Ask Eirik Storsve, Director, Head of European Government Affairs, Emergent
The challenges facing the next government
Looking to the UK General Election on 4 July, there are many pressing foreign and domestic issues facing the next Government. But among the most significant of these after the experience of Covid-19 must be ensuring that the UK is better prepared for major health crises.
The pandemic demonstrated how dangerous biological threats can be. In the UK alone Covid -19 caused thousands of deaths and left many with ongoing health issues; closed schools and businesses; triggered unprecedented restrictions on personal freedoms; and created huge economic damage. This experience ought to fundamentally challenge policymakers’ assumptions about risk, resilience, and preparedness for biological and other significant threats. The very first duty of any government, after all, is to “keep citizens safe and the country secure”.1
Naturally occurring threats
Underlying the Government’s approach to biothreats must be the knowledge that, due to globalisation, rapid urbanisation, and climate change, the probability of facing another significant biological incident in the near future is rising. Including Covid -19, there have been seven infectious disease crises in the 21st Century alone. Covid is the largest, to date.2
The Government’s National Risk Register, which places pandemics and large-scale chemical, biological, radiological, and nuclear (CBRN) attacks in the highest category of risk to the UK, estimates a 5 – 25% chance of another pandemic taking place in the next five years.3 Analysis by Duke University in the United States of America (USA) similarly estimates “a high probability of observing pandemics similar to Covid -19 (probability of experiencing it in one’s lifetime currently about 38%), which may double in coming decades” (emphasis added).4
Importantly, policymakers should consider that Covid -19 had a relatively low mortality rate5 compared with some known biological threats. Certain forms of smallpox, for example, have a human mortality rate of 20-45%,6 while the epidemic of Ebola virus disease case fatality rate is estimated at around 50%.7 Marburg, another Filovirus like Ebola, has seen local outbreaks over the last several years. The latest registered outbreak (in Tanzania last year) is likely to register a fatality rate of 66.7% (still under investigation). Avian flu is considered to have moderate impact and a 1-5% chance likelihood3. While there has been a reduced number of cases of HPAI H5 in poultry and wild birds in Europe over the last few months, Mexico recently saw one fatality where the disease had spread to a human in April this year. It is no surprise, then, that World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus has warned that the world needs to be prepared to respond to a disease outbreak of “even deadlier potential” than Covid-19.8
Perhaps most importantly, Covid-19 demonstrated that biological threats are international problems that command coordinated approaches among countries. Collaboration between allies on preparedness, as with the recently agreed UK-USA Strategic Dialogue on Biological Security9, is increasingly in the national interest.
Man-made threats
The next Government must also contend with the fact that we live in more dangerous times. Prime Minister Rishi Sunak has warned “the next few years will be some of the most dangerous yet the most transformational our country has ever known… Here at home, China has conducted cyber targeting of our democratically elected MPs. Russia has poisoned people with chemical weapons.”10 Technological advances, including a “proliferation of information online”, mean that those who would wish the UK harm – both hostile states and terrorists – have greater access now more than ever to the knowledge and material needed to develop dangerous weapons, including chemical and biological threats.11
A security review by the Government in 2021 warned there was “a realistic possibility” a “terrorist group will launch a successful Chemical, Biological, Radiological or Nuclear attack by 2030”.12 Bodies such as the United Nations and NATO have raised concerns that “Covid-19 has revived the spectre of bioterrorism” by demonstrating to hostile actors how devastating they can be. The Department for Science, Innovation & Technology has also cautioned that Artificial Intelligence can “make it easier to build chemical or biological weapons”.13 14 These threats may seem remote, but they should be seen against the backdrop of the UK having already experienced two deadly man-made CBRN attacks in the 21st century, in 2006 (Litvinenko) and 2018 (Salisbury).
Lastly, policymakers must also contend with the increased prevalence in laboratories working on biological threats around the world, particularly following Covid-19. More labs mean a greater potential for accidental releases of pathogens. In 2022, for example, the WHO warned that the conflict in Sudan posed a “huge biological risk” because of the presence of an internationally-funded laboratory in the capital holding measles, polio, and cholera samples. For a period during the conflict, the security of the laboratory could not be guaranteed.
As Deputy Prime Minister Oliver Dowden has summarised: “our world is increasingly vulnerable to biological threats with catastrophic impacts – whether it is another pandemic, a terrorist attack or antimicrobial resistance. Those threats have only multiplied in recent years”.15
How we can be better prepared against these threats
Have a clear strategy for Medical Countermeasures (MCMs): Understand and catalogue their availability
The UK’s main preparations against biological threats are contained in the Biological Security Strategy (BSS), published in 2018 and “refreshed” in 2023 to include lessons from Covid-19. The strategy seeks to make the UK “resilient to a spectrum of biological threats” by 2030 by setting out “short, medium, and long-term commitments”.16 Importantly, it contains a long-term aim to “develop and evaluate prototype vaccines, therapeutics and diagnostics for priority pathogens of pandemic potential”.
This is a crucial component of preparedness. One of the significant lessons from Covid-19 is that, while governments can deploy measures to delay the impact of biological threats, such as social distancing and lockdowns, ultimately it is often medical countermeasures (MCMs) that are needed to protect people against them.
To improve UK resilience against biothreats it is essential that all political parties consider how best to deliver on this ambitious aim of ensuring MCMs are available for priority pathogens. Doing this will involve multiple elements:
- Supporting a range of MCMs against multiple threats, including pathogens of security potential
We do not know what the next significant biological events will be, nor do we know which types of MCMs will be the most effective defence against them. Preparedness, therefore, requires investment in multiple platform technologies across both vaccines and therapeutics to build a full-spectrum preparedness strategy. The Government is a leading part of the G7 100 Days Mission, which seeks to ensure the correct infrastructure is in place to enable diagnostics, therapeutics, and vaccines to be available within 100 days of a pandemic being declared by the WHO.19 Both of these are laudable initiatives.
However, a much broader MCM strategy is needed to achieve the Government’s aims. While mRNA vaccines demonstrated strong efficacy against Covid-19, it is yet to be seen if they will be the best vaccine technology against a future biological incident. The 100 days mission will boost our protections against certain families of diseases, but there are multiple biological threats for which even 100 days is far too long a time period to wait for access to MCMs. These threats require a more robust approach to preparedness.
To learn the lessons from Covid-19, there must be a clear plan for ensuring the UK has timely access to a range of MCMs to protect against the highest risk threats.
- Creating predictable and accessible sources of investment in research and MCM technology
In contrast to other sectors, MCM development necessarily depends in large part on governments. The appropriate role for policymakers in ensuring pandemic preparedness is to communicate their public health security needs to industry, and then to ensure sufficient resources are in place to help industry action those needs. Improving preparedness requires investment and greater prioritisation. The long-term effects of Covid-19 have demonstrated the potential significant costs of failing to invest in preparedness.
- Greater transparency, dialogue and cooperation with industry
As with many policy areas, improving preparedness begins with an honest assessment of the UK’s current plans for responding to biological and chemical threats. The UK can facilitate this by publishing candid assessments of priority threats and the resources it commits to CBRN preparedness, including the MCMs that it currently supports and stockpiles. Greater transparency is crucial for preparedness because, if industry is to develop solutions aligned to policy, it must have clarity and certainty on governments’ biosecurity strategies and needs. The UK could seek to establish permanent forums to communicate with industry and academia on a continuous basis regarding its MCM needs, similar to the role of the Vaccines Taskforce during Covid-19. It could use existing related forums to do this, such as the new UK Biological Security Leadership Council.
- Learning from international best practices
Looking at international examples, a potential model for the UK to consider is that used by the USA, where an agency called the Administration for Strategic Preparedness and Response (ASPR), and within ASPR, the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) coordinates US Federal efforts to develop MCMs against priority threats.20 Though similar in some ways to the UK’s Health Security Agency, PHEMCE publishes a multi-year budget21 which publicly details priorities and investments in MCMs, including the US Government’s Strategic National Stockpile of MCMs. This sets clear priorities and budgets which industry can pivot toward when developing R&D strategies. Adopting this approach in the UK would help inform debate around preparedness and guide industry toward the UK’s MCM needs. Working more closely with the USA on biosecurity, as anticipated in the recent announcement of the new UK-USA Strategic Dialogue on Biological Security22, could also help the UK to share the costs of preparedness.
Conclusion
The debate about the UK’s preparedness for biological threats is still ongoing, with the hearings of the Public Inquiry into Covid-19 due to continue into 2025. While it is important that proper consideration is given to these issues, to delay addressing them could mean losing valuable time that might be spent putting in place mechanisms and infrastructure that we already know could improve UK CBRN resilience. Recent polling in the UK has suggested that voters believe more should be done to prepare for the threat of future pandemics.23 This General Election – the first to take place after Covid-19 – is an opportune time to gain a mandate to invest significantly in better UK defences against biothreats.
References
1 Home Office website: https://tinyurl.com/2b4jzlpm
2 Kate Kelland, Disease X: The 100 Days Mission to End Pandemics (Canbury Press 2023), p.19.
3 Cabinet Office. 2023. National Risk Register: https://tinyurl.com/29vx2enr
4 Marani, M, et al. 2021. Intensity and frequency of extreme novel epidemics. (Proceedings of The National Academy of Sciences Vol. 118, No. 35, August 2021): https://tinyurl.com/2a659ckz
5 Estimates for the mortality rate for COVID-19 vary due to multiple factors. Our World in Data has previously estimated a rate of 1.2%. See the following sources for further information:
- Our world in Data, Coronavirus (COVID-19) Cases, available at: https://ourworldindata.org/covid-cases#confirmed-deaths-and-cases-our-data-source
- Johns Hopkins Coronavirus Resource Center, available at: https://coronavirus.jhu.edu/data/mortality
6 Berche P., “Life and death of smallpox”, La Presse Médicale Volume 51, Issue 3, September 2022 – https://www.sciencedirect.com/science/article/pii/S0755498222000100?via%3Dihub
7 Pan American Health Organization, “Ebola Virus Disease” fact website (accessed 17 June 2024): https://tinyurl.com/2afcqov2
8 WHO Director-General’s Report to Member States at the 76th World Health Assembly – 22 May 2023: https://tinyurl.com/2yjqyh3l
9 Cabinet Office, “UK and U.S. announce new strategic partnership to tackle increased biological threats”, 16 January 2024 – https://tinyurl.com/29lp9uyp
10 PM speech on security: 13 May 2024 https://www.gov.uk/government/speeches/pm-speech-on-security-13-may-2024
11 Gates, B. 2022. How to Prevent the Next Pandemic (Allen Lane), p.194.
12 UK Gov. 2021. Integrated Review of Security, Defence, Development and Foreign Policy: https://tinyurl.com/ysfgxk4e
13 Prime Minister’s speech on AI: 26 October 2023 – https://tinyurl.com/23zryetk
14 Analysis by Dan Kaszeta, a biological weapons expert and Fellow at RUSI, has set out how “Developments in science and technology will simplify efforts by hostile actors to operate small-scale production of these materials for hostile use.” See Kaszeta, D. 2021. Small-Scale Chemical and Biological Production: Current Threats and Future Trajectories. RUSI: https://tinyurl.com/2h2w2sdg
15 Cabinet Office. June 2023. UK Biological Security Strategy, p6: https://tinyurl.com/yqgdq86s
16 Cabinet Office. June 2023. UK Biological Security Strategy: https://tinyurl.com/yqgdq86s
19 Cabinet Office. 100 Days Mission to respond to future pandemic threats. 12 June 2021: https://tinyurl.com/27wgf5xd
20 Public Health Emergency Medical Countermeasures Enterprise website. Functions, Goals, and Objectives: https://tinyurl.com/25oxw27z
21 Public Health Emergency Medical Countermeasures Enterprise. 21 March 2023. Multiyear Budget: Fiscal Years 2022-2026 – https://tinyurl.com/2c5mptlu
22 Cabinet Office. UK and U.S. announce new strategic partnership to tackle increased biological threats. January 2024 – https://tinyurl.com/2bm266v2
23 Rhodes Trust, Over half of the UK think politicians aren’t taking the threat of the next pandemic seriously, new poll finds, 13 April 2023 – https://tinyurl.com/2aj9wn6l / https://tinyurl.com/28eyyp6y
About the Author
Ask Eirik Storsve is the Sr. Director, Head of European Government Affairs at Emergent, a global life sciences company whose mission is to protect and enhance life by developing and manufacturing medical countermeasures (MCMs) – vaccines, therapeutics, devices, and drug-device combination products – that address many of the most significant threats to public health.