VACCINES: BE PREPARED, HEALTH SECRETARY TELLS SCOTS

By Jeane Freeman,  Cabinet Secretary for Health and Sport

I am grateful for the opportunity to set out our current plans to deliver a programme of Covid-19 vaccination to everyone in Scotland who is over 18. As I will cover shortly, there remain some key areas where we have still to receive or confirm information, and I will continue to update members as information becomes available and our plan develops.

Last week, we all had the good news from Pfizer, and this week we had more good news from Moderna, as they both announced over 90 per cent effectiveness in phase 3 clinical trials of their vaccines. Those are just two of 12 vaccines that are undergoing phase 3 trials worldwide, including three involving clinical trials here in Scotland. Pfizer and Moderna will now share evidence from their trials with the regulatory and advisory bodies to allow clinical and scientific review, with advice then to each United Kingdom health department to determine on safety and effectiveness.

That is a critical point. I want to be clear to members and to people around Scotland that the safety of the Covid-19 vaccine is paramount to us.

The global scientific, research and pharmaceutical communities have come together and worked as never before. We have seen unprecedented investment worldwide in research, development and manufacture, volunteers around the world—including here in Scotland—taking part in clinical trials, and driven and dedicated research teams. That is why we are seeing the front-running vaccines delivered in months, rather than in the many years that vaccine development can sometimes take. It is impressive, but it is not at the expense of safety.

Each vaccine goes through a rigorous and independent three-phase testing process long before it can be licensed as safe and effective for use. Regulators such as the European Medicines Agency and the UK’s Medicines and Healthcare products Regulatory Agency review trial results and decide whether to approve the vaccine. During a pandemic, the time frames can be compressed, but never at the expense of safety.

Vaccinating the adult population—everyone aged over 18—in Scotland means vaccinating 4.4 million people. We have, rightly, worked across the four nations to secure the vaccines and secure agreement on the population share of the purchased doses for each of the UK nations.

From December, we expect to have the first delivery of vaccines to Scotland. We are planning on the basis both that the Joint Committee on Vaccination and Immunisation is able to review the clinical evidence and provide Governments with a recommendation, and that the vaccine receives a licence.

As I said, we are hopeful that, over the coming weeks into 2021, we will have more than one vaccine available to us, so that we can, with minimum delay, vaccinate as many people as possible as quickly as possible. However, I must be clear that there are a number of challenges and, at this point, unknowns to our delivery programme, which we hope will take from December to spring next year to complete in full.

The first of the unknowns is obviously the start date. We are ready for December, but the first available vaccine has yet to be approved, and supplies have yet to arrive. Thereafter, we need more vaccines to become available and we need to understand the delivery schedule for each.

The Pfizer vaccine has specific requirements in terms of transportation, storage and accessibility for use in certain settings. Other vaccines will have their own requirements, which might be similar to those of the Pfizer vaccine or might be different. It will be important to understand the differences to inform clinical advice about deployment. Our national plan has to be able to adapt to accommodate different requirements.

A vaccine must be used in a way that ensures that those who are most in need of protection receive that protection first, so our planning will be informed by the independent scientific and clinical advice of the Joint Committee on Vaccination and Immunisation. The JCVI has already offered interim advice on prioritisation, which we have used in our planning for the early but limited vaccine supply that we expect to receive.

In the first wave of our plan, from December through to February, we will vaccinate front-line health and social care staff; older residents in care homes and care home staff; all those aged 80 and over; unpaid carers and personal assistants; and those who will be delivering the vaccination programme. The current interim advice from the JCVI is that we then work through those aged over 65 and those aged under 65 who are at additional clinical risk, followed by the wider population.

This is a national vaccination programme that sets out clearly the parameters within which our national health service boards will lead local delivery. Nationally, we will set out the policy direction and the delivery framework, accompanied by guidance and information for those at the front line. We will develop and deploy a national workforce model; provide national training; undertake procurement and logistics work; provide national information and advice; create tools to record data about vaccinations, so that they are on people’s medical records; and, from phase 2, provide a national booking service.

National health service boards will then lead local delivery, identifying acceptable and accessible locations both for mass vaccination and for local access, taking population and geography into account. They will undertake recruitment and deployment of staff and the management of local vaccination clinics.

Over the coming weeks and months, we will be sending information to everyone across Scotland explaining what the vaccine is, how we are prioritising who gets it, what to expect when vaccinated and so on. Those in the first wave of the programme will be contacted during December and January either by mail or, for health and social care workers, by their employer. They will be told where they will receive their vaccine, how to make an appointment and what they need to know.

In truth, the programme is a major public service exercise. We need the expertise and resources that our local authorities, community planning partnerships and the third sector can bring, and we need locations—both fixed and mobile—so that we can make the mass vaccination programme as accessible as possible wherever someone lives in Scotland and whatever their circumstances.

We need a workforce that is diverse in its skills and availability. Our planning assumption is that we will need over 2,000 vaccinators and support staff by the end of January, so that—vaccine availability and delivery schedules yet to be confirmed—we will be able to vaccinate around 1 million people by that time.

We need registered clinicians to vaccinate and to supervise vaccinations, as well as nurses and doctors, but also the wider clinical workforce such as pharmacists, dentists and optometrists. We have now concluded an agreement with the British Medical Association on terms and conditions for general practitioners’ involvement in the programme and are working through agreements with other independent NHS contractors.

However, we also need a workforce that understands the importance of logistics, minute planning for delivery, location set-up and building, and Covid-safe locations, as well as the importance of data collection and performance management. Scotland has an excellent track record on vaccinations, but this will be one of the biggest civilian logistical challenges in our lifetime, so we have strengthened our NHS planning teams, engaging with local authorities, local resilience partnerships and the military.

We know from the beginning of the pandemic, when the military assisted in the delivery of NHS Louisa Jordan and the deployment of testing sites, that they bring real value to supporting our efforts. With so many vaccines in phase 3 clinical trials, there is the potential for multiple vaccines to be available over the next 12 months and it is possible that those will have different characteristics that impact on how they are stored, handled and delivered. That requires real logistical expertise from one organisation that can cover the whole country, so I am grateful that the military have responded once again and stand ready to bolster our planning, bringing with them a wealth of logistical and operational expertise.

It is important to be clear about what we do not yet know. We do not know which vaccines will be approved for use and when doses of those vaccines will reach us. We do not yet have information about all the vaccine characteristics; for instance, we do not yet know whether the Pfizer vaccine will be approved for transportation beyond the ultra-cold temperature that is currently being used, in order to allow us to vaccinate in multiple smaller locations such as GP practices and care homes. Although we have some welcome news on the efficacy of the Pfizer vaccine from the trials, we do not know whether it will stop a person from getting the virus, from passing it on or will prevent the virus from causing serious harm.

It may take many months before we fully understand the level of protection on transmission and the impact on reducing the severity of the illness that is caused by the virus. We know that the first vaccines will require two doses, three to four weeks apart. It is possible that further booster doses, and even an annual programme, may be required, given that we do not know how long any protection will last. For now, the important thing is that, when we start to deliver the first vaccines, it will be on the basis that they offer some form of protection, even if we do not know at this stage how much protection that is.

It will be safe, so when we get in touch, please go for the vaccine. It offers you a level of protection that we do not have through any other means. If you are not in the first group that is called, you should please be patient. I know that you will understand how important it is that we protect first those who are most vulnerable to serious illness and death.

A safe and effective vaccine brings hope. It gives us all encouragement that where we are now will end. However, right now, we all have to keep following the necessary restrictions, tough though I know they are, and keep washing our hands, wearing face coverings and keeping a 2m distance. That is how we protect ourselves, our loved ones and our NHS, while science brings us hope.

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