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

Recommendation 3 – Improve monitoring and evaluation of vaccine uptake and delivery

Chair’s recommendation:

Each of the four UK public health or health security agencies should work together to:

• Maintain accurate, UK-wide insight into the state of vaccine uptake and hesitancy; and
• Understand the measures proven to be effective in increasing uptake across the four nations of the UK.

There should be collaboration and some standardisation in the agreed approach across the four nations for monitoring and publishing routine vaccine uptake and vaccine confidence levels to better understand regional variations and patterns. Each nation should set and regularly review its minimum acceptable standards of vaccine uptake, which would trigger targeted uptake campaigns if not reached.

The effectiveness of vaccine uptake campaigns should be evaluated against clear, standardised measures. This includes retrospective analysis of the Covid-19 uptake campaigns, as well as evaluation of routine vaccination uptake campaigns.

Scottish Government response:

The Scottish Government accepts this recommendation in principle.

The Scottish Government agrees that robust monitoring, evaluation and reporting arrangements are essential to understanding vaccine uptake, identifying inequalities, addressing vaccine hesitancy and informing targeted interventions. We also recognise the value of collaboration and standardisation across the four nations to strengthen the evidence base on vaccine confidence and uptake and to support preparedness for future public health emergencies.

Scotland already maintains comprehensive systems for monitoring vaccine uptake through PHS and PSD Scotland. Vaccine uptake data are routinely collected, analysed and published across all national immunisation programmes, providing insight into coverage levels, demographic variation and inequalities in uptake. PHS also undertakes surveillance, analysis and research activities to inform service improvement and targeted action where lower uptake is identified.

The aims of this recommendation align closely with Scotland's 5-Year Vaccination and Immunisation Framework and Delivery Plan (2024-2029), which emphasises the importance of population health intelligence, reducing inequalities, improving equitable access to vaccination and using evidence to drive continuous improvement. The Framework commits partners across the SVIP to using data and insights to inform the design and delivery of vaccination services and to better understand barriers to uptake among different groups and communities.

SVIP are able to undertake large linkage studies using national datasets to investigate epidemiological and operational questions, to help inform, measure impact, evaluate and improve vaccine programmes.

A considerable number of large, national linkage studies have been undertaken since improvements to vaccination data and data structure at the beginning of the pandemic. These studies include measuring impact of vaccination programmes (e.g. effectiveness and safety) which provide evidence to support informed consent and decision making, and improvements to operational delivery, across immunisation programmes.

A key element of Scotland's approach to improving the monitoring and evaluation of vaccine uptake is the ongoing digital transformation of the SVIP. A multi-year programme is underway to modernise and expand Scotland's vaccination digital infrastructure, with the aim of delivering a lifelong national vaccination record and a more integrated digital experience for citizens and healthcare professionals. This will improve the quality, completeness and accessibility of vaccination data, enhancing interoperability across NHS systems, and strengthening Scotland's ability to monitor uptake, understand inequalities, evaluate interventions and support operational delivery.

Through implementation of the Framework, the Scottish Government will continue to work with PHS, NHS Boards and UK partners to:

• Maintain and enhance surveillance of vaccine uptake and confidence levels across Scotland;
• Strengthen understanding of inequalities in uptake and identify groups and communities that may benefit from targeted interventions;
• Use data, insight and evaluation findings to support evidence-based approaches to increasing vaccine confidence and uptake;
• Evaluate vaccination campaigns and improvement initiatives, using agreed measures where appropriate, to assess effectiveness and inform future policy and delivery;
• Share learning and evaluation findings publicly, where appropriate, to support transparency and build confidence in vaccination; and
• Work across the four nations to identify and share effective approaches to improving vaccination coverage and addressing vaccine hesitancy.

The Scottish Government supports ongoing collaboration between the public health agencies of the four nations to improve comparability of data and to develop a shared understanding of vaccine uptake trends, vaccine confidence and the effectiveness of interventions. While recognising that each nation operates within its own health system and data landscape, as well as responding to specific demographic and geographical realities, we agree that there is value in pursuing greater consistency where appropriate to support collective learning and pandemic preparedness.

The Scottish Government is currently considering the recommendation around the retrospective analysis of the Covid-19 uptake campaigns. Multiple analyses of various stages of the Covid-19 programme were undertaken during the pandemic and pandemic recovery phases and the learning from those analyses forms the genesis of most of the quality improvement work that has been completed and is underway. The Scottish Government and SVIP undertakes continual analysis of vaccine programmes, which informs quality improvement work at a national and local level.

Actions and implementation timescale(s)

• The Scottish Government will implement this recommendation through Scotland’s 5-Year Vaccination and Immunisation Framework and Delivery Plan, which runs to 2029. PHS will continue to develop its routine monitoring and publication of vaccine uptake data, alongside research and evaluation to improve understanding of vaccine confidence, inequalities and the effectiveness of interventions.
• During 2026-27, the SVIP Quality Improvement, Indicators and Standards Group will develop a Vaccination Reporting Framework to strengthen assurance and oversight of vaccination standards, indicators and improvement activity. This is expected to be published during Spring 2027.
• SVIP is also developing a Data & Intelligence Framework, setting out data and intelligence needs over the next 5 years. This is expected to be published during Spring 2027.
• The multi-year transformation of Scotland’s vaccination digital infrastructure is already underway. The first phase, running to 2027, will stabilise and strengthen existing systems, with the subsequent phase running from 2027 to 2032 to deliver a lifelong national vaccination record, improved data and greater integration across the wider NHS digital landscape. The business case for this subsequent development phase is due for delivery in 2026/27, and therefore further detail on milestones will be available in future updates to the Inquiry.
• The Scottish Government and PHS will also continue to work with four-nations partners to improve the comparability of vaccine uptake and confidence data and develop more consistent approaches to evaluating vaccination campaigns.

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.