Coronavirus (COVID-19) vaccine inclusion: vaccination programme - phase one

1. Introduction

This report is an overview of the inclusive approach taken during the first COVID-19 vaccination programme (December 2020 until September 2021).

It outlines examples of health board approaches and activities delivered in collaboration with a range of partners. It also includes examples of national programme activity and support. However the extraordinary volume of activity undertaken to facilitate an inclusive approach necessarily means that this report cannot detail every piece of work.

Background

The World Health Organization declared a COVID-19 pandemic on the 11 March 2020. Many teams across the world worked on a COVID-19 vaccine with the first
to be approved for use in the UK being Pfizer.

On the 8 December 2020 Scottish Government and NHS Scotland began a national vaccination programme, with the first COVID-19 vaccines delivered in Scotland
on this day. This phase of the programme covered:

• two doses of COVID-19 vaccine to all adults over the age of 18;
• young people aged 12 to 17 who have underlying health conditions that put them at higher risk of severe COVID-19; and
• children and young people aged 12 years and over who are household contacts of persons who are immunosuppressed.

Immunisation policy in Scotland is determined by Scottish Ministers and guided by advice from the Joint Committee of Vaccination and Immunisation (JCVI) and other appropriate bodies. Our high level approach to delivery was laid out in successive COVID-19 Vaccine Deployment Plans.

The JCVI advised that implementation should involve flexibility in vaccine deployment at a local level with due attention to:

• mitigating health inequalities, such as might occur in relation to access
  to healthcare and ethnicity;
• vaccine product storage, transport and administration constraints;
• exceptional individualised circumstances; and
• availability of suitable approved vaccines, for example for specific age cohorts.

The national programme was clear from the start that the vaccinations programme must be equitable and reach everyone in Scotland, both for individual health and our collective community wellbeing.

To achieve this, inclusion and equality was embedded throughout. National agencies and local health boards worked alongside local government, business, third sector and community groups to encourage engagement, remove barriers and respond
to evidence of low uptake of vaccination in certain communities.

Health boards' inclusive approaches evolved throughout the programme, responding to new data, emerging evidence and changing situations. Each area strove to meet the needs of their own communities, working across civil society.

Each health board developed their own Health Inequalities Impact Assessment (HIIA) or inclusion plan. These were informed by their own community knowledge and engagement, as well as, in many cases, insights from local equalities and inclusion advisory groups.

Although each health board's response was tailored for their own population, all 14 considered their inclusive approach, in line with six themes, set out by the national programme. These were:

• Communications
• Flexible delivery models
• Accessible transport and clinics
• Engagement and co-production
• Staff
• Data and evidence

These six themes form the chapters in this report detail activities and approaches taken by health boards and partners for each.

Recommendations in the national Health Inequalities Impact Assessment (HIIA)^[1] developed by Public Health Scotland helped to inform the national and local approach alongside a range of other emerging evidence which can be found in the appendix.

The main learning points can be found at the end of this report.