Corporate report

UKHSA Advisory Board: core preparedness for environmental hazards

Updated 12 March 2024

Date: 13 March 2024

Sponsor: Isabel Oliver

Presenter: Lea Barrang-Ford

1. Purpose of the paper

The purpose of this paper is to provide an update to the May 2023 paper describing environmental threats and hazards to health, with a focus on climatic and natural hazards. That paper provided an overview of current threats and highlighted the specialist public health and scientific functions and capabilities of the UK Health Security Agency (UKHSA) to prepare and respond to these hazards. This paper also includes an update on environmental threats associated with vector-borne diseases (VBD), supplementing the ‘Preparedness for Infectious Disease Threats’ paper.

The risk and general description of environmental threats and hazards to health have not changed substantively since May 2023. However, UKHSA preparedness and capabilities to respond to these threats have progressed over this period which covers the first year UKHSA’s Centre for Climate and Health Security. This paper describes this progress. This paper complements recent board papers on the threats posed by chemical, radiation, and nuclear incidents, and by infectious diseases.

2. Recommendations

The Advisory Board is asked to:

• note progress at the UKHSA to build capacity to protect health from environmental hazards

• comment on the current work and development work underway in the UKHSA and identify any significant gaps in the approach

• comment on the work that UKHSA is doing to continue to improve preparedness to protect health from environmental hazards

3. Summary and conclusions

Climate and environmental change are major determinants of health and drive increased risks to health, affecting a range of climate-sensitive health outcomes as well as many health determinants. Climate and environmental change will become increasingly important contexts within which the UKHSA works to protect health security.

The Health Effects of Climate Change (HEEC) report has been a major success for UKHSA and was very well received among diverse audiences. The report provides an authoritative evidence base to inform policy and action. We are working with partners to ensure that the evidence translates into policy and action.

We focus in some detail on the environmental aspects particular of vectorborne diseases, as one of the most concerning potential health implications of a changing climate. Work with local authorities and other government departments in a one health approach is key to preparedness and control. 

The establishment of the Centre of Climate and Health Security (CCHS) has significantly strengthened UKHSA’s leadership, capability and visibility. We are establishing partnerships in climate and health with local authorities, devolved authorities, other government departments, and academia.

UKHSA’s Adverse Weather and Health Plan and related Health Alerts, released in partnership with the Met Office, continue to receive positive feedback and have high levels of engagement from local authorities and the NHS. There is strong evidence that early warning systems are among the most effective interventions for weather-related risks, with high benefit to cost ratios.

We continue to lead work with partners across government on guidance to reduce health risks from mould, a growing health concern, and respond to a range of incidents and concerns relating other environmental hazards.

Plans for 2024 to 2025 include continued commitment to work with partners, develop UKHSA’s capacity to respond to environmental and climate threats to health further, and release a set of new products to translate science into policy and action.

4. Background

Our environment is a major determinant of health with environmental conditions varying between populations and geographic locations. UKHSA protects health from environmental hazards including adverse and extreme weather (for example heat, drought, flooding, cold), environmental determinants of infectious diseases (for example vector-borne disease ecology and transmission), contamination of, water, and land, as well as noise and air pollution (for example wildfires, volcanoes), and radiological threats (for example UV, light, radon). Climate and environmental change are major global and national drivers of health risk in the population and the context in which UKHSA will need to protect health from infectious diseases and environmental hazards in future. 

UKHSA is a Category 1 responder under the UK Civil Contingencies Act, has responsibilities under the UK’s National Adaptation Programme within the Climate Change Act, and holds response functions through regional and national health protection teams. The health protection response to adverse weather (extreme heat, cold, flooding, drought) are with UKHSA remit through the Centre for Climate and Health Security. Public health risk assessment and expert advice on air pollution due to wildfires or volcanic eruptions, and contributions to health protection related to light, noise, electric and magnetic fields, mould, and space weather are led by the Radiation, Chemical and Environmental Hazards Directorate.

The UKHSA’s Centre for Climate and Health Security (CCHS), established in October 2022, has formed an Agency-wide network, providing leadership and coordinating partnerships and integration on climate risks to health. The centre comprises 46 people in 3 teams:

• Medical Entomology and Zoonoses Ecology (MEZE)
• Extreme Events and Health Protection
• the Climate and Health Assessment Team

The centre works on a ‘hub-and-spokes’ model, bringing together skills and expertise from across the organisation including policy. This paper covers updates associated with the 12 to 18 months of centre activity, including the publication of the single integrated Adverse Weather and Health Plan and the publication of the Health Effects of Climate Change report by strategic priority in the UKHSA Strategic Plan.

5. UKHSA Strategic Priority 1: be ready to respond to all hazards to health

UKHSA provides public health and scientific capabilities and functions to prepare for, respond to, and build resilience to environmental- and climate-related threats to health security, including air quality, volcanic activity, wildfires, environmental noise, radon, damp and mould, vector-borne disease incidents, and extreme and adverse weather.

UKHSA also supports other organisations to respond to threats to health. Long-term exposure to air pollution is associated with 29,000 to 43,000 deaths annually in the UK. In February 2024, the London Air Quality and Public Health Programme Office (a collaboration between the Mayor of London, NHS England, UKHSA, and the Office for Health Improvement and Disparities) launched a new air quality alert system to directly notify London’s health professionals of high and very high air pollution episodes (Mayor launches UK’s first targeted air quality alert for healthcare profressionals). UKHSA is also working with the Department for Environment, Food & Rural Affairs to improve how air quality information is communicated to members of the public when there is an air pollution episode.

There is cross-UK work with the devolved administrations to prepare air quality risk assessments on recent volcanic activities in Iceland. UKHSA is working directly with GO-Science in support of Scientific Advisory Group for Emergencies and key UK volcano experts, academics and partners to ensure there is an agreed framework for supporting specialist advice and sharing information when responding to the potential hazards and associated health effects from volcanic eruptions which could impact the UK.            

UKHSA leads the public health response to wildfires, including the provision of public health messaging and health advice in England and coordinates air quality risk assessment and monitoring. UKHSA works as part of the Cross Government Wildfire Working Group, Wildfire Framework for England, and England and Wales Wildfire Forum. UKHSA provides authoritative advice across Government on the health effects of environmental noise, including from new energy sources (onshore wind) and from the way new homes are designed, built, heated and ventilated. UKHSA is a member of a Department for Energy Security and Net Zero noise steering group and is providing advice into guidance and standards development.

In September 2023, UKHSA published guidance on understanding and addressing the health risks of damp and mould in the home working with the Department for Levelling Up, Housing and Communities and the Department for Health and Social Care (DHSC). Damp and mould primarily affect the airways and lungs, but they can also affect the eyes and skin. The respiratory effects of damp and mould can cause serious illness and, in the most severe cases, death. UKHSA analysis found that exposure to damp and/or mould was associated with approximately 5000 new cases of asthma and approximately 8500 lower respiratory infections among children and adults in 2019.

We maintain systems for the identification and surveillance of vectors of public health importance and vectorborne disease risks in the UK, including emerging global trends with relevance to the UK. These capabilities have been strengthened over the past year through the work of the Centre for Climate and Health Security. Further detail is provided in Section 6. The Medical Entomology team comprises 12 people a three-fold increase since UKHSA was established through some increase in code budget and external research funding from UK Research and innovation (UKRI).

In 2023, UKHSA launched the Adverse Weather and Health Plan for England, harmonising and updating the Heat and Cold Weather Plans for England. This is complemented by a supporting scientific evidence document, and Weather Health alerts developed in collaboration with the Met Office, which rolled out heat-health alerts for Summer 2023 and cold-health alerts starting Winter 2023-24. Further detail is provided in Section 7.

6. UKHSA Strategic Priority 3: reduce the impact of infectious disease and antimicrobial resistance (AMR)

We are expanding our partnerships on environmental threats to health security to reduce the impact of infectious disease and AMR. Vector borne and waterborne diseases are known to be particularly sensitive to climate, environmental, and weather conditions, with some evidence for foodborne, airborne infectious disease pathways.

There is growing evidence of diverse interactions between AMR and climate change, including the potential for increasing temperatures to accelerate development of AMR and modify other determinants of AMR risks. In response, CCHS and the AMR team have agreed joint business plan objectives to assess the implications of changing climatic conditions on AMR risk and surveillance and are partnering on a UKRI grant proposal to establish a transdisciplinary network on climate change and AMR.

This remainder of this section provides a more focused update on vectorborne disease risks and UKHSA activity to prepare for and respond to these risks. The paper on infectious diseases presented at the last board meeting highlighted that vectorborne disease risk to the UK is increasing largely due to the effects of climate and environmental change. There has been an accelerated spread in the distribution of key arbovirus mosquito vectors (that is Aedes albopictus) throughout many countries in Europe, including in France where two thirds of French departments now report this invasive mosquito present, including its widespread establishment in Paris. This has resulted in an increasing number of locally acquired dengue cases in France, with increases also documented in Italy.

This mosquito has been detected by the UKHSA Medical Entomology team on six occasions in the UK, and our joint work with local authorities has led to successful control. There are currently no known established population of this mosquito in the UK, however our climate is now suitable for vector establishment.  In this paper we summarise the key insights from our vector surveillance and from the evidence in UKHSA’s Health Effects of Climate Change report (see Section 7). This evidence is feeding into our public health risk assessments and response plans, using a One Health lens to integrate human and animal health drivers of risk. This paper focuses on our environmental surveillance and does not cover our wider surveillance, preparedness and response to infections transmitted by vectors.

There is potential for warming to increase the UK distribution of several tick species of public health importance, including Ixodes ricinus, which can transmit Lyme disease (Lyme borreliosis) and tick-borne encephalitis (TBE). Lyme disease incidence is already increasing in the UK and although the risk of TBE is currently very low, there have been a small number of TBE detections in the UK since 2019. Increases in these 2 infections are the most likely emergent tick-borne risks in the UK as the climate warms. Other risks include recent detections of Hyalomma ticks (vectors of Crimean Congo haemorrhagic fever virus), arriving on migratory birds, and now able to complete their development during summers with high temperature. However, despite variations in model runs, the climate projections modelling suggest that autumn temperatures in the UK may not currently meet the threshold for the establishment of Hy. marginatum populations, even in the worst-case scenario.

Under warming temperatures, we can expect the introduction and establishment of invasive mosquito species in the UK, particularly Aedes albopictus, an aggressive daytime biting mosquito species that can transmit several arboviruses of public health concern, including dengue, chikungunya and Zika. This is a particular concern following the increase in autochthonous transmission of dengue in France and Italy in the last two years.

Climate modelling suggests that the area around London already has a suitable climate for Ae. albopictus survival, and most of England could become suitable for its establishment by the 2040s and 2050s. Under a reasonable worst-case scenario, by the 2060s or 2070s, most of Wales, Northern Ireland and parts of the Scottish Lowlands could also become suitable.

London could become suitable for endemic dengue transmission as early as the 2060s under a high-warming scenario. Similarly, high-warming scenarios indicate the potential suitability for chikungunya transmission in the UK beginning in the latter half of the century, with spread linked to rate of warming. This evidence indicates that the establishment of Ae. albopictus in the UK is one of the most significant risks for public health posed by climate change.

Climate change will also increase the risk of West Nile virus (WNV) in the UK. To date there have been no cases of this infection acquired in the UK. The virus is carried by Culex mosquitoes, including Culex modestus, which is now established in coastal parts of south-east England. While current UK temperatures are generally too low for WNV transmission cycles to be established, projected warming will increase the risks of WNV outbreaks, with epidemics possible by the second half of the century and south-east England is the area most at risk. This is particularly pertinent following the recent detection of Usutu virus in UK birds and mosquitoes. There remains the potential for other mosquito-borne arboviruses to emerge, such as Tahyna and Sindbis viruses, particularly those sensitive to climate change.

Experience from elsewhere in Europe has shown that once a non-native invasive mosquito species is established, it is difficult for it to be eliminated, highlighting the critical role of early and robust vector surveillance and control. Early indications of emergence of vector species and new pathogens are already apparent: localised detection of invasive Ae. albopictus in the UK in recent years and increasing reports of small outbreaks of dengue, chikungunya and Zika in Europe are examples of early indicators of rising risk.

The public health implications of changing VBD risks and introduction of the nuisance mosquito Ae. albopictus are significant, with implications for building design (such as screens on windows and doors), substantial shifts in public behaviour to avoid bites and increased awareness among frontline and diagnostic health services. Managing the risks of invasive mosquitoes will require individual and community engagement, particularly in the management of water capture systems (as mosquitoes exploit container habitats and stored water) as well as engagement with local authorities. Ensuring that communities are resilient to these future health threats is a key component of the CCHS mobilisation workstream, working with MEZE and local authorities.

UKHSA monitors tick and mosquito populations through both passive and active surveillance activities, including non-native vectors. We have published a cross-government contingency plan to deal with the detection of invasive mosquitoes in England, which involves a network of invasive mosquito trapping locations coordinated by UKHSA. We work with local authority pest control teams (including some local authorities in devolved administrations) to detect and manage invasive mosquitoes and survey local authorities on incidence of nuisance biting by mosquitoes and their local capacity to respond and provides training on invasive mosquito surveillance. UKHSA also works with local authorities and the Chartered Institute of Environmental Health in the development and implementation of contingency plans and guidance on mosquito control. Our programme of invasive mosquito surveillance is currently prioritised to local authorities with major international points of entry or where there exists a heightened risk from suitable climate for the mosquito. There are challenges in some local authority areas in being able to support to UKHSA-led mosquito surveillance activities, or deliver mosquito control responses upon detection of invasive mosquitoes, or in the event of local transmission.

UKHSA leads research and provides advice on both clinical and public health aspects of VBD, including medical entomology, virology, bacteriology biosurveillance, genomics, VBD epidemiology, modelling, travel health and clinical and public health, spanning multiple directorates and has established a VBD horizon scanning group. In addition, UKHSA works through the cross-government Human Animal Infections Risk Surveillance group, to identify and risk assess emerging and potentially zoonotic infections which may pose a threat to UK public health.

7. UKHSA Strategic Priority 4: protecting health from threats in the environment

This section provides a more detailed update on two key UKHSA outputs published over the past 12 months, including the UKHSA report, ‘Health Effects of Climate Change in the UK: State of the Evidence 2023’ (the ‘HECC’ report), and the UKHSA’s Adverse Weather and Health Plan (AWHP).

The HECC Report was published in December 2023 in fulfilment of a UKHSA-DHSC commitment under the National Adaptation Programme to update the evidence base on climate risks to health every 5 years. The report provides an authoritative summary of the scientific evidence on the health effects of climate change, potential implications for public health, and gaps in evidence. The report is primarily a scientific and technical document that collates up-to-date knowledge to inform policy and action in the UK. The report that has been very well received by partner organisations, and also acts as a resource for public health and other professional bodies and groups, government departments and authorities, science-facing civil society organisations, and interested stakeholders and partners with a role in securing health from the effects of climate change.

We thank the Science and Research Committee of the Board for comments and contributions to the publication of the ‘Health Effects of Climate Change in the UK: State of the Evidence 2023’ report.

The Health Effects of Climate Change report was debated in the House of Lords on Thursday 14 December, focusing primarily on the impact of vector-borne disease. The report is also being referenced in speeches from ministers, including the Minister for International Development’s speech to the World Health Organization’s Alliance for Transformative Action on Climate and Health on Tuesday 5 March.

The report demonstrated that there is now extensive evidence on the health impacts of climate change on health which should be used to inform policy. There is, however, limited evidence on effective interventions to adapt and ensure that our communities are resilient and protected from these impacts. UKHSA is working with partners across government to help consider how the evidence in the HECC report might translate into policy and action. UKHSA has also agreed to work with research funders to establish a funders forum on climate change and health to help ensure that research needs and priorities are addressed.

UKHSA responsibilities under the National Adaptation Plan require the evidence base on climate and health to be updated again in 5 years (2028). Responding to the need for more rapid evidence mobilisation, however, the HECC report will be replaced with a UKHSA-led 5-year Climate and Health Assessment Cycle. This programme is modelled on the Intergovernmental Panel on Climate Change reports, reflecting international standards in climate assessment, and better aligning with UK climate assessment and reporting (for example Climate Change Committee Risk Assessments and Progress Reports). This Assessment Cycle programme is expected to release 1 to 3 special reports per year. Engagement with the devolved administrations to ensure coordination of assessment priorities has already begun, with plans for all special reports to be co-developed with UKHSA partners based on report focus.

We work with partners to understand, prepare for, and respond to health impacts arising from extreme and adverse weather. The AWHP was launched in April 2023. The second edition of the AWHP will be published in March 2024, providing updates following user feedback, evaluation, and review. These updates include consideration of emerging hazards such as thunderstorm asthma, as well as integration of recommendations from an equity review.

Updated Weather-Health Alerts, in partnership with the Met Office, were launched simultaneously with the AWHP. In summer 2023, there were 5 hot weather alert periods. During the 2023 to 2024 winter season, there were 3 periods of cold weather alerts, 9 updates or extensions for prolonged cold conditions, and 20 Joint Dynamic Risk Assessments (JDRA) of cold weather threats to health. Colleagues from the devolved administrations are invited to join JDRAs where impacts of cold and heat may also impact other nations, under the Cabinet Office Winter and Summer Resilience Networks protocols.

Engagement by UKHSA partners with the AWHP and weather-health alerts has been strong. Currently the weather-health alerts reach over 29,500 subscribers, while AWHP webinars aligned with cold and hot seasons are very well attended by local authority and NHS partners (n=790 for mid-term 2023 webinar).

UKHSA has updated most of its guidance and related materials on adverse heat, adverse cold and flooding – a total of 29 products (9 guidance documents, 5 action cards, 8 summary action cards, and 6 public advice materials). In March 2024, UKHSA will publish the translations of its guidance materials for the public. The materials have been translated into the eleven languages. British Sign Language versions also produced to improve accessibility.

In 2023, UKHSA undertook a series of evidence reviews to understand what is known about the potential contributions of cooling and warm spaces (for example libraries, community centres and other venues) to protecting people during periods of extreme heat and cold respectively. This work culminated in the publication of a warm spaces toolkit to support better approaches to evaluation of the impact of these spaces.

Evaluation work for the AWHP, the Weather-Health Alerts, and supporting materials is underway. An annual report will be published in the third quarter of each year summarising progress on implementation by hazard and area of action, a review progress against indicators in the AWHP, and recommendations for future improvement. A full impact evaluation for the AWHP is planned for 2028.

8. UKHSA Strategic Priority 5: improve action on public health through data and insight

UKHSA is equipping partners to take action (assess, anticipate, detect and plan) and catalysing policy integration by curating data, synthesising evidence, and developing appropriate, accessible, and policy-relevant products and services (for example tools, guidelines). We have reorganised our teams to streamline the mobilisation of evidence for policy and practice, modelled on a ‘boundary organisation’ approach to act as an agile intermediary between academia and UKHSA’s partners.

The Climate Change and Health Assessment Team is primarily science-facing, leveraging academic partnership and leading strategic research to bring together evidence to respond to key policy and practice priorities. This team previously led the HECC report and will now lead CCHS’s 5-year Assessment Cycle.

The Mobilisation Team is primarily policy-facing working in partnership to mobilise evidence into policy and practice, and to deliver products and services to our partners. We are working to release a UKHSA online climate and health digital service in 2024 to 2025.

9. UKHSA Strategic Priority 6: develop UKHSA as a high performing agency

UKHSA leadership in climate and health has received media coverage and recognition in relation to key global events such as COP 28 where UKHSA led a session on ‘National Governmental Response to the Health Threats from Climate Change’.

UKHSA is engaging widely to partner with scientific networks and institutions at the national and international level to raise the profile of the health impacts and to establish UKHSA leadership in science for environment, climate and health.

We have established CCHS as a National Training Centre for Specialist Registrars in Public Health in winter 2023. Our first cohort of 3 registrars started in Spring 2024 with two cohorts planned per year.

We are mapping activities and identifying strategic priorities for Climate and Health International Impact. This work will inform development of a strategic agenda for leadership in climate and global health. A similar commission to on Climate and Health Metrics and Indicators is planned for 2024 to 2025.

We have established an Academic Partnership Committee on climate and health to leverage growing opportunities for grant funding and coordinate partnerships with academic institutions. External income on climate and health in 2023 to 2024 consisted of National Institute for Health Research (NIHR) Health Protection Research Unit funding (£319,000) and MEZE research income (£178,000). The establishment of the CCHS has enabled stronger partnerships with academia and placed UKHSA in a better position to compete for necessary research and development funding to advance health protection science in this area.  Pending or in-progress grant proposals include a UKRI Centre for Climate and Health (up to £2.5 million), a UKRI-NIHR Research Hub on the Health Benefits of Transitions to Net Zero (£1.8 million), and a proposal partnering with 6 universities to host a Natural Environment Research Council Doctoral Focal Award in Climate and Health Co-benefits.

UKHSA is also considering innovative approaches to our work. We are currently assessing opportunities to leverage quantum technologies through the University of Cambridge Centre for Science and Policy to support a step-change in automation of mosquito detection and diagnostics. This initiative aims to assess the potential for UKHSA to implement a step-change in vectorborne disease monitoring and surveillance.

10. UKHSA Strategic Priority (Cross-cutting): achieve more equitable outcomes

CHS is developing a robust equity framework to inform all programmes, products and services. During its first year, CCHS undertook a review and assessment of climate and health equity to assess opportunities for strategic integration with UKHSA climate and health programming, working closely with UKHSA’s Equity and Inclusion Team. This has informed several areas of work:

• a rapid mapping review to synthesise evidence of climate change and health equity in the UK, focusing on impacts on CORE20PLUS populations – publication is anticipated for Q3, 2024 to 2025

• embedding equality, diversity and inclusion within the CCHS Theory-of-Change to underpin all divisional work and partnerships

• equity review of the AWHP using NHS England’s CORE20PLUS framework – this review highlighted increased risk from heat and cold among certain groups; focus groups with older adults and health care providers identified opportunities for improving AWHP communications, informed by behavioural sciences, which are being implemented in annual AWHP updates

11. Collaboration across the 4 nations

Tackling the public health effects of climate change is a strategic priority for all 4 nations. Working together for a Healthier Wales, the longer-term strategy for Public Health Wales published in May 2023 sets objectives to tackle the public health aspects of climate change in Wales. In September 2023, Public Health Scotland published its Climate Change and Sustainability Strategic Plan setting out the actions they will take. UKHSA, Public Health Wales, Public Health Scotland and and the Public Health Agency in Northern Ireland have agreed to work together meeting regularly as a group to share good practice and coordinate work on joint priorities. The Environmental Public Health Network facilitates joint working on other environmental hazards.

12. Developments and upcoming activities in 2024 to 2025

The Director General of Science and Research is in the process of commissioning a rapid review of the Centre of Climate and Health Security to inform its ongoing development and ensure we realise its full potential.

We have developed a roadmap for the delivery of our strategic priority to protect health from threats in the environment. Over the next year we will:

• expand our collaborations on environment, climate and health to include climate drivers of waterborne disease, climate change and AMR, econometric assessment of climate risk and intervention, and data analytics to accelerate climate-health evidence generation

• launch a 5-year Climate and Health Assessment Cycle, with a schedule of planned assessment reports that will replace the HECC report as core deliverables under the National Adaptation Programme to update the evidence base on the health risks posed by climate change

• launch a beta version of a Climate and Health Digital Service – an online platform hosting UKHSA’s key products and services related to climate and health

• work with academic partners as part the commissioning of new NIHR Health Protection Research Units – this has included the identification and communication of research needs and priorities

• publish the Adverse Weather and Health Plan PowerBI Monitor Dashboard

• increase desegregation of data on heat and cold mortality monitoring to include impacts on different genders, regions and age groups

• develop an evaluation framework in 2024 to 2025 to assess effectiveness and impact of UKHSA activities and broader risk, with initial analysis expected the following fiscal year