Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 16 September 2024

Date: 10 September 2024

Sponsor: Dame Jenny Harries

1. Purpose of the paper

The purpose of the paper is to provide a forward look of priorities and brief overview of the recent operational and response status of the UK Health Security Agency (UKHSA) since the last Advisory Board.

2. Recommendations

The Advisory Board is asked to note the update.

3. Overview

As we have come to expect, while the summer has provided some opportunity for colleagues to take some well-deserved time off, the work of UKHSA has continued unabated.

Only a few days before the Board last met, the UK held a Parliamentary General Election. This election returned a new Government and consequently we have welcomed a new ministerial team to the Department of Health and Social Care (DHSC), led by Wes Streeting MP as the Secretary of State for Health and Social Care and including Andrew Gwynne MP as the Minister for Public Health and Baroness Merron whose portfolio includes life sciences and genomics.

The new Government has established five central missions that it will deliver, and the new Health Secretary set out his ambitions for the Health Mission in July. This includes strong focuses on both prevention – reducing the burden of ill health on individuals, the health system, the economy, and society – and on health and life sciences as drivers of economic growth. UKHSA has a significant role to play in realising those ambitions.

We have had early opportunities to explore this with new Ministers. In July, Minister Gwynne visited Porton Down to see firsthand some of the cutting-edge research that we undertake to deliver innovation in health protection science and to support the NHS and wider life sciences sector. I also joined the Minister towards the end of August visiting frontline health workers giving life-saving maternal pertussis vaccines – the end point of just one of our many complex but vital immunisation campaigns.

While the political landscape in which we operate may have changed, it is essential that the work of the agency to respond to emerging and ongoing health threats robustly continues. Alongside a regular cadence of new incidents, covered in more detail in section 5, the most notable development in recent weeks is the World Health Organization declaration on 14 August 2024 of the mpox clade I outbreak in the Democratic Republic of Congo as a Public Health Emergency of International Concern.

It is important to note that the outbreak itself has been ongoing since late 2023 in 5 central African countries and UKHSA has been closely monitoring the situation. However, recent developments, including a rapid rise in suspected cases and of the virus within Burundi and subsequent spread at lower rates to countries neighbouring the Democratic Republic of the Congo together with the first confirmed reports of imported cases outside of Africa have raised concern that this could develop into a wider global outbreak. As of 6 September 2024, there have been 27,439 confirmed and suspected cases and 636 deaths from confirmed or suspected infections reported this year in the 8 affected countries in Africa.

Mpox clade I is a different strain to mpox clade II, which was responsible for the global outbreak in 2022 and which continues to circulate in the UK, albeit at lower levels. Clade I is thought to be associated with more severe disease and higher mortality than clade II and is initially classified as a High Consequence Infectious Disease (HCID). HCID cases are subject to very stringent management protocols to maximise patient health outcomes and minimise transmission risk, especially in healthcare settings.

Working closely with DHSC, the NHS, and partners across Government we have stepped up both activity to mitigate and manage the risk from imported cases and our preparedness in the event that a wider response to an outbreak within the UK is required. Alongside Home Office, Border Force, and Department for Transport we are working to ensure that there is clear information and advice available to everyone arriving directly or indirectly from an affected country and that frontline staff are able to help identify travellers who are unwell to ensure they receive the right timely support.

We are also making sure that clinicians within our health services are informed and enabled to take the right actions when presented with possible cases and have additionally re-established the Returning Workers Scheme to support UK organisations whose staff are participating in the humanitarian and healthcare response where direct exposure risk to mpox clade I is heightened, both prior to departure and when they return to the UK.

We are also preparing for a vaccine programme using the available smallpox vaccine, which is licensed for use as a treatment for mpox in many countries and has been used effectively in the UK in response to mpox clade II. In addition to rolling out the routine immunisation programme that the Joint Committee on Vaccination and Immunisation has recommended in relation to mpox clade II, we intend to offer vaccines to those at highest risk of exposure, including to the close contacts of cases of mpox clade I should these occur, to laboratory workers who work with live pox viruses, and to healthcare workers in sexual health services and high consequence infectious diseases centres.

4. Strategic Forward Look

In August, the Chancellor announced a multi-year Spending Review, to conclude in Spring 2025. The first stage will conclude with the Autumn Budget on 30 October and will confirm further savings within 2024/25 budgets and set budgets for 2025 to 2026. The second phase will address budgets for future financial years ahead of a further fiscal event in Spring 2025.

Separately from financial considerations Ministers have already shown interest in the potential for UKHSA to go further in support of the Government’s mission-led agenda through its unique functional capabilities. UKHSA already collaborates with academia and industry to develop new tools – such as vaccines and diagnostics – which improve our capacity to prevent and respond to health hazards, but the Agency has the potential to build additional health protection capability at home and abroad and to contribute to the Government’s economic growth, science and innovation agenda. The recent Public Bodies Review highlighted that, with the right investment, the Agency could deliver even greater public health impact.

However, such ambitions currently require appropriate resource prioritisation, and we need to ensure that we balance any new commitments against our ability to continue to deliver critical foundational health protection functions. These core activities are a non-optional requirement to support the Secretary of State to fulfil his legal duty regarding health protection under the NHS Act.

Since the last settlement was reached UKHSA has absorbed the costs of infrastructure and capabilities that were built for COVID-19 response but have been repurposed for other infectious diseases. UKHSA was challenged to deliver this from within the existing core budget when COVID-19 funding ceases, but this is now proving very difficult when accounting for forecast drivers including future pay and inflationary pressures, the 2024 to 2025 pay awards and non-recurrent income. We actively addressing these significant pressures and new, material challenges within a changing political and threat landscape. However, while UKHSA has made efficiencies and reprioritised resources to absorb as many of these pressures as possible, the Agency’s minimum future core budget requirement exceeds the current core budget settlement.

My executive team continues to implement the restructure of our Senior Civil Service cohort, which has been discussed in more detail with the Audit and Risk Committee and People and Culture Committee. Consultation has now closed, and I am working with my Directors General to review the feedback in detail and amend the structure accordingly. We continue to review our design principles, ensuring that we are both strengthening capabilities and increasing efficiency as we review the design.

After the publication of its Module 1 Report on the resilience and preparedness of the UK, the public activity of the COVID-19 Inquiry has been relatively quiet over summer. However, preparatory work for new and current modules has not slowed. We are in the process of actively responding to four modules and are preparing for statement requests on a further two.

The public hearings for Module 3 (Impact of COVID-19 pandemic on healthcare systems in the 4 nations of the UK) began on 9 September. Both myself and our Chief Medical Adviser, Susan Hopkins, will be appearing to give evidence on behalf of UKHSA and predecessor organisations. The public hearings for Module 4 (vaccines) are then expected to begin in January 2025, and will require significant input on areas for which Public Health England and the COVID Vaccines Taskforce were responsible.

5. Update on activities

While our preparedness and response capabilities continue to be tested, there have been positive developments for our Vaccine Programmes and progress towards the implementation of our new Vaccine Preventable Diseases Operating Model as part of the Building for Ambition programme.

On 1 September 2024 the new campaigns to protect younger infants (via a maternal vaccine) and older adults from respiratory syncytial virus (RSV) began in England. This is the culmination of 2 years of dedicated work across the Agency and by our NHS partners, with the potential to prevent 5,000 hospitalisations, 15,000 Accident and Emergency visits, and 20,000 GP appointments for babies this coming winter.

Efforts are not just limited to the new RSV vaccine, however. Back in February I launched a new multimedia campaign across England aimed at improving childhood vaccine uptake and encouraging catch-up for missed vaccinations. We have scaled this campaign up, building on what we learned during the initial phase. Beginning on 29 August we have begun six weeks of advertising across a range of platforms focussed on uptake in immunisations for children under 5.

Alongside this, we have reached the next stage in the development of our operating model for vaccine preventable diseases. On 27 August, alongside our Commercial Director, Sarah Collins, I launched the formal staff consultation phase for the proposed new Vaccines and Countermeasures Delivery Team. This would integrate the expertise currently divided between the COVID Vaccines Unit and the Vaccines and Countermeasures Response team. The aim is to deliver an entirely new focused vaccines and countermeasures team, working more closely and appropriately with industry, enabling greater alignment and efficiency within our internal functions, reducing duplication, and improving our resilience, agility and responsivity and improving quality standards in stock management and controls. The current consultation phase will run until 10 October.

5.1 Incident management

Alongside routine management of local incidents, we continue to respond to a range of incidents that require national level coordination. Our response to the mpox clade 1 outbreak is being managed as an enhanced national incident and we are currently running 2 standard national incidents: measles and pertussis.

Measles: The higher than typical rates of measles activity have continued, with children aged 10 and under still accounting for the majority of cases. The measles, mumps and rubella (MMR) vaccination is the key public health intervention to control outbreaks and prevent cases and the enhanced communications referenced under paragraph 5.3 above should help increase MMR vaccine uptake, reducing the population susceptibility to measles and consequently limiting the number of further cases. Our health protection teams continue to work alongside the NHS, Directors of Public Health and local communities to support information provision and vaccine confidence in those where uptake is low and protection particularly limited.

Pertussis: The current wave of pertussis infections continues. The latest epidemiology will be published on 12 September, including case numbers up to the end of July. These are expected to be similar to those reported for June and it is therefore not yet clear whether we have reached the peak of the current wave. As with measles, vaccination is the primary intervention to reduce significant harms from pertussis. In mid-August we cascaded further briefing to health professionals regarding the high levels of pertussis activity and corresponding guidance on surveillance, disease management, and vaccination to reinforce clinical best practice.

Aside from formal incidents, we continue to closely monitor developments in the current outbreak of Highly Pathogenic Avian Influenza H5N1 in dairy cattle in the US and associated science. We are in the process of procuring 5 million doses of pre-pandemic vaccine as a contingency that could be used to protect those considered most likely to be at heightened risk of exposure to avian flu or harm from avian flu in the event of an outbreak in humans.

The outbreak was first declared in March and, as of September, presence of the virus has now been confirmed in farms in California bringing the total number of affected US states to 14. Human cases have continued to rise slowly; however, all have been linked to direct exposure to infected animals, including most recently a cluster of 9 cases in workers at a poultry farm in Colorado. There also continue to be isolated global reports of human cases of different strains of Highly Pathogenic Avian Influenza – reinforcing the need to continuously monitor internationally for potential spillover event in humans.

Jenny Harries

Chief Executive

September 2024