Corporate report

UKHSA Advisory Board: Chief Executive’s report

Updated 10 May 2023

Date: Tuesday 14 March 2023

Sponsor: Scott McPherson

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. As the Chief Executive has been on annual leave, this report is from the Director General for Strategy, Policy and Programmes.

Recommendation

The Advisory Board is asked to note the update.

Overview and update – achievements and challenges

The past 8 weeks have seen the NHS under high-sustained pressure, including for bed occupancy, accident and emergency (A&E) attendances and admissions, and ambulance wait and handover times.

UKHSA continues to directly support the NHS to alleviate these pressures upstream through:

• mitigating the impacts of preventable infectious diseases
• support and guidance on infection prevention and control in healthcare settings
• surveillance and demand modelling to manage healthcare capacity and resources

We are closely monitoring increased norovirus activity. Cases of norovirus had fallen during the first few weeks of 2023, before rising sharply and are now around twice the 5-season average for this time of year. Most cases are in people aged over 65 years and outbreaks have been identified in hospital and care settings.

However, we are beginning to see the UK health system emerge from the winter period, with seasonal pressures easing in many areas although remaining higher overall than in previous years. The overall incidence and risk of seasonal infectious diseases – including respiratory viruses flu A, flu B and respiratory syncytial virus (RSV) – is declining. There has also been a sustained decline in laboratory confirmed invasive group A streptococcus (iGAS) cases. As a result, we have now been able to de-escalate the enhanced incident for the management of our winter preparedness and response activities. We are already beginning to undertake lessons learned on this winter in preparation for winter 2023 to 2024.

The mpox (monkeypox) outbreak in the UK has a similarly positive outlook. Uptake for vaccination within the eligible cohort has been high and we are continuing to support efforts to increase second dose uptake. Since the peak in July 2022, cases have fallen to a sustained very low level. Only 6 new cases were confirmed in the UK in January and February 2023 (of which 3 are linked to international travel). As we have now passed the emergency phase of the outbreak, the incident was stood down on 25 January, and mpox is being managed as business as usual. Globally the outbreak continues and the World Health Organization (WHO) has confirmed cases in 110 member states across all WHO regions since the start of the year.

There has been increased media and political interest in H5N1 avian influenza, following the WHO announcement of a fatal human case in Cambodia on 22 February 2023. The current risk to the public is low, however, we are monitoring developments closely. The Department for Environment, Food and Rural Affairs (Defra) continue to lead, with our assistance, on the surveillance and management of cases in birds domestically. The Centre for Pandemic Preparedness is coordinating UKHSA work to ensure our overall readiness, working closely with the Department of Health and Social Care (DHSC) on advice about any additional steps Ministers may want to consider, including in relation to pre-pandemic vaccine. We are also stepping-up the evaluation of commercially available flu tests to assess efficacy at detecting H5N1.

We are also monitoring other health incidents internationally, with 2 of particular significance. An outbreak of cholera in Mozambique has been growing since December 2022 with geographic spread to new districts. WHO reported 5,260 cases and 37 deaths between September 2022 and mid-February 2023, and considers the risk of further disease spread as very high at the national and regional levels. The Government of Mozambique has begun a vaccination programme aiming to reach approximately 720,000 people.

There has also been an outbreak of Marburg virus in Equatorial Guinea, the first confirmed in the country. WHO has stated that the capacity to manage the outbreak is insufficient and there is a risk of cross-border spread to neighbouring countries. Nine cases have been reported since 21 February 2023, including one laboratory confirmed case. All these cases have sadly died.

In January 2023, we put in place a COVID-19 surveillance testing programme for international arrivals from China at Heathrow, to increase our surveillance for a new COVID-19 variant. The programme exceeded our targets for the number of people tested, and genomic sequencing of the few positive samples from travellers has not identified any new variant of concern. Our approach is under active review; we have noted the improvements in sharing of sequences from China and are monitoring changes in epidemiology.

It is now over a year since the Government announced the move to a Living with COVID-19 approach. We will continue to follow these strategic priorities as we head into the next financial year. The approach to managing COVID-19 is centred on:

• vaccines and treatments to protect those most at risk of severe disease
• protection of vulnerable people and vulnerable settings
• surveillance to monitor the changes in prevalence and detect any changes to the virus that may present an increased risk to the public

As part of this, there should be an overall reduction in the cost of COVID-19 activity next year as we scale back further in proportion to the level of response.

We are supporting the COVID-19 spring booster campaign following advice from the Joint Committee on Vaccination and Immunisation (JCVI) for further boosters to be administered in spring and in autumn. This will begin rolling out to care home residents, immunosuppressed people and those aged 75 years and over from 17 April 2023.

We will also continue to provide testing to the NHS for the purposes of infection prevention, outbreak management and to support clinical treatment of patients for the first 6 months of the next financial year, after which it is agreed the responsibility for delivering this testing will transfer to the NHS. Final discussions are ongoing on the exact detail of the financial arrangements.

Alongside this, we will also see the closure at the end of this month of the Enhanced Protection Programme as a coordinating function across the organisations and agencies who have roles in safeguarding people who are most at risk of severe disease. This is not a de-prioritisation of the support for those people but rather an important step to make sure that support is fully integrated within their routine care under the NHS and tailored appropriately to their ongoing individual clinical circumstances and need.

There will also be contingency provision to reinstate the coordination function in the event of a new variant of concern or emergence of a novel pathogen with similar impacts on a specific cohort of people, such as people who are immunosuppressed. As part of the ongoing support, the National Institute for Health and Care Research announced on 2 March 2023 that they have launched a study for thousands of immunosuppressed people to participate in antibody testing with the aim to determine which groups remain at highest risk of severe disease after vaccination.

On 26 January 2023, the agency’s first annual report and accounts were laid before Parliament, covering our first 6 months of operation up to March 2022. The Comptroller and Auditor General has taken the unusual step of disclaiming his opinion on the accounts. He concluded that he had not been able to obtain sufficient evidence from the National Audit Office (NAO)’s audit to form a judgement. He also raised concerns about the governance and quality of accounting in the relevant period (which was the first 6 months of the agency) and with the audit exercise coinciding with the very significant downsizing of the organisation. We take this extremely seriously and are taking action to resolve the issues.

While the agency has faced some exceptional and unprecedented challenges, it is vital that we account fully and correctly for the public money we spend. We have already taken steps to make the improvements that are needed, including a Finance and Control Improvement Board, which includes representatives from HM Treasury and NAO, as well as UKHSA and DHSC.

The response to the requests for evidence from the public UK COVID-19 Inquiry remain a major priority for the Executive Committee and the organisation. This is critical both in supporting the Inquiry in its work and also in ensuring we can maximise and act upon the learning from the pandemic as the agency with overall responsibility for health protection within the UK.

We submitted a complete draft of the statement for Module 1 (pandemic preparedness) on 2 February 2023, which will be finalised once we have received the Inquiry’s comments. On Module 2 (core decision making), we anticipate sending a complete draft to the Inquiry shortly and on Module 3 (impact on healthcare systems) we have been confirmed as a Core Participant and are awaiting a formal request for evidence under Rule 9 of the Inquiry Rules 2006 (referred to as a Rule 9). The public hearings on Module 1 have been scheduled for summer 2023, and Module 2 for autumn 2023.

In November, the Board discussed the agency’s Science Strategy. This has since had further input from the Science and Research Committee, the UKHSA and Devolved Governments board, and external engagement workshops with partners across industry, academia, and the health system. The Science Strategy has now received final sign off from the Executive Committee and is due for publication shortly. This is a thorough and hugely important piece of work to set a vision for science in the agency up to 2033 and our ambition to embed our industrial partnerships, innovation, and the UK’s global leadership in life-sciences at the heart the of the organisation.

A final decision on the agency’s core budget for the next 2 financial years is currently with Ministers. We have been engaging in constructive discussions with DHSC to set out the resourcing requirements to deliver the different aspects of our remit. We are also, as ever, seeking out efficiencies where there are opportunities to do things better and in a more cost-effective way. The finalisation of our 3-year strategy and our business and delivery planning are dependent on the outcome of this process. We will be able to update you further on these once a determination has been made.

Alongside the other items for this meeting is a paper reviewing UKHSA’s first full year of operations. This is an important opportunity to reflect on the successes and challenges we have experienced over a busy year. This includes managing the continuing COVID-19 response alongside a high number of major incidents – hepatitis and salmonella in children, mpox, poliovirus detection in wastewater, iGAS – while also delivering a major organisational transformation programme, scaling back from around 18,000 staff at peak to around 6,700 now and welcoming in elements of the Vaccine Taskforce to form the new COVID-19 Vaccine Unit (CVU).

Current health security responses

As of 7 March 2023.

Vaccine-derived polio virus type 2

UKHSA continues to respond to the detection of vaccine-derived polio virus in sewage as an enhanced incident. The risk to the public overall remains low given the UK’s high vaccine coverage. However, primary vaccination coverage for children aged one year in London was 87% (92% in the UK overall) - those who are unvaccinated remain at risk of paralysis.

UKHSA, in partnership with DHSC, the 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 uptake. 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.

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. The cumulative number of new cases has plateaued with only one case reported in 2023, corresponding to a significant reduction in new arrivals. We expect the prevalence of diphtheria in this population to remain high and so, as arrivals increase, we will start to pick up more cases again.

Health protection teams are supporting local health services with the early identification and treatment of suspected cases. However, in view of the high prevalence in settings where case and contact management have been challenging, wider population-based control measures have been recommended. Given high vaccination coverage in the UK the risk to the wider population has remained very low.

iGAS

We have continued to respond to the unseasonal wave in iGAS and scarlet fever cases and notifications. 2,085 iGAS cases were reported through laboratory surveillance in England between 12 September 2022 and 2 March 2023, resulting in 262 deaths overall, including 31 deaths in children. This exceeds the number of deaths in the last peak season (2017 to 2018), although it appears to have a similar case-fatality rate.

Cases peaked in early-December 2022 but have now fallen to and stabilised at more typical levels. The enhanced incident was therefore stood down on 10 January 2023, but due to the ongoing risk level, this continues to be managed as a standard national incident. Interim guidance to clinicians on management of suspected iGAS cases was withdrawn on 16 February 2023 with reversion back to standard National Institute for Health and Care Excellence (NICE) guidance.

Other standard incidents

We continue to respond at a ‘standard’ incident level to COVID-19, flu A (H1N1), Grenfell Tower fire air quality monitoring, listeria, and Pseudomonas aeruginosa.

Scott McPherson
Director General, Strategy, Policy and Programmes

March 2023