Health Experts Criticize Decision To Replace Public Health England During Pandemic
UK Health Secretary Matt Hancock announces that Public Health England will be replaced with a new institute.

United Kingdom Secretary of State for Health Matt Hancock’s announcement to replace Public Health England (PHE) with a new agency focused on biosecurity and infectious disease threats has drawn widespread criticism from health experts.

The Health Secretary announced that PHE will be replaced with a new National Institute for Health Protection (NIHP) in a speech on Tuesday, following widespread media reports hinting at the move on Sunday. Ministers, including Prime Minister Boris Johnson, have supposedly been unhappy with the PHE’s handling of the pandemic for weeks.

The NIHP will merge the PHE, the National Health Services’ Test & Trace program, and the Joint Biosecurity Centre (JBC) into a single organization, modeled after Germany’s Robert Koch Institute and focused on protecting the United Kingdom from “new” and “external” infectious threats, according to Hancock.

But critics have called the move a dangerous and distracting play in the middle of the pandemic. They have also questioned how PHE’s other responsibilities, such as managing environmental health or non-communicable diseases, will be taken into account in this reshuffle.

“Where is the evidence, the independent review that has informed such a significant organisational change to the national public health response for England at such a critical time? It takes time to build an organisational culture and the way the tired, hardworking PHE staff heard via a leak at the weekend is shocking,” wrote Gail Carson, deputy chair of the Global Outbreak and Response Network (GOARN).

“Now is not the time to replace Public Health England. The pandemic may have shown us that some changes are needed, but they need to be made at the right time. PHE is playing a key role in keeping the country going, and we really don’t need the upheaval that this move is going to create,” said Andrew Goddard, president of the Royal College of Physicians, in a statement.

Many Uncertainties Remain About New Institute’s Leadership & Responsibilities

In particular, Hancock’s decision to place fellow Conservative Dido Harding, the current head of the widely criticized NHS Test & Trace program, at the helm of the NIHP has sparked ire. Many critics have pointed to the lack of transparency behind Harding’s appointment.

“I was looking forward to applying for the role of Chair of the UK’s National Institute of Health Protection, but somehow I missed the open transparent recruitment process,” Richard Horton, chief editor of the global health journal the Lancet, tweeted.

Similarly, it’s unclear how PHE’s responsibilities in carrying out programs outside the realm of pandemic threats will be managed in the wake of the agency’s dissolution. Outside of COVID-19, PHE managed programs for a variety of health-related issues, including programs focused on curtailing smoking and the harmful use of alcohol, reducing obesity, improving maternal and child health, and managing sexually-transmitted diseases.

“We shouldn’t forget that the overwhelming burden of death and disease in this country is not caused by ‘external threats’ as Matt Hancock put it, such as infections and biological weapons. Instead it is caused by chronic diseases – cancer, cardiovascular disease, diabetes, dementia and others. A significant proportion of these diseases are preventable and Public Health England plays a central role in that through its health improvement functions,” said Linda Bauld, a professor of public health at the University of Edinburgh. “There is a real risk that reorganisation threatens these functions. We don’t yet know how or where they will continue to be delivered.”

And for a coalition of organizations battling a decades-long epidemic at home in the UK, the  institute’s focus on “new” and “external” threats brings out concerns that longstanding domestic health issues will be ignored.

“The announcement made today focuses on “new” and “external” health threats while not acknowledging the public health emergencies that already exist in the UK,” wrote a coalition of UK-based HIV organizations, in a statement. “While attention has rightly been given to the ongoing COVID-19 pandemic, focus must not be lost in tackling long-standing HIV and STI infection rates and reversing sexual health inequalities.

“The Secretary of State’s speech today leaves us with more questions than answers…a knee-jerk restructure of the public health system which is non-transparent, ill-thought through and leads to more fragmentation in accountability structures risks holding us back.”

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