Coronavirus (COVID-19): Scotland's Strategic Framework update - February 2022

Future Strategy

As we have all learned over the last two years, management of the pandemic demands a flexible approach and an ability to respond quickly and decisively. Whilst we may be beyond the peak of the latest Omicron variant, we know that there is a continuing COVID-19 risk to manage in the future. There is no absolute certainty in what lies ahead, but by carefully monitoring the situation and having in place effective contingency plans, we can reduce risk and harm in more proportionate and less restrictive ways.

Over the period from initial lockdown in March 2020 through to spring 2021, when the risk of infection was high and before the positive impact of vaccination and more effective treatments were available, our response was characterised by extensive (though variable) use of legal restrictions and requirements. Individuals and organisations also adapted their behaviours and physical environments to reduce transmission risk.

Since summer 2021, the use of protective measures, both regulations and guidance, has remained important – particularly to deal with the Omicron wave – but has been much more targeted, as the positive impact of the vaccination programme has helped reduce serious health harm.

Looking forward, we expect to be able to rely much more on the beneficial impact of immunity, on the increasing availability of effective treatments, and on routine adaptations to behaviours and environments, to render the use of legal measures at best unnecessary and at worst limited and temporary.

But we must also acknowledge the risks we face – of new, more harmful variants appearing or of waning immunity. In addition, seasonal factors may shape people's behaviours and increase transmission. Each of these – and in particular a combination of them – might cause a period of increased harm from the virus and require us to consider whether, when and to what extent a temporary increase in protective measures was necessary and proportionate. We expect that, often, no additional intervention will be required but we need to be ready to respond if and when it is.

Strategic Intent

We must maintain and improve our strategies to sustain immunity, enhance the availability of and access to treatments, adapt behaviours and physical environments, monitor risk from the virus, and develop contingency plans, all with the aims of reducing both the risk of infection and harm from the virus. This Strategic Framework sets out the various elements of that work in the sections below, within the overall context of our strategic intent.

In light of the current state of the epidemic and our consideration of future potential scenarios, we judge that the strategic intent guiding our COVID-19 response should be changed to reflect the calmer phase of the pandemic that we are hopefully now in, and the possibility of the virus becoming endemic:

To manage COVID-19 effectively, primarily through adaptations and health measures that strengthen our resilience and recovery, as we rebuild for a better future.

Practically, this means that we expect to be less focused on suppressing case numbers than in the past, and more on reducing and mitigating harm. This recognises that - after two years of the pandemic and in light of vaccines and treatments - the impact of the other harms that arise from a strategy overly focused on suppression is too great.

Whilst it is inevitable that a varying level of COVID-19 will continue to circulate in society, our new strategic intent does not signal a willingness to allow the virus a free hand regardless of the harm it might cause. Instead, it will help to ensure that our overall approach and any future use of protective measures – should we face a significant new threat – is necessary, proportionate and consistent with our broader purpose of creating a more successful, sustainable and inclusive Scotland.

The revised strategic intent recognises that responsibility for the management of COVID-19 is shared by central and local government, wider public services, businesses, the third sector, communities and individuals. While central government will always have a responsibility to lead, support and, if necessary, take tough decisions, we all have a part to play in remaining vigilant for COVID-19 infections, in adapting how we live, work and interact to reduce harm, and for building greater resilience against potential acute phases of the virus in the future.

Delivering this strategic intent will require a range of actions across a number of areas as summarised below and set out in further detail in later sections of this document. These include: health measures such as vaccination, treatment, testing, surveillance, and strengthening the resilience of health and social care generally; adaptations to behaviours and physical environments to reduce the spread of the virus; and the ability to monitor and respond effectively to renewed threats, including more harmful variants of the virus. If we can collectively deliver on these actions then the prospect of both managing COVID-19 effectively and restoring and retaining normality in our lives is achievable.

Health

Health measures - such as vaccination - that strengthen our resilience will continue to be a vital aspect of our approach to managing COVID-19 effectively. We will use expert scientific and clinical advice and our well established infrastructure to build on our learning throughout the current vaccination programme. The success of the programme to date has been remarkable, both in scale and impact, and it will continue to develop as we help ensure that everyone who will benefit from a vaccination is able to receive one, including further booster shots if recommended, and as we integrate future advances in vaccine technology into our programme in line with future JCVI advice.

We will also continue to invest in our public health capacity and capabilities to support greater resilience in the health and social care system.

Monitoring disease prevalence through appropriate testing and wastewater sampling must continue, and we need to retain and enhance the capability to track new variants through PCR testing and genomic sequencing. We will continue to maintain and develop a proportionate testing capability, to support public health decision-making, population health, and treatment of those who will benefit from it. Adequate surveillance, internationally and domestically, is critical.

For those who become infected and subsequently require treatment, there is now a range of therapeutics that can lower the risk of serious illness or death. We will continue to develop new and better approaches, and invest further in treatment and vaccine clinical trials, especially for those who are most at risk of severe disease. We will also broaden our understanding of the long-term effects of infection, particularly the syndromes known as Long COVID, so that we can continue to improve treatments and outcomes.

Adaptation

We must build a stronger, infection-resilient society and there will be an ongoing ask of the public and organisations to take responsibility for their safety. This includes embedding many of the protective behaviours we have become so familiar with over the past two years into our daily lives and business operations. We will ensure that clear and up-to-date guidance and information is available to help achieve and maintain safer behaviours.

In terms of adapting where and how we work, live and access services, it will be essential for us to work together to make buildings and settings safer, for example through better ventilation, and in so doing limit transmission. As part of this, we will continue to encourage employers to engage with employees to consider, for the longer term, hybrid working models where feasible and appropriate. We recognise the broader impacts of hybrid working and will continue to work with partners to learn from best practice.

Effectively responding to future threats

We expect there to be future outbreaks or resurgences of the virus: these will occur at an institutional, local or national level. Guidance on the Management of Public Health Incidents will be updated, and we will develop with partners a new framework of modelling, data and analysis to support the future monitoring and surveillance of COVID-19. This will help us determine when and how we need to respond.

At a national level we will implement measures that are necessary and proportionate to the threat posed by the virus. We hope that a very small number of ongoing protective measures will keep the harm from the virus in check in the near term and provide the longer term stability that we need to plan ahead.

We expect that there might be occasional, acute periods over the next few years when it will be necessary to increase protective measures temporarily, for example, to control a harmful new variant of the virus. We will be prepared for that and want to provide as much clarity in advance as possible (as set out in the Protective Measures section below). However, we will do this only when absolutely necessary and in as limited and targeted a way as possible. It is important to stress that we are at a point now where life can be expected to be much more normal for much of the time.

To inform the response to an outbreak of a potentially dangerous variant of COVID-19, the Scottish Government with Public Health Scotland (PHS), Local Government and other partners, are developing the COVID-19 Outbreak Management Plan, which will set out the process and methods for responding to future outbreaks. We aim to publish this in spring 2022.

The variant outbreak responses described in the COVID-19 Outbreak Management Plan will be designed to operate as a set of short and medium-term measures that can mitigate impact across the country or in specific localities. It will include processes to: commission and use evidence, data and risk analysis from both PHS and UKHSA; assess the risk posed by a variant; determine possible response objectives and options; and continually assess the operational impact throughout any period of intervention.

Adequate surveillance, both internationally and domestically, at borders and across the population is critical to provide advance warning of potentially dangerous variants. That is why the COVID-19 Outbreak Management Plan will be supported by the use of existing and new and emerging testing and surveillance procedures to support early identification of future variants, including whole genome sequencing, wastewater surveillance, testing and contact tracing.

Legislation

In order to maintain the ability to respond effectively to the future threats that the virus may pose – within institutions, locally or nationally – we will ensure that necessary legislation is kept up-to-date. Having this legislation in place does not, of course, mean that it will be deployed – but it does mean that it will be ready should it be required. And whenever legal measures are deployed, they will remain subject to ongoing regular reviews of necessity and proportionality to ensure that they are removed as soon as no longer required. Existing coronavirus legislation is expiring this year and Scottish Ministers propose that it be replaced with provisions in the Coronavirus (Recovery and Reform) (Scotland) Bill which was introduced to Parliament on 25 January 2022. This non-emergency legislation is intended to support our COVID-19 Recovery Strategy and embed any of the COVID-related measures that have delivered improvements for people using public services.

International Context

As we think about the next phase of our response to COVID-19 and fix our sights on recovery, we also recognise that COVID-19 is still affecting different parts of the world in varying degrees and that the pandemic will not be over until it is effectively managed internationally. That highlights the need to continue with efforts to support international vaccination, treatments and surveillance.

Equality and inclusion

We must continue to consider the needs of everyone in society in developing future adaptations, mitigations and protective measures. The pandemic has exacerbated inequalities, poverty and disadvantage, and there is clear evidence that harm has been felt unevenly, including by people and communities who were already experiencing poorer outcomes. Disabled people, minority ethnic communities, people on low incomes, older people, younger people, and women are amongst those who have experienced greater impacts, with multiple disadvantage making things even harder for many. It is imperative that we continue to ensure that any continuing or new measures do not exacerbate inequality, which is why equality, human rights and inclusion remain at the heart of our ongoing response. We need to ensure that everyone can live their lives with greater normality as we open up society and learn to live with COVID-19. We cannot let it become established as a disease of the poor, disadvantaged or clinically high risk.

Future pandemics

Plans, procedures and protocols to help Scotland prepare for infectious threats, such as an influenza pandemic, are in place, alongside the legislative mechanisms that underpin how infectious hazards are managed when they occur in Scotland. That legislation is being strengthened through the Coronavirus (Recovery and Reform) (Scotland) Bill to ensure that Scotland is in the best possible position to protect the health of its citizens from an infectious threat. PHS provide strategic leadership in guiding and supporting our response to high consequence infectious diseases.

The last two years have seen huge investment globally and within Scotland in surveillance, testing, vaccination and therapeutics, alongside our understanding of what measures make people safer. The body of scientific and clinical knowledge about COVID-19 has hugely increased, as has public awareness. In all cases, the science and research that has supported our efforts, and keeps us safer, depends on national and international co-operation.

As new variants of SARS-CoV-2 emerge, we now have the capability to generate much of the data and analysis we need within Public Health Scotland and the Scottish Government. Alongside that, our scientific and research communities are active nationally and internationally and have benefited from the advice of the Scottish Government's COVID-19 Advisory Group.

Existing public health knowledge must absorb and adapt to the new technologies that have changed our ability to detect, understand and respond to new viruses on a different scale. While our ability to respond to new threats has advanced, we must accept that the rate at which we will face them has also increased. Ecological and technological changes mean the chances of new viruses emerging have increased, and global travel patterns mean they are more likely to spread when they do. To capitalise on this investment and learn from the experiences of the pandemic we will:

• commission the Standing Committee on Pandemics to provide a report to us on improved preparedness for future pandemics, with interim recommendations by July 2022;
• use that report, and in due course, the outcomes of the Public Inquiry to inform our approach to surveillance, monitoring, diagnostics, vaccination and treatments;
• work under the Common Framework on Public Health Protection and Health Security to strengthen coordination of public health and health security policies; and
• work across the four nations of the UK, and with the UKHSA and other international organisations to promote measures that increase biosecurity.

Next Steps

We hope now to be entering a calmer phase of the epidemic. That allows us to consider afresh the adaptations that we need to make to build our resilience and manage the virus in a less restrictive way going forwards, helping Scotland recover and rebuild for a better future.

The continuing loss of life to COVID-19, the continuing suffering of those with Long COVID, and the challenges that many businesses, organisations, families and individuals continue to face as a result of the pandemic remind us of both the continued seriousness of this virus and the need to learn lessons for the future, which the coming COVID-19 Public Inquiry will help us to do.

The various interventions that we are taking and will take in the future to tackle the epidemic are set out in the elements of our Strategic Framework below, which have been updated to reflect our new strategic intent.