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There are powers to enforce in other parts of the system. The professional regulatory bodies can take action and the police can take action if there is a police concern. A number of different bodies other than the commissioner can ensure that enforcement occurs, should it be needed. The key point in relation to the commissioner is for the system to learn lessons. We have a responsibility there.

If we think of the big issues that have been raised with us—for example, by mesh-injured women, the valproate families and infected blood people—those people were asking for a long time for their story to be heard and for inquiries and explanations to be made. They did not necessarily want blame to be apportioned; in fact, the infected blood people were very keen simply to have an apology and an acknowledgement. Ensuring that the system learns, and that issues are picked up and dealt with, is really very powerful, because we can see so many examples of where that has not happened in the past.

I think that people should have confidence that that work is on-going. It cannot happen overnight, and nobody has a magic wand, but it is on-going. The thing to try to communicate is that we are in a very different place from where we were at the start of the pandemic, in that we have a really effective vaccine. I am a pharmacist. It is perhaps a little hard for people to understand that, despite the fact that the vaccine does not prevent transmission, it is really effective. It does not prevent you from catching the illness but it has taken away the death and serious illness. We are not seeing the level of hospitalisation that we had, and we are certainly not seeing the level of mortality that we had. The vaccine is incredibly effective and has transformed the situation.

The people who are not responding well to the vaccine are largely people whose immune systems do not make antibodies when they are vaccinated. That is why there is the evolution in the groups who are particularly at risk. It is why people who we thought were at risk pre-vaccine, such as people with COPD, are less likely to be in the high-risk groups now, because their immune systems work well. People’s immune systems are less effective at 81 years old, but they are not immunosuppressed in the same way as people who have had organ transplants are, for example.

The other tool that we have in the box that has transformed things is antiviral medications. People who are eligible for those medications know who they are and how to get them. Wherever those people are in the country, they know that there is information on NHS Inform. They can find the phone number of their health board and telephone if they test positive. As long as they are in that eligible group and within the first five days of illness, they can get the antiviral drugs. Even for the people for whom we know the vaccine is less effective, we have treatments that can reduce the risks from the virus.

We are not in the same situation that we were in before, and none of us has forgotten about the people who are severely impacted. One challenge is communicating to that particular group how important it is for them to protect themselves and keep safe. Using words such as “vulnerable” makes people feel ill and vulnerable, but it had to be communicated in that way—there is a tension. When I used to work in mental health, I had to work hard with the patients whom I worked with to help them to understand that they were ill. Once they understood that they were ill, they were motivated to take their medication.

It is a good and healthy thing if we feel healthy, and the understanding that you are not healthy, or that you are at risk or vulnerable, has quite a profound impact on people. We find that people are struggling a little to recover from that feeling of vulnerability, which is perfectly understandable. I think that nearly all of us—every human being in Scotland—has felt more vulnerable, and it is hard to remind ourselves that the situation today is very different from the situation that we faced in March 2020.

I think that Dr Audrey MacDougall, as our superb data scientist, is keen to contribute, as well.

I think that Linda Bauld has already talked about the independent fact-checking service.

I would love it if children were more interested in science, and I think that we are seeing that. People are inspired by folk like Linda Bauld and Jason Leitch, who have been on our television screens—

Again, I will let Linda Bauld say a little bit more about that. One of the challenges for Government is that countering disinformation can validate it. There are some suggestions that tackling it head on is more dangerous than leaving it to rumble on and finding your own way to reach the groups who are susceptible to that.

Our work on collecting ethnic data relating to vaccination and identifying uptake, including low uptake, in particular communities has enabled us to change course and to do different things for those communities. We had our general vaccine communication, which was targeted at the whole population, but we had specific ways of approaching and outreaching into those communities where uptake was low.

I will give an example of that. Last week, I met Gypsy Traveller community health workers. In many ways, the Gypsy Traveller community is either hard to reach or we make it difficult for them to engage with our healthcare system. Having those trusted members of their community helping to push public health messages is a much more successful way of reaching that community and ensuring that we engage them with healthy behaviours and those offers. That is far more successful than a media campaign, for example. I will let Linda Bauld say more.

We are preparing a plan for that. We have learned a great deal during the pandemic about how to do that in a way that does not impact on the rest of the NHS. Most NHS boards have built up vaccination teams and vaccination plans. Over the past year or two, given how vaccines are now being delivered, people are finding that different vaccines are being done at different rates and in different places. For example, people are getting their flu vaccine in a different way—that has moved largely out of general practices and into health board centres.

We are absolutely aware of the challenge for the teams on the ground. I am a pharmacist by profession. If I think back to the course of the pandemic, we did not even know what the virus was when we were hit by it. In a year, we had a vaccine. I looked at that vaccine and thought, “Oh, my goodness, it comes in a multidose vial. It needs to be reconstituted and—good grief!—it needs to be stored at minus 70 degrees. How on earth will we manage that logistically? How will we get that into people’s arms?”

That complexity has continued to evolve. We now have multiple different vaccines. We have different ages eligible, which brings in different doses. We have people in the community with different needs. For example, people with severe immunosuppression are getting more vaccines than the general population, because their immune response is suppressed.

There is massive complexity in the vaccination programme, but we have done an amazing job in Scotland in rising to each and every one of the challenges. I was in absolute awe. Last December, I remember when omicron hit and we thought—like Brenda in that famous clip—“Not another one!”. It just seemed incredible that we were facing, in the depths of winter, when everybody was looking forward to Christmas together, yet another variant and that need to get boosted by the bells at new year. It was the most phenomenal effort and response from our NHS and our teams.

I volunteered at a vaccine centre during the previous winter. People came out of retirement to help. I did not go through the training to vaccinate; I was just helping out with managing crowds. Jason Leitch has been vaccinating. People from Public Health Scotland have come forward and joined and the vaccinating team. It is just remarkable how our health professionals have answered the call. It is also remarkable how our communities have answered the call, because vaccines do not work unless people get them into their arms.

If I think about the levels of vaccination that we have achieved in Scotland, it is absolutely incredible for a vaccine that is not mandatory and that has had to be delivered at pace in a changing environment for a brand-new virus. There is no doubt that we have learned a great deal from each and every challenge that we have faced throughout the pandemic.

I think that it is inevitable that, in a global pandemic, people will feel a little bit frightened and lack confidence, frankly. The thing to communicate about how the vaccines were developed is that no stages in development were skipped. What happened was that Governments underwrote the development and took the risk out of it for drug companies so that the trials that are required—the different phases of clinical trials—happened simultaneously instead of one after the other. Normally, in drug development, those things take up to 10 years because an early trial is followed by a trial on humans and a trial for efficacy and so on, with those stages happening one after the other and an assessment being carried out between each stage to see whether the vaccine seems to work. Because we needed the vaccine so quickly, there was a high risk of putting a lot of money into something that would not work, which drug companies do not want to do. Therefore, the risk was largely underwritten by Governments and those trials were able to happen simultaneously. No steps were skipped, and it is really important that the population understands that.

On the yellow card surveillance, there are surveillance schemes all around the world. The yellow card surveillance scheme is the one that is run by the MHRA. Post-marketing surveillance is absolutely vital when any new drug is developed and used in a population, as it gives us information. As Jason Leitch says, it does not establish causality but we get information on a population-wide level of what things might happen when a new drug is used. When new drugs are launched into the population, every side effect is reported through the yellow card scheme. There are ways that individuals themselves can submit a yellow card report, or their medical team can do it—there are loads of routes into that. What happens is that you gather a huge amount of information. What we have seen is that that level of analysis of that information has happened at absolutely remarkable pace. Of course, this is happening all around the world. The whole world is being vaccinated and we are learning globally. From all of that global data, we are getting a good idea of how to use the vaccines safely and effectively in the population.

The example that Linda Bauld gave of the changing picture for pregnant women is a good example of understanding. Rarely are drugs tested in pregnant women, for obvious reasons, so, when new drugs are launched, it is difficult to say definitively that they are safe in pregnant women. However, the vaccines were used worldwide and millions of pregnant women have now had those vaccines. That data is collected and analysed and used to refine the offer and make it even safer and more effective as we go on. It is really remarkable. I hope that that level of global scientific collaboration continues beyond this particular emergency.

Professor Leitch will be able to give you more detail, but we are watching the numbers closely. The numbers are rising. That was expected, actually; it was not unexpected. We anticipate that we will face rising then waning numbers of cases of Covid for some years to come. My experts tell us that we are about halfway through the pandemic; we are not at the end of it, as some people might perceive. I will let Professor Jason Leitch give you much more detail.

Can you believe that even I will possibly be eligible? [Laughter.]

See—I did not remember that one, although “Hands, face, space” is a very simple three-word message that science would say is an easy thing for people to remember and to understand.

To be honest, though, with either of those, people would know that it meant that they had to do something. They might not remember the specific phrases, but we see even now, two and a half years into the pandemic, that people know and understand the non-pharmaceutical interventions that they can deploy to keep themselves and others safe, which the information was about. We now hear people talking about whether they should be wearing face coverings again. Everybody is washing and gelling their hands much more routinely than they did pre-pandemic and they know that keeping their distance is a way to keep themselves safe. People know that being outside is a way to keep themselves safe and they know that ventilation is helpful. Lots of people know the behaviours that they need to adopt to keep themselves safe, which I think is an important measure of the success of the information campaigns.