Experts fear new biodefence agency will neglect health priorities

Concern that there is ‘little information’ on how the UK Health Security Agency will work and whether it will address wider socioeconomic determinants of health

Dr Jenny Harries is to lead the new agency (Getty Images)

Experts have raised concerns that the UK’s “vague” new biodefence agency will mean other areas of public health are neglected amid a focus on future pandemics.

The UK Health Security Agency (UKHSA), which will be launched on 1 April, brings together the work of Public Health England (PHE), NHS Test and Trace and the Joint Biosecurity Centre with the aim of better coordinating Britain’s response to future pandemics and health emergencies.

The health secretary, Matt Hancock, said the new body would be a “dedicated, mission-driven national institution for health security”, one that is responsible for monitoring and responding to infectious disease outbreaks.

But experts have expressed concern just days before its launch that there is “little information” on how it will work, and that it is not clear how it will address wider socioeconomic determinants of health.

Scientists have welcomed the “recognition” that infectious diseases need to be taken seriously, but some believe the decision to subsume PHE into a security-focused agency could undermine England’s wider public heath strategies.

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Professor Gabriel Scally, an expert in public health and former senior civil servant, told The Independent: “This is just another step in the path of degrading public health, in moving it further away from its core task, which is improving and protecting the health of the population.

“If you just focus on the external threats outside, you’re leaving yourself absolutely open to anything that could happen inside.”

He said the government can’t afford to neglect non-communicable diseases, including cancer, the wider health of the UK and those social inequalities, such as cramped housing and unequal access to care, which have exacerbated Britain’s “awful” experiences throughout the pandemic.

“The UK lost its elimination status for measles in 2016 and that was not about an external threat,” Prof Scally said. “That was about internal incompetence of the government in handling public health issues.

“The rate of sexually transmitted diseases has climbed dramatically over the last years, and that’s not an external threat. That’s about the destruction of sexual health services.

“And one of the big problems about going into this pandemic is that the health of the population was poor and in many cases getting worse. The improvement of life expectancy had stalled from 2012 onward. Will the agency deal with this?”

According to the government, the UKHSA will undertake functions in five core areas – preventing, detecting, analysing, responding and leading – in relation to future infectious diseases threats.

It will also “act to strengthen health protection capability from top to bottom” and place a “strong focus” on reducing inequalities in the way different communities experience and are impacted by infectious disease or environmental hazards.

However, Martin McKee, professor of European public health at the London School of Hygiene & Tropical Medicine, said the government’s “documentation on this is so full of gaps that we have no idea how it will work”. 

Insiders at PHE are also said to be unaware of what their responsibilities will be and what kind of resources they will have access to, even though the agency comes online within a matter of days.

“There were so many questions to answer,” Prof McKee told The Independent. “We don’t know what the government plans for all of the other areas of heath promotion and prevention.”

The wider determinants of health, which “have had a huge impact on the UK’s very poor outcome with Covid”, aren’t going to be improved by the “classic infectious disease responses we’re seeing here”, he added.

“I can’t see anything that starts to address the issue of people in precarious occupations in the informal economy who are unable to self-isolate, people who live in multi-generational homes. And yet one of the major failures of the UK’s response to Covid has been the inability of people to isolate. Where is that in this?”

Prof McKee said there were also “big questions” regarding the legal basis of its relations with the “devolved administrations”, which, under law, determine health policy and decision-making within their borders.

“And what about engagement with international agencies such as the World Health Organisation? Decisions will need to be made on this,” he said.

UKHSA will not replace the devolved nations’ public health agencies, but will form a close collaborative relationship with them, the Department of Health and Social Care (DHSC) said.

Its formation follows initial plans to replace PHE, which was seemingly accused by Boris Johnson of being “sluggish” in its pandemic response, with the National Institute for Health Protection. 

“Thank you indeed to all the teams at Public Health England who were restructured in the middle of a pandemic and now for a second time. Who, despite this, remained focused on protecting the nation,” said Dr Gail Carson, deputy chair of the Global Outbreak Alert & Response Network (GOARN).

Questions have also been raised over the appointment of Dr Jenny Harries, the current deputy chief medical officer for England, as head of UKHSA. This will involve overseeing the running of Britain’s coronavirus testing programme, which has a budget of £22bn for 2021.

She has drawn previous criticism for saying in the earlier stages of the pandemic that masks should not be worn, that widespread testing was “not an appropriate intervention” and that bans on mass gatherings were not necessary.

One expert, who asked not to be named, said: “I’m not sure if she’s the right person for the job. I think there are others better suited.”

A former PHE director for the south of England, Dr Harries helped lead the UK’s response to the Ebola outbreak of 2014-15 and the novichok attacks in Salisbury in 2018.

Stephen Griffin, a virologist at the University of Leeds, said he welcomed the investment that was being made into tackling future infectious diseases. However, he said the government needs to “look at the whole package”.

“Establishing this is fantastic, but at the same time they’re disinvesting in UKRI research funding,” he told The Independent. 

UK Research and Innovation has warned of a £120m hole in its budget following recent cuts – a shortfall that threatens to undermine overseas scientific projects seeking to understand “how we can better mitigate against zoonotic diseases like Covid-19”, according to the Institute of Development Studies.

Prof Griffin said: “They will invest money into things like this [UKHSA], which is a public-facing entity, but also must put it into the back-end too.”

The government has committed to increasing R&D spending to 2.4 per cent of GDP by 2027, but many scientists have called for this timeframe to be shortened. “We must instead start right now, not in some distant time beyond the next general election,” said Jeremy Farrar, director of the Wellcome Trust.