Future Pandemic Preparedness Ministerial Oversight Group minutes: January 2025

Attendees and apologies

Co-Chairs    

• Angela Constance, Cabinet Secretary for Justice and Home Affairs 
• Neil Gray, Cabinet Secretary for Health and Social Care 

Lead Co-Chair

• Neil Gray, Cabinet Secretary for Health and Social Care

Member Attendees

• Graeme Dey, Minister for Higher and Further Education; and Minister for Veterans
• Natalie Don-Innes, Minister for Children, Young People and the Promise 
• Jim Fairlie, Minister for Agriculture and Connectivity 
• Kate Forbes, Deputy First Minister and Cabinet Secretary for Economy and Gaelic 
• Jenny Gilruth, Cabinet Secretary for Education and Skills 
• Jenni Minto, Minister for Public Health and Women’s Health 
• Angus Robertson, Cabinet Secretary for Constitution, External Affairs and Culture 
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport 

Deputy Representative Attendees    

• Paul McLennan, Minister for Housing, attending on behalf of Kaukab Stewart, Minister for Equalities

Guest Officials Attendees  

• Daniel Kleinberg, Deputy Director for Population Health Resilience and Protection and Co-Chair of FPP Cross Government Delivery Group 
• Mhairi McCowan, Deputy Director for Civil Contingencies and Co-Chair of FPP Cross Government Delivery Group 
• Christine McLaughlin, Director for Population Health and Co-Chair of FPP Programme Board 
• Lisa Mcguinness, Director for Strategy & Delivery and Co-Chair of FPP Programme Board 
• Gregor Smith, Chief Medical Officer 
• Clare Tynte-Irvine, Director for Covid Inquiries 

Secretariat    

• [Redacted] Pandemic Preparedness Unit, Population Health Resilience and Protection Division, Population Health Directorate

Items and actions

Welcome and introductions

Neil Gray opened the meeting, noted apologies, and welcomed attendees to the first meeting of the Ministerial Oversight Group (MOG) on future pandemic preparedness. 

The MOG is co-chaired by Neil Gray, as Cabinet Secretary for Health and Social Care and Angela Constance as Cabinet Secretary for Justice and Home Affairs and portfolio lead for wider civil contingencies. Officials from population health resilience and protection and wider civil contingencies are supporting this meeting, with additional input from the Chief Medical Officer.

Neil Gray set out how the MOG forms parts of the wider Scottish Government (SG) Crisis Preparation Oversight Group (CPOG) which manages wider catastrophic risks in the SG. Neil Gray reminded members of the reason this group and the new governance processes for pandemic preparedness have been established. The COVID-19 pandemic serves as a stark reminder of how interconnected our public systems are and of the duties of Ministers in response to crises of that nature. Neil Gray emphasised the importance of harnessing lessons from the experience of the COVID-19 pandemic to strengthen the SG’s preparedness for future pandemics across all of government. 

The MOG aims to provide its members with an understanding of the current pandemic preparedness landscape and the status of plans and preparedness in SG. 

Neil Gray introduced the upcoming presentations being made today by the Chief Medical Officer (CMO) and Daniel Kleinberg. 

Fundamentals of high consequence infectious disease outbreaks

[Redacted]

CMO shared a presentation aimed to give MOG members an overview of the fundamentals of pandemics, noting that it is not known when the next pandemic will take place, but it is not unrealistic there will be another pandemic in the near to medium term future. 

CMO introduced key definitions for terms such as epidemic and pandemic. CMO explained that a pandemic is not technically declared by the World Health Organization (WHO) but instead it can declare what is referred as a Public Health Emergency of International Concern (PHEIC). There are criteria used by its expert advisors to determine this and these are set out in the International Health Regulations (IHR). Key amongst these criteria is the geographic scale of a pandemic, crossing international borders and requiring a coordinated international response. CMO noted recent amendments to the IHR made in 2024 which emphasise the global nature of pandemics and the likely impact of a threat on health system, and causing wider social and economic impacts. The CMO noted that there have been major diseases that have not been declared a PHEIC by the WHO, but which nonetheless have had a significant impact globally, citing the example of HIV/AIDS. 

The CMO introduced the UK CMO Technical Report. This document, aimed at future scientist, clinicians, and medical advisors, draws together learnings from the COVID-19 pandemic. It includes a series of key questions to consider early on in a suspected outbreak or pandemic. Two key concerns which the CMO expanded on are the transmissibility of a particular pathogen (how quickly it spreads, as measured by the attack rate) and the severity of a pathogen (impact on human health, and whether there is a differential impact across the population). The CMO underlined that different pathogens may affect different parts of the population in different ways; however, the burden is often greatest on those already marginalised or facing inequalities. 

The CMO outlined the main transmission routes for pathogens, highlighting that for some routes, such as vector-borne diseases, the risk is increasing due to climate change. CMO gave the example of clusters of autochthonous dengue cases in France (i.e. originating in France, not imported). 

The CMO outlined that the WHO publishes a list of priority diseases which are typically those that are highly transmissible or where there is a lack of readily available countermeasures. These diseases are encountered sporadically in the UK. The CMO also explained what is meant by Disease X, which is the risk of an unknown disease. The CMO stressed the importance of continued surveillance to monitor new and emerging infectious diseases. 

The CMO noted that the UK-wide National Security Risk Assessment (NSRA) and the Scottish Risk Assessment (SRA) both include pandemics and emerging infectious disease risks. Following this, the CMO gave a high-level overview of existing plans for the management of pandemics and emerging infectious disease; the Management of Public Health Incidents (MPHI) guidance, the plan for monitoring and responding to new SARS-CoV-2 variants and mutations (VAM plan) and the 2011 UK Influenza Preparedness Strategy. The CMO stressed that work is underway in the Population Health Directorate, and with UK counterparts to review and update the Influenza Preparedness Strategy and expand this to become a Respiratory Pandemic Response Plan. A Tier 1 pandemic exercise – Exercise Pegasus is also being planned for the Autumn 2025. 

The CMO acknowledged the wealth of recommendations and lessons from Scotland and internationally, including the Standing Committee on Pandemic Preparedness (SCoPP) final report. It is important that the SG draws on these to ensure it is as prepared as it can be for future pandemics. The response to pandemics is not limited to health and will require input from all parts of government and society. 

Finally, the CMO noted the recent decision of the United States of America (USA) President to withdraw the USA from the WHO and the impacts this could have on infectious disease surveillance and intelligence sharing, and wider cooperation in global health. 

Neil Gray thanked the CMO for his input and reiterated that preparedness and response to pandemics requires input and action from all parts of government, the public sector, and wider partners. 

In discussion recent developments around US withdrawal from the WHO and a potential reduction in information sharing were covered, as was review of the MPHI guidance, for incidents which become an all-government response. Also covered was the spread of avian influenza into, and from, dairy cattle in the US, a case of avian influenza which has evolved for mammal-to-mammal transmission. There have been a couple of cases, including that of a teenager in Canada, where individuals have become seriously unwell as a result of the same clade of the virus passing from wild birds to them. This serves as a reminder that the virus has the potential to continue to mutate and evolve, hence the importance of continued surveillance and intelligence sharing. 

Neil Gray concluded the discussion on this agenda item and invited Daniel Kleinberg to begin his presentation. 

Future Pandemic Preparedness programme overview and current incidents of interest

[Redacted]

Daniel Kleinberg outlined that the aims of the future pandemic preparedness programme of work are to give Ministers and officials tools for their work on pandemic preparedness and for the management of this risk. Daniel Kleinberg underlined that in the event of a pandemic Ministers are directly responsible and that there is a 5-25% probability of another pandemic in the next five years.

Daniel Kleinberg shared an overview of governance structures for major risks in government, focussing on structures for the management of the pandemic risk. He outlined the timeline of existing work. There are four phases of the pandemic preparedness work programme, and the current phase aims to review the level of existing plans across all parts of SG, the level of confidence in the ability to deploy these, connections and input from stakeholders, and budgets to deliver these. From the early stages of this work a few common issues have been identified, including further clarifying roles and responsibilities; bolstering whole system planning and moving on from a reliance on capabilities and individuals who were in post during the COVID-19 response.

Engagement with officials across government has also identified cross-cutting areas for priority work. These are data, personal protective equipment (PPE), guidance, and wider system coordination. These are crosscutting across all parts of SG, not just health. 

Daniel Kleinberg gave a brief overview of work being undertaken in partnership with the UK Government (UKG) and other Devolved Administration (DAs). The UKG are a key partner with assets and capabilities which we rely on but do not seek to replicate in Scotland (e.g. Porton Down). Part of the ongoing collaborative work with UKG and other DAs is for the review and updating of pandemic plans. The 2011 Pandemic Influenza Preparedness Strategy is being updated to become a wider Respiratory Pandemic Response Plan. This collaboration is welcome. [Redacted]

Daniel Kleinberg described early cooperation by the Four Nations on Exercise Pegasus as positive and noted the desire expressed by Neil Gray for Scotland to be actively involved in this and take as much learning from this as possible. [Redacted]

Finally, Daniel Kleinberg noted that the First Minister had expressed a desire for information on ongoing outbreaks to be shared today. This has been covered off by CMO earlier. Daniel Kleinberg summarised these as:

H5N1: We are monitoring reports of highly pathogenic avian influenza (H5N1) identified in dairy cattle in the USA. The risk level for animals for the UK, which is currently ‘low’ and we have no reason to suspect the virus is circulating in our cattle and nor is this virus strain circulating in Europe. Daniel Kleinberg noted that the Chief Veterinary Officer (CVO) has shared that informal intelligence-sharing channels with counterparts in US exist, but these are now at risk. 

MPXV (mpox): there have been eight confirmed cases (3 cases currently active) of Clade 1b MPXV confirmed in the UK. Daniel Kleinberg assessed that mpox transmission means it will not become a fast-moving pandemic. 

Daniel Kleinberg concluded his presentation. Neil Gray noted the ask for views from MOG members and reiterated the need for each portfolio to have plan for pandemic preparedness and response, with input and engagement with stakeholders. 

In discussion it was agreed that the work of the Covid Recovery Committee and should inform ongoing work on pandemic preparedness. Border controls were discussed – both the importance of these being approach in a 4 Nations manner and their value in containment. CMO acknowledged border controls are a challenging question, however travel measures delay rather than prevent the importation of a pathogen in the context of the UK where all travel (including the flow of essential goods into the country) cannot be halted in the same way as New Zealand did during the COVID-19 pandemic. Delays in the presentation of disease and the possibility of asymptomatic transmission also add to the challenges of travel measures. Daniel Kleinberg raised the role of Four Harms assessments in evaluating the impact of such measures and noting the need to return to the topic of Four Harms and decision-making mechanisms at a future meeting. The Chair reflected that this had been part of the considerations of the Four Nations Small Ministerial Group convened on Mpox Clade 1b.

The Scottish Government should continue to assert the need for Scottish Ministers to be involved in any Pandemic Strategy formation to ensure any response is effective and 4 nations wide, and that Scotland should continue to be closely involved in Exercise Pegasus was endorsed by Ministers. Daniel Kleinberg committed to keep Ministers updated on the progress of this programme of work. 

Ministers raised data on the longer terms harms from measures brought in during the pandemic, for example the impact on child development. Daniel Kleinberg invited CMO to input but noted challenges around data and the vital importance of this to understand the effectiveness of measures and impact. 

Neil Gray reiterated the need for planning across all sectors to inform the data needed to plan for, and respond to, future pandemic response. 

CMO returned to the Four Harms approach. In the context of an unknown pathogen with unknown attack rate and infection fatality rate, the balance that existed in the Four Harms model feels right to attempt to balance known and possible unknown harms. CMO reiterated that populations’ experiences of pandemics are different, but these usually have the greatest impact on those who already face the most inequalities. 

As Chair Neil Gray noted that data across all sectors is part of the programme and reiterated the need for planning across all sectors to be in the purview of the group.

• ACTION 1: Population Health Resilience and Protection officials to review lessons identified by the Covid Recovery Committee
• ACTION 2: Officials to continue to advocate for proper Scottish involvement and four nations involvement in Pandemic Planning at UK level
• ACTION 3: Officials to continue to engage in Pegasus and provide further advice to Ministers on Scottish involvement

Any other business

Neil Gray closed the meeting and thanked presenters and attendees for their contributions and participation. 

These meetings will take place to bi-annually, with the next meeting scheduled for 4 June 2025.