Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 29 January 2024

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.

Recommendations

The Advisory Board is asked to note the update.

Overview

As we mark the start of a new year, I would like to begin by expressing my thanks to all of our colleagues within UKHSA who were working throughout the holiday period to keep the nation safe. Hazards to people’s health do not take time off and whether through identifying potential E. coli contamination in cheese, advising on extreme weather events, or providing technical support to the Department for Education as children return to school, UKHSA officials were fulfilling their public health duties with the same dedication and diligence that they deliver year-round.

As we start the New Year, and on behalf of myself, the Executive Committee, and the Agency, I would also like to congratulate our Advisory Board member Dr Jennifer Dixon for being awarded a damehood in the New Years Honours list.

On 25 January, we laid UKHSA’s Annual Report and Accounts for 2022 to 2023 before Parliament alongside the overall Department of Health and Social Security (DHSC) Annual Report and Accounts. Due to a combination of the inherited position from the disclaimer of opinion for 2021 to 2022, the additional accounting assurance required when UKHSA, as a smaller organisation, takes on increased responsibilities from DHSC (in this case the Vaccine Task Force, now the COVI Vaccine Unit (CVU) and issues preventing the completion of a National Audit Office (NAO) audit of the closing balances for the CVU’s budget before the statutory deadline for laying the Accounts, we have chosen to accept a disclaimer of opinion in order to comply with our legal duties.

It is unfortunate, however, that the unavoidably binary nature of the audit opinion overshadows the difference in this disclaimer from that of the 2021 to 2022, and the significant dedicated work and progress that has been made over the 2022 to 2023 financial year and that is ongoing this year-to-date. We are not complacent however. We will continue to work closely and proactively with the NAO to provide sufficient evidence over the CVU balances, and we will now look to accelerate and embed the outputs of the Finance and Control Improvement Programme to further strengthen our governance.

Strategic forward look

This first board meeting of the year is an opportune and critical moment to lay out 4 of my top priorities for the year ahead. Our strong response to public health incidents will continue throughout the year as will the delivery of key priorities set out in our strategy. However, the organisation is entering the first financial year in which no clear distinction is made in routine work between COVID-19 and other preparedness and response provision, It is important to provide clarity and focus of learning from the pandemic and the changes in, and development of, new capabilities and opportunities to prevent and respond to serious health threats. This includes threats both known and unknown and the focus is equally on delivery of scientific development, economic growth and NHS support.

Vaccine preventable disease: impact and innovation

Vaccines are an essential tool to prevent and reduce harm of infectious diseases, including that from antimicrobial resistance. As part of the Building for Ambition programme, a review into our vaccine operating model is well underway. This has been assessing the most effective ways to draw together our clinical, commercial, operational, and wider expertise, including embedding lessons learned from COVID-19 into how we support the development and deployment of both existing and new vaccines more broadly, so that we can maximise the effectiveness of our programmes while also delivering better value for money for the taxpayer, reducing demand on health and social service  and importantly creating rapid pathways to mitigation in the event of novel pathogen derived epidemics or pandemics. The Executive Committee will shortly be considering how we take forward the outputs of this work, including setting our vision for vaccines, improving governance (both internal and critically with industry partners), collaboration, and outcomes as well as a roadmap to implementation.

Pandemic preparedness

We expect the initial recommendations from the COVID-19 Public Inquiry relating to the pandemic preparedness module to be published in the coming months. It is important that we reflect on this, and how it relates to the work collated within the Agency through the Centre for Pandemic Preparedness on the approaches and capabilities required nationally and those available within UKHSA, to mitigate and respond to future threats (including vaccine work above). Working closely alongside DHSC, it is critically important that we can articulate the framework for preparedness and response, not only to shape and guide our own activity but also to set out for our stakeholders how we collaborate with them now and in the event of a potential pandemic scenario. I will bring an update on this work to the next board meeting in March.

Partnership with industry and academia

From the outset we have recognised the importance of both these 2 sectors to effective delivery of novel health protection opportunities. We have held an initial highly successful industry day at UKHSA Porton Down, launched the new UKHSA Vaccine Development and Evaluation Centre, continued to develop the Moderna Strategic Partnership programme and have presented at, and with, a number of conferences and scientific meetings with industry colleagues We are developing strategic commercial frameworks to support effective, responsive, well-governed interactions and continue to develop data streams and access to provide insight for product development focus. Having contributed to the Pandemic Science Institutes’ network meetings in 2023, in 2024 I will be seeking to provide the same focus for academia as we have for industry colleagues. My ambition is to ensure clarity of linkage for both emergency and routine response as well as close alignment with the work of National Institute for Health and Care Research. We will be hosting our first roundtable with Pandemic Institutes in February.

Modernising frontline operations

To deliver more efficient, scalable and consistent services and allow staff to focus on the highest risk incidents, the Health Protection Operations group has embarked on an ambitious modernisation programme called Health Protection Operations 2024. Through automation, standardisation, replacement of legacy systems, and streamlining structures, this work is now making a difference at the front line. Changes already implemented include the rollout of a new outbreak reporting and assessment tool for care homes; the coming months will see the launch of electronic notifications of infectious diseases (NOIDs) amongst other innovations. This sets a model for improving how we deliver frontline services, and other groups within UKHSA are progressing similar efforts.

Linking directly to the delivery of these priorities, it is also important to note that the current Spending Review period is nearing its end and we can expect to engage in a new Spending Review process by the end of the calendar year. Confirming our budget until the end of 2024 to 2025 is critical to being able to embed our structures and begin building the long-term capabilities UKHSA provides for the country as it emerges out of the COVID-19 pandemic. The next spending review will be an opportunity to showcase the value that an effective health protection system brings – directly for people’s health, in reducing the pressures on the NHS and wider health services, in developing new science and through supporting economic growth – as well as the efficiency with which we can deliver it.

I expect 2024 will also be another busy year for our engagement with government, industry, academic and other partners at home and overseas. The following are some significant examples that are happening over the coming months.

• in February, I will be travelling to Nigeria where I will be visiting the UKHSA team based there as part of our International Health Regulations Strengthening Project and also holding meetings with the Nigerian Ministry of Health to reaffirm our partnership in supporting global health security

• our Director General for Data, Analytics, and Surveillance, Professor Steven Riley, will be in Rwanda for the Annual Meeting of the International Association of Public Health Institute; this will bring together agencies from across the globe on the theme of Advancing Public Health, Resilience, and Sustainability and Steven will be leading a session on the development of our pandemic plans and the establishment of the Centre for Pandemic Preparedness

• later in the month, I will be convening a roundtable with the academic research teams that comprise the UK Pandemic Institutes Network to discuss how we can best collaborate on preparing for future pandemics; the strength of the UK’s academic sector is one our greatest national assets, and by Government and universities working symbiotically rather than disparately we can realise this potential to the fullest

• towards the end of March, we will be sending a delegation to the World Vaccines Congress in the USA, including our Chief Scientific Officer, Professor Isabel Oliver, and the Director of the COVID Vaccines Unit, Philippa Harvey; this provides an opportunity to engage with senior industry and government partners from across the globe on vaccine development, deployment and how to improve health outcomes through vaccination. This is likely to also be coupled with site visits to partner organisations in the USA and Canada, including in relation to the Moderna Strategic Partnership

• at the same time, I will be in South Korea visiting the Korea Disease Control Agency (KDCA); we will be exploring opportunities to further the commitments to collaboration set out in our new joint Memorandum of Understanding

Lastly, I would like to draw your attention to our Genomics Strategy, published on 24 January to coincide with the Festival of Genomics. Pathogen genomics is already a critical tool in our routine management of infectious diseases – helping us to identify sources of contamination in food and other products, identify target strains of flu for seasonal vaccines, determine the most effective treatment path for TB patients and so on - and its value in supporting the response to COVID-19 was of critical importance. Building on this base to integrate genomics across all possible aspects of disease control has the potential to yield significant improvements in both health outcomes and efficiency. The Genomics Strategy, sitting alongside our Science Strategy, sets the direction for our investment in, and use of, pathogen genomics to deliver this ambition over the next 5-years.

Update on activities

Since 1 October 2023, we have been seeing a rapid increase in measles cases with over 200 confirmed cases in England. Most cases have been identified in the West Midlands, centred on Birmingham and Coventry but there have also been small clusters or isolated cases across the region. Notably, current cases in the West Midlands have been predominantly in younger children under 10 years of age, but adults are now forming an increasing proportion of those affected.  The ‘Wakefield cohorts’ describe children who missed primary vaccination and are now in the 19 to 25-year age group. Overall, it is this birth cohort who have the lowest measles, mumps and rubella (MMR) vaccination rates of all birth cohorts and therefore approaches wider than schools need to be considered.

The number of people who have not received a full, 2 dose course of the MMR vaccine and are therefore susceptible to measles has been a growing concern for some time. We have never met the World Health Organization’s (WHO) 95% MMR coverage target for and, whilst WHO elimination status has been briefly achieved in the UK, the epidemiological trajectory for a significant rise in cases in coming months remains likely unless vaccination coverage can be urgently improved. The position in the UK sits against increasing cases internationally.

In July 2023, we published an updated risk assessment for measles in England, which highlighted in particular the levels of susceptibility in the population and the possibility that London could see an outbreak of 40,000 to 160,000 cases if MMR vaccine coverage did not improve. Some specific communities and local populations are particularly susceptible to rapid growth in cases.

A long-term sustained vaccination programme is the main control mechanism and requires not only catch-up activity but consistent year on year improvements in vaccination rates in each new birth cohort as they become eligible. Vaccination is not very effective as an outbreak control mechanism. A range of activity is underway. We are supporting the NHS in delivering targeted action in the West Midlands to both increase uptake and enable catch-up, including national, regional, and local communications to draw attention to the issue and to the universal free vaccine offer; pop-up MMR clinics in settings where there have been outbreaks; broadening routine year group immunisation in schools to include whole school catch-up; and increasing awareness of animal or porcine-free products. We will also be working closely with NHS colleagues on delivering a national catch-up campaign from the end of January, with a specific emphasis on the West Midlands and London as the regions which, on overall cover rates, have the highest at-risk populations.

Winter seasonal infection rates have remained relatively low over the winter period to date. Since December, seasonal respiratory viral activity has been declining, and both flu positivity and hospital admissions are lower than they were at the same time last year and RSV rates also declining. We, have, however seen a small uptick in Norovirus-like symptoms and related bed closures, but this remains significantly below the previous winter peak.

In addition to the rise in measles and monitoring of winter pressures, UKHSA teams have also continued providing national level response to the following standard incidents:

Clostridioides difficile

Investigations are continuing into a relatively new strain of C. difficile that has been identified in low levels in different parts of England. As of 10 January 2024, 2 further cases have been identified since my last update to the board, bringing the total cases in England to 50 since September 2021. All cases, however, remain limited to a narrow range of specific settings and there is no indication of community transmission. Investigations are ongoing to identify possible sources for the outbreaks.

Shiga Toxin-Producing E. coli (STEC)

We are responding to an outbreak of a strain of STEC associated with higher than typical medical complications, with cases identified in England, Wales, and Scotland. Epidemiological investigations remain ongoing and we are working closely with the Food Standards Agency and our devolved counterparts to progress food chain investigations.

Alongside partner agencies, we are also continuing to manage 2 further STEC outbreaks from a different serogroup. Investigations are underway to identify the potential sources of and vehicles for infection in order to limit further growth of the outbreak.

Burkholderia cenocepacia

Following the recall of specific carbomer-based eye gel products associated with the outbreak, no further cases have been reported since 14 December 2023. On 10 January a decision was taken to de-escalate the incident due to the reduced risk to the public as a result of the interventions in place.

Diphtheria

We are continuing to support the Home Office to manage the risk to the asylum seeker population from diphtheria infection and the offer of vaccination to all arrivals remains in place. No new cases have been identified since October 2023.

Jenny Harries

Chief Executive

January 2024