Corporate report

UKHSA Advisory Board: Chief Executive’s report

Updated 17 July 2023

Date: Wednesday 19 July 2023

Sponsor: Jenny Harries, Chief Executive

Purpose of the paper

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

Recommendation

The Advisory Board is asked to note the update.

Overview and update – achievements and challenges

Health protection issues

The effects of climate change have been clearly seen in the unprecedented global heat over the last month. Since the Board last met, summer has arrived in the UK in earnest, bringing with it changes in health protection risks. This includes changes in risk dynamic stemming both from changes in types of threat and in people’s activities and behaviours. We have issued a range of communications and amplified guidance to help people understand sensible, proportionate steps they can take to protect their health.

Earlier in June, we issued the first Heat-Health Alert under our combined Adverse Weather and Health Plan, the latter published in April, with all of England being placed under a Yellow alert (unlikely to impact most people but could impact those who are particularly vulnerable). This was subsequently extended due to continuing high temperatures. The announcement generated recognition in the media, with some responses indicating the very significant risk to life, as well as the availability of very simple but effective practical mitigations, has not yet been universally accepted. However, it was received very positively by health and care sector partners and as temperatures have continued to rise and direct health service impacts reported, reporting has been mainstream and straightforward.

Summer also brings with it significant movement and mixing of people, both within the UK and overseas. Throughout the summer many people will come together for holidays, pride events, religious celebrations, etc. We have issued targeted guidance to help enable people to take part in and enjoy these opportunities as safely as possible, including specific advice to festivalgoers and on Middle East Respiratory Syndrome (MERS) for people participating in the Hajj and Umrah.

Public interest in avian influenza remains high domestically and globally. UKHSA has proactively established a new Asymptomatic Avian Influenza Surveillance Study to further understand any potential infection risks for those working in close proximity to known infected flocks.

The study involves collecting throat and nose swabs from individuals who work intensively on poultry farms designated with high levels of confirmed or suspected H5N1 and continues to test new premises. Several cases of human H5N1 have been confirmed in these worker cohorts in the UK (4 positive as of 10 July) and as appropriate they have been notified to the World Health Organization (WHO).

The study has highlighted several study complexities including a generally mobile workforce, specific communication requirements, the need for accurate timing and labelling of samples by participants to distinguish environmental contamination from potential infection and assurance of appropriate use of personal protective equipment.

There has been no evidence to suggest human-to-human transmission from the cases found to date and as such the current risk level remains at level 3 of 6 (limited mammalian transmission excluding humans). The study is ongoing and, as at 21 June, 113 participants had completed a formal testing period, from 6 infected premises. UKHSA continues to respond to these cases, undertaking contact tracing where possible and appropriate, and providing welfare support to cases through the incident management system.

UKHSA colleagues continue to work alongside the Department of Health and Social Care (DHSC) and Animal and Plant Health Agency (APHA) to enhance avian flu preparedness through progressing work on vaccines, diagnostics, surveillance among other pandemic preparedness activity including close monitoring and understanding of new reports of mammalian detections, for example in Poland.

With regard to infectious diseases more widely, there has been a significant increase in measles cases in the UK, and a UKHSA health protection briefing has been issued to partners outlining actions to reduce the risk of wider resurgence.

As a likely result of the non-pharmaceutical interventions during the COVID-19 pandemic, measles incidence had fallen from the high level seen in 2019, when epidemics were occurring across all of Europe. Since the start of 2023, 49 cases have been confirmed in England, compared to 54 across the whole of 2022.

Globally, levels of immunity to measles have fallen and childhood coverage of the MMR (measles, mumps and rubella) vaccine in England is at its lowest level in a decade – 89% in those aged 2 years and 85% in those aged 5 years, well below the 95% target.

WHO Europe has called for urgent action to address the decreasing levels of immunity. Indonesia has reported a particularly notable increase in incidence of measles driven by low levels of population immunity, including in unvaccinated children.

Proactive UKHSA media coverage in May has encouraged parents to check their children’s vaccination records, especially before travelling overseas, and healthcare professionals to ensure appropriate sampling is carried out for every case.

The national mpox (monkeypox) outbreak response-vaccination programme ended on 16 June for first doses and will formally end on 31 July for second doses. This vaccine offers 78% protection against the virus from 14 days after receiving it, while the second aims to provide longer term protection.

Since the beginning of 2023, 29 cases of mpox have been reported in the UK, with 14 presumed acquired within the UK, most cases being in London and with no indication of spill over into wider vulnerable population groups. Due to a recent cluster of cases in London, we have agreed with the NHS that they will temporarily continue offering vaccination in London after July. We will also retain the ability to offer vaccination in response to new clusters after the end of July, when required, to respond to any further clusters of cases over the summer.

We are additionally exploring with stakeholders (including Terence Higgins Trust, British Association for Sexual Health and HIV, Sexual Health Commissioners) the viability of them standing up a small network of sexual health clinics across the country to enable eligible individuals who have not yet come forward for their vaccine to do so outside of London until the end of summer.

UKHSA has been leading a cross-government Discovery Phase for a National Biosurveillance Network (NBN), which is a flagship aspect of the Cabinet Office led Biological Security Strategy (BSS). It was published in June and is strongly supported by the Prime Minister.

Our team was successful in being awarded £20 million over 2 years through the HM Treasury Shared Outcomes Fund to take forward piloting (an alpha development phase of) the NBN, working with colleagues across the Department for Environment, Food and Rural Affairs (Defra) and other government departments. UKHSA is playing an active role in the implementation of the BSS, with Steven Riley, Director General for Data, Analytics and Surveillance leading the work on the next stages of the NBN.

External engagement collaboration

In May, I attended the World Health Assembly (WHA) alongside Minister Quince, Chief Medical Office for England, Deputy Chief Medical Officer for England, Clara Swinson and other DHSC and Foreign, Commonwealth and Development Office (FCDO) colleagues. Ahead of the formal WHA start, I was delighted to participate in the official launch of the International Pathogen Surveillance Network (IPSN). I have co-chaired the initial global Implementation Coordination Group and will now form part of the IPSN Leadership Committee going forward. UKHSA has additionally strongly supported IPSN’s development through technical expertise and exemplar work programmes such as our New Variant Assessment Platform (NVAP).

I also presented to the Commonwealth Health Ministers on the necessity and opportunities for surveillance and data sharing ahead of WHO discussions on the Pandemic Instrument. Through these various discussions I met with important international leaders in genomics and with health leaders from around the world specifically including the Chinese Health Minister, the Irish Health Minister, Ministry and Public Health colleagues from Pakistan, colleagues from Korea Disease Control Agency, Singapore Ministry of Health, senior WHO colleagues, Pan American Health Organisation, Africa Centres for Disease Control and Prevention, Nigeria Centre for Disease Control and Wellcome.

It was an excellent opportunity to strengthen global relationships and showcase the work of UKHSA to UK and international colleagues. UKHSA’s work has a strong reputation internationally and it was gratifying to have this represented from colleagues around the world.

On 22 June, I joined Health Minister Will Quince, Cabinet Office Minister Jeremy Quinn, and Moderna President Stephen Hoge to formally launch the landmark Moderna-UK Strategic Partnership. This includes a significant investment by Moderna into the UK’s life sciences infrastructure, including a state-of-the-art manufacturing and research centre in Harwell. The partnership brings messenger ribonucleic acid (mRNA) vaccine manufacturing capabilities for the NHS onshore and provides scalable capacity for up to 250 million vaccine doses per year to allow us to respond more quickly and effectively in the case of an emergency. This is a critical part of embedding the learnings from the COVID-19 pandemic to ensure greater resilience, faster innovation and, most importantly, better health outcomes for the country.

Corporate updates

The public inquiry into COVID-19 continues to progress, with the public hearings on Module 1 (pandemic preparedness) beginning with the opening statements from core participants, including UKHSA, on 13 June. Witness hearings have been taking place since 14 June, and I attended to give evidence on behalf of UKHSA and predecessor organisations on 26 June. Given the scope of this module, this hearing focussed solely on the role and work of the Health Protection Agency and subsequently Public Health England in relation to pandemic preparedness in the period up to January 2020. A full transcript is available on the UK COVID-19 Inquiry (begins on page 116, row 6).

We are also continuing to make progress on written evidence to support Module 2 (key decision making). A full initial draft of our statement was submitted to the inquiry on 4 July.

In the last meeting of the Board we discussed our 3-year strategy for delivering health equity through health security. That strategy has since been published at the end of June. It sets out how we will achieve more equitable health security outcomes for all by targeting the people and places most at risk from external hazards to health. We have highlighted 4 areas of focus to foster the right environment for delivering health equity:

• data to build visibility of those at most risk
• a ‘people and place’ approach
• stronger partnerships across the health system and communities
• a diverse, inspired, empowered workforce

and set out a roadmap of deliverables to ensure we make progress and impact.

The full strategy is available on UKHSA’s intranet, Pulse.

I am also pleased to update the Board on progress in finalising and stabilising my senior executive team. After a fair and open external recruitment process, we have now received final approval from the Prime Minister to appoint Professor Isabel Oliver as our permanent Director General for Science and Research. I am grateful for the enormous skill and leadership Isabel has shown and I know will continue to show in delivering our science and research functions, including our new science strategy. I would also like to express my thanks to Andrew Sanderson, whose loan as Director General for Finance, Corporate and Commercial came to an end last month.

I am also glad to be able to confirm that Andrew will continue with us for a further year in the role of Chief Finance Officer and will remain as a member of the Executive Committee and continue supporting the Board and Audit and Risk Committee (ARC).

Current incidents (as of 10 July)

Vaccine Derived Polio Virus type 2 (PV2)

UKHSA continues to respond to the detection of Vaccine Derived Polio Virus (VDPV) in sewage as an enhanced incident. The risk to the public overall remains low given the UK’s high vaccine coverage.

There have been no new PV2 detections in London sewage since December 2022, and an additional 18 sites tested across England have all been negative for PV2 to date. For WHO to confirm that the UK no longer has a circulating Vaccine Derived Polio Virus type 2 (cVDPV2), there has to have been no detections for 12 consecutive months.

Other standard incidents

We continue to respond at a ‘standard’ incident level to:

• invasive group A streptococcal (iGAS)
• Grenfell Tower fire air quality monitoring
• Pseudomonas aeruginosa

Forward look

UKHSA’s ambition to systematically promote more efficient pathways and vaccine uptake for vaccine preventable disease will now be enabled through a new (internal) UKHSA Vaccine Board, which has now been stood up. Reporting directly to the Executive Committee in recognition of the importance to the organisation, this will assist in positioning immunisation as core to our mission and to protecting the public.

UKHSA and its predecessor organisations have a strong track record on vaccination, and our system excels internationally; however, the context is falling coverage of key childhood immunisations and urgent attention is required across the system, many strands of work led by UKHSA, to arrest this as well as appropriate understanding of the complexities of monitoring vaccine programmes and training and retaining world leading experts. This will be paralleled by continued pathways to work in a governanced way with industry including through piloting of a new strategic partnership framework.

In anticipation of the launch of our 2023 to 2024, to 2025 to 2026 strategy, we have begun a programme focussed on the next stage of the agency’s strategic corporate evolution. I will personally lead this work to finesse and progress the agency’s strategic direction, enhance the efficiency and effectiveness of the way we operate, and ensure we are in the best position to protect the nation’s health. My Chief of Staff is currently running a scoping exercise with each Executive Committee member to understand our areas for focus and impact, but initial goals are that we will:

• improve the agency’s decision making and intra-organisational collaboration, looking to develop and implement best practice on effective and speedy delivery
• assess and revise the agency’s organisational structures in order to meet our long-term strategic objectives and to optimise our delivery
• identify and deliver operational efficiencies

As a final point to note, when the board next meets there will be a change of scenery as we will have completed the move of our central London office to the Government Hub at 10 South Colonnade in Canary Wharf.

This is an important opportunity to complete the consolidation of our London estate in a more cost-effective, modern and collaborative space. This will also co-locate us with the Medicine and Healthcare products Regulatory Agency, providing a practical support for our shared ambition for closer partnership working. Decommissioning on our Nobel House offices has begun, and we are due to have completed the move on 1 August.

Jenny Harries
Chief Executive
July 2023