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The next item on our agenda is an evidence session on pandemic preparedness. I welcome Professor Sir Gregor Smith, chief medical officer for Scotland; Daniel Kleinberg, deputy director, population health resilience and protection division, Scottish Government; and Dr Jim McMenamin, interim director of clinical and protecting health, Public Health Scotland.
We will move straight to questions.
We are a few years down the line from the Covid pandemic, and I am sure that we all have personal experiences and remember things about it, including what could have happened or what could have been done. During the pandemic, as a registered nurse, I was giving vaccines as well as being an MSP. I am therefore interested to know the detail of any progress that has been made in implementing the United Kingdom Covid-19 inquiry’s module 1 recommendations that the emergency preparedness and resilience structures should be simplified. I see that Sir Gregor is nodding.
I will begin, and my colleagues will add to what I say. As you said, we are now—unbelievably—just over five years on from the moment when a pandemic was declared and the world changed for all of us as we sought to combat the effects of Covid-19. You are right that there has been substantial learning since that time, during the pandemic response and in the period afterwards, through statutory inquiries, which you have referred to, and other sources. It is important to reference those other sources of learning, starting with the production of the four UK CMOs’ technical report and the substantial body of evidence within that as to how, technically, we should respond to future threats when, inevitably, they arise.
Moving on from that, the standing committee on pandemic preparedness produced a substantial report with recommendations that have begun to be implemented. In addition, the UK public inquiry has published its module 1 recommendations. I will turn to my colleague Daniel Kleinberg in a second, as he can speak about some of the work that has been taken forward in relation to that.
At a UK level, extensive work has been done in examining the technical aspects of the response that will be necessary when, inevitably, a future pandemic arises. We should think about that as “when” rather than “if”, because, whether it is in the next year, five years or 20 years, we will continue to encounter pathogens with pandemic potential. During this hearing, we can speak a little about the types of pathogen that are most likely to cause that threat.
At the moment, an update to the respiratory care action plan is in preparation, looking at the broad range of respiratory pathogens that may have pandemic potential, on which we may need to act and provide some sort of technical response to. Work continues on that at a UK level, with Scotland contributing in a technical and a policy sense.
In the Scottish context, the standing committee has probably provided one of the most important pieces of work in recent times. It has developed recommendations for us to consider and take forward, not least on the formation of a Scottish pandemic sciences partnership. Daniel Kleinberg can give us an update on that.
Before I talk about the standing committee, it would be good if I could start with the question, which was specifically on the Hallett inquiry’s module 1 recommendations.
The Scottish Government has welcomed, in full or in principle, all 10 of the Hallett recommendations. However, some of them fall to the UK Government—for example, there are recommendations about simplified structures for civil contingencies and the lead Government department model in the UK, on which we are working closely with the UK Government. We will wait to see where it goes with that.
For the most part, Hallett talked about the need for things such as simplified structures and how to go about that, which is something that I recognise. Kate Forbes, as Deputy First Minister, has written to Baroness Hallett to say that the Scottish Government will make full responses to each recommendation by the end of the year or, in some cases, sooner.
As Gregor Smith alluded to, we are already seeing the beginnings of simplified structures, which tend to relate to the wider contingency response. I am interested specifically in pandemics, but pandemics do similar things to some of the other big risks that we face. The pandemic diseases capabilities board, a UK structure in which we fully take part, has begun to look specifically at future pandemic preparedness. Gregor spoke about the respiratory action plan that is being prepared and drafted, which will be the basis of a more specific response to future respiratory threat.
Hallett said that too much emphasis was placed on a pandemic flu plan—a point that I think is uncontroversial and accepted by everybody. At a UK level, we have already looked at different types of pandemic threat. There is now a draft respiratory action plan, which will be followed up with plans on other threats such as sexually transmitted diseases and other sources of disease—it is a much broader-based planning approach.
The response to module 1 is well under way and the formal response from the Government will follow later in the year.
I know that there are complexities around planning, whether that is for flu or other potential disease pathogens. We have talked about various reports, such as the module 1 report, the respiratory action plan and the one that recommended the Scottish pandemic sciences partnership. Work is under way, but are you confident that that is a process of simplification?
Yes, although it is still a complex environment. I do not want to give false assurance that it is all straightforward, because pandemics are such complex things to respond to. In Scotland, there is now a single-level ministerial group that is looking at pandemic preparation and capabilities assessments. That group first met this January and it will next meet tomorrow. There is an improving position in the UK as well. So, we have mapped out the governance better than we did in the past. Having that specific group on pandemics will add to the number of groups, but it will potentially allow for much greater specificity in thinking about and responding to the risk.
I agree with Daniel Kleinberg’s assessment. There is an improving situation in an area that is necessarily complex because of the wide range of potential threats that could be faced in this space. However, sorting out the governance at the centre of all this has been a tremendous step forward.
A co-ordinating centre that involves the Scottish Government, academia, the public health agencies and industry is being set up to co-ordinate the science that sits around a future pandemic response. That is a big step forward for us. It is beginning to find its feet. I see elements of that forming around us just now.
Good morning, everyone. My question is about risk assessment and future planning. Further to the findings of the UK Covid inquiry’s module 1 report, what changes, if any, have been made to the risk assessment process in Scotland to take better account of the specific needs of the Scottish population and who might be vulnerable?
In effect, we are managing two risks: emerging infectious diseases and full-scale pandemic diseases. Both of those are described at a UK level in the national risk register, which is a public-facing document. To give you a sense of it, that assesses the risk of a future pandemic occurring in the next five years as being between 5 and 25 per cent. That will be catastrophic if it occurs, and the risk of it doing so is fairly probable.
The methodology that lies behind that is constantly under review—it is being looked at again at the moment. That informs how we work with the Scottish preparedness community. There has previously been a Scottish risk assessment, but, in effect, the risk of a pandemic is a global risk, so the articulation of that and the methodology are very similar in both cases. It is how you respond that changes and is local.
Jim McMenamin might want to add to what I have to say. Across the UK, there is constant horizon scanning of emerging pathogens or disease patterns through the global sharing of data and surveillance mechanisms. That is a really important point. The strength of global surveillance is absolutely key in all of this. We might want to go into the role of the World Health Organization in that regard at some point in the meeting.
That data is considered at a UK level as well, through the UK Health Security Agency, and risk assessments of emerging pathogens are produced. An example of that is the consideration of the recent Mpox data from central Africa and how that disease might impact on the UK. We are also keeping a close eye on the way in which H5N1 is crossing from avian sources to mammalian sources and how that affects the risk assessment for the UK.
Beyond what Daniel Kleinberg has outlined, there are technical assessments of risk for individual pathogens, which are fed into the risk assessment process by UKHSA, of which we are a part.
From my perspective in Public Health Scotland, as part of the continual risk assessment process that the CMO has just outlined, horizon scanning is undertaken not only by our organisation but by our UKHSA colleagues and by a number of expert groups, such as the World Health Organization, the Centers for Disease Control and Prevention and various branches of organisations across the globe. That co-ordination network has continued to share information about new and emerging threats to enable the risk assessment process to be undertaken.
I happen to be a member of the UK new and emerging respiratory virus threats advisory group—NERVTAC—which is one of the UK groups that would look at the issue from a respiratory pathogen perspective. I have been a member of that group since its formation. Groups such as that continue to keep a close eye on any emerging threats. They provide advice to the Government of the day and share with the devolved Administrations what those threats might be.
09:30To come back to the first question and offer some insight, none of us is waiting for the recommendations of the UK public inquiry; rather, we have just got on with things. It may well be that we already discharge many of the recommendations that come through, now or in the future, because the learning of the past has been that we have to take action now. In all that we do, whether that is surveillance or risk assessment and future planning, we respond by having the additional resource that has been provided to all the UK agencies to put us on a firm footing to respond to whatever our bread-and-butter challenges are today, and to ensure that we are in a good position to build on existing infrastructure and prepare for our next challenge. That includes some of the national exercising, which the committee might wish to hear a little more about.
What has been done in pandemic preparedness planning to ensure a greater focus on preventing the spread of a disease rather than on the impact of the disease? A lot of the time we are reactive rather than prepared.
How we prevent the spread of an emerging disease will depend very much on what the disease is and the mechanism by which it transmits. Lots of pathogens have pandemic potential, but they exert that potential in different ways. Some spread through airborne and respiratory routes, some spread through contact and some spread through water sources. There are a variety of means by which those pathogens can act, so how we prevent the spread depends very much on the mode of spread.
First, we need to understand the nature of the pathogen and whether it is a virus, a bacterium, a fungus or whatever. It is about learning the characteristics of that pathogen and the means by which it spreads, so that we can take measures to reduce the possibility of its spread. Personal protective equipment remains important in that regard. One thing that has changed since the beginning of the previous pandemic is that Scotland now maintains stockpiles of respiratory protective equipment that can last for up to 12 weeks.
A broader understanding of how the pathogen exerts its effects and spreads from one individual to another will determine the response. As a new disease begins to emerge, it becomes key to get samples of that pathogen in order to fully understand how it transmits and the process by which it exerts its effects on the body. Jim McMenamin might want to say more about that, because he is an expert in that area.
Our capacity to detect pathogens has gone up a gear with the advent of the opportunity to look at genetic fragments of any new pathogen. We came to see that new frontier of whole-genome sequencing as being at the forefront of our Covid response, and it remains at the heart of our capacity to identify infections that might prove challenging.
Beyond that, in the very recent past, a newer branch of that process, called metagenomics, has emerged. Imagine that one of us has travelled somewhere exotic. That person could come back with a range of symptoms that mean that they present to a medical service, but the normal battery of tests for the place where they have come from might produce negative results. Depending on the severity of the illness, that would leave medical professionals scratching their heads.
The advent of metagenomics—that capability exists on our doorstep, at the Medical Research Council and University of Glasgow centre for virus research—has offered us the opportunity to look at new infections that might not have a name yet. Genetic fragments can be identified, allowing the instances of new infections in a population to be identified for the first time. In the events that the CMO has just described—if a new infection results in severe illness that spreads rapidly among the population, with the potential for pandemic spread—metagenomics can offer us an illustrative first insight into what we might be able to do about it.
We have used the metagenomics approach in the very recent past. Children in Scotland were presenting with a liver infection—something called a hepatitis. As at least two committee members will be aware, because of their clinical knowledge, the main way that that infection might present is through jaundice, with children developing yellowing skin and eyes. The presentation was so severe that the children were managed in an intensive care setting in Scottish paediatric hospitals. The normal battery of available tests produced negative results, so the illness was classified as non A to E hepatitis—an illness that was not yet characterised, with the cause unknown. However, the centre for virus research, which is on our doorstep, and an additional unit in England were able to prove conclusively, by looking at the genetic fragments, that the infection presented was a combination of two viruses: an adenovirus and another virus.
That metagenomics potential is the next frontier in the development of our capabilities. That process potentially offers us a unique insight into how, in the future, we might rapidly identify a virus, communicate the threat and deploy treatments or vaccines if they were available.
It is worth saying that, in the particular incident that Jim McMenamin has highlighted, the cases of infection in children were not unique to Scotland; there were such cases elsewhere in the UK and, indeed, across Europe. It is a real testament to the Scottish team’s expertise, as well as to the infrastructure and techniques that have been developed here, that the team led the identification of the pathogens that were underlying those infections.
I will add to that and go back to Ms Harper’s question. We are keen to get on with founding the pandemic science partnership that you referred to, because, as I started rather grimly by saying, there is a 5 to 25 per cent chance that we could have another pandemic. Nobody wants to hear that, and nobody wants to hear that it is getting more likely rather than less likely, because of the threat of the potential malicious use of new and developing technologies, and as people travel to different parts of the world as climate instability hits.
What will work in our favour is how much the technology has moved on since Covid, as well as how much investment has been put into metagenomics, whole-genome sequencing and water-based epidemiology, which involves waste water testing. Our ability to look for those things and to characterise and assess them is much better than it was, although I am not an expert like the other two witnesses, especially Jim McMenamin.
Globally, there has been huge investment in the 100 days mission initiative in response to future pandemics. The response focuses on the use of new technologies on vaccines, the mRNA platform and so on, and a huge amount of investment is being put into that. The idea is that, when we find the next one, our chances of responding swiftly and preventing the level of harm that we might otherwise see will be greater. However, it is always a risk management process.
It is useful to think about that response as being scalable. That is the really important aspect for me, because we might be facing something that involves the whole country or there could be much more localised outbreaks that involve imported cases of diseases, such as we see now from other countries. If that technology and that approach face the right way, that will allow us to provide a scalable response. It will allow us to identify and manage those cases, whether it be a viral haemorrhagic fever that is already known about or disease X that is yet to be characterised. In the future, the important thing is that, no matter what, we have the infrastructure and the elements in Scotland to be able to respond to that.
Sorry—we are getting geeky and excited.
That is all right.
The link into the science and research network in Scotland is huge. Jim McMenamin mentioned the centre for virus research, and Scotland has a genuinely excellent research community in that area. Some researchers will tell you that the next step is the use of artificial intelligence to characterise how viruses might behave. You can find something that you have not seen before and, with AI, in a very short period, achieve what might have taken years previously. I think that that is the next technology that will come in our favour. Therefore, whatever is brewing away in a bat cave in some place where we have not been before, we will be able to understand how that is likely to behave and how to respond to that.
Thank you.
I declare an interest as a practising national health service general practitioner.
Sir Gregor Smith, you spoke about global surveillance. I want to briefly explore our relationship with the United States of America, given its size, wealth and power. The health secretary, Robert F Kennedy Jnr, has criticised vaccine safety, and he has said that autism comes from vaccines, for example. What is our relationship with the USA like?
During the pandemic response, a very strong relationship was developed with the centre for communicable diseases in the United States—the Centers for Disease Control and Prevention. We had regular meetings in which we shared data, and that has continued in the post-pandemic period. Jim McMenamin has taken part in many of those meetings with me.
I think that it is fair to say that there was a period, particularly at the beginning of this year, less data flowed from the CDC than we had previously enjoyed, particularly in relation to the close scrutiny that we undertook with the CDC on the emergence of H5N1 in cattle herds in the US. That has since improved. You will also see that the CDC is back to sharing data extensively on its website.
The CDC is a changing organisation, and we are yet to see how the changes that have been instituted by the new Administration will settle down and influence the way in which the CDC interacts with the world outside the United States. At this stage, my observation is that that interaction is perhaps not as strong as it used to be, and I think that the withdrawal of the US from the WHO creates a significant gap in our surveillance systems globally, not just in the United States. In addition, the loss of funding as a consequence of the United States withdrawing from the WHO means that there is a risk that global surveillance systems will be undermined rather than strengthened.
I have certainly been anxious about that, and I think that the WHO recognises that as a potentially developing issue. Having said that, I am very aware that the WHO continues to take steps to reform itself and, as it carries out that reform, to prioritise actions that allow us to have the degree of confidence that we need about global surveillance systems.
In May, at the 78th World Health Assembly, the pandemic accord was agreed, and international health regulations were strengthened as part of that. I am reassured to a large extent by such global co-operation, particularly the WHO’s continued prioritisation of global surveillance systems. That is one of the things that it sees as an absolute must-do.
09:45
You both spoke about the excellent work that is being done in Glasgow on viral haemorrhagic diseases and metagenomics. The University of Glasgow, which runs the lab, is very concerned, with funding streams shifting and ending, that it will not be able to provide the 24-hour support that it provides now. When we needed instant genomics testing when a nurse came back from Africa, lab workers woke up and found the code quickly, with the nurse being treated in London. What can we do to make sure that such labs, which are world leading, do not lose funding and close?
We are incredibly fortunate to have the work that the centre for virus research at the University of Glasgow gives us. It is a fascinating place. When I had the great privilege of attending a recent conference hosted by the University of Glasgow on UK pandemic sciences, I heard many members of the CVR speak about the innovative and groundbreaking work that they do. My very strong view is that that work must be sustainable. Funding streams from a variety of sources—whether from the research environment or from other sources—must ensure that the CVR is allowed to proceed with the plans that it has in place to continue its viral research.
I completely agree with the CMO on the need for that very important relationship with the CDC to continue. It has been very important for us to be able to share information with each other about emerging issues, whatever the geographical location of the cases.
On the issue that we have just discussed, it is important to say that we do not have just one centre of excellence. Indeed, the whole thrust of having a national Scottish pandemic science partnership is to strengthen the link with all the teams that are involved. Exceptional work is also done at the University of Edinburgh, through our computing resources and by our mathematics associations with the University of Strathclyde and Glasgow Caledonian University in relation to the incident and outbreak issues that we deal with. There is incredible technical expertise across the board in all those settings.
To strengthen our approach, it is important that we are well connected and that we are able to learn from one another—not just in Scotland but internationally. That should be an essential feature beyond our main reasons for existence in Public Health Scotland. We are, of course, involved in addressing inequalities and preparing for pandemics, and we have a statutory responsibility to do that. It is about building relationships with those who will assist us in managing our future problems.
I do not want to cause shock or alarm to anybody, but how do the scientists who work with humans in tracing the genomics of pathogens and viruses work with our veterinarians, for instance? We have recently had issues with Schmallenberg virus and bluetongue, and there has been foot and mouth in Germany, so I am thinking about the zoonotic aspects of avian influenza, which Sir Gregor has mentioned. How do we work with other scientists to track and trace the potential pathogens from ticks, fleas and other wee beasties?
I hope that it will not surprise you to learn that there are very rich contacts and huge co-operation between the medical and veterinary scientific communities in relation to that. In fact, I have regular contact with the chief veterinary officer on developments in her world and disease patterns across Scotland that result from those. What has been very evident to me in the contact that I have had through the scientific networks that have formed around pandemic control—the UK pandemic sciences network, in particular, and the Scottish pandemic sciences network as it begins to form—is that there is one health umbrella under which we are looking at the broad biological threats to both the animal world and the human world.
You are absolutely right. There is a variety of vectors that we need to consider in that space, including vectors such as mosquitoes, midges and ticks, and vectors that have an avian or mammalian source. However, I see very close scientific co-operation on that. In fact, I have recently received presentations on the changing patterns of vector-borne diseases, in particular, across Europe and within the UK. That is a factor that we will need to take much more and closer consideration of as climate change begins to exert its effect across Europe. We have recently seen the emergence of diseases in Europe that have gradually spread their hold from southern areas northwards. We have had dengue fever in Italy and Spain and now even in the suburbs of Paris. It is only a matter of time before we see further spread of such diseases as a result of climate change. We are also seeing changing patterns of illness in the animal world across Europe, which can sometimes lead to the emergence of small pockets of disease in humans. A good example of that is the recent incidence of west Nile fever in Germany and Holland. Those are all issues on which there is close co-operation in the veterinary medicine and human medicine scientific community.
I am delighted that you have raised that, Ms Harper. Last year, we made a consultant appointment in Public Health Scotland. Professor Dominic Mellor came from the veterinary team there and is our lead for veterinary public health. That important close integration in what we are doing is just one example. The CMO took us into one recent example of why that is important. Just two weeks ago, our UKHSA colleagues reported that west Nile virus had been detected for the first time—admittedly in a sample dating back to 2023—in mosquitoes that were local to Nottingham.
The global issues of climate, sustainability and potential public health impact are critical. Indeed, probably the best epidemiologists I have ever worked with are on the veterinary side. I am particularly mindful of the work of Marta Valenciano, who was a colleague I worked with in Epiconcept. There are incredible epidemiologists and we all learn from each other about how to appropriately investigate and manage any new incident, no matter whether it starts in an animal population or in humans.
Good morning to our witnesses. I will briefly pick up on one of Sandesh Gulhane’s points before I move on to my own questions about the relationship with the US. One of the things that the US Administration is threatening to do is prohibit publicly funded researchers from publishing in respected peer-reviewed journals and potentially to set up alternative journals that look as though they would be guided by the ideology of politicians who have been known to promote conspiracy theories and debunked science. If that happens—if that threat is realised—would you agree that there is a need to re-evaluate US agencies as partners?
I would not want to be drawn into speculation about what may or may not happen in the United States until we have firm evidence of the approach that the CDC will take. The CDC is working on various reports that are looking at the patterns of infectious disease and illness across the country, including how vaccine uptake might have impacted on them. I would not want to be drawn into saying what approach is likely to be taken, until I see firm evidence of how the CDC is likely to report on those matters and, in particular, how the reports are likely to be peer reviewed. An important aspect of the science that is produced is not just the provenance of the reports and data and how they are interpreted but how the scientific method is peer reviewed.
If it happens, will that judgment rest with you as the CMO, rather than with ministers?
Certainly, the clinical and scientific community would provide advice to ministers about our view on the veracity of any reports.
I will move on. Whatever level of technological and research progress we have—and there have been some positive and optimistic comments about that—the planning and preparedness need to be there if we are to get effective use out of it.
Before Covid hit, the influenza preparedness strategy was, essentially, the only game in town. The devolved Administration in Scotland had adopted it, despite having the option to go in a different direction. The inquiry has found significant flaws with that strategy, not least that it was specific to influenza, which did not turn out to be what hit us. Presumably, that was one of the reasons why the strategy was effectively abandoned early on and the different Administrations in the UK went their own ways with new approaches.
The inquiry noted that there has been some work on various documents since then, but it found that there is still a lack of clarity in how both the problems and the solutions are set out. It recommended a UK-wide whole-system civil emergency strategy. Where are we with implementing that recommendation—both at a UK level and under the devolved Administration in Scotland?
I will pass that question to Daniel Kleinberg, who has been quite involved with all of this work.
Some of that comes back to my first answer about Baroness Hallett and the response around the wider civil contingencies. However, if we are going into pandemics specifically, one very positive thing that has come out of the past couple of years is exercise Pegasus, which is focused around autumn, with anchor days in September, October and November. It is a tier 1 UK exercise in which all the four nations participate, and it looks at pandemic preparedness. It will test itself against a scenario that will not be known before we go into it or that will be known only to those who design it. For me, that is a good opportunity for Scotland to test how it would structure itself.
The pandemic flu plan from 2011 structured quite a lot of what we did in Covid. It was not fundamental to how we designed our approach, but nor was it abandoned. It creaked and did not work, and people have said why. However, as we learn what we would do next time, two things stand out. One is that nothing in that flu plan envisaged some of the advances in technology, but another thing that it did not envisage was the use of non-pharmaceutical interventions. It did not suggest that, by using social, non-pharmaceutical measures, we could stop flu in its tracks, which we did for two years during Covid. We did not see a flu season for two years. I do not know whether we would reach for that again, but some of the impacts of flu are horrific. A pandemic flu that is felt primarily in young people is a genuinely terrifying prospect, and the fatality rates would be way beyond the rates that we saw with Covid. It is important to think through how we would make those decisions.
10:00In exercise Pegasus, I would like Scotland to test, as will be tested at the UK level, what we stand up—it might be a respiratory response plan rather than a flu plan, although I still think that flu is a big pick for what comes next, so I do not think that any of us would want to denigrate flu planning. However, we should have a variety of responses.
In exercise Pegasus, we should test the four-harms approach that we used in Scotland during Covid. Ministers took decisions not only on the basis of stopping the virus or disease. Harm 1 was about how we counteracted the virus and the disease that it caused; harm 2 was about pricing in what we might be stopping in health and social care—the impacts of the control measures; harm 3 was about the social impacts, such as the educational impacts; and harm 4 was about the economic impacts. We need to test our ability to make decisions that take into account the full range of impacts, immediately and in the future. That needs to be part of our decision-making framework. It feels to me that we will have those things in place and will test them.
Just as you do not want to downplay the importance of flu planning, I do not want to downplay the importance of pandemic planning in isolation, but how does such planning integrate with a wider approach—what has been described as a whole-system approach—to emergency planning? Planning for a pandemic is very important, but it has to be seen as part of our wider understanding of how the country responds to emergencies.
Daniel Kleinberg can respond to that first, but I want to say a little bit about it, too.
There is definitely commonality. Whatever else we do, health and social care resilience is likely to be a big feature of just about any of the major contingencies that we plan for. A lot of that happens at the UK level—a lot of it is about financial planning, for example. I agree that the connection into the wider contingencies world is important, but the specificity of pandemics is such that both of those parts of planning have to be run in tandem.
I go back to my point that having a scalable response is really important, particularly in relation to how the NHS responds to an emerging threat. There are commonalities, whether the threat relates to winter surgeries and respiratory disease or whether it is the emergence of a novel pandemic. Part of the issue is the scale of the response. We are working through our resilience mechanisms, and a branch of the Scottish Government—health emergency preparedness and resilience and response—is developing new guidance for health in relation to scalable responses.
Will that be specifically for health?
Yes. I want to drill down into that issue, because we need to develop that guidance to ensure that the NHS is able to scale our response—whether it be to a malicious threat or attack or to a new or emerging infectious disease—in a way that we would expect.
I want to say a little bit about the second aspect of the contingencies and preparation work, which is about our learning about any emerging disease or pathogen. That is really important, and I cannot emphasise enough the work that has to be done in preparation. UK sciences are particularly strong in being able to analyse and develop scientific learning about the nature of any pathogen threat and, as a consequence, develop interventions that can address that threat. Those interventions might be novel tests, the use of infection vaccines and so on.
I appreciate those answers—it is inevitable that there will be a health focus this morning, given the witnesses—but I am asking about the context. Is that work being done in the context of implementing the recommendation that the UK Government and devolved Governments should work together to introduce a whole-system civil emergency strategy?
Something that has been agreed, and which has been signalled to Baroness Hallett in the Scottish Government’s response, is that the Cabinet will consider doing biannual papers on whole-system civil emergency.
Is it beginning?
That work is certainly beginning. I am not as familiar with that as with the pandemic side of it, but it is under way, I would say.
I have one additional point to make. The national Scottish pandemic sciences partnership is not only looking at what we would do for the hard sciences, such as laboratories and data, but, just as importantly, considering the behavioural perspective. What do we need to do to keep the trust of our population? What do we need to do to ensure that we can discuss some hard things that will, potentially, have to be discussed at the time? Stephen Reicher and other colleagues will be able to make an incredible contribution to work on how we will address those issues.
That brings us on to my final question. One of the flaws that were identified with the 2011 influenza preparedness strategy was the lack of an economic and social dimension to it. That covers a great deal that is non-medical and not specific to a health pandemic but still very relevant to a health pandemic, and it would have been relevant five years ago.
Trust and trusted sources of information in an age of disinformation are very important, as is community infrastructure, so that people know where they can get help informally and quickly. Are we investing in those community organisations and relationships? We have not been for 15 years or so.
There are also very basic things such as homelessness. Having safe, secure and adequate housing is important to keep people safe in any emergency, particularly during a pandemic. Can you comment on the extent to which a connection—beyond the direct medical and public health response to a pandemic—is being made to the social and economic conditions that will enable us to weather a storm?
Daniel Kleinberg might want to say a little bit about that first, and then I will come in and speak about working with the population in relation to that.
Pandemics exacerbate underlying social and economic inequalities; that is just a given. I do not think that it is for me to comment on the wider socioeconomic policy. We have a better understanding of how we would support and reach out to vulnerable groups because of the Covid pandemic. Continuing with that work is important, as is some of the learning that we took from trusted sources of information. I agree with what you said—that is an important part of where we need to be.
Data is key in all of this. Data was one of our blind spots, particularly at the beginning of the pandemic. It got better as the pandemic response went on, but we need to ensure that we have the right data to inform us of where the pandemic is particularly likely to have a more severe impact. As Daniel Kleinberg said, in every pandemic over the ages, back to medieval times, the most disadvantaged have tended to suffer the worst effects.
What is interesting, having taken a retrospective look at the impact that the Covid-19 pandemic had on people, is that evidence from across Europe identifies that countries that already had challenging trajectories for improving healthy life expectancy, particularly relating to cardiovascular disease, tended to fare worse than the countries that had been able to maintain their trajectories of health improvement in such areas. Therefore, creating better health resilience in the population has to be a target, so how we work with communities to ensure that we are creating healthier communities is essential.
The work that proceeds on reducing inequalities not only has an effect on improving the health of the population now but makes us much better prepared for the impact of the next pandemic, in the event that there is one.
From the public health perspective, public health is fundamentally shaped by social context.
The marginalised or seldom-heard-from individuals in the population are at the heart of what we are trying to do through our routine public health offer. However, as the chief medical officer has just taken us through, that is just exacerbated whenever we are faced with a pandemic issue.
Data is at the heart of everything that we need. I am delighted that we have made such significant progress on our capability to link data, because the Scottish population would expect us to be able to say whether the interventions that we make work. What is the reduction in hospitalisation? What number of lives are saved by whatever we are trying to do? That comes back to the point that I have just made, that it is fundamental to maintaining the trust of the population to bring them with us on any journey that we make in the response.
Thank you.
I thank the witnesses for coming. Sir Gregor has hinted at the theme of some of my questions. The module 1 report highlighted the importance of data and research when we are responding to a pandemic. Professor Patrick Vallance told the UK inquiry that there was a paucity of data, and I think that Sir Gregor just echoed that point. In Professor Patrick Vallance’s words, the UK Government and devolved Administrations
“were flying more blind than you would wish to”.
Issues were identified around the lack of formal structures for the Office for National Statistics to contribute to preparedness planning, as well as a lack of compatibility in data systems across the four UK countries. At paragraph 4.75, the report identifies that
“This means that, despite England, Wales, Scotland and Northern Ireland being at risk of the same health emergency, the data and health systems were so different that they were a barrier to effective preparedness.”
Could members of the panel comment on that paucity of data, which the UK Covid inquiry identified as a weakness? What work is specifically under way to establish countermeasures to those weaknesses so that we have appropriate and reliable data systems across the UK?
I will begin and then turn to Jim McMenamin, who will be able to expand a little on some of the specific data sets that we have developed since the pandemic. Actually, we used those extensively towards the middle and later stages of the pandemic, but you are right that, in the early stages, actionable data was difficult to come by in developing a response. That was partly because, in the early stages of the response to any emerging pathogen, there is a learning process in trying to determine key aspects such as transmission rates or case fatality rates.
Although the UK had good mechanisms by which that information could be derived, none of those was particularly rapid and they depended on the number of cases that were being seen to develop the information. That has all been looked at and thoroughly examined as part of the response to what is likely to happen the next time.
Over the course of the pandemic, developing data became a feature of paramount importance, as did sharing data across countries. You are right that there were points during the pandemic response when data was not directly comparable across the four nations, because definitions were used in a slightly different way or the data was collected in a slightly different way. The more that we have a confluence of approach in that space, the better.
The data world in Scotland has progressed significantly since those early days. As I said, even during the response to the pandemic, we saw much more sophisticated data systems. Jim will no doubt speak a little about the EAVE II platform, which he was extensively involved in and which became a fascinating and trusted source of information on how, for instance, vaccines were exerting their effect on the population.
I am much more confident now, but there is more to be done. One important aspect of the work of the pandemic sciences network will be ensuring that we have data platforms and have identified the means to collate and link data. That latter aspect is particularly important to ensure that, the next time, the response is as effective as it can be across all groups of society.
10:15
Before we hear from Jim McMenamin, I would like to add something that relates to Mr Harvie’s point. One of the sub-groups of the standing committee on pandemic preparedness is looking at data, and we have learned from colleagues on that group that they have been working very closely with the UK Government’s Cabinet Office on the use and sharing of data for emergency preparedness generally—not only for pandemics, because a lot of the material is common. A memorandum of understanding on that, which will be part of an analytical framework, will be signed by the Cabinet Office and devolved Administrations in the coming weeks. That embodies the idea of collecting and sharing data across different types of crisis.
That also raises the need for us to have a conversation about the issue with the public, because what we would want to know in a pandemic might include data on people’s movements and so on. How such data could be collected fairly, decently and transparently is hugely important.
I will come back to the area that the CMO took us into. The work of the University of Edinburgh’s Usher institute was extremely important in enabling us to deliver for the early estimation of vaccine and anti-viral effectiveness—EAVE II—study. That had its origins more than a decade ago, in 2010-11, when we thought that it would be a good idea to have the capability to link general practice information with hospitalisation data, data on vaccination status, laboratory data and death data.
That approach was in place in a hibernated project that had been jointly developed with a predecessor organisation to Public Health Scotland—Health Protection Scotland—in which I was based. I was one of the folk who took that through the ethics committee for approval at the time.
That approach stood us in such good stead for the deployment of the Covid vaccines that Scotland was the first country to be able to produce a national estimate of the effectiveness of vaccination in the first wave. My colleagues in Public Health Scotland agree that that was not only of critical importance in enabling us to demonstrate the effectiveness of a vaccine in allowing us to find a path out of some of the societal restrictions that were in place but was of great utility for the rest of the UK and the international community. That work was intensely covered by a number of international reports in Washington, New York and elsewhere. All that information allowed the world to change its perspective and continued to enforce the message about the usefulness of the vaccines that we had available to us.
You have given us a helpful and encouraging insight into Scotland’s underlying data picture. Inevitably, however, I want to focus on areas of development. What work is being done specifically to improve the data systems? What projects are being commissioned? How will new systems be tested? Are there exercises in the pipeline? Is there a timescale for when data systems are likely to be tested in a pandemic simulation exercise? Will that happen in the next few years? What new hibernated studies or existing studies are being developed? It would be good to get a more specific indication of what work is under way in the light of the learning from the Covid-19 pandemic.
Jim McMenamin can say a bit more about data, while Daniel Kleinberg will be able to talk about exercises.
I offered the example of what we did with the EAVE II study. Using a similar approach, we were able to do a whole-UK study for the first time, called COALESCE—the “Capacity and capability Of UK-wide Analysts to LEverage health data at Scale using COVID-19 as an Exemplar” study. In that study, we addressed what the CMO just discussed: ensuring that we have data comparability among the constituent bits of the UK and are able to offer insight into how we would undertake such work in the future. That is really important and sets the scene for where we are and what our capabilities are, much of which we have also covered in setting out the ambition for what the national Scottish pandemic sciences partnership will offer. We are trying to ensure that data provision and data flow, as well as the information governance around that, are all in place in advance and that any amendments can be rapidly implemented to allow early sharing of information for action.
There is a data strategy within the Scottish Government for health and social care, which includes a creating data for insights programme. We already have Scottish dashboarding for key indicators across health and social care, so developing that further is already well in hand.
When it comes to exercises, I spoke earlier about the four-harms approach, and that is what I would expect us to use in exercise Pegasus. In order for ministers to make decisions, they need data and analysis on each of the four harms that I mentioned—the best economic, social and educational data that we have at the time. I expect us to be standing that up, seeing what data sources are online and working well, and where those gaps are felt to be when we test it out. Pegasus is a really good chance to have a look at that.
Thank you. We are over an hour into our session and we have reached only the halfway point of our questions, so I ask members to be concise with their questions and witnesses to try and be more precise with their answers. I will go to Stephanie Callaghan.
Ms Callaghan is not online—oh, she is there.
Sorry, convener. I could not unmute myself.
Given the 5 to 25 per cent chance of a new pandemic that has been mentioned, learning from past experiences will clearly be crucial. I will focus on the planned autumn exercise, which is not that far away. The UK inquiry identified a number of limitations across previous exercises. Can the witnesses detail how this year’s Pegasus exercise will be different from previous exercises, particularly around containment strategies, following up recommendations and addressing the disproportionate impact that falls on vulnerable people and groups that we have already spoken about?
I do not know whether it will be different, but Pegasus will publish the learnings from the exercise. The UK has indicated that it wishes to publish a pandemic strategy, for example, which will be informed by the findings from Pegasus. However, for me, what is key with all such things is, once we have identified the lessons, to say how we will implement them, who will implement them, and where they will be implemented. I cannot really speak further about the details of Pegasus, because the nature of an exercise is that the detail is revealed only at the point at which you go through it.
I am wondering how confident you are that those actions and follow-ups will happen, because that has certainly been quite a weakness in the past.
I am confident that there is a very high level of interest, scrutiny and willingness to learn those lessons. I am confident that many of the lessons that were identified in the past are in hand, but what we have not done is report back on them in a way that fully makes that transparent. All of that is likely to be better under exercise Pegasus, because I suspect that the level of scrutiny and interest post-Covid will be greater and the need to learn those lessons is shared. The best that I can say at the moment is that I am hopeful.
The inquiry report also recommended that guidance should be kept in a single UK-wide online archive, which would make it much easier from the sharing and access point of view. What work is under way to develop the UK online archive, and is there an expected timeline for completion?
I am sorry, convener, but I did not catch the question.
Ms Callaghan was asking about the development of a UK online archive to allow data to be shared more effectively.
Is that about data guidance?
I am certainly not aware of a UK data archive or of moves towards the development of such an archive, and I have not been involved in any discussions about that.
I think that you were asking about guidance—it is a slightly bad line. One of the things that we are doing under the future pandemic work is looking at guidance. Public Health Scotland stood up an awful lot of guidance under Covid. A lot of that is likely to be the sort of thing that would be needed again in future pandemics, but we are refreshing it, understanding it and placing it into the Scottish context. One of the challenges with guidance is that many of the principles in relation to the disease are the same, but the deployment and the response are often local. We have a cell looking at guidance in Scotland.
That is fine. Thank you, convener. I am aware that the line is quite bad.
I will focus on key lessons for future pandemics. Daniel Kleinberg spoke about the likelihood of another pandemic in the next five years being up to 25 per cent. Covid variant NB.1.8.1 is the dominant strain in China. There has been a huge surge in hospitalisations, and it is more contagious than previous variants. It has spread to 22 countries and accounts for 10 per cent of Covid cases worldwide. Is that of concern here? If so, how prepared are we for that variant?
We have been watching variant NB.1.8.1 for some time and looking to see how cases of it develop. You are right that some of the statistics that have been reported from China, in particular, suggest that there has been a rise in hospitalisations associated with respiratory problems, and the number of emergency department presentations seems to have risen in China, too. We are also seeing the variant in pockets of other parts of the world. In the United States, some states have issued advice on it. The variant is not ubiquitous; at this point, it seems to be fairly localised with regard to where it is exerting its effect. However, from a relatively low baseline globally, we are now seeing a rise in the number of Covid cases that have resulted in hospitalisation.
There have been some cases of the variant in the UK. Jim McMenamin and I had a conversation earlier about that and about the analysis that is being done to try to make an accurate assessment of any potential impacts, particularly in well-vaccinated and exposed populations. Jim might want to say more about the work that Public Health Scotland is doing on that.
As the CMO has just described, it is early days with regard to what we might see as a consequence of that genomic type of Covid. In our current surveillance arrangement, we have an opportunity to use whole-genome sequencing, which is undertaken on Scottish samples, alongside colleagues in the rest of the UK, to look at whether there will be any more than just the penny numbers of cases that we currently have or whether the variant will become more dominant among the different variants that are reported across the UK population and particularly in Scotland.
For individuals who have the infection, we would consider the profile, including what age groups are affected and whether the infection shows an ability to hurt people more than any of the other Covid variants. We continue to look at hospitalisations and intensive care unit activity to see whether it will be an issue for us. At the moment, it is too early for us to say from the early information that we have on the infection whether it will translate into more of an issue for the Scottish and UK populations.
10:30
For me, more than anything, that emphasises the on-going need for vigilance and surveillance not just of the way that the Covid virus inevitably will develop over time—we have seen it develop different characteristics during the five years that we have been aware of it—but across the broad respiratory pathogen network, to ensure that we have robust mechanisms in Scotland to pick up different patterns of disease presentation. Public Health Scotland has very good respiratory surveillance data, which is used extensively to look at the emerging picture of infections across all the respiratory pathogens in Scotland. Dr Gulhane previously mentioned global surveillance data, and that is why global co-operation on data sharing is so important.
Let us assume that that variant or something else comes along next week or in the next couple of weeks. What is our preparedness level like right now? You spoke about having 12-week stocks of PPE, but what is in those stocks? As far as I am aware, the common mask that we tend to use becomes useless after about half an hour. Do we have enough stock of real PPE that could go out to GPs, social care workers and others who are on the front line?
The short answer to that is yes. Just now, in Scotland, we have 12 weeks of PPE stock of an amount that is comparable to peak usage during the Covid pandemic, and distribution mechanisms have been developed for that. We have scalable assets across Scotland, whether that is medical equipment or ICU departments. If necessary, we are able to double our ICU capacity, and we have platforms that have been mothballed but kept under licence that can be brought back into play to allow us to develop the data and the infrastructure for contact tracing at scale. There is scalable infrastructure in Scotland that can be rolled out should something necessitate a wide response.
You spoke about data being king. Would it be helpful if we had a single information technology platform across health and social care in Scotland that we could harvest data from?
I can give you my view on that. There are many reasons why there would be tremendous advantages from a single digital platform that links data, with appropriate access, across health and social care.
Daniel Kleinberg spoke about the harms that were caused—not just health harms, but many other things. Lockdown caused harms to our mental health, hospitals could not facilitate cancer treatment and children who were going through school suffered harms. In my opinion, the evidence on lockdown is not great; it is really about vaccines, not lockdown. Where are we with potentially having to use a lockdown again in a future pandemic scenario?
One thing that we did not mention about that Covid variant is that although, at the moment, we have no idea what it will do, if it were causing a threat we would consider vaccination.
On the future use of social restrictions, I do not have an answer as to when to use them, because that is a political question. The best that you can say is that, once you have understood the threat that your society faces, and once you have characterised the severity and profile of the disease, you can begin to offer an analysis across the different considerations.
The withering effects of a high level of social restrictions are uncontested, but you do not have a good option, because you are measuring those against the potential impacts on people—if the disease profile is different, it might be young people—and your ability to keep your society functioning. Those are, by definition, questions for the disease and the politics of the day. I have nothing better to say about that.
The more that we can understand the longer-term impacts of those social restrictions, the better. For example, we did not know that they could stop a flu, but they did, which is something that we should learn from. Equally, we are still learning about the longer-term educational and socioeconomic impacts.
I do not have an answer as to whether we should use them. That is a question for the politicians of the day.
Thank you.
The UK inquiry’s module 1 report emphasises the importance of surge capacity in the NHS and says that that was not planned for in the simulated exercises. Given that the NHS and social care sectors were found to be unable to “surge up” at the onset of the pandemic, to what extent do you think they could deal with that now, given that we are still catching up after the pandemic? Where are we on that, if we needed it in the future?
The efforts made by the NHS and social care across Scotland throughout the pandemic were nothing short of phenomenal. The really significant sacrifice that staff across all professions made to make sure that people received the care that they required was exceptional, but we cannot rely on that as a response to the next time. We need to make sure that there is adequate planning in place for surge, no matter what the cause of that surge.
This is the point that I wanted to bring out earlier. We might need to surge the NHS, in particular, for all sorts of reasons. It could be because of the emergence of a particularly bad flu or winter season, a response to a malicious attack or the global instability that we see abroad. On the NHS’s ability to surge, the Government is currently undertaking a piece of work in the health resilience area to see how it can work with our various health boards on surge planning and capacity. We already have the means to surge in particular specialties such as critical care if that becomes necessary.
There is no doubt that the NHS has never been as exceptionally busy as it is now, and to work in the NHS is a difficult job for my colleagues because of the volume of very complex illness that they continue to see. Some of that is a consequence of our experience during the past five years, particularly the pandemic, and some is related to changing patterns of disease in an ageing population.
Surge planning is a key aspect of the work that is under way on how the NHS will respond in future. We have partnerships between local government and the NHS. The resilience partnerships across Scotland also play a key part in ensuring that all assets in the community, across social care, third sector organisations and statutory organisations, can play their part in that.
I am pleased to hear you talk about resilience across the NHS and social care. The pandemic shone a light on the need to ensure that the parties in that relationship are equal and are considered at all times. Is enough work going on among the Scottish Government, NHS boards and local government for that to happen, were we to see a pandemic in the near future?
That work is under way, and, when we proceed further with it and can report findings and approaches, I will be able to give you a more complete answer to your question.
That is helpful; thank you.
It is good to see you all. I want to go a little further on the WHO, which you touched on in answering Sandesh Gulhane’s questions. The suggestion of a pandemic international agreement was first mooted back in 2021 and was agreed by the World Health Assembly on 20 May this year. It would be good to hear a bit more about what that means for Scotland. If you want to make a pitch for why other countries should join it, it would be helpful to hear about the benefits.
I would state unequivocally that that is a good thing for Scotland. Although we do not have a direct relationship with the WHO, our relationship is strong through UK mechanisms. It will not surprise you to hear that the UK CMOs still spend a significant amount of time in discussion, particularly in order to share information and approaches as they relate to the WHO.
I welcome the pandemic accord and the update of the International Health Regulations 2005 that sit alongside it. There is still work to be done, particularly around pathogen sharing and so forth, and that work will proceed in the months ahead. The accord puts us in a significantly better position globally. I see the WHO as being the organisation that can co-ordinate the response globally and ensure that the surveillance mechanisms on a global scale are present and working to give us an early warning of any emerging or potential threats.
An important aspect of the accord is having the legal basis on which people will co-operate and share information. Although it has been a long time in the making—it has taken more than three years to negotiate with members—the weight of support that you saw at the 78th World Health Assembly is significant.
I absolutely wish that all countries in the world had signed up to the accord and had continued to support the WHO. Having a country that is as significant as the United States, which has much to offer with its scientific basis, step away from the WHO means a weakening of the global position. That does not enhance the capability of the WHO, and I hope that the position is reversed at some point—certainly in my lifetime.
I cannot add much to what the CMO has offered other than to say that that is a very laudable approach that all countries should consider. I am delighted that the accord is in place.
I will mention one component of the accord that is important for us. Vaccine availability is, of course, critical whenever we have any new emerging threat, and ensuring that the most disadvantaged countries have access to a proportion of global production is essential. Every developed country should look on that as an important aspect of what needs to be covered.
That is a really interesting point, which you have added just at the end of our time for questions. I see the convener pushing in, but I will ask one more question and maybe let Daniel Kleinberg have the last words. How can we get across the message that it is important for us all that the whole world works together? Health in Africa, for instance, is just as important to us here, in Scotland, as it is to people in Africa.
I can see from the convener’s eyes that my answer should be short, so I will go back to something that one of our scientific advisers said during Covid. It is a commonplace saying. No one is safe until everyone is safe. Therefore, anything that boosts the international rules-based order is a good thing for public health. How it is done is a second-order issue for me, but that is what we have been saying.
Thank you for your brevity, Mr Kleinberg, although I am a bit concerned that you can see into my eyes from that distance.
I thank the witnesses for their evidence this morning. It has certainly given the committee a lot of food for thought. You have given a lot of information about the work that is being done, perhaps not as publicly as it might have been before we were able to ask you about it.
I suspend the meeting briefly so that we can change witnesses.
10:46 Meeting suspended.