Table 1.

Research and Surveillance Centre implementation of the World Health Organization mosaic framework.

WHOa domain and WHO surveillance objective			RSCb deliveryc		Completeness
Domain I: Detection and assessment
	Rapidly detect outbreaks and other events	Our sentinel network covers over 32% (N=19 million) of the population and includes virology and serology sampling. A new ARId phenotype and POCTe enhance the capability.		Full delivery: RSC and UKHSAf
	Assess transmissibility and its risk factors, and extent of infection	RSC data include a household key to identify any household spread, and we can identify people in residential homes. We are starting asymptomatic testing.		Partial delivery: RSC and UKHSA
	Describe clinical presentation and risk factors for severe outcomes	Our ARI phenotype includes, as child concepts, most clinical presentations. We have specified key clinical data to collect. Links to hospital data provide severe outcomes.		Full delivery: RSC and UKHSA
Domain II: Monitoring epidemiological characteristics
	Monitor characteristics of illnesses over time	Our surveillance of ILIg, ARI, and SARIh, applying the ARI phenotype, enables the ongoing monitoring of respiratory illnesses over time.		Full delivery: RSC and UKHSA
	Monitor characteristics of circulating viruses	Our collaboration with the UKHSA in virology and serology sampling (including asymptomatic individuals) supports the monitoring of circulating viruses.		Full delivery: RSC and UKHSA
	Monitor high-risk settings and vulnerable populations	Long-term investment in UK health computing and pay-for-performance means that primary care records capture risk groups. Other settings may be excluded.		Partial delivery: UKHSA from other settings
	Monitor the impact on and coping abilities of health care systems	We can make year-on-year comparisons of data, running back over many years. However, there are no specific “coping abilities.”		Partial delivery: RSC and UKHSA
Domain III: Informing use of interventions
	Monitor the impact of nonmedical interventions	We have conducted epidemiological studies to explore the impact of nonmedical interventions during COVID-19 (eg, shielding).		Exemplar studies: RSC and UKHSA
	Provide candidate vaccine viruses	We do not provide candidate vaccine viruses as part of surveillance.		Out of scope
	Vaccine coverage, effectiveness, impact, and cost-effectiveness	Standardized national data indicate excellent coverage and impact. We have the capacity to supply data for vaccine effectiveness and cost-effectiveness studies.		Partial delivery: RSC and UKHSA
	Monitor the effectiveness of antivirals and other therapeutics	We have conducted studies on the effectiveness of antivirals but have limited ability to assess new therapies owing to their central administration and data access issues.		Exemplar studies: RSC and UKHSA
	Monitor the effectiveness of diagnostic tests	We have provided a comparison of results from POCT and UKHSA reference virology laboratories. This work could be scaled; see our additional objectives.		Exemplar studies: RSC and UKHSA
	Monitor the effectiveness of clinical care pathways	We can monitor care pathways where we have access to data. Gaps include out-of-hours, NHS 111, and care homes. UKHSA syndromic surveillance fills these gaps.		Partial delivery: RSC and UKHSA
	Monitor adverse events to vaccines and therapeutics	Ad hoc studies monitor adverse events of interest, either through data (passively) or by providing additional questionnaires. This is not a systematic part of surveillance.		Exemplar studies: RSC and UKHSA

^aWHO: World Health Organization.

^bRSC: Research and Surveillance Centre.

^cEach row is cumulative. Only new features are added in each row.

^dARI: acute respiratory infection.

^ePOCT: point-of-care testing.

^fUKHSA: UK Health Security Agency.

^gILI: influenza-like illness.

^hSARI: severe acute respiratory infection.