Briefing: UK Pandemic Preparedness - Exercise Pegasus September to November 2025

In this iPMI Global insights article we explore NHS England's approach to pandemic preparedness and detail Exercise Pegasus, a significant cross-government simulation scheduled for autumn 2025. This exercise, the first of its kind in almost a decade, aims to evaluate the UK's pandemic response capabilities across various government departments and devolved nations, with NHS England as a key participant.

Emergency Preparedness for Pandemics

It focuses on developing a comprehensive Pandemic Response Plan for different transmission routes, initially prioritizing airborne pathogens, and involves high-level participation from national executives and local resilience forums. The objectives of Exercise Pegasus include testing decision-making processes, assessing the impact of inequalities, and examining the effectiveness of coordination across various tiers of response.

1. Renewed Focus on Pandemic Preparedness and a New National Response Plan: The UK government, led by the Department of Health and Social Care (DHSC), is actively developing a comprehensive "Pandemic Response Plan." This plan will define "national roles and responsibilities" and outline how the health and social care system will react to a pandemic, with an initial focus on "a respiratory/airborne pandemic." This indicates a clear effort to formalize and streamline the UK's response mechanisms following previous experiences.
2. Exercise Pegasus: A Significant National-Level Simulation: "Exercise Pegasus" is highlighted as a critical component of current pandemic preparedness efforts. It is classified as a "Tier 1 exercise," signifying its national importance and involving "ministerial participation and Cabinet Office Briefing Rooms [COBR] activation." This exercise, scheduled for September to November 2025, is notable as the "first of its kind in nearly a decade," emphasizing a renewed commitment to large-scale, realistic pandemic simulations.
3. Multi-Agency Collaboration and Broad Participation: Pandemic preparedness and Exercise Pegasus involve extensive collaboration across various governmental and health bodies. Key participants include:

• DHSC (leading overall)
• NHS England (a "key participant" supporting DHSC, with involvement from NHS Resilience, programme teams, and National Clinical Directors)
• UKHSA (leading Exercise Pegasus alongside DHSC)
• Cabinet Office
• Other Arm's Length Bodies (ALBs)
• Devolved nations
• Local Resilience Forums (LRFs) (all 38 LRFs are "requested to participate")
• Integrated Care Boards (ICBs) and NHS providers

This broad involvement underscores the interconnected nature of pandemic response across different tiers of governance and healthcare.

4. Structured Participation within NHS England: NHS England's participation in Exercise Pegasus will be structured, including:

• "Partial use of incident management structures."
• "National executive participation," including the National Director for UEC and Operations, Chief Medical Officer, Chief Nursing Officer, selected National Clinical Directors, and Regional Directors.
• "Key staff involvement for those already involved in pandemic preparedness."
• Participation will occur across "three two-day phases in September and October 2025."

5. Exercise Pegasus Objectives: Focused Learning and Improvement: While the exercise aims to simulate a realistic scenario, its "objectives...set specific elements where there is a reasonable prospect of useful learning rather than assessing the totality of pandemic arrangements." The eight core objectives aim to:

• "Exercise decision making processes for measures to contain, control or mitigate the impact of a pandemic."
• "Explore the impact of inequalities, and their consideration within pandemic decision making." This is a significant inclusion, indicating a focus on equitable response.
• "Investigate likely impacts of HMG decisions on the health and care system, local responders, communities, businesses, civil society and the general public."
• "Examine processes for the scaling up of relevant capabilities."
• "Investigate the effectiveness of coordination, including the exchange of information, between different tiers in a UK wide response."
• "Test the strategic response to disinformation and misinformation." This highlights the importance of managing public information during a crisis.
• "Enable and support local exercising of selected capabilities and response issues."
• "Identify and report on relevant areas of learning to improve future pandemic preparedness."

These objectives indicate a nuanced approach to identifying specific areas for improvement, rather than a broad, undifferentiated assessment.

Conclusion:

iPMI Global analyst Christopher Knight concludes, “The UK is actively bolstering its pandemic preparedness through the development of a comprehensive national response plan and the initiation of "Exercise Pegasus," a major cross-government simulation. This exercise, the first of its kind in nearly a decade, involves extensive collaboration across various governmental and health entities, from national ministries to local resilience forums. The objectives of Exercise Pegasus are clearly defined to facilitate focused learning and identify specific areas for improvement in future pandemic responses, with particular attention paid to decision-making scaling capabilities, inter-tier coordination, and addressing societal impacts like inequalities and disinformation.”