UK Covid-19 Inquiry Module 4 report: Scottish Government response

Recommendation 2 – Formalise work with communities about vaccine equity strategies

Chair’s recommendation:

The UK Government, Scottish Government, Welsh Government and Northern Ireland Executive should maintain networks with local communities to produce targeted vaccination strategies and communications.

To achieve this:

• The Scottish Government, Welsh Government and Northern Ireland Executive should establish local community networks, mirroring the approach being taken by the UK Health Security Agency.
• All four governments should work with their network to identify specific and measurable actions to improve vaccine uptake and reduce inequalities and consult with these networks on communications campaigns and delivery approaches.
• All four governments should publish a report annually on progress against these actions.

Scottish Government response:

The Scottish Government accepts this recommendation.

The Scottish Government recognises the Inquiry's finding that, while Scotland's Covid-19 vaccination programme achieved high levels of uptake overall, disparities remained across some communities and population groups.

We agree that sustained engagement with communities is essential to reducing health inequalities, improving vaccine confidence, and ensuring equitable access to vaccination programmes in both routine immunisation programmes and future public health emergencies.

We believe that responsibility for the establishment and management of those relationships should sit with the Scottish Vaccination & Immunisation Programme (SVIP), which is led by Public Health Scotland (PHS), but encompasses representation from the Scottish Government, NHS Boards, local authorities, the third sector and community organisations.

SVIP was formally launched in January 2024, with PHS taking on the role of senior responsible officer (SRO) with national leadership and coordination remit for delivery of all vaccination programmes in Scotland. PHS are resourced for this function by the Scottish Government.

Throughout the pandemic, Scotland adopted targeted approaches to improve vaccine uptake among underserved communities, including minority ethnic groups, people experiencing deprivation, faith organisations, disabled people, and others facing barriers to access. These approaches demonstrated the value of trusted community relationships and locally tailored communication and delivery models and CIREG members’ feedback highlighted the critical and essential role these relationships and organisations should play in any future whole-system civil emergency.

The Scottish Government already works closely with PHS, NHS Boards, local authorities, the third sector and community organisations to support equitable vaccine delivery. We agree that these relationships should be maintained and strengthened between public health emergencies, building on existing structures and avoiding duplication of established local engagement mechanisms.

The objectives of this recommendation align closely with the SVIP’s 5-Year Vaccination and Immunisation Framework and Delivery Plan, published in November 2024, which places equity, community engagement and public confidence at the heart of Scotland's vaccination programme.

The Framework sets out goals to improve impact, reduce inequalities, and reduce illness from vaccine-preventable disease, and also commits to ensuring timely and equitable access to vaccination, addressing barriers faced by underserved communities, and improving public engagement through the SVIP.

In taking forward this recommendation, the Scottish Government will continue to build on existing arrangements through the Framework and Delivery Plan, including:

• Strengthening partnerships with local communities, third sector organisations, community leaders and NHS Boards to better understand and address barriers to vaccination.
• Using population health intelligence and local insight to identify communities with lower uptake and develop targeted interventions to reduce inequalities.
• Initial work is being undertaken to recognise the individual needs of protected characteristics and underserved groups in relation to vaccine accessibility and equity. This includes burden of disease and vaccine uptake data, some of which is focussing on certain disabilities, and learning disabilities.
• Improving vaccine confidence through ongoing engagement and evidence-based conversations about vaccination.
• Supporting a whole-system approach that mobilises the wider health and care workforce to promote vaccination and improve access.
• Monitoring vaccine uptake and inequalities through SVIP and using this information to inform local and national improvement activity.

Annual reporting

To support this work, PHS began reporting childhood immunisation data by ethnicity and urban-rural classification in 2024. PHS has been publishing ethnicity and urban-rurality data for adult vaccines since the pandemic. It has now been rolled out across all vaccination areas subsequently and it is now standard to have a suite of equality breakdowns (e.g. by deprivation, ethnicity, urban-rurality, age, sex) in our uptake statistics.

In addition, more granular data is provided to stakeholders through the password protected platform (Discovery) for management information, local situation awareness, and local action.

PHS publishes an annual ‘Vaccination and Immunisation report’ that encompasses all programmes, as well as standalone reports for individual programmes that can be accessed via their ‘Publications’ page. PHS also report regular vaccine inequality data through its Vaccination Surveillance Dashboard. PHS also contribute to UK-wide reports, such as the ‘Influenza in the UK, annual epidemiological report’ published by the UK Health and Security Agency (UKHSA). We believe that the publications above meet the recommendation to publish an annual report.

Local Community Networks

PHS has a commitment to strengthen multi-sector stakeholder engagement with statutory, third sector, community, religious, workforce and other partners to increase support for vaccination within their networks. Engagement with organisations such as the Health and Social Care Alliance Scotland and Voluntary Health Scotland is well established, and partnerships are being expanded with organisations including the Scottish Refugee Council, Deep End GPs, Community Links Workers and charities representing ethnic minority communities, faith groups, LGBTQ+ communities, people with disabilities and those with specific health conditions.

Engagement with third sector partners has highlighted financial and capacity challenges and the importance of working through existing community networks rather than creating new vaccine-specific structures. Partners have also emphasised the need to build trust by addressing the wider issues affecting communities, including poverty, racism and exclusion.

Stakeholder feedback, including from CIREG members, has also highlighted the need for greater focus on people with learning disabilities and other disabled groups. PHS has undertaken initial engagement with relevant charities and support organisations to better understand barriers to vaccination and identify opportunities to improve uptake. This included a survey and workshop with charities representing people with disabilities, long-term conditions and older adults; research with primary and secondary care professionals, and a winter vaccines stakeholder webinar to raise awareness of the 2026 programme and encourage uptake among those most at risk. Further, PHS have been working with Scottish Government and the Adult Learning Disabilities - Annual Health Checks Implementation Group to support improved content on vaccinations.

Healthcare professionals remain among the most trusted sources of vaccine information. PHS has commissioned qualitative research with primary and secondary care professionals to explore the acceptability and feasibility of recommending vaccination across different care pathways. Early findings indicate knowledge and confidence gaps among healthcare professionals who do not routinely deliver vaccinations, and recommendations will be considered through SVIP governance structures during 2026.

Public Services Delivery Scotland (PSD Scotland) leads national workforce education on behalf of SVIP and has developed resources including:

• Vaccine Conversations
• Combatting False Vaccine Information
• Inclusive Vaccination Practice

In addition, the SVIP Workforce Engagement and Development Sub-group is mapping the wider health and care workforce to support a "make every contact count" approach to vaccination promotion.

Four Nations Partnerships

The four nations address questions on equity in multiple forums, but in 2023 the nations, convened by UKHSA, participated in a UK Four Nations Forum to consider factors contributing to declining uptake in some routine immunisation programmes and increasing inequalities across the UK. Its report was published in March 2026, an equity strategy subgroup of the forum is being established to support co-ordination and shared learning across the 4 nations in response to declining coverage and increasing inequalities in routine immunisation programmes.

UKHSA have also begun to incorporate Scottish participants into its attitudinal and insight surveys for the first time, which should support greater co-ordination and coherence.

Communication strategies

PHS is committed to adopting an audience-first approach to vaccine communications, using insight to understand and address barriers to uptake within specific groups. Working with NHS Boards and community partners, PHS develops clear, accessible and evidence-based vaccine information, supports informed decision-making, works with trusted voices to reach groups with lower uptake, and evaluates the effectiveness of communications activity to support continuous improvement.

Work to support the aims of this recommendation is already well established in Scotland. Scotland's Population Health Framework (June 2025) sets the Scottish Government and COSLA’s long-term collective approach to improving health and reducing inequalities, recognising the role of prevention, including vaccination. Public bodies are also progressing towards becoming Public Health Organisations, embedding prevention and reducing inequalities across health and social care services.

Health Information Integrity Strategy

The Scottish Government's Health Information Integrity Strategy (October 2025) provides a framework for addressing false and misleading health information, recognising its potential impact on health inequalities and vaccine confidence. Delivery of vaccination-related actions under the Strategy is being taken forward through SVIP's Citizen Engagement Group.

Alongside this work, Scotland is continuing to strengthen and streamline vaccination data systems, including the collection, reporting and analysis of equality data, to support evidence-based improvements to vaccination services and reduce inequalities in uptake.

We also recognise the importance of collaboration across the four nations to share evidence and learning on effective approaches to increasing vaccine confidence and uptake among populations experiencing health inequalities. This will support a more resilient and equitable vaccination system for future pandemics and routine immunisation programmes. There are already examples of collaboration in four nation forums, including some vaccine programme specific groups, as well as the UK Forum on declining coverage and increasing inequalities across the routine immunisation programmes 2023-2025. In this, the four UK public health agencies explored factors that may be contributing to the continuing declining trend in immunisation uptake for some programmes together with increasing inequalities, which had occurred within all nations of the UK over the last decade.

We will work with colleagues across the four nations to ascertain the value of establishing a formal group to share evidence and best practice, beyond those that currently exist.

Actions and implementation timescale(s)

• PHS, in collaboration with the Scottish Government, NHS Boards and the third sector, leads a Citizen Engagement workstream focused on reducing inequalities. Current priorities include strengthening stakeholder engagement, developing trusted community voices, particularly in relation to deprivation and ethnicity, and supporting a consistent approach to communications and marketing activities. The workstream is also finalising an action plan for combatting false health information in relation to vaccination. The action plan will be presented to the SVIP Strategy Board for approval at the December 2026 meeting.
• PHS is developing a stakeholder map and engagement plan for SVIP, covering the four delivery groups (Maternity, Children and Young People, Adults, and Selective and Non-Routine programmes) alongside third sector organisations supporting people experiencing inequalities throughout their lives. The stakeholder maps will be live documents which will be constantly added to and updated. They are intended as internal documents for use within SVIP.
• To support community engagement, PHS has secured funding for 2026-27 to commission third sector organisations to co-produce vaccination information resources for communities with lower vaccine uptake. PHS, with support from the Scottish Government, are also increasing their engagement with COSLA, to facilitate greater collaborative working with Local Authorities in areas such as school vaccination programmes, and increasing flu vaccine uptake for non-NHS frontline health and social care workers.

Accountable Officer:

The Director General for Health and Social Care, working with the Population Health Directorate within the Scottish Government and Public Health Scotland through the SVIP, will be accountable for the implementation of the Scottish elements of this recommendation.