Fergus Cumming

Published and Forthcoming Research

Public reporting guidelines for outbreak data: Enabling accountability for effective outbreak response by developing standards for transparency and uniformity with Vanessa Grégoire et al., 2025

Currently, there are few standards for what essential information about an infectious disease outbreak should be reported to the public and when. To address this problem, we undertook a consensus process to develop recommendations for what epidemiological information public health authorities should report to the public during an outbreak, including the administrative level and frequency of reporting. 25 experts participated in voting across three rounds, demonstrating consistent engagement in the consensus-building process. The final stage of the Delphi process consisted of a hybrid consensus meeting to finalize the voting items. This resulted in a final list of nine reporting items representing the minimum set of information to include in publicly available situation reports: Numbers of new confirmed cases, new hospital admissions, new deaths, cumulative confirmed cases, cumulative hospital admissions, and cumulative deaths, each reported weekly and at the state- or province-level, and stratified by sex, age group, and race/ethnicity. This minimum reporting standard creates a strong framework and guidance for uniform sharing of outbreak information and promotes consistency of data between jurisdictions to enable prompt and effective response.

When should lockdown be implemented? Devising cost-effective strategies for managing epidemics amid vaccine uncertainty

PLOS Computational Biology with Nathan Doyle et al., 2024

During an infectious disease outbreak, public health policy makers are tasked with strategically implementing interventions whilst balancing competing objectives. To provide a quantitative framework that can be used to guide these decisions, it is helpful to devise a clear and specific objective function that can be evaluated to determine the optimal outbreak response. In this study, we have developed a mathematical modelling framework representing outbreaks of a novel emerging pathogen for which non-pharmaceutical interventions (NPIs) are imposed or removed based on thresholds for hospital occupancy.  Motivated by the scenario early in the COVID-19 pandemic, we incorporate the development of a vaccine into our modelling framework and demonstrate that a policy maker’s belief about when a vaccine will become available in future, and its eventual coverage (and/or effectiveness), affects the optimal strategy to adopt early in the outbreak. Furthermore, we show how uncertainty in these quantities can be accounted for when deciding which interventions to introduce.

Symptom propagation in respiratory pathogens of public health concern: a review of the evidence

Journal of the Royal Society Interface with Phoebe Asplin et al., 2024

Symptom propagation occurs when the symptom set an individual experiences is correlated with the symptom set of the individual who infected them. Despite accumulating evidence that symptom propagation occurs for many respiratory pathogens, the underlying mechanisms are not well understood. Here, we conducted a scoping literature review for 14 respiratory pathogens to ascertain the extent of evidence for symptom propagation by two mechanisms: dose–severity relationships and route–severity relationships. We identify considerable heterogeneity between pathogens in the relative importance of the two mechanisms, highlighting the importance of pathogen-specific investigations. 

Epidemiological impact of a large number of incorrect negative SARS-CoV-2 test results in South West England during September and October 2021 

Epidemics with Luke Hounsome, Steven Riley et al., 2024

Based on differences in the rate of positive PCR tests at a single laboratory compared to the rest of the laboratory network, a substantial number of UK PCR tests processed during September and October 2021 may have been incorrectly reported as negative, compared with the rest of the lab network. We estimate that around 39,000 tests may have been incorrectly classified during this period and the most affected areas in the South West could have experienced around 24,000 additional reportable cases. We estimate that this central estimate could have translated to approximately 55,000 additional infections, which means that each incorrect negative test likely led to just over 2 additional infections. In those same geographical areas, our results also suggest an increased number of admissions and deaths. The incident is likely to have had a measurable impact on cases and infections in the affected areas in the South West of England. 

Media Coverage:

• BBC, Guardian, Telegraph, Bristol Live, The National

Diversity of Symptom Phenotypes in SARS-CoV-2 Community Infections Observed in Multiple Large Datasets

Scientific Reports with Thomas House, Elizabeth Fearon, Graham Medley et al., 2023

We bring together four large datasets in the UK and use cutting-edge unsupervised classification techniques from statistics and machine learning to characterise symptom phenotypes among symptomatic SARS-CoV-2 PCR-positive community cases. While we observe separation due to the total number of symptoms experienced by cases, we also see a separation of symptoms into gastrointestinal, respiratory and other types. We also observe different symptom co-occurrence patterns at the extremes of age.

Simulation Study of Surveillance Strategies for Faster Detection of Novel SARS-CoV-2 Variants 

Emerging Infectious Diseases, with Selina Patel, Steven Riley et al., 2023

Earlier global detection of novel SARS-CoV-2 variants gives governments more time to respond. However, few countries can implement timely national surveillance, resulting in gaps in monitoring. The UK implemented large-scale community and hospital surveillance, but it may be faster to detect new variants through testing UK arrivals for surveillance. We developed simulations of the emergence and importation of novel variants with a range of infection hospitalisation rates (IHR) to the UK. We compared time taken to detect the variant though testing arrivals at UK borders, hospital admissions, and the general community. We found that sampling 10 to 50% of arrivals at UK borders could confer a speed advantage of 3.5 to 6 weeks over existing community surveillance, and 1.5 to 5 weeks (depending on IHR) over hospital testing. We conclude that directing limited global capacity for surveillance to highly connected ports could speed up global detection of novel SARS-CoV-2 variants. 

Nowcasting the 2022 Mpox outbreak in England 

PLOS Computational Biology with Chris Overton, Tom Ward et al., 2023

In May 2022, a cluster of mpox cases were detected in the UK that could not be traced to recent travel history from an endemic region. Over the coming months, the outbreak grew, with over 3,000 total cases reported in the UK, and similar outbreaks occurring worldwide. These outbreaks appeared linked to sexual contact networks between gay, bisexual and other men who have sex with men. But the mpox outbreak in the UK was characterised by substantial delays in the reporting of the symptom onset date and specimen collection date for confirmed positive cases. These delays led to substantial backfilling in the epidemic curve, making it challenging to interpret the epidemic trajectory in real-time. We developed a novel nowcasting model to correct the mpox epidemic curve in England, and provide real-time characteristics of the state of the epidemic.

The Role of Vaccination and Public Awareness in Forecasts of Monkeypox Incidence in the United Kingdom

Nature Communications with Sam Brand, Matt Keeling et al., 2023

Since May 2022, monkeypox virus (MPXV) has spread rapidly in high-income countries through close human-to-human contact primarily amongst communities of gay, bisexual and other men who have sex with men (GBMSM). Behavioural change arising from increased knowledge and health warnings may have reduced the rate of transmission and vaccination is likely to be an effective longer-term intervention. We find that MPXV cases peaked in mid-July, declining due to decreased transmission rate per infected individual and infection-induced immunity among GBMSM, especially those with the highest rate of new partners. 

Responsive Modelling of the Mpox Epidemic in England as a Cross-government and Academia Collaboration

Lancet Microbe with Jasmina Panovska Griffiths, Meera Chand et al., 2023

Mathematical modelling played an important role during the COVID-19 epidemic in England, providing scientific evidence to policy makers at important policy junctions. Learning from this experience, in early May, 2022, the UKHSA Senior Modelling Leadership team established an mpox modelling consortium comprising government and academic epidemiological modellers working collaboratively together. The purpose of this consortium was to understand the transmission routes, identify early warnings of transmission outside GBMSM, evaluate the effect of different interventions and provide scientific evidence on estimates of current and future trends of the mpox epidemic in England. This article explores the process, challenges and lessons learned in that endeavour.

Monetary Policy and Birth Rates: The Effect of Mortgage Rate Pass-Through on Fertility 

Review of Economic Studies, with Lisa Dettling, 2023

This paper examines whether monetary policy pass-through to mortgage interest rates affects household fertility decisions. Our empirical strategy exploits variation in households’ eligibility for a rate adjustment, coupled with the large reductions in the monetary policy rate that occurred during the Great Recession in the UK and US. We estimate that each one percentage point drop in the policy rate increased birth rates amongst households eligible for a rate adjustment by three percent. Our results provide new evidence on the nature of monetary policy transmission to households and suggest a new mechanism via which mortgage contract structures can affect both aggregate demand and supply. 

Media Coverage:

• Guardian, Telegraph, Mail, Reuters, New York Times, Wall Street Journal, BBC R4 Today, BBC Radio Scotland, inews.

• Featured in the FT's Alphaville Pub Quiz 2025 - Round 2 question 10

Transmission Dynamics of Monkeypox in the UK: Contact Tracing Study

British Medical Journal, with Tom Ward, Chris Overton et al., 2022

Our analysis indicates that the epidemic peaked in the UK as of 9 July and then started to decline. Short serial intervals were more common than short incubation periods suggesting considerable pre-symptomatic transmission, which was validated through linked patient level records. For patients who could be linked through personally identifiable data, four days was the maximum time that transmission was detected before symptoms manifested. An isolation period of 16 to 23 days would be required to detect 95% of people with a potential infection.

Media Coverage:

• In the top 5% of all research outputs scored by Altmetric.

Mortgage Cash-flows and Employment  

European Economic Review, 2022

This paper quantifies the impact of the cash-flow channel of monetary policy on employment by combining novel micro datasets with near-universal coverage. When interest rates fall, mortgaged families spend an important share of the extra cash-flow in their local economy, increasing local labor demand. Overall, a reduction in mortgage payments of £1,000 per household leads to a 0.5 percentage point increase in locally non-tradable employment growth over three years, almost entirely driven by the restaurant sector. Employment-growth effects operate through the intensive margin for small establishments, lower death rates for the mid-sized and higher birth rates for the largest outlets.

House Prices, the Distribution of Household Debt and the Refinancing Channel of Monetary Policy

Economics Letters, with Paul Hubert, 2022

We investigate whether the refinancing channel explains why the effect of monetary policy on aggregate consumption is conditional on the distribution of household debt. We find a heterogeneous impact of monetary policy on aggregate consumption depending on housing price dynamics and the share of highly-indebted households. Consumption responds more to monetary policy when the share of highly-indebted households is large and house prices have recently decreased, but we find no effect of monetary policy when house prices have recently increased. 

The Distribution of Households' Indebtedness and the Transmission of Monetary Policy 

Review of Economics and Statistics, with Paul Hubert, 2021 [Slides]

We investigate whether the dynamic response of aggregate consumption to monetary policy depends on the distribution of household debt relative to income. Using UK loan-level micro-data, we propose a novel approach to isolate the fraction of households with a limited ability to smooth consumption. By exploiting time and cross-sectional variation, we show that consumption responds more to monetary policy when the share of  financially-vulnerable households is large, but  find no state-contingency with respect to the overall level of debt-to-income. Our results highlight the role of household heterogeneity and the importance of indirect channels for understanding monetary transmission to consumption behavior.

Science/COVID-19 Working Papers

Slowly declining growth rates and dynamic reporting delays characterise the Mpox epidemic in the UK in 2022 

[Pre-print] with Jasmina Panovska-Griffiths, Christophe Fraser et al., November 2022, under review

Using a custom nowcasting method which allows for time-varying delays (EpiLine), we show that the reporting delay for Monkeypox in the UK decreased from an average of 22 days in early May 2022 to 10 days by early June and 7 days in August 2022. Accounting for these dynamic delays shows that the time-varying r(t) declined gradually in the UK over this period. Not accounting for varying time delays would have incorrectly characterised r(t) by a sharp increase followed by a rapid drop. We discuss the importance of this gradual decline, which helps identify the potential mechanisms responsible for the decline in the rate of spread of Monkeypox, which started well before vaccines were widely used. 

Public Health Policy Contributions

The Case for Investment in Pandemic Preparedness

[Asia-Europe Foundation Article], 2023

In this article I outline some of the reasons it is often difficult to invest in pandemic preparedness activities by exploring the drivers of short-termism. This class of problems, which goes well beyond pandemic preparedness, has been explored by many others and the article goes through some of the solutions that have been proposed in other settings, and how they might be applied to public health. In the second part of the article, I offer three tangible things public health authorities can do to make their case for longer term investment as convincing as possible to budget holders.  (Short video of the associate conference here).

Covid 19: Early release from self isolation using LFD tests

[UKHSA Report] with Tom Fowler et al., 2023

Between 22 December 2021 and 24 February 2022, there were 6,922,949 positive cases of coronavirus (COVID-19) reported from antigen detecting LFD tests or PCR tests for SARS-CoV-2. At the time, people with positive test results were required to self-isolate for 10 days to reduce the risk of onwards transmission; however, this could be reduced to 5 full days days if 2 consecutive daily LFD tests returned a negative result. Over the 65-day period, 717,722 individuals were eligible for early release from self-isolation through this policy. In total it is estimated that individuals regained 2,346,781 days of self-isolation or an average of 3.3 days per person through implementation of this policy.

Investigation into the Risk to Human Health of  Avian Influenza (A H5N1) in England: Technical Briefings

[Technical Briefings] with Steven Riley, Susan Hopkins, Isabel Oliver et al., 2023

UKHSA worked with the Animal and Plant Health Agency (APHA), the Department for Environment, Food and Rural Affairs (Defra) and the public health agencies of the 4 nations to investigate the risk to human health of avian influenza (influenza A H5N1) in England. This briefing was produced to share data useful to other public health investigators and academic partners undertaking related work. It includes early evidence and preliminary analyses which may be subject to change. 

Technical report on the COVID-19 pandemic in the UK 

[CMO Report] by the CMOs of the four nations et al., 2022

A technical report for future UK Chief Medical Officers, Government Chief Scientific Advisers, National Medical Directors and public health leaders. There are four broad reflections which run through the report. First, there were multiple strands of scientific work from different disciplines needed, and these had to be integrated at considerable speed. The second is that, unsurprisingly, the UK was relatively effective and rapid in responding in areas in which we already had strengths and substantial capacity, including in biomedicine, which could be adapted and built on. The third is that, while we have concentrated on the UK experience, science and medicine are international and pandemics by definition are cross borders. Finally, the engagement of policymakers and the public in the scientific insights was profound and critical to the response. 

Investigation into Monkeypox Outbreak in England: Technical Briefings

[Technical Briefings] with Steven Riley, Susan Hopkins, Isabel Oliver et al., 2022

UKHSA worked with the NHS and the public health agencies of the 4 nations to investigate the monkeypox outbreak in 2022. This briefing was produced to share data useful to other public health investigators and academic partners undertaking related work. It includes early evidence and preliminary analyses which may be subject to change.  

SARS-CoV-2 variants of concern and variants under investigation in England: Technical Briefings

[Technical Briefings] with Meera Chand, Steven Riley, Susan Hopkins, Isabel Oliver et al., 2022

These reports are published to share the detailed variant surveillance analyses, which contribute to the variant risk assessments and designation of new SARS-CoV-2 variants. These specialist technical briefings contain early data and analysis on emerging variants and findings have a high level of uncertainty. 

Test Trace and Isolate for epidemic control: lessons learnt from COVID-19 in the UK and preparing for future pandemics

[Meeting Report] with Liz Fearon et al., 2021

Test Trace and Isolate (TTI) has been a corner stone of the response to the SARS-CoV-2 pandemic in the UK and elsewhere in the world over the past 18 months. With the successful rollout of the vaccination programme in the UK and the longer term role of TTI in control measures for COVID-19 still be to be clearly understood, now is a critical time to consider the lessons learnt over the future and to look forward to the role TTI will continue to play in SARs-CoV-2 control measures and also future pandemics. 

Written Contribution to the UK Covid-19 Inquiry [here]

Economics Policy Papers

Examining UK financial stability during the coronavirus pandemic outbreak with Alex Brazier and Matt Waldron, Bank of England

Various publications and reports, 2020  [Research link]  

Mapping the UK Financial System with Oliver Burrows and Katie Low, Bank of England

Bank of England Quarterly Bulletin, Q2, pages 114-129, 2015   [Paper]   [Video]

Assessing the Adequacy of  CCPs' Default Resources with Joe Noss, Bank of England   

Bank of England Financial Stability Paper No. 26, November 2013   [Paper]

Blog Articles

Opportune time to rethink, reimagine and re-ignite economic relationships: Cumming | Daily FT, April 2025

‘IMF program best chance for Sri Lanka to return to broad-based growth and prosperity’ | Daily FT, March 2024

Why lower house prices could lead to higher mortgage rates  with Danny Walker, Bank Underground, November 2023

Are Rates Hikes Raising Regional Inequality? with Andy Paterson, OECD Cogito Blog, February 2023

First-Time Buyers: How do They Finance Their Purchases and What's Changed?  with John Lewis, Bank Underground, September 2020

The Age Evolution of First-Time Buyers with John Lewis, Bank Underground, August 2020

Monetary Policy Transmission: Borrowing Constraints Matter! with Paul Hubert,  Bank Underground, May 2020

The Birds, the Bees and the Bank? with Lisa Dettling, Bank Underground, February 2020

How far do people move house? with Alastair Firrell,  Bank Underground, October 2019

Fixing ideas - The slowing of interest rate pass-through to mortgagors, Bank Underground, September 2019

Houses are assets not goods: Pt.1 Bulbs and flowers; Pt.2 Taking the theory to UK data with John Lewis, Bank Underground, September 2019

Diffraction through debt: the cash-flow effect of monetary policy, Bank Underground, March 2019

Why the Black Box should become more transparent, Bank Underground, October 2018

How China lost UK GDP in 22 working days, Bank Underground, September 2015 

Helicopter money: setting the tale straight, Bank Underground, August 2015