Corporate report

UKHSA Advisory Board: summary report on Commonwealth Games 2022

Updated 3 November 2022

Title of paper: Summary report on the Birmingham 2022 Commonwealth Games and UKHSA
Date: Thursday 29 September 2022
Sponsor: Dr Paul Cain
Presenter: Katie Spence and Caryn Cox

Purpose of the paper

This paper highlights the successful contribution of the UK Health Security Agency (UKHSA) to the Birmingham 2022 Commonwealth Games (CWG).

Recommendations

The Advisory Board is asked to note the achievements of the West Midlands region, supported by pan-UKHSA, in identifying, preparing for and mitigating the risks of a mass gathering of 1.5 million people.

Early engagement, support, advice and cross- government collaboration has been regarded as exemplary with surveillance data indicating no outbreaks linked to the Games.

Despite the breadth of risks visitors were able to attend the event in contrast to the restrictions placed at the Tokyo Olympic venues.

The board is also asked to note the contribution to the worldwide body of knowledge for planning and delivering mass gatherings – sporting or otherwise.

Background

The Birmingham 2022 CWG met the World Health Organization (WHO) definition of a mass gathering: events ‘attended by sufficient people to strain the planning and response resources of a community, state or nation’.

It was a key opportunity for the UK in terms of tourism and the economy but also a major challenge in terms of the potential for adverse events for example, outbreaks of infectious diseases and terrorist attacks.

This increased the degree of scrutiny and threatened reputational risk. For UKHSA, as a new organisation amidst a rapidly changing public health landscape (Living with COVID-19) this was a very public test.

Scale

The CWG were a significant undertaking for the public sector overseen by the Birmingham 2022 Organising Committee (OC) sponsored by the Department for Culture, Media and Sport and included:

• 26 different sports (including 7 para-sports), 286 sessions, across multiple venues across 12 local authority areas across the West Midlands (and track cycling in London) for a 2-week period – 28 July to 8 August 22
• more than 5 million visitors to Birmingham city centre during Games time
• 1.5 million spectator tickets sold
• 6 Games Villages and 5 Polyclinics
• Multiple sites including hotels, competition venues, UK wide training venues, ports of entry and festival sites across many local authorities
• 14,000 volunteers, including 2,000 healthcare and medical personnel
• 2,000 cast members – opening and closing ceremonies
• more than 6,500 athletes and team officials from 72 nations and territories
• Technical Officials and Delegates (approximately 6,000)
• Games Family, including approximately 2,000 VIPs, dignitaries and key sponsors
• broadcast and media (approximately 10,000)
• workforce and contractors (approximately 35,000)

UKHSA’s involvement in the Games

The CWG were awarded to Birmingham in late 2017. Planning commenced in 2018 by the then Public Health England (PHE) West Midlands regional team. Work continued during COVID-19 despite the wider pressures. In May 2021, a small core programme team was established in the West Midlands to accelerate preparation and draw the many workstreams together including:

• an assurance structure for the preparation for and during the CWG period including UKHSA advice to the Organising Committee and DCMS
• advice on a the COVID-19 mitigations adopted, including a proportionate COVID-19 testing policy that was designed to be flexible
• staff and stakeholder preparation through a comprehensive programme of exercising and training;
• increased staff numbers and skill mix able to adapt (step up or step down)
• agreeing a 2 million pound budget for the Games focused work
• an operational response structure from 14 July to 19 August 22
• plans were put in place and tested to provide a health protection response in the event of an incident for example, infectious diseases; chemical hazards; ports and borders; surveillance; communications and so on
• other mass gatherings were reviewed for transferable learning including the 47th G7 Summit held June 2021 in Cornwall, the UN Climate Change Conference (COP26) in Glasgow in October and November 2021, the 2020 summer Olympic Games, held in July and August 2021 in Tokyo, Japan and the 2022 winter Olympic Games held in February 2022 in Beijing, China
• enhanced surveillance systems were activated

UKHSA stood up its enhanced incident response 23 May to 19 August 22 with a Strategic Response Group (SRG) and Strategic Response Director in place and Incident Management Team (IMTs) meetings established. The dynamic risk assessment was reviewed regularly and assurance provided that the appropriate mitigations were in place. This approach was endorsed by DHSC.

UKHSA has worked collaboratively and transparently with local, regional, and national stakeholders providing reassurance throughout the process, identifying and escalating issues at an early stage to enable resolution.  Despite the substantial issues delivering the Games following a pandemic has presented, the team have remained resolutely positive and have been a joy to work with.

UKHSA have risen to the challenge and have forensically identified a vast suite of risks and put in place strong mitigation.

John Bentham, Head of Resilience and Risk, DHSC

Risks

Risks were managed through the standard UKHSA dynamic risk assessment supplemented by delivery and public health risk registers. Key public health risks included but were not limited to:

• infectious diseases currently endemic in the UK such as COVID-19, monkeypox, tuberculosis, food and waterborne infections
• capacity of critical in place systems, for example vaccination, immunisation, surveillance, testing, health promotion and so on
• importation of infectious diseases not currently endemic in the UK but present in Commonwealth countries;
• non-infectious disease risks for instance, chemical hazards and other environmental risks such as air quality, water quality, heat wave
• chemical, biological, radiological, nuclear and explosive (CRBNe) risks
• cyber attack on medical and broader response systems

Physical risk assessments for potential hazards were undertaken and environmental inspections of other Games family accommodation were also undertaken in partnership with local authority (LA) environmental health teams. Specialist teams in UKHSA added their perspective and advice. Broadly this allowed for a mitigation that minimised the risk, prioritised surveillance and/or provided a response plan.

The process for identifying health protection risks, continually assessing them, and mitigating them remained challenging throughout. Circumstances changed and the priorities of and perspectives of government bodies, LAs, teams and athletes did not always align, creating tensions. These were largely resolved and key to this was the relationships built during the run up to the Games.

Some of the key risks for any international multisport event are related to matters of public health across a wide range of areas. Early engagement with PHE and subsequently UKHSA West Midlands was my priority in planning for Medical Services for the Games in Birmingham. The support from the team in the West Midlands through the planning and delivery at Games time has been exemplary, bringing a wide range of expertise to support the Games in a challenging environment.

Dr Pam Venning, Head of Medical Services for the OC

Evaluation, research and lessons learned

Initial rapid debriefing has identified the following early lessons:

Early embedding of the West Midlands team with the OC Medical Team ensured early engagement with the Medical Commission.

UKHSA staff placed as Public Health Advisory Liaison in the Games Operations Centre (GOC) ensured early intelligence of any potential health protection and health security issues could be reviewed or investigated and acted on immediately.

Daily epidemiology reporting (including regional and international surveillance) internally and to partners provided reassurance that there were no significant public health issues requiring escalation.

Due to the high-profile nature of the Games, early proactive communications and preparation of ‘ready to respond’ reactive comms for the media and partners, kept the UKHSA on the front-foot to deal with key health issues.

Collaborative approaches across the UKHSA enhanced the subject matter expert input to regional health protection operational processes.

Data quality from patient encounters will need to improve in future events in order to increase the effectiveness of surveillance and there may be a mismatch in data needs between patient care and population health.

Enhanced surveillance was invaluable.

No outbreaks were detected linked to the CWG.

A small number of microbiological tests were undertaken and nothing of significance was noted.

Overall, COVID-19 positivity was low and as expected increased slightly during the CWG. The exact rate of positivity is unclear as some countries were self- testing.

Enhanced surveillance specific to the West Midlands continued until 24 August. This provided reassurance to the community that there were no population ill effects linked to the CWG.

This information has yet to be fully synthesised but there is clear learning. UKHSA will deliver a Transfer of Knowledge report specific to 2026 CWG taking place in the State of Victoria, Australia and a public facing report (similar to the Health Protection Agency ‘Learning from London 2012, a practical guide to public health and mass gatherings’).

A more detailed and operational focused internal UKHSA report will address minor areas for improvement. More broadly a range of scientific papers will be produced for both publications and future conferences to enable the learning to be shared widely.

Summary

The Birmingham 2022 Commonwealth Games was the first large scale multi-sport event in the ‘Living with COVID-19’ era. Ultimately, the planning, risk assessment and mitigation in the lead up ensured that no outbreaks occurred. Even if it had occurred UKHSA was confident in its readiness to provide a robust response. The contribution to the CWG has enhanced our overall preparedness, refreshed our ‘all hazards’ response and confirmed our ability to play our role in delivering health security for the nation.

Importantly the learning is transferable and will place UKHSA at the forefront of those adding to the body of knowledge around the world for planning and delivering at a regional level for mass gatherings – sporting or otherwise.