 Gwneud i'r 14 eich niwn i'r Cwyd-19 Rheinydd Cymru i'r 2021. Rhywbeth ymddangos i'ch gŷr ystod o'r ffoton o'r hyn o'r ddigon ystod o'r ddigon ystod o'r gwyrdd ystod o'r ddigon ystod o'r ddigon ystod o'r gwyrdd. Maen nhw'n gweithio ychydig, oedden nhw'n gweithio gyda'r ddigon ystod o'r ddigon. I welcome you to the meeting. Would you like to make any further remarks on the Maid Affirmative Instrument before we take the motion? Recognising the busy schedule that the committee has, I'll weave it into that. If that's okay, you can just move the motion. That's fine. I now invite them to move the motion. Is any member's got any comments? No comments? Sorry, could you move the motion, please? I can be up. I note that no member has indicated that they wish to speak, so I'll now put the question on the motion. The question is that motion S6M-02261 be agreed to. Do all members agree? Yes. Thank you that the motion is agreed. The committee will publish a report to the parliament setting out our decision on the statutory instrument considered at this meeting. I would like to thank the minister for his attendance this morning. I will now suspend the meeting to allow a changeover of witnesses. Thank you. Good morning. I now move on to agenda item number two, which is an evident session on the vaccination programme. I'd like to welcome to our first panel to the meeting, E-Man Hanny, general manager of Central Scotland Regional Equality Council, Parveen Ishark, office manager for Edinburgh and Lothian's Regional Equality Council, Magda Zanica, chief executive officer of Phoenix counselling, personal development and support services, Maria Jose Pavez-Laria, policy officer and project coordinator of Grampian Regional Equality Council, Mohamed Razzack, executive director, West of Scotland Regional Equality Council and Dr Paulina Trevina, research associate in urban studies university of Glasgow. Welcome and thank you for giving us your time this morning. We are the lead committee responsible for scrutinising the rollout of the vaccination programme. Today's session is an opportunity to consider why uptake of the available vaccines has been below average in some of the communities in Scotland. Our first panel will be speaking to us about the experience and perspective of ethnic minority communities. Each member will have approximately eight minutes to speak to the panel and ask their questions. If you would like to respond to an issue being discussed, please type R in the chat box and we will bring you in. We have a large panel today and I am keen to ensure that everyone gets an opportunity to speak. I apologise in advance therefore if time runs on too much I might have to interrupt members or witnesses in the interests of brevity. I will now turn to questions and if I may begin by asking the first question. We find ourselves again in this challenging situation with the new variant. We know that vaccinations may not stop you catching the virus, but from evidence so far vaccinations most definitely hinder the severity and reduces the need for hospitalisation. To protect not only our communities but also our health service, we need people to take up the vaccines. We have representation today from four of Scotland's regional equality councils and Iman Haney. I know that you need to leave early today, so I will ask you what challenges you have faced trying to get minority communities to take up the vaccination and what you believe the Scottish Government could be doing to give confidence to those minority groups to get vaccinated. Thank you very much and good morning to everybody. I will try and be as short and as quick as possible. There are a variety of factors. We deal with people from a wide range of different backgrounds, and that does not only include their ethnic backgrounds but the intersectional diverse nature of these people. However, I will try and summarise the most common reasons for why the people that we deal with at least have hesitancy or reluctance to uptake the vaccination when they are offered ones. The main one would come across to us as the lack in trust in the NHS services or anything that is coming from an authority. That is mainly because of the nature of where these people had come from. People who have either grown up in communism or are playing their countries because of war or they have been oppressed in their own Governments, often due to tendency things that are coming from the Government as against them. That naturally creates that hesitance and resistance to taking anything that the Government is telling you is not going to be for my benefit. Unfortunately, that is one big factor within many of the groups that we deal with. We have also got the other usual suspects, the myths and the misconceptions where people have best beliefs about certain concepts of the vaccine. It has not been there for long enough. How do I know that I am not going to grow a third leg? How do I know that I am not being chipped? You have got to understand that for certain people, refugees, asylum seekers, illegal migrants, people who are on zero-hour contracts, people who have got poverty, childcare barriers, all of these factors work together and make things harder for people to really want to take the opportunity of getting the vaccine. We also have other resistance because of personal experiences. Word of mouth, someone had had symptoms afterwards and they went very well for a few days and they did not want to have similar experience. On the other side of the coin is those who have no experience whatsoever. They are in denial. I do not believe that the whole Covid thing is real until I actually see it or experience it myself. There is a big variation of reasons why people from certain backgrounds are either reluctant or completely against having the vaccination. What can we do to overcome this? Plenty of things. Communication is key. We need to communicate with people in a way that is understandable to them in a language that they understand. I do not just mean language as in the different languages that we speak. The approach is that there are multiple grassroots organisations that have existing relationships with people from ethnic minority backgrounds. We can use those existing relationships to build the trust and try to have the information delivered to those communities in an accurate manner, but also in a way that feels friendlier that it is coming from an authority. We have been participating in the Venus ethnic minority nationalism network, and there has been an awful lot of support through that network. All the resources from the Government, NHS, Public Health Scotland—it is all valid stuff, but we were using the resources from the Government and the authorities, but delivering them through grassroots organisations, community organisations and community groups is easier. It just overcomes the whole trust barrier. I hope I am not taking too much time, but that is just a short summary of what the situation is like. Great. Thank you very much, Amanda. It is very interesting. I was just going to open it up to the Equality Council's Pavine, Maria or Mohamed. Did you want to come in on those points? I do not know if you can just raise your hand so I can see. Maria, would you like to come in, please? Yes. Thank you very much for the invitation today. I am just trying to summarize a few key points. We identified four main things that were reasons for people not taking the vaccine or not accessing it. The first one, just as a summary, because I am aware that you have all the reports and you can see the details there. Just as a summary, the first team is related mainly with vaccine information. The main issue is there being uncertainty around the safety of the vaccines, as it was developed too quickly, in comparison to others. There is longing for wanting more evidence to be collected. There is a development of blood clots related with Oxford as a personical vaccine. Concerns related to unknown long-term side effects especially, and concerns about the impact of pregnancy and fertility, paired with the lack of clear guidance when asking GPs and healthcare staff about it. There is also a lack of trust in public authorities and NHS information provided. The perception is that, once you have Covid, you are protected and you do not need the vaccine, and that was across all ages. In terms of practicalities, a second theme that is very important and is practical, so it can be addressed, is related to the vaccine appointments and people not receiving the letter, people receiving the letter at other addresses, miscommunication of appointments, misinformation or lack of information coming from local health lines, related to where and when to access the vaccine, and also related to the support language available in vaccine centres. Of course, it is not understanding the letter due to language proficiency and the inability to self-register online, which I think takes relevance now because the main way that people are registering now for the vaccine is online, so that that should be taken into account. The third theme was vaccine hesitancy, as Iman said, low perception of risk, views against Covid-19, as it violates personal rights and freedom, and believing that the pandemic does not exist or is exaggerated. Fourth topic, other reasons, the lack of support networks when someone has recently arrived in a new city or in a new region in Scotland, and perhaps the side effects concerning the person and not having access to a network of support in that regard, which is also important in terms of people that does have zero hours' contract or no records for public funds in their visa category, and, of course, also some conflicts with personal beliefs and family conflicts because of different views around the vaccine, and how to tackle all these concerns, and how to promote vaccination uptake, just as main topics. First of all, more information and resources about the vaccine are needed, also more information about the consequences of long Covid, more information and resources about incentives and positive consequences of receiving the Covid-19 vaccine. For example, including the booster certificate in the vaccine certificate, I understand that it's currently not included. Just to summarise, continue to increase the number of community members that encourage others to get the vaccine, include faces from the communities in the promotional material, and increase flexibility in the access and information on their appointments as well. I'm sorry if I was too long in that summary. Thank you, Mary, and now that's much appreciated. I know that there's quite a few members of the panel that do want to come in, but I've also got John. Do you want to ask a question specifically to them? Well, it wasn't specifically, but generally, I mean, I'm just wondering, especially from the first, was it, Eamonn said, about skepticism about Governments and Health Services, so I think my question then would be, well, do we just have to accept that that will take 20 or 30 years to overcome, or is there some quicker way of overcoming that? Secondly, I think it's been suggested before that some people get advice and perhaps the Polish community from Poland, and so they're hearing what the Polish Health Service is saying. I mean, is that actually an issue? So, I'll leave it at that. Does Eamonn want to come back in? Yes, thank you very much. It's not a matter of, you know, it's not going to take decades for people to overcome the issues of lack of trust in authorities. I think if we understand what the makeup of ethnic minorities is like and people who are living in disadvantaged situations, it's a complex matter, but there's nothing that is set in stone. There's always ways that we can work together with people and reassure them. It's just a matter of personal experiences, and in certain situations, at least with the communities that we deal with, that those experiences have been going on for long enough to have left that much of a scar into the system and where and how they can accept things that come from the authorities, which is why, in my suggestion, I think and I believe that if we work together with existing organisations that already have got over the trust issue with these communities and work along with them, rather than always having to come from the clinical perspective, that would overcome that massive barrier. The other point that you've asked was with the Polish communities. It's not just the Polish communities, it's the information. Many ethnic minority groups under the Polish communities are one of them. They tend to have and rely on information from their own back home Governments, authorities back home or relatives back home. That's a common theme within many of their ethnic minority groups. That's, again, due to the nature of the trust and the relationship that they've got. I'll believe what my sister tells me more than I would believe someone that could be out of stranger. It's just how it works. Again, it's not to say that we're not going to be able to deal with it. There are existing organisations, not just ourselves, there are many grassroots organisations that deal with ethnic minority groups, have got the relationship, have got the trust built up. I think that it's just a matter of working together with other groups and with other organisations to deliver these information, to deliver this reassurance and try to overcome that obstacle and help people to get vaccinated as soon as possible. Thank you. We do have a bit of time, so I'm going to move on to the rest of the panellys that want to comment, and then I'll move on to the member's questions. Parveen, would you like to come in? Yes, hello everyone, good morning. Oh, I think I'm on. There we go. Good morning everyone. I'm the manager from Edinburgh and Lothian's regional equality council. I would agree with all the points Iman has mentioned. They are exactly the reasons that we have also found, but if I speak specifically from a South Asian background, I would say that the two main reasons that we've had regarding the vaccine update. One is, as you know, a lot of South Asian communities have long-term health issues, such as diabetes, hypertension, high blood pressure, and many other things. They are just not convinced that the vaccine will help them. In fact, it may deteriorate their health more because they've just not got enough information, which tells them that it's safe for them to take it, and that it's not going to have any adverse side effects, knowing that they've got the long-term health issues. The other thing is that we're more likely to get a better uptake of vaccines if it was coming directly from your own GP. For example, for the rest of the population at the end of the age of 50, it's fine, but anybody with underlying health issues from those ethnic backgrounds, specifically South Asia, they would feel better if that information was coming from their own GP who knows about their health issues and who knows the possible risks that they may have. They are more likely to take the vaccine if it came from their GP, but I appreciate that the GPs are not able to do this work that is already very busy and inundated. I'm not sure if that's possible, but it goes back to the main issue of lack of trust in the Government and also how the vaccines have been rolled out. It's been a one-size-fits-all approach in which they don't have any faith in. During the lockdown, it was a case of a lot of misinformation coming from different channels from abroad. We did try and do a small project during the lockdown to try and combat that, but like Iman said, people would rather believe somebody that they could relate to rather than just the general message coming from the leaflets or from NHS Scotland saying, you know, take your vaccine, but they don't say why they should take the vaccine if it's safe for them and it's been tested enough or your ethnicity, so because of that, it's 99 per cent safe. So, they are the main things that we felt. Now, recently, what's coming up is a lot of people have already had the vaccine, sorry, had Covid. They've recovered from it and there isn't any major side effects of Covid, apart from maybe persistent cough or chest problems, which, obviously, the doctors have said, it could take months to recover fully. Now, the issue is people are thinking, well, if our bodies can deal with Covid or the flu or any other illness that comes up or any other virus comes up, then, shortly, we can get over Covid as well. So, why do we need to put the vaccine in our bodies when it's just a new vaccine? There's no guarantee that it's not going to give us adverse side effects, so it's not really worth putting in our bodies if we're recovering from it. So, they're the main things that we've found over the last number of months. Thank you very much, Perfeyne. Can I bring in Mohammed, please? Very much. Can you hear me okay? Yes. Yes, Mohammed Razack from West Scotland Regional Equality Council and part of SAREC. I think that a lot of issues have been mentioned already by my colleagues here. I just want to touch on a couple more things in more detail. We've talked a bit about lack of trust, and I think that it's not just about previous Governments, but even within the UK, you have discrimination, you've got an immigration issue, you've got hate crime, the way it's dealt, the negative effect of prevent programme, for instance, the Windrush scandal, and even now, the new nationality and borders bill that can take away your nationality without you being notified. So, those things do matter along with what has been said already, and the information coming to ethnic minorities through social media, and my colleagues have mentioned about back home countries, which, to be honest, have different cultural and environmental issues there than we have here. For instance, in most of Asia and Africa, people spend most of their time outside their home. They don't sit inside offices or sit within their home. It's an outside environment, so the spread of the virus is not as much, and people don't take it as an important thing. Also, they're getting social media from other countries, which is telling them a different story. Who do they believe? One thing that's not mentioned is the faith-related issues. It's certainly within Islam that it is very clear that it is God that decides if you live or die. Some followers, in particular the elderly, will say that if this is already decided, why take the vaccine? If it's up to God, why should we take it? There is some element of that as well, and we need to adhere to that. One of the things that might not be mentioned as well is about ethnic minorities having larger families. If you've got a head of the family that is an anti-vaxxer, you've got a large number of people who will not take the vaccine because of that. As you go along, the numbers become bigger and bigger. Similarly, word-of-mouth is huge in these communities, and any one anti-vaxxer could put out their information to others. Before you know it, you've got a lot more that are taking up the message of anti-vaccine. Does that issue that we don't take into account? Of course, there are closed-knit communities, as you know. Therefore, the message gets out there much, much quicker. The other thing that I wanted to mention is that, in the early days of Covid, we had some consultation with the Government and we said that there wasn't enough role models and information going out to ethnic minorities. I'm pleased that, within a couple of months, there was a lot of information coming from the Scottish Government, the NHS, with role models giving their views about vaccine. That was having a positive effect for us anyway. As an organisation, we were able to send that out to all our client groups and partners. I thought that we were winning the battle in terms of getting that message across about getting the vaccine, but that stopped after a few months. Now, there's nothing going out. I don't know whether the Government thinks that the job is done and that we have crossed that line, but it feels that it hasn't. I was thinking that it may have, because there was nothing coming out from the Government. Now, I realise that it's still an issue. Why did we stop? There's nothing coming out at all at the moment, and I'm sure that my colleagues will agree with that. Just like my colleagues said about the whole stigma about communications, sharing that information and making people aware, along with the religious and cultural needs, it's not just about the vaccine itself. What does each religion have to say in terms of vaccines and whether you should take it or not? We need to get role models from various religious groups saying that this is okay. All that happened earlier on. It did happen, but it stopped all of a sudden. I think that continuing that would help quite a lot. That was the main thing that I would say from my point of view. We were very, very happy to liaise with the Government and NHS, to bring those information and to pass it on to our communities, but sadly that has stopped. Thank you very much. Thank you, Mohammad. You raised some very valid points and interesting points. I know that there are a few more panellists wishing to come in, but I am going to pass over to my colleague Amrto Fraser to ask a question, and he will bring you in. Good morning to the panel. I wonder if I could put this question first of all to Magda from Phoenix. I am interested to get your views on what has already been said, but I know that if we look at the number, there is a particular issue in the Polish community with the lack of uptake of vaccinations. We have heard from other contributors that there is an issue with suspicion of government. I am interested to get your thoughts on that, too, if that is a driving factor. One of the things that we have seen develop just in the past few weeks in other parts of Europe is a tightening of restrictions, particularly on the unvaccinated. Some countries have brought in lockdowns for unvaccinated people, and there has been a conversation in some countries about making vaccinations compulsory. We have not gone anywhere close to that here, but we have seen vaccine passports here in Scotland and elsewhere in the UK. I am interested to get your perspectives on whether that approach is likely to encourage people to be vaccinated or might actually have the opposite effect. Magda, first of all, please. Hi. Thank you for inviting me. To refer to what was already said, I think that the vaccine hesitancy in the Polish community was already quite well known even before Covid appeared. As a phoenix, we were working with NHS Lovian on the future research with Dr David Gorman on understanding why that was happening. It proved that the main anti-vaccine movement was coming from Poland. I am not sure if there was anything that we were able to do about that, but it is important to highlight that it was the most opportunities from the Government and from the other institutions that until our campaign that started in June, there was no real outreach to ethnic minorities coming from the Government. It was one year since the lockdown that all those anti-vaccine and conspiracy theories managed to develop in Scotland. We, as phoenixes, were trying to do as much as possible. We were translating information about the ever-changing conditions of social distancing, but I do not think that we had the strength to combat all the myths that were developing on social media. Since Facebook, for instance, is one of the main channels used over lockdown to communicate. I have to say that I think that there were a lot of misoffer opportunities. There were materials translated to Polish and other languages that are available, for instance, on NHS inform, but I am pretty much not searchable in the sense that all the files are titled in English. They say that there is vaccine information in Polish, and there are in PDFs, and there are on NHS inform. If you are looking in Polish vaccine Covid Scotland or Edinburgh, it is not coming up. All the information that was created, whether videos or leaflets, they are pretty much not searchable. For the person who is not using English very well, they were looking for information in Polish, but they were not finding it. I think that it has to be understood that it was pretty much the kind of information gap for one year at least. All the information was coming from Poland, and it is also an issue that we found that it was called Ryanair medicine even before. People were choosing the modality of medicine that was fitting them. Lack of trust to the authorities, to the system was also exacerbated in the situation, because there was no communication with the Polish community. Pretty much people felt that they were left by themselves, and they had to make decisions by themselves. If there was no information, they were making decisions that way. The colleagues before said that it is important to give information, but what has to be understood is that the information has to be a lot more in-depth than for the local community. The way in which people have to register for the vaccination and the way in which the vaccination is important to address the values that people have. During our campaign, a lot of people really wanted a personal conversation with a specialist, such as a GP, to be able to discuss their health issues, which they did not have. They did not have the opportunity. With that, it was also the problem of having a choice between the vaccinations. Scotland was very strong on AstraZeneca for a very long time, whereas Poland, for instance, already gave access to Pfizer or Moderna, which was a choice that was giving a little bit more trust to the system. The second question is about whether making vaccines compulsory or making it harder for people to be unvaccinated. Would that help, or would that make matters worse? I am in two minds about that. It is very difficult to say. I think that if people have economical incentive of any kind, they will probably get vaccinated. Economically, it is not being paid, but having limited access to places and to work, then, probably, a big part would get vaccinated. We found that there was a vast group of users who would call late adopters, possibly, who were looking and trying to understand what was happening and what were the effects of vaccination. Possibly, they are now suffering with Covid or not. It is difficult to question. There is no specific answer to that. Thank you very much. I will bring in Dr Polina Trevenna, who we have not heard from so far. Can I get your reflections on the discussion that we have just heard in general terms, but also specifically on the question that I asked about whether making vaccines compulsory or bringing in more restrictions on the unvaccinated actually encourages people to take up the vaccine, or does it have the opposite effect? Good morning. Let me address this question first. I think that that would cause a lot of polarization. Basically, some people would be encouraged, some people would be very discouraged, and I think that there has actually been some research done on that. There is an LSE blog that you can have a look at, which shows that that is what would happen. During Covid, I worked on a research project on Polish essential workers in the UK. Vaccination was one of the things that we discussed. Basically, the same thing comes across from our research that some people are very much against it. There is a mistrust towards NHS or the Government. If those people are told that it is obligatory, they will go even further down the conspiracy theory road. While other people said that if it is made compulsory, then they will get vaccinated. Travel is a big motivator. Being able to travel freely, being able to travel without tests or just being able to travel because, for a lot of Poles, it is very important not because they just love travelling but because they have families abroad. It is a big thing not being able to see your family. Many people mentioned that that was a big difficulty for them during Covid. For example, if travelling was made more difficult because they were not vaccinated, they would consider vaccination. However, I also wanted to reiterate all the points that Magda Charnedscan made. One of the biggest problems with encouraging people to get vaccinated is the fear of the vaccines not being trialled properly and not safe of the side effects. I was taken aback by the fact that a lot of our interviewees did not see any medical benefits being vaccinated. They were of the view that it does not fully protect them and it does not help to protect anybody else. Some people were sitting on the fence and saying that once we see how the vaccination programme proceeds, if there is proof that it actually works, I will consider it. I cannot underline enough how important it is to get out messaging that is reliable and unbiased. We have already mentioned that a lot of people use sources from abroad. One of the reasons is because they are used to it, but another reason is the language barrier in accessing reliable sources locally. Magda Charnedscan already mentioned things such as documents not being searchable in Polish, for example. For people who are not entirely proficient in English, there were not reliable sources of information. That is why they were turning to information from the home countries. As Magda Charnedscan and other people said, the problem with that is that in Poland there is a very strong anti-vaccination movement and there was a lot of influence from that movement. One important thing to mention is that getting information out is not just having reliable sources but how you spread the information. For example, Magda Charnedscan also picked up on that. Social media is a big, big thing for Poles living in the UK. It is a big source of information that is very often used. There are a lot of Facebook groups, conspiracy groups and so on, which were spreading all this false information. I just wanted to say that, for example, when we were doing our study under Covid, we were recruiting people via Facebook for our survey Poles. We targeted Facebook advertising and we were really taken aback by how many people responded. We have over 1,100 responses to our survey. The reason I am saying this is because I am just trying to underline that if you place information in social media or through social media advertising, that might be a more effective way of getting it out than just having it somewhere on official websites. If I may, I would just like to make one more point. That is maybe specifically about the Polish community and practical barriers to vaccination. What is characteristic of the Polish community is that they have a very high employment rate. A lot of people are in employment but it is often low-paid employment in low-skilled sectors. The practical barriers that people are coming across are taking time off work, for example, because a lot of people are in precarious employment, working on zero contracts or for agencies. If they are not working, they lose income. There are a lot of people who live in poverty or very close to the poverty line, who live from paycheck to paycheck. That is a big thing for people. That is a big barrier. It might be good to consider how the Scottish Parliament can support people in employment and in precarious employment in getting the vaccine. Other people also mentioned the lack of support networks. That is also a problem in terms of if you have side effects, what do you do? If you cannot go to work, if you are not being paid, what do you do with your children and so on. I apologise if that was a bit long, but I just wanted to reiterate a few more points. I want to direct my questions to two people specifically. Iman, I want to ask you first. You said about you need grassroots organisations to deliver the message into these communities. We have sat in this committee before and been told that that is already happening. Are you telling us that it is not? It is happening, but it is not happening as much as it can be happening. I think that it is because of more than one reason. One of them is that sometimes grassroots organisations are getting mixed messages. I have personally been told that you are not allowed to give information sessions—we have delivered information sessions, by the way—to ethnic minority groups, but I have been told by somebody that there was an initial resistance being told that it has to come from the NHS. You have to be a registered doctor with the NHS to deliver the information, which I know is not exactly the case. However, there are mixed messages that we are getting. Community groups and organisations are equalities in human rights organisations, but we had all our resources from the NHS in Public Health Scotland. We were not giving information out of nowhere, but you do get some resistance because of mixed messages and confusions. It is happening, but not as well as it should be. Thank you. That is something that we can put to the Government. Mohammed, I was also going to come back to you. You gave a similar kind of a message, but one of the things that caught my attention in what you were saying is that there are certainly some of the older people in the Islamic faith who believe that if it is God's will then it will happen. Now, please forgive my ignorance of your faith because I really do not know enough about it, but is there not also a message in Islam that would say that we look after each other and that the vaccine is part of that process? Yes. No, you are absolutely right that there is. However, that message has to go. That is what I meant about trusted people, whether that is from the religious fraternity or the Government saying or people who are role models to say that is the message. So somebody has to get the message out. Yes, we can put the message out, but it has to be produced by a relevant organisation. In the first hand, just as Iman has said, people will not trust us as an organisation, which is a non-religious organisation for the West of Scotland regionally called the Council itself, but it needs to be a religious organisation that produces these things produced through the Government from a religious perspective and then sent that out. So that message has to go out. I totally, absolutely, that there is the other bit in religion is that you have to look after yourself. God has given you this life and you have to look after yourself. That is another message, but then again, how do you pull that together and obviously organisations like ourselves can put the message out because we are nearer the communities, we know where to go, we can do all that, but we need somebody to pull it together that has the confidence of the community. Either it is a role model or it has to come from the religious fraternity to get that message across. I attended a Sikh women's event recently and one of the phrases that they kept coming up with again, it is a new phrase to me, that they live in a very gendered society. You talked about having one head of the family who could be anti-vax in his thinking and that would then determine how a whole family would react. Can you expand on that and is there a way of finding out where that is happening? Sorry, can you hear us now? Sorry, I think that we temporarily lost connection. Can you hear us now? Yes? Did you hear Jim's question? No, Jim, would you like to say the question again please? Mohammed, I am sorry, I am sticking with yourself. I recently attended a Sikh women's organisation briefing session and they talked about a very gendered society, which I did not understand what they meant until they explained it. You also talked about the head of a family, of a very large family, who could end up influencing the entire family. How do we get to those individuals in order to be able to get this vaccine into more arms? I think that I have explained that just now in terms of getting role models. If it is a religious aspect, you have to get somebody religious within the community, where there is an imam of a mosque, or you have a Muslim council of Scotland, or you have members who could get that message out in terms of either a video or in certain languages that we can pass on to our community. Somebody, as I said, has to take the lead in making that and whether that is the Government or the NHS. As I said earlier in the early days, I think that mid last year about June-July, there were a number of things that came out in terms of passing that message across. We did as an organisation but nothing news came back from the Government since then. It was only three to four months. There were quite a number of different things that came through, very pro-vaccine information from Lord models and so forth, but that stopped in terms of coming through. No new material came through that we could send out because things are changing all the time. The same message a year ago will not be relevant now. It is about how you change that message so that we can then pass it on. Again, if it is faith related, it has to be somebody from the faith, whether it is Christian or whichever religion that might be. Ethnic minorities are not all from Islam or one religion. They are from all different religions, Christianity, Buddhist and everything. Each religion has to be represented to make sure that all the community gets the message. I am trying to focus on how we get the message to each individual group, which is why I have come to E-Man. We have heard very clearly from Paulina about Facebook and social media. The point that I am making is to the clerks and to the committee that we need to focus on where the message needs to come from. I was interested in the term of vaccine hesitancy. Within that vaccine hesitancy, there is almost an inertia. It is perceived that it is too difficult to access the vaccine or travel to the vaccine. As an extension of the conversation that we have had so far, do we need to be taking the vaccine to the public, to the ethnic minority groups, rather than waiting for them to come to the vaccine for want of a better expression? The behavioural difference is that we have talked about social media, the fake news, how people are accessing their information. Do we really need to be almost more proactive in going into the communities and taking the vaccine into the communities? Do we have Dr Kerri Llewyddon with us at all? Do we have? No? No? That's the second one. That's the second one. Sorry, I've got the wrong one. In that case, can I ask Magda, please? We found that the proactive approach is very important to address the hesitancy. It can be done in many ways. We were thinking of the buses getting closer, being more available and getting closer to the rural areas. I think that it would be great if Maria Josef Aves could say a little bit about the project that she had in Breck about the community navigators or health champions that she had. The personal approach of having a conversation within the community with the health champions who would be trained well enough to be able to speak about the vaccinations. The personal contact would probably be best, but the more proactive approach is definitely welcome. Thank you. Maria, would you like to come in? Yes, I completely agree with what Magda said. Facilitating access and flexibilising access to the vaccines is key. Community vaccination clinics in, for example, churches and mosques have been really good at a local level. The possibility of going to those clinics without an appointment allows the whole family to go together, so it also increases the conversations within the family with a healthcare specialist. Those are the sources of information that are trusted by the healthcare staff. I think that this conversation has to be prompted. Community clinics are a way of doing it and showing that staff trust the vaccinations not only in the clinics but in all healthcare settings. It is really important. As I mentioned, some pregnant women were seeking for advice regarding the vaccine that we are asking the midwives and other GPs. They did not find the reassurance that they were looking for. In that regard, those are the most trusted sources of information. Regarding what Magda mentioned about community health champions, we have been working with that structure to approach community members. It has been really positive, creating those one-to-one conversations with members of the community, members of the community want to see themselves represented in the information material that is out there. Just to add to what Magda mentioned before, the resources that are translated are not too friendly at the moment, but it is also the format. I think that a lot of members in our communities have been asking for more resources that are in a video format, dubbed or with subtitles, or even coming straight from their community members in their language. That would be another way of reaching people farther. I also wanted to make a conclusion to a question that I mentioned before about making the vaccines compulsory. We had people saying that we will not get the vaccine until they are compulsory, but I really think that it is important to follow all steps in terms of communication efforts before that to reach the communities before making a decision of that sort. Mohammed, do you want to make a comment? Yes, thank you. I was just speaking about bringing the vaccine to the people, an excellent idea. I think that we had some of that in Glasgow, at Glasgow Central Mosque, and I think that that encouraged a lot of people, but I think that they felt that the powers to be that Central Mosque was the only one in Glasgow, for instance. There are 22 others, and normally people go to one just like that. Similarly, there are a number of churches where most Polish people will go to or other minorities—there are churches where ethnic minorities from South Asia would go to. It is about pinpointing those and having vaccination centres in there. However, some might not be large enough for that, but you could have mobile vaccination centres outside. Particularly for mosques, it is a Friday, and maybe for other faith groups, it might be Sunday. The besieak community is a Sunday, and some churches are a Sunday. It is about getting that information. We have to go to the people. We have to find out that information and not sit back and say that we have sent out a message and people will get to it. Getting to people is very important. That is just the religious aspect. Some people have mentioned where most of communities work—I mean, people's shopkeepers, for instance—in different communities, but they all go and buy their stuff from one cash and carry, for instance. How about having a mobile van out there? It only takes a couple of minutes to get vaccinated. We just have to go to the communities. That is one thing that has not really happened apart from Glasgow Central Mosque. It was a very good idea to come up with it. That needs to be extended. If you want to catch everybody, it needs to be extended. I think that one of the things that, within South Asian communities, there was something about women being separated. I think that there needs to be a look at how women do not go to mosques, for instance. How do we capture women in terms of whether they are groups that come together locally? Local organisations like ourselves give you that information in terms of where local women are. There are elderly care centres for minority communities, in particular in Glasgow. Why not set up? I am conscious of time because we have to stop by 10.30, but could we move on to John Mason, please? I would pick up on the point that Brian made. The fact is that we know that our health service is overrun. People struggle to be able to get appointments with GPs. There is limited ability to extend the health service into communities, but one of the suggestions that has been made is that, as long as there is a doctor or a nurse overseeing vaccination, more people can be trained up and we can support local organisations to organise vaccine delivery. Is that something that members of the panel think that that should happen, where we engage and involve the local community not just in encouraging people to take up vaccine but in delivering the vaccine? Alex, do you want to direct it to someone in particular? Well, I cannot really see for you or anybody else. I cannot. Yeah, my thought will start with you. To be honest, it is a very surprising idea. That would have to come with additional resources for our staff or even employing a new member of staff, because at the moment we are pretty much dealing with other impacts of Covid on the Polish community. We have a massive increase in requests for emergency appointments and there is nothing that we have a free capacity to deliver. It sounds like a very innovative idea, but it does not have to come with resources. Dr Polina? Yes, thank you. I also think that it is a good idea. If you have people from the community and people from the community who are trained to deliver the vaccine and can actually explain the advantages or possible side effects, that would really build trust. Throughout our study, we have interviewed a number of, I do not know, nurses, for example, who deal with people who advocate for the vaccine just on their own personal initiative. However, I do think that in terms of building trust, giving access to information that, at the same time, I have to underline unbiased information, but just really reliable information and being able to vaccinate there. I think that would be a good idea. If I can just touch on the idea that was raised earlier about bringing the vaccine to the people, again, I think that I tried to underline that a lot of people of poverty, for example, are in employment, work long hours. If there were these vaccine buses that could be brought either nearer to the workplaces, sometimes you have workplaces where we have a thousand or more people who are migrants, basically, or to the areas where they live. That would make it easier for people to get vaccinated. I think that it would be a good mix. As a committee, it is important that we go back, not just by outlining all the concerns that the anti-vaxxers and the levels of misinformation are creating, but we have to go back and start to put forward some positive ideas. Do we need more resources for community organisations? Maria, would you perhaps pick that up? Yes, in terms of supporting community organisations, it needs to be done and also to point out that the pandemic is on-going, so the communication efforts have to be on-going and the work with the communities has to continue. It can be like we work on this already for a year and it should be done by now. It is going to take time, not 20 years per half, but it is going to take time and we have to continue to work with the communities. As I said, follow all the steps in communication and conversations that we can come prompt to support the vaccination effort. There is also a big number of health staff from the community communities, so leasing through them can also be an option and seeing how many community members can be interested in participating in something more concrete than you mentioned. Can I please move on to John Mason? Can I ask about the vaccine information fund, which has been administered by Bemis, which is Black and Ethnic Minority Information Service? A couple of you have had experience of using that fund, so that follows on from Alec Rowley's point about funding. Some things that you have asked for today, I think that the NHS probably needs to do or the Government needs to do, but if you had a bit more funds or have you tried applying to these funds so that you could do more yourselves. Parvin, you have not said anything recently. Hi. I cannot remember if it was the Bemis grant, but we did get a small grant of, I think it was £500, but that was only to disseminate some vaccine information, as in general information, that you should get vaccinated and how to do it. This was during the lockdown, but since then we have not had anything else after that. However, we are at that stage now, where it is not just about getting the information out there in different languages. People have different concerns now, and the concerns are mainly around the vaccine and how effective it is in general and also how and if any impact it will have on them based on the fact that they have underlying health issues. There are different issues now to what there was during the lockdown. Going back to the other question about resources and getting the community involved, I think that that is a great idea, and I would definitely work, but again everything needs resources. Community champions doing this work, whether it does not need to be vaccinated in the community, it could purely be assisting the health professionals in getting to the communities and in helping with translation of any issues that people have and getting over all the barriers. Going back to the question about working together, I agree that we really need to get into the communities and try to get rid of some of the barriers and myths that people have, but we also need to differentiate between anti-vaxxers and people who generally do not want to have the vaccine for just general reasons that they do not take medicine or would rather have a more holistic approach. During the whole conversation, we have discussed more about how to get BME communities vaccinated, but the same with the Scottish population, we are not going to have 100 per cent communities taking up the vaccine because everyone or there will be people who are not anti-vaxxers, but they do believe that they would rather deal with the Covid in a more holistic approach than get the vaccine, so we need to differentiate between that. That is helpful, thank you very much. Mohammad Razaik, did you want to come in as well? I think about the idea of local organisations helping, I think that it is a wonderful idea and it would work, however, just like everybody else, it will require resources to be put forward. Your question about... We were one of the organisations that did apply for that, and it was, as Parveen said, I think that it was a £1,000 maximum that we could get, and we did apply and we got it, and it was for, I think, three months or four months of work about just passing on the information about the vaccine. It wasn't anything bigger than that, to be honest, and £1,000 doesn't take you far, to be honest. What you need is a bit more longer-term thinking about having projects that will hold the whole year in terms of various different things, getting the information out, maybe getting more volunteers that would volunteer with the health service and so forth, so it needs to be something thought out bigger than the £1,000, it needs to be something worthwhile for organisations to do. I get your point that we need to... There's probably a long-term question here and also a short-term question, so I take your point long-term, we maybe need to do more. Do you think that in the short term it would be worth repeating, even if it was only £1,000 again? I think yes, it would be, but I think it would need to be coupled with fresh resources that are available. Yes, we can make certain amount of resources ourselves, but it has to be coming from the Scottish Government or the NHS in terms of resources, bilingual material or videos and things like that that we can then pass out. I think that the £1,000 would be helpful to invigorate what we've done last year along with other organisations, but I think that the longer term would need to be substantial. I think that we're just about to run out of time, but Magda, did you want to say something as well? Yes, we were also funded by... We received this £1,000 from being from the vaccination fund. The work that we've done, we calculated, was worth at least £6,000, and it was over three months. We did what was necessary at a time, so we organised meetings with the specialist Jason Leitch, for instance, and also specialists from Oxford University. However, and created a guide to vaccination that is now available on our website. The biggest issue, I think, was that all of a sudden we were invited to communicate with the NHS and the Scottish Government and the Parliament. I think that because we were the only organisation reaching out to the Polish community, all of a sudden we were invited to all the conversations that were happening in the backgrounds. We didn't expect that when we were applying for those grants, and that's why the amount of engagement that we had to put into this work was a lot more than we expected. It was to produce, maybe, materials and extend them further, but the unexpected engagement put a lot more work into this. We'll take that on board. We'll make a note of that. Okay, thanks so much. We are now out of time, so I'd like to thank all the witnesses for their evidence and giving us their time this morning. If witnesses would like to raise any further evidence with the committee, they can do so in writing, and the clerks will be happy to liaise with you about how to do this. Thank you very much, and I suspend the meeting. Thank you. Dr Andrea Williamson, the Scottish Deep End Project, Professor Neil Quinn, Professor of Social Work and Public Health and Co-Director of the Centre for Health Policy University of Strathclyde. Thank you for giving us your time this morning and welcome. As I explained to our earlier panel, we are the lead committee responsible for scrutinising the rollout of the vaccination programme. Today's session is an opportunity to consider why uptake of the available vaccines has been below average in some of the communities in Scotland. In this panel, we will discuss the vaccination uptake in communities experiencing higher levels of deprivation according to the Scottish index of multiple deprivation. Each member should have approximately eight minutes to speak to the panel and ask their questions. If you'd like to respond to an issue being discussed, please type R in the chat box, and we will bring you in. We have a large panel today, and I am keen to ensure that everybody gets an opportunity to speak. I apologise there in advance if time runs on too much. I might have to interrupt members or witnesses in the interests of brevity. I will now turn to questions if I may begin. If I can ask Hilda Campbell from Cope Scotland. Firstly, thank you for the extensive briefing that you provided to members highlighting lots of the issues why vaccinations may not be taken up. One point that I thought was interesting, we all know about the misinformation and the scare mongering regarding vaccinations. When you pointed out that when there was a broadcast on the BBC regarding recent queues for vaccines and one person was waiting for 45 minutes and said it was worth it because it was saving lives, I can't agree enough with that comment. Your comment was perhaps more work needs to be done to praise those who are taking the vaccine and recognise their contribution to helping us to move out of the pandemic. Can I ask Hilda? What should the Scottish Government be doing further to increase vaccine uptake in the minority groups from the more deprived areas where perhaps living day-to-day is more important than getting the vaccine? Thanks very much and thanks for inviting me along. I won't go over all the points in the report that I sent in. Many of it resonates with what the speakers were saying earlier about lack of trust, zero or contracts, which pierce people seeking information from, but I do think that there is some need for use in almost an appreciative inquiry that is building on what works. If I had sent an image in as well, someone had taken, they were in a queue for two hours to get their vaccine, but they stood in that queue. A simple thing like being given a banana or a hot drink would have encouraged people perhaps to actually left the queue because they were just too cold. So there are some real practical things about celebrating the fact that there are a lot of people coming forward. To gather that information, I had spoken to, and it's anecdotal, but I had spoken to a variety of colleagues around the experiences that they had with people that they were working with, as well as community leaders and others. What I would say was that it wasn't uniquely people who were facing inequalities that weren't taking the vaccine. There were some professionals who were choosing not to take the vaccine. For whatever reasons, they felt that it wasn't right for them, they weren't sure if enough research had been done. What was interesting, I noticed that people who are vaccinated, when someone asked them a question about whether or not they should get vaccinated, they are usually pretty positive about it. Whereas someone who has not been vaccinated, if someone asks their opinion, they are more likely to say, well, I'm not really qualified to tell you, you should go back and ask your GP. What one local support worker had said was that they recognised that GPs don't have the time to reassure everyone about the vaccination. If they had more helpful information, they could have given that reassurance themselves. That resonated with the speakers earlier. One of the things that perhaps Scottish Government can do is to find ways instead of Jason Leitch and no harm to Jason Leitch, but a lot of people won't identify with Jason as to have people working with the communities to make up some not just videos that go around little halls and things, but go on the television, because that's what people watch. If you get it on the television at peak time viewing, where it's real people that people identify with and they're saying the benefits that they've had for the vaccine, then that's maybe one of the steps that can go forward. I also noticed the conversations about do we make it mandatory now. We've got Twitter accounts, so when I was doing some tweet in this morning, I noticed that there's quite a scary trend going on, which is we will not comply. I don't want to get into the whole party business in this, because I'm only raising it as things that don't help. When the public see something that they view as unfair, their kick back to that can be, well clearly there can't be such a problem, because if there was a problem, they wouldn't all have been partying. The fact that they were partying, they know something we don't. Whatever people's view on the whole party gate is, the fact that we will not comply is trending on Twitter. I had a quick scan through, because I knew I was coming on to this today, and a lot of that is I won't be taking the vaccine. There is something about role models and who people perceive as someone to be trusted. Tapping into lived experience panels, and there's a lot of good work that the Scottish Government's doing through lived experience panels, through gambling harms, through suicide awareness and many more, is maybe inviting and saying, could you give us a hand to put together some materials that can go out and actually offer some credibility. The Government Youth project did an amazing piece of work around gambling harms. I'm quite sure that if they were approached to ask if young people would be willing to work with them on animation, even, around young people's anxieties about gambling harms, it could be done to overcome, would be really valued. There's a lot of questions asked, so why did people go for the vaccine? Consequences was one reason. People felt pressurised by work to take our pressure from the Government. The other day, I received a communication from Glasgow Council of Volunteer Services, because we were on the HR contract. It's a template for a vaccine policy in the workplace. We already have all that in place, so it was fine. There was nothing there that was new to us. For others, it did give them something to think about. In the workplace, we begin to have vaccine policies, training on vaccine, looking at staff attitudes, volunteer attitudes to vaccines. There is a lot of information. A hard question is not information given out, it's information overload. We get the public bulletin, it's dry reading, it's no pictures, no images, no cheery things, it's just a lot of text in times in New Roman. When you're busy reading 100 and one other things, you're not cutting to the chase. We were fortunate that we worked with Jackie Sneddon from the Scottish Antimicrobial Prescribing Group to put together a tip sheet on antibiotic resistance to help to raise awareness with the public about the role of antibiotics and not to demand an antibiotic when it's not appropriate and how to prevent infection. Although that's not directly related to Covid, I mention that and I'm happy to send a copy of that in to let you see it. It's a very simple, basic tip sheet. Sorry, Hilda, I'm just really conscious of time and I've used up my question time, so I'm going to have to move up to Murdo Fraser now, thank you. Thank you very much, convener. Good morning to the panel. I might maybe just get a chance to bring some others in. I'll maybe start. Who will I pick on? Professor Quinn. I'm really interested to get your thoughts in particular on this question of vaccine hesitancy and people's distrust of government that we were discussing earlier and that Hilda just touched on. There is this conversation about making vaccines compulsory or at least, as other countries have done, bringing additional restrictions on the unvaccinated. I'm interested to get your thoughts on whether that's something that's helpful or whether that might be counterproductive. Thank you for inviting me to be part of the panel this morning. I was going to talk about our research with excluded communities and our research, which the quality was also involved and looked at the experiences of a number of excluded groups in relation to accessing services more generally, so we didn't focus on vaccine take-up, but I think that there's lessons from that that are helpful for this committee. So we spoke to people with experience of homelessness, with poor mental health, with refugees and asylum seekers and women facing commercial sexual exploitation. I guess some of the key lessons there were around the barriers that existed to people accessing health services, which seems to have worsened during the pandemic. So people described services being limited, withdrawn, or having less face-to-face supervision. That impacted on people's ability to access the services and support them required. Many respondents felt that statutory services were inaccessible during lockdown and the issues of poor communication. So I think that there are, particularly for excluded communities, issues of trust, issues of barriers to access, and I guess that flows through on to some of the problems around vaccine take-up. Perhaps as a first step, trying to remove some of those barriers to access are important. I suppose that, in relation to your question about compulsory vaccination, I think that there's obviously pros and cons around that. I think that we obviously need to increase vaccine roll-out, whether we should go down the roll of making that compulsory. I think that we'd have to look at evidence from other settings in other countries as to whether that seems appropriate. As a first step, I think that trying to remove barriers to certain communities being excluded would be a first step, I think. Okay. Thank you very much. I could maybe bring in Dr Kerry Lunan just to get some general observations and then some thoughts on the specific question. Yep, good morning. Good to be here. I suppose that some general observations are that the findings that we've had with the Covid vaccine roll-out and the findings that we've had in all vaccine roll-outs, so there's lots to learn from previous vaccination campaigns in that uptake tends to be lower in certain groups, which is why we're having those conversations today. We've talked a little bit about trust issues and I think that that does come across quite strongly. I think that people are generally feeling a bit more disconnected in the world at the moment, which is probably not helped. Also, there are issues of whether Governments are able to have moral authority on being able to give advice to populations when they're maybe not being perceived as acting in the way that they should. I think that in terms of the issues for why people in more deprived settings are not necessarily having higher levels of vaccine uptake that we would like to see, there are issues that I've accessed. Sorry, I think that your sound is going. No, we can't hear you. Can we try somebody else? Sorry, we'll just move. I'm a bit afraid to, but you don't hear me. Yeah, sorry. Dr Lundin, I think that we're losing your sound. Can we maybe bring in Dr Williamson to get her perspective on this? Oh yeah, speaking specifically about whether we should make vaccine compulsory, I would echo what other contributors have said so far. Building on the first evidence session this morning, a really big factor in all of this is about trust and who you, as an individual or as a community, really think you should believe and who you should therefore. You have to trust and you have to believe before you will then take action. From my perspective, I would suggest that compulsory vaccination would be really challenging because it would definitely drive some people to increase their uptake for the communities that we are wanting to focus on this morning. I don't think that that is a good reason to do it. If we're going to think about why is it not, the Scottish Government has made a commitment to move towards being a trolman-formed nation. One of the principles of trolman-formed practice is that you always work collaboratively with people, you never tell a person what to do and in a healthcare setting. This is a healthcare intervention. That's one of the things that we have to be really, really thoughtful about. Carrie, when you start to talk there, was mentioning that we have precedents here, we have other things that we can draw on. I think that it's really important that across history people have not taken up offers of healthcare, which this is an offer of healthcare unless they feel it's right for them and it's going to be a benefit to them. I just wanted to mention, while I'm on the wider context for this, because although we may all be forgetting this, there will be a world before Covid and there will be a world after Covid as well. I wanted to specifically mention some of the research that I led on, which is about missing this in healthcare. We and my team did a large-scale epidemiological study in Scotland before Covid hit looking at patterns of missed appointments across healthcare. Our focus was in general practice missed appointments, but we also looked across the healthcare system. This was a study of a sixth of the population of Scotland and 19 per cent of people had missed two or more GP appointments on average over a year of the preceding three years. This is not that Covid and vaccination and all the issues that we're having to grapple with now do not happen in a vacuum. People have a history of their interaction with healthcare and we have to really think about that and we have to really consider what that means for going forward. I'll stop talking now and I'm happy to come back in to talk about what it is that we think would work to address that. I'm going to move to Alex Rowley, who's joining us remotely. Alex, do you have any questions for the panel? I think that, in terms of what Dr Williamson is saying, it would be good at some point for us to talk to Dr Lleonon and Dr Williamson about how GP services are raised. We have raised as a committee before the new comodol, for example, so that's perhaps something combative, but specifically for those two GPs I could ask, in terms of communities that are hard to reach, is it a practical thing to say that we should be able to put in place training that would support local people within those organisations with the correct supervision to be able to deliver that programme, given the urgency that we face with this latest variant? I think that we're in for a really difficult few months. There is something urgent about trying to get as many people vaccinated as possible. Could I put that to Dr Lleonon, if the computers work in? Dr Lleonon is back, she's got a new headset, so sound should be all right? No, I'm sorry, we're still having problems with your sound. We've got existing people trained up to deliver vaccines, and I know that there's been a huge sort of further recruitment campaign to increase that again. We also, and we heard this morning in the first evidence session, we've also got an amazing amount of fantastic people and communities who are connected across the communities of Scotland, whether that be with our ethnic minority communities or in areas of high socioeconomic deprivation, and there's often great overlap with that. If I was running this, I would be thinking, right, okay, we've already got people trained to do vaccinations, it's not actually about giving the vaccinations that's the issue, it's about getting them to people who still need to be vaccinated, it's about helping people overcome their vaccine hesitancy. How do we do that? We've heard, and I absolutely agree with this, it's about people who are trusted and people who have on-going relationships with individuals. You get people who are trust, who have on-going relationships out there acting as community champions, get them onto national TV, get them out and about in local communities, and you maybe even have to have them accompanying vaccinators who are going out into localities, whether that be through buses, whether that be through chaplain doors. We've had to do that across the health service for many, many years. We do do that in inclusion health settings. It's about chaplain doors, it's about meeting people where they're at, and it's about helping people understand and move towards a place where they feel that the vaccine's the right thing for them and then being able to give it. Do you not think that there is a capacity problem? Politicians are telling us that it will be all task to be able to deliver for all over 40s the booster by the end of January. We see more and more young people coming on, and there needs to be decisions made there. Do you believe that the capacity is there to do all that and manage the health service through what is going to be a very difficult few months? We are living that difficulty right now, but what I'm saying is that, on balance, it's better to think about increasing capacity among the groups of people who have already been targeted as vaccinators. Retired staff, staff who maybe work part-time who are able to increase their seasonal commitments—I'm not saying to take people away from mainstream services, but I'm talking about that. I absolutely recognise that there's a capacity challenge, but, at this point, to suddenly switch and say, right, okay, let's train up and lay people to vaccinate, it's possible, but we know from evidence in other countries where there is a long history of communicating with people who are able to provide those health interventions. That's not the sort of capacity that you can upskill quickly. Okay, I'll leave it at that, Camila. Thanks. Thank you very much. Can I move on to Brian Whittle, please? Thank you, Camila. Good morning to the panel. I'm going to just move on a little bit from my colleague's question. We are around that vaccine hesitancy within the groups that we were discussing just now. I wonder what that hesitancy is. Is that inertia, if you like, the perceived difficulty in accessing a vaccine? Perhaps vaccines are just seen as another issue that needs to be dealt with among so many other issues that the people we're discussing are facing. With that question, as Alex Rowley said, do we need to take vaccines to the public rather than wait for the public to come to the vaccines and overcome where most people seem to be getting their knowledge from? Is this social media, this fake news, undermining trust? Is that the approach that we really need to be doing? I'll take that and ask Derek Holiday of that question, if I could. Good afternoon, everyone. We've talked a lot about trust and the people environment. I think that's the key component to taking that risk, to putting yourself outside your comfort zone, but we need to focus on place-based approaches. All those relationships are in the community, its family, its friends, its peer networks. It's also those local health members that you see for your wellbeing, the pharmacy, spiritual and faith and recovery networks. That's where the trust is. We think about transport poverty and we're having a conversation where we're sending people for our life-saving vaccine without actually assessing where they can actually afford to do that. Who's going to take care of their kids in a lockdown? Who's going to support the members of the family that they've got caring responsibilities? When we're looking at vaccines and we're looking at the end of the journey, there are a lot more based on the community when they were in the first half. I remember the first year, unless you drove, you couldn't get a vaccine because it was specifically geared towards those who could drive. Anything that we're trying to build trust, we need to have it in the community where the trust is, where the relationships are where people feel safe, but also thinking about travel poverty, babysitting caring duties and responsibilities and mental health and anxiety for people who are scared to leave their homes still because the messaging hasn't targeted them and also focusing more on their younger generation and adding them to the priority group. They were left at the end of the entire pandemic and now we're wondering why we're struggling for this group and community to uptake the vaccine. We didn't communicate to them, we didn't give them trust and the media attacked them through the lockdown. So as we move into the next phase, I think we should add them to the priority group and show them that they are part of our society and not a disconnected part that seems to be the one that's driving this when everybody has that responsibility. Thank you. I wonder if I could bring in Hilda Campbell into that question as well, please. Hi, I think it's just echoing what people have said about recognising what the barriers are and how they can be overcome. Certainly the anecdotal evidence that I have is that there are more people willing to take the vaccine than not, but it's already been mentioned that it can be things like the person's a carer, they can't get out, they may live in a property where there's a communal area that males left, so they don't actually see their appointment letter. To transport, sometimes you'll get people who have been given a vaccination appointment, maybe 18 miles from where they lived, which is two or three bus journeys, depending on the route that they're on. Whereas if they may be just checked what's the postcode of the person, where's their nearest vaccination centre, which is what people are already being saying, is around how do we take the vaccine to people. But I think it's building on what works. It's about values and attitudes. If we shine a light of the positive response that people of Scotland have had to dealing with Covid and they have, then other people who may be reluctant will be inspired by that and want to join in. Whereas if we do go down the route of mandatory vaccinations that could undo an awful lot of goodwill and make people feel very hesitant and further enhance the scaremongering, if you like, that there's some big experiment that we're all being involved in. So I think, yes, take the message to people, recognise where people are and that actually the vast majority of people do actually want to take the vaccine and sometimes the reasons for not a very valid, other health conditions and their concerned is that going to make it worse. So going into communities, local contacts, building up a rapport, keeping the message simple, I think would make the difference. Just to finish that line of questioning, I'm going to take it to the ultimate conclusion then. Do we know those who haven't taken the vaccine? Should we be approaching these people to ask them their opinion and why they haven't taken the vaccine and in that respect be able to then reassure them that the vaccine is a safe way to protect themselves and then offer them that vaccine locally, basically. I think that that's really where we're getting to can I ask Dr Andrea Williams in that particular question, please? So yes and no, I think is the answer to that question. So I think the important thing though is that this doesn't come across as a criticism. I think one of the really key things we have to do is suspend moral judgment because I do feel that that is creeping into a lot of the public discourse on this matter. I think we have to be able to approach people and say, we really want to support you the best we can to meet your, to be healthy. We think that we would like to offer you Covid vaccination. Let me tell me what are your worries, what are your concerns, what are your worst fears. It absolutely could not be a, you've not had the vaccine, can you answer that, tell me this, answer this questionnaire about what's going on. I think that one of the other key things that we've heard from all many of the contributors so far this morning is that that can't be an impersonal approach. It needs to be an approach from someone in that person's life that they trust and that they will listen to and that they will accept that from. We know over many, many years and public health colleagues know that. It's been really simple things and that's one of the reasons why the vaccine, a point in letters or blue, that whenever we send letters out and we send them out in brown envelopes, we know that people buying large throw them away because they think they're bills and we know that people are worried about official headed not paper coming in. So that, yeah, not talking there. Thank you. Can I move on to John Mason please? Thanks. I was going to start with Derek Holiday as well, if that's okay. I think we've had a long problem with younger men especially, but men in general not engaging with the health services across a whole range of things, so it's not just about the vaccine. Do you think there's a particular problem with the vaccine and men say not getting involved in poorer areas, I represent East Endoglasko, and is that a longer term problem rather than just the vaccines? Thank you. I'm from East Endoglasko as well. I think we have many issues in this area. Male population toxic masculinity makes it very difficult in the west of Scotland for us to deal with emotion, which is quite often historically come from our upbringing. But in these communities, when I was homeless four or five years ago, food poverty, energy poverty, red poverty, debt collectors, travel poverty, phone data poverty, internet poverty, mental health. Those are all the things that come first in our poor area, rather than focusing on a vaccine unless that message is in my communities from someone who I can trust. It's easy, it's accessible, and I don't have to go out my way because this part of just living life to life acts consuming me. We're looking at the deprivation areas in access. We really need to be in that community. We really need to give time. We need to do town halls where we can sit in the community and sit with our expert panel on community members and talk until we can't talk any more, so that everybody gets to ask every single question that they can think of. We haven't had that in any television, but we've sat down and had communities and actually unwrapped the vaccines and what it meant and the process and the details and having our whole day programme to sit out for the country so that they could ask their questions to really understand what's going on. I don't believe that we should be mandating people to do something because that's a measure of what we haven't done for job right. We can't do one-size-fits-all for everyone, so we need to be more specialised and tailored. We need to bend those communities and understand what those needs are. We can't do it from afar, and we really need to connect with third sector organisations and health settings to really get the proper partnership so that we can get the whole person to view. You're suggesting that some people have questions and they're just not getting the opportunity to ask them and have them answered, but do you not think that there's just some people who are just—you could be there all day to answer questions and they just wouldn't engage so that they're just not wanting to engage as you said, the kind of male traditional view? Yes, yes, but we're focusing on that when we're ever honest. Not every single person in the world will have a vaccine, so not every single person in England will have a vaccine or Wales or Ireland. We're never going to get to 100 per cent, so we're always going to have a percentage of people who will not take it for whatever personal choice, but I think the more we hit people and attack people and push people into it, I think we have longer damage for pandemics in the future. This is a situation of understanding how that impacts a person. It's understanding that people's individual learning needs. We don't all learn from a picture or learn from a book. Some people use different styles to understand their information. Some people have more time to reflect to see how that impacts their life. A booklet and a leaflet is very one-dimensional. As everyone said today, we need proper people speaking to those groups and communities that don't trust or not have taken that medication and really understand the real people that they can connect with and identify with, who they can trust, because all until we actually sit down with the individual groups, we can have lots of committees and we can consume, but we'll still be dealing with the issue that we're dealing with, is that the message is not to get to the groups properly. That's our responsibility to be more flexible and adaptable, and we need to be more specialised and targeted. Okay, if I could move on the same question. I don't know if it's just yourself, Dr Williamson, from the deep end side of things now. We're lost. Oh no, we have got Dr Lunan back. We'll try her again. Is there a particular problem? I mean, I'm a fan of the deep end kind of movement or whatever. Is there a problem with contacting men, younger men especially, in poorer areas, getting them involved in the health service? Is that why this is all happening and it's not specifically for the vaccines? Can you hear me okay just before I start? Yes, that sounds great. I'm not sure that I fully heard the whole question. It was about particularly targeting younger men, is that right? Yes. My question to Mr Halladay is the same for you, is that I think that the health services have generally struggled to interact with men, younger men in poorer areas. It's not just about the vaccine or is there a particular problem with the vaccine? As I was trying to say at the start, the Covid vaccine roll-out and the demographics that we've seen have very much mirrored previous vaccine roll-outs. There are specific practical issues around vaccination for younger men living in poorer communities and being able to get to the mass vaccination centres. General practice was involved in vaccinating people over the age of 75 and people who were shielded. All the other vaccines have been delivered through mass vaccination centres, which requires them often to be able to drive, because a lot of people are very fearful of public transport and have secure employment that lets them away. A lot of our patients have struggled because they have been matched to vaccine centres that are quite a long way away from where they live. It makes it very difficult for people to attend the vaccine appointments that they are allocated. To be able to change the vaccine appointments, you need to either get through on a phone line, which is incredibly busy, or go through the NHS-informed website, which can also be challenging for other reasons. There are practical issues that have made it difficult for people to be vaccinated. Maybe I can come to Professor Quinn on the same theme, although I was going to ask you another question as well. There was some suggestion earlier on that it shouldn't be just age that we used for vaccines, but clearly people in more deprived areas are experiencing older life issues earlier on. Do you agree with the JCVI that they were as rigid as they were on purely age? I agree with that question earlier on. Professor Quinn, I am sorry to let him in. Will you answer both your first question first? Yes. On your initial question, I think that all the contributors have talked about the issue of trust. There are obviously major issues in certain communities about trusting services. We have to look at ways to build trust, and that is partly about removing barriers to access. It is about more active and assert about reach. It is also about more lived experience involvement in designing services as well. Hilda mentioned at the beginning about lived experience panels. I think that there is some quite creative and innovative work around how we bring the value of lived experience into service design. The colleges have a lot of work on that. We have a partnership that is trying to do that. I think that looking at ways of building trust and bringing that lived experience dimension into service design is very important. On your second question, to be honest, I do not have a particular expertise in that. One of it is better—obviously, Dr Lulean wants to come in. My sense is that we have to be a bit more flexible because in relation to excluded communities, using age as the only criteria probably does not make sense. We need to think about communities that are very excluded and people who are experiencing homelessness and other communities. We need to think about how we reach those communities. I think that being flexible in that criteria is probably important, but perhaps Dr Lulean wants to come in and respond. I think that Dr Williamson wants to come in. We will let him in first if we have time for that. I will come back to the previous question about young men living in socioeconomic communities. I suppose that it is to try and pull us back to the principles of that. It is the idea that if we are not meeting and effectively managing to meet the health needs of our group within society, that means that we are not doing our job right. That means that policy planning and healthcare delivery are not working effectively. It is not that we should be trying to problematise our particular group. I want to say that. I think about the language that Derek was using when he was talking about this. He was talking about understanding. It is how do we better understand how to meet the needs of people. That is where we need to be moving with that. I wanted to talk about the principle that underpins all of that, that proportionate universalism. In lots of ways, we have a really successful vaccine campaign, because we have really high coverage. People have pulled out the stops to help to vaccinate, and people have really worked hard to get to be vaccinated. We are now at the point where we have a proportion of people in our communities who are really struggling to get that. We need to think about the additional resource, the additional expertise that needs to be pulled in, and the community expertise. I absolutely agree about the experience element to that aspect. That is really vital. I do not want to pre-empt what Carrie is going to say, but I think that we are probably going to say the same thing about the issue of age being an important factor. We have really strong evidence of people's experience or health conditions, i.e., the ultimate morbidity at a much younger age. She can not include deprived communities. She is one of the key drivers, from a health point of view, of the health equity gap. I would say that we need to be targeting younger people, and more so she can not include deprived communities. If we have a final word from Dr Lunan on this point. Thank you. It was just to say that deprivation of just-of-age is really important here. It is that people develop the diseases of old age at least 10 to 15 years earlier in more deprived communities. Although the JCVI guidance did specifically allow flexibility to address health inequalities, unless there was clear guidance on how that could happen, I think that there was quite a lot of anxiety about delivering that on the ground. There needs to be clear public messaging about why there may be deviation from the JCVI cohorts so that we do not seek kickback or discrimination or stigmatisation. It needs to be done in a very sensitive way, but I think that we need to be guided by the evidence base and the needs of patients in those groups. I would agree that we need to take age into account for our future vaccine in the light. I am going to try to summarise what I am taking out of what I have heard from you. It really concerns me the hashtag we will not comply, because if we will not comply it demonstrates to me a real lack of trust. You talked about the Government's moral authority. How far back are we now from where we were at the start of the programme? Neil Wight, you were talking about the restrictions on the unvaccinated and excluded groups, and I have to ask myself if you are living as a homeless person, somebody who is a refugee, sexually exploited, how much community concern do you have for getting a vaccination? I see all those silos of problems. The other one that I was going to talk about was raised by the Polish community. They want individual face-to-face GP appointments to persuade them that vaccination is the right thing to do. I really struggle to see how we get all of those small groups and tackle them in a way that we can get the maximum amount of roll-out into that. However, there are significant numbers of people who are simply not getting vaccinated. Does anybody have a one-size-fits-all answer to that? I see lots of little problems that are creating a big issue. It does feel quite overwhelming, for sure. The thing that struck me about the first evidence session is what we would be echoing in the second, the expertise of localism. The connected communities is the key thing. That is something that we have that is really fantastic in Scotland in lots of ways. We have amazing community groups and volunteer organisations that live in really important services. If a group this morning talked about how, with a bit of extra resource, they would be able to help by being community champions to help reduce vaccine hesitancy and increase uptake. That is one element. The other element is that it extends what has been done pretty well in some places. If you remember when I was living in Glasgow, when there was the big outbreak or bumping cases last year, there were buses available. When I spoke to people, people were really appreciative of the fact that a bus was coming to some of the local secondary schools that public health colleagues and the planning for it were quite visible. We have the building blocks. It is just a case of getting local intelligence and local knowledge about what is going to work for specific communities. There is a lot of intersectionality in that as well. People from BME communities may have precarious work experiences or they may be living in socio-economically deprived communities or they may not be. It is really mixed, but local communities will be able to help us. I think that there is no one-size-fits-all. If there was, I think that we would probably be implementing that already, but the important thing is that we learn as we go and tweak roll-out as we go based on learning. We should never underestimate—in addition to what Andrea said about the importance of community networks and lived experience, we should not underestimate the importance of relationships of trust. I listened into parts of the first session and there was a consistent theme coming across about people wanting to speak to people that they knew that they could recognise to have conversations where they could unpick some of the things that they were struggling with. As a GP, I have felt very conflicted about general practice involvement in vaccination. I think that at the very beginning, when we were involved in the Over 75s and Shielded Group, it was a hugely rewarding thing to be doing. I think that we all hugely enjoyed doing it and vaccination has been largely taken away from general practice for lots of complicated reasons, but it is essentially to do with workload and other priorities and the lack of a workforce. However, I have found that often we need to have serial conversations with people over a period of time to help them to unpick why they are concerned about the vaccine. I have been doing that now for the past 10 or 11 months. Often it will be a light bulb moment. At some point, our family member gets sick or they are worried that they might have had Covid and suddenly people will decide that they would like to be vaccinated. At that point, you can plug them into the system where they can get the vaccine. There are pros and cons, but if general practice had the workforce and the resource, I think that a lot of people would still prefer to be vaccinated in their surgery and there is no getting away from that. It is difficult to operate opportunistic vaccine in general practice because they come in packs of 10. Once you open one pack, you need to be able to use them all to avoid vaccine wastage. However, when we design and deliver single dose vaccines, it will make it much easier for general practice and community pharmacies to be able to deliver opportunistic vaccine to people who are in or coming in about a different problem and have not been vaccinated. There are a lot of different things that need to be considered. That is an excellent point, and we will definitely carry that one. Hilda, can I quickly ask you to come in on that as well, please? Thank you. For all, there is a huge problem, but if we could look at the common themes across all groups in terms of work, messaging and individual concerns, and I wonder whether I am not, because we can become overwhelmed by the effort that is happening in trying to find a solution for every single distinct group. If we look at the themes and then we bespoke the responses to those themes to the individual groups, if we agree on an effective communication strategy, that is adapted depending on who that is being targeted to. That includes the media, because sometimes the coverage in the media and the sheer plethora of experts who sometimes are saying, and I am a health professional, and I sometimes find what has really been said here, so if you do not have any background that can be really confusing. Having some sort of overall action strategy, which is recognised and ok, here is a barriers to work, what could we do about having a vaccination bus near areas where there are a lot of workplaces that people could come and get that done? What is the message and how do we involve people who have had a positive experience? How do we also personalise it? Is there a capacity within NHS 24 or some other line that, if someone has an individual concern about the vaccine, they are encouraged to phone and that can be available to people from multiple cultures to recognise the particular challenges they have got? Also, to try to make it more of an event going for the vaccine, I tried this a few years ago, to increase the uptake of the flu vaccine, jolly jabdy. Now, we did not have all Covid restrictions down, so maybe it would not work the same way. However, there is a social event here. In some ways, you have a tour queue, you have a public health opportunity, the likes of which you rarely would actually get. It is something about making this good. While I recognise that there are some people who would want to get it from the GP, there are a lot of people who actually like going into a sports centre because it is non-medical, it is less threatening. Again, it is finding what suits different people, be it a bus, be it a community centre, be it at the GP practice but recognising that it would probably be practice nurses because GPs have got so many other things that are going on, so I hope that that is helpful. However, look at the themes and the target them. Yes, very helpful. Thank you very much. Neil, can I quickly ask you that same question, please? Yes, you have raised a range of challenges, gentlemen, in your introduction. Again, I would be low to a one-size-fits-all approach. For me, what I found helpful is a human rights-based approach framework, which I know is gaining more traction at a policy level and in the health services, because what we are seeing is a denial of people's rights, particularly for excluded groups having that right to health. Having that human rights lens is important. There are different aspects to that. It is about tackling stigma and discrimination that occur within communities and within services. It is removing barriers and trying to promote that lived experience voice within service provision. I think that the inclusion of the health group of public health Scotland that funds the research that we have done, and having that human rights-based approach is important. That includes things such as people knowing the right to complain if they are not receiving a service. That would be, I guess, my take on that. Okay, thank you very much. Derek, I am not going to come to you because I know we are very short of time and I know that the convener does want to bring something else in. Thank you, Mr Fairlie. Just one important point. I think that we have not raised today, and as the only woman on the committee in having three children and going through three pregnancies, and every woman goes through a pregnancy and trying to look after herself and the baby through the nine months. We know that there is a hesitancy from women that are pregnant. Can I ask Dr Lunan and Dr Williamson very briefly—I know that we are short of time—what can we do to encourage women that are pregnant to take up the vaccine, especially as we are going through winter to protect themselves and their babies? Dr Lunan, would you like to come in first? Thank you. Yes, I think that it has been difficult for pregnant women because the guidance changed a lot at the beginning and left people feeling quite confused and anxious. I think that the guidance is now very clear, but the anxiety persists for longer than the changing guidance does. I think that nothing substitutes hearing directly from pregnant women who have been vaccinated. Seeing people like me having a vaccine and feeling confident about it and having access to resources that are easy to understand and relevant and available in lots of different languages, I know that there are lots of really good resources on the Royal College of Obstetrics website and on the NHS-informed website, but that does not substitute an additional conversation if that is needed with either midwives or with GPs. We need to make ourselves available to people who are worried. We need to know where people can find good information, and we need to recognise that there was a lot of confusion at the beginning and understand why people might still feel anxious about it. I do not have anything to add to that. That was a comprehensive and excellent answer. I have a very specific question to Derek Holiday. I think that one of the groups that we have not really focused in on is those who are caught in homelessness and caught in addiction. How do we reach out to those specific communities and bring them into the fold, if you like, and make sure that they are offered vaccination along with everybody else? I guess that we need more place-based health settings with multidisciplinary services that contain everything that that person would need in one day, rather than the subway experience where you are constantly travelling to try to get different aspects of your health, well-being, finance, security, information and your rights. The Simon community hub that is in Edinburgh and Glasgow is a perfect example. We should have them in every deprived area, so that it is a one-stop shop. We are stopping people going around 14 or 15 services when they are in the worst state of their life, so trauma ingest. We are asking them to do all those tasks, have a service that is in a community, measure the staff from both health and lived experience, where compassion, nonjudgment and dignity are the forward, and give people the space and trust so that they can make decisions to trust a service rather than to force them to trust them. During the lockdown, all the services closed. That face-to-face contact ability to deal with the other aspects of our life that are not health lies on those services, and it literally is life and death. These become more priority than a vaccine, so there is a balance there. However, I think that we need to move all our services to a place-based approach. We are stopping people to travel for their health. It is not a free health system then. We should be able to get everything that we need from our community, and that is where we build long-term trust, long-term relationships and people who have been starting to manage their own life system. Rather than currently, we are going to get people moving here and there and everywhere to see doctors, and they do not see the following week or the following month. We have a consistent trail for a majority of services where we cannot build that relationship, so I can never build that relationship with a professional that manages my health. How do I ever feel safe to be able to discuss my trauma, find out what options and choices I have and how do I move that forward with support? That brings us to the end, and I would like to thank all the witnesses for their evidence this morning and giving us their time. If witnesses would like to raise any further evidence with the committee, they can do so in writing, and the clerks will be happy to liaise with you on how to do that. The committee's next meeting will be 16 December, when we will take evidence from the Deputy First Minister and Cabinet Secretary for Covid Recovery on coronavirus discretionary compensation for self-isolation Scotland Bill, and a ministerial statement on Covid-19 and subordinate legislation. That concludes the public part of our meeting this morning. I suspend the meeting to allow the witnesses to leave and for this meeting to move into the private section.