Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 11 September 2023

Date: Wednesday 13 September 2023

Sponsor: Professor Dame Jenny Harries, Chief Executive

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.

Recommendation

The Advisory Board is asked to note the update.

Strategic forward look

Summer may only just be coming to an end, but our focus is already on preparing for expected pressures over winter. Alongside the likely seasonal spikes in influenza, the COVID-19 situation remains dynamic. We are identifying appropriate planning scenarios and ensuring that appropriate contingency plans are in place, including in the event of the emergence of new variants or significant surge in COVID-19 infections. The recently identified BA.2.86 variant adds to this uncertain picture.

The core pillar of our national strategy for COVID-19 is vaccination, and work has been underway for some time to support the delivery of the autumn/winter COVID-19 and flu vaccine campaign. In light of the BA.2.86 variant, although we have insufficient evidence so far to assess any changes to its characteristics compared to the current dominant circulating strains, we have announced alongside the NHS that we will be bringing the start of the campaign forward to September.

To further support the resilience of our healthcare system over winter, we are in the process of finalising a refined community surveillance study for COVID-19 for delivery this winter. We are working closely with the Office for National Statistics (ONS) as our delivery partner, building on the successes of the previous Community Infection Survey. The study is designed to use our existing stockpile of lateral flow devices (LFDs) and provide vital insight to the NHS and other key partners through the winter months when infection rates and hospitalisations tend to be higher.

Linked to enduring surveillance functions and building on the capabilities we developed through the pandemic, we are working on a next-generation public data dashboard to replace the award-winning COVID-19 dashboard. Timely, robust, accessible and meaningful data is central to effective health protection, which is why we have identified it as one of our 6 ambitions in the UKHSA strategic plan 2023 to 2026.

At launch, the dashboard will focus on respiratory viruses, embedding learning from the development of the COVID-19 dashboard throughout the pandemic. A soft launch is planned for this month, with data included for:

• COVID-19
• influenza (flu)
• adenovirus
• human metapneumovirus (hMPV)
• parainfluenza
• rhinovirus
• respiratory syncytial virus (RSV)

The long-term vision for the dashboard will be to extend the data to cover a broad range of threats in an iterative manner.

Looking beyond seasonal infections, it is also my priority that we maximise the benefits of our public health programmes to minimise the health burden of vaccine preventable diseases. We are placing a particular emphasis on the measles, mumps, and rubella (MMR) vaccine, although work to improve routine uptake and close the immunity gap through catch-up will have relevance across our wider immunisation programmes.

Analysis that we published in July 2023 shows that London is particularly susceptible to a measles outbreak and we are working closely with the NHS at local and national levels to address this risk. This includes taking a leadership role in bringing together partners across the health, community, and technology spheres to explore challenges to vaccination, new initiatives and to share experiences and best practice.

Looking ahead to November, I am delighted to say that we will be returning to Leeds for the 2023 UKHSA Conference. This year we are focussing on 4 main themes:

• innovation and life sciences partnership
• reflections on public health responses
• delivering prosperity and equity through health security
• building a successful health protection system

I am keen that we build on the success of last year’s more research-focussed conference with a broader scope now linked to our published strategic goals. This is an important opportunity not only to bring in external insight to improve the effectiveness and content of the agency’s delivery, but also to use UKHSA’s position as a system leader to promote health protection practice across the UK.

Autumn will also see the publication of our Health Effects of Climate Change (HECC) report. This will be the fourth report of its kind produced by the UK Government (the last was published in 2012), and the first from the new Centre for Climate Health within UKHSA. It is a critical part of the National Adaptation Programme, drawing together cutting-edge research and the latest evidence on where and how changes to the climate could adversely affect human health. This includes direct impacts, for example through increase in the frequency of extreme weather events, and indirect, such as impacts on food supply or higher prevalence of vectors competent for transmission of certain types of disease.

This is an area of national and international significance, and it is integral to our core mission to be better prepared for and more resilient to future health threats. The HECC report is, therefore, a crucial means to capitalise on the advances in understanding that we have made over the last decade as well as to provide up to date scientific analysis to inform decision makers in considering how we can best respond to the evolving threat landscape.

Lastly, the COVID-19 Public Inquiry continues to be a priority for the agency. The public hearings for Module 2 (core UK decision-making and political governance) are due to begin on 3 October. The Provisional Outline of Scope for the Module includes a number of areas that will have relevance to UKHSA and to predecessor organisations, including around the provision and use of expert (clinical and scientific) advice in relation to decisions on strategy and interventions. This may also touch on decisions leading up to the establishment of UKHSA. A corporate witness statement on Module 3 (impact of COVID-19 pandemic on healthcare systems in the 4 nations of the UK) will also be submitted to the Inquiry shortly by Susan Hopkins on behalf of the agency.

Update on activities

Since the last meeting of the Advisory Board, we have stood up and subsequently de-escalated one national-level enhanced incident. This was in relation to the detection of Legionella bacteria in the water systems of the Bibby Stockholm barge, which had entered into use as asylum seeker accommodation. Given the pre-existing media interest in issues relating to asylum seekers, and the Bibby Stockholm in particular, this has received a high level of coverage.

Legionella sampling was undertaken on the Bibby Stockholm Barge in July, commissioned by Environmental Health Officers from Dorset Council and subsequently processed at UKHSA’s laboratory at Porton Down. Following notification of consistent high levels of legionella detected in samples, we instigated an incident response and undertook a public health risk assessment.

The assessment concluded that, based on the available information there was a risk of exposure to legionella for individuals residing and working on the barge, and advised that no further embarkation should take place to avoid any additional exposures. Home Office took the decision to remove all 39 residents from the barge as a precaution and transfer them into alternative accommodation. To date, no cases of legionella infection have been detected in individuals at risk of exposure and the time passed since potential exposure now exceeds the incubation period for the disease.

We have remained vigilant in management of the continuing global outbreak of mpox (monkeypox), which began last year. So far in 2023, the total number of cases in England is now 44 (21 are presumed acquired in the UK, 19 imported and 4 unclassified). We are closely monitoring recent cases detected in Manchester which were likely acquired in country. We issued targeted Warn and Inform communications around mpox to coincide with Manchester Pride, which took place over the bank holiday weekend (25 to 28 August), to increase awareness.

On 22 August, we also announced the launch of a £1 million research study called PRIME, funded by the Medical Research Council, to better understand asymptomatic transmission of mpox.

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. These include the following incidents.

COVID-19 BA.2.86

As noted above, a new COVID-19 variant, designated BA.2.86, has been identified in a number of countries. Cases have been confirmed globally through sequencing, including in the UK. A small number of countries have also reported detections in wastewater. It is important to note that, although the numbers are low, the levels of testing and sequencing are also now much lower than at the height of the pandemic.

This variant is a sub-lineage of Omicron with more than 30 mutations relative to Omicron and more than 50 relative to wildtype COVID-19. However, there is currently limited information on transmissibility, severity, and vaccine evasion and the actions taken in accelerating the autumn vaccination programme are precautionary to protect the most vulnerable population cohorts while we seek to determine the extent to which these parameters may have changed. Our variant technical group published an initial risk assessment on 18 August and a situational assessment on 1 September. We will publish further technical advice as our understanding develops.

Shiga toxin-producing E. coli (STEC)

25 cases of STEC have been confirmed from samples taken between late-May and mid-July, with a geographic spread across all four nations of the UK. Investigations through incident control response arrangements involving all 4 UK health protection organisations are ongoing to seek to determine the source of infection; however, as no new cases have been reported since 5 August, the incident has now been de-escalated to a routine response.

Listeria

We are continuing to work closely with Public Health Scotland, Public Health Wales, the Food Standards Agency and Food Standards Scotland on an outbreak of listeriosis that has been linked to listeria in smoked fish. As is the recognised concern with these incidents, the outbreak has predominantly affected older people, severely immunocompromised and vulnerable groups who are known to be prone to more severe outcomes from listeriosis. There have been 19 cases including one pregnancy associated case and 4 deaths, making this the largest listeriosis outbreak in the UK in the last 20 years.

Vaccine-like poliovirus

We have identified no new isolates of poliovirus type 2 from samples collected since 8 November 2022. Once we have passed 12 consecutive months with no new detections the World Health Organization (WHO) will be able to confirm that there is no longer circulating vaccine derived poliovirus type 2 in the UK. We are in the process of transitioning ongoing surveillance activity to business as usual, which will allow the national level incident to be stood down.

Diphtheria

Since the beginning of June, a rise in migrants travelling to the UK has been observed, however case numbers remain low. Only 2 cases of diphtheria have been confirmed to date for 2023 (an increase in one since the last Advisory Board meeting). We continue to recommend mass antibiotic prophylaxis and vaccination within a focused protocol while challenges remain or until the risk of diphtheria in Europe has decreased sufficiently to suggest further importations are unlikely.

Tuberculosis (TB)

We are currently responding to a cluster of TB cases of the same strain. At least one of the cases is likely to have been acquired outside of the UK. However, there is evidence to suggest transmission may have occurred within the UK and the national response is focussed on supporting identification and tracing of contacts as these are geographically dispersed.

Last month I travelled to Pakistan to experience some of our critical global health work first hand. I was hosted by our local International Health Regulations (IHR) Strengthening Project team, who oversee delivery of peer to peer technical expertise to support and enable public health partners to prepare, prevent, detect and respond to global health threats.

Work in Pakistan, commenced in 2016 and funded by the Foreign, Commonwealth and Development Office through the Department of Health and Social Care, has focused on supporting the development of national infectious disease surveillance systems. Huge strides in both practical and political enablement have taken place in that time frame, with strong leadership throughout from Dr Anne Wilson, Clinical Consultant in Global Health and an in country recruited UKHSA team. The system has already evidenced wider value through utilisation during the recent severe flooding.

I had the opportunity to meet with senior representatives from Pakistan’s Federal Ministry of Health to discuss their work in managing and protecting against infectious diseases and UK-Pakistan collaboration as well as Ministers and senior professionals from the Punjab provincial government and the National Institute of Health. I also visited local laboratories in both Islamabad and Lahore to see their work on genomic sequencing, strengthening Pakistan’s response to global health security challenges as well as opportunities for growth of national capabilities for vaccine production for the future.

It will come as no surprise given our location for this meeting, but on 1 August, we formally took possession of the 5th floor of the UK government hub at 10 South Colonnade in Canary Wharf as our new London headquarters. We have now completed the move and I would like to express my particular thanks to the project, facilities, and IT teams for their excellent work for making this as seamless as possible. I know that many colleagues will, like me, have already found the space to be much more collaborative and with vastly better IT and facilities. These are improvements that we are looking to replicate across our other regional and specialist team hubs as well.

Professor Dame Jenny Harries
Chief Executive Officer
September 2023