Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 13 December 2023

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

I have 4 particular highlights to which I would like to draw the Board’s attention.

In the time since we last met, UKHSA has celebrated 2 important anniversaries. 1 October marked the Agency’s second birthday; a helpful moment to reflect on the strides that have been made in developing a high performing organisation and protection of the public’s health. This has meant building on the strengths of our predecessor organisations, learning from the COVID-19 pandemic, and recognising the innate scientific skills that we hold and using them to embrace continuous scientific progress. It has also been a year since the establishment of the Covid Vaccine Unit as part of the Agency, taking crucial capabilities of the former Vaccine Taskforce and embedding them within the country’s enduring health protection system.

We have also seen changes in the Ministerial team and welcomed a new Secretary of State, the Rt Hon. Victoria Atkins MP, to the Department of Health and Social Care (DHSC). As she familiarises herself with her new brief, we will be looking to understand her priorities for the health system, for health protection in particular, and her approach to the inter-departmental breadth of our work, in particular with the Department for Science, Innovation and Technology.

Lastly, I want to express my sincere thanks to all of those involved in organising and participating in the second annual UKHSA conference. Building on the success of the 2022 event, this focussed on attracting and engaging external partners from across the public health landscape, life sciences and allied industries, academia, charities and delivery partners. The programme this year combined the breadth of UKHSA’s scientific endeavours with practical calls to action and strategic policy insight. Delegates enjoyed plenary talks and panel discussions from a variety of speakers including the Chief Medical Officer Professor Sir Chris Whitty, Professor Sir Jonathan Van Tam, Professor Wei Shen Lim and Professor Kevin Fenton.

I was pleased also this year to be able to partner with the Faculty of Public Heath, who co-produced a full track of parallel sessions, themed around building a successful health protection system. As an indicator of success, we doubled the number of external delegates attending this year, and our exhibition space was fully booked with a 64% increase in exhibitions and a 25% increase in scientific abstracts submitted. Early feedback from delegates on site has been overwhelmingly positive and we will be carrying out full delegate and internal evaluations to inform the future direction for our conference.

Strategic forward look

In early December, I will be leading a UKHSA delegation to COP28, the 2023 United Nations Climate Change conference, alongside our Chief Scientific Officer, Professor Isabel Oliver and our Head of Climate and Health Security, Professor Lea Berrang Ford. This will be the first time that COP28 has had a dedicated day for focussing on health impacts arising from climate change and will include the first climate-health ministerial meeting.

This is a hugely important opportunity, not just for the recognition of public health as a critical consideration, but also for UKHSA’s positioning as a leader in climate health security. Both mitigation and adaptation responses are needed to tackle the inevitable challenges to health, and these will require global as well as national collaboration and action. We will lead events on response to health impacts of climate change at national level and on opportunities for better health through climate science and data.

The timing serendipitously aligns with the publication of our Health Effects of Climate Change Report, on which I updated in my last report. The publication has now been confirmed for the week following COP28.

While the ongoing circulation of COVID-19 and our own experience of more frequent extreme weather make pandemic and climate health risk feel very real to us all, we do need to keep sight of the less visible threats – in particular antimicrobial resistance (AMR). This was the focus of my keynote speech to conference and the findings within our English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report for 2022 to 2023 only serve to make the potential threat more stark.

In my speech, I outlined 3 priority areas for reducing AMR risk through the combined efforts of the health system and our academic and industry partners. These are:

• reducing the need for, and unintentional exposure to, antimicrobials, including through best practice infection prevention and control (IPC) to reduce the numbers of infections that would require treatment
• optimising the use of existing antimicrobials through more and better surveillance, including cutting edge tools like genomics
• investing in innovation, taking a One Health approach, and both anticipating and mitigating the impacts of climate change on AMR risk

The Joint Committee on Vaccines and Immunisation (JCVI), for which UKHSA routinely provides the scientific secretariat, has submitted recommendations to DHSC to introduce routine targeted vaccination for gonorrhoea offered opportunistically to at-risk individuals attending sexual health clinics and for the addition of a 2-dose course of vaccination for chickenpox to the routine childhood immunisation programme. This advice will now be considered in full by DHSC ministers before any policy decisions are made on any new routine immunisation programmes and UKHSA stands ready to support implementation of any decisions alongside the NHS. These are in addition to the recommendation earlier in the year for the development of rolling programmes of vaccination against respiratory syncytial virus (RSV) for neonates and infants, and older adults, following UK licensing of the first vaccines.

In addition to what we deliver, I am also focussed on improving how we deliver on our mission. The Ready to Respond work considering UKHSA’s capability to respond to main public health threats and hazards identified 24 recommendations spanning practical aspects of our strategic priority to be ready to respond to all hazards to health. Significant progress has been made on implementation including modernisation of local health protection systems, and I will be challenging ExCo members to make this one of their top priorities over the coming months. This will provide important clarity in roles and responsibilities during incidents, provide a more systematic approach to much of our preparedness work, and improve the effectiveness of our Incident Response Plan. I will bring an update on this to the Board early in the new year.

Lastly, we will be engaging with an arm’s length body review of the agency, commissioned by DHSC Ministers under the Public Bodies Review Programme. This is an important process to provide assurance to Ministers on the good governance, effective use of resources, and appropriate delivery of UKHSA’s remit – to provide critical health protection services to the public. The Chair of the Defence Science and Technology Laboratory, Adrian Belton, has been appointed to lead the review. I will be meeting with Adrian to discuss the terms of the review but I am confident that this process will offer both constructive challenge to inform areas where we can improve and showcase the breadth of our science and health protection work and the value that we provide to the public.

Update on activities

We are closely monitoring reports of an increase in respiratory illnesses in China, in particular reported clusters of pneumonia of uncertain cause in children. The World Health Organization (WHO) has made an official request to the Chinese Government for detailed information. We are continuing to work with international partners to assess the emerging information as and when it becomes available.

UKHSA’s monitoring of winter health threats is well underway, providing timely, actionable insight to support capacity and response planning within the NHS. This includes our weekly winter concurrent health threat assessment, which provides a critical overview of patterns in seasonal infectious diseases and COVID-19, extreme weather, and other related issues that pose a potential risk to the public’s health or to our health services. We are also supporting the new Secretary of State’s programme of winter meetings, providing epidemiological assessment and modelling alongside operational feedback capability from local and national health protection teams.

With regard to the status of winter hazards, as of 17 November, we can see that the current RSV season is underway. Prevalence is slightly higher week-on-week than last year but remains below last year’s seasonal peak. Winter Flu season has not yet begun and prevalence remains within typical levels.

Close monitoring of genetic changes in circulating SARS-CoV-2 virus, including the BA.2.86 variant (amongst others) remains a priority. In my last report, I noted the emergence and spread of BA.2.86 across the world, including in the UK, and the level of uncertainty about the characteristics of this variant. Although, with the NHS, we took the sensible, precautionary step of bringing forward the start of the autumn COVID-19 and flu vaccination programme to provide as much protection as possible to the most vulnerable, I am pleased to say that we have not seen a notable change in epidemiology or in the severity of the disease.

Initial investigations have indicated that vaccines within the current portfolio in use for the autumn campaign have similar levels of effectiveness against BA.2.86 as against other circulating strains, and therefore remain a strong defence against severe disease. We have continued working closely with our NHS partners on deployment of the vaccine campaign throughout autumn.

UKHSA teams have also continued providing national level response to a range of standard incidents, in addition to managing routine local and regional health protection responses:

Clostridioides difficile

We are investigating a relatively new strain of C. difficile that has been identified in low levels in different parts of England. Cases are currently limited to individual clusters in specific settings and there is no indication of community transmission. Investigations are ongoing to identify possible sources for the outbreaks.

Burkholderia cenocepacia

We are investigating a novel cluster of Burkholderia cenocepacia, with confirmed cases in both England and Scotland. Although the bacterium rarely causes infection in healthy individuals, it can cause severe disease in people with cystic fibrosis, who are in intensive care or who are immunocompromised, and it can result in poorer outcomes for lung transplant patients. We have identified a potential product association, although results are not yet conclusive and investigations are ongoing. As a precaution we have issued information to the health system across the UK and advised against the use of the product for those at highest risk.

Salmonella Enteritidis

Multiple clusters of different strains of Salmonella Enteritidis have been reported through whole genome sequencing since the start of the year. Previous investigation of related clusters in 2021 identified associations with imported chicken meat products, and the Food Standards Agency (FSA) has stood up an incident to review controls and risk management measures. We have therefore initiated a standard incident to manage the level of epidemiological support from UKHSA that the FSA will require.

Vaccine-like Polio Virus

We have now transitioned ongoing surveillance activity for the presence of vaccine-derived poliovirus type 2 to business as usual and there has continued to be no new detection in 2023. We are working towards standing down the incident and expect WHO to be in a position shortly to reconfirm eradication status for polio in the UK.

Diphtheria

The epidemiology in Europe indicates that the risk relating to toxigenic diphtheria in the asylum seeker population has fallen. Reflecting the reduced risk, we have reverted to individual level control measures rather than prophylactic treatment to reduce unnecessary exposure to antibiotics. The offer of diphtheria vaccination remains in place.

Alongside UKHSA’s frontline health protection activities, a significant amount of resource has been given over to supporting the work of the UK COVID-19 Inquiry. With support from across the Agency, our public inquiry team has been hard at work managing disclosure of relevant materials and responding to requests for evidence from the Inquiry.

On 28 November, I will be attending a public hearing of the COVID-19 Inquiry to give evidence on Module 2 (key decision-making during the pandemic). I expect that much of the hearing content will focus on the role of those in the Office of the Chief Medical Officer, and therefore my contribution will largely cover my role while Deputy Chief Medical Officer for England, it may also touch on the roles of UKHSA and its predecessor organisations in providing advice to decision makers throughout the pandemic.

Both myself and our Chief Medical Adviser, Professor Susan Hopkins, have also submitted corporate witness statements on behalf of UKHSA to support Module 3 of the Inquiry (the impact of the COVID-19 pandemic on healthcare systems in England, Wales, Scotland and Northern Ireland). The public hearings for Module 3 are due to begin early next year and work is well underway to provide written evidence for Module 4 (vaccines and therapeutics).

Jenny Harries
Chief Executive Officer
November 2023