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Updated 16 November 2022
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This publication is available at https://www.gov.uk/government/publications/ukhsa-board-meeting-papers-november-2022/ukhsa-advisory-board-chief-executives-report
Date: Wednesday 16 November 2022
Sponsor: Jenny Harries
This report gives a brief overview of UK Health Security Agency (UKHSA) from the perspective of the Chief Executive.
The Advisory Board is asked to note the update.
The time since our last board discussion has been a tale of 2 perspectives. The country, and consequently, UKHSA is going through significant political and economic changes at a time when the organisation is still early in its formation and stabilisation journey. This wider context has delivered a strong reminder that UKHSA’s skills and functions directly support and enable a thriving economy but also that high uncertainty impacts our ability to fully establish the strategic direction and budget for the organisation as well as affecting the everyday lives of our staff both in and out of work. The leadership team and I are working hard to mitigate any negative impact wherever possible and to enable our staff to focus on their critical health security work.
Despite this, we have also made great strides in establishing the organisation in other directions. We held our first conference in Leeds over 3 days from 17 to 19 of October – almost one year after our establishment as an organisation. It was inspiring to see, in person and in one room, so many people who have worked together tirelessly, and often virtually, through the pandemic. Early feedback, much unsolicited, suggests that our ambition to showcase the breadth and depth of our experience and skills to and with the many partners that we work with at a local, national and international level was successfully accomplished (86% of attendees rated the conference as ‘good’ or ‘very good’). There was very positive engagement with representatives from the life sciences industry and articulated support from partner organisations and colleagues in local authorities. Unfortunately, we also experienced some protests from anti-vax campaigners – a strong reminder that our work affects individuals very personally and very viscerally and that we have a duty of care to nurture our excellent young staff and scientists, many of whom were less familiar with such direct personal impact of differing views.
At the conference we also launched the Centre for Climate and Health Security, which has been welcomed by many wider groups than were present at the conference itself. This centre brings together experts from across disciplines and will strengthen the scientific evidence available to professionals and policy makers – with work ranging from extreme events, vector borne disease risk in warmer climates and direct health impact on food security and health service provision.
With the interim Chief Scientific Officer and colleagues from UKHSA’s Porton Down Centre for Vaccine Development and Evaluation (VDEC), I also attended the World Vaccine Conference in Barcelona, and subsequently the Gates Foundation health forum in Berlin. These interventions helped evidence and strengthen UKHSA’s role in the international vaccine arena as well as influencing the practical arrangements for future pandemic surveillance and response – working closely with and through IANPHI (the International Association of Public Health Institutes).
On 1 October 2022, we formally welcomed the former Vaccine Task Force (VTF) into UKHSA as the new UKHSA COVID-19 Vaccine Unit. The unit has a critical role to play both in relation to their current core task of procuring COVID-19 vaccines but also in helping UKHSA shape our culture and ways of working to capture the successful approach during the pandemic for wider health protection opportunities, whether in vaccine development or new therapeutics.
We have received our first rule 9 requests for the first 9 modules of the COVID-19 public inquiry on pandemic preparedness and decisions taken in the first part of the pandemic. Like Immensa this will be a chance for us to reflect on relevant areas of preparedness and operational response of predecessor organisations and ensure UKHSA is operationally and professionally making changes to deliver optimally for the future.
We have concluded our pay offer for 2022 to 2023, operating within our budget of 3%. For delegated grades we will apply a consolidated uplift of at least 2.5% or £1,000, with higher awards for our lower grades. The offer was rejected by trade unions but we have concluded – after considerable exploration of potential alternative options – that this is the best that could be achieved operating within our current guidance. Additionally, all staff will receive a recognition payment of £350 for extraordinary work in recent months. We will implement the award for delegated grades in November. Awards for SCS will be implemented in December. We have also explored in detail what opportunities there are for specialist pay recognition for different staff groups, and in particular for clinical staff. I hope to be able to be able to share an update at the next Advisory Board.
We have done all of the above whilst continuing to deliver our core health security response – a summary of which I have included below.
Finally, I would like to welcome Chris Coupland to the Executive Committee as our Chief Technology Officer. He brings a wealth of experience that I know he is already applying to one our critical priority enabling functions.
As of 1 November.
UKHSA has established a single incident management team to oversee our winter preparedness – including respiratory illnesses, norovirus, weather, and energy and industrial action impacts on health.
Following routine review of UKHSA COVID-19 data the UK CMOs were content to reduce the UK COVID-19 alert level from 3 to 2 on 31 August 2022. While maintaining appropriate preparedness, testing and ongoing variant and vaccine evaluation, UKHSA has moved the management of COVID-19 to a standard level incident with the ability to escalate rapidly to enhanced if or when required. Latest Office for National Statistics (ONS) survey data for the 7-day period to 24 October 2022 show continuing decline in positive case detections in England, with a prevalence of 2.92% (a round 1 in 35 people with COVID-19). We continue to monitor new variants and 2 in particular are currently being investigated (BQ.1 and XBB) for severity and transmissibility.
Activity is increasing in line with pre-COVID-19 seasonal activity. A/H3N2 is the most common (sub)typed and is genetically well-matched to the vaccine strain. Older adults are on track for another high vaccine uptake season. Influenza is not yet causing significant strain on the NHS although there are a number of care home outbreaks that UKHSA health protection teams are responding to.
UKHSA continues to respond to the detection of vaccine-derived poliovirus. Links with detections in Israel and the US have also been explored in detail with relevant clinical and epidemiological professional counterparts. The risk to the public overall is low given the UK’s high vaccine coverage. However, in the 2020 to 2021 financial year, primary vaccination coverage for 1-year-olds in London was 87% compared to 92% in the UK. Catch-up vaccination of under 5s in London has commenced as well as the supplementary booster campaign. As of 3 November, 238,367 doses have been administered. UKHSA has increased sewage surveillance both within and outside London.
Cases of monkeypox have continued to fall significantly. The NHS has launched a new online vaccine site finder to support those at greatest risk of exposure whose eligibility is provided by UKHSA guidance. There are already almost 100 sites on the monkeypox vaccine site finder across England and those eligible can find their nearest one. As of 9 November, there have been 61,933 first dose vaccination events in England. In early November, UKHSA published a British Medical Journal article that shows the first global evidence of pre-symptomatic transmission of monkeypox using both modelling techniques and data linkage of real cases.
Detections of avian influenza (AI) continue to increase. The new AI season started in October and there are already more premises affected than at the peak of last season. The focus has moved around the country over the past few months and has involved wild birds and farmed flocks, but the current focus is in farmed flocks in the East of England. There are large numbers of human contacts but no detected cases in the UK since December 2021. Health protection activities for these contacts are consuming very significant resource. There is also an increased number of symptomatic contacts requiring testing due to co-circulating respiratory infections. There is a high degree of uncertainty about the potential for the current H5N1 clade to cause severe human illness. There is a meeting scheduled with academic partners to identify support for a technical risk assessment with rapid turnaround. Potentially exposed populations are vulnerable due to nationality and ability to access information with language barriers, all of which is considered within response arrangements.
An Ebola virus disease outbreak caused by Sudan ebolavirus was declared in the Mubende District, Central Uganda, on 20 September 2022. As of 30 October 2022, there have been a total of 150 cases and 58 deaths, including 129 confirmed cases (37 deaths) and 21 probable cases (21 deaths). Forty-three cases have recovered. UKHSA is actively monitoring the situation given the increasing footprint of cases including in urban areas. The possibility of ingress into the UK remains low and individuals registered and broadly at higher risk of importation, including NGO care workers from red zones, are included within arrangements known as the returning workers scheme (RWS) which provides follow-up and relevant support in the UK by UKHSA. Two members of the UK Public Health Rapid Support Team (joint UKHSA-London School of Hygiene and Tropical Medicine team) have been deployed in October and November to provide technical assistance on the ground.
UKHSA continues to work with other government departments and professionals to monitor health risks of Ukrainians caught up in the current conflict and support mitigations in Ukraine and domestically. There is no recent change in public health risk assessment. Work is focused on supporting any arrivals (including guidance to primary care) and potential health security issues. UKHSA continues to work with NHS England (NHSE) and the Department of Health and Social Care (DHSC) on guidance around tuberculosis screening.
The focus of support to asylum seekers this year has been to revise the migrant handbook which sets out appropriate interventions for provision of care, including critical vaccinations, predominantly in dispersal settings. Given a recent increase in diphtheria cases in the UK – 25 cases confirmed as of 31 October, of which 13 cases have been among asylum seekers, with a further 6 cases awaiting toxigenicity confirmation testing – revision – as well as protracted unplanned stays in certain sites, most notably Manston, further risk assessment has been carried out by the UKHSA local South East regional health protection team and the UKHSA national inequalities team. This is to assess the potential for in centre treatment and vaccination to prevent onward transmission of infection and wider dispersal to other UK regions, considering all potential infectious disease risks. Additional health personnel have been brought into the Manston site and UKHSA has worked with Home Office colleagues to provide a system of assurance for onward flows of relevant information for asylum seekers dispersing to individual local authority areas. Work is underway to update the migrant health guide to include guidance on diphtheria.
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