Corporate report

UKHSA Advisory Board: Chief Executive’s report

Updated 2 February 2023

Date: Tuesday 24 January 2023

Sponsor: Jenny Harries

Purpose of the paper

This report gives a brief overview of the recent operational and response status of the UK Health Security Agency (UKHSA) from the perspective of the Chief Executive since the last Advisory Board.

Recommendation

The Advisory Board is asked to note the update.

Overview and update – achievements and challenges

The UK’s healthcare system has remained under severe pressure in recent weeks with record A&E attendances, 999 calls, and emergency ambulance call outs. UKHSA routinely contributes support to the NHS through a number of different routes – for example:

• the prevention of infectious disease cases through robust vaccination programmes
• reduction in transmission of infection in the population, and in hospital, care and vulnerable group settings through public health protection and infection prevention and control guidance
• appropriate use and evaluation of therapeutics through work such as the antimicrobial resistance programme work
• in support to healthcare service planning through surveillance, data analysis and modelling

Although the majority of the population has remained largely protected from severe outcomes and hospitalisations from coronavirus (COVID-19) in recent weeks due to high vaccination coverage, the winter has been predictably unsettled in terms of seasonal epidemiological patterns of infections with early peaks in many and forward uncertainty whether second waves of respiratory and other winter pathogens will follow. Flu vaccination coverage is comparable to previous rates, except in younger children (aged 2 and 3 years) where uptake is lower.

Significant changes in social mixing patterns over the Christmas and New Year period – including changes in interactions with vulnerable elderly cohorts, the closure of schools and the reduction in workplace gatherings and travel – means data collected over this period requires longer term monitoring to assure observed trends in prevalence, or variant composition, are maintained as post festive living returns to normal.

However, the most recent UKHSA weekly national influenza and COVID-19 surveillance report (published 13 January 2023 with data to 10 January 2023) highlights reductions in key variables for almost all tracked respiratory infections at the start of the year including COVID-19 positivity, hospitalisations and intensive care unit (ICU) admissions, influenza positivity and hospitalisations and similarly for respiratory syncytial virus (RSV). Other viral positivity rates decreased or stabilised (adenovirus, rhinovirus, human metapneumovirus.

Nevertheless, rates could stabilise or even increase again over the coming weeks and therefore it is important that our successful flu and COVID-19 national marketing campaign, together with the autumn boost bivalent vaccine campaign for the most vulnerable continues to support the NHS to implement strong vaccine uptake rates in priority cohorts. More broadly, we are tracking an unpredictable syndemic of respiratory infections and will continue to monitor and give robust public health advice and communications on vaccination and preventative measures to the population.

Despite this pressure and uncertainty our operational teams have continued to respond with effective, professional and timely interventions. New laboratory confirmed cases of mpox (monkeypox) are now down to less than one case per week. Our response to scarlet fever and invasive group A streptococcal infections (iGAS) was crucial in helping people and professionals understand the significant and early seasonal increase in cases, thereby raising awareness of both the NHS frontline services and parents to make the right proportionate choices.

Most recently, over Christmas, in response to rapid shifts in China’s pandemic policy, UKHSA was able to stand up a testing programme for incoming arrivals from China in a matter of days. This strengthens the ability of the UK in early detection of new COVID-19 variants and, given our commitment to early and transparent sharing of sequencing data, additionally supports international knowledge of variants from regions with low current publication of genetic sequences. This work has proven that despite the significant proportionate ramp down of UKHSA resources as we learn to live with COVID-19, UKHSA has successfully built agility to scale up health security measures at pace, demonstrably strengthening the capacity of predecessor organisations and systems.

We continue to monitor global and national emerging variants and have published two variant technical briefings since the last board. The most recent technical briefing highlighted two variants being tracked closely XBB1.5 and CH1.1. The World Health Organization (WHO) Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) has recently adopted the UKHSA rapid risk assessment methodology earlier developed by Dr Meera Chand for UK national assessment of new variants, thereby recognising the exemplar nature of UKHSA’s work.

Beyond our immediate operational response, we are also building our links to industry in order to enhance our ability to response. The Covid Vaccine Unit (previously the Vaccine Task Force and now part of UKHSA), together with colleagues from the new UKHSA Vaccine and Development Centre, have concluded negotiations and signed a non-exclusive definitive agreement for a strategic partnership between His Majesty’s Government and Moderna.

Moderna will build a UK based research and development and manufacturing facility, providing the UK with priority access to Moderna’s COVID-19 mRNA and other respiratory vaccines. Construction is expected to commence in early 2023, with the first mRNA vaccine expected to be produced in the UK in 2025. Under the partnership, Moderna will invest in research and development in the UK including in a Global Research and Development Centre which will encompass clinical trials, research grants and PhD studentships. We are also in dialogue with other industry partners on future collaboration.

More broadly, as part of our ongoing work with Wellcome Sanger Institute (WSI) on COVID-19 sequencing, we have established a Wellcome funded work programme on respiratory viruses and microbiome. WSI is a key collaborator in developing the methodology and tools that will enable UKHSA to deliver respiratory pathogen agnostic metagenomics, enabling earlier detection of new or emerging respiratory viruses and antimicrobial resistance and our delivery of the 100-day mission.

We are continuing to adapt to living with COVID-19 and ramping down our COVID-19 workforce and infrastructure. In light of ongoing low demand for COVID-19 polymerase chain reaction (PCR) testing and to ensure value for money to taxpayers, the number of laboratories conducting PCR testing for COVID-19 has reduced from 3 to 2. PCR testing at the Rosalind Franklin Laboratory (RFL) ceased on 16 January, with the site mothballed and the testing equipment kept in place. We have robust plans in place to increase PCR testing capacity if required and are working closely with the NHS to assess further opportunities for the world-class facilities at RFL to contribute to the nation’s health.

We have successfully responded to the Module 1 rule 9 request of the UK COVID-19 Inquiry – focussed on pandemic preparedness and are now responding to the second, more detailed, module relating to decisions taken in the initial phase of the pandemic. This is a complex response request involving multiple predecessor organisations including the challenge of gathering data and evidence from the immediate crisis response when systems and process were not fully embedded and my own personal involvement as the Deputy Chief Medical Officer and now Chief Executive of UKHSA. We continue to fully support the public inquiry whilst also recognising the demands on senior colleagues’ time as they maintain the frontline response and expert professional services highlighted above.

We continue to push on international engagement. In December, I visited Stockholm to attend the International Association for Public Health Institutes Annual conference. It was fascinating to learn about the different approach’s countries are taking in dealing with COVID-19 in the current economic climate and the reviews and revisions of longer-term national health protection systems and capacity being undertaken in many countries for the future. It is these relationships that are cornerstones of our pandemic preparedness – sharing experiences and building trust.

Organisationally, this 3-month period has remained challenging for our accounts due to inherited system decisions and the unprecedented context of the pandemic prior to UKHSA’s inception. This week we can expect the National Audit Office’s outcome on our accounts for UKHSA’s first 6 months (1 October 2021 to 1 April 2022). We have made good progress in implementing robust mechanisms for financial governance in the last 6 months but will need to retain significant focus over the coming months as well as secure a clearly defined budget for future financial years, which is in discussion with the Department of Health and Social Care (DHSC) now. Of particular note is that UKHSA continues to be asked to take on new functions – a vote of confidence in our ability to manage complex tasks professionally but a position where clarity of risk ownership and transfer also needs to be continuously highlighted.

On a people front, UKHSA is not immune to the difficult economic climate and pressures on pay. We are working hard to re-shape our workforce from the pandemic peak – down-sizing staffing by 60% and rebalancing away from expensive contingent labour, whilst at the same time building a stable, skilled core future workforce. Most indicators in the People Survey results have declined since last year along with similar movement across the Civil Service, most notably pay and benefits and managing change. However, we have seen significantly improved results on organisational objectives and purpose. This reflects an organisation that is going through change but purposefully planning a clear functional and relevant scientific path forward. This will be our focus over the next year – including on specialist pay, which is covered in a separate paper and the People and Culture Committee.

Finally, I would like to formally offer my congratulations to 2 UKHSA staff who were recognised in the most recent New Year’s Honours – Mary Ramsay and Pouria Hadjibagheri. Mary, for her 30 years of public service to the detection and prevention of serious infectious diseases and immunisation programmes, and Pouria, for his commitment to data and transparency in public health – in particular the COVID-19 Dashboard. I know that both of these colleagues would also want me to recognise alongside their own personal contributions that of their teams and wider health protection system represented in their success.

Current health security responses

As of 10 January 2023.

iGAS

There was an unusual seasonal persistence of scarlet fever and iGAS through the autumn. A total 1,212 iGAS cases were reported through laboratory surveillance in England between 12 September and 29 December 2022, compared to 588 for the same period in the last peak year (2017 to 2018). However, the 7-day (all-cause) case fatality rate for iGAS this season is comparable with recent seasons. The result of UKHSA communications – supported by both RCGP and RCPCH leaders – media reporting, and increased disease in the community has been very high attendance of children to healthcare settings, increased antibiotic use aiming to save lives, and a great deal of pressure for UKHSA health protection teams.

Diphtheria

The epidemiology of diphtheria in asylum seekers continues to largely reflect the number of arrivals in the UK and the risks in vulnerable populations before reaching asylum accommodation here. s Given high vaccination coverage in the UK the risk to the wider population has remained very low.

We have published supplementary guidance for management of diphtheria and other infectious disease in asylum seeker settings (where individuals are often under immunised, with skin lesions and wounds, and have been living in high-risk areas including migrant camps). Data is being shared with European colleagues through EpiPulse and has been included in the recently published Rapid Risk Assessment by European Centre for Disease Control and there is active engagement with cross government policy teams, most notably Home Office, to maintain and improve where appropriate holistic healthcare for those needing support.

Winter preparedness

Our Incident Management Team continues to provide oversight of cumulative winter impacts including respiratory illnesses, norovirus, weather, energy and industrial action impacts on health. Nationally influenza and general ICU or HDU hospital admissions had risen sharply over recent weeks to a point where influenza admissions were at a higher level than at the same point in the previous 4 years. There is considerable uncertainty over how COVID-19 infection activity will change over the coming weeks with positivity starting to drop in a number of infections (for example, RSV) but where stabilisation of incident cases could occur. We will continue to monitor closely.

Norovirus remains at lower than expected levels overall, although an increase in those aged 65 years and over has been observed recently. The collation of the multiple winter hazards into a single coherent incident management team has enabled us to utilise our surveillance and short-term forecasts to provide advice to ministers and public health advice to the population in an effective way, supporting the NHS in identifying likely service demand and mitigating risks.

Vaccine-derived poliovirus type 2

UKHSA continue to respond to the detection of vaccine-derived poliovirus in sewage. The risk to the public overall remains low given the UK’s high vaccine coverage. However, primary vaccination coverage for those aged 1 year in London was 87% (92% in the UK overall) – those who are unvaccinated remain at risk of paralysis. UKHSA in partnership with DHSC, Medicines and Healthcare products Regulatory Agency (MHRA) and the NHS has led the response that expands our surveillance, raises awareness and training in professional groups, and improves data and vaccination. We are now working with the NHS on the next stage of our vaccine response to integrate a vaccine booster programme on wider pre-school vaccines including polio into a school catch up programme.

Other standard incidents

We continue to respond at a ‘standard’ incident level to COVID-19, China testing, lead contamination in breast milk, mpox, flu A (H1N1), avian influenza, Ukraine, and listeria monocytogenes.

Jenny Harries

Chief Executive

January 2023