 Ieithaf. Welcome to the eighth meeting of the Covid-19 recovery committee in 2021. I apologise for being slightly late this morning. The second agenda item this morning is a decision to take item number 5 on the consideration of evidence heard in private. Are members agreed to take agenda item number 5 in private? Yn ymdweud yma yw ymdweud yma yw ymdweud yma, nesaf y gallai defnyddio gyda llyfr i gynllunio cyfrifiadau ar yng Nghymru a Gweinidolol Cymru. I welcome to the meeting our witnesses from the Scottish Government, Grand Day Minister for Transport, Professor Jason Leitch, national clinical director, Penelope Cooper, director of Covid Coordination, and Graham Fisher, deputy director of Scottish Government legal directorate. Thank you for your attendance this morning Minister. Do you want to make any remarks before we move on to questions? I will briefly address the instruments that are being considered by the committee today in order, if that's okay. Since coming into force, the international travel regulations have been amended extensively and are contained in several instruments. The health protection coronavirus international travel and operator liability Scotland regulations 2021, SSI 2021 byddwch o'r rhan, oeddo Redwun i Ffwrdd, a chyfodwch o'r drefnidol yn gwybr y briadwyr dwyrrydol ar y sylwm pan ddysgu'r话t. Rhaid i ddweud i ddweudiaethau strategiau sy'n i ddweud i ddim yn cael ei cyfrwngu ffwrdd y roi'r mexiwn ar gyfer oedd eich gwerthegol. Mae ffwrdd y Ffwrdd ei ffwrdd ac yn cynnalol y rhan, a llinwg o'i annes. Rhaid i ddweud i ddweud i ddweud i ddweud i ddweud i ddweud i gwrdd y rhan, yng Nghymru Cymru, the First Amendment, which is SSI 2021-328, moved Bangladesh, Egypt, Kenya, Maldives, Oman, Pakistan, Sri Lanka and Turkey from the list of red countries to the list of amber countries. As Scotland and other countries continue to respond to the challenge of the pandemic, vaccines have played a key role in allowing international travel to open up to a greater extent in a safer way. For people arriving or returning to Scotland who have been vaccinated in Scotland, the option of providing evidence of being vaccinated was previously limited to showing a paper certificate. In addition to the paper and downloadable PDF version of the vaccine certificates issued by NHS Scotland, the number two amendment regulations, SSI 2021-343, enabled the NHS Scotland Covid status app to be used as proof of vaccination status. In recognition of the shifting landscape of international travel and vaccines, as well as a new framework for assessing the risk posed from other countries, the four nations collectively agreed to overhaul the international travel policy to make it more straightforward and responsive to the current public health landscape. This new travel regime, implemented by the number three regulations, SSI 2021-350, abolished the traffic light system for all but the highest risk red list countries. Travelers would, for the vast majority of cases, be subject to border health measures based on whatever they meet, whether they meet the eligible vaccinated travel criteria or not, rather than which country they have travelled from. The eligible vaccinated travelers would no longer be required to take a pre-departure test or self-isolate for 10 days upon arrival, with all others still being required to do so. Travelers arriving from a red list country regardless of vaccination status are still required to book into managed quarantine facilities, and the associated testing regime remains in place, as those countries are assessed to pose the highest risk. Other changes introduced by the instrument included accepting more countries vaccination programmes for the eligible vaccine policy, amending the obligations and carriers following the new regime. New arrangements were put in place for cruise passengers, following the restart of international cruises as well as some minor sectoral exemptions and specified competition additions. The number four regulations, SSI 2021-357, made further countries vaccination programmes eligible for this new policy in addition to recognising individuals vaccinated through the United Nations vaccine programme and allows for the EU digital Covid certificate to be used as proof of a negative pre-departure test. The number of countries on the red list was also significantly reduced to seven. The spread of delta variant across the world in its interaction with previous variants of concern means that many countries are now assessed as posing no additional height and risk to the UK from international travel. Those who remain on the red list are all in Central, South America and the Caribbean. Delta has been slower to reach that region than it has elsewhere in the world and there are still variants of concern there, particularly Lambda and Muay, where there is not yet sufficient evidence of the interaction with Delta to reduce the risk assessment. The SSI has also made a number of changes to cater for the arrivals for COP26, where bespoke travel arrangements based on public health advice have been agreed with the UK Government and UNFCCC in order to hold a successful conference in Glasgow. The number five regulations, SSI 2021-359, made further amendments to the eligible vaccinated arrival policy, including provision that an eligible vaccinated arrival will include a person who is resident in Scotland in England who is not vaccinated on medical grounds. The amendment is the outcome of the on-going review of the scope of the exemption for eligible vaccinated arrivals, where we have been particularly conscious of the qualities-based impacts of the policy, particularly in those who cannot be vaccinated for medical reasons. Further amendments are also made to clarify the position for COP participants, as well as amendments in relation to the diplomatic exemption in the regulations. I will now turn to questions, if I could ask a few questions first, if I may. The Covid-19 Committee is currently trialling an online platform for members of the public to put forward questions for the committee to put forward in evidence sessions. I will start with the member of the public's first question, and it is really about global collaborative working. Why are all countries not following the same travel rules? This person feels that, if there was a global approach, the spread of the virus could have been controlled better. I think that I should bring in the expert here, Jason Leitch. It's a really good question, genuinely, and I like your innovation. It's good. The challenge, of course, is that there are 6 billion people in the world in 200-something countries, and to manage that would be pretty much impossible. I think that, actually, the global co-operation has been outstanding and quite surprising. Certainly from my piece of the puzzle, the clinical advice bit, led by the WHO, down through each continent, the European Medicines Association, the UK-wide clinical collaboration and then the Scottish collaboration, I think has been exceptional. We've pretty much given the same advice across the whole of the UK. How governments choose to use that advice and take that advice is a matter for them, of course, and we have based that on what the WHO has said. However, the WHO has an incredibly difficult job because it has to give advice to Scotland and Zambia and Indonesia. Those have very different health systems and very different demographics, and that takes you into the travel challenges. Travel is only part of the response to the global pandemic, and it should be in every country's response, but how each country manages that varies hugely. New Zealand is clearly the poster child for international travel restrictions, and it has served it well, but it is a relatively isolated piece of the world that does not have a massive airport like Heathrow or Berlin or Chicago. I think that each country has to take the clinical principles and then apply them more locally to whatever they are going to do. The question's premise is good, but it is a little bit tricky to do globally. Thank you for that answer. If I can move on to another question. We now have the digital certification passports in place where people can download when their vaccinations took place. As we know, some people are unable to travel, particularly maybe teenagers that haven't had their vaccination and have had Covid, and then they're having a PCR test and the test is still coming up as positive, even though they had Covid weeks ago. With the digital app that we have, is it being explored that we can adapt it? For example, if somebody does get Covid, that it can go into the app, so you've had your two vaccinations, you've got Covid, say, on 1 October, because the NHS wouldn't know this if you had been pinged that you had Covid, and then you would have the history moving forward for boosters on the app. Sorry if that's a bit technical, but it's just something with people that are travelling and are unable to travel at the moment because they're coming up with a positive test even though they're not positive and they've had Covid previously, just as we move forward. This is an overstated problem, but not none. The headline is that you can still be positive 90 days after you've had Covid. That's very unusual. You're much more likely to have a PCR that's negative after just a matter of weeks, so although there are some in the literature who have still tested positive because they're still shedding dead viral particles after that 90 days, the difficulty is that we don't control other countries' entry requirements, we control our own entry requirements, so some countries demand a negative test. That puts us in a really difficult position because you can't get to those individuals a negative test. It's impossible. So until the testing technology moved on and gave us something new, we can't get those individuals a negative test, but I say again that it's a very small group and we can be ready with the technology when the policy position changes to, for instance, include testing or include previous disease, the technology would adapt to be able to do that. It wouldn't do it in 24 hours, but it could adapt. Other countries have passports, for lack of a better word, that look a bit more like that, that have testing in them. Let's remember that if nor we want a negative test, I just choose them randomly, not because there's a problem. If nor we want a negative test and somebody is still getting a positive PCR, there's nothing I can do about that. My last question, and I think that this is for yourself again, Professor Leitch, is to do with symptoms of the virus and conflicting information, which is currently in the public domain. So the British Heart Foundation updated information on their website on 22 October. They're saying that the main Covid-19 symptoms, if you're fully vaccinated, is if you've got a headache, a runny nose, sneezing or sore throat, or a loss or change to your smell. But if you're not fully vaccinated, it still includes headache, runny nose, sore throat, fever and a persistent cough. So there seems to be a bit of conflict between guidance from the UK Government and the Scottish Government to what other bodies are putting out. There are 19 symptoms of Covid-19, most of all of which you get with other diseases. So that gives us a big challenge. Unfortunately, you don't get a 10-pence piece-sized rash on your wrist that makes sure that it's Covid. You get a vague and broad set of symptoms that could be many, many other diseases. So some people only get gastrointestinal symptoms. Some people only get the loss of taste and smell. So we've got 19 roughly symptoms. We get clever people to work out which of those symptoms are most likely to give us the right balance between testing, isolation, disease, etc. That's a very difficult formula and they have stuck with the three cardinal symptoms, let's call them. Fever, cough, loss of taste and smell. Those cardinal symptoms have stayed consistent throughout the almost two years. Every few weeks they look again and they say, if we added headache into that, what would that do? How many people would have to self-isolate? How many PCR tests would have to be done and how much disease would we find? Do you see what I mean? They make a judgment. It's not an exact science, they make a judgment. The judgment has always been to this point that the cardinal symptoms should stay the same. That doesn't mean that people should ignore other symptoms and there's advice online about what to do if you have these other symptoms. The cardinal symptoms are the ones that should lead you down the PCR testing route in the United Kingdom. Everything else let's do two lateral flow tests a week and it will find you if you've got it because it will find the frequency of the testing, we'll still find the disease. Just to continue on the convener's theme about engagement with the public, one of the other issues that the public have raised with us is around COP26, coming up next week and the week after. The potential that there are up to 100,000 people converging on Glasgow, some of those going to the main conference, travelling internationally, may not have been double vaccinated and clearly there is a risk for further spread of Covid. I suppose that what the public would like to know is what are the mitigations that have been put in place to avoid further spread of Covid around COP events? Has the Scottish Government done any modelling around the potential increase in cases that we might see as a consequence of COP? Very extensive preparations for COP and a range of measures, which I'm chasing out on you for you in detail. As someone who's attended myself, I was very impressed by the range of measures that are in place, tailored to different sets of circumstances for delegates. I invite Jason to give you the full detail of that. Fundamentally, as you can imagine, we've been in the planning for this for some time. We've had a pandemic for two of the years of the planning for this. It was postponed last year, if you recall, so we had quite a lot of stuff in place for that and now here we are. It's this week. There are already delegates in the SCCC. I did a final site visit for Covid safety, let's call it, on Monday or Tuesday of this week. It is as impressive as you would expect it to be, but there weren't many human beings inside it yet, which is the variable that we're going to add principally this weekend. Three zones, to explain it quickly. The blue zone is the delegates, 26,000 of them, 14,000 at a time at a maximum inside the SCCC. Some of the headlines are a bit deceiving that at any one time in the huge complex they've trebled the space in the SCCC with temporary structures that will be up to 14,000 people. That blue zone will pretty much all be vaccinated, 90-something per cent at last count. We don't know everybody's status, but we're high numbers and the UK Government, with our help, have reached out to those who are unvaccinated from the global south and we have offered vaccine to all registered delegates. Everybody will wear a face covering except in negotiation rooms, where they're speaking, where they're in rooms like this, but walking and in other places, in social areas, apart from eating and drinking and all the exemptions, they will wear face coverings. One metre distancing as far as possible, although there are 14,000 people in the SCCC, those of you who know it, will know that there are some pinch points in there where that will be more difficult, but one metre distancing and all the hygiene measures that you would expect. There are layers of security on the way in and the kind of unique measure that isn't happening in the rest of Scotland is that you have to show a lateral flow test to get in. I'm going this afternoon again for a gold command meeting after you, after this, and I will have to show a lateral flow test that I did this morning in order to get through the first layer of security. You won't get through the first outdoor gate if you don't have a negative test from that day, not yesterday, that morning, for all delegates. I'm actually not overly concerned about the blue zone, genuinely. I can't guarantee it, but it's as secure as we could make it, given the circumstances. The green zone and the protesters and activists beyond that will have to follow the rules in place in Glasgow at the time, and we all know them. That area worries me more. We're not entirely sure where all those people are from. We have less control. We can't lateral flow test them all every day. I don't know their vaccine status, etc. That piece has always been the bit that's worried us more—large gatherings, just as you would expect. They will be subject to the same rules as you and I if we were walking down Sarchi Hill Street tomorrow. I'm very helpful in trying to understand the mitigations. The part of my question that you didn't really address was about have you done modelling. One of the issues that concerns people is, could we see a spike in cases? Could that lead to further restrictions being brought in on people in Scotland as a consequence of a spike in infections caused by COP? We've done autumn-winter modelling. It's pretty much impossible to model this. It's too complex. There are too many people, too many countries, too many variables. The next few weeks of modelling don't show the stuff that we publish every Friday. They don't show a particular spike, but you won't get a spike from COP next Tuesday. The spike from COP either in this country or, remember, we could export virus as well as import virus, so spikes that other countries would take home wouldn't happen because of the incubation period for two or three weeks later. Our present modelling doesn't show a spike after COP, but I cannot guarantee that there won't be a spike after COP. I also can't guarantee that that would then need a reverse gear. You wouldn't expect me to be able to do that. If the First Minister asks me today what would be your advice, I'd say, let's stay where we are. This is what we should do, but if the numbers go up, that advice will change. Okay, so there is a risk, basically, is what you're saying. Oh, of course. Yeah. But there's also, yes, there's a risk. Okay, thank you. But there is also the creation of a culture and a mindset around this as well. As you've heard from the measures that are put in place, we're trying to make it very clear to everyone that we can who's participating about the measures that need to be followed, whether within COP26 itself or using public transport, whatever it is, to everyone to be mindful of essentially looking after themselves and those around them to minimise that risk. Okay, thank you. Thank you, Alex Rowley. So how's the booster jags going on? Yes, I think the booster jag process is going remarkably well. On the day that the joint committee announced booster doses, there were already hundreds of thousands of people eligible. You can't do them all in a day, it's impossible. There are tens of thousands of NHS workers around the country vaccinating people today. It's the biggest winter vaccination programme in history, and I am enormously grateful for every single volunteer in the Orkney hospital to the Queen Elizabeth hospital, for everything they've done over the last little while. We have vaccine, we have vaccinators and we'll get to you. Some of the narrative around this is plainly not correct. Your immunity doesn't stop at 24 weeks. It doesn't suddenly fall off a cliff and you're going to get Covid because you haven't had your booster dose. The joint committee said, don't give booster doses before six months because they wanted maximum benefit from elongating the time that you could get the immunity. So they said, give it from six months on and we're doing that just as quickly as we can. The present vaccines were, let me just check my numbers, we did 8 million in nine months. We're now trying to do 7.5 million in four months. It's a remarkable exercise. Nobody's ever done anything like it before. I think it's going really well. You appreciate that most MSPs will be getting correspondence coming for people, so a couple that I saw yesterday, one was that somebody went on the website and saw that the appointment in a couple of days' time, but they were still sitting waiting on their letters, so there seemed to be a problem there. I've also noticed that for the over 80s in the Cowdenbeathlock early, they're not due to be done until I think November at their GP practice, and yet the 70 upwards, they will be getting their booster before the over 80s, even though they would be more at risk. My point really is, is there a specific minister, a specific email that MSPs can be channeling through all these issues too, because it just seems you go around the houses, you go to ministers and you get a response for weeks, sometimes months. You try and go through your NHS board and you get sent a website. For older people, and bear my mind, older people in their 80s and their 70s, for them this is a real worry. Is there something that we can do to try and ensure that people who are raising concerns have some place to take those concerns where they will get a response? I noticed the finger point in my direction about ministerial responses. I hope that that's not the case. In my case, I like to think that my correspondence has turned around very quickly. I'm sure you'll tell me if that's not the case. As Minister for Parliamentary Business in the last Parliament, we set up some dedicated contact points within Government. One of the problems that arose with that was, I don't mean this as a criticism of MSPs because they were trying to help their constituents and it was a pretty fraught time. We were getting the same email going to three or four different boxes, which was creating difficulty in the system. Whatever Jason says from his side in a minute, I'll mention this to the Minister for Parliamentary Business and to have a chat with health colleagues if that is deemed to be something that might be helpful and to share that with MSPs on that basis. You can be absolutely certain that I get copied into almost all of the emails that go to each MSP about each of those challenges, so I get it 139 times. We are doing our best to work our way through those challenges, and you're right. Of course, in a system where we're vaccinating 7.5 million arms, there's going to be some who get an appointment put online before they get the letter through the mail. Of course there are, so they should go to the appointment that's online if they now know when that is, and I apologise that the system isn't exactly as smooth as those would like. I know, for instance, my parents, 80 in Lanarkshire, done in Airdrie Town Hall, with their flujags could not have been smoother and not because of who their son is. And there are stories like that all over the country of it going really well and the NHS working really hard. But if there are specific issues, like your 70 versus your 80s story, that is worth investigation. I agree with you. So if you wanted to send that to me, I will get somebody to look at that for you. Okay, thanks. I think the point is that everybody understands that the NHS is under immense pressure. Staff are under too much pressure, quite frankly, and someone will have to give at some point if we don't get a hold of it. But for people in their 70s and their 80s, you do understand the worry. Can I also pick up on the death rates in Scotland? I noticed that this week, they said that in terms of the number of deaths of all causes registered in Scotland, 24 per cent more than the five-year average. Again, I know for people that have contacted me, struggling to get a GP appointment and struggling to see anybody in the medical centres, they eventually present themselves to the hospital and find out that there is cancer or someone that has moved on stages. Are you aware of that? To what extent is that an issue? Are you monitoring that? Are we going to see excess deaths coming through as a result of the fact that the community parts and other parts of our NHS are shut down? Where we are, we are trying to move forward so that the general practices are given people an appointment where they say they need an appointment because they feel ill. It is genuinely difficult. Excess mortality is a notoriously challenging statistic. It is historical, it is retrospective, it takes the years previous and it works out, please forgive the shorthand, the number of people who should have died. Then it extrapolates that forward to your next year and then you monitor how many people died. It compares the expected death rate with the actual death rate. That is a horrible way to think of it. I know that those are families and real people in my family and your family, but that is how the statistic works. Excess mortality has varied during the pandemic in every country in the world, because we have seen excess mortality. People have died of a new infectious disease. Unpicking that from those who have died because of the response to the infective disease, whether they are in India or Scotland, because of late diagnosis of cancer or a stroke or whatever else is incredibly difficult to do, so we do not know the causes of the excess mortality. Just in the last few weeks and months it has ticked up again, that is because we are in a third wave of Covid and Covid deaths are higher. Remember, in the previous five years we had no Covid deaths, so we have a new disease and we have not taken anything away that is killing people. Excess mortality will only help us historically and we will eventually get into that. Your question is about what the health service now does, partly there not for me, partly there for ministers, but I can tell you that the GP practices are open. The GP practices have been open throughout, one of the only pieces of the whole societal puzzle that has been open throughout. They have had to make some difficult choices about who to see and who to see online and who to do with phone calls, but I am hugely grateful to my colleagues in clinical general practice, their broad teams, the doctors and everybody else who have done that. Face to face is back, it has never went away, so some people get face to face appointments. The decision about who is based on safety and the health of those individuals has to be clinical decisions made locally. I know that I mean to move on, but that is not the experience of people out there in communities. People out there in communities who are feeling ill are finding it difficult to get a face-to-face appointment. Some people... It is not the experience of the whole of the community. If it is your family that has tried to get an appointment, can you get an appointment and discover when they eventually get through into the hospital that they have got stage 2 cancer or whatever and it could have been diagnosed earlier? That is an issue that is coming up again and again. People are struggling. I understand that there was a letter sent by Dr Beust and the health secretary to GPs, but I would say to you that it is not just about clinical choices, there is a responsibility on government when people feel ill and feel the need to have a face-to-face appointment with a medical person, then it is a responsibility on government to ensure that those people can access face-to-face appointments. Surely that is the case, minister? It would also be determined by the clinical judgment of someone who has had that conversation whether it is over the telephone as well. Ultimately, the GP will make a decision based on that consultation. I recognise the point that you make, Mr Rowley, absolutely, but we are in very difficult circumstances. Good morning, Professor Leitch and Cabinet Secretary for Transport. I have various bits and pieces that keep popping up as we go through this. Two seconds while I write this last bit down. Can you also note that it is minister? Minister, sorry, yes. I did not even read your thing there. Can I go back to the very first point that was raised by the convener? That was the question from the member of the public asking about the positive. If people have had Covid in the past, why does that not show up and give them a level of ability to travel? Can I just ask for some clarification on if you have had Covid, are you scientifically confident that that gives you the same level of immunity as you would if you had had a vaccine? If it has been Covid that you have had, what length of time do you have that immunity for? We do not know and nobody knows. We do not know if vaccine immunity and natural immunity give you the same thing. We probably do not. Vaccine immunity is probably longer lasting and that is why everybody who has had Covid should have the vaccine. It is not an excuse not to get it. Immunity is enormously complex. It is not that you get one individual chemical and then you are protected for X number of times. It is a massively complicated biological mechanism with multiple cells, multiple proteins protecting you at various levels. It also varies according to the individual. If you are young, you are more likely to have a better response than if you are 90, but not always. Some 90-year-olds have a very good response. One of our challenges is that you cannot take a blood test and give the response a marks out of 10. You can only give a yes or a no to whoever has immunity or not. People who have had the disease are unlikely to catch it again soon. What we have been saying from the science is about 90 days. You do not need to test yourself again for 90 days because you are likely to get more positive than others would. However, people do get the disease twice. It is usually less severe the second time and it usually goes away quick, but it can still happen. That is why you should restart your testing after the 90-day period to check it. However, natural immunity is good and you will be somewhat protected, but you should still get your vaccine. However, following on from that point, you may have some natural immunity, but you do not have the kind of timescales that we talk about when we have a vaccine. I am merely emphasising the point that you made. Despite the fact that you may have had Covid, it is still essential to get your vaccine in order to help to protect society as a whole. Remember that the vaccine is not to the virus, so superimposing it on top of your virus that you have had is risk-free. There is no reason why you cannot have the vaccine if you have had the disease. The reason that I am pressing this issue is because I have numerous constituents who are saying to me that they have had the virus and they do not want to get the vaccine. This is the disgrace and it is an impingement on my human rights, so I needed that scientific assessment of why we are still asking people to get the vaccine. That is their choice. I would argue that that is the wrong choice for them and their families. If you have had it and you have had the vaccine, you should still be taking lateral flow tests. Just to come back on the point that Alex was making about older people, we are getting concerns about why older people are not getting their booster jag in the same way as they did before, where the vaccine programme went to the community. That is not happening now. I do not know whether you can answer that on a very local basis. It is in Perthshire, South and Rossshire. We have people who are having to travel huge distances in their mind to go and get their booster jag whereas before they could go down to the GP or whatever. I am assuming that the answer will be the same. That is a much bigger programme in a shorter period of time and therefore we are doing the best that we can. That is the fundamentals. We apologise for the compromise that you have to make. Everybody wants it yesterday at their doorstep. You have to compromise somewhere in there to get it as fast as you can, as close as you can. Unfortunately, some people will have to travel further. I was on a site visit to Orkney and Shetland 10 days ago and Orkney was doing all of its 12 to 15-year-olds in one weekend. That was the compromise that they had made. All those youngsters were going to come in a one-hour to the hospital and all be vaccinated if they wanted to. It meant that they got huge numbers, but it meant that the logistics of travel were enormously complex for some of those families. Then they will be picked up and will go out to get people who have changed their mind. It is a compromise between speed and distance. A very quick question for Graeme Deynaud. I do have to come back to you almost just in leech, but I apologise. Can the Scottish Government force GPs to take face-to-face appointments and say that they will now take all-face-to-face appointments? Can you do that? It would not be the right thing to do to force GPs to do all-face-to-face appointments. My dad does not want to go every time. Sometimes he likes a phone conversation. That is the answer that I needed. It is either a yes or a no, and I am quite happy with that answer. We talked at great length about vaccine resistance when we will come up to the vaccine passport process. I heard yesterday on the radio that there is still resistance in the 18 to 29 age group. Do we still have resistance in ethnic minorities and certain age groups that we should know about at this stage? The biggest worry for us as clinical advisers is that invincible age group who think that they are special. If you look at the most recent data, I was just going to bring it up. The most recent data suggests that pretty much everybody over 50 is done. There is a few catch-up, but pretty much everybody over 50 is done. It then falls a little in the over 40s, but not significantly. The last time I looked at the 18 to 29s, it was about 75 to 80 per cent. I will bring it up and come back to you. That looks like a stubborn 20 per cent, because it has not moved much. We have done quite a lot of outreach to that community vaccine passport. It is part of the solution, we hope, for that cohort. We have done a lot of advertising that is invisible to the likes of the 50-year-olds like us, but inside there we have done a lot of mobile units at further education colleges, workplaces, universities and freshers weeks. We have a lot of mop-up vaccines during them, but it remains a personal choice. If they do not come forward, there is only so much we can do, but anything that MSPs can do to encourage that youngster age group who will, in the main, not have severe disease to protect themselves and others would be grateful. On the point about the role of MSPs in that, we are reliant on colleagues in the Parliament to assist us to get some of that messaging across, whether it be in that sphere or in my own area of responsibility. If you take public transport, for example, we have opened up the ferries and lifted restrictions there. We have seen a lot of outbreaks affecting ferry crews. Any kind of assistance that MSPs in this committee can provide in reinforcing the messages about the simple measures that people can take to help us to get through, as Jason referred to at this third wave, would be incredibly helpful. 78 per cent of 18 to 29-year-olds have had a first dose, 67 have had a second dose. That will be catching up because they will not be ready for their second dose yet. That is, let us say, 20 per cent stubborn that we would like to get. We need to mop up that 20 per cent. One very last quick one, for you, minister, is face masks on public transport. Huge numbers of people in the local bus service in my constituency, again, are not wearing face masks. What can we do to actually get that enforced? It would surprise me if it was huge numbers. A lot from people who are coming to me. Colleagues will have different experiences. My experiences in buses have been more positive than that. We are engaged directly with the bus providers. I pay tribute to the work that they have done to support us in that. There will be examples. If you have specific examples about particular bus routes or anything like that, please bring them to me. I had a meeting with CPT just two days ago and they are doing more and more to try and encourage us. However, there is a limit to what they can do. Someone will go on the bus. The bus driver may well say, could you please put your mask on? We have had unfortunate instances of bus drivers being verbally abused for asking people to do that. Of course, there will be some people sitting on the bus who are actually medically exempt. It is just not obvious. However, if you have specific examples of any MSPs, please bring them to me and we will engage with the relevant bus provider for you. Thank you. Good morning, minister. Good morning, Professor Leitch. Just a couple of points that have been raised from constituents. The time of the change of the status of travelling to and from countries, the time of pre-empting of the warning for that, specifically people who have travelled abroad, and then the status changes while they are there and then there is the mad scramble to try and get back again. Is there a timescale or a change of timescale that perhaps does not catch these people out? I think that that was a thing large way of the past and I do recognise that description. However, if you consider the number of countries that are captured by the red list now, it is very small. I think that all the four nations have become increasingly aware of the need to try and avoid the situation like that. I think that what you are articulating there is something that has happened previously. I am not sure that it is as relevant now when there is only a small number of countries captured by that. Right now, if I was not here, I would be on a Covid-19 meeting with the rest of the nations of the UK discussing what we do next. There is a regular dialogue, and certainly in the midst of that is a recognition of that engagement with Travis to try and minimise the difficulties that have happened perhaps previously. One that I have been on for a while is the status of vaccinations from other countries and how they measure the proliferation of the vaccine in other countries into this. How can we be confident that the data that is coming out of other countries is robust? I am always wary of how we compare ourselves with other countries because the way in which they measure their status is hugely variant across the world. How can we be confident that the data that we get from other countries is robust in that sort of travel zone? I speak from a political perspective in the discussions that I have been involved in. The clinical advice that we are given is pretty extensive. Where there are degrees of doubt, that is explained to the politicians before we make such decisions. If you want to call it progress in the number of vaccines that are now deemed to be acceptable, there are still a couple that do not pass muster from our perspective. However, from the political judgment point of view, I have felt more comfortable with the explanation that was provided by our clinical advisers, who have drawn down expertise from across the globe as well, but perhaps Jason can expand on that. You are right. It is a challenge, particularly because we are trying to do it globally. It is not just European or just America, and COP has brought that into blinding light for us. We are trying to do it in two different ways. We recognise vaccines and vaccination programmes from specific countries. Those vaccination programmes have been through a rigorous exercise across the whole of the UK to say that. We started by recognising the European and the US vaccination programme, which is as robust as ours. There is another layer that says that we have to have had those vaccines. There are three or four categories of vaccines, from UK recognised, through European recognised, through WHO recognised, through not recognised at all. We have to make choices then. We give that advice, and the politicians UK-wide have to make choice about which of those are accepted or not. I do not want to use the word dangerous to try to compare ourselves with such a wide variety of approaches from around the world in terms of how we measure those who have tragically died from the disease. So separate problem, not a vaccine recognition problem, but a can you compare Covid data globally problem? That is much more difficult. If you look at the UK, for instance, the headline in the UK would be large numbers of cases, we have also done more testing than anybody else. I think that is a good thing, because that finds the disease, you are able to treat the disease, you are able to die, but that is not how our countries have chosen to deal with it. So if you just look at raw cases of country A versus the UK, you might think that country A has got away with the pandemic in a completely different way from the UK has. The reality is that they have not found the disease, they have still had the disease. So you have to be very cautious and you should go to trusted sources like the WHO who have tried to get beneath those data to try and work out what the reality is. We want to know what the pandemic has genuinely done around the world for a long time until we can look back and see what happened. That is what we are saying, because us MSPs have got to temper the way we talk to each other in the chamber. You should talk to each other however you choose, you should temper the way you speak to me, that would be a different problem. I think that one of the other things that has been raised with me from NHS professionals is the pressure on the NHS from absenteeism for those who have been pinged or are getting regularly pinged by track and trace. I think that I have very specific cases around neonatal units where they are supposed to be 12 on duty and there are only three. That is inherently dangerous. That relates to the impact of non-Covid-related incidents. I do not know where we are with that and how we are keeping top of that and how we are measuring that. I do not have the actual absence data. I looked briefly. I do not think that I have it. We can absolutely get you. Last time I saw it, which was probably last week, it was average. However, you highlight the problem with looking at average absentee data. Average absentee data is across 183,000 employees across just the NHS system. Underneath that, you have very specific pinch points such as paediatric intensive care, such as a dental practice that only has four people in it or whatever. Of course, there it is more challenging. There is nothing on my radar that says that there is a particular workforce challenge other than the general workforce challenge that we have everywhere about a specific unit. That would get raised through health board up the way and it would eventually reach us if there were a real problem. We have mutual aid in place for really fragile services like paediatric intensive care. We have two paediatric intensive care units in the country. They share staff if they have to. They can share cots if they have to so people can move. There are mechanisms in place to manage that. I do not know of any particular challenges that are self-isolation. The self-isolation rules have changed relatively recently to allow a little bit more flexibility for health and care workers if they are vaccinated. As I said, I am not looking at across the country. I am only talking about my particular area where there seems to be a specific issue. Lastly, if I could, I will take Alex Royle's point on access to GPs. I think that there is a variance of approach across the country for accessibility to GPs. I can speak specifically about one elderly relative trying to get them on a point with a GP who still has not seen a GP but ended up in hospital. I have my parents who phone up the GP and say that it is as easy as anything to walk in and get a GP appointment. I note that there is a wide variance across the country, and you cannot force GPs to do whatever they do, but it has to be continually monitored at the moment because there is a huge variance across the country. I am done. As transport minister, that is not something that I am expert in responding to, but it might be worthwhile if I ask health colleagues to write to the committee on that point, because a couple of MSPs have raised that, so I will raise it with their relevant health minister and ask them to engage with their officials and the committee on that. I have covered quite a lot of ground already. I noticed in the amendment 3 regulations that we were recognising mixed-dose vaccinations from this country and overseas. If I remember correctly, earlier on, we weren't mixing vaccines and there was a bit of uncertainty, although there was suggestion that there might be greater protection, but there might be more side effects. Can you give us an update on where that is? It is not definitive. Early trials suggest that the vaccines are behaving in the main, roughly the same, and mixing the vaccine for second, third doses does not really make that much difference. That is not much of a scientific sentence, but in the main, a vaccine is a vaccine for this disease, and they are all roughly in the same place. That is why, for instance, the booster dose is tending to be the one that we have available. We have Pfizer, so most people are getting Pfizer for their booster, because that is what the joint committee said to do, the messenger RNA vaccine. If you were going to India and you needed a typhoid vaccine, you would not check the manufacturer. That is where we are headed. We just had to do the science in real time on TV, so people have known which company went first and which company came second. Actually choosing your vaccine is honestly neither here nor there. Unless you have a specific indication where you cannot have it, some of the young and some who are allergic, that is a whole different question. In the main, the vast majority can have whichever vaccine is available. Following on from the question that the member who answered asked before, the length of protection that you have, is that varying between the vaccines? At one point, there were figures showing that it did vary a bit. Early data suggests that the more medium-term data suggests that it is all coming together, and that is exactly what you would expect, as more people get the vaccine. It is going to be a normal distribution. Remember, it is only yes or no. It is not marked out of 10, so it does not tell you if you are going to get the disease or not. You will get 9, 10, 11 months and some people will be less and some people will be more. In the end, the reason why we are doing boosters is that we are not sure what happens. Chile and Israel have seen vaccine waning, and Israel did a three-week gap between first and second doses. You will remember the controversy about three versus eight to twelve. They appear to have vaccine waning, and they have done a booster programme earlier than ours. They started earlier than ours because they were seeing vaccine waning. We are not seeing significant vaccine waning across the UK, so our booster dose is in anticipation of vaccines beginning to wear off. We have not mentioned the vaccine certificates much today. Is there any evidence so far that they are having an encouragement to get for people to take up that, Jags? I simply do not know. It is difficult to unpick it from general increase. I could argue that the teenagers have gone really well. 75 per cent of 16 and 17-year-olds is amazing. I did not think that we would get anywhere near that in that age group, but, as we discussed over here, the 20 per cent of 18-29-year-olds worries me a little bit. I have not pushed that to 95, which is where I hope to get it. We are running a bit short of time now, but Professor Leitch will be back next week, so there are more general questions that we could ask him then. I now move on to the fourth agenda item, which is consideration of the motions on the made affirmative instruments that were considered during the previous agenda item. The Delegated Powers and Law Reform Committee have yet to consider the health protection coronavirus international travel and operator liability Scotland amendment number five, regulations 2021, SSI 2021 oblique 359. We will take the relevant motion at our meeting on 18 November. Minister, would you like to make any further remarks on the SSIs listed under agenda item number four, before we take the motions? I now invite the minister to move on block motions S6M-01315, S6M-01398, S6M-01466, S6M-01528 and S6M-01634. I note that no members have indicated that they wish to speak, so I will now put the question on the motions. The question is that motions S6M-01315, S6M-01398, S6M-01466, S6M-01528 and S6M-01634 be agreed? Do members agree? The committee will publish a report to Parliament setting our decision on the statutory instruments considered at this meeting in due course. That concludes our consideration of this agenda item and our time with the minister. I'd like to thank the minister and his supporting officials for their attendance this morning. The committee's next meeting will be on 4 November, when we will take evidence from the Deputy First Minister and Cabinet Secretary for Covid Recovery. That concludes a public part of our meeting this morning, and I suspend the meeting to allow the witnesses to leave and for the meeting to move into the private session.