On 22 February 2022, the Scottish Government published its latest COVID-19 strategy (its updated strategic framework). On the same day the First Minister warned that “Covid is still a public health risk” and “is likely to remain so for the foreseeable future, but also said that there was “increasing confidence in, our ability to achieve a sustainable return to a normal way of life”.
Back in the October 2020 Strategic Framework, the overall strategic aim, underpinning the approach was:
“…to suppress the virus to the lowest possible level and keep it there, while we strive to return to a more normal life for as many people as possible.”
Subsequently in the June 2021 Strategic Framework Update the strategic aim became
“…to suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future.”
Now, the latest framework describes the strategy as being
“To manage COVID-19 effectively, primarily through adaptations and health measures that strengthen our resilience and recovery, as we rebuild for a better future.”
This means that during this “calmer phase of the pandemic” the strategy is “less focussed on suppressing case numbers” (with much less reliance on legal requirements) and more on “reducing and mitigating harm”. The adaptations and health measures referred to include vaccinations, treatments, surveillance, “strengthening the resilience of health and social care generally”, and “adaptations to behaviours and physical environments”.
The framework also describes how, at any one time, Scotland could be placed in one of three broad threat levels (low/medium/high), with that decision being informed by evidence of the impact of the disease and the risk of infection. Illustrative packages of response to different threat levels are described as:
- routine adaptations to behaviours and settings
- baseline protective measures
- targeted protective measures,
- extensive protective measures.
The government maintains a considerable degree of flexibility in its future response and says:
“we cannot have a one size fits all response. For example, a new variant that is highly transmissible but of lower severity may represent less of a threat than one that is less transmissible but more severe. That is why setting fixed thresholds or triggers for action – e.g. a set number of cases per 100,000 population – would not be appropriate or helpful, as it would potentially result in either under or over reaction. Judgement about the nature and likely impact of any future risks will be key.”
The framework says that the current threat level is “medium” reflecting “a variant in Omicron that is highly transmissible (with the infection level still high) but of lower severity”. However, assuming infections fall/stabilise “it is likely that our ‘threat’ level will move down to “low” as we head into the spring and summer”, and the plan included the following milestones:
- 28 February 2022 – COVID certification scheme (vaccine passports) ceasing to be a legal requirement (app remains available).
- 21 March 2022 (indicative date, to be confirmed at preceding review) – the legal requirement to wear face coverings in public indoor places and on public transport will convert to guidance. Other remaining legal requirements will convert to guidance and good practice as appropriate.
What does this mean for parliamentary scrutiny?
As well as setting out the decision-making framework to tackle further outbreaks (as described above), the framework sets out a wide-ranging list of actions and policies.
Here are ten things coming up that MSPs may wish to look out for
1. A COVID-19 Outbreak Management Plan, which aims to set out the process and methods for responding to future outbreaks, (to be published spring 2022).
The government says this will:
“inform the response to an outbreak of a potentially dangerous variant of COVID19” …. [and it] will be supported by the use of existing and new and emerging testing and surveillance procedures to support early identification of future variants, including whole genome sequencing, wastewater surveillance, testing and contact tracing.”
2. Updated plans for Test and Protect for the endemic phase, and how to transition (detailed transition plan to be published in March)
The government says that “in order to move to this new Test and Protect approach we are developing a managed transition plan which will ensure that Scotland continues to have a proportionate and effective testing response and effective domestic and international surveillance infrastructure”. This is expected to include:
- the duration of the transition beyond the end of March.
- detail on surveillance capabilities that will remain long term;
- contingency infrastructure scalable if required in the event of a future variant; and
- continuing provision of testing.
The government is also reviewing the frequency of asymptomatic testing taking place within the health and social care workforces. In addition, it has asked the educational advisory subgroup for advice on lateral flow testing for schools and will update on the approach when this is available.
3. The Standing Committee on Pandemics to provide a report on improved preparedness for future pandemics, (interim recommendations by July 2022)
The government says it will then:
- use that report, and in due course, the outcomes of the Public Inquiry to inform our approach to surveillance, monitoring, diagnostics, vaccination and treatments
- work under the Common Framework on Public Health Protection and Health Security to strengthen coordination of public health and health security policies
- work across the four nations of the UK, and with the UKHSA and other international organisations to promote measures that increase biosecurity.
4. A data and reporting strategy (to be published in spring 2022)
The government says it will:
“… consider what evidence, data and analysis will be required going forward…. We are now identifying the key public reporting that needs to be retained and the frequency of publication. We will publish a data and reporting strategy in spring 2022 to support implementation of the Strategic Framework.”
The government is also exploring the establishment of a People’s Panel. “to enable us to explore the reality of personal responsibility and safer behaviours for people in a wide range of different circumstances.”
5. The next phase of the review of international travel measures will focus on what the response should be to the identification of a future variant of the virus
The government says this will include the definition of ‘fully vaccinated’ in an international context and the development of a border contingency toolkit being carried out by the UKHSA.
In late February/early March 2022 the government will look at alternatives to Managed Quarantine Service hotels for any travellers arriving from a country that is on the red list in future.
Longer term, the government will (on a four nations basis and with business/stakeholders) to move away from a ‘one-size-fits-all’ red list approach to a more agile set of contingency measures, and will also explore options to move away from relying on managed quarantine hotels to a home isolation model.
6. Vaccinations programme
On vaccinations, the government is working on a number of areas including:
- a delivery plan to offer vaccination to all 5 to 11 year olds, following by an additional booster to all adults over 75 years old, care home residents and everyone over 12 who is immunosuppressed
- efforts to ensure the vaccination programme reaches everyone
- planning for a number of different scenarios including an annual booster programme
- surge plans that could be rapidly deployed, if required
- a sustainable model for the delivery of COVID-19 vaccines alongside existing vaccination and immunisation programmes.
7. Work to support high risk groups, and adult care homes, and tackling racialised health inequalities, and local inequalities
For example, for high risk groups, the government says it will:
- provide further advice and information to support this group, particularly on issues related to mental health and loneliness;
- work with the Clinical Advisory Group, to provide support to those who no longer need to be on the list
- respond to scientific and clinical advice regarding COVID treatments
- look at ways to identify and support people who may be at highest risk
On adult health care this includes implementinga new healthcare framework led by the Clinical and Professional Advisory Group (CPAG) for adult social care, and a new sub group will look outcomes for people with learning disabilities.
To address inequalities the government is also carrying out further work to improve the collection and use of ethnicity data to better understand and address inequities in health access and outcomes for minority ethnic communities in Scotland. And, for example, the government is also “exploring how to wrap services around families and developing a model of family support based on integrated multi-disciplinary teams”
8. Work with employers, trade unions, and organisations on hybrid working
The government says it will “work with employer and business organisations and trades unions to understand the wider and longer-term impacts of hybrid and flexible working” and look at the “challenges and opportunities, the barriers to participation, the support available and recommended and where hybrid working supports our wider ambitions.”
9. Actions on Long Covid
The government says it aims to broaden its understanding of the long-term effects of infection, particularly the syndromes known as Long COVID, to improve treatments and outcomes. It will support the implementation of the UK-wide clinical guideline on the development of a strategic network.
10. Support for international vaccination, treatments and surveillance
For example, the government says it will
- Share Scotland’s experience in delivering a mass vaccination programme with the Governments of Malawi, Zambia and Rwanda.
- Provide COVID-19 medical supplies to partner countries
- Provide multilateral partners with assistance to ensure effective vaccine programming in our African partner countries, including a £1.5 million contribution to UNICEF
- Call for improvements in vaccine equity globally, fund support for equitable access to COVID-19 vaccines in Sub-Saharan African partner countries
For the latest COVID-19 statistics, timelines, explainers and updates, please check out the SPICe COVID hub
Simon Wakefield, Senior Researcher, SPICe