Corporate report

UKHSA Advisory Board: Chief Executive’s report

Updated 22 May 2023

Date: Wednesday 24 May 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

Since the Advisory Board last met in March, pressure on NHS healthcare services from infectious disease over the winter period has eased. The trends we are observing for seasonal conditions are now broadly as we would expect for this time of year. Flu and other seasonal respiratory conditions have fallen and remain stable at a low level. Conversely, we are seeing an increase in primary care presentations of allergic rhinitis linked to increases in tree pollen in line with seasonal expectations. After an atypical peak before Christmas, invasive group A streptococcal disease (iGAS) cases continue to decline and are now close to the pre-pandemic (i.e. 19/20) five-year average – noting that rates still remain relatively high in keeping with the normal seasonal peak time. The incident will continue to be monitored under routine incident response arrangements.

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 put in place to reduce the risk of wider resurgence. As a 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 measles, mumps and rubella (MMR) vaccine in England is at its lowest level in a decade - 89% in 2 year olds and 85% in 5 year olds, well below the 95% target. The World Health Organisation (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.

We are also jointly investigating, with Public Health Wales, an exceedance of cases of severe myocarditis (heart inflammation) associated with enterovirus infection in babies in the first month of life. All of those confirmed to date are geographically clustered in South-West England and South Wales. The majority occurred from September to December 2022. There do not appear to be cases elsewhere in the country, and there are no reports of similar clusters around the world. We are working closely with Public Health Wales and the WHO. We have published a technical briefing note to support ongoing retrospective and enhanced surveillance which was published in the first week of May.

Our ongoing management of COVID-19 continues on a business-as-usual approach, more akin to our management of other respiratory viruses. Hospital admissions and occupancy related to COVID have been declining for several weeks and there are no current signals of a change in this pattern. The COVID Spring Booster programme is well underway, and planning is already in progress for a possible Autumn Booster campaign.

As of 1 April, changes have been made to the ongoing setting-specific testing regimes. The amount of routine asymptomatic testing in healthcare and social care settings has reduced in line with the epidemiological context and vaccination continues to be focused to protect those at higher risk of lowering immunity. Testing has been prioritised for symptomatic cases and outbreak management, and we have moved to predominant use of responsive LFD tests rather than PCR although the latter are readily available for all clinical appropriately use contexts. The responsibility for delivery of testing in NHS settings will transfer to the NHS from October.

The COVID Infection Survey has also been paused since the beginning of April, and so surveillance data focused on primary care and hospital services are now the major sources available. This, combined with the reduction in PCR testing, means that fewer samples are available for genomic sequencing, and we have therefore suspended routine publication of our variants technical briefing. The last briefing was published on 21 April although our technical teams are continuing to sequence and monitor domestic and international variant development

Public interest in avian influenza remains high domestically and globally. In Chile, a human case of A(H5N1) was confirmed in April - most likely through direct exposure to infected birds and with no evidence of onward transmission - and in China the first human death from H3N8 Avian Influenza has been reported. The current risk to the public is low and we remain risk level 3 of 6 (limited mammalian transmission excluding humans). UKHSA has been conducting an Asymptomatic Avian Influenza Surveillance Study, which tests exposed workers at infected poultry farms. The study involves collecting nose and throat swabs to understand the potential for asymptomatic infection and spread of avian influenza for people exposed to or working with birds that are infected or are suspected to be. The study is ongoing and to date there have been 42 participants tested. Active detailed review of very limited positive test results form part of the study response arrangements.

We are actively monitoring several ongoing health incidents internationally. This includes separate outbreaks in Nigeria of diphtheria (centred around Kano state) and of meningitis (centred around Jigawa state). Both are assessed to be of high risk at national level, but low at global level. Given the strong travel and community links between the UK and Nigeria we continue to monitor closely.

The outbreak of Marburg virus in Equatorial Guinea continues, with new cases reported on 18 and 20 April. There has also been a confirmed outbreak of Marburg virus in Tanzania, the first confirmed in the country. No new cases have been reported in Tanzania since early April and subject to no further cases emerging the outbreak there will be declared over on 31 May. Both outbreaks are assessed to present very low risk to the UK.

Turning to organisational matters, since the last Advisory Board in March, Ministers have approved our core resource budget for 2023/24 and 2024/25. The fact that this is a 2-year settlement is of particular importance, allowing UKHSA to deliver transformation to a steady state and to stabilise and invest in critical health protection capabilities. Being a leaner organisation than we are now and continuing to strive for further opportunities for more efficient ways of delivering quality public health outcomes will remain critical components of prioritisation of our resources and we will be seeking the Advisory Board’s input on our corporate strategy as part of this process. Budget holders have now received delegation letters with their indicative allocations and are developing their group level business plans, to feed into the overall Agency business plan for publication in the summer.

The Public Inquiry into COVID-19 held a preliminary hearing on Module 1 (pandemic preparedness) on 25 April. This confirmed that the first hearing will take place on 13 June and witnesses are being invited to give evidence at hearings through the second half of June and through July. We have also received a supplementary request for evidence following our initial Module 1 submission, with a response to the additional questions provided Inquiry earlier this month. In parallel we continue to work on our response to the Module 2 (core decision making) request for evidence and await a request for evidence for Module 3 (impact on healthcare systems).

March and April were busy months for our engagement with our global partners. Prof. Steven Riley gave a keynote speech at the new WHO Pandemic Hub in Berlin on pandemic data preparedness and visited the US CDC to share learning from COVID-19 and understand more about their analytics capabilities. Alongside Prof. Isabel Oliver and Philippa Harvey, I travelled to Washington D.C. to attend the World Vaccine Congress, which provided an excellent opportunity to meet with academic and industry partners from across the globe. UKHSA was also represented at a range of other international events including at the WHO in Geneva and the International Association of Public Health Institutes (IANPHI) Europe Annual meeting in Lisbon.

We have also had an increase in Parliamentary engagement in recent months. In April, I attended the Health and Social Care committee alongside our Director of Public Health Programmes, Dr Mary Ramsey, and the Chair of the Joint Committee on Vaccination and Immunisation (JCVI), Prof. Andrew Pollard, to give evidence on the role of our immunisation programmes in supporting prevention. Also in April, Prof. Isabel Oliver joined a session of the Science, Innovation, and Technology Committee covering current research into the potential use of bacteriophages (viruses that target bacteria) as a treatment for antibiotic resistant strains. In May, Dr Edward Wynne-Evans gave evidence to the Lords’ Science and Technology Committee on the effects of light and noise pollution on human health.

On 28 April, we published our first combined Adverse Weather and Health Plan. This brings together in one place the different guidance and plans that we have for weather-related health risks including for heat, cold, and flooding events. It also seeks to improve our guidance and deliver a series of outcome focused goals to protect individuals and the resilience of our health system. Alongside this we have developed a new Weather Health Alerts system in collaboration with the Met Office to provide targeted advice to health and social care providers and individuals on appropriate mitigating actions during an adverse weather event.

As a final point of interest, I would invite the Board to note that on 18 May we will be holding the first ‘We are UKHSA Awards’. This is an opportunity to celebrate the exceptional work of colleagues across all aspects of the Agency and how they contribute to the health of nation, our expert science, and making UKHSA an excellent place to work. It builds on the success of similar events in our predecessor organisations and follows a similar model to the Civil Service People Awards.

Current health security responses (as of 4 May)

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. We are 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. A Dynamic Risk Assessment has recommended that the incident be de-escalated to a standard incident once funding to support routine polio surveillance activity can be put in place.

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.

Sudan: UKHSA supported the cross-Government programme for evacuation of British nationals from Sudan due to the ongoing conflict as a standard incident. This included assessment of the potential infectious disease risks for individuals being repatriated (specifically TB) and ensuring the right guidance was available to clinicians in the UK to identify imported infections in this cohort. The incident was stood down on 2 May alongside the cessation of flights.

Neonatal Myocarditis: As noted above, this has been escalated to a ‘Standard’ Incident while epidemiological investigations are ongoing.

Other Standard Incidents: We continue to respond at a ‘Standard’ Incident level to iGAS, Grenfell Tower Fire air quality monitoring, and Pseudomonas Aeruginosa.

Jenny Harries
Chief Executive
May 2023