John Roughan: Cabinet gave the vaccination programme entirely to the Ministry of Health, it won't turn out well

Just the facts - A closer look at the Covid-19 vaccine being rolled out across Aotearoa. How it works, why we need it and who developed it. Video / NZ Herald

OPINION:

It was hard to give the Budget much credence after reading the Auditor-General's report on the Covid-19 vaccination programme this week. The gulf between word and deed in Government has probably never been greater.

From the moment the Cabinet gave the vaccination programme entirely to the Ministry of Health you just knew it wouldn't turn out well. Ministries these days do what the Auditor-General calls "high-level" planning. He doesn't mean high quality, he means the plans made on high that do not get down to the harder work of deciding exactly who will do what, when, where and how.

Ideally, those on the higher floors of management know how things are done on the ground floor but the bigger the organisation the more likely it is they don't know, and this becomes even more likely in Government departments where heads seldom fall for failure at any level.

We saw this disconnect vividly last year when GPs were complaining they weren't receiving their usual supplies of flu vaccine and director-general of health Dr Ashley Bloomfield kept assuring the daily Covid press conference supplies had been dispatched as usual.

Where had they gone? My sister, a practice manager, had a reasonable guess. Quite a lot, she reckoned, would be sitting in agencies that normally service workplaces because they, like the industries they serve, were locked down at the time. From her dealings with health officials, she thought it quite possible they would not know this.

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As soon as the vaccination programme was given to the Health Ministry it started telling us what a big, unprecedented, complex undertaking it was. The ministry is still telling us this, so is the minister. Chris Hipkins told us again this week, by way of explaining the next shipment of vaccines might be delayed.

The hard part of this vaccination programme, you would think, is transporting and storing a vaccine that needs to be kept deep frozen and used within five days after coming out of the freezer. But the private sector manages to deliver frozen food around the country every day and business leaders offered to help the Government tap the sector's know-how and resources. The offer was ignored.

Covid-19 Response Minister Chris Hipkins said again this week that the next shipment of vaccines might be delayed. Photo / Mark Mitchell

The easy part of any vaccination programme, you would think, is getting the needle into the arm but the Auditor-General has revealed the ministry is making heavy weather of this too. It has decided "vaccinators" need special training for this jab and the AG doubts enough of them will be trained by July when the mass vaccination is supposed to begin.
Why do they need training? We have thousands of nurses in general practices throughout the country, and in agencies contracted to offices and factories, that do inoculations every working day.

The Auditor-General says his office heard that some nurses "felt they had not been properly engaged to be core vaccinators despite their vast experience in vaccination and links with a wider range of communities." Business leaders know the feeling.

Vaccination looks like one of a nurse's easier tasks, easier than taking a blood test for example. No need to find a vein, a jab anywhere in the upper arm does the business.
I went to the GP for the flu vaccine two weeks ago and it took about 30 seconds. Most of that time was spent telling me the diseases in the dose this year, which included Sars1 incidentally. I thought I'd be able to get a Sars2 ( Covid-19) jab two weeks later, but then the roll-out for over 65s was postponed to the end of May.

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Now the Auditor-General says most of this age group will not be vaccinated before the end of June. Is anyone surprised? He doubts the whole programme will be completed by the end of the year.

"All vaccinators will need training," he explains, "to use the Covid-19 immunisation register, as well as training specific to Covid-19 and the Pfizer vaccine. This includes training on vaccine safety, the vaccination process, and how to respond to common concerns." Do they need all that?

"High-level" planning isn't just disconnected from practice on the ground, it thinks up needless things that get in the way of practical work. But mostly it just wastes time and high salaries thinking of the bleeding obvious.

The Auditor-General reports that a Cabinet paper in December set out four principles: that vaccines would be free and safe, the roll-out would be sequenced as vaccines became available, the sequencing would be based on need, and would continue until there was confidence the population is sufficiently protected." Well, yeah.

He concludes those principles were not sufficient to guide even "high level" design decisions, with the result "some decisions were relitigated late. Other decisions are being made later than is desirable ..." This not going to end well.