New Zealand's first Covid-19 vaccinations will be given at the workplaces of border staff - and some glitches are expected when a new database is used to track who's been inoculated.
The largest vaccination campaign in Aotearoa's history begins on Saturday, when frontline workers in Auckland will start being vaccinated.
Details of vaccinations - and when the crucial follow-up dose is due - will be stored in a new database, the Covid Immunisation Register, which will eventually expand to cover all immunisations and replace a badly outdated system.
The change will mean inevitable glitches, but they shouldn't be blown out of proportion, said Dr Nikki Turner, director of the Immunisation Advisory Centre, which is providing coordination and training for the vaccine campaign.
"There will be glitches along the way, but I think the key building blocks are there... when you do programmes like this, things are not always smooth right at the start."
A bigger challenge is ensuring the frontline workers who will be vaccinated in the first phase - cleaners, nurses, security staff, Customs and border officials, airline staff and hotel workers - have enough understanding to give informed consent.
"We have just developed a brief video that we've actually got [director general of health] Dr Ashley Bloomfield speaking on, to try and impart the key information to people who are about to be vaccinated - 'Here's the information on the vaccine, we do know it's safety profile, we know how effective it is,'" said Turner.
"There are always people who are anxious about new vaccines, so being able to offer effective communication in all the ways we can is the hardest challenge for us."
Turner said people could be reassured by the evidence behind the "extremely impressive" Pfizer vaccine, which now not only included clinical trials but safety data from more than 12 million doses given in the United States, and in other countries.
How to prepare the vaccine: 'Do not shake'
About 60,000 doses of the Pfizer-BioNTech arrived in the country on Monday morning - enough to cover around 30,000 people, given the vaccine needs two doses, given about three weeks apart.
The vaccines must be stored at ultra-low temperatures, and will be kept in nine -80C freezers that can store more than 1.5 million doses in total.
Those will be in Auckland and the South Island. However, because the vaccines can be stored for up to five days in normal cold chain fridges at temperatures from 2-8C, and up to two hours at room temperature prior to use, vaccines will be administered across the country, in areas with borders or MIQ facilities.
An inventory management system has been set-up to track where vaccines are, their temperature and expiry dates.
A nationwide "dry run" was held last week to test systems ahead of vaccinations starting on Saturday (in the Auckland region at first).
Officials have also kept a close watch on strengths and weaknesses in systems used overseas, including in the United Kingdom, which has now delivered 15 million vaccines.
"Obviously we don't want left-over vaccine. So it's trying to match the numbers to your vaccine supplies, within a five-day window," said Turner.
It will take several weeks to vaccinate border workers, with vaccinations mostly taking place in their usual workplace such as MIQ facilities.
The next phase will cover the people they live with, and from then onwards people will probably be asked to come to specific sites or clinics, set-up by each DHB.
The general population will likely be offered vaccination in the second half of the year, and that will need an extra 2000-3000 vaccinators, to be drawn from retired or non-practicing nurses, doctors or pharmacists and final-year medical students (with training and oversight).
However, for now, the 2200 trained vaccinators are enough. The Immunisation Advisory Centre has provided specific training around the Pfizer vaccine, including an online two-hour tutorial.
Medsafe guidance runs through processes including diluting the vaccine to ensure six doses can be taken from one vial, and "gently inverting" thawed vials 10 times prior to dilution, making sure to never shake, and watching for particulates or discolouration.
How frontline workers feel
David Wills, director of the Nurses Society of New Zealand (NSNZ) union, said he expected 100 per cent of his members to accept vaccination, as would their family members.
"Everyone is looking forward to it. Nurses are well sold on the value of vaccination, and no one has ever expressed any concerns about safety."
That was because people working in MIQ facilities were "effectively on level 3 [restrictions] all the time" - limiting what they did in their time off, and who they mixed with.
Some nurses who decided to live alone while doing the work had been put up in rooms in the Stamford Plaza Auckland, as part of employment agreements with DHBs.
"They can't live with people who are potentially vulnerable. And there are plenty of people who have been asked to move out of flats and so forth, because their flatmates don't want them in there, because they are working in MIQ," Wills said.
"These people are on contracts for nine months - so for some of them it's living in a hotel for months."
There will likely be more hesitancy from other frontline workers. John Crocker, national secretary of the Unite Union, representing some cleaners and hotel workers in more than 30 facilities, said members wanted full information about the vaccine's safety.
"They're actually very brave, but they just want their questions answered... they are less worried about it than the public as a whole, I think.
"They have been in a different headspace for the past year, being on the frontlines - they are very conscious [of the risk from Covid] all the time. It's never gone away for them. We hear about precautions they are taking in their own households, and things like that."
E tū assistant national secretary Annie Newman agreed, and said she wasn't aware of any members who had indicated they wouldn't consent, and the union supported vaccination.
However, it must be a choice - and while some organisations could shift employees away from the frontline if agreed upon, employment shouldn't be affected if someone did decline.
The current community cases
There's no evidence yet to suggest the four vaccines that New Zealand has pre-purchased won't work on the so-called "UK variant" of Covid-19, which has caused the latest community infections here. Initial studies indicate the Pfizer-BioNTech vaccine and the AstraZeneca shots should still work.
The Ministry of Health is prepared to change plans if the current outbreak widens significantly - communities particularly affected might get vaccines earlier than other areas, for example.
There are signs it may have already changed the approach. One of the current cases, a woman who worked in the laundry department of a service for airlines, was being tested periodically, because her company offered that to her, despite her not being airside.
On Monday, Prime Minister Jacinda Ardern indicated such workers might be included in the first phases of the vaccine rollout: "We are also looking closely at any border workforce who may be on a regular testing regime, but not necessarily through regulation".
Whoever goes first, precautions like strict PPE use and hygiene controls will stay in place.
There's strong evidence that vaccines like Pfizer's greatly reduce people from getting seriously sick, but it's not understood how well they reduce Covid-19's spread.
"The jury is still out as to what extent [Covid] vaccines reduce spread from people who are mildly unwell or people who are not symptomatic at all. We are watching closely for further data on that, it's really important for New Zealand, and really hard to know strategically how we plan without that piece of data," said Turner.
"Through all our materials, we have really stressed that just starting to vaccinate does not mean that we have got the cure to our problem - it is not the magic bullet, and we cannot let go of our traditional public health messages. Because at this stage we do not know how protective these vaccines are against spread.
"New Zealand is in a very different position from other countries. Other Western countries, [vaccines] are there to protect against severe disease - death and hospitalisation. We are hoping that we can also stop community transmission. But we do not know that yet."
Some evidence is emerging that vaccination does curb transmission, and both Turner and Bloomfield are hopeful that will soon become clearer.
"It would be unlikely that it didn't reduce transmission significantly," Bloomfield told reporters yesterday.
"Because the main factor that makes someone infectious is the amount of virus that they are carrying around, and if they have got either an asymptomatic or a very, very low infection, if they are infected, then the likelihood they will transmit onto others is greatly reduced."