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Respiratory infections with pandemic potential represent the greatest risks to UK health security, according to a report published by the UK Health Security Agency (UKHSA).
In its first five-year health security risk assessment (HSRA), published on 11 June 2026, the UKHSA also suggested that antimicrobial resistance (AMR), seasonal pressures and healthcare system capacity were notable risks which could exacerbate the impact of potential infectious diseases.
Environmental hazards, such as extreme heat and extreme cold, pose threats of significant health and socio-economic disruption, the report added.
It said the risk of respiratory infections with pandemic potential — such as influenza and novel coronavirus — was ranked highest as they have “high impact and likelihood, and repeated historical precedence”.
“Response and preparedness need to consider how population groups and settings may be disproportionately affected by health security risks,” the report added.
“[Previous pandemics] exposed weaknesses in public health and healthcare system resilience, capacity, and preparedness, and revealed how population-level vulnerabilities, such as underlying health inequalities, can amplify impacts.”
In a statement published alongside the report, Steven Riley, chief data officer at the UKHSA, said: “As we continue to experience risks from a wide range of complex health security threats which disproportionately impact more vulnerable groups in our society, it is vital we continue to enhance our preparedness measures and resilience planning.”
Regarding AMR, the report said: “AMR has the potential to exacerbate the risk of infectious diseases. For example, a viral respiratory outbreak occurring in an environment of ineffective antibiotics could result in higher number of deaths from secondary bacterial infection.
“AMR could also worsen other scenarios, such as resistant bacterial or fungal infections following a respiratory virus pandemic, or increased healthcare-associated infections like bloodstream infections and Clostridioides difficile.”
In particular, the report highlighted the potential scenario of the spread of drug-resistant gonorrhoea. In this scenario, “expanding access to STI self-sampling kits and ensuring timely treatment would support early detection and prevent onward transmission,” it said.
“Point-of-care diagnostic tests to detect ceftriaxone resistance could be introduced to guide effective second-line treatment and reduce the risk of treatment failure. Where resistance is identified, alternative antibiotics may be prescribed, although cost and availability could be limiting factors.”
Nathan Burley, advanced public health and sexual health pharmacist at NHS Greater Glasgow and Clyde, told The Pharmaceutical Journal: “The worst-case scenario outlined in the UKHSA HSRA is a potential reality, but thankfully there are steps that can be taken to mitigate such a future.
“Clinicians in primary care especially must be aware of the first-line treatment for gonorrhoea, which does not involve using oral antibiotics.”
He also noted the value in reducing transmission by signposting eligible patients to 4CMenB vaccinations through sexual health services.
“Additionally, there are exciting developments in the new antibiotic pipeline such as gepotidacin and zoliflodacin,” Burley added.
The report also highlighted that changing conditions in the UK may make some risks, such as vector-borne diseases, more of a threat in future.
“Neglecting low-impact health security risks because they pose a minor risk in the short term may lead to a higher impact risk beyond the five-year period of the HSRA due to a lack of mitigation in early stages. Proactive measures are essential for minimising future risks,” the report said.
Tase Oputu, president of the Royal College of Pharmacy, commented: “Pharmacists are on the frontline when a pandemic occurs and demonstrated their value through vaccination delivery, health advice and maintaining access to medicines during COVID-19.
“Tackling AMR is an area where pharmacy leadership is already well established. Pharmacists play a central role in antimicrobial stewardship, supporting safe, evidence-based prescribing, reducing inappropriate antibiotic use and educating patients on self care.
“Health security cuts across the whole of the health system. Pharmacy teams, working in partnership with UKHSA, the NHS and others are essential to improving population health, addressing health inequalities and ensuring speedy access to treatment during potential future health emergencies.”
Mark DasGupta, director of professional development at the Pharmacists’ Defence Association, said: “Evidence to the UK COVID-19 Inquiry showed how community pharmacies were essential acting as a frontline service during the [COVID-19] pandemic, maintaining access to medicines, supporting vulnerable patients, and absorbing significant additional demand, including substantial vaccination capacity. Meanwhile other parts of the health system, including hospital pharmacists working on COVID-19 wards, were under extreme pressure.
“That evidence also highlights that the community pharmacy network operated under significant strain, with concerns about funding, workforce capacity and long-term sustainability. The key lesson for future preparedness is therefore not simply recognising risk, but ensuring that resilient, properly supported delivery networks are in place before a crisis emerges.”
