Seòmar agus comataidhean

Certainly. Thank you for the opportunity to discuss the Scottish Government’s communication of public health information.

Communication was at the heart of our response to the pandemic. Our overarching communication aims were to reach the entire population of Scotland as many times as possible in the most cost-effective way, with accessible information that was easily understood and which motivated people to stay safe and to protect others. The challenges were significant, in that the situation was changing constantly. Information was often complex and sensitive, and there were risks around overload and confusion, particularly when the measures and messaging were different from those of the United Kingdom Government.

Behavioural science was, and continues to be, central to our approach to all pandemic-related communications activity. Alongside the significant behavioural asks that were identified by medical and other experts, our understanding of the factors that inform behaviour change among the population has been essential in delivering effective public health messaging.

As well as drawing on behavioural science best practice, we undertook our own research to strengthen our insights and understanding. Specifically, we sought to understand people’s attitudes, awareness and motivations related to Covid.

We also looked to identify barriers that people had to adopting important public health behaviours. We used that evidence to develop our messaging across a range of media channels to ensure that different audiences and population groups were reached.

I turn briefly to the work that we did to drive vaccine uptake as one specific example of how we targeted our messages to help us to achieve the public health goals. We have ensured that all our Covid-19 vaccination communications are suitable for everyone in Scotland, with tailored messages, where necessary, to reach specific groups. We have translated vaccine information into multiple languages and provided it in a range of formats on NHS Inform.

We also developed a culturally sensitive vaccine explainer video, which was informed by insights from organisations that represent various communities across government.

Equally important is that we worked, and continue to work, with health boards and other partners to encourage uptake, particularly where it is low in specific communities. Our approach is informed by the evidence, including Public Health Scotland’s equality data, which gives a breakdown of vaccination uptake by ethnicity and by deprivation.

We have sought to build trust, and to remove barriers for people who might not otherwise take up the vaccination, through a range of outreach activity and partnerships with local authorities, and community and third sector organisations. The research that was published yesterday shows that people welcomed having a local and more flexible service when they were considering vaccination.

Just as our approach to public communications was influenced by behavioural science and insight, our communications were informed by the science of the pandemic and how to fight Covid. That has meant that rapid access to the evidence and expertise across a range of disciplines and organisations has been vital throughout.

Just as the science behind our understanding of the pandemic constantly evolved, so too did our approach to how we commissioned and considered scientific advice. For example, we established the Covid-19 advisory group and sub-groups, which have brought together experts from a range of disciplines and organisations, including universities, Public Health Scotland, National Services Scotland and Scottish Government advisers.

The chief medical officer and the chief scientific adviser for Scotland also led a new network of our science and evidence-related chief advisers to share information across their specialisms. That has delivered a holistic approach to commissioning and co-ordination of scientific evidence.

I look forward to this morning’s discussion, and am happy to answer questions from the committee.

Jason Leitch will probably give you a fuller answer on that, but the sensitivity around the word “vulnerable” indicates just how difficult it is to choose the right words to communicate risk to a population with different levels of susceptibility.

Not all sites on social media are worth looking at, but travellingtabby.com was absolutely brilliant at analysing the data and presenting it in a way that was understandable to the population. It was remarkable work by a university student, who has rightly been lauded for it. More of that would be great.

I will let Professor Linda Bauld answer that.

I certainly do. Of course, I do; I am the public health minister.

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.