, to ensure that everybody knows what is being asked of them. We will put particular stress on the request to people to test themselves before they go to the pub or a restaurant, before they visit someone in their house over Christmas and before they go Christmas shopping. That is really important and can do a lot to help us to break chains of transmission.

Local authorities and the police, too, continue to take action to raise awareness in particular settings. There will be a big focus on making sure that people understand what we are asking them to do.

All that is important, but after two years, I think that we all know what works against this virus; we are all just tired of doing it—and I include myself in that. That is why this is an important moment for all of us to up our compliance again, so that we can stop not just the new variant but the virus generally in its tracks and mitigate the risks over winter.

Only 33 per cent of 50 to 59-year-olds have received their booster jabs, but last week that age group accounted for 20 per cent of hospital admissions—the highest rate of any age category. In light of that, will the First Minister say how many more vaccinators need to be deployed and how quickly resources will be on the ground to speed up delivery of the booster jab? Will she—finally—commit to mass vaccination centres?

I will not repeat my answer on mass vaccination centres; I set out the rationale and the thinking on them. I underline the point that we are currently the most vaccinated part of the UK, in particular on booster jags.

On the important issue about getting uptake—in all age groups—some 50 to 59-year-olds are not vaccinated yet, and until yesterday, when the gap between the second dose and the booster dose was reduced, some were not yet eligible for their booster. I am in that category: I would not have become eligible for my booster until later in December, but because of yesterday’s change I have been able to go online and book an earlier appointment. Lots of appointments are becoming available every day. That will continue to be the case. I say to everyone who is in a similar position to me: try now to bring forward your booster appointment.

We cannot vaccinate everyone on a single day or even in a single week. This will take a number of weeks for us to work through. We will do it in the order of priority that the JCVI recommends. We will get through this as quickly as possible, because it is our best line of defence in the period ahead.

I thank the First Minister and the health secretary for acting so swiftly to resolve the boosters issue on Cumbrae that I raised last Tuesday. My constituents greatly appreciated that.

Figures show that vaccination levels in Scotland are lower in the often highly mobile 30 to 39 age group than in any other group. What steps are being taken to encourage people in that cohort to get vaccinated?

A lot of different actions have been taken by health boards, through communication and through the location of vaccination centres, to target groups in which uptake is lower and where we know that people are less likely to come forward, for a variety of reasons. Actions include having vaccination centres in places of worship and other community settings, providing concessionary bus travel to appointments and working with community leaders in different parts of society.

All of us have a part to play and should do everything that we can to get those messages across.

It is worth noting that, even in the 30 to 39 age group, uptake is high. Uptake across the age groups is higher than for flu jabs, although not all age groups are eligible for flu jabs. However, we are seeing a much higher vaccination uptake than we have seen in recent years for flu. This is about trying to get to those groups where we need uptake to be higher. A range of approaches are being used, and will continue to be used, to try to do that.

It is welcome news that the First Ministers of Scotland and Wales are in close contact about precautions in the face of the new variant. Can the First Minister provide an update on any response that she and Mark Drakeford have received from the Prime Minister regarding greater controls for travellers arriving in the UK?

As far as I am aware, no formal response to the letter has been received yet, although the UK Government indicated its initial views on it yesterday, as it was perfectly entitled to do.

We will continue to argue for things that we think are sensible. It would be good if all four nations, through the medium of the Cabinet Office briefing room, could get together to discuss different approaches to the matter in the coming days, and I hope that that will be possible.

That said, all four nations are communicating closely. I took part in a four nations call with the other First Ministers and Michael Gove on Saturday evening. I know that the health secretary has had a number of discussions with counterparts in the other nations, so there is good and close communication.

However, some decisions are driven by the views of the UK Government so, on occasion, if we think that different things have to be done, it is really important for us to press the UK Government. In that regard, I speak to the First Minister of Wales reasonably often and we exchange views on these matters, and we will continue to do so.

I want to follow up on that response from the First Minister. The First Minister and the First Minister of Wales suggest that the travel restrictions should apply to everybody and that everybody, irrespective of country of origin, should self-isolate for eight days. If the UK Government responds negatively, will the First Minister impose restrictions herself, as she has the power to do?

The First Minister will recognise that this situation has already had a chilling effect on travel businesses, with many families’ plans for Christmas in the balance. What advice can she offer people? Should they book to go away or not, and what compensation could she put in place for the travel industry if further restrictions are applied?

What has had a chilling effect on people—if that is the case, although it is not terminology that I would use—is the emergence of a new variant; it is not anything that we are trying to do, sensibly, to limit the spread of that new variant so that further restrictions on people’s freedoms and way of life are not necessary in the weeks to come. Thankfully, the Labour First Minister of Wales seems to take a more constructive and sensible approach to these issues than some of his colleagues in this chamber.

We have discussed travel restrictions many times before. I am not averse to doing things unilaterally, where that make sense. However, as anybody who understands travel patterns knows, many people travel to Scotland and Wales via airports in England. If we had travel restrictions only here, they would not be effective. It would not get us the public health benefit but would do disproportionate damage to our airports, which is why the protections that we have been discussing, which are only really effective on a four-nations basis, are better.

I and the First Minister of Wales are in agreement. We hoped that the measure would be temporary. However, right now we need to do two things. We need to try to limit transmission of the variant, which is already in Scotland. While we are doing that, though, we need to try to ensure that we are not exacerbating the difficulty by importing more of the variant here. That is why such measures are important. We will continue to have what I hope are constructive discussions about these issues in the days and weeks ahead.

The Scottish Greens have promoted a cautious approach throughout the pandemic. With the emergence of the new omicron variant, we believe that caution must be maintained. Robust test, trace and isolate systems have never been more important.

The reintroduction of the day 2 PCR test is welcome; I previously made the case for retaining it. We know that PCR tests allow us to monitor new variants entering the country in a way that lateral flow tests simply cannot. Will the First Minister commit to keeping those important tests in place for the duration of the pandemic, so that we can detect any new variants on entry, and not wait until community transmission is already taking place?

We have to continue to judge the proportionality of all the measures, protections and restrictions. There is no doubt that having some protections in place now will avoid the need for restrictions later. However, it is not possible—legally and in other ways—to give a blanket commitment to keep anything in place indefinitely. We have a legal requirement to test the proportionality of measures on an on-going basis, which is why we have three-weekly reviews.

I take the point that Gillian Mackay makes about the importance of measures to detect whether new variants are coming into the country. The new variant appears to have been detected very quickly. It has been detected in southern Africa—all credit to the Governments there for doing that so assiduously and so quickly. That does not mean that the variant originated in any of those African countries—we do not know about that yet. However, it underlines the importance of having good surveillance and detection measures in place. Testing will always be a part of that, but we have to ensure that any measures remain proportionate and are not kept in place for any longer than necessary.

Further to Annabelle Ewing’s question, although I accept that we are talking about a minority, anecdotally, there appears to be an increase in the number of people not sanitising their shopping trolleys and not wearing masks on public transport or in stores, and in the number of stores not having someone monitoring their entry points. What discussions has the Government had with transport operators and store managers on increasing customer awareness of those mandatory requirements? Does the Government have any data on non-compliance?

We have a range of data about compliance with different measures. If memory serves me correctly, we publish some of that regularly—if we do not, I will see what we can provide. We have regular discussions with the transport operators, the retail sector and businesses in general. The finance secretary had a round-table discussion with business organisations just yesterday about all the different ways that they can help, including facilitating working from home wherever possible.

Because we are sick and tired of it and because we have been in a period where the perceived risk has been reducing and we all feel stronger because of vaccination, as we should, we have all—I include myself in this—been letting our guard slip a bit in relation to those basic mitigations. That is understandable. However, we are now at the moment to tighten that up, not just because of the new variant—although that is definitely increasing the need for caution—but because of the risk that winter poses anyway. Over the next period, which might be really challenging, if we do all those basic things, all of them added together will make a difference.

If we have been forgetting to do some of those things in recent weeks—I am sure that we all have—now is the time to stop, think about what we need to do and make sure that we do it. That will really help us to get through the winter much more safely than would otherwise be the case.

In August, we were told that a Scottish inquiry into the handling of the pandemic would begin before the end of the calendar year. Will that commitment be delivered? If not, when will the inquiry begin?

Our commitment, which was to ensure that the public inquiry was established before the end of the calendar year, will be delivered.

We are in the process of identifying and appointing a chair to the inquiry. We intend to update Parliament on that before the Christmas recess. Once the chair has been appointed and the inquiry has been established, the timescale and process for starting to take evidence and other aspects of the inquiry will be down to the independent chair who will take it forward.

Thank you for the update, First Minister. Given the new variant, it has become much more important that people get their booster jag. Many people received their first and second vaccinations outside Scotland, even though they are Scottish residents. How can we ensure that they receive their booster jag here?

They should be able to receive their booster jag here. There may be some individuals in a particular category who have issues, and any members who have constituents in that position should let us know and we will look into the individual circumstances.

In general, anyone who is eligible for a booster in Scotland and has not received an appointment or cannot get one through the website can call the helpline on 0800 030 8013. That includes anyone who has received one or both doses outside of Scotland. If you do not have an appointment, call the helpline and they will assist you to get one.

The enhanced surveillance that the First Minister talked about earlier and the vaccine roll-out are extremely impressive and give people hope that we can fight the virus. Given the massive pressures on the booster programme and the wider eligibility, including reducing the time after the second dose from three months to six weeks, does the First Minister think that NHS Greater Glasgow and Clyde should be resourced to again set up the NHS Louisa Jordan as a vaccination centre, because it was a critical venue in achieving our current success?

Like all health boards, Greater Glasgow and Clyde will judge what health facilities it needs, and if any health boards want to discuss with us the establishment of a vaccination centre on that scale, we will discuss that and the resource implications. There is no doubt that the Louisa Jordan did a fantastic job. What I am about to say is not intended as any criticism of those who did so much work there—it is in the nature of those very large centres—but I think that it had the highest “did not attend” rate in the country.

Members have heard me say this many times: there is a constant balance that needs to be struck between big throughput and speed of access and local accessible availability. Many members raise the inconvenience of people having to go somewhere such as the Louisa Jordan. Health boards are striking that balance really well, but with the kind of extension that we have had as of yesterday, we have to rethink whether any of those different approaches are appropriate. That process is under way right now and will continue right throughout this programme and into the next one, which I fear will come before we know where we are.

With not only winter but the new omicron variant upon us, it is imperative that everybody over the age of 70 is vaccinated with the third dose at pace. Although third dose vaccination coverage among that age group is positive and encouraging, around 10 per cent of over-70s in Lanarkshire are still to receive their third dose. Can the First Minister confirm when she expects the programme for over-70s to be effectively completed?

The programme for over-70s will be completed as soon as everybody who is going to come forward for a vaccination has come forward. People in the over-70 age group have been receiving invitations since early October and the vast majority are already vaccinated, so if anybody in that age group is not vaccinated, it is because they have chosen not to be or have been unable to come forward and get vaccinated.

We continue to put out the message that if you are one of those people, it is not too late to get vaccinated. Go online, book an appointment, phone the helpline, the number of which I have just given, and get an appointment. Everybody in that age group who wanted a vaccination has been offered one, and we are now working rapidly through the other age groups and will continue to do so.

The First Minister said that

“vaccination is the best line of defence”,

but yesterday NHS Grampian closed vaccination centres in Aberdeenshire as a result of storm Arwen. Damage and debris are still affecting the road infrastructure in the north-east. Has the Scottish Government made any assessment of the number of people who have been unable to attend vaccination appointments because of the storm and will action be taken to ensure that vaccination centres stay open safely during severe weather this winter?

Efforts were made to ensure that vaccination centres, where possible, could stay open safely, but everybody, particularly those from the parts of the country that were most heavily affected by the storm, knows that it was not possible to safely keep every vaccination centre open, and it would have been deeply irresponsible to have sought to do so.

Anybody whose vaccination appointment had to be cancelled will have that rescheduled, and everybody will get access to vaccination. Work will already be under way on that. The Deputy First Minister is about to make a statement more generally on the severe impacts of the storm that many people in the north, and some people in the south, are still experiencing, such as still not having access to power. There is a significant amount of work under way to make sure that people are reconnected as quickly as possible, that welfare support is provided in the interim and that any wider impacts, of which vaccination is certainly one, will be rectified and caught up with as soon as possible.

Can the First Minister indicate when those who are exempt from having vaccination passports due to a terminal illness will receive their vaccination exemption letters? A constituent of mine who was confirmed as exempt by NHS Greater Glasgow and Clyde on 10 November still has not received their letter. It is clear that time is of the essence for patients such as my constituent.

If Stuart McMillan wants to write to the Cabinet Secretary for Health and Social Care about his individual constituent, I am sure that that case can be looked into. However, it is important to stress that, in the vast majority of cases, a successful route to safe vaccination can be found, and that usually includes people who have a terminal illness.

Most people who are in that category will still benefit from vaccination. However, support is available where vaccination is not straightforward. The local helpline, the Covid status helpline or local vaccination centres can help to answer questions about the vaccine and the arrangements that are in place for exemptions.

That is the general position but, if there are individual cases in which somebody has not, for one reason or another, been able to navigate the system, I ask that members please let us know about them so that we can look into them as quickly as possible.

Like others, I have been contacted over the past few weeks by a number of constituents who are eligible for the booster but have had difficulty accessing it, despite the helpline. Can the First Minister provide a detailed breakdown by age group of those who have been offered and have received the booster? If she feels that mass vaccination centres and drop-in centres are not the best way forward at the moment, will she outline what can be done to put resources in to make it easier for people to get their booster?

Information on the numbers in different age groups who have been vaccinated with the booster is regularly published. That information is available.

It has been reflected in some of the questions and answers today that there is mixed provision of access to booster vaccinations. That is right, because not every part of the country is the same, and there has to be a reflection of the geographical position. We continue to address and resolve any localised issues whereby access has been difficult.

Overall, it is really important to stress that the vaccination programme is going incredibly well. I think that most people across the country recognise that. I think that, from yesterday’s figures, just over 34 per cent of the over-12 population have been vaccinated with booster jags; that compares with Wales, at 31.5 per cent, or England, at 31 per cent. We are therefore significantly ahead. Of course that does not mean that everybody is having a flawless experience, and we will address that as often, as far and as quickly as we can.

Those who are working in the programme are literally saving lives every single day. They are doing that at pace and with the utmost determination, and all of us owe them the most immense debt of gratitude.

Given the public health advice to redouble efforts in respect of face covering, space and infection-control measures, does the Scottish Government intend to update guidance on the type of face covering that the public should use to ensure that that is an FFP2 mask or equivalent, that it is worn over the nose and the mouth, and that it is disposed of or laundered properly?

We have published guidance on face coverings, and that guidance is certainly kept under regular review. A face covering can be a covering of any type, except a face shield that does not fall within the definition, that covers both the nose and the mouth. Due to equality and accessibility considerations, we do not mandate certain specifications, but we recommend that face coverings are made of cloth or other textiles, that they are two or, preferably, three layers thick, and that they fit securely around the mouth, nose and chin while, obviously, allowing the person to breathe easily. Our guidance is in line with the WHO recommendations.

Emerging variants of Covid-19, such as omicron, may require the development of updated vaccines over time. What discussions is the Scottish Government having with the UK Government and the JCVI on the potential need to develop updated vaccines?

It would not really be the role of the JCVI to do that, although it is integrally involved in advising Governments about who to vaccinate.

However, I know that such discussions are on-going all the time. Members will have heard many representatives of vaccine companies talking in the media in recent days: those companies are already thinking about how they may need—it is “may” at the moment, as we do not yet know the impact—to change or adapt their vaccines to deal with the new variant. Some of them have given indications—as I heard Pfizer do publicly the other day—of how long they think that that will take. That work is already under way.

Given how quickly, relatively, the vaccines were developed from a standing start, I think that we can have confidence that the scientific community and vaccine developers and manufacturers are well placed to do anything that is required. However, we do not yet know that the vaccines are less effective, so let us not assume that at this stage. Even if that is the case, the current vaccines will still be hugely important.

Now that we gather that the booster jag is to be given three months after the second jag, instead of six months later, does that mean that immunity is waning faster than we had expected and that we have to get a booster every three months?

No, it does not necessarily mean either of those things. It is not necessarily the case that we suddenly think that immunity is waning faster, but we have a new variant that some think may manage to evade the immunity of the vaccines or natural immunity from past infection. Getting as many antibodies into people as possible—to be non-clinical in how I express it—becomes all the more important. That is the rationale for reducing the gap at this stage.

We do not yet know what the frequency of the vaccination programme will be in the years ahead. My working assumption is that, like for flu, it will be a regular programme. We should certainly be planning for that. We do not yet know, but it may be a regular three-dose vaccination programme, or there may be developments in the vaccines that enable a single dose. There is so much that we do not know yet, and we need to get on with doing what we do know about, which is getting boosters to as many people as possible as quickly as possible.

On a point of order, Presiding Officer. On a number of occasions, the First Minister and cabinet secretaries have said that, if we write to them with a request, they will look into it. I have written to different cabinet secretaries about a number of situations, often concerning urgent inquiries from constituents, and it has taken more than 20 days to get a reply. Can you help me? How do I get a quicker response so that I can help my constituents? Is there any way that you can intervene to ensure that we get the appropriate response at the appropriate time?

As Mr Balfour may be aware, that is not normally a matter for the chair, but his comments are now on the record.