Bird flu is another warning to improve the UK’s resilience

A new strain of the H5N1 ‘bird flu’ virus is tearing through the globe’s avian population, leading to the death of over 200 million birds worldwide over the past two years. ⁴⁰ Marshall C and Prior M, Bird flu 'spills over' to otters and foxes in UK, BBC News, 2 February 2023, www.bbc.co.uk/news/science-environment-64474594 ⁴¹ Department for Environment, Food & Rural Affairs and Animal and Plant Health Agency, Bird flu (avian influenza): latest situation in England, 4 November 2022, www.gov.uk/government/news/bird-flu-avian-influenza-latest-situation-in-england Concerningly, the disease has spread to a small number of mammals who are believed to have contracted it by feeding on birds infected with the virus, and mammal-to-mammal transmission seems to have occurred on a mink farm in Spain. ⁴² Kupferschmidt K, 'Incredibly concerning': Bird flu outbreak at Spanish mink farm triggers pandemic fears, Science, 24 January 2023, www.science.org/content/article/incredibly-concerning-bird-flu-outbreak-spanish-mink-farm-triggers-pandemic-fears

The UK Health Security Agency currently assesses the risk of the disease as level 3 of 6 – meaning there is evidence the virus has mutated in a way that makes it easier to infect mammals. One of the virus’ mutations “has a propensity to cause zoonotic infection”, increasing the chance the disease could jump to humans. At present there are “no indicators of increasing risk to human health”, but the UKHSA acknowledges this is a “low confidence assessment” and that “the risk assessment is dynamic and requires regular review during this period of unusually high levels of transmission in birds with mammalian spillover”. ⁴³ UK Health Security Agency,Investigation into the risk to human health of avian influenza (influenza A H5N1) in England: technical briefing 1, 21 December 2022, www.gov.uk/government/publications/avian-influenza-influenza-a-h5n1-technical-briefings/investigation-into-the-risk-to-human-health-of-avian-influenz…

As the coronavirus pandemic showed, novel diseases can quickly become serious threats to which the UK is vulnerable. We don’t know whether bird flu will jump to humans, and if so, what the consequences would be. But its emergence should be treated with the utmost seriousness by the government.  

The government should reverse decisions which have reduced the UK’s pandemic preparedness 

The government has consistently undervalued and unpicked successful pandemic legacies rather than using the architecture it set up to bolster its resilience in the future.  

First, wastewater monitoring for the spread of Covid was “paused” in England in March 2022, despite the government acknowledging that “wastewater based epidemiology is likely to be of significant importance in the future” – and the Welsh government continuing its own monitoring programme. ⁴⁴ UK Health Security Agency, EMHP wastewater monitoring of SARS-CoV-2 in England: 1 June 2021 to 7 March 2022, 31 March 2022, www.gov.uk/government/publications/monitoring-of-sars-cov-2-rna-in-england-wastewater-monthly-statistics-1-june-2021-to-7-march-2022/emhp-wastewater-… ⁴⁵ Welsh government, Wastewater monitoring reports: coronavirus, www.gov.wales/wastewater-monitoring-reports-coronavirus The UK government said it would be “exploring further opportunities for this technology”, but there is no evidence of this happening.  ⁴⁶ UK Health Security Agency, EMHP wastewater monitoring of SARS-CoV-2 in England: 1 June 2021 to 7 March 2022, 31 March 2022, www.gov.uk/government/publications/monitoring-of-sars-cov-2-rna-in-england-wastewater-monthly-statistics-1-june-2021-to-7-march-2022/emhp-wastewater-… Wastewater surveillance costs relatively little and could have provided more general surveillance capability with the capacity to be re-oriented to specific diseases if necessary. ⁴⁷ O'Keeffe J, Wastewater-based epidemiology: current uses and future opportunities as a public health surveillance tool, Environmental Health Review, November 2021, https://pubs.ciphi.ca/doi/full/10.5864/d2021-015

Second, the Vaccine Manufacturing and Innovation Centre (VMIC), which would have increased the UK’s domestic vaccine manufacturing capability and reduced reliance on imported vaccines, was sold to the US firm Catalent – who subsequently suspended the project. ⁴⁸ Ralph A, Catalent suspends Oxford unit for vaccines, The Times, 28 November 2022, www.thetimes.co.uk/article/catalent-suspends-oxford-unit-for-vaccines-qr3jc2sbb  In 2021, the centre was described by UKRI chief executive Sir Mark Walport as “an essential new weapon in the UK’s arsenal against diseases and other biological threats” – now it may never become operational.” ⁴⁹
Department for Business, Energy & Industrial Strategy, UK Research and Innovation, and The Rt Hon Sir Alok Sharma KCMG MP, Vaccines Manufacturing and Innovation Centre to open 12 months ahead of schedule, 17 May 2020, www.gov.uk/government/news/vaccines-manufacturing-and-innovation-centre-to-open-12-months-ahead-of-schedule#:~:text=The%20Vaccines%20Manufacturing%20….

Third, progress made on data sharing during the pandemic appears to have been reversed, with Professor Sir John Bell, a scientist who served on the vaccine taskforce, telling a parliamentary select committee that “during Covid, we ended up with the best data in the world… now, of course, we have gone back to the fact that everybody is sitting on little databases all over the country.” There is scope for the government to re-invigorate its data sharing agenda – with a recent Institute report containing some suggestions. ⁵⁰ Science and Technology Committee and Health and Social Care Committee, Oral evidence: Coronavirus: lessons learnt, HC 908, 30 November 2022, https://committees.parliament.uk/oralevidence/11977/pdf/

Other successful pandemic innovations are seemingly at risk. It has been reported that the world-leading ONS Covid infection survey could be discontinued and the Covid-19 Vaccine Research Registry, through which over 500,000 citizens signed up to contribute to vaccine trials, almost shuttered without those on the registry being offered an opportunity to contribute to other trials. ⁵¹ Science and Technology Committee and Health and Social Care Committee, Oral evidence: Coronavirus: lessons learnt, HC 908, 30 November 2022, https://committees.parliament.uk/oralevidence/11977/pdf/ ⁵² Merrick J and Gye H, Covid testing: ‘Gold standard’ ONS testing set to be scrapped making it more difficult to monitor virus spread, inews, 10 February 2022, https://inews.co.uk/news/politics/covid-testing-gold-standard-ons-testing-set-to-be-scrapped-making-it-difficult-to-monitor-virus-spread-1454482

Demolishing existing architecture, only to have to build it back up in the face of new threats, is a bad strategy. Ministers should urgently reconsider decisions which have dismantled effective and low-cost parts of the government’s pandemic infrastructure and alter the government’s approach to maintaining successful pandemic legacies.  

The government should be thinking about long-term decisions it may have to take

The key operational lesson of the vaccine taskforce was that the early procurement of a large and diverse pool of vaccines is the best way to ensure a timely and plentiful supply. The government should ensure that it is able to procure the H5N1 vaccines it may need, including by proceeding at risk where necessary. It should look into acquiring existing H5N1 vaccines and identify candidate vaccines tailored to this specific strain which may be worth investing in. It should follow the same process for therapeutics. 

The government should implement structural reforms to prepare for the next pandemic

Institute research showed how coronavirus exposed problems with the government’s approach to managing extreme risks. Risk management was not seen as a priority, central co-ordination was weak, departments weren’t held to account, and there was a lack of engagement with external scrutiny.  

The government’s recently published national resilience framework sought to address some of these problems, and it has established a Resilience Directorate, led by a Head of Resilience, in the Cabinet Office, as the Institute previously recommended. But there is more to do. 

Another lesson of the coronavirus pandemic was that it is important to be able to bring in outside experts with specialist skills into government, something that the government can struggle to do quickly and on a wide scale. The government should also adopt the Institute’s recommendations for making this process easier.  

Whether or not bird flu becomes the next major pandemic, its emergence is a warning for government not to discard successful pandemic-era innovations – or the lessons it learnt from the successes and failures of its Covid-19 response.