Coronavirus (COVID-19) advice for people on the Highest Risk List: evidence review

This report presents key evidence underpinning our advice to people on Scotland's highest risk (formerly shielding) list.

Medical specialists consultation and feedback for the review

8. Throughout the COVID-19 pandemic the Scottish Government regularly consulted with medical experts to seek their clinical perspective and views in order to support the continuation of safe, effective, person-centred and sustainable advice for people on the Highest Risk List. These experts recognise:

  • Vaccination has been a critical component in preventing severe illness and death associated with COVID-19, including for those at highest risk
  • The availability and effectiveness of new treatments such as antivirals and monoclonal antibodies mean we are now able to take a different approach to supporting those at highest risk
  • Death rates as a result of COVID-19 amongst people on the Highest Risk List are now significantly lower
  • There is now a far better understanding of the impact of COVID-19 on those with specific clinical conditions and the risk factors that may put someone at increased risk of becoming seriously unwell from COVID-19
  • Asking people to isolate away from friends, family and society in general had a substantial negative impact on people psychologically and socially
  • Evidence clearly points to the reduced clinical risk for the majority of people on the Highest Risk List, however, there are people who continue to have a higher risk from COVID-19 post vaccination, primarily people whose immune systems are suppressed or compromised due to a health condition or treatment
  • Consideration should be given to ways of identification and support in the future for people who may continue to be at highest risk, taking into account potential new variants and emerging evidence

8.1 As part of those ongoing discussions for the Highest Risk List, the Scottish Government and medical experts considered the data and agreed it reasonable to now retire the Highest Risk List. They went on to add:

  • Asking people on the Highest Risk List to follow the general population advice, unless otherwise stated by their GP and clinician, is appropriate
  • A future identification process is needed to allow for the rapid identification of individuals to be prioritised for vaccination, for treatments and, if the threat level increases, for additional protective advice
  • Clear communication on the change is needed to ensure individuals have a clear understanding of the reasons for retiring the Highest Risk List

Review of groups

9. A systematic approach was taken to reviewing the information available resulting in the retiring of the Highest Risk List and taking account of the needs for support for those individuals who have a residual risk post-vaccination. A full summary of the review of groups is included in Annex C.

9.1 The general principles below informed the review and provide a clear path to retiring the Highest Risk List.

is informed by the best available evidence.

uses data which monitors trends and supports progress.

is understood by people on the HRL, clinicians and providers of secondary and third care and support, through a clear communication strategy detailing the rational for retiring the list, including ongoing support available.

is informed by residual post vaccination risk.

shifts the approach from broad universal measures and actions to strategies targeted towards newly defined higher risk group/s.



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