Written evidence submitted by Her Majesty’s Government
1. Monitoring Risks
2. Risk assessment and COVID-19
7. Cross-Government working and DA engagement
8. The Joint Biosecurity Centre
1. Monitoring Risks
The Civil Contingencies Secretariat (CCS) supports and coordinates government departments in planning for, responding to and recovering from disruptive challenges.
CCS is responsible, among other things, for:
CCS coordinates the national risk assessment process through which risks to the UK over the next two years are identified and analysed.
There is a well-established risk assessment methodology which receives input from external academics, and its effectiveness is reviewed regularly to ensure lessons arising from emergencies are identified and actioned. The UK is regarded as a leader in risk assessment and the Cabinet Office's well established methodology is shared by partners internationally.
The risks the UK faces are continually changing and the Government relies on a number of internal and external experts to identify risks and understand how they might affect the UK. This ensures that the scenarios are robust and based on intelligence and publicly available information. On the basis of the evidence collected through risk assessment, the Government is able to inform and prioritise contingency planning.
Global health security is our ability to prevent, prepare for, detect and respond to serious cross-border health threats, including outbreaks of infectious disease and antimicrobial resistance. The Government’s work in this area is led by the Department of Health and Social Care (DHSC) but involves coordinated work and input from a range of other government departments and government agencies.
DHSC leads on the UK’s implementation of the International Health Regulations (2005) (IHR), which aim to prevent, protect against, control and provide a public health response to the international spread of disease. Public Health England (PHE) support this work by delivering the national focal point function described in the IHR 2005 regulations.
The IHR takes an all hazards approach to preparedness and response, including chemical, biological, radiological and nuclear threats. Under IHR, countries are required to build and maintain national capacity for prevention, detection and response to any public health events with the potential for international spread. This is in order to enable countries to detect and notify the World Health Organization (WHO) of all events that may constitute a Public Health Emergency of International Concern (PHEIC) and rapidly share accurate information about such threats. COVID-19 was declared a PHEIC by WHO on 30 January 2020.
The UK Government have designated PHE as the UK’s IHR National Focal Point (NFP). The NFP is expected to be accessible at all times for communications with WHO. The NFP is responsible for sending, on behalf of the UK, urgent communications relating to events that may constitute a public health emergency in any part of the UK territory, including the Overseas Territories, Crown Dependencies and Devolved Administrations, in collaboration with relevant national experts, public health authorities and DHSC. The UK’s NFP is responsible for disseminating and coordinating inputs from relevant departments and agencies within the UK and for notifying the WHO of relevant potential emergencies, and providing subsequent epidemiological data.
The Government continues to review and improve surveillance for zoonotic and potentially emerging infections, with early detection of outbreaks and incidents through horizon scanning and epidemic intelligence activities; diagnostic techniques, through research and increased use of laboratories for identification of zoonotic pathogens; and risks assessments to determine the potential risk to public health. This is coordinated and undertaken by PHE on behalf of the UK Government for public health risks, and by Defra for animal health risks (via the Veterinary Risk Group). These are brought together through the Human and Animal Risk surveillance group and the International Natural Hazard Forward Look, which is coordinated by the Government Office for Science.
In the UK, most surveillance data come from mandatory notification of human disease by medical practitioners or laboratories. In England, this is enforced by the Health Protection (Notification) Regulations 2010. These regulations create a scheme for notifying actual and suspected cases of infection and contamination to specified bodies with public health responsibilities. This allows prompt action to be taken by those bodies to protect public health where appropriate. Reports from veterinarians and associated laboratories for notifiable animal diseases, including zoonoses, are coordinated through the Animal and Plant Health Agency (APHA) - an agency of the Department for Environment, Food & Rural Affairs (Defra). This is enforced by the Animal Health Act (1981) and the Zoonoses Order (1989).
COVID-19 was added as a notifiable disease in humans in March 2020, meaning doctors are required to notify PHE when they identify a patient with COVID-19 in England and laboratories are required to notify PHE when a causative agent listed in the regulations has been identified. Similar notifications and requirements have been put in place in the devolved administrations. The identification of the virus responsible for COVID-19 in animals is not notifiable but reporting to the competent authority of positive tests in companion animals or other animals is required so Defra can fulfil international reporting obligations to the World Organisation for Animal Health (OIE).
The availability of data from surveillance systems developed by PHE, and continued work with other organisations over a number of years allows the early detection of cases and clusters of unusual syndromes or infections. Using local health protection teams, these can be rapidly investigated and would allow for the appropriate control measures to be instituted across the relevant agencies.
PHE’s specialist and reference laboratories have a key role in providing advice and support to international agencies, including undertaking risk assessments for new and emerging microbiological threats. To do this, PHE is able to identify rare, novel, unusual and dangerous pathogens and undertake pathogen discovery in relation to unusual syndromic illness; respond to new agents and threats through the development of diagnostic and microbiological surveillance tools; and utilise cutting edge technologies which provide the most rapid and robust analytical information to inform public health interventions in the event of an emergency.
2. Risk assessment and COVID-19
The National Security Risk Assessment (NSRA), last produced by CCS in 2019 and based on the latest and most robust science, identified both a pandemic influenza and an emerging infectious disease (EID) as key risks facing the UK. Based on the available data, it was assessed that a pandemic influenza represented the more likely source of a pandemic in the UK.
The NSRA determined that a coronavirus equivalent to the SARS and MERS outbreaks represented the reasonable worst case scenario for an EID. This information was made available to both central and local governments to inform contingency planning.
The Government plans for a range of infectious disease risks, including those High Consequence Infectious Diseases, which, while not likely to cause pandemics, would lead to harmful outbreaks.
Recognising that the COVID-19 pandemic represents a scenario more challenging than the original EID risk, the UK’s capabilities have been and are still being rapidly scaled up to reflect the fact that this new strain of virus is spreading further than previous coronavirus epidemics.
The Cabinet Office continually updates the information included in its risk assessments as new data becomes available. As is normal with all responses, the Cabinet Office and other government departments are capturing new insights from the COVID-19 pandemic and will incorporate these into future risk modelling.
Alongside this risk assessment process, CCS implements a short term horizon- scanning process to identify both concurrent and COVID-related risks. As required, CCS supports departments with contingency plans to attempt to mitigate some of the impacts of these risks.
In addition to the within government horizon scanning capability described above, a number of expert advisory groups advise the Government on new and emerging threats:
The Government prepares and plans for emergencies, working nationally, locally and cooperatively to ensure civil protection in the UK underpinned by the Civil Contingencies Act, and accompanying non-legislative measures to deliver a single
framework for civil protection in the UK. The Act is separated into two substantive parts: local arrangements for civil protection (Part 1); and emergency powers (Part 2).
The Civil Contingencies Act allows the Government to make urgent, necessary, temporary legislation (emergency regulations) to prevent, control or mitigate an aspect or effect of an emergency, without the prior scrutiny of Parliament.
The Cabinet Office’s role is to coordinate the regular assessment of the UK’s overall risk landscape for both internal and public purposes, to run the Resilience Capabilities Programme, and to manage central government response. This programme considers the preparedness for a broad and generic set of capabilities that are applicable across multiple risk scenarios. The programme’s purpose is to inform cross-government discussions about generic capability strengths or where capabilities could be improved to ensure a successful end-to-end response to a wide range of risks.
CCS works closely with government departments in planning for, responding to and recovering from disruptive challenges across their sectors. This included working with DHSC and others to plan for a potential flu pandemic.
An influenza pandemic has been assessed as the most serious non-malicious risk facing the UK since the first iteration of a national-level risk assessment in 2005. This has been communicated openly to the public since 2008 when the first public version of the risk assessment, entitled the National Risk Register of Civil Emergencies, was published on gov.uk.
Significant preparatory work has been undertaken by the Government to ensure readiness to mitigate and manage the risks of an influenza pandemic. The initial response to COVID-19 built on this planning. For example, the draft pandemic flu bill formed the basis of what is now the Coronavirus Act 2020.
Planning for flu pandemics, like all civil emergencies, is based on a Reasonable Worst Case Scenario (RWCS). The UK Influenza Pandemic Preparedness Strategy 2011 sets out a UK-wide strategic approach to planning for, and responding to, the demands of a future RWCS scale influenza pandemic within which 50 per cent of the population become ill.
The UK has tried and tested systems in place to respond to and mitigate the impact of an influenza pandemic, including a zoonotic avian or swine influenza strain. These systems include:
Where pandemic flu plans can be used to inform the Government’s COVID-19 response, they have been, for example:
The Government has committed to establishing a new centre of national and international scientific expertise through the creation of PHE Harlow. PHE Harlow has been designed with the threat of a novel and pandemic infection in mind. Early learnings from COVID-19 clearly show the importance of an integrated public health response and the need for rapid sharing of data, information, new laboratory tests and other innovations, coordinated and led from centres like Harlow.
One of the core purposes of Government communications is changing behaviours for the benefit of society through accurate, clear and timely messaging. There can be no greater demonstration of this than the Government’s communications response to the effects of COVID-19; the biggest threat this country has faced in decades. It reminds us that calling communications a ‘lever of delivering public policy change’ isn't an abstract notion, but a way to save thousands of lives.
Preparedness is central to the Government’s approach to delivering world-class public service communications during crises. Exercising is key to this and our professional specialists are an integral part of the CCS exercise programme, where skills are tested and lessons identified to ensure that we are able to organise and deliver complex communication campaigns at short notice and at unprecedented scale.
As part of a drive for capturing and sharing best practice, DHSC published the UK Pandemic Influenza Communications Strategy 2012. While this strategy was designed to address an influenza pandemic, many of the communications requirements remain relevant. The document covers health-related communication in the stages leading up
to a UK pandemic, during a pandemic itself, and during the recovery phase. It provides a high-level strategy, the principles and recommendations of which set a framework for the planning of public communications and engagement in a future pandemic.
In addition to being able to draw upon written pandemic communication frameworks, the Government has communications professionals across the UK. Staff specialisms include: campaigns, marketing, strategic communications, behavioural science, insight, digital, and press handling. This includes individuals specialising in health communications, including those with experience of pandemic communications. This wealth of experience and skill sets enabled the Government to quickly identify and deliver the necessary communications campaigns (such as the ‘Stay at Home’ campaign) as part of the Government’s COVID-19 response.
The Government’s communications model emphasises the need for continual and robust measurement of effectiveness as standard practice. During the COVID-19 response, Government deployed a range of means to measure effectiveness - both overall and in relation to specific communications activities. These methods included: public polling, focus groups, engagement rates with online content, viewing figures, and media monitoring to assess press reaction.
Exercises at both the national and local level form an essential element of the Government’s pandemic flu preparedness programme.
Building on local and departmental activity to validate plans, national level exercises focus on the response to complex cross-sector issues, scenarios where interoperability across responders is most challenging or where new capabilities have been developed following previous learning.
Exercises at the national and local level have formed an essential element of the Government’s pandemic flu preparedness programme:
UK plans for a future influenza pandemic are multi-sectoral. Though the health and social care system is central to these plans, an influenza pandemic, especially one of the scales considered by Exercise Cygnus, will require a cross-government response. Lessons learned from Exercise Cygnus, along with the most recent scientific advice, have informed the development of plans to respond to a future influenza pandemic.
Working across government and with stakeholders, CCS and DHSC led a cross- government Pandemic Flu work programme, informed by the lessons from Exercise Cygnus, which included a number of workstreams, such as:
6. Local readiness
The Government aims to ensure all organisations have effective, well-practised emergency plans in place. Departments and resilience partners aim to have robust, flexible and deployable capabilities that can be brought to use when required.
UK’s resilience model operates on a principle of subsidiarity. The NSRA and the public facing version, the National Risk Register (NRR), inform local level planning and support LRFs to develop their own local understanding of risk, prioritise resources and plan effectively for critical risks.
As well as placing duties on public sector bodies (the so-called ‘Category 1 Responders’, including the emergency services, local government and the NHS), the Civil Contingencies Act 2004 put in place two important mechanisms to enable the active engagement of private sector bodies in building stronger emergency preparedness:
LRFs are required under the Act to lead on risk assessment and emergency planning in their area. Private sector ‘Category 2’ organisations have been active members in the work to improve the UK’s preparedness, including taking part in collective training and exercising.
Those arrangements at local and regional level are complemented by arrangements at national level for the engagement of a range of private sector organisations and representative bodies in building stronger emergency preparedness, including:
The 2007 National Framework for Responding to Pandemic Influenza formed the basis for the 2009 ‘Swine flu’ pandemic response. It identified government departments, devolved administrations, the local and regional planning tier, the voluntary sector, businesses and community networks as key stakeholders. As such, throughout the ‘Swine Flu’ response, the Government engaged with these sectors to share guidance and support decision making.
Major forms of engagement included:
planning, especially the impact of high levels of staff absence;
7. Cross-Government working and Devolved Administration Engagement
The UK Biological Security Strategy describes the roles and responsibilities of departments in relation to their work under the four pillars of Understand, Prevent, Detect, and Respond.
The governance structure for much of the activity falls within departments’ existing portfolios and governance mechanisms. However, achievement of many of the strategic commitments is only possible through cross-government and fused working.
Ministers from the Home Office, Defra, and DHSC signed off on the Strategy. A two- tier governance structure has been created: a senior Governance Board, and a Working Group. Through the Working Group and Governance Board, all relevant departments, agencies and devolved administrations work together to implement the Biological Security Strategy and take forward actions to support the achievement of its strategic objectives.
All relevant government departments were involved in the development of the Strategy and they remain involved in the realisation of the strategic commitments. The following provides summaries of the roles of the main departments:
England (NHSE) and PHE to respond to emergencies and is engaged in a range of cross-government groups to ensure the response is coordinated.
the United Nations Secretary General’s Mechanism for the investigation of alleged use of chemical and biological weapons.
The Biological Security Strategy has highlighted the risk of spread of infectious disease across borders, which is a particular issue for low- and middle-income countries (LMICs) where health systems are weak. This has also highlighted the importance of the leadership role of the UK in improving global health security.
CCS works closely with government departments in planning for, responding to and recovering from disruptive challenges across their sectors. Ensuring that central and local government have clear crisis management structures in place and that they are supported by doctrine and training. This included working with DHSC and others to plan for a potential flu pandemic, and develop the response to COVID-19 as it emerged.
Government departments remain responsible for overseeing levels of preparedness within their sectors, ensuring they have up-to-date plans to mitigate and respond to risks contained in the NSRA and the NRR. The NRR outlines what is being done about key risks and how the public and businesses can make themselves prepared for these risks.
Work to prepare for the UK’s exit from the EU has helped improve the overall resilience of our public services, giving us a better understanding of our supply chains and ensuring we were more prepared to deal with some of the cross-departmental impacts of COVID-19. On a practical level these preparations included the implementation of cross-government coordination structures, ministerial committees, upgrades to COBR crisis management facilities, and establishing data collection, analysis and reporting mechanisms that have been fundamental to our response to COVID-19.
A Pandemic Flu Readiness Board, jointly chaired by DHSC and the Cabinet Office, and which included representatives from the Devolved Administrations, was established in May 2017 to develop and manage a cross-Government work programme to improve the UK’s preparedness for a future pandemic. This work, when
complete, is expected to inform a refresh of the current 2011 UK Influenza Pandemic Preparedness Strategy.
During a pandemic, including the current COVID-19 outbreak, meetings of the four UK health ministers and also of the CMOs are included as part of the operational planning and response. If this is a zoonotic infection then the four UK Chief Veterinary Officers and ministers for Agriculture and Environment would also be involved in these meetings.
UK Central Government Concept of Operations makes provision for access to expert scientific advice in emergencies. Where scientific advice is required, the Civil Contingencies Secretariat works closely with the Government Office for Science to ensure there is a single considered view of scientific advice (through SAGE – the Scientific Advisory Group for Emergencies). As new scientific questions emerge, SAGE membership changes to provide the best available scientific evidence pertinent to the crisis.
Whilst it is vital to continue to strengthen the UK’s domestic health security and preparedness, increasing global connectedness through travel and migration heightens the necessity to prioritise global health security.
The UK believes WHO has an essential role in fostering strong governance and in providing leadership for health security at the global level. The UK supports and constructively challenges WHO to fulfil that role, both as a major donor and as a Member State. We support WHO and at the same time promote and encourage reform, to ensure continued improvement of global health security governance and leadership as well as coordinated capacity building.
The UK has a strong track record of investing in global health security which we can build upon. In particular the support we offer to LMICs to comply with the International Health Regulations (2005) and develop sustainable health systems so they have the capacity to prevent, detect and respond to public health emergencies.
The UK has a comprehensive portfolio of Official Development Assistance (ODA) health programmes and projects to support priority partner countries (which are eligible to receive ODA funding) in their response to health emergencies and in building their own resilient health systems. In this way we have a direct impact on welfare and sustainability in LMICs at the same time as protecting the UK and the world from global health threats.
8. The Joint Biosecurity Centre
The Joint Biosecurity Centre (JBC) was established in May 2020 and reached initial operating capability on 1 June. It is an integral part of the wider NHS Test and Trace
Service and brings together the UK’s leading epidemiological expertise and best analytical capability. The JBC will ensure that outbreaks of COVID-19 are detected as quickly as possible and, alongside the contain pillar of the test and trace service, that local and/or regional authorities have access to best practice advice and, where needed, the national level support they need to bring those outbreaks quickly under control.
The JBC will use a broad set of data in its analysis and assessment for local, regional and national decision-makers so they can respond rapidly to localised outbreaks of COVID-19.
The JBC will also be responsible for the COVID-19 Alert Level and advises CMOs across the UK of a change in the level. The CMOs will then advise their ministers on the appropriate response. Once the JBC is fully operational, later in the year, it will set the Alert Level independently and inform the CMOs.
The JBC will be part of the Test and Trace Service’s Regional Support and Assurance team, ensuring that local areas get the support they need to manage outbreaks, to share good practice, to learn what works to inform future outbreak management and the deployment of non-pharmaceutical interventions, to provide assurance, and intelligence to inform the escalation process.
Since its launch on 1 June, the JBC has advised CMOs on setting of the National Alert Level and is beginning to provide situational awareness reports to the wider NHS Test and Trace Service. As the JBC capability continues to build, it will incorporate additional data sources, including from the Contract Tracing service, the NHS Test and Trace app and devolved authority equivalents to enhance the quality and timeliness of the advice that it is able to provide.
31 July 2020