Coronavirus (COVID-19): vaccine deployment plan: update - March 2021
Update to the January 2021 plan setting out how we will roll out vaccinations in Scotland to vaccinate 4.5 million people. This plan was updated in July 2021.
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Next steps
The success and pace of the programme to date, and the collective effort, provide us with a strong platform as we move into the next steps of the programme. We are now also able to identify people in the remaining JCVI priority groups who have already been vaccinated because they also fall into another priority group (e.g. someone who is 60 but also a frontline health and social care worker). This means that the size of some of the remaining priority groups is smaller than we had initially estimated in our deployment plan in January.
At the time of publishing this update, we are making excellent progress towards the final stages of offering first doses to those in the initial 9 JCVI priority groups. The vaccination programme is currently moving through group 6 on the priority list which includes those with particular underlying health conditions, unpaid carers, and people experiencing homelessness and rough sleeping. The self-registration service for unpaid carers purposefully does not have a short cut-off date to ensure it is inclusive. Therefore, vaccinations for this group will continue as more unpaid carers register through the self-registration service. In order to ensure that all vaccine supply that is available to us is being used, first dose vaccinations are also underway for group 7 (people aged 60-64), group 8 (people aged 55-59) and group 9 (people aged 50-54), with people being invited for vaccinations in that order.
We are making sure there continues to be sufficient appointment capacity for those unpaid carers in group 6 who have yet to self-register, for outreach to people experiencing homelessness, and also any outstanding or new individuals who weren’t previously identified in groups 1 to 5, as vaccinations for groups 7, 8 and 9 proceed. This is to ensure that no one in the 9 JCVI priority groups is left behind in receiving their invite for vaccination. As part of our programme governance, this approach is reviewed and monitored on a weekly basis.
We are also making sure that there is sufficient appointment capacity to ensure that everyone who has had the first dose of vaccine receives the second dose of the same vaccine within the necessary time frame.
We continue to vaccinate as quickly as supply allows. This means that the speed at which we can invite people for vaccination depends on the availability of vaccine supply. Uncertainty and some variability with supply continue, and in response we are matching vaccination appointment numbers to the amount of vaccine we expect to have available. Our plans remain responsive so that we can rapidly flex the number of people called for vaccination, matched to our vaccine supply.
Given that our ability to invite people for vaccination is dependent on us receiving sufficient supply and there is the potential for this to fluctuate, NHS Inform continues to be the source of information about who is being invited to vaccination and when. NHS Inform is regularly updated to show the latest information. We are also continually communicating with Health Boards so that they have the latest information and can schedule appointments and carry out local communications and engagement accordingly.
Phase 2
Once we have offered vaccination to the 9 priority groups, we will move forward to begin offering vaccination appointments to adults aged under 50 who haven’t already been included in phase 1. This will be phase 2 of our vaccination programme.
Subject to supply, we are on track to have offered first doses to the remainder of the adult population who were not included in the 9 JCVI priority groups by the end of July, rather than September as we previously planned.
How we will prioritise in phase 2
The JCVI recently published their interim advice on how prioritisation in the next stage of the COVID-19 vaccination programme should happen. The JCVI has said that age remains the greatest risk factor in terms of serious outcomes from COVID-19, and that vaccinating as many people as possible as quickly as possible is the most important way to maximise public health benefits. The JCVI interim advice also provides that unvaccinated individuals who are at increased risk of severe outcomes from COVID-19 on account of their occupation, male sex, obesity or ethnic background are likely to be vaccinated most rapidly by an operationally simple vaccine strategy. They have said that operationally simple and easy-to-deliver programmes are necessary to achieve rapid deployment and high vaccine uptake and that an age based delivery model will facilitate rapid deployment.
The JCVI has therefore advised that phase 2 of the programme should be age-based, starting with the oldest adults first and continuing in the following order:
- all those aged 40 to 49 years
- all those aged 30 to 39 years
- all those aged 18 to 29 years
The JCVI’s advice is supported by evidence that the risk of hospitalisation and critical care admission with COVID-19 increases with age. Those at highest risk of hospitalisation outside of the JCVI priority 1 to 9 are those aged 40 to 49 years, and the risk reduces with reducing age.
We have considered this interim advice, and in phase 2 will continue prioritising people for vaccinations by age, in line with the JCVI advice.
This means that in phase 2, subject to the final advice given by the JCVI, we will be inviting adults under 50 who have not yet received the vaccine in age cohorts, as follows:
- all those aged 40 to 49 years
- all those aged 30 to 39 years
- all those aged 18 to 29 years
All 4 parts of the UK have said they will follow the recommended approach for phase 2 of the vaccine roll out, subject to the final advice given by the JCVI.
More details of the JCVI’s advice and the evidence they have considered can be found on the UK Government website.
A key priority for us as we continue through the programme is that we make every effort to ensure that younger people who may be at less risk themselves of severe outcomes from COVID-19 are encouraged and supported to take up the offer of vaccination – both the first and second doses.
Looking ahead
Vaccines are a critical part of suppressing the virus to the lowest possible level, both in order to save lives and also to allow us to gradually ease restrictions and return to a more normal life. The rapid progress with the vaccination programme provides all of us with firmer grounds for hope about the weeks and months ahead. It is not just the scale of the vaccination programme that is positive. What we are learning about its impact is also hugely encouraging.
Given the progress we have made in our vaccination programme, and the people of Scotland sticking to the wider protective measures we have in place, fewer people are contracting the virus and therefore fewer people are requiring hospital treatment. For example, one study (part of the EAVE II project) showed that, four weeks after receiving an initial vaccine dose, the Pfizer and Oxford-AstraZeneca vaccines reduced the risk of hospitalisation from COVID-19 by up to 85% and 94% of people respectively.
According to National Records of Scotland, at the time of publishing this update, the latest statistics show that for the eighth consecutive week there has been a reduction in the number of deaths involving COVID-19 (as at 21 March).
In addition, a recently published study by Public Health Scotland and the University of Glasgow shows promising findings that vaccination helps prevent people from passing on the COVID-19 virus (transmission). The study found that the rate of COVID-19 for people that live with healthcare workers is at least 30% lower when that healthcare worker has been vaccinated.
Despite this good news, we are still learning about exactly how effective vaccination is against COVID-19 disease and transmission, and the duration of immunity it might provide. The Public Health Scotland/University of Glasgow study on the reduction in the risk of transmission is extremely promising, but additional data on transmission impact are needed.
We know that the COVID-19 variant first identified in the UK is much more transmissible than the original variant. We also need to take careful note of other emerging variants of the COVID-19 virus and, in particular, how transmissible they are and to what extent the currently available vaccines are effective against them.
Vaccine developers and other stakeholders continue to work on understanding more about variants and the efficacy of the vaccines. It is also important that there is a regulatory approach ready to be implemented should virus mutations at any time mean that an update of already authorised vaccines is needed.
The Medicines and Healthcare products Regulatory Agency (MHRA) is the regulator in the UK that approves vaccines for supply and monitors their safety on a UK wide basis. The MHRA published guidance on 4 March 2021 which sets out what information the medicines regulators would need to approve any modifications to authorised COVID-19 vaccines, should mutations of the virus make them less effective.
The vaccination programme is one of three key ways we are working to control the virus, along with our expanded testing programme to identify cases and break chains of transmission and the important restrictions everyone in Scotland must follow. All these measures work to greatest effect when they work together.
It is therefore essential that, as our understanding of the effectiveness of vaccination against COVID-19 disease and transmission is developing, for now all of us continue to follow our current rules and guidance to suppress transmission of the virus. The latest information about current rules and guidance can be found on the Scottish Government website, which is updated regularly to make sure that the people of Scotland have the most up to date advice about what we all need to do to suppress transmission of the virus.
Will children under 16 ever receive the vaccines?
The JCVI has started to consider evidence on the risk of serious disease in children, the role children may play in transmission, and the safety and efficacy of COVID-19 vaccines in children. Following infection, almost all children will have asymptomatic infection or mild disease. There are limited data on vaccination in adolescents, with no data on vaccination in younger children at this time. As evidence becomes available it will be reviewed and advice offered as appropriate.
Currently the JCVI advises that only those children at very high risk of exposure and serious outcomes, such as older children with severe neuro-disabilities that require residential care, should be offered vaccination with either the Pfizer-BioNTech or the Oxford University/AstraZeneca vaccine. We look forward to considering any future JCVI advice and will continue to be guided by expert clinical advice as we move forwards.
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