Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No 7) Regulations 2021 (SSI 2021/425)
Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2021 [Draft]
Under agenda item 2, the committee will take evidence from the Scottish Government on the latest ministerial statements on Covid-19 and on subordinate legislation.
I will start by saying a few words about the draft Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2021. Last week, George Adam, the Minister for Parliamentary Business, asked to speak to me about the changes to the Covid vaccination certification scheme that the First Minister outlined on 23 November. At our meeting, George Adam explained that the Government is mindful of the concern that this committee and the Delegated Powers and Law Reform Committee have expressed about the use of the made affirmative procedure and he suggested an approach whereby an expedited affirmative procedure might be used on this occasion.
Members will have seen the correspondence from the Minister for Parliamentary Business explaining the Government’s position. On this occasion, I was minded to accept that suggestion. That meant that the regulations were formally laid on Monday and were considered by the DPLR Committee on Tuesday.
Following its consideration of the regulations, the DPLR Committee has written to this committee. Members have a copy of that correspondence. Following our consideration of the regulations this morning, the regulations will be taken at decision time later today in the chamber.
Although I was minded on this occasion to agree to the Scottish Government’s proposed expedited timetable for scrutiny, that should not be viewed as setting a precedent for future scrutiny. That is something that we can keep under review.
10:30I welcome to the meeting our witnesses from the Scottish Government: John Swinney, the Deputy First Minister and Cabinet Secretary for COVID Recovery; Professor Jason Leitch, the national clinical director; and Elizabeth Sadler, the deputy director of the Covid ready society. Thank you for your attendance this morning.
Deputy First Minister, would you like to make any remarks before we move to questions?
Yes—thank you, convener. I am grateful to the committee for the opportunity to discuss a number of matters, including updates to Parliament this week and last week on Covid-19 and the incidents to which the convener has just referred.
As set out by the First Minister on Tuesday, although case numbers in Scotland have continued to fall, the emergence of the omicron variant is deeply worrying, and it requires a proportionate and precautionary response. There are now confirmed cases of omicron in Scotland and Public Health Scotland is working hard to identify any and all cases as quickly as possible.
There are indications that omicron might be more transmissible than the delta variant, which is currently dominant in Scotland. However, at present, there is no evidence to indicate that the disease that is caused by omicron is more severe than that caused by other variants. Our understanding of the new variant is developing, and we will know more—especially about the protection that is provided by vaccines—in the days and weeks ahead, thanks to the dedication of scientists across the world.
Although I very much hope that our level of concern will reduce in coming weeks, our precautionary approach is the right one for now. As the First Minister set out on Tuesday, at this stage, we are not introducing additional health protection measures beyond some necessary travel restrictions. Instead, we are asking everyone to renew their focus on following existing protections. We need people to wear face coverings where required, maintain good hygiene, work from home wherever possible, ventilate indoor spaces and test themselves regularly. Those protections are especially important as cold weather and the possibility of festive gatherings mean that we might be spending more time inside with other people.
This week, the Joint Committee on Vaccination and Immunisation updated its advice, such that 1 million more people are now eligible for booster vaccines. That is good news, as we know that vaccines are effective and save lives. Indeed, according to a study published last week by the World Health Organization, there might be more than 27,000 people in Scotland who are alive today only because of the vaccines.
With more than 88 per cent of the adult population having had two doses of the vaccine and more than 93 per cent having had one dose, Scottish ministers now consider it proportionate to amend the certification scheme to include negative test results. The change will make it possible for people who cannot be vaccinated, who are not yet fully protected, or who have received a vaccine that is not recognised by the Medicines and Healthcare products Regulatory Agency, to be able to attend venues that are covered by the scheme.
The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2021 make the necessary amendments to the Covid-19 certification scheme. With effect from 5 am on Monday 6 December, the scheme will allow people to show a record of a negative test for coronavirus that was taken in the 24 hours prior to attending a venue as an alternative to proof of vaccination.
Certification continues to play a role in helping us to increase vaccine uptake, reduce the risk of coronavirus transmission, alleviate pressure on our health and care services, and allow higher-risk settings to continue to operate. It is an alternative to more restrictive measures, such as capacity limits, early closing times or closure.
I am very happy to answer questions from the committee.
Thank you, Deputy First Minister. I remind members and witnesses that we are restricted for time and each member has around eight minutes for questions.
I will start with the first question. Deputy First Minister, the committee agreed to the expedited timetable because the Scottish Government’s view is that the regulations require to come into force on 6 December. For the record, could you please explain why the Government considers that 6 December, and not another date, is when the regulations should come into force?
Essentially, we want the regulations to be in place to facilitate an increased level of protection and assurance in the run-up to the festive period. From 6 December onwards, people will be engaged in activities that are habitually associated with Christmas, including retail and hospitality opportunities. Putting in place the regulations at a moment when we are preparing for such events is the pragmatic approach that the Government wants to take to maximise protection and to maximise the involvement of members of the public in the assurance that we are trying to create.
In light of the new variant, and given that we are trying to suppress transmission, I will mention one of the comments and one of the questions that we have received from members of the public. The comment is:
“I work as a symptomatic Covid 19 tester. My colleagues and I find it shocking that people who come for testing will arrive with families and friends in tow. Sometimes we get full carloads. Usually none are wearing masks and it is obvious they have been to a drive-in fast food outlet before attending for their test. We have been told that now they have had the test ‘they are taking the family out for lunch to cheer them up!’”
That brings to me to the question, which is from Geraldine from South Ayrshire. She asks:
“What is being done to ensure people self-isolate whilst symptomatic or waiting for test results, as the message does not appear to be getting through?”
There are a number of points in the question and scenario that you have put to me. The first point is that a key response is the necessity of ensuring that baseline health protection measures are habitually followed by everybody in all circumstances, including when going for a polymerase chain reaction test. Important measures that should be applied include ensuring that people are wearing face coverings in the appropriate settings and following the basic hand hygiene measures. All those measures are critical at all times. Members will be aware that, in our public messaging in Parliament and in our wider public messaging through television advertising and so on, the Government is regularly reinforcing those messages.
The second point is that the greatest care must be taken by individuals when going for PCR tests. In the scenario that you put to me, if a whole carload of people from the same family are being tested, it is understandable that they are all in the car. However, I encourage only the people who need a PCR test to go, and to observe all the hygiene measures that are appropriate in such circumstances.
Finally, when it comes to observing self-isolation, the requirements could not be clearer. If an individual has symptoms or cause to secure a PCR test, or if they have undertaken a lateral flow test and tested positive, that should instantaneously bring about a change in behaviour, because that person is potentially infectious. That individual must take every care in their movements and in observing the appropriate restrictions to ensure that they minimise the risk of transmission.
I assure the individuals who have contacted the committee that those messages are uppermost in the Government’s communications.
It is crucial that we reiterate the importance of following the guidance.
Earlier, we were discussing the omicron variant and the impact that it might have. It is now generally understood that the best way to address the issue is to accelerate the booster vaccination programme. Yesterday, we heard about a number of incidents involving individuals who turned up at vaccination centres expecting to be given the booster but were turned away because it has been less than 24 weeks since their second jab. That was clearly not in line with the new Scottish Government guidance. Has the issue now been resolved?
Yes, the issue has been resolved. I very much regret that some individuals had that experience yesterday. The guidance has changed and it should have been applied in all vaccination centres and scenarios.
In light of what emerged yesterday—I am advised that the issue arose in a limited number of cases—we have reiterated the guidance to all health boards to ensure that all vaccination centres are operating to the new updated guidance, which emerged only at the start of the week.
I regret that some individuals were inconvenienced in that way. The fact that people are so willing to come forward for the booster jag at such an early stage after the change of guidance is an indication of public attitude to participation in the programme, which is welcome. That makes it doubly disappointing that people were inconvenienced in the way that they were.
Thank you—that is helpful. You just referenced that there will be substantially increased demand for boosters. The public will be seeing the news headlines about the omicron variant and will be concerned about it. There will be a lot of extra demand. Is the capacity in place to respond to that demand? What steps are being taken to increase capacity, particularly over the coming weeks?
There is no issue regarding vaccine capacity. Obviously, we have to go through the process of vaccination in an orderly fashion to ensure that it is done efficiently. We have already expanded significantly vaccine availability as part of the programme.
The change in JCVI guidance on Monday increased the number of people who are eligible for a booster vaccination. If memory serves me right, an additional 1.3 million individuals immediately became eligible. Colleagues will understand that we cannot vaccinate 1.3 million people in one day, so we have to increase capacity to move through that as efficiently as possible. Work is under way to ensure that we satisfy the understandable demand that there will be in the community.
Prior to the new JCVI guidance, we were confident that all eligible individuals would be able to secure their booster vaccination before the turn of the year. We are confident that, with the new guidance in place, we will be able to reach that point by the end of January. There will be a period during which people will have to wait some weeks to secure their booster jag, but they will certainly get it earlier than would have been the case in other circumstances, such as if they had to wait 24 weeks after their second vaccination.
That is helpful. I want to ask about the connection between the booster and flu jabs. Many people, including the over-50s—the cabinet secretary and I fall into that category—have been invited to get the booster and flu jabs at the same time. However, in some cases, that will mean that people will not have an appointment until January. Would that create an additional risk for people? The peak flu danger season is presumably in early January.
I will bring in Professor Leitch on part of that question, because we will get into the assessment of clinical risk. I will explain the thinking behind the programme.
This year, we took a decision to vaccinate more people than ever before for flu, and we had a commitment to administer the booster jags for a range of population groups. Our judgment was that the most effective and efficient way of doing that was to combine, as far as possible, the flu and Covid booster vaccination programmes to ensure that we were using resources wisely and calling in people when they could get two doses together. I had my flu and booster jags on Sunday, in a very efficient programme in Blairgowrie town hall.
10:45The programme is designed to enable us to make as much progress as possible, but there will be some people who will get a flu jag slightly later in the year than they would have done under a stand-alone programme. Professor Leitch can set out the clinical issues around that.
We are trying to maximise the protection that is available to individuals and within society by having as efficient a programme as we can. I accept that some individuals might get a flu vaccination slightly later than they would ordinarily have received it.
The Deputy First Minister is right. I will make a couple of points about flu. There is no flu at the moment, so there is no panic. As yet, nobody needs to worry about catching flu, because the numbers—across the whole country—are in single figures, although I do not anticipate that that will last.
The flu season is later than we think it is. Most people think that flu comes with the winter. It does, but it takes a bit of time for it to spread. The real flu season for hospitals is into the new year—January, February, March and April. It is not usually in November and December. There are exceptions, but this year is not one of those. It might be the case that we will get away with having fewer cases of flu than is usually the case. That would be fantastic because, frankly, the hospitals could really live without more respiratory disease.
We will need to make a judgment about when we start to call people for a flu vaccine who have now had a Covid booster, because the Covid appointments have shifted. The appointments of people who were expecting to get Covid booster and flu vaccinations in January will probably stay in place, but if someone is to get their Covid booster in March, I would expect them to go for their flu vaccine before then.
Now that the JCVI has issued new advice, we have changed the operational plans and each board will make a judgment. Part of those operational plans relates to the flu vaccinations. We will now shift some of those forwards or backwards. It is possible that we might be able to do more joint vaccinations than we thought. That will all get sorted out at board level and people will be told.
If people are confused or worried about the situation, they can talk to their general practitioner. Their GP may well not vaccinate them, but they can at least reassure them about where they are in the process and the risk that they face.
Do I have time to ask one more question, convener?
We need to move on to Alex Rowley.
You said that the capacity is there and that there are no issues with it. Just as you came into the meeting, I noticed that somebody in Kirkcaldy had tweeted:
“Turned away for my covid booster in Kirkcaldy this morning, seems the message still hasn’t filtered down, wouldn’t have been a big deal but the place was deserted.”
There is a mismatch between what the Government is saying in this place and what is happening out there.
On Tuesday night, I went along to the drop-in centre in Dunfermline, which was open from 5 till 8. I had queued for about 40 minutes and got to the front door of the vaccination centre at about 25 past, at which point the staff announced that there were another 50 people still waiting inside and that they were going to have to stop. I was lucky and got in, but about 40 people were turned away. That suggests that the capacity is not there.
More important is the fact that, as I was told once I had got into the vaccination centre, staff had had to put up with quite a bit of abuse, because of the massive queues. The staff were brilliant; it was clear that they had never lifted their heads for the whole evening. They said that it is fine for politicians to stand up in Edinburgh and tell people to go and get their boosters, but if they are not prepared for that and the staff are not in place, there will be a mismatch and people will struggle. Where are we with that?
With a programme of such magnitude, there will be a phenomenal number of operational issues. We must bear in mind the numbers that we are talking about. More than 10 million vaccinations have now been undertaken. What has been achieved in the programme has been a colossal undertaking. I pay tribute to the staff who are delivering the vaccinations and those who are organising the programme, because it is not a simple logistical exercise.
Mr Rowley raised several points that need to be addressed, the first of which relates to the tweet that he mentioned. We have reiterated the guidance to health boards, and it is important that that guidance is applied in all scenarios and circumstances on the ground. I will take away the fact that an example has been raised with me where that message has clearly not reached all the distribution points for the vaccination programme. Obviously, there has been a change of circumstances and the advice is relatively new, and it takes time for those messages to be put across. However, I will make sure that the issue that Mr Rowley raised is taken up.
The second point concerns the capacity questions. When I answered Murdo Fraser, I said that there was certainly capacity in terms of the availability of vaccines. There is adequate provision of vaccines; the question is about the best means of administering the programme at a local level. Of course, there is a range of options for how we might go about doing that. There are probably three main options: a drop-in service; self-selection of appointment via the online portal; and setting appointments via letters from health boards.
There are upsides and downsides to each option. For example, sending out letters gives an order and an organisation to the programme, but the downside is that it takes time to get the infrastructure in place to administer and distribute the letters, and there will be a reasonable level of did-not-attends.
The portal option, which we are using, can give people a choice about when their appointment is. I was able to choose to go to Blairgowrie town hall on Sunday morning, which suited me down to the ground, and I have now had my vaccination. However, for some people, digital access is a challenge and other people might find that they cannot find an appointment that suits their choices.
The drop-in option, as Mr Rowley has recounted, can be quite challenging if too many people decide to drop in at the same time. The vaccination centre in Kirkcaldy was quiet this morning, as we heard from the member of the public whose tweet Mr Rowley quoted, but the vaccination centre in Dunfermline that Mr Rowley went to on Tuesday night was busy. The smoothing of demand is difficult with a system that has only drop-in appointments.
We have tried to opt for a means of balancing out the best of those options as far as possible. When I went on Sunday morning for my vaccination, the couple after me were drop-in candidates. They were not in a different queue; they were right behind me and they got taken right after me.
We are trying to work through every possible practical permutation to maximise access. Obviously, if the 1.3 million people who are now eligible for a vaccine decide to drop in for a vaccination today, there will not be adequate places. We are therefore trying to balance the vaccination programme over the country with a number of mechanisms to enable us to maximise participation in it.
There is a lot that we do not know about the latest variant. What we seem to know, based on the evidence that is coming out of South Africa, is that it spreads quickly, which is a massive worry to scientists. The evidence suggests that it can spread much more than the delta variant, which was bad enough.
Given that fact and the fact that people are being turned away when they go for their booster jag because the capacity does not exist, do you agree that the Government needs to look at what is in place in each health board area and see what needs to be put in place? The other day, the Cabinet Secretary for Health and Social Care was on the radio saying that there would not be enough staff to increase the capacity, because we cannot bring in staff from other parts of the national health service. What else needs to be done? What other professions can be quickly trained to provide the capacity? Based on the evidence that we have seen to date, we need mass vaccination to happen as quickly as possible.
We have a mass vaccination programme, which is under way. We are distributing in excess of 60,000 vaccinations daily in Scotland. We are the most vaccinated part of the United Kingdom, with the highest levels for first, second, third and booster vaccinations. We have a comprehensive mass vaccination programme.
The Government is looking at the situation from health board to health board, and the health boards have submitted plans to intensify the vaccination programme. Dialogue continues between the Government and health boards to maximise that capacity. The programme must take place in a variety of geographies and scenarios across the country. I assure Mr Rowley that we are trying to maximise the capacity of the vaccination programme, but he must accept that there is a challenge.
The two pieces of information that Mr Rowley has just given the committee highlight that challenge: before 11 this morning it was quite quiet at the Kirkcaldy vaccination centre, but last night, between five and eight o’clock at the Dunfermline vaccination centre it was very busy. That illustrates the challenge of operating such a programme. We are providing capacity. In Kirkcaldy this morning, drop-in appointments could be fulfilled because it was quiet, but in Dunfermline on a Tuesday night that becomes more problematic. I assure Mr Rowley that every step is being taken to maximise the programme.
Professor Leitch has been involved in work to expand the pool of individuals coming forward to deliver the vaccination. I will ask him to say a bit about that in a moment. The more that we draw in people from within the health service from other disciplines to administer the vaccination programme, the more that we will have to address the issue of what other services the national health service can deliver. If, to deliver the vaccination programme, we draw in healthcare staff who usually deliver elective activity, we will obviously reduce the capacity for the elective work of the national health service. I know how much it matters to the public and to members of the Parliament that we do as much elective work as we can. Jason Leitch might need to get more detail on that.
Mr Swinney has covered it well. It is a real balance. To put it in context, we are vaccinating people faster than we have vaccinated in history. It is the fastest that any country in the world is vaccinating, apart from possibly the Republic of Ireland last week. We have put out recruitment calls for every board for anyone who can help us, from medical students through to optometrists and dentists.
Earlier this week, I made a private visit to NHS Greater Glasgow and Clyde’s human resources department, which is in the old Yorkhill hospital, just to meet the staff and thank them. They have been overwhelmed by the response to the most recent advert. A new set of individuals have been recruited, but it takes a bit of time to get those people on board, depending on their history, whether they have done vaccination before and whether they are a clinician or a student. That is going well and those people will be put into the shifts as quickly as possible.
Glasgow has vaccination centres throughout the city and the broader health board area, which are running every day. Drop-in clinics are awkward for us, for the reason that has just been described. Logistically, we would rather that people had appointments so that we know when they will come and so that there is an order. That would allow us to plan the next two months to vaccinate 1 million to 2 million individuals with the Covid booster.
Mr Rowley and Mr Fraser are both right that vaccination is, in Mr Fraser’s words, the best way to fight omicron, but it is important that we understand that it is not the only way to fight it. I know that this is not what you are suggesting, but we should not just think about vaccination. Of course, we need to vaccinate, and tens of thousands of people—staff and citizens—are being vaccinated today in vaccination centres, but we also need to think about how we protect the population from omicron in other ways.
11:00
I will talk about vaccine uptake and where there is a bit of hesitancy. My points come from questions that members of the public have put to the committee.
A number of people have been in touch about women’s reproductive health and the vaccine. Some are asking whether fertility is impacted in any way by having the vaccine. I know that we have covered that before but, if we are getting the questions, it is clear that the message still has not got out to some individuals.
Others have asked whether breastfeeding women will be eligible for the booster vaccine, and whether health and social care partnerships and midwives have appropriate information and training on eligibility for the vaccine. Parents have highlighted that there is inconsistency of knowledge and understanding in HSCPs across Scotland in relation to breastfeeding and vaccine eligibility.
Finally, I have a constituent who is very concerned about getting the vaccine because she is on cancer drugs. I ask Jason Leitch to comment on that.
It would be best if Professor Leitch responds to those.
Let me be as blunt as you would expect. There is no contraindication, at all, to the vaccine if someone is pregnant or breastfeeding. There is no biologically plausible mechanism for the vaccine to cause them any more challenge than if they were not pregnant or not breastfeeding. Is that blunt enough?
If people do not believe me, they can head to the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health or any trusted source of clinical information, including our own NHS inform. Young Scot has really good information for young people to help them to make those choices.
It is important that we do not suggest that vaccination is always an easy choice for people. The vaccination centres do not force people to be vaccinated. In fact, one reason to go to a vaccination centre might be to have that conversation. People can leave unvaccinated—nobody will force them to be vaccinated—but the best people to have that conversation with may well be the senior clinicians who are in that vaccination centre in Kirkcaldy, Dunfermline or wherever. They are well equipped. If the individual in the centre is not able to answer more technical questions—on cancer drugs, for example—we have escalation processes in place in the centres, and by phone to even more senior immunologists, virologists and others, where someone would be able to get all the information that they require. Tiny numbers of people might have to be given a reappointment in a specialist centre, but that would affect very small numbers.
For Jim Fairlie’s constituent who is on cancer medication, it depends what that is. If it is long term, there is probably no risk, but the best answer for them is to talk to the care team that is looking after them, who will be able to point the constituent in the right direction. It is vanishingly rare for people not to be able to be vaccinated, even during cancer care. However, there are some who cannot be, so Mr Fairlie’s constituent should check with the care team whether it is safe to be vaccinated.
As I said, I know that we have been over the issue before, but it is worth re-emphasising.
It is important. We are seeing a number of pregnant women across the UK fall ill with Covid—proportionately more than we would expect if it were random. In the UK and around the world, pregnant women are falling ill with Covid because they are choosing not to be vaccinated. That is a much bigger danger than the vaccine.
When the committee spoke to experts this morning, I suggested that the emergence of omicron was expected—mutations of the virus were expected. I asked how we manage that continual process, but the response of the experts was that omicron matches the worst-case scenario modelling that they have done, which was not what I wanted to hear.
Nor did we, to be clear.
I know. That changed how I will ask my questions. The scientific and medical communities are examining the impact of omicron on transmission, the severity of the condition and vaccination effectiveness. How are you considering what measures need to be taken while we wait for that information, given that, as one of my colleagues said, it is likely that transmission rates will increase, which could put stress on the NHS? We have heard that the number of cases in South Africa has gone in two weeks from a few hundred a day to more than 8,000 a day. It will take a little time to find out the exact impacts. Where are we with the thought process?
You raise the fundamental dilemmas that we wrestle with all the time. That is why I said in my opening remarks that we are taking a proportionate and precautionary approach to handling the situation.
Modelling of the pandemic’s likely course is undertaken regularly, and a variety of variables are considered. A few weeks ago, the modelling looked at the potential impact of the 26th United Nations climate change conference of the parties—COP26—and it has covered the impact of winter and all sorts of scenarios.
The modelling gives central, better and worse scenarios, on the basis of the virus’s prevalence and circulation. We hope for the better scenario, we prepare for the central scenario and we hope that we do not reach the worse scenario. Different actions are required if we face the better, worse or central scenario. That is why I used the word “proportionate” in talking about our judgment.
The precautionary approach is important, too. If we look at the pandemic today in Scotland, we see that case numbers are high but fairly flat. The figures for the past seven days are slightly down on those for the previous seven days. The hospitalisation rate of Covid patients today is slightly lower than it was, although the figure is still more than 700. If those 700 people were not in hospital with Covid, we could provide other treatments for 700 patients.
There is a careful judgment to be made about the proportionate steps to take. If omicron turns out to be more transmissible than delta, there will be more cases. If the level of serious illness from omicron is no different from that of delta, a relatively small percentage of cases will be hospitalised, but that will involve more people if the number of cases is higher. That will place even more pressure on the national health service and will mean that services are under pressure.
If the level of serious illness does not change but the volume changes significantly, we will have to take more dramatic action. I have no justification for that today because, although I can look at the omicron scenarios, a compelling evidence base does not yet exist for taking more severe measures. It might well exist in the future, so the Government will keep the situation under constant review.
The expert whom Brian Whittle cited is correct. Omicron looks terrible down a microscope. It has mutations that we know are linked to vaccine escape, it has mutations that we know are linked to increased transmission, and it has new mutations—we do not know what they do, in rough terms.
We do not know how omicron will perform in the real world. Virologists talk about the fitness of a virus, to summarise what it can do. We do not know whether omicron will be fitter than delta in the long term. If it is fitter than delta, we can only slow it—we will not be able to stop it—and it will overtake delta, which has become the dominant virus around the world.
We must do, and have done, two things. We must try to stop omicron coming here and, when it is here, we must manage it as we managed the original virus—you will remember that we tried to put a ring of steel around cases. When the first outbreaks took place in Coupar Angus and Gretna, we really focused on them.
We are dealing with two simultaneous pandemics just now. Health protection teams are dealing with delta in ways that are fully understood by the committee—they involve restrictions, testing and vaccination—but at the same time we are trying to control the new omicron pandemic in a much more targeted way, with enhanced contact tracing and enhanced PCR testing.
If omicron is worse than delta, we can only slow it down. We cannot stop it or hope that delta stays and omicron goes away. That will happen only if it is not as fit as delta. We need to know omicron’s impact on three things: transmissibility, severity of disease and vaccine escape. We can tell some of that from looking down a microscope, but for most of it we need real-world data. For every 10,000 delta cases, roughly 3 per cent go to hospital and 1 per cent die. What are the percentages for omicron? Are they 3 per cent and 1 per cent, too, or are they, say, 4 per cent and 2 per cent? That is a massive difference, but we just cannot tell yet.
The early signs from South Africa are bad. It took 100 days for delta to be the dominant variant there, whereas it has taken omicron only 20 days. That suggests increased transmissibility, but we just do not know. The population in South Africa is much less vaccinated than ours and the demographic is different and younger. We cannot make exact extrapolations to our context, the Japanese context, the Californian context and so on.
We need more time. In fact, the sentence that I probably say most often—indeed, every day—to the Deputy First Minister is, “I need more time.” Sometimes, we just do not have the time, so we have to make proactive decisions before we get all the data.
That last point completes the proportionality argument. At some point, we have to make a call that, on the basis of the best clinical assessment that we can get of the three factors of vaccine escape, transmissibility and serious illness, this is the moment to act. I accept that we might not have all the demonstrable evidence—or, indeed, the conclusive certainty—to support such a conclusion, but the fact is that the Government has been making such judgments since March 2020.
That was really helpful, and it leads me on to a point that I raise reasonably regularly. The committee is looking at holding an investigation into the number of excess deaths in Scotland, which is currently sitting at 12 per cent above the average. Those are not all Covid-related deaths. With the emergence of omicron, the question of how we take such decisions becomes even more acute. After all, there is mortality associated with other non-Covid-related conditions. We will have a look at that at some point, and I am sure that the medical profession is already looking at it much more deeply than we will, but—I know that I keep looking ahead—how do we strike a balance and find a route that allows us to get back to some normality with regard to other conditions that have mortality associated with them?
That is a very significant and legitimate question. In my answers to Mr Rowley’s completely legitimate questions about expanding the scale of the vaccination programme, I made the point that one of the options could be turning down the dial on elective work and putting more resource into the vaccination programme. If I do that—I do not wish to personalise this, but I will use these distinguished members of Parliament to illustrate my point—Mr Rowley might be more happy, but Mr Whittle will not be. Mr Whittle’s primary concern is the treatment of what I will call non-Covid conditions that are perhaps leading to early mortality because health services are unable to undertake all that we would ordinarily hope they would be able to.
That is why we have to invest in all the precautionary measures possible to avoid the virus circulating. We are not in any shape or form powerless with regard to omicron circulating, because people can come forward for vaccination, which they are doing in substantial numbers, and they can observe the baseline measures on a routine and rudimentary basis in order to put up barriers to circulation.
There are all sorts of steps that we can take. It is incredible to watch what our contact tracers are doing in response to the early cases of omicron. It is jaw dropping to see the degree of intensity with which they are looking at where people have been, whom they have been close to and what is happening around them, to try as much as possible to interrupt the circulation of the virus.
We have to use a variety of devices because, the more we do that, the more activity we will have to try to address the core point that Mr Whittle puts to me.
11:15
Can we move to John Mason, please?
Thank you very much, convener. We could all do with more time.
Because I was getting my booster vaccine after six months, I thought that I had been safe for six months. I got it on Friday. However, now, the gap is three months. That sends out the message that people are at risk after three months. Is the vaccine protection waning more quickly than we thought? Will we have to get a vaccine every three months?
I will bring in Professor Leitch because of the clinical nature of some of the points.
Obviously, the vaccine will wane. Over the past few weeks and past two months, there was an increase in cases in the older age groups. Then, when the booster vaccination programme started to kick in for those age groups, the number of cases for them came down more aggressively than for other age groups. Professor Leitch can tell me if I have got this wrong, but I deduce from that that the vaccine was waning but the booster arrested that and gave more protection.
The logic of that would be that we should have the booster after two months.
Clinical points might mean that there is no justification for doing so because there may be sufficient vaccine protection for a sufficient length of time. The disease is new, so clinicians and scientists are trying to work their way through to the best answer. Their judgment was that the gap should be six months. The JCVI has revised that to three months.
Going from six months to three is quite a dramatic fall.
It is but, to go back to my two key words—proportionate and precautionary—it is also a recognition that, in the light of omicron, it is necessary to take the precautionary stance of moving to an earlier time for the booster jag. That strikes me as a rational decision for the JCVI to arrive at.
Perhaps Professor Leitch will want to add something.
I will add a few things—I will try to be quick.
Remember that the JCVI advice is that the booster jag should not be given before three months, not that it should be given at three months. Before that, the advice was that it should not be given before six months. The JCVI knows that we cannot do everybody on the Tuesday night that it issues its news release. The JCVI is smart and knows that we need a bit of run-in time to get everybody.
My booster is on 17 December, which will be 26 weeks from my second vaccination. I could have brought that forward, but I am going to go on 17 December. I figure that 10 days will not make that much difference. I might live to regret that, but it is my present position.
I will try a metaphor. Immunity is not like an on-off light switch; it is like a dimmer light switch. I cannot tell what your dimmer is doing and you cannot tell what mine is doing. At a population level—looking at the number of infections and hospitalisations across the whole world and looking at the vaccine that we used, how well it went and which age groups we vaccinated—the boffins can say, “Oh, Scotland’s dimmer has reduced, so we need to turn it back up again.” The way to turn it back up again is to boost from the oldest all the way down to the youngest. They have to take into account the fact that we had a large gap between vaccinations 1 and 2. Israel did not and its immunity waned first, so it looks as though vaccinations wane.
The next thing that will happen is that we will watch the dimmer again. Immunologists tell me that it will dim less the next time because your body remembers. Each time you get a vaccination, immunity stays higher for longer. Immunity is complicated. It is not just about antibodies—there are also cells remembering things. It may well be that the next booster might be a little further out, and the next one after that might be further out again. Alternatively, we might say, “We’ll only do the elderly next time,” because for young people, their imprint has stayed on for longer. However, it is all quite difficult, because we have to take serial blood tests from people to check that they have immunity and then watch the whole population to see how the dimmer is working. If we need to turn the dimmer back up again, we vaccinate from the top to the bottom.
Could we expect new vaccines to give longer protection?
We absolutely could, principally around new variants. Again, variants are not like a binary light switch. Omicron will not escape the vaccine completely, but it might give—I am completely guessing here—60 per cent protection rather than 95 per cent, in which case we would probably want to adjust the vaccine for next year. The companies say that they can do that within 100 days—they can produce the vaccine, and we would have it within approximately six months from start to finish. We are not only turning the dimmer up but making it more efficient. We can turn up it faster, because we have got it acting against the one that we want it to.
I think that I overstretched that metaphor a bit.
No, I get the point—that is helpful. It is not black and white; that is pretty clear.
On the question of vaccine certificates, from Monday—if I am right—a negative test is going to be allowed, possibly along with some other variations. Will that appear on the app or the certificate?
No, the lateral flow test will not appear in the app.
The lateral flow test will not appear. What about the booster? A constituent has been in touch with me to say that, when he goes to Germany, they will want to see a recent jag.
The app has been revised to include the booster jag; we expect that to be completed and the update to be available in early December. A critical date is 15 December, when a number of European countries will make it mandatory for booster jags to be evidenced on Covid vaccine certificates, and the update will be in place by then.
The app will be updated for international travel and boosters from 9 December; it will take longer for the app to be updated to include boosters for domestic certification. The current domestic certification scheme defines “fully vaccinated” as having had two vaccines, and it does not currently include a requirement for a booster.
That is helpful.
Finally, what about children aged from five to 11? Are we thinking of vaccinating them?
We are awaiting advice on that point from the JCVI, which has been exploring the issue—
Every week.
We will look carefully to the recommendations that come from the JCVI in that respect.
That concludes our consideration of item 2. I thank the Deputy First Minister and his officials for their evidence.
Item 3 is consideration of the motion on the expedited draft affirmative instrument that we considered under the previous agenda item. Members will note that Scottish statutory instrument 2021/425 was laid on 19 November, and we had intended to take the motion on the instrument at this meeting. The Delegated Powers and Law Reform Committee has decided to consider the instrument at its meeting next week, so we will defer consideration of the motion.
Deputy First Minister, would you like to make any further remarks on the draft affirmative instrument on the vaccination certification scheme before we take the motion?
No, convener—I am satisfied with what I have said.
I invite the Deputy First Minister to move motion S6M-02332.
Motion moved,
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 4) Regulations 2021 [draft] be approved.—[John Swinney]
Are there any comments from members?
I had hoped to make this point in the earlier session, but time ran away with us. I draw to the Deputy First Minister’s attention the comments that have been raised with this committee by the DPLR Committee, which considered the instrument on Tuesday.
The instrument that is before us allows for the use of a negative lateral flow test as an alternative to vaccine certification for entering certain premises. That is a welcome step—it has been welcomed by the business community, and it brings Scotland into line with most, if not all, other European countries that operate a vaccine passport scheme.
However, the DPLR Committee raised the issue that the change, in effect, relies on individuals’ honesty, because it will be relatively easy for someone, if they want to, to present a false negative test. The DPLR Committee asked the Government whether it had considered that and whether it had given any thought to making the system more rigorous, for example by introducing sanctions for people who present a false negative. I do not know whether the Deputy First Minister can respond to that, or whether he has any thoughts on that point on behalf of the Government.
May I make a point, convener? That would not be a false negative; it would be a fraudulent negative.
I think that members of Parliament have wrestled with that question for a considerable time. Indeed, Mr Fraser and a number of other members have been pressing the Government to take that step for some time.
The Government wanted to have a scheme in place that would help to boost vaccine take-up, which is why we resisted that move to begin with—it does not suit the purpose of our scheme. For completeness, however, I put on the record that, at the same time, we indicated the risk that Mr Fraser puts to me.
There is a risk here. I cannot deny that. However, the approach is part of the culture that we have to take forward if we are serious as a society about resisting the spread of the virus. We need to test ourselves and follow what the one or two red lines tell us when the test is complete. I encourage members of the public to take the process deadly seriously, and I know that many are doing so. There is very high demand for lateral flow tests, thankfully.
I return to the questions that the convener put to me at the beginning about how seriously people are taking the testing approach. Testing is a very important tool in stopping the circulation of the virus, and it would not be right for somebody to report a test result that was inaccurate. If Mr Fairlie will forgive me, I am not sure that it is for me to decide what is fraudulent and what is not, but that would not be the right thing to do, because it would undermine the purpose of the scheme and the taking of the test. I encourage members of the public to test and to report the findings accurately.
I will be brief because I have to go to the chamber, but I will comment on my use of the word “fraudulent”. Christmas is coming up, and if someone who is 18, 19 or 20 is going out with their mates and they do not feel bad but their test comes up positive, they might just chance their luck because they feel okay. I have a genuine concern about that. That has always been my concern about going down this road.
I accept those points and that is why I make my plea to people. I do not think that it is just 18 and 19-year-olds—
Yes—we should not demonise that age group.
It is everybody. Personally, I am now undertaking lateral flow tests much more frequently. I was doing them twice a week, but I am now doing them much more frequently because of the degree of interaction that I have in the course of my work. I have no social life, but—
That is not pandemic related. [Laughter.]
That is nothing new. However, I am taking tests more frequently because of the degree of interaction that I now have in the course of my responsibilities.
Thank you. I am conscious of the time. Are members happy for me to put the question on the motion?
Members indicated agreement.
The question is, that motion S6M-02332 be agreed to.
Motion agreed to,
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 4) Regulations 2021 [draft] be approved.
The committee will publish a report to the Parliament later today setting out our decision on the regulations. That concludes our consideration of this item and our time with the Deputy First Minister. I thank him and his supporting officials for their attendance this morning.
The committee’s next meeting will be on 9 December, when we will take evidence from stakeholders on the vaccination programme.
That concludes the public part of our meeting.
11:29 Meeting continued in private until 11:33.