Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 3 November 2022

Title of paper: Chief Executive’s Report
Date: Thursday 29 September 2022
Sponsor: Jenny Harries

Purpose of the paper

This report gives a brief overview of UK Health Security Agency (UKHSA) from the perspective of the Chief Executive.

Recommendation

The Advisory Board is asked to note the update.

Establishing UKHSA

The establishment of UKHSA is a unique opportunity to improve how the UK identifies and tackles health threats, drawing on learning from the pandemic, as well as building an organisation at the heart of the UK’s ongoing development and economic contribution as a global Science and Technology superpower. Our establishment acknowledges the need and significant internal ambition to make the UK better prepared to protect people’s lives and livelihoods and to fully realise the UK’s scientific excellence across both the public and private sector.

UKHSA is an executive agency of the Department of Health and Social Care (DHSC) – accountable to ministers for delivering its remit of preventing, detecting, analysing, and responding to external health threats including those of chemical, biological, radiation and/or nuclear origin. We are already a globally recognised leader in high quality, evidence-based health protection and associated scientific development.

UKHSA is a Category One responder under the Civil Contingencies Act and provides Emergency Preparedness and Response training and exercises for our own staff as well as cross-government and external stakeholders. We routinely manage around 10,000 health protection incidents a year in England under clear UK tiered response arrangements as well as share provision of the UK Public Health Rapid Support Team (UKPHRST) – a multidisciplinary team deployed at pace to support significant international response with World Health Organization (WHO) and other partners.

Currently we have 2 national UK enhanced incidents running (monkeypox and polio) – our highest-level incident response category – and have been instrumental in enabling the UK to move to Living with COVID-19.

Connecting with other nations and international public health institutes has been one of my early priorities for UKHSA. In recent months good progress has been made on strengthening existing partnerships and building new ones. We have memorandums of understanding with the European Centre for Disease Prevention and Control, Africa Centres for Disease Control and Prevention, the Nigeria Centre for Disease Control, Zambia’s National Public Health Institute and Ministry of Health, the West Africa Health Organisation and the Korea Disease Control and Prevention Agency. These collaborative partnerships strengthen global security and help us to share scientific insights and surveillance data.

Progress has been made in establishing a Centre for Pandemic Preparedness inside UKHSA. The aim of the Centre will be to bring together the UK’s existing and new pandemic expertise, data, research and surveillance – building on the learnings from the pandemic and enabling a UK-wide network of similar institutes.

Although the past 2 years have been immeasurably damaging to people’s lives and livelihoods, it has also been a catalyst for developing new health security capabilities. Advances in biomedical and genomic technologies have enabled the UK to develop vaccines and therapeutics at pace; new information technologies and systems have allowed real-time data, improved surveillance, and better coordination of local, national, and regional health system; and new partnerships in academia, industry, and across government have enabled us to better responds as one coherent system.

Strategy and business planning

Building a new organisation has been a complex task, and UKHSA has both significant organisational challenges and opportunities in establishment. We have brought together 3 organisations (NHS Test and Trace, the health protection functions of Public Health England, and the Joint Biosecurity Centre) along with the Vaccine Task Force joining us next month. This comes with a myriad of complexity in cultures, IT systems, terms and conditions but also varying missions.

UKHSA received its financial settlement at the end of March 2022 and we have been focused on planning how this budget can be invested to achieve the biggest impact on the public’s health. The government has also published UKHSA’s remit letter which sets out a shared ambition and targets for this year.

We will set out more detailed plans on how we will deliver the objectives in the remit letter in our first business plan and first 3-year strategy in the autumn. In particular, our focus will be on delivering a world leading response to health protection incidents, including the ongoing response to COVID-19; and building the capability and capacity of our science and supporting our excellent staff.

I am also working to develop relationships across government and the broader UK and international health system. We will do this in line with our values – ensuring that we are relentlessly impactful, insightful and inclusive.

The remit letter, strategy and business plan will show how our resources – including the significant income we generate from our scientific activity – deliver the UK’s priorities. At a time of rising living costs, it is vital that we can demonstrate value for the taxpayer in delivering public health outcomes and protecting the economy from health shocks.

Current infectious disease and health hazard responses

Working with the NHS and Directors of Public Health across England, with the Devolved Administrations and directly with the public, UKHSA routinely provides expert support and oversight to over 10,000 incidents each year, the majority at a local or regional level. Key recent or ongoing national level incidents include:

Monkeypox

The current outbreak is the first global outbreak of monkeypox and was declared a Public Health Emergency of International Concern by the WHO Director General on 23 July 2022. As of 23 August, there were 3,355 cases in the UK – with clear community transmission.

There is no robust evidence of sustained transmission outside sexual networks of gay, bisexual and other men who have sex with men (GBMSM). A high proportion of cases in England are London residents (70%) and approximately 5% of cases have needed hospital admission but with no reported deaths.

While case numbers continue to increase, we now estimate that the R number to be below 1, suggesting the number of new people getting the infectionhas reduced. The estimate of new cases is around 20 per day. At the previous peak of the epidemic in mid-July we saw about 60 to 65 new cases per day in London alone.

UKHSA’s aim is to suppress transmission and minimise the public health impact in the UK. Given cases have been confirmed in more than 90 countries we will continue to see new cases introduced from other countries. However, targeted interventions to support those at the highest risk of transmission; protecting against transmission in healthcare settings; and working with at risk communities to help break chains of transmission are showing early signs of success.

The UK moved quickly to secure all readily available vaccine supplies from the single vaccine supplier at the start of the outbreak as well as further additional procurement – a total of more than 150,000 doses. So far, 54,000 doses have been received and more than 45,000 administered with a further 100,000 due for delivery in September. The UK was the first to publish its outbreak control vaccination strategy as well as a key portfolio of research requirements to guide greater learning through the outbreak and beyond – including monitoring the changing genomic profile and so on.

On 22 August, we announced that vaccines would be piloted in smaller but equally effective doses using fractional methods. This approach has the potential to increase the amount of vaccine available by up to fivefold. In addition, UKHSA has procured over 1,000 courses of Tecovirimat – a therapeutic treatment for those with severe clinical disease and for use within a fully evaluated clinical trial of earlier intervention.

COVID-19

Following the publication of the government’s Living with COVID-19 strategy in February, an appropriate rapid, phased step down of testing has been completed alongside decommissioning of lab capacity, physical testing sites and tracing capability. Critically, contingency arrangements to rapidly stand- up capacity if necessary have been retained and we continue to support the development of the private testing market, the surveillance programme and contingency planning.

The Office for National Statistics (ONS) COVID-19 Infection Survey, for which 300,000 swab tests and around 120,000 blood tests are completed each month to estimate national prevalence has been retained as the main national surveillance tool. Additionally, the Vivaldi and the SARS-CoV-2 immunity and reinfection evaluation (SIREN) studies investigate COVID-19 case rates in adult social care and the NHS.

The development and deployment of current and novel vaccines remains the most significant current national COVID-19 defence intervention and from the end of September UKHSA will also work with stakeholders on COVID-19 immunisation, in particular providing clinical advice and guidance, and (through the Vaccine Taskforce) procurement of COVID-19 vaccines.

Poliovirus in London wastewater

UKHSA responded to the identification of vaccine-like poliovirus in London sewage between February and June 2022. These detections occur when an individual vaccinated overseas with the live oral polio vaccine (which is no longer used in the UK) travels to the UK and briefly ‘sheds’ traces in their faeces. This year several closely related viruses have been found. In some samples the virus has now been consistently found to have evolved and is classified as a ‘vaccine-derived’ poliovirus type 2 (VDPV2). There appears to have been virus transmission across north London.

On rare occasions, VDPV2 can cause serious illness, such as paralysis, in people who are not fully vaccinated. UKHSA is working closely with the NHS to ensure children aged 1 to 9 in London are vaccinated; with the Medicines and Healthcare products Regulatory Agency to increase our waste water testing; and with colleagues in New York, Israel and the WHO to investigate the potential links between cases.

Hepatitis of unknown cause in children

UKHSA has been investigating an unusually high number of sudden onset hepatitis in children aged 16 and under. No children have died, but infections have been so severe that 15 have needed to receive liver transplants. Several other countries have also reported cases.

UKHSA’s ongoing investigation continues to suggest an association with adenoviruses – a family of common viruses that usually cause mild symptoms including colds, vomiting and diarrhoea from which most people recover without complications.

Avian flu

The UK has been experiencing the largest outbreak of avian influenza on record. On rare occasions, avian influenza can be transferred to humans via close contact with infected birds with potential for severe disease. The Department for Environmental, Food and Rural Affairs (DEFRA) and Animal and Plant Health Agency (APHA) are leading the response to avian influenza in birds with UKHSA managing the risk to human health. UKHSA developed a pilot for asymptomatic swabbing of exposed persons in England to detect emerging respiratory virus threats.

Ukraine conflict

UKHSA continues to monitor the health security impacts associated with the war in Ukraine. Many displaced populations are likely to be at increased risk of communicable diseases (for example COVID-19, measles, polio) as well as tuberculosis and HIV primarily due to closer social mixing as well as vaccination coverage gaps, poor access to health care and poor living conditions.

UKHSA has been providing advice and training to, and with, the public health authorities in Ukraine.

Achievements and opportunities

In August I received a letter from Health Minister Maggie Throup confirming the UK Health Security Agency’s role for the financial year 2022 to 2023. The remit letter included thanks to all of UKHSA’s staff for their ‘significant achievements in responding to COVID-19, and in other areas including monkeypox, hepatitis C and HIV’. It is clear that UKHSA’s core achievement since October 2021 has been our rapid and agile response to Omicron, the efficient closing of Test and Trace infrastructure and the move to Living with COVID-19.

Beyond this, and in addition to the above incidents, across the year we have; detected and alerted salmonella in chocolate and listeria in smoked salmon; continued to deliver our national action plans on tuberculosis, HIV, and antimicrobial resistance (AMR); and led the government response to the summer heatwaves. This is whilst building a new agency and preparing for the winter.

Beyond operations, organisationally we have confirmed that the Vaccines Taskforce will transition into UKHSA in October, complementing our existing vaccines and immunisation work. The transfer of functions to UKHSA is an exciting opportunity for us, and one which helps us realise new ambitions as a global scientific leader working hand in hand with industry. I look forward to welcoming our new colleagues and the invaluable expertise they will bring.

We are establishing UKHSA as the system leader and enabler for health protection across the UK. UKHSA’s first scientific conference on 18 and 19 October is a further opportunity to bring together a range of partners and colleagues to share the breadth of knowledge and research across the system.

Operational pressures and challenges

The Terms of Reference for the COVID-19 Inquiry have been confirmed. I have established a Public Inquiry Team to lead our engagement with the public inquiry and ensure that we are able to quickly learn all of the lessons from the Inquiry.

In line with the Living with COVID-19 plan, we have significantly scaled back our workforce and budget. Our workforce was 18,000 at its peak, with 0% being filled by non-permanent staff and temporary resource. We currently have 6,800 FTE and will have reduced to 6,700 FTE by March 2023. As part of this we have ramped our tracing service down from 26,000 FTE (including outsourced contracts) to 90, closed all of our 580 test sites, and ended our reliance on consultancies and contractors.

Much of UKHSA’s value is contained within our unique and critical skill set. Over 3 quarters of UKHSA employees are providing frontline delivery services who have a skills and qualification base that is not typically found in the Civil Service (for example laboratories, local health protection teams, operational data analytics).

Recruiting to enduring roles within the structure is vital to enabling UKHSA to deliver its priorities at the right quality but at a reduced cost and we anticipate only a small reliance on contractors within specialist, flexible and time limited roles particularly within Technology and Data, Analytics, and Surveillance teams.

The above are existing and enduring challenges. Over the coming months I expect to add to that list the winter pressures associated with COVID-19, monkeypox, flu, the vaccination programme and the cost of living. This will be challenging but I fully expect our staff, supported by the new capabilities that we have built, to rise to that challenge.

In helping us meet these challenges I welcome the appointment of the Advisory Board and establishment of its committees as sources of advice, guidance and challenge. The board members, and their diverse skillsets, will be critical in the coming months and years.

I would like to thank all UKHSA colleagues and multiple partners across the public and private sector. Our work is only possible due to their dedication and expertise. I am proud to work with all of them to protect the nation’s health.

Jenny Harries, Chief Executive, September 2022