Two Years Since NZ First Locked Down – Expert Reaction

Monday, 21 March 2022, 12:14 pm
Press Release: Science Media Centre

Prime Minister Jacinda Ardern announced Aotearoa would enter strict lockdown on 23 March 2020 – two years ago this week.

The Prime Minister’s speech signalled the start of the country’s elimination approach to COVID-19, giving two days’ notice before New Zealanders collectively launched into Alert Level 4 lockdown. Looking back over the first two years of the country’s pandemic path, how do experts sum it up – and what do they want to see next?

The SMC asked experts from a range of academic areas to comment:

1. Epidemiology and public health
2. Māori health
3. Pasifika health
4. Child and family health
5. Infectious diseases and microbiology
6. Modelling
7. Genomics
8. Technology
9. Economics and public policy
10. Psychology
11. Food insecurity

EPIDEMIOLOGY AND PUBLIC HEALTH

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow and Co-director, HEIRU Research Group, Department of Public Health, University of Otago, Wellington, comments:

“Two years ago Aotearoa New Zealand was facing an explosive outbreak of a new, serious infection for which there was no vaccine and no effective treatment. The elimination strategy saved thousands of lives and gave New Zealanders many months of freedom in their everyday lives. Although there were areas where New Zealand’s response could have been much more effective and equitable, the strategy was sound and it worked. However, vaccines didn’t deliver the end of the pandemic as we had hoped because so many places around the world that could have chosen a similar strategy to New Zealand instead allowed the virus to spread, generating new variants.

“Emerging knowledge about the SARS-CoV-2 virus is changing our idea of the shape of this pandemic and what needs to be done. This is not a simple respiratory infection where you quickly gain immunity from vaccination or from a disease episode. Instead, it’s now understood that Covid-19 is a multi-system inflammatory condition with potential to cause lasting damage to health. Vaccines have a crucial role in protecting health, but the protection is incomplete so people can be infected and re-infected. What that means for now is that we need to minimise the number of times we become infected, including children, while more effective treatments and vaccines are being developed.

“In New Zealand we have outstanding outbreak control infrastructure and expertise and we have many effective tools in the toolbox, including effective ways to prevent airborne transmission. But we need to choose to control the virus. At the moment New Zealand’s pandemic strategy seems unclear and reactive when it could be clear and proactive. This lack of clear strategic direction is a bigger threat to population health than the virus itself. Everyone is exhausted after two years of crisis management: we need to pivot now to a sustainable strategy that protects New Zealanders from Covid-19 and from the other infectious diseases waiting to make a comeback. This is a highly feasible goal, but it has to be an active choice.”

No conflict of interest declared.

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:

“New Zealand needs to continue investing in public health and pandemic control infrastructure: Colleagues and I have summarised some of the key lessons from the first two years of the pandemic in a Conversation article to mark the two-year anniversary of the first confirmed Covid-19 case in New Zealand. Our major conclusion is that taking a highly proactive public health response to the pandemic has given New Zealand some of the best health, wellbeing, and economic outcomes seen globally.

“New Zealand was the first country to publish an elimination strategy for responding to the Covid-19 pandemic. This response minimised harms to the population and economy during the first 18 months of the pandemic until effective vaccines became widely available. Since then, New Zealand has shifted its response in a highly strategic way to suppression and now mitigation. This strategic approach has given the country the lowest Covid-19 mortality in the OECD and increased life expectancy.

“As the Omicron pandemic wave will soon start to recede, it is appropriate to lessen many pandemic control measures, such as border entry restrictions and the ‘Traffic Light’ system. At the same time, New Zealand needs to maintain a set of key control measures that can be turned up or down depending on the future evolution of the pandemic. Such a ‘pandemic tool kit’ should include the following:

A sustainable border biosecurity system, potentially including purpose-built quarantine facilities;

A successor to the Traffic Light System / Alert Level System to provide a framework for organising control measures for a full range of current and future pandemic scenarios;

An enhanced national immunisation register that is flexible for new vaccine requirements;

Maintenance of vaccine passes to support situations where individuals need evidence of vaccination status, e.g., for international travel and potentially high-risk environments like visiting aged care facilities;

Refining vaccination requirements (mandates) for agreed workforce groups in areas such as health and aged care, and first responders;

A national mask strategy with requirements (mandates) for specific settings, such as health care and public transport in winter;

A core contact tracing system that can be expanded if needed;

Updated, evidence-based protocols and guidelines for all aspects of pandemic management, including case isolation and maintaining safe indoor environments (including workplaces, schools, transport, hospitality, and healthcare).

“This is also the time to develop and enhance our public health infrastructure, including: a) an effective Public Health Agency and Māori Health Authority (underway); b) developing a national pandemic response centre to continue coordinating the Covid-19 response and building capacity for managing future major public health emergencies (could be located in the Public Health Agency); c) building national disease surveillance and research capacity to support an improved response to pandemics and other infectious diseases threats, with expanded capacities in key areas such as epidemiology, genomics, disease modelling, and information dissemination (potentially within a national CDC-type agency); and d) updating public health legislation to provide a coherent legal framework for current and future needs.

“An official inquiry into the pandemic response would be valuable to identify some of the medium- to long-term system improvements needed to enhance our public health infrastructure for managing such events. This strengthened public health infrastructure and ‘pandemic tool kit’ can be described as ‘legacy benefits’ of the pandemic response. Our successful response has cost billions of dollars so it is important to obtain these lasting benefits to improve New Zealand’s health security for decades to come.”

No conflict of interest.

Dr Jennifer Summers, Senior Research Fellow, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, comments:

“The ongoing COVID-19 pandemic has had an impact on every aspect of Aotearoa New Zealand society. We came together as a nation in 2020 to achieve elimination of COVID in our communities, and by doing so we were one of the leading examples globally of how public health interventions protect ourselves. This approach also highlighted the ability of interventions in terms of reducing infectious diseases that could be adapted in the future to address ongoing health inequalities.

“When we compare New Zealand internationally, there is evidence that by pursuing an elimination approach our economy was also shielded from the more dramatic impacts of the pandemic. However, there were negative impacts felt both as a nation, but also at a whānau/community level. The use of MIQ facilities created a barrier to the outside world, but it was also this very barrier that protected New Zealand and its most vulnerable while the vaccination rates increased. This is why our excess mortality rates have declined and our life expectancy has increased; an achievement that is still undervalued.

“New Zealand is now in a vulnerable position with the emergence of Omicron in our communities while many public health protections are being reduced or removed altogether. Therefore, it is hard to envision what the Government’s strategy for managing the pandemic is going forward. However, it is worth remembering that our ancestors emerged from the devastating 1918 influenza pandemic by strengthening the health system with a goal of learning lessons from their pandemic response. So too can New Zealand; with the hope that our society will recover with a strengthened resolve to improve the health and wellbeing for all those in our society.”

No conflict of interest.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“Two years since the dramatic lockdown in New Zealand to control the Covid-19 pandemic is a good time to reflect on what has happened and where to from here. The country is probably near the peak of hospitalisations from the current Omicron wave but will sadly keep seeing deaths on most days for some weeks to come. Overall, however, the prevention of Covid-19 deaths with the country’s elimination strategy has been a remarkable success story with New Zealand having the lowest excess deaths in the OECD group of countries. Overall economic performance since the start of the pandemic has also been relatively good compared to other OECD countries when considering GDP and unemployment levels.

“Many lessons around pandemic control have been learnt and going forward we will need to consider keeping those that continue to protect health at low cost in terms of inconvenience and basic freedoms. For example, over coming months it would probably still make sense to keep certain mask requirements (e.g., on public transport and in hospitals). Similarly, some vaccine mandates should probably be kept e.g., for health workers and aged care workers (including the need to update passes as booster requirements change). Specific venues and workplaces could be left to decide for themselves if they wish to have mask and vaccine requirements – according to what is most appropriate for the safety of their workers and customers (albeit with evidence-based guidance provided by health authorities).

“Another key move is to capture the lessons learnt through a Royal Commission of Inquiry into the pandemic response (as we argued for in June 2020). This is particularly important as the world could face future pandemics far worse than Covid-19 in the future e.g., from bioengineered weapons. These lessons might even help us reduce the annual health burden from winter respiratory illnesses, including seasonal influenza.”

Conflict of interest statement: Nick Wilson has no competing interests. He gets no funding for any of the research he does on Covid-19.

Dr Matthew Hobbs, Co-Director, GeoHealth Laboratory, and Senior Lecturer in Public Health, School of Health Sciences, University of Canterbury, comments:

“New Zealand’s pandemic response may not have been perfect, but it has been world-leading. Initially, the ‘go hard and early’ approach rapidly escalated the use of non-pharmaceutical interventions to a national lockdown. Without vaccines, a combination of movement restrictions, physical distancing, hygiene practices, and intensive case and contact detection and management was used. New Zealand was able to successfully control COVID-19 in the early stages of the pandemic. It also had unexpected benefits like the unprecedented reduction of influenza and other respiratory viral infections.

“The evidence supports New Zealand’s response so far:

Evidence showed that reductions in life expectancy in men and women were observed in all the countries around the world studied except in New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020.

Other research has shown that COVID-19 deaths per 1 million population in OECD countries that opted for elimination (i.e., Australia, Iceland, Japan, New Zealand, and South Korea) have been about 25 times lower than in other OECD countries that favoured mitigation.

There is also increasing consensus that elimination was the preferable approach to mitigation in relation to a country’s economic performance. Research shows that elimination was superior to mitigation for GDP growth on average and at almost all time periods. GDP growth returned to pre-pandemic levels in early 2021 in the five countries that opted for elimination, whereas growth was remained negative for the other 32 OECD countries for much longer.

Among OECD countries, civil liberties were most severely impacted in those that chose mitigation, whereas swift lockdown measures—in line with elimination—were less strict and of shorter duration.

The elimination approach New Zealand used, not mitigation, of COVID-19 created the best outcomes for health, the economy, and civil liberties.

“The journey was not without difficulties: It is important to acknowledge that these early measures included difficult decisions like closing the border and, opening but then closing the Trans-Tasman bubble. Despite these difficult decisions, these measures bought New Zealand crucial time to increase vaccination coverage and wait until potentially life-saving treatments are developed.

“Where to from here? Before Omicron arrived, New Zealand was rather remarkably, very close to eliminating Delta. If you remember, even as Auckland opened up, hospitalisations and case numbers dropped. However, the course of the pandemic clearly transformed with the appearance of Omicron. New Zealand was better prepared than most countries to tackle it, but inequities in terms of vaccination levels and the safe reopening of schools are just some challenges that still persist. In addition, alarm bells are now slowly beginning to quietly sound again beyond our borders. Cases and hospitalisations are increasing in the UK perhaps due to waning immunity, the emergence of BA2, and the removal of restrictions. Cases are also increasing in China, which may have important long-term economic knock-on effects around the world should Omicron take hold there.

“How does this end? While some countries, including New Zealand, have had domestic success at controlling COVID-19, the arrival of Omicron has changed the course of the pandemic. Wealthy countries around the world continue to hoard vaccines. Ultimately, this gives the virus more opportunities to replicate and mutate elsewhere. History teaches us that relying on only COVID-19 vaccines to control the pandemic as some countries are doing, is extremely risky due to their uneven roll-out, and especially in this case due to their time-limited immunity and the emergence of new variants. Research indicates that the eradication of smallpox required concerted, decades-long efforts, including vaccination; communication, public engagement; and test, trace, and isolate measures. Until we have an effective and coordinated international strategy, it is plausible that it may take some time to emerge from the ongoing effects of this pandemic.”

No conflict of interest declared.

Professor Nigel French, Co-Director, One Health Aotearoa; and Chief Scientist, NZ Food Safety Science and Research Centre, comments:

“In March 2020 I was visiting the European Centre for Disease Control in Sweden and witnessed the early response to the growing pandemic in Europe. This was just a few days after the first case was seen in New Zealand. After arriving home on the 9th March 2020 I was contacted by the Ministry of Health and told to self-isolate – I had sat next to one of our first confirmed cases on a flight from Dubai. What followed has been at times horrifying, fascinating, moving and inspiring.

“It’s easy to lose sight of how the situation unfolded, as both the virus and our response evolved at remarkable speed. We successfully eliminated the first wave, characterised by multiple cross-border incursions, some of the strictest border control and lockdown measures in the world, and no available vaccine. This was followed by a long period where we were the envy of the world – society was able to function relatively normally, albeit with strict border controls, and we effectively bought time to plan for the next phases of the pandemic.

“The emergence of Delta in August 2021 was an important wake-up call. Our initial response was effective but did not result in elimination. However, it did buy further time to expedite the vaccination programme ahead of the next challenge: the global emergence of the highly transmissible Omicron variant. The current situation now couldn’t be more different – the total number of confirmed cases in the entire first wave was just over 1000; we are now recording roughly 20,000 cases a day, and that is likely to be a considerable underestimate of the true number. In contrast to the first wave, we now have one of the most immunised populations in the world, with no lockdowns in place and our borders are re-opening. It is quite mindboggling.

“As an epidemiologist I have been fortunate to be involved in several aspects of the response over the last two years. It’s been heartening to see how science has advanced and directly informed decision making, and how effective public health interventions have been. Difficult and rapid decisions have been made in the face of huge uncertainty about the impact of the pandemic on public health and the economy. These have been informed by scientists engaged in many disciplines including diagnostics, genomics, modelling and social science. Many have become household names as a result of their effective and courageous communication to the wider public, often in the face of unintentional misinformation and deliberate disinformation.

“Even more heartening has been the professionalism, courage and dedication of front-line health workers, and others working in high-risk settings. We owe a huge debt of gratitude to them. There have been inequities in the response, businesses have suffered, kiwis have been unable to return home, and many have lost loved ones in the most distressing of circumstances. Undoubtedly things could have been done better, but we can be encouraged by the fact that, despite the raging Omicron outbreak, our high vaccination coverage has so far limited our rates of hospitalisation and death among cases to much lower levels than those seen in earlier outbreaks, both here and overseas.

“We face many challenges over the coming months. It is very difficult to anticipate how the virus will evolve, what the longer-term impacts of infection will be, what new technologies will be developed, or how public opinion will change. What we do know is that we have a remarkable ability to adapt and respond to new challenges as they arise, and this should help us maintain our international reputation as a country that has led one of the most effective public health responses to COVID-19.”

Conflict of interest statement: Nigel is a member of the Ministry of Health COVID-19 Technical Advisory Group, a member of the peer review team for Covid-19 Modelling Aotearoa and a member of the team responsible for reporting on the genomic epidemiology of Covid-19. He is an academic at Massey University and Co-Director of One Health Aotearoa.

Professor Peter McIntyre, medical advisor, Immunisation Advisory Centre, and University of Otago, comments:

What’s been learned from NZ’s pandemic approach and its contribution to academic fields?

“NZ has learnt, along with the rest of the world, that border closures work – especially if you have remoteness and surrounding ocean to make isolation feasible. This was previously in some doubt – for instance in the wake of the last influenza (H1`N1) pandemic in 2009 – as was the importance of masks in reducing transmission, both now shown to be pivotal and likely to be brought to bear in future respiratory pandemics. The question of the threshold for decision-making is still remaining challenging in balancing health and economic consequences.

“The other contribution to academia is making terms like “epidemiologist”, “R” and vaccine effectiveness household words, although going along with this has been a tendency of the media to treat anyone who can lay claim to the label “epidemiologist” as speaking with equivalent authority. Epidemiology is the study of diseases in populations rather than (or in tandem with) diseases in individuals – just because you know about cardiac epidemiology, or geriatric epidemiology or cancer epidemiology does not bestow expertise in vaccine or infectious disease epidemiology (just as I would not claim expertise in the former three fields), although some principles are similar.”

“Implications for health inequities: NZ, like other high-income countries, has learnt that lockdowns work in the short term and with an agent transmitted by the respiratory route, especially if only transmissible to the same extent as a virus like influenza (R of <2) as opposed to measles (R>10). However lockdowns do worsen inequalities if effective counter measures are not employed – ie those who are least advantaged in work or living circumstances are most adversely impacted on. Examples include those whose livelihood is not covered by provisions like sick leave or does not permit remote working. This was vividly demonstrated at a global level in countries like India and South Africa where harsh lockdowns were implemented because this was seen as the endorsed method, failing to recognise that in their country context (non-authoritarian regimes, most people in casual workforce) the downsides would exceed any achievable benefits. Nevertheless, some commentators in high income countries were critical of failure to implement or to successfully implement lockdowns.

“Strengths of NZ’s approach: For at least the first 18 months of the pandemic, the adoption of the elimination approach resulted in among the lowest mortality among high income countries and achieved greatly superior social and economic outcomes overall, although at the cost of making return to NZ for a large number of citizens and residents living overseas onerous and difficult. Introducing various levels of requirement for vaccines from nudge factors, such as vaccine passes to push factors such as employment conditions, was successful in the context of widespread community concern about the delta outbreak and associated public support in reaching what seemed unachievably high adult vaccine uptake of 95% or greater. This in turn has shielded NZ from one of the downsides of the elimination approach – lack of any contribution to population immunity from infection. With the arrival of Omicron, extension of border provisions to allow higher booster uptake, especially among those over 60 years, has put NZ in a very strong position in terms of preventing deaths and severe disease compared with Australia (where failure of the booster rollout to aged care facilities and earlier arrival of Omicron led to record deaths in January 2022) and especially Hong Kong (where despite rigid adherence to elimination, it failed to vaccinate elderly residents so that when Omicron hit, the death toll is and continues to be staggering).

“What has surprised you in how the pandemic has played out so far in NZ? How quickly community sentiment has switched to accepting that COVID is here – ie elimination was not sustainable – and that previously accepted provisions like border closure and vaccine mandates must be wound back. I expected more strident concern/opposition to any such relaxation and less concern/opposition as evidenced by protests in Wellington and elsewhere.

“Reflections on NZ’s approach: There are both lessons about issues evident before the pandemic and which the pandemic has shone a light on (such as inequality, especially but not only as it pertains to Māori and Pasifika people), and the need to respond to these, as well as lessons on the need for flexibility and willingness to adapt responses as evidence shows that those previously successful are no longer fit for purpose. Home isolation is one example of this – in the presence of widespread and to a significant extent undetected transmission in the community, it does not make sense to continue home isolation of asymptomatic people who have been in contact with a known case. It continues to be important that cases with symptoms isolate and adoption of broader mask use is likely to be the way of the future. However, it should be based on assessment of risk – one unwanted outcome of the elimination approach was disconnection of responses from risk. School children are at very low risk of severe outcomes and with the adults with whom they are in contact vaccinated, and increasing vaccination rates amongst children, the focus needs to change to only symptomatic children staying at home, not universal testing, and discontinuing use of masks as the educational downsides of these measures overtake short-term benefits in reducing transmission during peak waves.”

No conflict of interest declared. NOTE: The Immunisation Advisory Centre (IMAC) has a contract with the Ministry of Health to delivery education and training to the healthcare sector for COVID-19 vaccines.

Arindam Basu, Associate Professor of Epidemiology, School of Health Sciences, University of Canterbury, comments:

“The biggest lesson, in my opinion, from New Zealand’s pandemic approach since March 2020, is the importance of coordination between experts, government, and the members of a press to address a global and local emergency situation. The epidemiology- and modelling-driven public health approach and taking the public on board (“the team of five million people”) has helped in containing the pandemic.

“In turn, the media too played a very responsible role. The role of the media must be commended and highlighted as they have unfailingly trained their sight on the latest scientific developments, presented the public health and rationale, educated the public, and presented the most balanced picture possible. This went a long way in educating the members of the public. As public education is a key factor in any public health emergency, New Zealand ended up with a very high vaccination rate, months of COVID19-free status, the lowest death rate from COVID in the OECD countries as of writing this, and a period of relative calm with several regions of the country virtually COVID19 free for many months before the Omicron wave set in, and even then, relatively lower and slower rates of Omicron than what would have been predicted.

“In 2020 and pretty much till about February 2022, the decisions invoked an epidemiological rationale, as well as a “whanau-based approach”. As a result, NZ attained over a relatively short period of time rapid mass vaccination rates (impressive two dose vaccination and booster dose vaccinations).

“In comparison, the approach in March 2022 seems to be driven more by pragmatism of what needs to happen to keep the economy running in the face of an ongoing relentless wave of infection. This may have its own risks, and how the government will step up to the challenges in the face of several uncertainties remains to be seen. In particular, while the current surge with Omicron was expected and with excellent vaccination and earlier prevention programmes in place, a massive upsurge has been avoided, and we understand COVID19 is far from over.

“As I write this, regions of the world known to have contained the pandemic are back in the wave that resembles a “camel hump”. China has closed down a couple of industrial cities (similar to what they did in 2020 in the beginning of the outbreak), Hong Kong has experienced an upsurge in death rates, and the rates of BA.2 variant cases are increasing in hotspots across Europe (notably Denmark, UK). With the war in Ukraine and thousands of refugees and people displaced all over the continent and travelling overseas with their low vaccination rates, it is only a matter of time new variants will emerge on the top of BA.2. It is not clear at this stage how prepared NZ is to address these changes if the borders remain open and current strategies like just seven days’ isolation continue.

“In summary, NZ has a great track record of containing the outbreak, but there is a case to be cautious in the face of an emergent uncertain phase in the pandemic. COVID19 is not over yet, and this lesson needs to go out to the public more emphatically. The days of wearing masks, tracing one’s presence in public places, avoidance of crowds, and getting booster shots are not over yet.”

No conflict of interest.

MĀORI HEALTH

Dr Rhys Jones, Public Health Physician and Senior Lecturer in Māori Health, University of Auckland, comments:

“Two years ago I wrote about the grave concerns many of us had in relation to New Zealand’s response to Covid-19: “that it will reproduce racist outcomes and end up being another chapter in the long history of health-related Treaty breaches.” (Spinoff, 18 March 2020) Those concerns were well founded – while there is clearly a lot to be grateful for in New Zealand’s approach to the pandemic, it has well and truly fallen short when it comes to equity and honouring Te Tiriti.

“The successes have come from following an evidence-based public health approach, and from enabling and supporting communities to protect themselves. The failures have come from ignoring the science and expert advice, including decisions that appear to have been influenced more by business lobby groups than by public health experts and community advocates. They have come from the government’s insistence on a paternalistic approach rather than sharing power authentically with communities, as highlighted by the shocking inequities in the vaccine rollout. And they have come from failing to prioritise investment in protecting Māori and Pasifika communities, particularly in South Auckland, despite clear warnings about the potentially devastating consequences of Covid-19 in these communities.

“An important lesson is that equity has to be central in every decision, and our approach has to be based on mana motuhake. There’s actually a really simple message for government – listen to Māori and Pasifika experts and communities, listen to disabled experts and communities, and listen to other structurally oppressed groups. Then do exactly what they say and invest the necessary resources and support to make it happen.”

No conflict of interest declared.

Dr Clive Aspin, Associate Dean Māori, Faculty of Health, Senior Lecturer, School of Health, Te Herenga Waka – Victoria University of Wellington, comments:

“In their haste to deal with the uncertainties of the impending pandemic, health officials failed to listen to experts who warned about the one certainty we could expect if warnings were not heeded.

“From the very early stages of the pandemic, leading experts in Māori health warned that there would be worse outcomes for Māori if measures were not taken to protect the health and well-being of Māori communities. As they pointed out, disadvantaged communities who struggled to access health services were at increased risk of Covid-19. They emphasised the importance of engaging early with vulnerable communities and providing priority access to vaccinations against Covid-19.

“Ministry officials were blind to these warnings and instead focused on other vulnerable populations such as the elderly and relegated Māori communities to lower levels of priority.

“By the time vaccinations were rolled out to Māori communities, anti-vaxxers and fake news sources had got into the ears of Māori, and especially those of rangatahi. The end result is that we now have lower levels of vaccination within Māori communities and higher rates of Covid-19 infection.

“If Ministry officials had been in tune with the people they purport to serve they would have known right from the start that they needed to pay attention to the needs and vulnerabilities of marginalised communities, and especially indigenous peoples.

“As well as the voices of Māori experts, they needed to engage with and listen to those who have knowledge and understanding of the impact of pandemics on indigenous peoples.

“Those of us who have intimate lived experience of the HIV pandemic know that indigenous peoples, including Māori, have experienced significant disparities, and it is sobering to see these playing out four decades later with Covid-19. Māori experience worse outcomes because of late testing for HIV and now the same thing is happening with Covid-19 and one wonders if we will ever learn.

“The disparities caused by Covid-19 over the last two years will affect Māori for generations to come because of long Covid, and will be a major contributer to ongoing health and social disparities in Aotearoa.”

No conflict of interest declared.

PASIFIKA HEALTH

Associate Professor Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“It is an opportune moment to reflect on the two-year anniversary of Alert Level 4 lockdown. The New Zealand response to the Covid-19 pandemic is regarded as one of the best in the world, informed by science with strong political leadership. Early and decisive public health restrictions, including lockdowns, played an important part in the success of the New Zealand strategy. Limiting the movement of people limits the spread of the virus. We have been extremely fortunate that safe and effective Covid-19 vaccines have been available within a year of the outbreak and the uptake of the vaccines have been exemplary.

“Despite the recent increase in the number of deaths, hospitalisations and large numbers of new cases, the New Zealand response remains world class. A critical gap in our response has been the failure to address inequities in the vaccine rollout where the most at-risk population groups have had the lowest uptake of the Covid-19 vaccine. One hopes that the reform of the health system would lead to more and better investments to reduce ethnic inequities in health.

“It is also apparent that the prolonged nature of the pandemic and high vaccination coverage has led to economic considerations overtaking the importance of protecting the health of the public.”

No conflict of interest declared.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

“A strong health response was our best response to fighting Covid-19, with early measures and steps in Aotearoa New Zealand helping keep people safe and protected while vaccines were being generated against the SARS-CoV-2 virus.

“The generation of Covid-19 vaccines through effective global collaboration, co-operation and knowledge sharing efforts and with appropriate funding/resourcing, clearly demonstrated what could be possible when barriers were removed to allow scientific research and researchers to make progress with their work. This timely development of Covid-19 vaccines was an important step in the global fight against the pandemic.

“Achieving global vaccine equity with more equal Covid-19 vaccine distribution and availability however, remains a challenge. Vaccine inequities will contribute towards the ongoing generation of new Covid-19 variants, while unaddressed.

“Across Aotearoa New Zealand, Covid-19 vaccination levels increased rapidly after early challenges, however inequities affecting vulnerable groups that included Māori and Pacific communities were evident, with some areas across Aotearoa New Zealand also having much lower vaccination coverage than others.

“The burden of Covid-19 would be experienced unequally across Aotearoa New Zealand, with Māori and Pacific communities vulnerable to being disproportionately impacted and affected by Covid-19. Focus and prioritisation efforts for Māori and Pacific peoples and their whānau, aiaga and kainga with respect to Covid-19 vaccination, boosters, testing and prevention were needed.

“Equity-based approaches that reduced barriers and built trust for vulnerable communities, helped address accessibility issues associated with the Covid-19 vaccine. Māori and Pacific teams and community groups in particular worked tirelessly to drive up general vaccination levels and protect our communities, whānau and kāinga using equity approaches to help people get access to vaccines, information and health services, while building trust at the same time within a supportive environment.

“Although it has been encouraging that Covid-19 vaccination levels have increased overall across Aotearoa New Zealand, vigilance is still needed. We remain in the process of protecting vulnerable communities that include our children, tamariki and tamaiki aged 5-11 years, and getting people boosted to protect them from Omicron. Vaccination inequities with respect to Māori and Pacific peoples, tamariki and tamaiki are again evident in booster and vaccination levels for our children, tamariki and tamaiki aged 5-11 years, must be addressed.

“The Covid-19 pandemic has exacerbated pre-existing inequities in health for vulnerable communities in Aotearoa New Zealand, a strong equity focus is needed moving forward. Equity in action has been clearly demonstrated by Māori and Pacific health teams – this work must be supported to continue.

“In the meantime, our collective fight against Covid-19 is not yet over, and we still need to do everything we can to slow down the spread of Omicron while our children, tamariki and tamaiki get vaccinated, and for people to get their boosters.

“Monitoring for new variants of the SARS-CoV-2 virus will be an important step moving forward particularly with easing border restrictions.

“Stay safe and take care – keep others around you safe also by getting vaccinated, boosted, tested, isolate when needed, have a plan, have a medical kit, follow the rules and guidelines, and reach out to help others do the same.”

No conflict of interest declared.

Dr Edmond Fehoko, Health Research Council of New Zealand Pacific Postdoctoral Fellow, Te Wānanga o Waipapa | School of Māori Studies and Pacific Studies, University of Auckland, comments:

“The COVID-19 pandemic has shifted the way people plan research, conduct research and, at times, fund research. For Pacific peoples, such opportunities need to be given to more than just the public health experts, epidemiologists and other health-related experts. A holistic approach is needed from a Pacific perspective.

“Key strengths include the significant amount of funding that was provided for Pacific peoples and communities to address COVID-19 information and increasing vaccination rates. Such funding would have not been made available for Pacific peoples pre-COVID-19 times. At the same time, the government, academics, church, and community leaders failed to counter the substantial number of COVID-19 misinformation and disinformation, which has resulted in slow rates of Pacific peoples being ‘fully vaccinated’.

“In terms of the current outbreak and situation, Pacific peoples live in big households and at times, overcrowded, which means longer periods of home isolation, which is time Pacific peoples cannot afford.

“Unprecedented times has seen unprecedented funding poured into Pacific peoples and communities to address the COVID-19 pandemic. However, it is hoped that such efforts, resources and funding opportunities need to be made available to address other health and social inequities that Pacific peoples have and may continue to face today and in the future.”

No conflict of interest declared. Member of the CARUL Collective, and Member of the Auckland Council Pacific Peoples Advisory Panel.

CHILD AND FAMILY HEALTH

Dr Hiran Thabrew, Child Psychiatrist and Paediatrician, and child mental health researcher, University of Auckland and Auckland District Health Board, comments:
 

“The COVID-19 pandemic has proved challenging and rewarding for many children and young people. While some have enjoyed spending more time with their families, experienced less academic and social pressure and become more socially-minded, others have not been so fortunate. From the early days of the pandemic, fuelled by traditional and social media, people of all ages experienced anxiety about COVID-19 and its potential impact. Children were more likely to develop clinical levels of anxiety in the context of pre-existing anxiety, parental anxiety and direct exposure to the virus. Those with neurodevelopmental issues such as autism experienced confusion, emotional dysregulation and behavioural difficulties amidst rapid changes to their routines.

“For young people, the multiple stresses of lockdown, limited peer contact and family disruption have led to an increase in a few key issues. Rates of emotional dysregulation and presentations to hospital following self-harm have increased in New Zealand and overseas. Lockdown appears to have exacerbated these effects, with a 25% increase in self-harm related admissions in the Auckland region. Rates of eating disorders among young people have also increased and inpatient admissions with anorexia have doubled in major centres. Due to previous primary care education and specialist service limitations, young people with eating disorders have been presenting late, with greater complexity and waiting for months following inpatient medical stabilisation for follow-up care.

“There’s nothing like a crisis to expose existing health service issues. While suicide rates among young people have gone down for the first time in a decade, New Zealand continues to have the worst suicide rate (19.3 per 100,000 young people) among OECD countries with Maori and Pacifika youth disproportionately represented (36.4 per 100,000 Maori). Over the coming years, rates of all mental health problems, especially anxiety and depression, are predicted to rise and there will be a ‘long tail’ to the pandemic. These will pose more of a challenge in the context of specialist workforce shortages and burnout.

“While the Government’s focus has been on boosting primary healthcare, investment into school-based health education, screening and early intervention will be important to contain the psychological impact of the pandemic on New Zealand children and young people. So will urgently increasing financial and workforce support for specialist clinical services, actively embracing and integrating evidence-based and culturally congruent e-mental health interventions, and addressing economic stressors that impact parent/whānau well-being. To preserve the prospects of the next generation, the team of 5 million will need to remain united against the effects of COVID for a while to come.”

No conflict of interest.

Dr. Kate Prickett, Director, Roy McKenzie Centre for the Study of Families and Children, Victoria University of Wellington, comments:

“Lockdowns and family and parent wellbeing: The goal of the first and subsequent nationwide lockdowns was to save lives and protect our health care system, which they did, and with New Zealand’s elimination success rightfully touted around the world.

“Another important success that was less highlighted, however, is the role that policy supports, such as the employer wage subsidy programme, played in protecting people’s jobs during lockdown, and in particular, mothers’ jobs.

“For example, while we did see a small dip in women’s employment rate during and just post-lockdown, this pales in comparison to mothers in the US and UK, for example, who have seen mass labour-force dropout due to dragged out “soft” lockdowns and school closures, with women more likely to be working in industries impacted by these trends, and mothers, specifically, who are most likely to take on the brunt of homeschooling and caregiving.

“The economic impact of lockdown on families despite these supports more generally, however, was not felt equally. Our research found that low-income families with children were more likely to have a parent lose a job or income during the lockdown than families with higher incomes. They were also more likely to report they hadn’t returned to work or had their incomes recover by the time New Zealand was back in Alert Level 1. In short, those with the least to lose, lost the most and were still carrying the cost of the burden post-lockdown.

“Hard and fast policy was necessary, and saved lives and jobs. But the lessons from that first lockdown that highlight the inequities in the economic and health burden of this pandemic call for an equity-lens when the next crisis hits.”

No conflict of interest.

INFECTIOUS DISEASES AND MICROBIOLOGY

Associate Professor Siouxsie Wiles, Microbiologist, School of Medical Sciences, University of Auckland, comments:

“Controlling the entry of COVID-19 into the country has been an important part of Aotearoa New Zealand’s success. That enabled us to embrace our ‘go hard and early’ elimination strategy and stamp out any cases that leaked through the border. While this approach was hard on many people and industries, it has meant New Zealand has had one of the lowest mortality rates and one of the best economic responses to the pandemic. Our genomic sequencing and contact-tracing efforts showed the world how the virus can be transmitted on international and domestic flights and even through the simple act of briefly opening hotel room doors.

“Our elimination strategy also allowed us to learn from other countries’ missteps and mistakes, and it bought time for safe and effective vaccines and antivirals to be developed and for medical professionals to better understand how to treat COVID-19 patients.

“I think the main weakness of the government’s response has been in the way existing inequities have been exacerbated by the types and levels of financial support provided to businesses and individuals and in how the vaccine was rolled out. Now that our response relies on individuals to manage their risk of getting COVID-19, we can expect these inequities to continue and for specific communities like the disabled and immunocompromised to become even more isolated and impacted.

“Two years ago, Aotearoa New Zealand did something unexpected, bold, and brave. Rather than return to the status quo, I want us to remember that. We shouldn’t be afraid to be bold and brave again so that we all have better outcomes not just for Covid-19 but for all the other big challenges we face like antimicrobial resistance and climate change.”

No conflict of interest.

Professor Kurt Krause, Infectious Diseases Physician; Professor of Biochemistry, University of Otago, comments:

“It’s hard to overstate how dramatically the Covid-19 pandemic has affected us. It has resulted in major changes in travel, tourism, education, commerce, healthcare, and daily life, and it is the most significant pandemic in our lifetime. Covid-19 compares in many ways to the 1918 influenza pandemic. Some will point out that the estimated mortality was greater in 1918 but healthcare was much more limited at that time and most authorities feel that Covid-19 mortality has been undercounted several-fold.

“During this time of great upheaval and great loss of life we have also seen many great successes. The rapid development and delivery of vaccines against Covid-19 was a great success as was the development of effective monoclonal antibodies and effective direct-acting antivirals. The anti-inflammatory treatments used against severe Covid-19 are a great success. The ability of the nation of New Zealand to stamp out strain after strain of Covid-19 was a great success.

“Covid-19 is on our landscape now and seems likely to be sticking with us, but we have learned that working together will allow us to endure. I think we knew that all along. That message remains the same. Kia kaha.”

No conflict of interest declared.

MODELLING

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“Two years on from New Zealand’s first lockdown, a comparison of our death toll with virtually any other country in the world shows just how well we have done in managing the pandemic.

“Our response has been far from perfect and unfortunately there will be more deaths to come. But by keeping the virus at bay until the vast majority of over 12s had been vaccinated, we avoided the horrors of pre-vaccine Covid-19 that many countries have suffered. If we had followed the trajectory of countries like the UK and USA, New Zealand would have had over 12,000 Covid-19 deaths and spent more time in lockdown than we did.

“However, the pandemic isn’t over and we still need to do more to ensure vaccine equity globally. While rich countries roll out boosters, many people in African countries still haven’t received a single dose.

“It’s clear the elimination strategy, as hard as it was at times, was absolutely the right one for New Zealand. The challenge is to take these lessons and apply them to preparing for the next pandemic. All pandemics are different and there’s no guarantee that what worked before will work again. But it’s likely decisions will need to be made quickly in a highly uncertain situation.

“Evidence-based decision making in a crisis means having good systems for collecting high quality data, the right scientific tools to analyse that data, and good relationships to ensure the data, the science, and the decision makers are brought together. We need to invest in all these areas to make sure that when the next pandemic (or even the next variant) comes along, we’re ready to respond.”

Conflict of interest statement: Michael Plank is partly funded by the Department of Prime Minister and Cabinet for research on mathematical modelling of COVID-19.

GENOMICS

Professor Mike Bunce, Principal Scientist (Genomics), Institute of Environmental Science and Research, comments:

“As a scientist working with the Prime Ministers Chief Science Advisor, the COVID-19 directorate within the MoH and

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