The response to New Zealand's first Delta outbreak ran into problems because the Auckland and Waikato DHBs didn't readily know which of their staff were vaccinated.
That "presented a barrier to rapidly and safely deploying staff to where they are needed most in the current Covid-19 response" and had been "problematic", a Ministry of Health email obtained by the Herald reveals.
Going "hard and early" has been the Government's rallying cry for dealing with the virus, and for months preparations were made for its re-emergence in the community. Worsening outbreaks of the highly infectious Delta strain in neighbouring Australia underlined the threat.
However, the Herald can reveal that when a community case was detected DHBs at the centre of the outbreak couldn't easily work out which staff were protected through vaccination.
That's despite health workers being eligible for the Pfizer vaccine since March.
The first case was confirmed on Tuesday, August 17 - a 58-year-old Devonport man, who with his partner had spent a weekend away in the Coromandel while potentially infectious.
By Saturday, there were 51 announced cases and the Ministry of Health sent an email, obtained by the Herald, advising the extraordinary action it was forced to take.
"While DHBs have been making good progress with the vaccination programme, many DHBs do not have reliable information on their workers' vaccination status readily available," wrote a senior official.
"This has presented a barrier to rapidly and safely deploying staff to where they are needed most in the current Covid-19 response. The three Auckland DHBs and Waikato DHB, in particular, have found this to be problematic since we went to level 4 on Tuesday."
The ministry runs the national Covid Immunisation Register (CIR), which records information about individuals' immunisation status. For privacy reasons, this personal health information isn't normally shared, including with employers such as DHBs.
However, the situation was concerning enough that, on behalf of the DHBs - Auckland, Counties, Waitematā and Waikato - the ministry sought advice from the Office of the Privacy Commissioner about allowing the register information to be shared, under an exception in the Health Information Privacy Code.
The ministry decided this was needed "to prevent or lessen a serious threat to public health or public safety", and because it wasn't practicable for the DHBs to obtain authorisation from each staff member. It would be a one-off, but might be widened to other DHBs, depending on where cases were detected.
DHB staff should be told "key messages", including that "due to the rapid roll-out of the Covid-19 vaccine to DHB staff, there has not been a consistent and reliable process for seeking the authority of vaccinated staff to allow the DHBs to access their vaccination status."
The Herald revealed last month that nine of 20 DHBs didn't know how many staff were vaccinated.
The remaining DHBs provided overall coverage figures. They included Auckland (88 per cent first dose last month), Waitematā (86 per cent first dose), Counties Manukau (87 per cent first dose) and Waikato (95 per cent of frontline staff).
National deputy leader and health spokesman Dr Shane Reti said the situation was hard to believe. Hospitals needed to know if staff were vaccinated against other infectious diseases, he said, and robust arrangements should have been in place.
"Why wait for Delta? Why did we not have this, regardless of the outbreak?"
The Auckland and Waikato DHBs referred all questions to the ministry, which confirmed it began sharing the vaccination records with the DHBs on August 21, a process that was only completed yesterday.
A ministry spokesperson said giving DHBs access to that information was a "key part" in allowing the rapid and safe deployment of their staff.
A spokesperson for the Office of the Privacy Commissioner (OPC) said it was asked by the ministry for advice on August 19 and was told getting the vaccine information was "seen as critical to the ability of DHBs to service their communities and keep staff safe".
For that reason and because of the threat of community transmission of Delta, the OPC told the ministry there was "likely to be an arguable case" for accessing the immunisation register. It recommended the ministry "should act urgently to regularise the approach to vaccination information with all DHBs in the future".
The Government has given DHBs until August 31 to report vaccination rates for staff. Yesterday the Herald revealed Covid-19 Response Minister Chris Hipkins had asked health officials for advice on making the Pfizer vaccine mandatory for health workers in contact with confirmed Covid-19 cases, including in hospitals.
Such policy wasn't on the table before the highly infectious Delta strain forced a rethink of how to protect the country. It would be a "last resort", Hipkins said.
Groups including the Medical Council and College of GPs have already advised members they shouldn't be working with patients if unvaccinated.
Yesterday 62 new Covid-19 cases were announced, bringing the total in the community to 210. There are now over 480 locations of interest. Nearly 50,000 tests were processed, and a daily record of over 80,000 vaccine doses was administered.
Full vaccination provides a high degree of protection against Delta infection, and greater protection against severe illness, hospitalisation and death. According to the ministry, the effectiveness of two doses of the Pfizer vaccine against illness is about 88 per cent, and against hospitalisation is about 96 per cent.
However, "breakthrough" infections do happen when a vaccinated person gets infected and risks transmission to others. This is rare but has occurred in the current outbreak when a fully vaccinated nurse at Auckland City Hospital and an emergency department staffer at Middlemore Hospital returned a positive test.