COVID-19 Recovery Committee

Meeting date: Thursday, September 30, 2021

Official Report 651KB pdf

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Vaccination Certification

Under item 2, we will take evidence from stakeholders on vaccination certification. I welcome to the meeting Professor Christopher Dye FRS, professor of epidemiology at the University of Oxford; Professor Stephen Reicher, Bishop Wardlaw professor of social psychology at the University of St Andrews; and Professor John Drury, professor of social psychology at the University of Sussex.

It might be helpful to start by giving a brief recap on the vaccination certification scheme. The Scottish Government announced on 1 September its intention to introduce a vaccination certification scheme, to be in place by tomorrow. The committee intends to listen to the witnesses’ views and to feed them back directly to the Scottish ministers in our regular evidence sessions with them. Any issues that you raise will also inform our scrutiny of any relevant legislation that is introduced to give effect to the scheme. As such, your input is valuable to the committee and we are very pleased to hear from you and to have received your written evidence.

What are the key priorities that should be embedded in the proposed scheme to make it work?

Good morning, everybody. I hope that you can hear and see me.

I think that I am attending this session because of the work that the Royal Society did some months ago, the purpose of which was to lay out what we felt and, through consultation, what others felt were the main criteria for using vaccination passports. In advance of the meeting, I circulated the report that we produced. We came up with 12 detailed criteria, but they fall into three main categories. The first relates to whether vaccines are technically good enough—in other words, whether they are protective enough and do what we want them to do in medical and clinical terms—to warrant certification. It is clear that the answer to that question is yes.

The second relates to whether it is possible practically, through software and hardware, to set up a system that will guard people’s privacy, for example, which is an issue that has concerned many people. There are many debates on that subject—perhaps we will have some of them during this session—but my broad answer to that question is that it is possible to do that.

The third area is perhaps still the most contentious and relates to whether Covid passes or vaccination certificates can be set up fairly. A certification scheme is intrinsically discriminatory and exclusive—that is the very nature of it. Can we set up a system that is broadly regarded as being fair? In other words, does the system do what we want it to do? Does it give peace of mind to individuals who attend collective events—restaurants, bars, nightclubs, sports events or whatever it might be—as well as to those who organise such events and to the overall community?

We laid out the criteria. We were not expressing an opinion about whether the passports should or should not be used; our goal was to lay out the criteria under those three broad headings, with the 12 points of detail, as you can see in our report.

My view of the situation, some months on, is that vaccination certification is a feasible and helpful process, by and large. We have not ironed out all the difficulties, but it is a feasible and successful approach that adds force to our central approach to controlling Covid nowadays, which is vaccination. In that regard, I read with interest the evidence paper that was circulated to us yesterday evening. With one or two comments and queries, I must say that it is a good report and I broadly agree with its basic recommendations, which are that vaccination certification is a useful approach to supporting the vaccination programme in Scotland.

I have a couple of queries, however. Why has the system in Scotland decided to focus on vaccination certification only and not on the other two things—negative testing and a confirmed prior episode of Covid-19—that I have seen used elsewhere? I am speaking to you from France, where I live mostly, especially during pandemics. That is one question, and I do not quite know what the answer is, although I can perhaps guess. The other thing that, to my eyes, is missing from the report is a discussion about approaches to care homes, clinical settings and hospital settings. Those are two smaller points.

That is my broad overview of where we now stand on certification.

Thank you, Professor Dye.

Professor Reicher, what do you think are the key priorities that should be embedded with the proposed scheme?

My sense of the vaccination certification scheme and of vaccination certificates more broadly is that they are a double-edged sword. How they work is a function of social trust. In areas of high social trust, where people believe that the vaccination certification schemes are there to help them and are a public health intervention, by and large, they give the vaccine indifferent—those people who are not anti-vaccine but who have not got around to it—a good reason to get vaccinated. When you introduce such schemes, there is quite often a surge of people getting vaccinated, and that is certainly true in France.

However, in countries and communities in which there is low social trust, such schemes can have a different impact because they lead to a sense of compulsion and a sense that the vaccine is mandatory, in effect. When you try to impose things on people, you get psychological reactance and people reassert their autonomy, and it also undermines their relationship with authority. Indeed, we have data to show that, in individuals and communities with a high level of trust, the prospect of vaccination passports increases the intention to get vaccinated, whereas in those communities with a low level of trust, such as the black community, it not only can have no effect but can increase opposition.

The evidence paper that we have been given slightly understates the problem. It says that a scheme might not have much effect among those who have a low level of trust, but it could actually lead to greater opposition. The issue of social trust is therefore a major problem.

The second issue is what it does to other behaviours. Early on in the pandemic, when vaccines were first introduced, there was some data to suggest that those who were vaccinated were given an illusion of immunity and invulnerability, and they increased their risky behaviours. What you get on one hand, from vaccination, you lose on the other, through an increase in risky behaviours, so messaging is important.

That has a number of practical implications. First, the broader context in which you introduce vaccination passports is critical. They work only when you are doing other things to increase social trust, especially around vaccination. It is important not to see vaccination passports as your sole strategy for increasing vaccination. They must be seen in the context of increasing the ease of getting vaccinated, including by ensuring that there are vaccination stations in schools, colleges, universities, workplaces and communities. Secondly, you must engage with people—listen to their concerns, take those concerns seriously and address them.

There are other things that you must do to increase trust, one of which, for instance, is to have a clear set of criteria for the end of the scheme, otherwise you will feed into those narratives that say that it is about controlling us and that it is the thin end of the wedge of identity cards. You need a clear set of criteria for when the scheme will be taken away, to show that it is temporary. It would also help to have an option for a conscientious objection, if you like—a procedure by which people do not have to get a vaccination passport if they do not want to. Not many people would be likely to take advantage of that, so I do not think that it would be a major problem in terms of numbers, but it would show that the passport was not going to be imposed on people—that they would not have to sign up to it. Those issues are critical in how you introduce such a scheme.

The other point is that messaging is absolutely critical. It is really important to say to people that vaccinations do not make them invulnerable—vaccinations make you safer; they do not make you safe. As I say, if behaviours change following vaccination, the advantage of vaccination will be undermined.

Finally, although the evidence document is very impressive, as I have indicated, it understates the risks and the importance of messaging. It also understates the alternative. One of the points that the document makes—it is not made prominently, but it is a really important point—is that vaccines are crucial for making us safer but they are not enough on their own. We need other measures, such as improved ventilation and improved hygiene. Indeed, the research on even larger events in indoor spaces shows that, if there is proper ventilation and hygiene, levels of transmission are very low.

Therefore, vaccination passports are a double-edged sword, because they create problems and alienate people from authority. There needs to be much more emphasis on making venues safe—necessarily safe—and having clear criteria for their opening. I do not think that vaccination passports should be an alternative to closure—it should be vaccination passports or safe venues. Indeed, perhaps we should have vaccination passports and safe venues. There is not enough emphasis on that aspect in the document or in the discussion more generally.

Thank you, Professor Reicher. May I ask the same question of Professor Drury, please?

Yes. I think that I am here because I conducted the only systematic review, so far, of possible behavioural consequences and social impacts of vaccination passports and other forms of Covid certification. My priorities relate to psychology, behaviour and social impacts, and they divide into three areas. The first, which has already been mentioned, is the possibility of social exclusions. As has been mentioned, by definition, vaccination passports exclude some people, but the question is whom they exclude. The criterion is vaccination, and we need only look at the vaccination data to see that there is a consistent pattern in that the groups who are behind others in getting vaccinated tend to be those who are more deprived and those who are black. They will be the ones who are disproportionately excluded by such a scheme. Therefore, recognising that or trying to mitigate it must be a consideration.

08:45  

My second concern is about take-up and backfire effects. One of the arguments for vaccination passports is that they might incentivise people to get vaccinated, although there is mixed evidence for that. There is anecdotal evidence that, in the countries that have implemented such schemes, there have been surges in take-up, but we have to take into account the fact that there are different cultures. Denmark is a good example of somewhere that has been successful. Denmark has high levels of public engagement with testing and vaccination, but it also has much higher levels of trust in its authorities than we have in this country.

There is some evidence that a scheme such as the one that is proposed would lead to an increase in vaccination take-up. I note that there is some evidence in the Government’s paper that the prospect of the scheme led to a surge in take-up in Scotland. However, there are also possible backfire effects. When we did our systematic review last year, we started to think about that and began to notice the circumstantial evidence. Most of the studies were carried out before vaccination passports were introduced. They were survey-type studies and experiments, and they were a bit hypothetical. However, there was a suggestion—a hypothesis, if you like—that vaccination passports could be introduced.

Since the review was published, there have been two studies that I know of that show backfire effects. One of them is cited in the paper, but I am not sure about the other one. We have much firmer evidence of what can happen with such effects. Some groups, instead of being motivated to get vaccinated, harden in their anti-vaccine view because they construe and understand the scheme as a form of control. Those tend to be the same groups—or people in the same groups—as those who are not getting vaccinated. Therefore, social exclusion and backfire effects interact.

There is a related point to that. It might benefit our response to Covid to introduce such a scheme and make many more venues and activities available, but, if the backfire effect occurred to any degree, I would be concerned about the impact on the long-term relations that those groups would have with authority. My research background is partly in public behaviour in emergencies and how the public interpret and respond to different interventions by the professional emergency services and the authorities. When there is a poor relationship, that relationship can be damaged by interventions, and the consequences of that could be long term. I am saying that there could be consequences for future engagement with the authorities. For example, one of the studies in our review found that, if vaccination was made mandatory, people would be less likely to be motivated to take a subsequent vaccine. There are such knock-on effects.

My third concern, which is probably less important than the other two, is that there is evidence that vaccination and vaccination passports can provide false reassurance. One of the mechanisms by which they would achieve that in the case of Covid would be the dichotomisation of risk. A sophisticated understanding of vaccination is that it reduces your risk; it does not eliminate it. However, with vaccination passports, there is suddenly a dichotomy of people who are able to engage in certain activities and people who are not. That creates and supports the impression that there are fully safe venues and other venues that are unsafe. We know about risk compensation, whereby people change their risk-related behaviours—their precautionary behaviours—after some vaccinations. That is a third possibility.

We have been joined by Graham Simpson MSP, who is not a member of the committee but is attending due to an interest in our proceedings. I welcome him to the meeting and invite him to declare any interests.

I have no relevant interests to declare, convener.

Thank you. I call Murdo Fraser.

Thank you, convener, and apologies for my late arrival, which was due to a train being cancelled.

Picking up on Professor Drury’s interesting comments about backfire effects, I think that one would have expected the introduction of vaccination passports to encourage take-up of vaccinations, but your argument is that, according to some evidence, it might be having the opposite effect on some groups. That seems counterintuitive, and it would be worth exploring that further with Professor Drury and the other panellists.

I have two questions that might help to form the discussion. First, would it assist with the groups that you mentioned if the vaccination passport had an end date? Would that make any difference? Secondly, as an alternative exclusively to vaccination passports, would it make a difference if, as has happened in other countries, there were an alternative to testing at venues? For example, people could either be double vaccinated or produce negative test results.

Perhaps we could start with Professor Drury.

As I have said, there are a couple of studies that show these backfire effects and, as Professor Reicher has pointed out, they are associated with existing levels of trust in those groups. It is all about what the scheme means, which I guess we can manage to some extent; however, sometimes those meanings escape our control. If the authorities that are trying to reconstrue the meaning of a scheme by presenting it as something democratic are themselves not trusted, that presents some limitations.

The end date issue is important, because if you set such a date, you work against the possible narrative that these things are about control. I understand that, in some of the existing schemes, no end dates have been set, which I think is problematic. If you want to increase trust, you will want to have an end date.

Testing is, as I have said in my submission, certainly one of the alternatives, but there are practical problems with it. For example, if people self-test, you have the issue of self-reporting and people’s honesty, and if testing is required to get into a venue, the fact is that not everybody can be tested.

On the one hand, people’s engagement with testing is subject to the same demographic variability as vaccination. Indeed, as evidence from last year’s mass testing programme in Liverpool has shown, it is deprived groups and ethnic minorities that are not coming forward. On the other hand, though, testing is far less controversial than vaccination, and it does not have the same connotations for those who mistrust authority. You can imagine a one-off testing scheme being more acceptable to people.

I agree with Professor Dye. I am slightly surprised that testing was not included, given that it is perhaps the more acceptable alternative to purely being reliant on vaccination passports.

Before I answer the question directly, I would point out that we have already heard this morning about the pros and cons of certification, and what we are ultimately dealing with is the balance of the two. Adverse effects have been documented, and Stephen Reicher and John Drury have outlined many of them, but the important question is whether they are dominant enough in any situation to outweigh the advantages of certification and, where they are important, how we can directly compensate for them. Stephen Reicher said as much, and I completely agree with him.

On the end date part of your question, in the United Kingdom—I am not there at the moment; I am in France—there has been a slogan: “data not dates”. There is some merit in that. My preference would be not so much for an end date, which might have to be rescinded, but for end criteria, so that, once we have reached them, we would remove the passport. That would give assurance that it is not a permanent method of control and that the intention is to release it. That would be a better criterion for doing so.

On the alternatives to vaccination certification, which John Drury has just covered nicely, I was surprised when I read in the documents for this meeting that the Scottish intent is to use vaccination only and not the other two back-up methods that are used most widely in Covid passes around Europe—namely, a negative test of some kind or evidence of a previous episode of Covid, implying that the subject is immune in some regard. The advantage of a tripartite system such as that is that it provides a back-up for those people who really do not want to be vaccinated or who cannot be vaccinated for medical reasons. It factors in the third aspect—fairness—which I spoke about in my introductory comments.

I do not know what the reason is for excluding those other two options in Scotland, but I can think of a couple of possibilities. One is that it increases the incentive for getting vaccinated, which is what we would like from a public health perspective. There might be cost aspects, particularly for a Government that is providing a free testing service with rapid antigen test or polymerase chain reaction tests. That is a cost that the Government might not wish to bear, so it might be another factor. However, I do not know the reason.

Across Europe in general, the tripartite system has been broadly agreed on and is what has been adopted by the European Union. As a consequence, the Scottish system would not be interchangeable with a European Covid pass and, with regard to travel and movement, that would be a considerable disadvantage.

To understand the backfire effects, it is important to place what is going on in a broader context to see the influences on people’s behaviour. People are not only subject to information from the Government telling them to get vaccinated. There are other voices—anti-vaxxer voices—telling them not to get vaccinated and that vaccines are a problem and a form of control. That is part of the broad populist politics that says that the system is trying to control you. People are positioned between the different voices. What does one do to ensure that the voice of the Government—the pro-vaccination voice—gets traction and the anti-vax voice does not get traction? One wants to avoid doing anything that will give traction to anti-vaxxer voices. We have to look at these things in that context and be aware of the fact that those voices are out there.

One problem is that vaccination passports potentially give traction to the argument that vaccination is about control, in particular among groups that, historically, have concerns along those lines. The reason why there is more vaccination hesitancy among the black population is not because they are stupid or backward in any way but because they have historical experience of the control element being a reality. A couple of years ago, there was a report by the House of Commons and House of Lords that showed that 70 or 80 per cent of the black population felt that the health system did not take their interests into account. Historical beliefs exist and the danger is that, if you feed into them—a vaccination passport is easily interpreted as being about control—that leads to more resistance.

Therefore, we have to ask ourselves how we undermine the sense that the passport scheme is about control and what levers we have in order to do that. I agree that we need end criteria rather than end dates. “Data not dates” is a slogan in the UK that has sometimes been observed in the breach, especially in England. Nonetheless, it is a key slogan here, and it has to be about criteria, because we have seen how dates can backfire.

09:00  

As I said, there are other things that we can do. First, we need to look again at the broader context of building trust. Building trust is essential in so many ways in the pandemic, so we need to engage with communities. We should not treat people who have doubts and questions about vaccines as if they are foolish, ignorant or selfish but, instead, take them seriously. It is absolutely central to any scheme that it is done in the context of building trust more generally. If we just have vaccination passports and use them as an alternative to community engagement, that will increase the backfiring effects. As I said, secondly, a conscientious objection process would also be helpful. It would not be something that people could do by just ticking a box—there has to be a process so that if it is a matter of convenience, it is easier to get vaccinated than to opt out—but it would show that people can opt out if they want to. As I said, in the way that we use messaging to introduce the passport scheme and provide alternatives, it is absolutely critical to build trust and undermine the narrative that the scheme is about control.

The final thing about testing—and here I agree with the others—is that, in one sense, it is very simple. People, especially if they are self-testing, will not test positive if they cannot afford to and, right at the beginning, we saw that with the mass testing schemes in Liverpool. There was much less take-up among the poorest sections of the community, who could not afford to find that they were positive, because they could not afford to self-isolate. The evidence from the events research programme was very clear about that, when the Euros led to a large spike in infections. One reason is that people might not go to the lengths of making sure that they self-test well if it makes it more likely that they test positive and therefore cannot go and see the game. The problem with testing is that self-testing is not very reliable if the effect of a positive is to stop someone from doing the thing that they want to do, and it is practically inconvenient to be tested by others.

There are difficulties, but I still accept the argument that those options are part and parcel of undermining the narrative that the scheme is about control. If the Government is going to introduce vaccination passports, it should include all the various options, even if that is less about practicality than about messaging very clearly that vaccines are for people and for their health—they are not imposed on them and they are not about controlling them.

Thank you. In view of the time, I will leave it at that.

We move to questions from Alex Rowley. We have about 10 minutes each.

I have noticed that, in the past few weeks, the messaging from NHS Fife has been saying to people that, if they have any questions or are uncertain, there are people who they can discuss it with, so I will pick up on that point with Professor Reicher. Have you come across concrete evidence from places where such schemes have been introduced—for example, Israel, across Europe and in some states in America—that shows that they have led to an uptake in vaccination? The UK seems to have good uptake, and the Government in Scotland seems to be aiming its messaging particularly at young people. Is there best practice out there that we can build on, with regard to encouraging those who have not yet taken the vaccine to take it? That question goes to all of the witnesses, but perhaps Professor Reicher will want to answer first.

Those are very good questions; they are also very challenging. Early on, one of the first examples of a vaccination passport scheme was the green pass scheme in Israel, which got lots of positive publicity. However, some of the literature coming out of Israel suggested that take-up was not simply to do with the green pass—indeed, the green pass was often not being scrutinised or as effective as it might have been. There were very impressive community engagement schemes. In many ways, the Israeli Government pioneered the philosophy of it going to the people rather than getting them to come to it. For example, there were vaccination stations outside the bars in Dizengoff in the middle of Tel Aviv for young people to go to. People were given something to eat and drink—it was not alcoholic—to make it attractive for them to do that. In many ways, the uptake in Israel was as much to do with those forms of engagement as it was to do with other measures.

Back in January, one of the first things that the WHO said was that community engagement must be at the centre of any vaccination roll-out. Indeed, historically, there is plenty of evidence that supports that. We wrote a piece in The Lancet showing how effective community engagement schemes are among the black community.

There are many such schemes. As you said, there is a large amount of very good work going on in that regard. If you go to the website of the Royal College of General Practitioners, you will find hundreds and thousands of such schemes up and down the country, which have been very effective.

It would be better if community engagement was the focus of a nationally co-ordinated campaign. I would echo the WHO’s position at the start: community engagement must be at the centre of any vaccine roll-out programme.

I live in France, so I will speak about the French experience. I also operate in Switzerland, which has a similar approach to that of France.

A number of people, particularly a vocal minority, have expressed reservations about vaccination and continue to do so. However, we know that that is not the majority sentiment. When President Macron announced in July that vaccination certification—the pass sanitaire, as it is called in France, which is a three-part Covid pass—would be mandatory for access to many venues, a million people signed up to get vaccinated within a few weeks. Most of those were people whom Professor Reicher referred to as not anti-vaxxers but those who did not initially feel the need to get vaccinated; they then did feel that need. Consequently, large numbers of people signed up and the scheme has been very effective in boosting vaccination coverage.

In France, the system has worked—from my perspective, it has worked pretty well. There are few complaints about the Covid pass and how it is used. It has quickly become a routine fact of everyday life, along with mask wearing. It is obligatory, so people just do it and they do not complain about it. The scheme has been a success.

That leads me on to Mr Rowley’s remark about the good uptake of vaccines. The question is: what level of uptake is good enough? During the most recent months of the pandemic, with the emergence of new variants, one thing that we have discovered is that we will need very high vaccination coverage to keep Covid at very low levels. The initial assessment that 70 per cent coverage might lead us to cross the herd immunity threshold is now generally viewed as being too low, so we will need higher vaccination rates. Vaccination rates are good but we need them to be as high as possible. Vaccination certification will be a way to help with that.

I will make a final remark on Alex Rowley’s first point about the need to support those people who might be excluded for one reason or another and what kind of support that should be, which follows on from what Stephen Reicher said. It is not good enough for it to be passive support—in other words, putting out an announcement saying, “Please contact us if you have problems,” because the people who have problems are not the people who will contact you. We need a much more proactive approach to those people who feel that they are excluded. We also need to work out the reasons why they are excluded and ways of compensating for that.

I will add a few points to what has been said. The Israeli situation is regarded as an example of success. As Stephen Reicher said, there is a confound there with the community engagement programme, which included things such as working with trusted leaders. Trust was important.

In my initial remarks I mentioned Denmark, which is also a success story. As far as I understand it, it has now abolished its passport scheme, because it has had so much success. As I said, there are very high levels of trust in that country and there were already very good levels of engagement with the vaccination scheme and testing before it introduced the passport scheme. I also read that it was reported in Italy that vaccinations increased by 15 per cent after it introduced its scheme and made it compulsory, as well as similar reports from the Netherlands. However, a lot of that is anecdotal and I have not seen any peer-reviewed evidence from those countries.

Professor Dye’s point about attitudes in France is interesting. We are all aware of the very visible opposition that there was before its scheme came in and at the beginning of it. I acknowledge that there are various dimensions of variability for attitudes to vaccination passports, which came through in the systematic review that we carried out last year. We have already talked about population demographic variability—that is, different groups having different attitudes to vaccination passports. There is also lots of evidence that the purpose to which the vaccination passport is put is another variable. Public support for vaccination passport schemes tends to be much stronger in relation to international travel and much weaker in relation to activities such as going to work. Other activities, including leisure activities, lie in the middle.

The other dimension along which attitudes vary is time. When we looked at the many attitude surveys that have been carried out on vaccination passports last year and this year, one thing that was clear was that attitudes change—they become more positive and they become more negative. One factor that makes attitudes more positive is implementation and roll-out, which tend to be associated with greater public acceptance. However, that is not to say that there will not still be a rump of people who oppose the scheme. The question of whether it is worth it boils down to knowing how big that rump of people is, and the consequences of that opposition for later public health engagement and interventions.

There is a lot in there. My first question is for Professor Dye. You mentioned people who could not be vaccinated. It has been suggested to us that that is fewer than one in 1,000 people. Is that about right?

I cannot give the committee a precise figure, but it is a very small minority from a medical perspective. However, I echo what others have said in that regard, which is that, just because those people who cannot be vaccinated are in a small minority, they should not be ignored. Nonetheless, in terms of balance, it is a very small number of people.

Professor Reicher mentioned conscientious objection. I am interested in how that might work. Can somebody simply say that they object to vaccination passports and therefore will not get one? If so, should they still be excluded from going to a big football match or a nightclub or that kind of thing, or should they be counted as exempt, just like somebody who is medically exempt?

09:15  

Let me go back to the logic for that. In relation to the impact of vaccination passports, we have to distinguish between the effect in the short and the longer term. The short-term effect is genuinely positive, because it leads those who I call the vaccine indifferent to think, “Well, I might as well get a vaccine, because it is more of a hassle not to”. Those are people who simply have not got around to it, which is why we then see the surge in uptake.

However, the danger is that, although that approach wins over the vaccine indifferent, in the longer term, it consolidates the opposition of those who are already doubtful. That is important not only in relation to social exclusion—as John Drury pointed out, those people tend to be in rather marginalised groups in our society—but because it has, in a sense, a biological implication.

One of the problems when we talk about herd immunity is that we do so as if the population is homogenous and as though, if 90 per cent of people are vaccinated, it is evenly spread. However, if take-up is unevenly spread and there are some communities in which there are much lower levels of vaccination, it means that we have pockets in our society where the virus can continue to spread and where new variants can still come about, which poses a major problem. Even if there are only some communities in which there are lower levels of vaccination, it is still very much a problem.

The great advantage of enabling conscientious objection in relation to the vaccine indifferent is that it will not undermine the take-up of the vaccine by the vaccine indifferent, as long as the procedures make it easier to get vaccinated than not to get vaccinated. At the same time, for those who are doubtful and who think that it is a form of control, that approach says to them that there is a way out if they want it. It could therefore have the advantage that we would still win over the people we can win over but would not alienate the ones we do not want to alienate. In order to achieve that effect, people who choose to go through the process and be conscientious objectors should still be able to go to venues and so on. In other words, it would be a device to undermine the narrative of control and to have the benefits of the vaccination passport system as a whole, without the problems.

Other members might have follow-on questions on that point.

France, which has been mentioned a few times as a comparator, seems to have a much wider scheme in the sense that people need to have a certificate for many more services. Does that make a difference? Can we be more relaxed because we are saying that our scheme is for only a very small number of high-risk, luxury items? Is the advantage of France’s wider scheme that it has become more widely accepted? I will put that question to Professor Dye, because he is in France.

The reason the French scheme is more comprehensive is that it was introduced at a time when a new resurgence of Covid was beginning during the summer. The Government decided that it wanted to use all means at its disposal to control that new resurgence. It decided, in effect, to take few risks by being more comprehensive about the way in which the vaccination programme was done, backed by the Covid pass system. Subsequently, for that and other reasons, case incidence has come down to relatively low levels.

That reminds me of what has been absent from this conversation so far. We have talked about balancing risks, but of course whether and how certification is used depends on the epidemiological circumstances of each country. Where there is no Covid, there is no longer any need for any certification process. That was the point that Israel almost reached earlier this year.

We have to translate what is happening in France, Denmark, Switzerland and other comparator countries into the current Scottish epidemiological situation, which is less favourable. I see from the data that the number of cases is now coming down, but Covid is still at pretty high levels in the UK, which means that there are stronger arguments for reinforcing the vaccination programme and strengthening methods to improve coverage. Certification is one part of that.

The difficulty that I see with conscientious objection—I offer this just for discussion—is that whether someone is permitted to object depends on the circumstances under which they are operating. Let me take an uncontroversial example in medicine. Doctors who do surgery have to be vaccinated against hepatitis. If you are in medical service, you cannot be a conscientious objector and refuse to have that vaccine, because the risk is simply too high for everybody concerned.

The same will be true under Covid certification. There will be circumstances in which people can simply opt out and be objectors. People do not have to go to nightclubs, for example. However, in medical and clinical settings, such as care homes, the community at large might take a different view on that. That is a difficulty with the idea of conscientious objection.

That leads me to my final question, which I will put to Professor Drury. Although the intention of the Government and the Parliament is that certification would be needed only for nightclubs, big crowds and so on, I presume that employers and other venues could use the system as part of their entry requirements. Would that be a good thing or a bad thing? Are there risks in that?

My first point is that a group that we have not talked about yet is people who work at such venues. One of the arguments in favour of a vaccination passport scheme is that it could make front-line workers safer. People who work in bars, for example, are exposed a lot.

It is interesting that you have brought up the question of employment. Earlier, I said that we can compare public attitudes on vaccination passports across the different activities that they allow or disallow. The activity for which there is most support for vaccination passports is international travel, and there is least support for their use in allowing people to go to work. Israel’s scheme included certification for people going to their workplace, and there is some evidence that that led to conflicts when some people were not able to get into their workplaces.

I would like to broaden the discussion and address the question of scope, which we have touched on. It is quite interesting to compare the scope of the Scottish proposals with the scope in other places. On the one hand, we could say, as Professor Dye did, that the activities and venues that are included under the scheme are ones in which people have a relatively high level of choice. Therefore, we could say that the possible exclusions for certain groups would be less severe, because those included are not necessarily everyday activities such as going to the pub or the shops. On the other hand, I was interested to see that, as well as nightclubs, which are indoors, outdoor events are included. That is perhaps slightly paradoxical, because, as we are all now aware, there is fresh air at outdoor events so people are much less likely to be infected.

Earlier, we talked briefly about the events research programme. It is useful to consider the evidence from that programme and other evidence that has been brought to bear on people’s attitudes on and engagement with vaccination passports for live events.

A survey that was carried out earlier this year by an agency in the live events industry found a very high level of support for such measures among people who go to events. However, the question was framed with a reference to “all biometric testing”, so that included not only vaccination passports but testing for immunity—the broad range of tests. There is broad support for that.

The events research programme has found considerable variability in outcomes, which is consistent with Stephen Reicher’s point that it seems that it is possible to operate outdoor live events and minimise the risk of infection without a vaccination passport scheme but with other things instead. The research picked up relatively low levels of infection at Wimbledon and relatively high levels of infection at other events, such as the Euros. There are two key variables that seem to matter. One is how an event is managed and the other is the behaviour of participants—the culture, the levels of intimacy and physical proximity, and whether people are shouting. The key point is that both those things can be modified. That is the logic and rationale behind a scheme that certifies venues and events as an alternative or complement to a vaccination passport scheme.

I am trying to establish where the evidence base is for not just the introduction of vaccination passports but the way in which the Scottish Government has introduced them. I am concerned that we seem to be comparing Scotland with what is happening in other countries and trying to take lessons from them when, of course, there is a huge variation in vaccine uptake across other countries, so there is variation in the need to encourage uptake. Is comparing the Scottish vaccination passport scheme with schemes in other countries an accurate way to assess whether we should adopt vaccination passports in Scotland?

Comparison with other countries is both the best of worlds and the worst of worlds. It is the best of worlds in that we can learn much from what has happened elsewhere, but it is the worst of worlds if the comparisons are made mechanically and ignore the key parameters that differentiate between countries. It seems to me that the key parameters are biological-medical and social. As Professor Dye has pointed out, incidence rates are a major factor. There is a need for schemes only if there are high rates in the community. At a social level, I come back to the absolutely critical role of trust—social trust is a key parameter. Such schemes are understood in different ways and have different implications in different countries. Professor Drury made the point that Denmark, where schemes have worked well, is a high-trust country. The Scandinavian countries have the highest rates in the world of trust in Government and of people’s trust in one another. The world trust surveys that are carried out every year find that to be the case systematically.

Any comparison must take those two factors into account. Whatever we do around the pandemic, the central issue for me as a psychologist and social scientist is about the building of trust. We can give people all the information that we like but, if they do not trust the source, they will not listen to us. I go back to the fact that we are involved in a battle with the anti-vaxxers over information. We will win that battle to the extent that there is more trust in us than there is in them. However, anything that atrophies or undermines trust is corrosive not only in terms of vaccination but in terms of any measure that we need to deal with the pandemic.

To go back to the question, let us take international comparison very seriously, but only in the context of an awareness of the key parameters that differentiate between countries. For me as a social scientist, that key parameter is trust.

09:30  

Do either of the other two witnesses want to add anything before I move on?

I agree with Stephen Reicher that international comparisons are important but limited. The difficulty is that we do not know how much of what goes on in France, Denmark, Switzerland or indeed any other country applies directly to Scotland. In other words, the decision that is being made now on certification will be made in the presence of uncertainty. That is a key point: we are never going to have all the information that is needed.

The question, therefore, is what decision should be made in light of a certain amount of evidence and plenty of uncertainty. Is the political decision to err on the side of caution and strengthen the vaccination programme through certification or is it to err on the side of less caution and more risk—one might say—and not introduce certification? It seems to me that the decision has already been made, given that, as we heard at the start of the meeting, the intention is to introduce the scheme tomorrow. What follows from that uncertainty is the need to follow things up with data collection and information in order to understand how successful the introduction of certification has been, with regard to not only the practicalities of what is and is not acceptable—which we have already spent a lot of time on—but the epidemiological impact. There is a really important need to continue collecting data and information to see how well the scheme is working.

The Scottish Government has said that the main driver for introducing the vaccination passport scheme is to encourage those who have not been vaccinated to get vaccinated. As we heard in last week’s evidence and as Professor Reicher’s evidence has highlighted, one of the key issues is the reluctance of certain groups to get the vaccine. In that regard, a big driver is ethnicity—I am thinking especially of our Polish and African communities—and another is living in areas of deprivation. If we are saying that people need to be vaccinated to get into nightclubs or football matches, I would suggest that the people in those groups are unlikely to be participants in those activities. Will the way in which the vaccination passport is being introduced help those groups do what the Scottish Government wants them to do, which is to get vaccinated? I will ask Professor Drury to respond first, given that he has not spoken to me yet.

First, I want to make a broader point about that particular evidence, because it frames everything that we say. How can we be confident in the arguments that we are making? We have four different types of evidence for the backfire effects in vaccination take-up and so on: international comparison is one such set, and we also have survey and self-report evidence and evidence from experiments. Of course, experiments and surveys themselves might be based on self-reporting and are rather artificial, but they provide relatively consistent patterns of the types that we have been talking about. There are also the vaccination rates and the demographic differences that I have talked about.

That is all we have. It might look like a lot, but we do not have, for example, the randomised control trials that are the gold standard. However, we still need to make decisions, and we are doing so.

I am afraid that I do not have any specific evidence with regard to the two groups that you mentioned, and I guess that, to answer your question, what we need to do is understand their existing attitudes.

My dad came from Poland during the war to join the Polish air force in the UK, and you should have seen him when the football was on. The Poles are quite interested in football, as is the black community.

We have some unpublished data from a study that I did with one of my masters students that showed reasonably clearly that, for black participants, the introduction of vaccination certification for large events such as concerts and football led to a greater sense that vaccination is about control—that it is done to us rather than for us—and led to lower intentions to get vaccinated. I absolutely accept all the provisos to which John Drury has just pointed—it is experimental data, self-reporting and so on—but I also echo what he said about it being consistent. The point is that, especially among the black community, there is traction for a narrative that people in the community are not well treated by authority and are controlled by it. Therefore, anything that feeds into that is more likely to be read in those terms and to lead to more resistance.

It is also consistent with the evidence on vaccine hesitancy. Overall, there is little vaccine hesitancy in the UK. Only 4 per cent of people are vaccine hesitant but, when we look at the smaller communities we see much higher levels of hesitancy: among the unemployed and the Muslim community, it is 14 per cent and, among the black community, it is 21 per cent. For me, that is not only a social problem—although it is a major social problem—but, potentially, an epidemiological problem because we have potential reservoirs of infection in the UK and will never get herd immunity while those reservoirs exist.

Professor Dye, would you like to add anything to that?

I will add a comment about the purpose of certification. You mentioned that the main purpose is to increase incentives for vaccination. The evidence paper says that as well. In fact, it is equally to protect health and stop transmission because it is a way of controlling—I use that word advisedly and, I hope, carefully—the transmission of infection at the events and mass gatherings about which we are talking. It is about incentivising vaccination but it is also about protecting personal and public health.

Given that, as has been highlighted, there are specific pockets of our population that are less likely to be vaccinated, what should we do to encourage vaccination uptake?

That is a difficult question to answer specifically. I can only reinforce everything that has been said.

Perhaps I am stating the obvious, but it starts with not dismissing people who do not want to be vaccinated as fools—stronger language has been used in many circumstances. My knowledge of the behavioural literature on the matter is somewhat limited. However, the studies that I know of that have investigated the reasons why people do not wish to be vaccinated discovered that it is not a single reason but that there are four, five or six different groups of reasons in different communities. We have to start with that understanding of why people do not want to be vaccinated. We might say that it is irrational but, from their perspective, it could be fully rational and very reasoned. Unless we understand those reasons by working with those communities, we will not be able to persuade them.

That goes to the point about messaging as well. We need not just messaging per se but effective communication with the people who are on the receiving end of those messages.

In short, we must understand why people do not want to be vaccinated. When we do that, we will be in a better place to increase vaccination rates.

There is a very long answer to that and a very short answer, and the short answer is community engagement. It is about going to people, listening to them, respecting them and allowing them to have doubts and to go away and come back to you. It is very much about treating those who are vaccine hesitant as perfectly reasonable people who have real doubts.

It is also important to distinguish between different populations. The first thing is that the number of people who are not vaccinated is far higher than the number of people who are vaccine hesitant, because most people who are not vaccinated are vaccine indifferent—they have not got around to it—and they are the ones who can catch up more easily. The difficult ones are those who are vaccine hesitant—they have questions—but they are fundamentally different to anti-vaxxers. Anti-vaxxers do not have questions; they think that they have the answers—they know that the vaccine is wrong. If you treat the vaccine hesitant as though they are like anti-vaxxers and lump them all together, the danger is that they will become all lumped together. You want people to see you as being on their side and to trust you, but you have got to respect them, if you want them to respect you. Therefore, engagement is the first thing.

Secondly—again, it is a simple philosophy—do not wait for them to come to you; go to them. Make it so much easier to get vaccinated: set up vaccination centres in communities, give people paid time off to get vaccinated, use community champions and so on. I would put all those things at the start of my debate about how to increase vaccination rates—I would not have it as an add-on after vaccination certification.

With regard to my final point, I agree absolutely with what John Drury said—in many ways, it is the most important thing that has been said today. Certification for individuals creates all the problems that we have been talking about, because you then need forms of scrutiny and surveillance to ensure that people have vaccination passports and you introduce all the problems of what happens when you have to stop people and ask them to show passports and all the problems of alienation that we have talked about. It seems to me that we ought to be placing equal, if not greater, emphasis on certification for venues.

If venues are well ventilated and have high hygiene standards, they are relatively safe. Not only is there evidence about large events outdoors, but there was a recent large study in Nature that showed that even indoor large events are relatively safe if they are well ventilated and have high hygiene standards. Therefore, if you had certification for venues, so that they had to meet particular standards before they could welcome individuals, you would have many of the advantages without so many of the disadvantages.

It is not a case of either/or—you can have both—but if you are going to have certification, you should do it in the context where you put much more work into community engagement and certifying venues. In that context, where you show that you are acting to protect people, again, you are likely to get far more trust in and traction for the narrative that vaccination passports are about protecting people rather than taking away their freedom.

As Christopher Dye said, incentivisation is not usually the main rationale for such schemes. I know that that has been mentioned by many policy makers, but, from a public health perspective, such schemes are usually about making spaces safer.

To echo what Stephen Reicher said, hesitancy is only one reason why people are not getting vaccinated. Successful public health campaigns around the world have all been based on community engagement. There are accounts of inspiring campaigns on AIDS and Ebola in some countries.

On top of community engagement and building trust, there is the practical side of facilitation. For example, sometimes people are reluctant to get vaccinated because they expect to be sick for two days afterwards, so we should give them paid time off work. Sometimes people are reluctant to be vaccinated, because the vaccination centre is out of town, so we should bring the vaccination programme to people—that is what was done in Israel and in some local authorities here.

The final point is about the different groups of people who are not coming forward to be vaccinated. Different groups have particular concerns. For example, yesterday, I was at a seminar where new evidence was presented that reluctance among young women often relates to concerns around pregnancy. That is a specific concern that needs to be addressed in a community engagement programme.

09:45  

Thank you. I am conscious of time, and I remind the committee that we have only 15 minutes before one of our witnesses has to leave.

I welcome the witnesses. First, I would like to know how to pronounce Stephen Reicher’s last name, because we have heard it pronounced in different ways.

I have listened carefully to what has been said today and I have read the committee papers. I have to say that this is a hugely confusing and conflicting conversation, but I have drawn some conclusions, which I will quickly run through. We know that the virus is endemic in the population and we know that it kills people; the target scheme is working, which we know because we are getting an uptick in the number of people who are getting vaccinated at the moment; the vaccine reduces infection by up to 50 per cent, as we heard in a previous meeting; the virulence of the delta variant is much higher, as we have also heard previously; the post-vaccination passport messaging requires a strong focus on continuing with hand washing and mask wearing, because of the false sense of reassurance that you have spoken about today; and, largely, the Scottish Government is trusted on what it has done so far, which is helped by the fact that the scheme that we are discussing is subject to a sunset clause—I know that there is a debate in relation to time and data.

To me, events and venues do not transmit the virus—people do. By and large, the nightclub industry has worked incredibly hard to make the venues as safe as possible. I take the point that you are making about venues and events, but I would argue that it is the people who transfer the virus, not the events, so I have a couple of questions.

Conscientious objectors have a choice: you are right to say that they absolutely can choose not to take the vaccine. The scheme is a targeted one. People do not have to go to the events that they will be excluded from if they do not have the vaccine. However, following on from what Professor Reicher has said, by allowing conscientious objectors access to events, are we taking away the rights of the people who are in the venue and also discriminating against the business owners, because having those conscientious objectors in the venue could put other people at risk and cause the business owners a problem?

My second question is one that I have asked on numerous occasions. Care home workers in my constituency have been sacked by a care home owner because they will not take a double vaccine. The owners have taken the view that, on balance, the rights of the residents are more important than the rights of the workers. We have discussed that at length and it is something that we need to delve into. The question is, whose rights are more important: the conscientious objectors or the people on the other side who want to see a vaccinated population?

I want to make a point about the backfire effect, which I will leave open for further discussion. If the backfire effect occurs, events cannot open and businesses cannot trade. If there are people who simply refuse to get vaccinated and continue to spread the virus and put pressure on our NHS by blocking beds and preventing other people getting various treatments—all the stuff that we know is already happening—how does the rest of the community react to that demographic, whether the reason for their not getting the vaccine involves a hesitancy or a failure to believe that it will work? How does that affect the majority of the community who are saying that those people are stopping everyone else from getting on with their lives? I know that is controversial, but I would like to discuss it.

There is no time left. [Laughter.]

There are lots of questions there. First, Christopher Dye pronounced my name correctly: it is Reicher with a “sh” sound. However, that is not quite correct, because the actual pronunciation is a guttural Polish sound that I cannot do. My father always used the “sh” sound.

I would not be able to answer every question even if we had three days to do it, but I will make two broad points.

First, in many ways, my arguments are pragmatic. They are about what will get people to be vaccinated. I absolutely agree that we want more people to be vaccinated. Vaccinations save lives. It has been estimated that they save more than 100,000 lives. What is more—this, too, is a really important message—is that if people are not vaccinated and, indeed, if they act in risky ways by not wearing masks or not socially distancing, they create an exclusive society. It means that people who are vulnerable do not feel confident and able to go out in society and that, as we reopen our society, we reopen it to some but imprison others more.

One thing that worked about the messaging early on in the pandemic was that it focused on the communal rather than the individual—it was about “we” rather than about “I”—and many people went along with restrictions that were quite onerous and quite difficult for the community. A lot of evidence in a number of studies showed that the key factor in adherence was about wanting the community to come out of things well. It was not about personal risk but about communal risk.

You talked about messaging. We need to get across that message and build norms in particular groups and communities that we are behaving in this way so that we as a community can reopen, so that even vulnerable people can go out to the cinema and nightclubs. That communal framing is an absolutely central point. We have forgotten it a little bit and the messaging needs to concentrate very much on it.

That is one general point. On the various issues about the impact of vaccination certification, my arguments are that if you introduce such interventions and moderate the scheme in such a way that people do not feel that it is a form of control, they are more likely to go along with it and get vaccinated in such a way that it becomes safer for everyone, the vulnerable can go out and the venues can stay open.

I absolutely agree that most places are good and have put huge efforts into making their venues safe. Why not then make that formal and show it? Just as when you go into a restaurant, you see hygiene certificates that tell you that you will not be infected by bugs from the cooking, if people see that the venue is safe, it will give them more confidence to go out and use the economy, which would be good not only for public health but for the economy. It is a matter of not only making us safe but making us know that spaces are safe so that we can use them. A certification scheme for venues would be good all round. It would be good for public health and for the employers and owners who have put huge efforts into making their venues safe.

As you said, Mr Fairlie, safe people are not an alternative to safe venues. We should have both because both together will have the best effect.

Your point about care homes and whose rights are important raises a question of general importance. The science that lies behind that, which is why we are here, can take us only so far. From the perspective of epidemiology, we can speak about risks to individuals and groups of people in different settings such as care homes. However, the assessment of rights and values is a subjective judgement that needs to be made by all those who are involved—not just by one group of people, such as the people who run care homes, but by the community of all the people who are involved in what care homes do. In the UK especially, we hear a lot about following the science, but it takes us only so far. When it comes to the assessment of value, that is a community-based decision, and it might be a different decision when made in different circumstances.

I have my own views on rights, but the points that I have been making are based not on rights but on public health outcomes. Care home workers are a case in point. The difficulties with retention in that respect are a real practical problem, so the argument that might be made against mandatory vaccination for those workers is, for me, not one of rights but all about having a viable care home.

The point about the rights of others is similar to that about those shielding; in fact, it was made in the UK—or, I should say, English—context around 19 July, when many people who were shielding felt that they were being systematically disadvantaged and losing their freedom and rights at a time when everyone else had been given the right not to wear a mask or distance. However, that was an argument in favour not of vaccination passports but of other public health measures such as distancing, mask wearing, hygiene and so on. It is important that we remind ourselves that most public health experts say that we will still need other public health measures and that vaccination cannot do all the work.

Finally, on your divide-and-rule point, division is a real worry for me as something that might come out of vaccination passports, with people feeling excluded and different groups feeling resentful towards others. However, my understanding is that the affected venues are already open. Unless I have misunderstood it, the scheme is not for reopening venues but for use by venues that are already open. I am not sure that that would be a basis for resentment.

I am sorry, Mr Fairlie, but we have to move to Alex Cole-Hamilton.

Good morning, panel. I have just one question that I hope will be pretty straightforward.

Section 5.1 of the Government’s evidence paper, which was produced last night, states that the scheme first and foremost

“aims to ... Reduce the risk of transmission”.

Driving vaccine uptake is in fact ancillary to that, as it is the fourth bullet point. That chimes, I think, with the theme that the Government is trying to set out in its case, which is that Covid ID cards and vaccination certification are in and of themselves tools of infection control. When I asked the First Minister to respond to the fact that 5,000 cases occurred at an event that had required vaccination passports, she stated as indisputable fact that, without those passports, transmission would have been worse. As Professor Stephen Reicher is leaving, I will start with him. Do you think that that is fact? Would the situation at that event have been worse had there been no vaccination certification?

It is terribly difficult to deal with such counterfactuals. The simple answer is that I do not know, but I can point to the issues that are important.

On the balance of risks, when it comes to the issue of vaccination take-up, which we have been discussing at great length, you have an advantage with the indifferent but a disadvantage with those who lack trust. That is the balance to be struck.

With regard to transmission, it is indisputable that those who are vaccinated are less likely to be infected and less likely to transmit the virus, although we do not know exactly by how much. What we do not know is whether people’s potential sense of invulnerability leads to riskier behaviours.

10:00  

There is some evidence that, when people were first vaccinated, they began to act in riskier ways. There was evidence from Israel that that was happening, and there was evidence of it in the UK—the over-80s were going out and socialising more. Although that is a rather nice image, it led to the potential for more transmission, because the simple fact is that the more contacts we have, the more transmission there will be.

We cannot say absolutely what effect vaccination passports will have on behaviour because, in large part, that is also a matter of communication, which is why the issue of communication and messaging is so important. John Drury’s point is an absolutely essential one. We misunderstand the pandemic and it is not helpful if we see things in binary terms, such as vaccination either works or does not work, or vaccination either breaks the link to hospitalisation or does not. Vaccination does not make us safe—it makes us safer. It is really important to message in such a way as to ensure that if people get vaccinated, they do not then behave more riskily. Let us say that, biologically, the vaccine makes us half as likely to get infected. If we then go out and see twice as many people, we will, in the end, have lost the advantage of vaccination. Therefore, behaviour and the messaging are critical.

Where the First Minister is indisputably right is that, at a biological level, getting the vaccine makes us safer. When it comes to the way in which vaccination is introduced, we must send the messages that make sure that that is not undermined by behaviours that are riskier.

I put the same question to Professor Dye.

I broadly agree with all of that, of course. It is never possible to say what would otherwise have happened in one particular instance or at one particular event, but it is clear where the balance of probabilities lies. It is clear that vaccination certification is a way of increasing the safety of such events—in other words, there would probably be less transmission under circumstances of vaccination certification.

On risk compensation, I take the point that that could happen in society at large, but one would have to imagine how risk compensation among people who are vaccinated doing riskier things would take place in a particular nightclub, bar or whatever. It seems to me that it might not be so important under such circumstances, because people do what they do in nightclubs. By and large, I think that the First Minister is right when it comes to the balance of probabilities, but it is impossible to speak about what might have happened at any single event.

I want to bring in Professor Drury, who has spoken extensively about behavioural science in this area. Given the significant coverage that vaccination already enjoys across the UK, is there a tipping point—I am thinking of an event such as the Boardmasters event in Cornwall, where there were 5,000 infections—at which the benefits of people evidencing their vaccinated status versus the risks of them dispensing with some of the precautions and indulging in riskier behaviour because of that means that it is more of a liability than an asset to ask for Covid certification?

On the specific question of the venue, I am not an epidemiologist, so I cannot comment on that. I understand that all the published studies on the reduction in transmissibility that is provided by the vaccine are pre-delta. Given that we are talking about delta, there is even more uncertainty.

On the balance of risks, again, it is not easy to give an answer to that, because it relates to what Stephen Reicher said about the consequences and how much risky behaviour follows from people’s understanding of what it means to be vaccinated. Therefore, I cannot really give an answer to that.

I thank the witnesses for their evidence and for giving us their time this morning. If you would like to offer any further evidence to the committee, you can do so in writing. The clerks will be happy to liaise with you about how to do that.

I suspend the meeting to allow for a changeover of witnesses and a short comfort break.

10:04 Meeting suspended.  

10:11 On resuming—