Introduction to the Appendix
This is an Appendix to the Interim Report from the Standing Committee on Pandemic Preparedness, which responds to the Commission to the Committee issued by the First Minister.
The Scottish Government has established the Standing Committee on Pandemic Preparedness with a remit to ensure that Scotland is as well prepared as possible for future pandemics. The First Minister's Commission to the Committee sets out the advice requested by the Scottish Government, which the Committee will respond to in its final report.
The Commission also specifies that the Committee should set out in an interim report:
- initial advice on priority work that should commence as soon as possible to improve preparedness for future pandemics; and
- interim conclusions on any of the issues covered by the Commission where, in the Committee's view, it is helpful to do so in advance of their final report.
The sections below set out both the Scottish and global context for its consideration of pandemic preparedness, including the vital role played by the NHS and wider health and social care services and the key recommendations of the Committee. Those key recommendations have developed from the Committee's initial discussions across a wide range of issues relating to pandemic preparedness. This Appendix provides further information on these discussions, which have identified a number of areas and issues for further consideration by the Committee as they take forward their work and produce their final report.
Beyond COVID – Overview of National and International Context
As lessons are learnt from the COVID-19 response, we now have the opportunity not just to reassess what stockpiles may be needed, but also to transform our capabilities to take advantage of advances in science and technology. However, we need to start preparing now. If we do so, there is the potential to fundamentally transform our ability to prevent, detect, and rapidly respond to pandemics and high consequence biological threats including for Disease X, as a serious international pandemic could be caused by a pathogen currently unknown to cause human disease.
Success is likely to depend on the adoption of innovative approaches and technologies. This relates to what the Biden-Harris Administration report describes as "critical scientific goal areas – vaccines, therapeutics, diagnostics, and early warning – as well as associated investments in strengthening disease surveillance, health systems, surge capacity, personal protective equipment (PPE), innovation, biosafety and biosecurity, regulatory capacity and global pandemic preparedness".
At the same time, an alignment of effective initiatives is needed to foster a network approach, which connects and coordinates groups and maximises synergies and outputs of initiatives, institutions, and projects and conserves valuable resources through reducing fragmentation, duplication, and redundancy.
In May 2022, the G7 published a Pact for Pandemic Readiness, which builds on past and current G7 initiatives to strengthen global pandemic readiness, with a focus on collaborative surveillance and predictable rapid response.
Within the global context, the UK landscape has changed significantly with the formation of the UK Health Security Agency (UKHSA) and the establishment of post-European Union (EU) Exit arrangements for the UK's monitoring and reporting under International Health Regulations. That, and the need to respond to the learning from the last thirty months, means the arrangements for pandemic and infectious disease preparedness are rapidly changing within the UK. The UK Strategic Risk Assessment for 2022 is being undertaken and work is underway on the refreshing of the UK Biosecurity Strategy. Pandemics, alongside major chemical, biological, radiological, and nuclear attacks, are identified as the most damaging events that can befall our society.
Across multiple reports and lessons learned exercises the biomedical and health resilience issues converge, and in the Scottish context particular themes emerge around science and innovation, links to industry, and public engagement and trust. The Scottish Science Advisory Council (SSAC), the Royal Society of Edinburgh (RSE) and the Campbell Report are among the reports that make specific recommendations for Scottish circumstances.
The SSAC report makes recommendations aimed at maintaining the integration of scientific capabilities and in particular, recommends that steps are taken to:
- Integrate the social sciences into planning for future emergencies
- Enhance access to high quality health (and linked) data
- Capitalise on laboratory investments made during COVID-19
- Broaden participation in and infrastructure to support clinical trials.
The RSE report identifies the theme of citizen engagement, public communication, and transparency as a Scottish priority. The theme of seeking to keep and build on the integration of science, health, and innovation investment is throughout the Campbell report – which explicitly links the need to bring together innovation, industry, and health priorities including pandemic response in Scottish life sciences and innovation policy and investment.
The Committee welcomes these reports and will consider their conclusions further as it takes forward its work.
The Fundamental Importance of a Resilient and Responsive NHS and Health & Social Care Systems
The Committee noted the fundamental importance to pandemic preparedness of a resilient NHS and health and social care systems. The Committee agreed that there will be much to be learned from the experiences during the pandemic of health and social care workers, patients, and users of our health and social care systems. While the details of operational management, rather than scientific advice, need to be dealt with elsewhere – noting the terms of reference of the Scottish and UK Public Inquiries into COVID-19 these points will require further discussion and consideration.
Health and Social Care Preparedness
The ability of the NHS to deliver effective healthcare in the event of a pandemic is of fundamental importance. It will be necessary to have rapid and sustained access to essential items of PPE, as well as therapeutics, associated equipment (e.g. ventilators), and vaccines when available. Adequate training of staff in health and social care in the use of PPE is critical, as well as appropriate 'fit-testing' of key staff for filtering face piece masks should they be required.
However, it is not just being able to deliver care to those patients who require direct care as a result of a pandemic infection, but in addition being able to maintain other critical NHS services. In the COVID-19 pandemic, most non-acute services were shut-down temporarily and facilities and staff diverted to deliver care to those who were infected. The effects of this interruption of care have been profound and prolonged, with extended waiting times for clinic visits, surgical, and other procedures.
Also, in line with Four Nations recommendations over optimal PPE for use in the context of a pandemic, there needs to be assurance that there can be manufacturing capacity, stockpiling or robust supply chains for elements of the recommended PPE ensemble. This should also for other equipment deemed necessary for care of patients during a pandemic, sufficient for rapid deployment in the face of a pandemic threat.
The Committee considers that, in order to address these issues, NHS Scotland should discuss how best to maintain both routine and other emergency NHS services (in both primary and secondary care) in the face of a pandemic threat. This will need to consider potential prioritisation of which services to maintain, and how best to balance delivering care for those who are infected while maintaining other areas of healthcare. In addition, planning needs to be in place to manage surge capacity for hospital beds in the event of a pandemic, and how best these should be staffed, as well as the potential for community assessment centres, which played an important role in triage of patients in the COVID-19 pandemic.
Social care, although not currently part of the NHS, should be an important focus for planning for future pandemics, as clients within this sector will likely be among the most vulnerable to adverse outcomes. Training of social care staff in infection prevention and control measures, as well as ensuring access to appropriate PPE, should be ensured as part of pandemic preparedness for this sector.
High Consequence Infectious Diseases
Expertise in management of infections is available within a number of infectious disease centres in Scotland. However, although they can act as 'regional' centres where patients can be transferred, they are not formally designated or resourced as High Consequence Infectious Diseases (HCID) Treatment Centres.
Within England, a network of such centres has been formally established to enable patients with severe infections designated as HCID to be managed more effectively. The initial stages of a pandemic will require a rapid response to provide clinical care and application of any available therapeutics or novel diagnostic tools. Formalising links, training and sharing of expertise between the different Infectious Disease Units within Scotland would enhance our ability to manage the initial stages of a pandemic equitably and consistently across Scotland.
The Committee considers that a National HCID network should be formally established in Scotland, with close links with the existing HCID network within England. The 2019 recommendations of the HCID Sub-Group of the Scottish Health Protection Network should be revisited to ensure they reflect learning from COVID-19 and are taken forward as a priority. In implementing the recommendations, the goal should be a HCID network in Scotland that provides a structured, interconnected service that could offer the best possible care to patients early in a pandemic, irrespective of within which health board patients were geographically located. In addition, where new healthcare facilities are being built in a centre providing specialist infectious diseases care, the specification of units where patients with a HCID could be managed needs to be fit for purpose. Such a network should provide a service for patients with any HCID (e.g. incoming travellers), as well as being able to accept patients early in a pandemic.
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