Correspondence

Letter from Maggie Throup to Professor Dame Jenny Harries, UKHSA chief executive

Published 12 August 2022

From:

The office of Maggie Throup
Parliamentary Under Secretary of State for Vaccines and Public Health
39 Victoria Street
London
SW1H 0EU

To:

Professor Dame Jenny Harries
Chief Executive
UK Health Security Agency
Nobel House
17 Smith Square
London
SW1P 3HQ

Dear Jenny,

UK Health Security Agency strategic remit and priorities

This letter sets out the government’s priorities for the United Kingdom Health Security Agency (UKHSA) for the period April 2022 to March 2023. Given the urgent work on the Omicron response and the implications for the spending review, which were agreed in late March, I acknowledge with thanks your work in the last 4 months before this letter has been issued.

UKHSA has brought together staff and capabilities of NHS Test and Trace, the health protection elements of Public Health England, the Joint Biosecurity Centre and, since April 2022, the Managed Quarantine Service to strengthen health protection capability across the UK.

I would like to thank all UKHSA’s staff for their:

• tireless efforts to establish the agency in a complex and challenging context
• significant achievements in responding to coronavirus (COVID-19), and in other areas including monkeypox, hepatitis C and HIV
• work to build relationships with partners across the health and care system, government and the UK

UKHSA is our permanent standing capacity to prepare for, prevent and respond to threats to health. Its responsibilities are for England, across the UK on reserved health matters, and in partnership with lead agencies in Scotland, Wales and Northern Ireland on devolved issues where relevant.

Since its creation, UKHSA has necessarily dedicated a significant proportion of its time and expertise towards responding to COVID-19. The agency’s capacity to continue to respond to resurgences and new COVID-19 variants is being maintained in line with the government’s COVID-19 Response: Living with COVID-19 strategy, and this capacity to respond is scalable within funding limits. This is enabling UKHSA to continue the response to COVID-19 alongside focusing on a broader range of health security priorities during the year ahead.

As agreed in principle, the transfer of responsibilities of the Vaccine Taskforce (VTF) from September 2022 to UKHSA provides an opportunity for UKHSA to harness the strengths of the VTF, including its:

• excellent relationships with industry
• culture of delivering at pace
• expertise in innovation

Once responsibilities have been moved to UKHSA, progress will be assessed at an agreed point in the year.

UKHSA’s core remit

The Department of Health and Social Care (DHSC) delivers its responsibilities on behalf of the Secretary of State for Health and Social Care through UKHSA and other delivery partners, and is accountable to Parliament for effective delivery of their remit and services.

As an executive agency of the DHSC with operational autonomy, UKHSA will:

• provide strong national leadership on health security and health protection
• ensure a cohesive response across public health functions
• embed effective clinical, scientific and operational functions in the public health system

UKHSA will develop its global-to-local reach, working with international and domestic partners, and combining robust science and analytics, insightful planning and responsive operational excellence, to keep the nation’s health secure.

As the nation’s expert dedicated health security agency, UKHSA will:

• prevent: anticipate threats to health and help build the nation’s readiness, defences, and domestic and global health security
• detect: use environmental, digital and biological surveillance to proactively detect and monitor infectious diseases and threats to health
• analyse: use science and data analytics to assess and continually monitor threats to health, identifying how best to control and mitigate risks and impacts across all communities
• respond: take rapid, collaborative and effective actions globally, nationally and locally to mitigate and recover from threats to health when they materialise
• lead: lead strong and sustainable global, national, regional and local partnerships designed to save lives, protect the nation from public health threats, and systematically reduce disparities at scale

UKHSA will be expected to align with and, wherever applicable, input to relevant cross-system work including:

• manifesto commitments
• the COVID-19 Response: Living with COVID-19 strategy
• the Levelling Up the United Kingdom agenda
• DHSC’s Outcome Delivery Plan 2021 to 2022
• the NHS Long-Term Plan
• the health disparities white paper
• the vaccines future operating model
• Global Britain in a Competitive Age: the Integrated Review of Security, Defence, Development and Foreign Policy
• the UK government’s strategy for international development
• the development of the UK’s future relationships with the EU and the rest of the world

UKHSA will co-ordinate closely with the Office for Life Sciences to support delivery of the government’s Life Sciences Vision including the healthcare missions, and with DHSC on global health security policy. Research will be a high priority, including through collaborative programmes with academia and industry, particularly playing an important role in signalling to research funders key priorities for research.

UKHSA will be proactive in its approach to infection control and collaborate effectively across the public health system in order to prepare for, respond to and recover from all health hazards. This will involve building and sustaining strong, impactful relationships across local and national government, including with agencies in Scotland, Wales, Northern Ireland, the Crown dependencies, local authorities and other system partners across the UK to ensure threats are effectively identified, mitigated and addressed at home and abroad.

The agency will work alongside DHSC – including the Office for Health Improvement and Disparities (OHID), NHS England (NHSE) and NHS public health teams – on priority programmes.

UKHSA will also set out how it will work with tripartite partners (DHSC and NHSE) to plan for and respond to health emergencies, including infectious diseases and other health hazards.

UKHSA will work closely with the Chief Medical Officer (CMO), who is the UK’s most senior medical adviser and head of the public health profession. The CMO will be:

• the ultimate arbiter for advice on scientific and medical matters
• formally consulted on wider health protection strategy
• the professional lead for UKHSA’s most senior medical professional

The CMO will co-ordinate closely with UKHSA in support of the agency’s global health remit.

Additionally, UKHSA will be a trusted source of public health advice and scientific expertise to government, and will also work closely with CMOs for Scotland, Wales and Northern Ireland. UKHSA will synthesise its multiple areas of expertise into an organisational view, which can be used to advise the system, CMOs and relevant ministers.

UKHSA will need to develop a culture that invests in its people and nurtures talent, enabling it to attract and retain highly talented individuals in public health. To empower and enable its workforce to succeed, UKHSA will create a working environment where innovation, collaboration and continuous improvement are at the heart of everything it does. Underpinning this are UKHSA’s values of being impactful, insightful and inclusive, which are fundamental to achieving this goal. UKHSA will strive to improve its capability to ensure that UKHSA’s future workforce is equipped to deal with health hazards.

UKHSA will develop and agree specific deliverables, and ensure that the agency operates at optimal effectiveness and efficiency, and provides value for money. UKHSA will plan to use its resources in an affordable and sustainable manner, and within agreed limits as set out in the framework document between DHSC and UKHSA, and in accordance with its obligations to the DHSC with regard to financial management, forecasting and reporting. UKHSA will look to take advantage of any income generation streams that may arise from assets such as UKHSA’s laboratory network.

UKHSA will prepare comprehensively for the UK COVID-19 Inquiry and communicate transparently with DHSC. UKHSA will fully engage with the inquiry, including responding to evidence requests as required and providing appropriate support to any witnesses to the inquiry for whom UKHSA are responsible.

UKHSA’s priorities for 2022 to 2023

The detailed priorities are attached at Annex A. In summary, organised in 3 areas, during 2022 to 2023, the government expects UKHSA to:

1. Reduce harm from infectious disease and other health security hazards, and achieve more equitable outcomes.

UKHSA will look to reduce the harm from threats to health, including COVID-19, by ensuring effective emergency preparedness, resilience, response and the ability to flex capacity where required in response to health emergencies, including infectious diseases and other health hazards.

UKHSA will:

• take on relevant COVID-19 responsibilities of the VTF from September 2022, ensuring that key elements of its legacy are retained and strengthened through close engagement with industry, harnessing technical and commercial expertise, and centralised procurement
• provide public health expertise to support DHSC as the system leader in delivering chemical, biological, radiological, nuclear (CBRN) planning and response work
• continue to improve our immunisation programmes and combat antimicrobial resistance domestically and globally
• embed lessons learnt from COVID-19 by providing technical expertise, and contribute to the evidence base for how we respond in the future to improve the health and social care system

2. Prepare for future health security hazards so that our health, society, public services and economy are less impacted.

UKHSA will strengthen pandemic preparedness to ensure that it becomes embedded within national security structures so that the country is well positioned to respond to all threats to health. UKHSA will learn lessons from and build on the legacy of the response to COVID-19, while delivering a resilient and scalable infrastructure to protect against future pandemics, and health threats, including waves of COVID-19.

UKHSA will:

• deliver a resilient and scalable infrastructure, including testing to protect against future waves of COVID-19, future pandemics and wider health threats
• develop a new strategic approach to pandemic preparedness to prevent, detect, track and respond to public health threats rapidly, harnessing the power of advances in technology and data science such as genomic surveillance
• continue to maintain and deploy robust emergency clinical countermeasures and stockpiled medicines
• ensure robust response capacity and capability to respond to health hazards, including CBRN incidents

3. Strengthen health security capability to improve the effectiveness of our local, national and global response.

UKHSA will look to deepen the UK’s role in global health security through playing a leading role on the global stage and fulfilling international responsibilities.

UKHSA will:

• improve links to disease surveillance and detection beyond UK borders through ongoing collaboration, and information and data-sharing with international partners, and supporting delivery of the cross-government global health strategy
• ensure that the UK is playing a leading part in the development and implementation of international health security initiatives, and will drive improvements in global health security
• engage effectively with the World Health Organization (WHO) and other international partners on global surveillance initiatives to:
  • promote UK expertise
  • enable UKHSA to be at the forefront of the response to global threats to health, and to be pre-warned and prepared for health threats to the UK that may arise outside its borders – this has to be co-ordinated with and under the strategic direction of the wider UK government

Much of UKHSA’s work outlined during 2022 to 2023 is vital core activity that is central to the function and capabilities of the agency, and that it should be carrying out on a continuous basis year to year. This remit letter distinguishes this core activity from the specific actions for the year. Going forward, core activity will not be formally re-commissioned each year for the remit letter, streamlining the process.

UKHSA is still in a development phase. Notwithstanding this, UKHSA will undertake an efficient, effective and robust transition of the agency’s functions in line with the Response COVID-19: Living with COVID-19 strategy and the spending review settlement, through a staged process of reorientation, transformation and re-design of internal structures.

DHSC and UKHSA will take the necessary time to develop and agree pragmatic and specific deliverables aligned to this remit letter.

Annex A: detailed priorities for UKHSA in 2022 to 2023

1. Reduce harm from infectious disease and other health security hazards

Response to public health emergencies

As a category 1 responder under the Civil Contingencies Act 2004, UKHSA will work with DHSC and NHSE to provide effective emergency preparedness, resilience and response to all public health emergencies. This includes surveillance, analysis, risk assessment, and management of and response to infectious disease incidents and outbreaks, building on the advice from its expert advisory committees where appropriate.

As part of its core activities, UKHSA will:

• take responsibility for the response to incidents on which UKHSA have a leading role, particularly at local and regional levels through health protection teams
• notify DHSC, NHSE and other system partners, and respond to incidents that meet escalation thresholds
• contribute to the development of relevant standard operating procedures, and review contingency plans for national security risk assessment (NSRA) and other health and social care system risks as required
• contribute expertise to cross-government resilience policy development
• collaborate in the delivery of CBRN planning and response work from a public health standpoint, co-ordinating with DHSC, across government and internationally
• set out how UKHSA will work with tripartite partners (DHSC and NHSE) to plan for and respond to infectious disease incidents, outbreaks and health security hazards

In addition, in 2022 to 2023, UKHSA will provide expertise to the National Resilience Strategy and Civil Contingencies Act 2004: post implementation review.

UKHSA will support a joined-up and UK-mindful approach to health security and health protection, embedding UK governance and engagement across all UK-wide programmes by building on collaborative action already in train, and drawing on lessons and experiences as appropriate.

As part of its core activities, UKHSA will:

• lead on delivering governance and engagement across UK-wide programmes
• promote regulatory alignment, and coherent access and interventions across the UK
• capitalise on collaborative opportunities to protect UK citizens
• deliver the secretariat function for the Four Nations Health Protection Oversight Group

In addition, in 2022 to 2023, UKHSA will:

• collaborate with Scotland, Wales and Northern Ireland and local or regional public health bodies responding to the COVID-19 pandemic
• deliver the programme of work agreed under the Public health protection and health security: provisional common framework, working alongside DHSC and Scotland, Wales and Northern Ireland

Vaccinations, immunisations and treatments including antivirals

From autumn 2022, UKHSA will take on responsibility for COVID-19 vaccine supply from the VTF, and ensure we build on the VTF’s legacy by retaining many elements of its structure, approach and culture, including through close engagement with suppliers, utilising technical and commercial expertise, and centralised procurement. This will cover existing and future contracts for vaccine supply including the recently announced Heads of Terms with Moderna. This includes:

• transitioning VTF core functions to UKHSA to:
  • ensure its innovative operating model, skills and close links with academia and industry are retained for all vaccine technologies
  • support UKHSA’s future ambitions as a global scientific leader. In particular, anticipating and fostering developments in vaccine technology, and exploring opportunities regarding research and development, manufacturing, supply chains and delivery by working closely with developers and clinical experts. This should include horizon-scanning for COVID-19 and assessment of other threats to which vaccination could be part of the response
• building off the experiences of the VTF, UKHSA may be required to surge this function to respond to an emergency, such as a new COVID-19 variant or novel pandemic threat. This may include the need to:
  • expand and strengthen ministerial and senior leadership
  • incorporate further expertise
  • re-strengthen links across the vaccine landscape
  • increase resource

UKHSA will contribute to improving our childhood and adult immunisation programmes, and drive maximum uptake, and aid in regaining the UK’s measles elimination status, and the sustaining of our rubella and polio status.

As part of these core activities, UKHSA will:

• collaborate with system partners, including NHS organisations, in the delivery of vaccination programmes, and advise on vaccine effectiveness and changes to these programmes
• actively collaborate with NHSE, as the delivery partner, to regain target coverage of 95% for 2 doses of measles, mumps and rubella (MMR), including advising on actions to reduce disparities in MMR vaccine uptake
• manage vaccine storage and distribution facilities
• in co-ordination with DHSC and partners, maintain and manage supply of centrally procured vaccines, including response on supply disruptions, and devising management and communications plans
• ensure and assure the end-to-end security and resilience of vaccine supply chains against risks to both supply and demand
• work across government to ensure systems of protecting and monitoring against health disinformation, including disinformation that encourages vaccine hesitancy
• deliver public health guidance and communications, supporting vaccine uptake and equity of access
• work with tripartite partners to deliver improvements to vaccination data to allow for timely and targeted action, prioritising MMR to improve coverage of this essential programme, but with a longer term aim to deliver data solutions for other routine programmes
• improve vaccine data with health system partners to allow timely and targeted action
• support the Joint Committee on Vaccination and Immunisation (JCVI) with modelling, secretariat and expertise, maintaining a leading role on clinical oversight and guidance, including Green Book updates and patient information management
• identify and provide advice on reducing disparities in vaccination coverage
• hold the secretariat for the UK-wide Vaccine Shortages Response Group
• maintain and contribute to the design, development and implementation of an effective operating model for routine immunisation programmes

In addition, in 2022 to 2023, UKHSA will be prepared to contribute to the development of a future vaccine strategy

UKHSA will collaborate with partners on the design, development and implementation of a future operating model for COVID-19 and influenza vaccination programmes. It will drive COVID-19 awareness, engagement and take-up of vaccinations, and support maintenance and supply of antivirals to ensure continued deployment of life-saving treatments for COVID-19.

As part of these core activities, UKHSA will:

• support equitable access to testing and treatments. This will include testing to support access to treatments for those at higher risk of serious illness and those currently accessing treatments through COVID-19 medicines delivery units, as well as supporting the transition of testing for treatment to primary care (NHSE-led) from UKHSA
• provide adequate surveillance and sequencing to aid understanding of antiviral or therapeutic efficacy to tailor deployment models and products
• maintain a scalable role to deliver the above activity, responding to localised outbreaks and to new variants of concern as they emerge
• prepare and manage supply and current stockpiles of antivirals, including current supplies, any buffer stock and longer-term stockpiles, which will be built up as part of the Antivirals and Therapeutics Taskforce procurement
• lead on distribution of medications to relevant delivery partners across the NHS in secondary and primary care, and in Scotland, Wales and Northern Ireland
• provide antiviral medications deemed to be cost-effective by the National Institute for Health and Care Excellence (NICE) for future COVID-19 waves, and/or for application in other viruses where oral antivirals are likely to have efficacy

In addition, in 2022 to 2023, UKHSA will support the transition of testing for treatment to primary care (NHSE-led) from UKHSA.

Response planning for the 10 key health hazards

UKHSA will continue work on surveillance and response to a range of health hazards, in particular the main transmission disease routes (gastrointestinal, respiratory, sexual, touch, vector-borne and blood-borne) as well as CBRN and big event disasters.

UKHSA will review and assess the public health risks, set out the appropriate mitigation and contingencies, and review the appropriate levels of preparedness against these to establish our enhanced response capability.

Health surveillance and data exploitation

UKHSA will lead in developing a strategic system-wide approach to health surveillance and data use to inform action at national and local level. This should cover communicable and non-communicable diseases, including measurable action on disparities.

FAIR (findability, accessibility, interoperability and reusability) principles should be at the heart of UKHSA’s data strategy.

As part of its core activities, UKHSA will:

• collaborate with system partners on surveillance systems, data management and data infrastructure to ensure availability of data to support public health purposes, nationally and locally
• develop and share with partners, such as the JCVI, modelling capabilities within UKHSA to enable analysis and planning for infectious disease threats
• contribute to epidemiological and health monitoring products produced by OHID, which have health protection components – for example, the health profile for England and Public Health Outcomes Framework

Tuberculosis action plan

UKHSA will collaborate with regional OHID and NHS public health teams on the delivery of the Tuberculosis (TB): action plan for England (2021 to 2026) with the aim to achieve a year-on-year reduction in TB incidence and in-UK TB transmission, and enable the UK to meet its commitment to the WHO elimination targets by 2035.

Adult social care

UKHSA will provide advice and support, working with policy makers, local authorities and wider sectoral partners and stakeholders to protect adult social care settings and populations from new and existing threats.

In 2022 to 2023, UKHSA will

• provide advice on ongoing offers for COVID-19 and flu vaccines within the adult social care system, including optimal coverage of vaccinated staff within settings
• collaborate with key stakeholders in building better systems to respond to future health security threats, including delivery of contingency planning (against plausible scenarios) such as winter planning
• lead on development and support the delivery of the Health and Social Care Act 2008: code of practice on the prevention and control of infections, including supporting infection prevention and control (IPC) best practice within the adult social care system
• embed lessons from COVID-19 to improve the adult social care system
• contribute to work on effective and up-to-date COVID-19 guidance on the operation of adult social care day services

Health equity and our place-based approach

Support delivery of the DHSC’s approach to health disparities, co-ordinating with partners to ensure all members of the community are, as far as possible, equally protected from health threats.

As part of its core activities, UKHSA will:

• develop and implement an internal UKHSA health equity strategy
• protect the most deprived populations, including the Core20 and inclusion health groups – such as people experiencing homelessness and rough sleeping, vulnerable migrants and detained populations – from the impact of infectious diseases and other health hazards

In addition, in 2022 to 2023, UKHSA will support the development and delivery of an effective and proportionate COVID-19 testing regime within vulnerable settings, incorporating the different risk levels relative to the wider population

UKHSA will enhance the resilience and scalability of national and local public health systems, including by incorporating lessons learned from COVID-19. As part of these core activities, it will strengthen resilience of national and local public health systems through the Future of the Local Health Protection programme. In addition, in 2022 to 2033, UKHSA will deliver a strategy and framework on future local health protection system by early 2023.

Antimicrobial resistance

UKHSA will support the government’s vision goal to contain, control and reduce harms from the spread of antimicrobial resistance (AMR) through delivery of UKHSA’s commitments in the UK 5-year action plan for antimicrobial resistance 2019 to 2024 and supporting DHSC’s work to develop the next 5-year national action plan.

Additionally, UKHSA will support and lead, where necessary, the delivery of international commitments, providing technical expertise in relevant work packages of the Transatlantic Taskforce on AMR (TATFAR) and technical support as needed on effectiveness of international efforts to combat AMR, including advice on potential new international commitments to be agreed at the UN High-level Meeting on AMR in 2024.

Sexually transmitted infections

Build towards the goal of zero transmissions of HIV in England by 2030 by providing scientific and analytic expertise in the detection, prevention and control of sexually transmitted infections and HIV through agreed commitments and future strategies.

As part of its core activities, UKHSA will support local authorities and NHS commissioning of sexual health, HIV and hepatitis service delivery in England, including through monitoring the impacts of disparities.

In addition, in 2022 to 2023, UKHSA will contribute to the development and implementation of the government’s Sexual and Reproductive Health Action Plan for England. It will also support the commitment to eliminate HIV transmission by 2030 and implementation of the Towards Zero: the HIV Action Plan for England – 2022 to 2025 jointly developed by OHID and UKHSA.

Air pollution

UKHSA will ensure that DHSC, other government departments, the public and other stakeholders have up-to-date information on the health impacts of air pollution to encourage behaviour change at every level, and the actions to take to mitigate against health impacts, including health inequalities.

As part of its core activities, UKHSA will:

• develop and share the evidence base on air quality impacts on health and actions to take to mitigate exposure, both outdoor and indoor
• improve on how information on the health impacts of air pollution is communicated
• work to counter false narratives that threaten behavioural change through an evidence-based approach

In addition, in 2022 to 2023, UKHSA will contribute to the cross-government commitments made in the Clean Air Strategy and in response to a Prevention of Future Deaths Report. In particular, it will lead on the provision of the evidence base in response to commitments to reduce fine particulate matter (PM2.5) in London and the south-east, and to work with OHID in support of this public commitment.

Health and climate change

UKHSA will support the UK’s COP26 commitments, which feed into building and bolstering a health system that is climate resilient.

As part of its core activities, UKHSA will provide expert scientific advice and support to DHSC, health and care system partners, and other government departments, to ensure the impact of climate change on public health, and on the delivery of health and care services, is considered as part of all system design.

In addition, in 2022 to 2023, UKHSA will:

• produce and implement the Single Adverse Weather and Health Plan
• reduce the evidence gap around the costs of extreme weather events and adaptation to the health and social care sectors, and stratifying interventions
• provide expertise to support the delivery of actions and indicators for the third national adaptation programme, in order to protect health and social care delivery, and the public’s health from the impacts of climate change

Major events

UKHSA will support preparations and provide public health guidance to host the 2022 Commonwealth Games and other major national public events safely, and contribute to cross-government initiatives where DHSC leads for the health sector, such as the Yarrow programme.

Border health

UKHSA will continue to support local authorities to deliver public health activity, including at the border, seaports, airports and rail crossings, to aid the local detection and management of outbreaks and help prevent wider community transmission. This includes:

In 2022 to 2023, UKHSA will:

• take the leading role nationally on the public health aspects of developing our Border Health Strategy to develop a strengthened vision for the future, including as part of the 2025 Border Strategy. This includes contributing to:
  • evaluating and identifying any gaps in the border health system
  • determining the objectives we want to achieve
  • developing the capabilities we need to deliver them
• contribute to cross-government work led by the Department for Environment, Food and Rural Affairs (Defra) by providing specialist expertise to ensure that:
  • any future UK import control regime for sanitary and phytosanitary goods does not have significant public health implications
  • there is sufficient operational capacity to carry out sampling and surveillance requirements at border control points

Science Hub

UKHSA will support progression of the Science Hub Programme business case, which carries a significant investment, to create the future UK infrastructure for public health scientific capabilities and capacity.

Research

UKHSA will conduct research to inform delivery of its aims in partnership with universities through the National Institute for Health and Care Research (NIHR) Health Protection Research Units. It will also conduct additional research by securing funding through open competition, including from NIHR research programmes and UK Research and Innovation (UKRI), in partnership with academia and/or industry.

2. Prepare for future health security hazards

Centre for Pandemic Preparedness

UKHSA will establish the Centre for Pandemic Preparedness (CPP) as a world-leading hub on all aspects of pandemic preparedness with a focus on securing the health of the UK population.

In 2022 to 2023, UKHSA will:

• work with partners across the health and social care system and wider government to deliver key elements of a new strategic programme on pandemic preparedness, such as future strategies for surveillance and diagnostics, including through working with system partners at the forefront of the COVID-19 response to capture lessons identified that will support preparedness planning
• lead on the development of the CPP strategy along with providing support to DHSC with existing pandemic preparedness policy and development of any future policy

Clinical countermeasures

UKHSA will maintain a robust programme for the delivery of emergency clinical countermeasures. This includes the procurement, storage and deployment of countermeasures and stockpiled medicines, and the re-procurement of a pandemic-specific influenza vaccine advance purchase agreement.

In 2022 to 2023, UKHSA will:

• collaborate with DHSC and other partners to complete and implement the review of emergency clinical countermeasures
• support a streamlined transition of antivirals and therapeutics functions in line with the COVID-19 Response: Living with COVID-19 strategy. This may include contingency planning, security and resilience, and evaluation and benefits

UKHSA will provide proactive, timely and well-evidenced public health advice and scientific expertise to support decision-making to ensure a comprehensive operational response to health hazards, including CBRN.

As part of its core activities, UKHSA will:

• support development and delivery of new research and mitigations, examining and countering areas of increasing consequence for health – such as disinformation and malicious cyber activity – that impact public health provision and infrastructure
• support development of new policy frameworks, including data and intervention policy, to enable effective security responses to modern and digital threats to public health provision and infrastructure
• collaborate with DHSC to support contingency planning and operational response
• collaborate with DHSC to ensure the right mix of skills, training and capabilities are safely embedded within the public health workforce and system

Response to COVID-19

Maintain a resilient system that can be scaled up as required to support the ongoing response to COVID-19 and other threats to health effectively.

In 2022 to 2023, UKHSA will:

• evaluate the efficacy of vaccines and vaccination programmes to control infection and hospitalisation
• provide evidence-based advice and expertise on the use of testing, pharmaceutical and non-pharmaceutical interventions, including at the border, as part of a contingency response
• provide symptomatic testing for patients in hospital for whom a test is required for clinical management or to support treatment pathways
• provide symptomatic testing for those eligible for COVID-19 treatments or who are at risk of getting seriously ill from COVID-19
• collaborate with DHSC to support contingency planning and operational response
• lead the national infection prevention and controlling guidance for healthcare settings
• keep existing UKHSA-owned public guidance on COVID-19 and other respiratory illnesses under review, and ensure that guidance is updated to reflect any changes to public health advice and government policy
• provide symptomatic testing for individuals who live or work in high-risk closed settings
• provide asymptomatic testing in periods of high prevalence for adult social care staff and a small number of visitors providing personal care, hospice staff, patient-facing staff in the NHS and NHS-funded independent healthcare provision, and prisons and places of detention (including immigration removal centres, homeless and night shelters, and domestic abuse refuges), Ministry of Defence settings and special educational needs and disability (SEND) residential settings
• provide testing to manage outbreaks in care homes
• provide COVID-19 surveillance in high-risk vulnerable settings, specifically of health care workers and in care homes
• provide continued COVID-19 surveillance to understand community prevalence (including national or regional breakdowns including by age cohorts) through the Office for National Statistics’ Coronavirus (COVID-19) Infection Survey
• retain flexibility to respond to a resurgence of COVID-19, including the retention of a lateral flow test stockpile and capacity for surge testing through mobile testing units
• ensure genomic sequencing capacity for variant surveillance
• provide continued PCR laboratory capacity

Health security and intelligence

UKHSA will broaden and deepen a security culture within appropriate aspects of public health, building on the experience of our COVID-19 response to strengthen our approach to future health security threats, and ensure better compliance, higher uptake and a more secure public health landscape through the following measures.

As part of its core activities, UKHSA will:

• use intelligence in horizon-scanning to identify threats to public health and infrastructure, and ensure UKHSA’s critical systems are protected
• qualitatively and quantitatively understand the risks that flow from identified threats
• deliver an approach that integrates security within public health, such as building in digital and physical resilience in vaccine supply chains
• ensure UKHSA is supported across government security relationships and intelligence with the view to tackle threats posed to the security and resilience of UK health systems
• deliver a response across all four nations and Crown dependencies to identify and tackle disinformation and misinformation narratives that pose a threat to public health
• utilise the deep understanding of disinformation or misinformation narratives to inform communications teams and develop effective interventions

UKHSA will develop a robust health intelligence system that is accessible and integrated for the timely identification and prevention of public health threats reaching the UK.

As part of these core activities, UKHSA will:

• support DHSC with investigation and development of further collaboration with like-minded national and regional centres of excellence to advance the exchange of epidemiological skills, data interpretation, research and health intelligence
• support the development of the International Pathogen Surveillance Network and related WHO surveillance initiatives
• work to support surveillance capacity-building in other countries, through the New Variant Assessment Platform or equivalent

Additionally, in 2022 to 2023, UKHSA will support DHSC to review and update the legal framework for health protection to best meet future health security needs. This includes any possible changes to the Public Health (Control of Disease) Act 1984 and relevant secondary legislation, as well as any non-legislative levers as appropriate. UKHSA is responsible for providing expert public health, operational delivery and policy advice to support decision-making and implementation of any changes.

3. Strengthen health security capability

Global health

UKHSA will deliver ongoing domestic health protection activity as the UK’s focal point on the international health regulations in collaboration with the WHO and the EU on incidents and outbreaks.

In 2022 to 2023, UKHSA will:

• contribute to the overarching goal of the Global Health Security Agenda for 100 countries to strengthen international health regulation capacities in at least 5 technical areas to a level of ‘demonstrated capacity’ by 2024
• co-chair the Zoonotic Diseases Action Package with Defra and provide expert technical advice across other areas

UKHSA will represent the UK in the global health security infrastructure and fulfil international responsibilities. It will:

• actively engage and, where appropriate, lead cross-government One Health co-ordination to support delivery of the UK’s G7 and G20 priorities, commitments and global efforts to mainstream a One Health approach
• improve global health systems for disease surveillance and pandemic preparedness, including genomic approaches and data sharing
• tackle AMR, leading the WHO Collaborating Center for AMR and contributing to preparation for the UN High-level Meeting on AMR
• support the UK’s participation in the Global Health Security Initiative and leadership of the Global Health Security Agenda
• establish activities to help strengthen the global clinical trials eco-system
• engage on leadership of the UK’s commitment to deliver vaccines, therapeutics and diagnostics within 100 days of a future pandemic threat being identified (the ‘100 days mission’)

UKHSA will assist the WHO in improving global surveillance, pandemic preparedness and response by providing expert input on public health issues.

In 2022 to 2023, UKHSA will:

• contribute to the WHO Immunization Agenda 2030 initiative, and work together with DHSC in analysing WHO and other international proposals particularly around health emergencies reform
• provide expert advice to WHO, on the new Scientific Advisory Group for the Origins of Novel Pathogens, supporting WHO in carrying out transparent, science-led outbreak investigations that are essential to prepare for future outbreaks and minimise the risk of disease outbreaks growing into a pandemic
• provide strategic and expert input and develop and implement global programmes to strengthen surveillance improvement, including genomic approaches and data sharing
• strengthen international partnerships and collaboration as well as co-ordination and expertise within UKHSA

UKHSA will deliver DHSC Official Development Assistance-funded projects to support low and middle-income countries in building capacity to prevent, detect and respond to health threats, including the International Health Regulations Strengthening (IHR-S) project and, working closely with the London School of Hygiene and Tropical Medicine’s UK Public Health Rapid Support Team (UK-PHRST).

In 2022 to 2023, UKHSA will:

• expand the scope of the IHR-S project to the ASEAN region
• agree and commence delivery of the UK-PHRST strategic framework and implementation plan
• form an agreement through scientific and technical collaboration with the European Centre for Disease Prevention and Control

UKHSA will continue to deliver on our health security commitments under the EU-UK Trade and Co-operation Agreement.