The Government has just announced a wide-ranging Royal Commission of Inquiry into New Zealand’s pandemic response. Covid-19 experts told Jamie Morton three things they’d like our next one to be.
New Zealand’s pandemic response might have been ultimately lauded by other nations, yet we confronted the coronavirus manifestly unprepared.
While experts like Otago University’s Professor Michael Baker saw what was coming as early as January 2020, it wasn’t until a month later, just before Waitangi Weekend, that our race to contain Covid-19 really began.
That was when the first of many emergency Cabinet teleconferences and calls between Prime Minister Jacinda Ardern and Australia’s Scott Morrison prompted the Government to stop flights from China.
Shortly before our first case was confirmed, an ad-hoc committee was formed within the Cabinet, and officials soon found new information was coming in faster than they were able to build cases for decisions.
In outlining what became New Zealand’s alert level system, experts stressed the “stark choice” the Government had to make – and Ardern announced an unprecedented, nationwide lockdown on March 23.
It couldn’t have come much later.
Delaying only another three weeks, modellers calculated, could have cost 200 lives, 12,000 infections, and probably scotched our chances of elimination.
In all, correctly making that 11th-hour call enabled the country to limit that first wave’s toll to just 22 deaths and about 1500 confirmed or probable cases.
Over the course of the next two years, New Zealand had minus 215 excess deaths per million, which equated to around 1103 fewer people dying than in a scenario in which the Covid-19 crisis never happened.
Otago University researchers have calculated that, if we’d experienced a similar per capita excess mortality rate with other jurisdictions, New Zealand may have seen 1856 extra deaths (Japan), or 2127 (Taiwan), 2577 (Australia), 3798 (Singapore) or 5167 (South Korea).
Remarkably, there were only nine jurisdictions on the planet which had recorded negative cumulative excess mortality for that pandemic period - of which New Zealand was the largest.
These historic wins stood in contrast to what was a messy scramble at the highest levels of power, across those chaotic first few weeks.
Our working pandemic plan at the time, geared toward a new influenza strain, focused on “mitigation” and “suppression” – Kiwis would remember early talk of “flattening the curve” - rather than an all-out elimination approach that Asian jurisdictions had already developed.
Our public health infrastructure – as lamented by eminent epidemiologist Professor Sir David Skegg in his book just a year before the crisis – was run down and under-equipped to meet and manage a massive tide of cases.
Infectious diseases expert Dr Ayesha Verrall, now the minister in charge of our pandemic response, was tasked with a rapid review to help bring inadequate contact tracing services up to speed.
Professor Shaun Hendy, whose small team faced a relentless workload of mapping out various scenarios, found it particularly frustrating that, unlike Australia, New Zealand hadn’t built up disease modelling capacity.
“Obviously, it was a challenge standing up all of that stuff in such a short period of time,” said Hendy, who’s since left his former role at the University of Auckland.
“So, getting all of those preparations right is important – and it needs to be backed up with funding.”
With Delta and Omicron since having put paid to an elimination strategy that introduced us to extraordinary and often divisive measures like lockdowns, MIQ, vaccine passes and QR-code scanning, our health landscape has transformed.
While this year saw the end of the traffic light system, it also brought the opening of a dedicated Public Health Agency and a new research platform to counter infectious diseases.
Verrall has repeatedly pointed out that New Zealand remained ready to scale up its health measures if the pandemic took another nasty turn, with options like revived mask mandates still on the table.
Yet we still didn’t appear to have a single, coherent strategy to confront a resurgent coronavirus or whatever came after it, Baker said, despite he and colleagues offering their own blueprint.
Though noting there’d been a “massive shift in thinking” and beefed-up public health capacity, Baker said a more strategic approach was needed to quickly and effectively respond to the next pandemic threat.
“We need an institutional focus, where we have a pandemic plan that can be used in a wide range of scenarios - from ‘do nothing’ all the way up to elimination - and agencies that are empowered to implement it.”
He wanted to see more cohesiveness, both within the science system – something that a just-launched sector revamp aims to address – and between experts and policymakers.
“All of these systems need to be put in place, as well as regularly upgraded and tested so we don’t forget what a pandemic looks like.”
Anyone working in the health system will have long been aware of glaring inequities that Māori, Pasifika and other communities face – but nothing brought that into public focus so tragically as Covid-19.
Of more than 22,000 hospitalisations with the virus recorded to date, Māori have accounted for 3822, and Pacific peoples 2750.
Combined, Māori and Pasifika patients made up four in 10 of all cases requiring intensive care – and also a heavily disproportionate number of deaths, particularly in younger adult groups.
This sadly aligned with what modellers had calculated back in the elimination era, when they found, after controlling for age and pre-existing conditions, that Māori and Pacific people were respectively two and a half and three times more likely to need hospital care.
It was owed to a complex mix of factors: these populations were more likely to have underlying health conditions, poorer access to healthcare and testing, and have higher levels of interaction and larger households.
There was another key demographic factor – a younger population structure.
That put a higher number of young Māori and Pacific people at the back end of a vaccine roll-out that, while the largest ever mounted in New Zealand’s history, was widely criticised for not being more equitable to vulnerable communities.
Earlier this year, a study led by Waikato University’s Dr Jesse Whitehead found vaccination services could have been better planned to target priority populations – particularly in rural areas where they faced bigger barriers around access and transport.
The Waitangi Tribunal similarly found the Crown actively breached Te Tiriti on multiple levels in its vaccination strategy and shift to the traffic light system, and failed to prioritise Māori due to “political convenience” and “fear of a racist backlash”.
It recommended a raft of changes to the Covid-19 response, including better resourcing and partnering with Māori organisations.
“I think we realised a lot around putting control of holistic health action in the hands of communities – particularly iwi and Pacific communities,” Whitehead said this week.
“These already have strong connections and have the solutions ready – they just need the support to make them happen.”
The Government had helped address these issues by boosting support to some 160 Māori and Pacific health providers, and at a national level, establishing the Te Aka Whai Ora - Māori Health Authority.
Elimination may have proven the best strategy to keep the virus at bay until we could vaccinate the population – but it still came with heavy economic and social costs.
Auckland’s Delta lockdown alone cost the economy an estimated $8 billion, while economists put the price of nationwide stay-at-home orders at nearly $2b each week.
Elsewhere, researchers have documented what constant disruption meant for everything from education and childhood development to inequality and mental health.
As early as May 2020, former chief science adviser Professor Sir Peter Gluckman warned how social cohesion – something that helped unite our “team of five million” against Covid-19 – would begin to fray amid the fall-out.
Commentators have also pointed out how our hard-line health measures coincided with a “misinfodemic” that gave rise to last summer’s ugly occupation of Parliament grounds.
Baker described lockdowns as having been a “blunt tool” that New Zealand mightn’t have had to rely on so much, had we had better systems in place.
“I also found it very frustrating, as someone who has experience and training in this area, that we could get no resources whatsoever to evaluate these extremely disruptive and expensive interventions.”
This would’ve helped refine our approach, he said, and compare it against alternatives.
While The Economist magazine’s Normalcy Index ranked New Zealand highly for having had comparably little disruption, Baker noted some well-prepared jurisdictions had spent even less time in lockdown.
A stand-out was Taiwan, which entered the pandemic with its own Centres of Disease Control – established around the same time a Kiwi equivalent was dismantled – along with a central epidemic command centre and special legal powers to use in outbreaks.
“It’s now well documented that, on the last day of December in 2019, they were already activating a multi-agency response.”
At a simpler level, Baker said Taiwan had an entrenched culture of mask use and staying home when sick.
“If we look at which countries achieved an optimal balance of health outcomes, equity and minimal disruption, Taiwan would be up there – and we could certainly learn some of their lessons.”
While it was entirely possible another virus that posed a larger threat to life could force New Zealand to once again raise its drawbridge, Baker hoped the next pandemic wouldn’t up-end society in the way the last three years had.
At the same time, Covid-19 hadn’t gone anywhere – and was still infecting, hospitalising and killing Kiwis each week, while leaving an untold number with long-lingering symptoms.
“We have not yet worked out an effective strategy for ‘living with Covid-19′ so that remains an important question for review.”
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