Experts' ideas: Is this how NZ can hold off Delta?

Health experts have called for a tougher Auckland boundary, a vaccine mandate for more types of workers, and better engagement with marginalised communities, among a raft of suggested measures to help the country keep a lid on Covid-19.

In a blog post published yesterday, Dr Amanda Kvalsvig and professors Michael Baker, Sue Crengle and Nick Wilson of Otago University, along with the University of Auckland's Associate Professor Collin Tukuitonga and NZ Drug Foundation executive director Sarah Helm, listed five steps that could be taken against Delta.

The experts warned that New Zealand's elimination strategy was under threat – particularly with infections becoming established among deprived groups – and said an upgrade was needed to buy more time for the vaccination drive.

"Auckland and New Zealand generally remain under-prepared for widespread transmission of Covid-19," they said.

While nearly half of eligible Kiwis were now fully vaccinated, they pointed out that just 30 per cent of Māori, and 41 per cent of Pasifika people, had received both doses – groups that modelling has predicted are at higher risk of death and hospitalisation.

Māori (19 per cent of all cases) and Pasifika (64 per cent) had also been disproportionately affected by Auckland's Delta outbreak, they said, and that impact could worsen if the virus kept spreading under the softer level 3.

Here, the experts called for an urgent meeting between experts, agencies and community leaders to discuss a new dedicated strategy for Māori and Pasifika, along with more equitable care and more resourcing for local providers.

Officials could also look at special options to protect people with drug and alcohol dependencies – even extending to a temporary, city-wide moratorium on drug possession prosecutions - which could help remove barriers to them dealing with agencies.

On top of that, the experts said support measures and the Covid-19 control service model should be reviewed to better accommodate marginalised people.

Elsewhere, they wanted to see surveillance and screening ramped up.

That could include enhancing wastewater testing to strip out more "false positive" results; phasing in rapid antigen testing, and saliva collection for quicker PCR testing; and routinely testing groups such as those travelling out of Auckland, visiting people in hospitals or care facilities, or detained in custody.

As well, routine testing could be expanded to people who were marginalised or moving through transitional housing, identified in enhanced contact tracing, living in suburbs where there was ongoing transmission, or potentially carrying out any essential or permitted work under level 3.

To speed up vaccination, they also suggested vaccine mandates could be expanded to cover essential workers moving across the border, all health and aged care workers, and any other public-facing workers in Auckland, ranging from supermarket staff to police and corrections officers.

As for New Zealand's alert level system, the group again recommended an overhaul essentially splitting alert level 2 into three – with "plus" requiring regional boundaries and mask-use outside homes, "standard" involving the usual measures, but also indoor mask use, and "minus" allowing for larger event sizes.

"Without these changes, school-age children will be particularly exposed if there is community transmission occurring at alert level 2 because they are still largely unvaccinated and are congregating each day in school buildings where ventilation is poor and mask-wearing is not adequately socialised," they said.

"To give an even more nuanced option, we could also define an alert level 3 minus – for potential suburb level application in parts of Auckland where the outbreak is persisting."

Regardless, they added Auckland wasn't ready to step down from level 3 as it stood.

Rather, they said it might be necessary to further tighten the border around Auckland for several weeks to prevent spread.

"Options for tightening this border include requiring vaccination for crossing the border and a rapid antigen test at the time of crossing," they said.

"The importance of careful management of this border is shown by such cases as a truck driver found to test positive after travelling to other parts of the North Island."

Officials could also look into a potential border between the North and South Island, they added, in case Delta travelled further around the north.

Police keep watch over an essential travel checkpoint at the Auckland-Waikato border. Photo / Michael Craig

Beyond the main measures they pitched, the experts saw scope strengthen the health system for Covid-19, develop a national mask strategy and prepare to immediately roll out vaccines to younger children as soon safety regulators approved them for use.

"Successful control of Covid-19 in NZ now depends on successful control in Auckland," they concluded.

"Slowing, or ideally eliminating, Covid-19 transmission benefits the entire country and buys time to achieve high and equitable vaccination.

"As always, this approach relies on good evidence-informed strategies and highly effective delivery."

The pattern of continuing Covid-19 transmission in Auckland in groups that experienced deprivation and marginalisation was a "vivid example" of why achieving equity was key to advancing public health, they said.

"With infectious diseases and pandemics, we are all in it together."

The Government has already begun taking some of the steps the expert set out.

Yesterday, Prime Minister Jacinda Ardern said she and Director-General of Health Dr Ashley Bloomfield had recently met with health providers serving large Māori and Pacific populations.

"And, there now, the switch in strategy is not to just have static mobile sites but to take vaccination into communities, on to people's doorsteps, and into their homes, and that's the switch you'll see in our vaccination programme from here."

Ardern said the Government had also looked at whether essential workers travelling out of Auckland needed to be vaccinated, but pointed out that some of these people only made one-off trips.

She also said that more frequent testing of people crossing the border hadn't been considered.

"Keep in mind, literally thousands of individuals, for very legitimate reasons, the vast bulk of which is freight, move across that boundary," she said.

"So it probably, I think, would pose some practical issues."