As the autumn chill begins to settle across Scotland, a heated debate is brewing over the country’s approach to winter vaccinations. The Scottish government has announced that, for the 2025 flu season, free flu vaccines will be offered to everyone aged 65 and over—mirroring last year’s policy. However, in a notable shift, COVID-19 booster jabs will only be available to those aged 75 and over, as well as people who are immunosuppressed. This change, based on advice from the UK’s Joint Committee on Vaccination and Immunisation (JCVI), has drawn criticism and confusion from campaigners and public health advocates alike.
Katherine Crawford, chief executive of Age Scotland, has emerged as a prominent voice questioning the rationale behind the new criteria. "I can't really understand the rationale behind the fact that if you're going for a flu vaccine, you wouldn't be able to just have a Covid vaccination at the same time," Crawford told BBC News. "It does feel as though the government is moving to vaccinate to the bare minimum and that feels really puzzling." Her concerns echo a broader sentiment among older Scots, particularly those aged 65 to 74, who now find themselves eligible for a flu shot but not for a COVID booster.
The Scottish government, for its part, insists it is simply following the expert guidance of the JCVI. According to the committee’s annual advice, COVID-19 now poses a "relatively mild disease for most people," with hospitalisation and death rates "reduced significantly." The JCVI recommends focusing on the oldest adults and those with compromised immune systems, arguing that this approach is "a standard cost-effectiveness assessment, in line with other routine vaccinations." In practical terms, this means that, starting this month, health boards across Scotland are rolling out a vaccination programme that prioritises adults over 75, care home residents, and immunosuppressed individuals for COVID boosters.
This policy marks a significant tightening of eligibility compared to previous years. In 2022, all Scots over the age of 50 were invited for a COVID booster. For the past two years, anyone aged 65 and over was eligible. Now, with the bar raised to 75, a substantial cohort of older adults is left wondering why they can receive a flu jab but not a COVID booster at the same appointment. The confusion, as Crawford points out, could have real-world consequences: "The confusion could cause some older people to change how they go about their daily lives through the winter and it could lead to more loneliness and isolation."
Adding to the anxiety is the recent surge in flu-related deaths. According to Public Health Scotland, flu deaths reached a 40-year high in the first 14 weeks of 2025. Campaigners have criticised the Scottish government’s decision to revert to pre-pandemic eligibility criteria for flu vaccines, which means 50 to 64-year-olds—who were included during the COVID pandemic—are now excluded. Flu vaccinations will, however, continue to be offered to all children aged 2 to 18, following a successful extension to secondary school pupils in 2024. Other eligible groups include frontline health and social care workers, prisoners, and people with certain health conditions.
The numbers tell a stark story. Last winter, almost 1.65 million people in Scotland received a flu vaccine. But in the 2024/25 season, that figure dropped to under 1.3 million—a decline of 350,000 doses, or about one-fifth. The government attributes this to "poor uptake from adults right across the board," though uptake among children and high-risk groups remained strong. In response, the NHS will be contacting eligible individuals with appointment details or invitations to book in the coming weeks.
For those not eligible for free NHS vaccinations, there is still the option to pay privately at high street pharmacies. According to Adam Osprey of Community Pharmacy Scotland, the changing age cohorts for eligibility can cause confusion about where people can access vaccines. "Last year, pharmacies had anticipated a certain level of demand for their private flu vaccination services, then when two key cohorts got cut from NHS eligibility, those two cohorts used up private stock, leading to a bit of a shortage," Osprey explained to BBC News. This year, private flu vaccines are available for about £20, while a COVID booster costs around £100—a steep price for many pensioners.
Public Health Minister Jenni Minto has defended the government’s approach, stating that Scotland continues to be guided by the JCVI. She emphasized that the overall threat of COVID-19 has diminished due to high levels of vaccine-based immunity. Still, the narrowing of eligibility has sparked debate over whether the government is doing enough to protect vulnerable populations and ease winter pressures on the health service. Crawford, for one, believes a broader vaccination programme could help: "Protecting more vulnerable people against Covid could help ease winter pressures on the health service," she argued.
Meanwhile, the situation stands in stark contrast to the approach seen in parts of the United States. In Washington State, for example, all residents aged six months and older—including pregnant women—remain eligible for COVID-19 vaccines, regardless of recent federal changes. The Washington State Department of Health issued a standing order in August 2025 allowing providers to administer vaccines without a prescription. Dr. Herbie Duber, interim health officer for the Kitsap Public Health District, cautioned, "It still causes severe illness. It is a significant risk of mortality and we’re seeing it have an impact on our health care system." However, even there, insurance coverage and future eligibility are under review, with national guidelines in flux.
Back in Scotland, the debate over winter vaccinations is likely to intensify as the season progresses. The government’s focus on the "bare minimum," as some critics put it, will be tested by the realities of flu and COVID transmission rates, hospital admissions, and public sentiment. For now, those aged 65 to 74—many of whom dutifully lined up for both jabs in previous years—are left to weigh their options, consider private vaccination, or simply hope for the best.
As the NHS prepares to contact eligible groups and pharmacies brace for potential surges in private demand, one thing is clear: the conversation about who gets protected—and why—is far from over.
