 Felly, rydw i'n gael i'n ffordd sydd y cymryd cymryd Cymru yn 2022. Yn gyfair, ydych chi'n gweld y ffordd a'r euddaeth yn yr eich cymryd cymryd Cymru yn gweld informau ond. Rydw i'n gael i'n gael i'n gael i'n gael i'r byd, Maria Todd, Y First Minister for Public Health, Women's Health and Sport, Professor Jason Leitch, Yngrifeswyl Clinical Director, Professor Linda Bald, chief social policy adviser, and Dr Audrey McDougall, chief social researcher. Welcome everybody. Minister, would you like to make any short opening remarks before we move to questions? Certainly. Thank you, convener, and 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 that 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 there were different measures and messaging from the UK Government. Behavioural science was and continues to be central to our approach to all pandemic-related communications activity, alongside the significant behavioural asks 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 want to 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 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, informed by insights from organisations representing various communities across the Government. Equally, importantly, we worked and continued to work with health boards and with other partners to encourage uptake, particularly where it is low in certain 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 also by deprivation. We have sought to build trust and remove barriers for people who might not otherwise take up the vaccination through a range of outreach activity and partnerships with local authorities, community and third sector organisations. The research that was published yesterday shows that people welcomed having a local and more flexible service when considering vaccination. Just as our approach to public communications was influenced by the behaviour of science and insight, our communications were also informed by the science of the pandemic and how to fight Covid, and that has meant 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 do, too, did our approach to how we commissioned and considered scientific advice. For example, we established the Covid-19 advisory group and subgroups bringing 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 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 delivered a holistic approach to the commissioning and co-ordination of scientific evidence. I look forward to this morning's discussion and I'm happy to answer questions from the committee. Thank you very much minister. I'm now going to turn to questions and we've got about eight minutes each this morning, so I'll have to keep that in mind. If I may ask, just to get really where we're at at the moment, we're aware that there's rising numbers and maybe one in 20 in Scotland currently have Covid, are there any concerns with the latest spike and also that it's happened really early in the summer that I don't think anyone was expecting and how's the pressure on the NHS currently? I don't know if this is for Professor Leitch or the minister. I think probably Professor Leitch will be able to give you more data, but we're watching closely the numbers are rising. It was expected actually, it's not unexpected. We do anticipate that we will be facing rising and waning cases of Covid for some years to come. My experts would tell us we're about halfway through this pandemic, not at the end of it, as some people would perceive. I'll let Professor Leitch give you much more detail. Morning everybody, nice to be back. I thought we were done, but here we are again. Covid recovery and I'm on day 14 of recovering from Covid, it seems appropriate. So I am one of those statistics and we are concerned. They have come at us four months, five months after the last variant. It's a pattern, I've had four versions of this. This is a sub variant of Omicron and is still responding well to antiviral, still responding well to vaccines. People are not getting seriously unwell, but as the numbers rise, predictably this room knows better than pretty much every room in the country that that means you get people in hospital and you eventually unfortunately get particularly the vulnerable diet. We've had 43 deaths in seven days, we've got over a thousand people in hospital with a Covid diagnosis, of course that's mixed in with other diagnoses as we've talked many times here, but that makes things worse. We're hopeful as we look across Europe that this won't peak at the level we saw a few months ago when Omicron first hit us. Portugal, other countries would suggest that if you had a big Omicron wave, you perhaps don't get quite such a big Omicron five or four wave, but it's still difficult and it's difficult for particularly those who are vulnerable. Our advice remains pretty much the same, but you can tell our tone has changed in the last few weeks and it's about staying off if you're sick, whether that's college or work or school. Certainly reintroducing or thinking about face coverings, handwashing, surfaces, all of those antiviral things, and of course the key intervention remains vaccination. So if you haven't come or if you're due a booster, if you think you've missed one and we want to see you, so those are the key interventions. So we're concerned but not panicking. Thank you. Just personally as well, my husband and my six-year-old currently have Covid as well. And I have to say over the weekend, I only tested my six-year-old because my husband was so bad and she was totally fine, but she tested positive. But I had to keep her off school and I was a bit confused about should she go to school, should she not go to school. So I think everyone being with the restrictions for the past two years, we're sort of into this territory now though with rising numbers that I think there has to be guidance that's quite clear and if it is, it evolves. I agree that it's more complex now because we're treating your six-year-old as if she had flu or norovirus and we're giving you quite a lot of the responsibility to manage that. And you're very informed. I mean you chair the Covid Recovery Committee so if you don't know what the guidance is then that gets more difficult. So let me be really clear. Our guidance is that your six-year-old doesn't need tested. Testing is optional, you can absolutely do that, but children who are sick should not go to school. They should stay off school and as should your husband, stay off work as far as humanly possible until they feel better. Our kind of guidance in the round is five days full isolation. That's not the rules. Nobody's going to come and arrest you if you don't do that or check up on you. But our rough guidance now for the disease and everything we know about this disease is five days full isolation and that gives us the kind of sweet spot for spread versus society reopening. Okay, brilliant. Thank you. This enquires primarily about misinformation and disinformation and to distinguish between the two misinformation is consumed and spread inadvertently and disinformation is some way deliberate. I do know that some countries are recognising that online media has become a new kind of warfare and to tackle this and fake news, Finland for example, has appointed a Government ambassador specifically with the role to protect attacks on social cohesion and public trust back in 2019. As suggested by the RSE, does the Scottish Government think an independent fact-checking service should be established in Scotland? So I think I'm going to let Professor Linda Bould and say a little bit more about this if you'd like to answer. Yeah, I participated in the in the Royal Society of Edinburgh's data and evidence subgroup to so you're aware of that. So that is a really important point and it's absolutely essential that we tackle misinformation and a whole variety of organisations have a role to play in that. I know you've heard from this committee from full fact who do pay an important role and of course they are not funded by the UK Government, they're a UK organisation, they can't tailor all of that what they do to the devolved nations but they have an important role to play. So I think we need to do that but I wouldn't say that we necessarily need to ask the Scottish Government to fund a new body. I think it would be worth thinking what is the correct model and looking at international examples. But at the moment we've done phenomenally well actually in Scotland in addressing that misinformation. We've had support from UK colleagues so we also have the Covid vaccine security group which looks at online hate and misinformation which I know and Professor Leitch and I and others have had some engagement with them and they've played an important role. And there's a whole network of others outside of government including actually MSPs who are playing their part in responding to constituents' queries and making sure people have the right information. So I wouldn't jump to say government should fund a new body. I would ask what are the gaps and what's the best model for Scotland. Okay, thank you very much. I'll move on to Murdo Fraser, please. Thank you, convener. Good morning, minister and colleagues. A couple of issues I'd like to pursue. Minister, you talked about information being easy to understand. I think that was true in parts. I think that there are other parts where we struggled. I know the Scottish Government early in the pandemic produced the fax acronym. I know Jason Leitch will know what fax stands for but I don't know many other people who do. Minister, do you know what fax stands for? I certainly do, of course I do in the public health minister. What is it then? So fax is F, wear a face covering. A, avoid crowded spaces. C, clean your hands. T, two metre distance. S, self-isolate. I agree. Very good. I am lousy at acronyms myself. I have to admit and I find acronyms very hard. I can remember the acronym and I can remember the general meaning remembering what the individual instructions are is tricky. And I agree that there are finding that sweet spot of simple messaging is difficult. I know that the fax campaign in England went for face, hands, face, face. See, I didn't remember that one. Hands, face, face. Which is a very simple three word message which science would say is a really easy thing for people to remember and to understand. To be honest though, either of those acronyms, if you asked people, they would know that it meant that they had to do something. They may not remember the actuality of the phrases, but we see even now, two and a half years into the pandemic, people really do know and understand the non-pharmaceutical interventions which that particular piece of information was about, that they can deploy themselves to keep themselves and others safe. So we see now people talking about whether they should be wearing face coverings again. Everybody is washing and gelling their hands much more routinely than we did pre-pandemic. People know that keeping their distance is a way to keep themselves safe. People know that being outside is a way to keep themselves safe. People know that ventilation is a helpful thing. So there are lots of people who know the behaviours that they need to adopt to keep themselves safe. And I think that that's the important measure of the success of these information campaigns. We've evaluated FACTS, as you would expect. 83 per cent of people said FACTS changed their behaviour. 83 per cent. And remember the order in which these two campaigns came out. FACTS was first, hands face space was second. Hands face space did run in Scotland and nobody stopped it running. It was on TVs, it was on posters. So it added to what we already have. But to stop what we had done for a number of weeks, switch the whole population to a new campaign. Marketing thought about that. There are marketing experts who do that kind of conversation. And they thought that was counterproductive. They thought that was going to make it worse rather than better. And we had given our FACTS information to all of the four countries. Remember Wales and Northern Ireland did other things of their own and all of that. So there were judgments to make in there about the timing of which marketing intervention you used. Fundamentally, they all pushed the population in the same direction. Okay, thanks. I was going to ask you about what follow-up we've done but you've already answered that question for me. One of the other issues we've looked at is around trying to counter disinformation which we were talking about earlier. And to put this in context, we've all seen with the vaccination programme. I mean the vaccination programme has been a great success. I don't know that but I doubt about it. But there is still a segment of the population who are resistant to vaccines. And when we see the segmentation, quite a lot of that is amongst particular ethnic minority groups. The Polish community are one example of a group who, for whatever reason, cultural reasons are resistant to taking up vaccines. Do you think enough was done in terms of public health messaging to try and counter disinformation about the impact of vaccination? So again, I'll probably let Linda Bould say a little bit more than I do. I think that one of the challenges for government is that actually countering disinformation can validate it. So there are some suggestions that tackling it head on is more dangerous than leaving it to rumble and finding your own way to reach these groups who are susceptible to that. The other thing I would say is that actually the work that we did in terms of collecting ethnic data relating to the vaccination and actually being able to identify uptake and low uptake in particular communities enabled us then to change course and to do different things for those communities. So we had 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. An example of that would be I just met last week with gypsy traveller community health workers and in many ways that's a community that is hard to reach or we make it difficult for them to engage with our healthcare system and having these trusted members of their community helping to push public health messages within the community is a much more successful way of reaching that community and ensuring that we engage them with these healthy behaviours and these offers and it's far more successful than a media campaign for example I'll let Linda say more. I'll just make briefly three points I think the first thing is that you need a multifaceted approach so vaccine equity and gaps in uptake are an international phenomenon as you know and in Scotland actually we've done much better than most countries I think you were given some evidence around the Euro surveillance journal article that showed that you know amongst European countries we were second to top after Iceland in terms of our uptake and reducing deaths in the over 60s but there are gaps and the multifaceted approach actually it doesn't work just for government to reach those groups minority ethnic communities others who don't necessarily trust the state the same way you have to fund and support organisations to do this and it's a shame you didn't hear from Bemis who I think we're going to give you evidence in one session I think you would have heard a lot more evidence from them Professor Leitch of course spoke to young scott to many different community groups himself personally so I think you know we would concede that of course I'm sure it could have been perfect and better than it was but a lot of efforts were made I think the final point I would make and I don't know whether a doctor in Medugol wants to add is that we had a lot of data underpinning where the gaps were and then tried to use that data to inform approaches and who should be supported to reach out and the final thing is for me it's not over so it's an evergreen offer those vaccines are still there they can still go into people's arms and I have a lot of sympathy for the voices that say we should keep talking about this all the time so that we make sure that that message isn't lost did you want to add so I'll just come in briefly and say that through the data that we collected both in vaccinations but also through our public polling data where we looked at people's attitudes to issues such as vaccinations we were able to hone in on where we thought there were particular issues or particular problems and use that information then to create new campaigns to have people like Jason and Linda and so go and speak to different groups to provide funding for different groups to work with those groups that were more reluctant to uptake vaccination and then again through you know monitoring the rates and through our polling we were able to see whether our efforts were making a difference so this was something that was monitored very very closely and we were very very conscious of okay okay okay thank you Alex Rowley please good morning good ask in terms of the vaccine so I'm 58 years old I've had my my first two I've had my first two then my booster there is honest talk about whether over 50s will need to get a booster coming into the winter and and there's no what is the government's position I suppose because if you're sitting there in your thinking well that includes my age am I at risk coming into the winter I think this is one of the challenges that we face throughout the pandemic is that we rely on expert advice so for vaccines we rely on the JCVI to give us advice on which groups should be targeted with the vaccine and and they can only work at a certain pace and people are wanting to know now whether they are going to get a vaccine in the autumn and often you know at the moment the JCVI hasn't come out completely clearly about exactly it said some of the population who is who is going to be eligible but it hasn't made a final statement on who is going to be eligible Scottish Government have largely followed JCVI advice because they are absolutely the experts on vaccination and will help us to make the most of that vaccine programme which has been so transformative in this pandemic Ministers absolutely right so here's where we are so the joint committee on vaccination has two steps interim advice that's really to help us plan are we going to need two million doses or are we going to need 25 million doses so their interim advice is get ready at least for the over 65s and everybody vulnerable over 12 and all health and social care workers so we can then add that group up so we know how many vaccinators we need we know how much vaccine we need in rough terms so that's what we're ready for that's over two million doses for Scotland so we're getting ready for that they're then saying over the summer we will look at vaccine waning we'll look at variants we'll look at what vaccines are available because there will probably be a new variant vaccine by the autumn not with us now so if we gave you a vaccine today would it maybe be better to wait and give you the variant vaccine we just don't know the science isn't there yet so over the summer they've said they will continue to consider the science and then they will give us definitive autumn advice my instinct and the solid is I don't have an in-road into the joint committee more than anybody else my instinct is they will reduce that age in the autumn and you and I because I'm 53 you and I will probably be in that group and it'll be a bit more like the flu group but we don't know that for sure and it will depend what happens to the disease our response to the disease but it will also depend what happens to the virus between now and the autumn so I think they will move to a broader group in the next three or four months I think I saw Professor Ball that you were actually saying the Scottish Government should make representation on this and should be calling for all over 50s well I think there's always a confusion with how the media uses a sentence that you've expressed as everybody in this so yeah exactly thank you so I think I was very clear that my personal view is given I'd seen some data for example from the US looking at the response to people in their 50s from an additional booster that it would be it would be likely that the JCVI would move in that direction which is exactly what Professor Leitch has said so actually we don't know what they will conclude but it wouldn't surprise me if that is the decision that they take but as Professor Leitch says having spoken to the vaccine team they are actually preparing on the basis that that eligibility could be expanded so they know they can press go if more of us I'm in my 52 are on that list so we wait to find out I won't possibly be eligible that then brings you to the question in terms of so I've in this last couple of months I've met trade unions in the public sector I've met with nurses being health centres and you come away from all the thinking these people have just run off their feet you know this has been a difficult time and people are if we think as politicians this recess day we want a rest these guys are working having to work through and so then then I think to myself when I read the comments attributed to Professor Bald I mean so if suddenly there's going to be a vaccination in the over 50s and we need to get that done over a certain period of time if what I saw the last time staff were pulled out a lot of the other bits of the NHS and I'm not as sure that what damage that would do given we're trying to focus on recovery so are we preparing a plan for that and how would we do that? We are preparing a plan for that and actually we've learned a great deal over the course of the pandemic about how to do that in a way that doesn't impact on the rest of the NHS and most NHS boards have built up vaccine teams and vaccine plans and the way that vaccines are delivered so people are finding over the last year or two different rate in different places they're getting their flu vaccine for example in a different way it's moved largely out of GP practices and into health board centres we are absolutely aware of the challenge for the teams on the ground I mean if I think back you know I'm a pharmacist by profession if I think back to the course of this pandemic I think about being hit by a virus that we didn't we didn't even know what it was within a year having a vaccine but I looked at that vaccine and I thought oh my goodness it comes in a multi-dose vial it needs to be reconstituted and good grief it needs to be stored at minus 70 degrees how on earth are we going to manage that logistically how are we going to get that into people's arms and that complexity has just continued to evolve we now have multiple different vaccines we have different ages eligible which brings in different doses we have different people in the community you know for example people with very severe immune suppression are getting more vaccines than the general population because their immune response is suppressed so that there is massive complexity in the vaccine programme but actually we have done an amazing job in Scotland in rising to each and every one of those challenges and I was in absolute awe last December I mean I remember when we when Omicron hit and we thought not I mean like like Brenda in that famous clip not another one and it just seemed incredible that we were facing in the depths of winter when everybody was looking forward to Christmas together to yet another variant and that need to get boosted by the bells just the most phenomenal effort and response from our NHS from our teams and I helped out I volunteered at a vaccine centre over last winter you saw people coming out of retirement I didn't actually go through the training to vaccinate I was just helping out with managing crowds but you know Jason has been vaccinating we've had people from public health Scotland have come forward into the vaccinating team it is just remarkable how our health professionals answered the call it is also remarkable how our communities answered the call because that vaccine doesn't work unless people get it into their arms and it has just been the most remarkable I mean if I think about the levels of vaccination that we have achieved in Scotland it is absolutely incredible for a vaccine that isn't mandatory that's had to be delivered at pace in a changing environment for a brand new virus it is really absolutely incredible and there is no doubt that we have learned a great deal from each and every challenge that we've faced throughout the pandemic so we're prepared and we're prepared in a way that will not impact on other services within the NHS we're ready but it's not a neutral act so let's be clear you can't use people twice but we are able to vaccinate with whatever the joint committee tell us to vaccinate and we'll be able to do it fast so it will be a temporary measure one of the things in the mix here is if we can do it with the flu vaccine that makes it logistically so much easier for us because we're already going to do over 55s the vulnerable whatever group that is so that would make things a little bit easier for workforce but we have a director of vaccination we have leads for vaccination in all the boards they know what's coming roughly and they will be ready for that but let's be clear we don't have an entirely new workforce or the funding for an entirely new temporary three month workforce and then they can all go back to hospitality that's clearly not how it works but we're as ready as we can be on a temporary vaccination basis and we're going to do that on a rolling basis probably at least once a year maybe even twice a year thank you thank you thank you Jim Fairlie please hey thank you thanks for coming good morning folks Jason Leitch if you don't mind I want to come back to you very quickly because I'm slightly confused the convener was talking about her daughter is positive but not sick should she go to school or not yes she probably shouldn't go to school but she shouldn't have been tested according to the guidance the test is optional entirely optional so you're allowed to test your child I'm not suggesting you don't test your child now that you have that knowledge I would probably keep that child off school for five days if you're an adult who's tested positive but haven't got any effects should you be going to work you shouldn't be going to work no again that's knowledge which you might not necessarily have remember 30% of people with this disease are entirely asymptomatic so you probably won't have tested unless you're a health and social care worker and you're still testing regularly which is why we do that to try and take those positives out of the at-risk groups but the present guidance is you do not need to test because tests are no longer free if tests are not free you're being given tests then you are asked to test health and social care workers some other minority groups that we do particularly because they're high risk areas but in the main you don't have to test if you choose to test and you get the knowledge of a positive test isolate for five days I can imagine the analytical discussion my wife and I will be having about this when I get home however I'm going to go back to the communication the committee has heard that the Scottish Government's review of the advice to those in the highest risk list has not convinced people in the list that they are now at lower risk and we heard from Dr Sally which her last week one of the things that struck I think all of us was the that feeling of we're getting left behind and how do we make life more livable for people and again I keep getting the wrong terminology she was quite concerned about the fact that we were using the world word vulnerable and I'm not quite sure how we managed that language how do we get people like Dr Sally which are to feel that society is now safe for them I think Jason will probably give you a fuller accent answer on that but you know just that that 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 but Jason yeah it's difficult I've watched that evidence and it is challenging and appropriately challenging for those of us in the public health communication space and in the decision making let me tell you how it actually works whether you think that's right or not is a different question there is an independent advisory group UK wide chaired by one of Scotland's let's call him Scotland's top doctor one of Scotland's top doctor a man called Professor Ian McInnes who works at the University of Glasgow and he chairs an independent advisory group that's basic exam question is who is at risk of this disease in the top end and therefore who should get the antiviral drugs antiviral drugs are not a neutral act they have side effects they have other things going on you can't just give them out in the high street so therefore if you're going to use those drugs who are you going to give them to those who will benefit from them the most and that's a clinical decision that's not a political decision that's rightly in the space of the senior clinicians across the UK who make those choices a bit like the joint committee on vaccination boffins for vaccination Ian's group is boffins for high risk now the challenge here is that high risk group has changed so let me use my own family as an illustration right at the beginning of this pandemic my mum 81 years old COPD otherwise well in the high risk group for sure so she was told to shield she was in that group we thought she was at risk of this respiratory virus 2022, June 2022 no longer in the clinical extremity of our overall group because we've learned so much about this disease that we know her COPD doesn't put her at extra risk she doesn't become eligible for antivirals except perhaps because of her age not because of her pre-existing conditions that's quite difficult to communicate with an individual who we've said you need to stay in the house you need to stop you need to remove yourself from society because we think you might die of this now two years later we're saying no no it's fine you can go back to the theatre you can go back to church you can do it so that communication has been tricky we've tried to do it in two ways Professor Bald and I never turned down a media bid if it's coming so we have pretty much done every single offer we've had to be on the TV or the radio to get that information across that's one way we've done it that has dried up a little of course as the world has moved on as media bids move away and we've written as often and as clearly as possible to those groups and that's been difficult people haven't always accepted the position of Ian McInnes's group with the vulnerable group but I think I have to rely on the expertise and the clinical knowledge and the increasing and evolving science on who should get those drugs we have massive trials one is the I've talked about it in this room before the panoramic study which takes big groups of people we give them a drug we compare them to those who don't get it and we watch the results that's how we know dexamethasol works in intensive care it's how we know some of the more far-fetched drugs don't work and we continue to do that for groups with antiviral drugs and it teaches us every single day an Ian's group with Scottish and UK-wide representation decides who is in that vulnerable group that's how it works Can I just add something to that? Yep, please So Dr Witcher also made a different set of points as you know about environments I think what she, her view and that is shared by many is that we need to change our environments across Scotland to reduce the risk of infection in a range of settings and that's a really valid point and of course we are trying to do that it can't be done quickly so just to highlight a couple of developments that MSPs are aware of recently I think Deputy First Minister has written around the fact that we had the short-life ventilation working group certainly the advisory subgroups I chaired on schools and on universities heard from that group and learned from them and took steps around adaptations in those settings much more to do there's also the Covid safety signage scheme which is now being piloted You've already read my notes Okay, I haven't actually my eyesight doesn't stretch that far That's Georgian your 50s Exactly, that's true That is a very good point Yo, it's true I didn't The reading glasses are in the bag So places like Orkney Council and other places will be polishing that that does not go as far as colleagues and Dr Witcher would like to see but I think that longer-term adaptation is something we really are committed to but it's not going to happen overnight I don't know whether you want to add to that please No, that's fine Yeah, she's used the inclusive new normal the hashtag inclusive new normal and I presume that what we're looking at is exactly what you've just outlined how we make public spaces safer how we make theatres safer and all of that work is on-going but as you say it's just going to take more time than and until that's done until people feel that that's done then they still feel like they are in that forgotten about category there's not really very much we can do about that until we move on, is there? So I think people should have confidence that that work is on-going it can't happen overnight nobody has a magic wand but it is on-going I suppose the thing to try to communicate is that we are in a very different place than we were at the start of the pandemic we have a really really effective vaccine we have a vaccine which and I think it's probably I mean I'm a pharmacist it is perhaps a little hard for everybody to understand that despite the fact that it doesn't prevent transmission that vaccine is really really effective so it doesn't stop you catching the illness but it has taken the death out of it it's taken the serious illness out of it we're not seeing the level of hospitalisation that we had we are certainly not seeing the level of mortality that we had so the vaccine is incredibly effective and has transformed the situation the people who are not responding well to the vaccine are largely people who have immune systems that aren't making those antibodies when they're when they're vaccinated so that's why the evolution of the groups who are particularly at risk that's why people who were at risk pre-vaccine or we thought they were at risk pre-vaccine people with COPD for example are less likely to be in those high-risk groups now because their immune systems work well less effective at 81 but they're 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 which has just transformed things are these medications these antiviral medications and we have in place people who are eligible for those medications know who they are and they know how to get them and actually wherever they are in the country they know there's information on NHS inform they can find the phone number of their health board and telephone them if they find that they test positive as long as they are in that eligible group and within the first five days of illness they can get these antiviral drugs and they have also transformed so even for the people for whom the vaccine we know is less effective we have treatments that also can reduce the risks from this virus so we are not in the same situation that we were in before and none of us have forgotten about those people who are so severely impacted I mean I think one of the challenges is communicating to that particular group just how important it was for them to protect themselves and keep safe using words like vulnerable make you feel ill and vulnerable when it had to be done it had to be communicated that way and there's attention that when I used to work in mental health I had to work really hard with the patients that I worked with to help them to understand that they were ill and once they understood that they were ill they were motivated to take their medication but actually they felt it's a good thing if we feel healthy it's a healthy thing to feel healthy and that understanding that you're not healthy that you are at risk or that you are vulnerable has quite a profound impact on people and what we find is that people are struggling a little bit to recover from that feeling of vulnerability which is perfectly understandable I think actually all of us are feeling you know we've every human being in Scotland has felt more vulnerable than they did before largely and it is quite hard to remind yourself that the situation today is very different from the situation that we faced in March 2020 Thank you Thank you, can we move to brown metal please? Thank you for being out good morning panel Just to go back to the way in which things were communicated I think the government or government's certainly UK used the term follow the science and I think you know generally you would think that there would be a lot of comfort to be had from the general population that there was reason for us asking them to do such extreme taking such extreme measures to look after the public health so follow the science was you know I think was well recognised as a good term however do you think we did enough to explain to people what follow the science actually means because of course the science is such a moving picture and you know for the simple example we had the First Minister and the Prime Minister early on in the pandemic standing up saying there's no evidence to say that face mask and make any difference until the science said it did make a difference do you think there's enough you know the follow the science was a great message did we do enough to explain what that actually meant so it's challenging and as a scientist myself I have a real passion for this I think that our general generally in our population we don't have a great understanding of science science isn't black and white it's not you know it doesn't tell you what's right and what's wrong what it does is help you to answer questions it's a way of seeking a way forward all it does is inform your decision making rather than telling you in a black and white way this is what you've got to do there is still always judgment in science follow the evidence base is slightly less catchy and that might have helped people to understand that that might be a changing feast but I think that I think I mean you know there aren't many positives to come from the pandemic it's been the most testing time for the whole population but if I'm honest I think that we've seen a far greater understanding of science in our population which I think will stand us in good stead we've seen a great deal of health literacy and risk assessment going on so people have you know gone on to public health Scotland and found the data for their local area and made there and that has informed their own risk assessment of what they might need to do I think that's a really healthy thing I think that's a really positive thing to come out of the pandemic the other thing I would say is I've seen a really vast improvement as somebody who used to yell regularly at the television I've seen a real vast improvement in our scientific reporting and our medical reporting you know when I worked as a pharmacist I used to regularly be frustrated at the way that clinical trials significant clinical trials were communicated to the general population I think we've seen that happen in a far better way we've seen our journalists who are involved with reporting science and medicine really step up to the task and do a pretty good job of communicating quite complicated things to a population who generally aren't scientists I don't know if my colleagues want to add Oh that's something so it's difficult I mean we have the structures to take in the science and to inform policy decisions we have the chief medical officer's advisory group we had SAGE which some of the same people sat on we had the subgroups on nosocomial infection testing the two that I chaired so we had all those structures but the problem is that the science is not always definitive so I'll just give you some specific examples that you've I think discussed in this committee already some one of the members raised pregnancy in a previous meeting around the very early days of the vaccines because pregnant women weren't involved in the trials and there was a little bit of confusion around that and then more clarity we didn't know as much as we do now at the beginning of our airborne transmission we didn't know as much as we do now about asymptomatic transmission and then you raised the issue around face cover so there wasn't always a single truth to communicate to policy makers I think it became much easier because we just got huge amounts of research I mean countries around the world threw resources at that and it became easier but I think in the early months to say there was a single science I think that's my point though is follow the science I think was a good message but then I don't think we communicated properly what follow the science meant and that that science would continually evolve we didn't communicate that that particular message out to the general public so what they saw was I need to do this but now I need to do this whereas I think you know what I'm trying to push at here is could should we have gone further than that and said follow the science as it currently says and it will evolve as we learn more about this virus probably was Behaviourally trying to communicate uncertainties very challenging I think if you look at things like the Covid social study and the trust that was in Scotland for the communication it was very high it was higher than elsewhere in the UK so it's never going to be perfect but you're right communicating uncertainties is a very challenging thing and you know whether it was perfect or not I don't know whether anybody else wants to know I completely agree the science changed sometimes during TV interviews I mean literally during the interview the science would change so somebody would text me and say there's been a study in pregnant women the vaccine is safe for example as literal as that while you're on TV so I think Linda and others have been exemplars in that public communication at a level we've never seen in our lifetime trying to get that science over saying this is today's science but we were literally moving we were literally doing the science in real time normally we would have medical journals and scientific journals that we could consider over a few months and then think about in giving that to the public six months from now but we didn't we didn't have that luxury we had to do it in real time and we tried whether you think we did that well enough or not there's a different question there is no criticism here whatsoever just trying to to stab me whether or not it's easy to look back in 2020 if we had to go through it again would we have been able to alter the way which we were going? the only other thing I would add is that it depends where you get your information from so if you get your information from mainstream public service broadcasters I think it was good I think it was well presented I think Vegas Walls for example is an obvious example of somebody who did the trials really well if you get your information from Twitter frankly you need to look elsewhere indeed can I just one more thing that I was going to raise something I never thought I would be raising but as a constituent has brought this to my attention I think it speaks to the communication this happens to be a nurse with of 26 years experience who raised the issue of VITT I have to say this I suppose vaccine-induced thrombosis of topenia and thrombosis which did I do that right having practised that for about a week and I think it's now acknowledged that as a condition and nice published guidelines clinical guidelines for it and her absolute belief that the vaccinations etc will be absolutely the way to go however I was surprised to hear that there's about 220 confirmed cases 78 fatalities 69 probable cases and 70 possible cases and she says you know that these are relatively very small numbers compared to the vaccine nonetheless these are people who have a condition and have reacted to it to a you know delivery of a multiple doses of a vaccine a relatively short time so it was inevitably going to be some medical and statistical harm done what she was saying is is that these are people who have have an adverse reaction to the vaccine and are kind of vilified and pushed away and not listened to at the time and have a clinical need and in terms of the way in which which we communicated her question is did we did we communicate the very small potential risk there was of the vaccine and by not doing that did we create a vulnerability in those few people who had who had an adverse reaction I'm sure Jason will want to say a little bit more about this but with any vaccine programme that you know I'm with any vaccination there will be a balance of risks and benefits I suppose we've seen that very clearly played out as the JCVI gathered together the evidence for vaccinating children where they felt that the benefit risk balance was a little bit different and you know you need to take into account which population you're aiming your vaccine at you know some people it'll be a complete no-brainer because they will be particularly at risk from the consequences of that virus for others it will be a question of considering their own vulnerability and how much it helps the population in order for them to be vaccinated so these aren't clear cut decisions vaccines always carry risks it's always a very small number of people who suffer adverse side effects it is often the case that you can't predict who is going to suffer those adverse side effects if you could predict it you would be able to take measures to avoid it and with a vaccine programme of the scale of this vaccine programme where you're targeting pretty much the entire population there are likely to be some people who suffer adverse events but the benefits on a population level still outweith the risks and I think that's a really important thing to communicate one of the challenges is there were some side effects which might have been more predictable and there were people who thought that they perhaps shouldn't have the vaccine so there was a question around people with allergies or allergic responses to vaccines and it's always if you've had an anaphylaxis in the past it's very frightening to consider that you accept a vaccine where there is potentially a risk of allergy and helping to reassure those individuals and to risk assess on an individual basis whether they were at particular risk from this vaccine or not is a difficult thing to communicate and you couldn't communicate that on a population level that had to be an individual discussion between clinician and patient at the time of vaccination I'm sure you can just wait I think that the question I'm really asking here is around that communication and should we have should if we had communicated you know a discussed at the potential risk more would that have prevented more people getting you know the very few people getting a vaccine opposite? I disagree with your premise entirely I was not a premise it's a question okay well the answer to your question is no the the Lancet has just published the first global study into vaccination live saved and it's not complete because it can't be complete it suggests 20 million lives have been saved in the last year 20 million it's quite remarkable we think 18 million have died of the disease your biggest risk for blood clots is Covid the number of people who have had blood clots and die because of Covid is off the scale higher than those who have had vaccination now in we've also adjusted the vaccination programme in light of some side effects which developed I don't recognise these numbers that you read out they're certainly not Scottish numbers so those numbers you read out would suggest that we should look at that and we have every time there are large scale side effects from vaccination we move right at the beginning you'll remember we adjusted Pfizer because we had some allergy later on we had some young men with blood clots we adjusted which vaccine they got the order in which they got them when we were going to do them so we have moved along the line along the road of vaccination and changed it as we've gone but let's be very clear to the public the thing you can do to protect yourself from this disease including the blood clots you get from this disease is to get vaccinated I think you've managed to adjust it I missed my point Mr Leitch sorry times moving on John Mason please I appreciate that thanks convener but actually to follow the same theme I mean as you said that it's important where we get our information from and Twitter is not the most reliable source but there is quite a lot of discussion on Twitter and that £20 million figure has been very useful and I've been quoting it quite a lot myself so I mean you said you disagreed Mr Leitcher with Brian Whittle as to the numbers can you give us any figure you know how many people do have a serious reaction side effects to the vaccines I mean I got sore armour or it didn't feel well for 24 hours that's pretty common but people are quoting these yellow card system and all sorts of things I mean you said way off the scale are there definite figures about you know how many people have actually either died from the vaccine directly or indirectly or had a serious injury Yes there are they're on the MHRA website you can I don't have them off the top of my head I'm happy to to look and send you more details but you'll be able to find it yourself it's tiny numbers and then you have the fundamental and unsatisfactory answer which is you can't always relate vaccine to outcome because inevitably when you vaccinate a whole world some people have a stroke the next day some people fall under a bus the next day neither related to the vaccine so when you vaccinate billions of people you inevitably get people who in time order end up with whatever happens to them there are of course some known side effects of vaccines sore arms some allergy there are some blood clots that's absolutely true and we think they're tiny numbers and we think when we adjust the vaccine we give we can reduce that number even further and that's what we've done I mean looking forward then rather than back and you know working with the MHRA and so on you know are the things we can do in future because science is moving on and as I understand it we produce these vaccines much quicker than we normally would and that might happen again in the future but that in itself you know gave people a wee bit of a lack of confidence is that just inevitable or do you think maybe we could do something in future I mean I think it's inevitable that in a global pandemic people will feel a little bit frightened and lack confidence frankly I think that the vaccines the thing to communicate about how the vaccines were developed is that no 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 these things take you know up to 10 years because a trial an early trial happens followed with a you know a trial in humans and a trial for efficacy and all of that and that happens one after the other and the assess in between each stage whether they think they've got a vaccine that's going to work because we needed the vaccine so quickly all of that was risk you know and drug companies don't want to run the risk of putting a lot of money into something that isn't going to work so the risk was largely underwritten by governments and those trials were able to happen simultaneously no steps were skipped and that's really important that the population understand that then the yellow card surveillance I mean there are surveillance schemes all around the world the yellow card surveillance one is the one that's run by the MHRA so post marketing surveillance is absolutely vital when any new drug is developed and used in a population and that gives us information as Jason says it doesn't tell you it doesn't establish causality but you get information on a population-wide level of what happens what sort of things might happen when a new drug is used when new drugs are launched into the population every single side effect is reported on yellow card and there's ways the individuals themselves can report to a yellow card report their medical team can do it so there's loads of routes into that and what happens is you gather a huge amount of information what we've seen is that level of analysis of that information has happened at absolutely remarkable pace and if you think this is happening all around the world as well you know the whole world is being vaccinated and we are learning globally from all of this global data we are getting a really good idea of how to use these vaccines safely and effectively in the population I think the example that Linda gave of the changing picture for women who were pregnant is a really good example of understanding that that you know rarely are drugs tested in pregnant women for very obvious reasons so when new drugs are launched it's very difficult to see definitively that they are safe in pregnant women but they were used worldwide and millions of pregnant women have now had those vaccines and 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's really a remarkable I hope that this level of collaboration globally scientifically continues beyond this particular emergency Okay, to move to a slightly different area we've taken a bit of evidence as to who people trust for information during the committee and especially that's the point about the Polish community and other ethnic minorities being a little bit reticent and in some cases receiving information from the Government of the home country or wherever be that Poland or Africa or Pakistan or wherever but I was interested in Public Health Scotland in that they've submitted a paper and they were saying the most trusted are NHS Public Health Scotland Health Professionals and the Government which is encouraging but less trusted were social media community leaders religious leaders and news media which did strike me as interesting because I think we had thought that if we could go to community leaders for some of the ethnic minority groups they would be more trusted but Public Health Scotland seemed to be seeing something different so in that areas to who's trusted and who's not have you any thoughts on that or thoughts going forward? I think that's probably a blanket response community leaders will have been a category in their survey there's a lot of evidence including from international studies around medicines and vaccine hesitancy that if there are community leaders that are from particular areas that are trusted whether there be somebody for example from the faith community or somebody who's working say with women in an area it's about people that they know and they trust so I wouldn't assume that all community leaders are trustworthy but I think there's a lot of literature to suggest that if you get to the right ones actually they are the best ones to pass on the message the other source of data is the Ipsos Moray veracity index which I think probably chimes with some of what Public Scotland have found but just to respond to your specific question Did Dr Maduro want to say that? No I mean it's just to say that all the evidence that we've seen certainly would support the general evidence of PHS but it's noticeable the very high levels of trust that we saw among the public for people in the health professions for scientists and indeed for government and there was absolutely no doubt and that has changed from pre-pandemic pre-pandemic I don't think we would have seen quite that same level of trust necessarily in the science profession for example people would just have been less aware of the role of scientists than what they did and we saw that really rise throughout the course of the pandemic and we saw as I say quite encouragingly trusting government maintained at a very very high level as well so in terms of that general communication of messages any time every time we pulled people had a very strong level of trust in government as a source of information and as a trusting in government to do the right thing Thanks very much and my final point I mean we had the RSE early on giving us advice Royal sites of Edinburgh and there was a few things they were quite keen on certainly more science education to try and get the whole population thinking more scientifically and also the idea of an independent fact-checking service I mean are you positive towards these suggestions? So I think Linda Bolts already talked about the independent fact-checking service I would love it if children were more interested in science and I think we are seeing that people are inspired by folk like Linda and Jason who have been on our television daughter who have been on our television screens for so long helping to guide us through this really challenging time and I think that there is definitely more interest in science amongst the population and amongst the young population and I can't I mean I would be delighted if that was an outcome from this pandemic that more people went into scientific disciplines that are lots of them and it is it would be a great thing I mean we there are very few of us with science degrees in politics for example and I know that that's been mentioned many times since I came into politics there are just a handful in those 129 MPs with a science background and actually it would be quite a useful thing if more people had that understanding that rigor that ability to analyse information put it together that ability to cope with great areas which is inevitably you know to make good decisions despite the uncertainty and the gaps is is absolutely a useful skill in government so more science please I think okay thanks so much Minister so we've got a message more scientists fewer lawyers and the counterns are just a bit right I think I think Audrey is keen to contribute as well as our superb data scientists just wanted to make a quick point which I found really encouraging actually over the course of the pandemic as you might imagine we got a lot of correspondence from the general public an enormous amount of correspondence from the general public but my team who are the team who have been looking at collating science evidence and data we got a huge amount of people actually engaging with us on an engagement around the science and the evidence to discuss it with us people actually emailing us asking us to look at some of the calculations they done does that look right how does that fit with what other people have done this is a microcosm but this has never happened before when we've had so many members of the general public just get in touch to actually discuss the science discuss the evidence and try and work it out for themselves and I found that immensely encouraging it made me think that there is a real hunger in the population and people in the population who want to engage and want to be able to do this so I would feel very positive about that going forward absolutely and you've just reminded me I should mention traveling taffy who absolutely outstanding citizen science wasn't it who you put together and so not all not all sites on social media are not worth looking at traveling taffy was absolutely brilliant at analysing the data and presenting it in a way that was understandable to the population remarkable work from a university student and he's been rightly lauded for it but yeah more of that would be great thank you very much I'm conscious of time I've gone slightly over but that concludes our consideration of this agenda item and our time with the minister and I'd like to thank the minister and her supporting officials for their attendance this morning thank you I will now briefly suspend the meeting to allow the witnesses to leave I've got subordinate legislation I now move to the second agenda item which is consideration of the negative instrument listed on the agenda a motion to annul the instrument has not a motion to annul the instrument has not been lodged does any members have any comments to make on this instrument okay members therefore content to agree that we have no recommendations to make on this instrument thank you we are agreed not to make any recommendations on this instrument and that concludes our consideration of this agenda item this is our last meeting before the summer recess period and the committee's next meeting will be on Thursday the 8th of September that concludes the public part of our meeting this morning and I now move this meeting into private