 The next item of business is a statement by Humza Yousaf on protecting those most at risk COVID-19 vaccination programme winter 2022. The cabinet secretary will take questions at the end of his statement and so there should be no interventions or interruptions. I call on Humza Yousaf cabinet secretary. Thank you, Presiding Officer. I welcome this opportunity to provide an update to the chamber on the winter vaccination programme for 2022. Vaccinations for the most vulnerable this winter started on Monday, so this week marks another key milestone in our continued effort to protect against COVID-19 and provide resilience for the NHS this winter. As a nation, we have faced enormous challenges since the start of the pandemic, the challenges that stretch beyond the initial and serious health impacts of the virus. However, it is important to recognise just how far we have also come. For many of us, though I absolutely accept not all of us, life feels like it has largely returned to normal. We have lifted all legal restrictions and protective measures. That is only possible because of the game-changing COVID-19 vaccination and high levels of uptake among the Scottish public who have come forward to receive it and the army of vaccinators up and down this country, to which I think that we are all eternally grateful. More than £12 million in Covid-19 vaccine doses have now been administered in Scotland. In fact, we have among the highest rates of Covid-19 vaccination uptake of first, second and third doses anywhere in the UK. At one point, during our last winter vaccination programme, we had one of the fastest vaccination roll-outs in the entire world—a fantastic achievement in protecting the most vulnerable in our society against serious illness and death. The European Centre for Disease Prevention and Control estimates that Scotland's vaccination programme has averted around 28,000 deaths among those aged 68 and over. We have an estimated total reduction of 86 per cent in fatalities due to the vaccine, the highest percentage in Europe after Iceland. Every single one of those saved lives is someone's family member, it is someone's friend. It cannot be stated enough that our health service and everyone involved in the vaccination programme are owed by all of us a huge debt of gratitude. At this autumn and winter, we will build on the success of previous programmes, including the spring-summer programme, which has just drawn to a close. Like previous rounds of the vaccination, Scotland's spring booster programme enjoyed tremendous uptake as of 5 September. 70 per cent of those with suppressed immune systems, 86 per cent of the elderly in care homes and 92 per cent of those aged 75 have received that spring booster dose. That represents 87 per cent of all of those who were eligible for a fourth dose, which has exceeded our expectations and planning assumptions. I express my sincere thanks to all those who came forward and again to those who have made that immense effort possible. Advancing our continued offer of vaccines and boosters will ensure as much protection as possible to those who are most at risk. Today, we are publishing the deployment plan for the winter 2022 vaccination programme, which sets out the detail of how we will administer vaccines to those who are in most need here in Scotland. This year's deployment plan still has at its heart the aim of tackling Covid-19. It recognises that there are other challenges that put pressure on the NHS and the danger of the health of some of our most vulnerable members of society. A key risk as we move into the winter is seasonal flu. As Cabinet Secretary for Health and Social Care, I am acutely aware of the pressures that the flu and Covid combined can weigh on both the NHS and people's personal health. That is why I am pleased that we will offer where possible both the Covid-19 and flu vaccine in the same appointment to those who are eligible. As part of our approach to tackling winter pressures head-on, we are aiming to vaccinate as many people against flu and Covid as possible by the beginning of December while ensuring that we have the necessary capacity in the system to achieve that. I am also aware of the strain that the NHS is under and that, in order to achieve the pace that we need, we may need to accept that there may well be some overlaps of cohorts receiving their vaccines and there may well be some small and, I hope, limited geographical variation, as we do not want to hold any one area back, particularly later on in the programme. That will not be unique to Scotland, I suspect, but against the challenging backdrop, the goal remains to vaccinate those most vulnerable as soon as possible. As ever, our decisions on who to vaccinate and when are guided by the clinical expertise of those in the joint committee of vaccinations and immunisation. In line with the committee's recommendations this winter, a Covid-19 booster will be offered to residents and staff in care homes for older adults, frontline health and social care workers, all adults aged 50 and over those aged 5 to 49 who are at clinical risk groups, including those who are pregnant, those aged 5 to 49 who are household contacts of people with immunosuppression and carers aged 16 to 49. Everyone eligible for a Covid-19 vaccination will also be invited for a flu vaccine and can safely receive both vaccines at the same appointment. That is why this winter, as I have already mentioned, we will aim to administer the Covid-19 and flu vaccine at the same time where possible. That will save time and will avoid the need for repeat journeys to vaccination centres and, hopefully, it will protect as many people as possible against the serious health risks that are exposed by Covid-19 and seasonal flu. The final point is particularly important, as we know this year that seasonal flu arrived much earlier than expected in the southern hemisphere. In addition to those eligible for a Covid-19 winter vaccination, the deployment plan sets out a range of other groups who will be offered the flu vaccine, prioritising those who are most at risk. That has been our approach from day 1 in accordance with the advice from JCVI. The winter vaccination programme started on Monday with care home residents. Many care home staff are being offered their vaccine at the same time or, alternatively, they can book their appointment through the online portal, along with health and social care workers, which has been open since the 22nd of August. Alongside care home residents and staff, health and social care workers and individuals who are housebound are being vaccinated from Monday 2, ensuring that we protect, as I say, the most vulnerable first. We have already scheduled more than 800,000 winter vaccination appointments for those aged 65 and over, with hundreds of thousands more being scheduled in the course of this week, so I would urge all those who are eligible to please wait until you have been contacted. Anyone who is in any doubt at all about whether they will receive an appointment should visit the NHS Inform website for more information. Given the immunity that is conferred by vaccination can wane over time, it is important that we maximise protection for the most vulnerable ahead of winter when the threat from Covid-19 and flu is likely to be at its greatest. By prioritising those who are most at risk, we can also limit strain on our NHS, as it recovers from the worst effects of the pandemic. On 15 August and 3 September, the MHRA granted regularity approval to two updated by-valent vaccines, so-called because of their dual aspect, which targets both the original strain of Covid and the Omicron variant 2. By-valent vaccines have been deployed as part of our winter vaccination programme from the start of this week. The vaccine use will depend on clinical eligibility, but also crucially on vaccine availability. However, I want to reassure the public that both the existing and the new by-valent vaccines provide excellent protection from severe illness and hospitalisation, and I would urge all those who are eligible to take up the offer of the vaccination whenever they are called forward. The vaccination programme is a vital step in our plans to address as many of the winter pressures as possible, but we are also well aware of the bigger picture. We cannot fail to acknowledge the cost of living crisis and all that entails the potential that we know for industrial action. Of course, we will work hard to ensure that that does not happen inevitable bad winter weather. All those issues, plus more, might make it difficult to travel to large-scale vaccination centres than previously. Of course, the fact that restrictions have been lifted—legal restrictions—means that those large-scale venues are quite understandable and quite rightly going back to their original purpose. For those reasons, we are instead offering smaller local clinics to facilitate access to those who need it most, with more than 440 clinics available across Scotland during the programme as of 6 September. We are also taking steps to ensure that people who may experience barriers or feel less confident are able to come forward for vaccination. Although we have a general level of assurance in vaccine supply and delivery, that may of course be impacted by extreme adverse weather or disruption to transport routes, and we will do all that we can to overcome those challenges. In conclusion, this year's winter vaccination programme will, without any doubt, confront serious challenges. Our NHS is still in the midst of a period of recovery and sustained and significant challenge, as we work towards ambitious targets and bringing down the backlog left by the Covid-19 pandemic. Nevertheless, I am very confident that the programme will be delivered in line with current JCVI planning, with the most vulnerable being vaccinated by the beginning of December. We will, like previous rounds of vaccination, achieve a high rate of uptake. If I may, I would like to say to this Parliament and the public again that the vaccines provide excellent protection from severe illness, which could otherwise strike at the very worst time of the year. I strongly encourage everybody who is eligible to take up the offer of the vaccination. I look forward to providing a further update to Parliament, detailing our progression through the programme in the coming months. Thank you. The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business. I will be grateful if members who wish to ask a question were to press their request-to-speak buttons now. I call Sandesh Gilhani. Thank you. I welcome the roll-out of the winter flu and Covid vaccination programme. This is the first bivalent vaccine targeting both the Omicron and the original strain of Covid-19. As seen throughout the pandemic, working together as the United Kingdom, we are able to swiftly get jabs into arms. An early procurement of this bivalent vaccine is only possible because of the broad shoulders of our United Kingdom. As a GP, I urge everyone who is eligible to please get vaccinated, as it will save your life. With the best will in the world, some people will not receive the letter through error, and some eligible people, for example uncaid parers, may also not be letted through not being known about. How does somebody who feels they are eligible but do not receive a letter, book and appointment? I thank Dr Gilhani for his comments and reiterate them around if you are eligible, please do come forward. I can also say that there are good four nations working. I have to say that although I have not had the opportunity to meet the new health secretary, I am certain that will continue with her new position. On those who are eligible, various different cohorts will be contacted, depending on the local structure. For example, the way of contacting those who are household contacts of those with immunosuppression might be different than Orkney, for example in Glasgow. However, if you have any doubt whatsoever about your eligibility, we can direct people towards NHS Inform. If they are digitally excluded or unsure, they can also call the vaccination helpline for confirmation about whether they are eligible or not and how they will be invited. Dr Gilhani is of course very aware of that. Our second winter vaccination programme for many people may be the fifth dose of the vaccine. I suspect that people now are in the rhythm of knowing whether they are eligible or not. Some may not be, so if there is any doubt, you have any doubt whatsoever. Do not hesitate to call the vaccination helpline for further information. Presiding Officer, let me in advance thank those who will be involved in running the winter vaccination programme. We are very grateful for all of their efforts. We know that the Covid vaccine lessens the impact of Covid, but we also know that it does not stop people from getting Covid in the first place. That remains a significant concern for those who have underlying health conditions who were originally on the shielding list and told to stay at home. Not all of them are eligible for antiviral medication and we have yet to see the use of prophylactics to prevent those who are most at risk from getting Covid in the first place. Can the cabinet secretary tell us when he will extend eligibility for antivirals to all those who are on the shielding list and when will access to prophylactics be given so that we can protect the very vulnerable from actually getting Covid in the first place? First of all, if I may, I forgot to say in my response to Dr Gohani that I am writing out or should have landed actually in most MSPs inbox an update on the winter vaccination programme. That will include details of who is eligible and is much of a leadership role, certainly I have my role as Cabinet Secretary for Health and Social Care. Of course, I hope that all MSPs will cascade that information locally. If they hear of any individuals who have any doubt about whether they are eligible or they think that they are eligible but not getting any further information, then they are more than happy for them to contact me too. I recognise what she says, I recognise that there are people out there who may not be suitable for whatever clinical reason to get a vaccine, although the vaccine remains, of course, the best protection against the serious effects of Covid. There will be some people who may just not be able to exhibit immune response due to whatever clinical condition they have. In terms of widening the access to antivirals, that is a clinical discussion that is very much taking place. I have been contacted by the likes of, for example, Parkinson's UK, who I know are very keen for their members—those whom they represent with Parkinson's—to be eligible for certain antivirals. I understand that one of the clinical trials under way is now in discussions with those with Parkinson's to gather that clinical data. That on-going evolution of the antivirals and the eligibility is a process, as I say, that is on-going. In terms of prophylaxis, I think that Jackie Baillie will be aware, but I am happy to give her more detail in writing, that there is a particular prophylaxis, Eversheld, which is of interest to many people. It has got a conditional HRA, regulatory, a conditional marketing authorisation, but that authorisation was given before the prophylaxis, before Eversheld was tested against Omicron. Therefore, there is insufficient data to give us any evidence—credible evidence—that Eversheld is effective against the Omicron variant. I understand that the UK Department of Health and Social Care has offered to explore the possibility of a clinical trial for Eversheld. I am very supportive of that, and we will make it very clear when I meet the UK Secretary of Health, the Secretary of State for Health, that I would expect that Scottish patients would also take part in those clinical trials. Emma Harper will be followed by Tess White. As a nurse, I, too, would like to encourage all those who are eligible to take up their vaccine offer. Many of those who are eligible for vaccines will face accessibility requirements, particularly those who are housebound. Accessibility should never be an obstacle for people who receive in healthcare. With that in mind, what arrangements have been considered in the roll-out of the next round of vaccinations, especially for those with accessibility needs? This is an issue that has been well rehearsed in previous iterations of the vaccination programme, but it is absolutely right that Emma Harper raises it. There may be people who are now housebound and who are not housebound in previous iterations of the programme, and I want to give an absolute assurance that they have not just been thought of in this programme, but given real priority when it comes to the vaccination programme. Housebound patients will be offered both flu and Covid vaccinations in their homes at the same appointment where appropriate. Those who are eligible will be contacted by their local board. People who are housebound have not been contacted much like anybody else who feels that they should be eligible, as Dr Gohanne asked me, but have not been contacted. They should call the national helpline and the number for that is 0800 030 8013. Cabinet Secretary, the deployment plan highlights that many health boards are using the Scottish ambulance service to reach deprived or rural communities. We know that the Scottish ambulance service is already under pressure. How will that be adequately resourced to ensure that those communities are not overlooked? Cabinet Secretary? Can I attribute to the work that the Scottish ambulance service has done? I think that many members here have visited their mobile units up and down the country. Some of those mobile unit test sites have been in remote rural areas, some of them have actually been in urban areas as well, but they have been a great asset to us in this vaccination programme. Of course, the planning for the winter vaccination programme has been done very much in hand and glove with the Scottish ambulance service. What I would say to Tess White is that, in remote rural parts and island communities in Scotland, there is still largely a reliance on those local, hyper-local vaccination centres. I think that I said in my statement that there are around about 440 vaccination centres. That will hopefully give some level of confidence to Tess White that the remote rural and island coverage is very good indeed in terms of the vaccination centres, let alone the additional complementary assistance that the Scottish ambulance service can provide through the mobile units. Fiona Hyslop, to be followed by Paul O'Kane. The cabinet secretary may be aware that West Lline has a bigger population than the city of Dundee. My constituency of Llynyddgo, the most constituent in Scotland, has a significantly disproportionate number of over 50s residing in it. The Pyramids facility in Bathgate provides the space for the very welcome over a third of a million Covid vaccinations, unlike other mass vaccination centres that are now understandably closed. What assurances can the cabinet secretary give me that staffing levels and venues, if they are to be based in GP surgeries in my constituency and across the country, will have the capacity and support that they need to ensure demands from the large number of people who will be eligible to have their winter Covid booster will be met? I agree with everything that Fiona Hyslop has just said. For various different reasons, those large mass vaccination centres are no longer available to us. They are being used for the original purposes. Some may have closed down, but there are still large centres in some parts of the country. I am very assured by the plans that I have seen by local health boards up and down the country, by using those local sites that are high in volume to hopefully provide that reach right across the country. In terms of staffing, if Fiona Hyslop is absolutely right, the very constrained timetable that JCVI is asking us to work under means that we are going to have to hit a run rate. Every single week, near the record run rate that we hit last year, we had that kind of boosted by the Bells campaign, if members remember correctly. That is on top of the usual winter pressures that we may well face. Therefore, if there is another wave of Covid, for example, that will undoubtedly have an impact on staffing. Those things are being monitored, contingency plans are absolutely being put in place, but it is fair to say that this is a really ambitious programme. The impact on staffing and the pressures on staffing are significant here, but we all know the importance of the vaccination programme, and that is why I am so grateful for every single member of the vaccination programme that is helping us with this winter programme. Paul O'Kane, to be followed by Gillian Martin. I note what the cabinet secretary has said in relation to vaccination services being as local as possible, but we know that restrict does not always match reality. There have been numerous examples of NHS Highland patients being made to make 100-mile round-trips, and then we are inclined that there have been numerous examples of people with respiratory illness being instructed to travel to Glasgow. It is also critical in terms of delivery to recognise that the RCNs are balloting for strike action, with more than 90 per cent of nurses having rejected the Scottish Government's pay offer. What specific actions are being undertaken to ensure that vaccination centres will be as close to people as possible, and what action, further action, is the Scottish Government taking to resolve the pay dispute and ensure that nurses are paid a fair wage, including those who provide vital vaccination roles? I am satisfied that the number of venues that we have is sufficient for the ambitions of the winter vaccination programme. If, for example, there is a need for more vaccination centres, I would expect local health boards to adjust their programme. Accordingly, he mentioned Highland alone. Highland has 121 vaccination centres, so I hope that that gives some level of assurance to Paul O'Kane about their coverage. In terms of the second part of his question, we are in regular dialogue with the trade unions. I want to see a fair settlement. I understand why they are asking in the RCN's example for an above-inflation increase, but, of course, as John Swinney has said in the last couple of days and spoken to this chamber, our public finances are constrained. Nonetheless, while I am disappointed that 5 per cent has been rejected, I completely respect the mandate that trade unions have been given, and, therefore, we are getting back around the table with them to get to, hopefully, a fair deal for our NHS staff up and down this country. The refugees in the last few years, most recently those fleeing from the war in Ukraine, what steps are going to be taken to ensure that all refugees who may not be registered with a GP can be made aware of the vaccine programme and access appointments? That has been part of our winter planning for this particular vaccination. Programme materials have been translated into Ukrainian and into Russian. Of course, we know where those Ukrainian refugees are and, therefore, there is a targeted effort to ensure that the material gets to them directly. They do not have to be registered to a GP to get the vaccination. We will continue with those efforts. We are also talking to a number of community and third-sector organisations to assist us with that communication. There is good working going on. I have said to those health board areas that are hosting Ukrainian refugees, which is a significant proportion of our local authorities. I want us to work with our health boards to be as proactive in this endeavour as we possibly can be. Hamilton to be followed by John Mason? Vaccine hesitancy will be as big an issue in this roll-out as it has been in previous roll-outs, particularly so given that people believe that we are now living around Covid. It is just a way of life. What additional messages can the Government give to those people who are sceptical about the efficacy of vaccines and how important it is to take up this new booster jam? School Hamilton is absolutely right. It has been one of the concerns that I have had that, as Covid is perhaps not as prominent on the agenda as it perhaps was in previous iterations of the programme, I do not want there to be any complacency setting in now the indications thus far from the portal that has been opened for health and social care workers and from the work that has been done in care homes. It does not suggest that the uptake has been affected, but we will not be complacent about that. We all have responsibility, primarily myself of course, in the role that I occupy, but I think that we all have responsibility to continue to communicate the benefits of the vaccine. I urge everybody to do that. I will certainly do that in my position. It is not just about vaccine hesitancy. We know that there are certain groups in the population where the uptake has been lower, and that is where we are going back to Tess White's point. That is where our mobile units can be really effective if they are outside particular community facilities. We know that they have been deployed previously in the Goodwara, the mosques and areas of high deprivation, and they have been a fantastic resource in that sense. If I can give Alasgo Hamilton absolute reassurance that nobody in the Government is being complacent, I urge everybody here to communicate the benefits of taking up the vaccine. John Mason, to be followed by Julian Mackay. Thank you very much. We were told previously at the Covid Committee that worldwide some 20 million lives have been saved by the vaccines, and yet there is a lot of misinformation and disinformation on social media. Can the cabinet secretary confirm that 20 million is roughly the figure of lives that have been saved, and can he reassure those who are made nervous by social media? Yes, he is referring to a study by Imperial College London. He is right that the number of lives saved is just below 20 million, which is 19.8 million. We know, of course, as I referenced in my comments, that Scotland alone, 28,000 lives, have been saved by the vaccine. There is a lot of disinformation, and we are doing our best to counter that disinformation by promoting the benefits of the vaccine on social media platforms that can reach a far wider audience than a watching our proceedings here in the chamber. We will continue with that effort to counter disinformation. As I said to Alex Cole-Hamilton, I think that we all have a responsibility in that. I welcome the update from the cabinet secretary. We are in a cost-of-living crisis, and I am sure that the cabinet secretary would not want anyone to not be able to make their appointment due to not being able to afford to get there. Has the Scottish Government had any conversations with health boards about what support might be offered in those circumstances? We have told health boards—they have been very willing to do that—that we have to factor the cost-of-living crisis into our planning. The cost-of-living crisis is a public health crisis. We know that. Therefore, that planning is well under way. If people do not feel that they can leave their house because they cannot afford to do so, they should contact the national vaccination helpline. They can contact the local health board, and my absolute expectation would be—I will further reiterate this to our health board colleagues—that we would do everything in our power to get to those people or, indeed, get those people to us at no cost to themselves if the cost of travelling to a vaccination centre is indeed prohibitive. Centralised vaccination centres simply do not work in rural areas. One has found a vulnerable elderly couple in Straths Bay. They have been given their appointments on two different days in two different locations, with one being asked to make an eight-hour round-trip of 70 miles to Inverness. That does not fit in with your statement to provide more local centres. I favour GPs in rural areas who are rolling out vaccines as they did earlier in the pandemic. If GPs are willing to do that, are you willing to support them? In short, yes. I would say to Mr Mountain that if he wants to furnish me with those specific details, I am happy to follow that up with the appropriate health boards. I gave the details of the local arrangements and how many local centres there are. If there has been an issue with scheduling, that is, of course, regrettable. My colleague Fregis Ewing and I had a meeting with local GPs. Of course, if local GPs, for example, in North Highland, are keen to be part of that vaccine programme and they are needed, if that is the case, there should be no restriction on behalf of Government. For example, we know that GPs have been used—in fact, I visited a GP in the island of Bute in Rothsy, who were administering vaccinations. There is not a legal restriction in that sense, if GPs are willing to do so. We know that it is not part of the contract, but if they are willing to do so. On his specific point around his constituents, I am happy to delve further if he is able to provide the details. Clearly we want vaccination centres to be as accessible as possible and to minimise, again, as far as possible, lengthy travel to get vaccination, especially for people who are reliant on public transport. Can the cabinet secretary advise if the number of venues for vaccination will be kept under review? It absolutely will be kept under review and I would expect if there is a need to adjust and health boards would adjust accordingly, so they will absolutely do that. I have seen that happen in previous iterations of the vaccination effort. I will make the point that I made to Gillian Mackay. If anybody is concerned about the cost of travel or their ability to travel and arranging transport to and from vaccination appointments for, for example, mobility issues or, indeed, other issues, there is support available from each board. You can go to the NHS Inform website for the details of that. You can also call your local health board vaccination helpline, or, indeed, the national helpline, who can direct you to the right place as well, because we want nobody, we want no barriers to anybody coming forward for the vaccination. Again, I would urge anybody who is eligible to please come forward to protect yourself, but also to protect others and, of course, to protect our NHS too. That concludes the ministerial statement. The next item of business is consideration of two parliamentary bureau motions. I ask George Adam on behalf of the parliamentary bureau to move motions 5, 9, 1, 0 on committee membership and 5, 9, 1, 6 on committee substitute.