Shane Reti: Lessons to learn about coronavirus vaccination from measles outbreak

A volunteer receives a dose of the Covid-19 vaccine candidate BNT162. New Zealand is developing a vaccine programme to start this year at a date yet to be determined. Photo / File

FROM PARLIAMENT

OPINION:

New Zealand had a practice run with an infectious disease outbreak almost exactly a year before coronavirus: the 2019 measles outbreak.

This was another small, infectious, droplet spread virus that swept through New Zealand. Issues at the time included a lack of PPE, poor contact tracing and varying public health policies, that is, many of the issues raised again a year later in coronavirus reports by the Auditor-General and the Roche Simpson report.

It seems we didn't learn enough from the measles outbreak. What may be more useful then is what we can learn about vaccine management as we confront a potential mass immunisation programme for coronavirus.

Working along the logistics pathway, the first step is procurement. In my view, we simply didn't order enough measles vaccines in 2019.

This looks a little different to the current four coronavirus vaccines that have been contracted and the numbers seem to be enough for the whole population. This is good.

We were told the measles vaccine issue was just a "distribution" issue and not supply. I don't believe that, but if distribution was a contributor then what have we learnt that would be different this time?

This is especially so for the supercooled Pfizer vaccine which, because of the cooling requirements, could well only be administered to, by and from DHBs. We shall see.

The real task with distribution is how we get vaccines out to primary care, which is the real engine room of public vaccination programmes.

This failed for the measles vaccine in 2019, the flu vaccine in 2019 and the flu vaccine again at the start of coronavirus in 2020.

In all of these cases, GPs were saying they didn't have enough vaccines.

This is not a great track record and so the workflow details will matter if primary care is to be the main deliverer of the coronavirus vaccine.

Attention will need to be paid to vaccine supply, vaccine storage (note: a GP's vaccine fridge often has little room for the seasonal and targeted flu vaccine let alone a mass targeted coronavirus vaccine), materials and reimbursement.

What people also don't realise is the time to data enter vaccines into the National Immunisation Register (NIR) often takes longer than actually giving the vaccine.

This time resource also needs to be taken into account, which lends itself to what I will predict will be one of the rate-limiting steps for the coronavirus rollout: the immunisation register.

By way of example, the whole bowel screening programme was delayed because the bowel screening register had not been developed and what we are hearing is that for coronavirus, the current immunisation register will need to be redone.

Considering how long it took to get coronavirus Bluetooth technology, I have grave concerns the coronavirus immunisation register may actually be what holds up the vaccine rollout and I would advocate sound caution and sound funding be applied to what we will require to be a sound outcome.

• Dr Shane Reti is deputy leader of the National Party and a Whangārei-based list MP.