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Most Vaccine Mandates To Be Lifted – Expert Reaction
Vaccine mandates, pass use, and QR code scanning are being rolled back as New Zealand nears and moves past the Omicron peak.
Prime Minister Jacinda Ardern announced this morning that all vaccine mandates will be removed from April 4, except for health and disability, aged care, corrections and border/MIQ workforces. Requirements to use My Vaccine Pass and scan in via QR codes also end on the same day.
The “Red” setting under the Covid-19 Protection Framework has been tweaked to increase indoor capacity limits for bars and restaurants from 100 to 200 people, and to lift all limits for outdoor events. These changes take effect this Friday at 11:59pm.
The SMC asked experts to comment on the news.
Associate Professor Siouxsie Wiles, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, comments:
“I’m relieved that not all of our protections have been dropped. The data from overseas is really clear – those countries that have dropped restrictions as their omicron wave was subsiding are now experiencing another wave. For that reason, I am relieved to see masks stay, and added to the orange setting of the traffic light.
“But, I am disappointed with parts of the announcement today. There was a lot of talk of things being safer now Auckland is coming out of this omicron peak, but safer for who? Certainly not everybody. We know that being boosted helps reduce transmission of this virus so upgrading vaccine passes to include the booster would have helped keep indoor environments safer for the more at-risk members of our community. Similarly, removing vaccine mandates for people working with our children who can’t yet be vaccinated makes me very nervous. The vaccines are safe and effective and being boosted helps protect those around us who can’t be vaccinated.
“I would also have preferred to see QR code scanning kept. It would have been much easier just to keep up the habit than rely on people picking it up again in the future.
“With Covid here to stay globally, and the next wave potentially just weeks or months away, I would have liked to have seen talk of the changes we need to be making to our indoor environments to make them safer for everyone against what is a deadly airborne virus. This variant may appear milder because of the protection of our vaccines and improvements in treatments, but there is no guarantee the next variant will be the same.”
No conflict of interest.
Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:
“Vaccine passes were an important part of safely emerging from last year’s Auckland lockdown and keeping Delta low over summer. But Omicron has changed the game – vaccines are still hugely effective at preventing severe illness, but less effective at stopping people catching and spreading the virus. At the same time, we now have increasing levels of infection-acquired immunity in the population. This means that allowing unvaccinated people into places like cafes and bars doesn’t substantially alter the risk of catching Covid there – there are likely to be lots of Covid-positive people there either way. As a blanket measure, vaccine passes are therefore much less effective now at reducing transmission than they were a few months ago.
“However, although we may be close the peak of this Omicron wave, we still have a difficult journey ahead. At least as many people will be infected on the way down the mountain as on the way up, and pressure on our healthcare system is likely to remain high. Keeping mask rules is crucial to limit transmission. Now that RATs are becoming more widely available, adding a requirement to ‘test to release’ after the seven-day isolation period would reduce the risk of people going back into the community while still infectious.”
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.
Dr Jin Russell, Community and Developmental Paediatrician, Starship Children’s Health, comments:
“The vaccination mandates have been an important layer of protection within early education centres and schools and have contributed towards reducing the risk of COVID-19 transmission in educational settings.
“Due to Omicron’s immune escape, two doses of the Pfizer vaccine – as the mandates currently require – would not be expected to significantly reduce the risk of breakthrough Omicron infection and subsequent onward transmission.
“Despite the vaccination mandates being lifted for school staff, it will be extremely important to continue to encourage triple vaccination among school staff to achieve very high levels of coverage. Children and staff with pre-existing conditions would have the most to benefit from maintaining high levels of vaccination.
“This shift should be coupled with concerted efforts to improve ventilation, indoor air quality, and high quality mask use consistently across educational settings, and catch-up on routine childhood immunisations, in preparation for winter and any future variants of concern.”
No conflicts of interest.
Dr Andrew Chen, Research Fellow, Koi Tū – Centre for Informed Futures, University of Auckland, comments:
“Over the last month, we have seen the use of NZ COVID Tracer shift from scanning QR codes to using Bluetooth Tracing. Location-based exposure notifications are driven by the locations of interest system – as locations of interest were no longer published when we entered phase three of the omicron response plan, exposure notifications based on QR code scans have not been generated. We have seen a corresponding drop in daily QR code scans at a rate of 20-30 per cent per week over the last month, now down to under one million per day.
“However, Bluetooth Tracing is now more automated, as positive cases are given a code to upload their data through the self-reporting form that they complete after reporting a positive test result. The latest Ministry of Health data shows that there are hundreds of cases providing Bluetooth data each day (almost 1000 per day in the last week), and that there are thousands of devices generating exposure notifications (approximately 3000-4000 in the last week). This tool is providing value in our response and gives individuals further information with which they can make their own risk assessment decisions. There are still 2.35 million devices with Bluetooth Tracing active, which (assuming that each device corresponds to one person) corresponds to almost 60 per cent of the adult population in New Zealand – one of the highest rates of participation in digital contact tracing in the world. It is important that people who test positive complete the self-reporting form to the best of their ability, and provide the data they can to support our response. At the moment we are seeing around 3-15 per cent of positive cases each day providing Bluetooth data.
“While it is understandable that the government has removed the requirement to scan or keep records when people enter venues, it is a little disappointing that the requirement for businesses to display a QR code or provide a mechanism for recordkeeping will be removed from 11:59pm on Monday, 4 April. The compliance cost of having QR code posters printed out is not that high, and I believe it is important for individuals to continue to have the option to scan the QR code if they want to. The Prime Minister indicated that if there was a new variant or a different type of outbreak that they may call for people to scan QR codes again – leaving the infrastructure in place, including having QR codes available for scanning, is critical to supporting a fast response.
“On vaccine passes, the government’s decision to remove the requirement as part of the Covid-19 Protection Framework makes sense given the current evidence. It has been shown internationally that vaccine passes or equivalent certificates are effective at incentivising vaccination uptake, but do not have as much impact on reducing transmission in access-restricted venues. While separating unvaccinated and vaccinated people in venues may make logical sense to many people, the international evidence suggests that the impact is minimal. With a very highly vaccinated population, the reason to keep using vaccine passes has faded away.
“However, keeping the vaccine pass infrastructure to allow businesses and organisations to voluntarily use vaccine passes makes sense. It is important that those businesses and organisations, however, understand that they are making their own decision to continue using this tool, and cannot rely on government regulation as the reason for using these passes. I am a little worried about customers or members of those organisations being angry at those that continue to use and require vaccine passes, and it is important that we all respect the choice to continue using passes. This does mean that people should continue to keep a copy of their vaccine pass in case they are asked for one by a particular business or organisation.
“For many people their vaccine passes will expire in the next two months as they reach six months from when the passes were originally issued. The system currently sets all vaccine passes to expire by 1 June, and so there may still be changes to how vaccine passes are defined, including whether or not a third booster shot is required in order to receive a vaccine pass. We expect further announcements on vaccine pass validity in the next month or so.”
Conflict of interest statement: I have had interactions with the Ministry of Health around digital contact tracing in an academic capacity but am not employed or paid by them.
Dr David Welch, Senior Lecturer, Centre for Computational Evolution and School of Computer Science, University of Auckland, comments:
“Today’s announcement highlighted the risk that new variants of SARS-CoV-2 pose to the health of New Zealanders. It is crucial that we improve our genomic surveillance system so we have a good chance of rapidly detecting and identifying new variants that arrive or arise in Aotearoa/New Zealand.
“The current genomic surveillance system is inadequate for these purposes, with few genomes being sent for sequencing and patchy geographical coverage.
“Genomic surveillance is a key line of defence in controlling COVID-19. It needs to be recognised as central to our response and funded appropriately so that diagnostic labs are incentivised and compensated to send all positive samples for sequencing.”
Conflicts of interest statement: My university has received funding from MBIE, HRC, and MoH for my work analysing and reporting on COVID genomics.
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:
“ It was announced today that use of the Covid-19 Protection Framework/Traffic Light System would continue in Aotearoa New Zealand, with adjustments. Under the Red setting, indoor gathering limits will lift from 100 to 200, with no restrictions on outdoor gatherings. Outdoor face mask requirements will be removed, although masks retained for indoor gatherings. Masks will be used under the Orange setting, with no changes announced for the Green setting. QR scanning requirements would also be removed. These come into effect from 11:59pm Friday 25th March 2022.
“It was also announced that Covid-19 vaccine passes will no longer be part of the Covid-19 Protection Framework/Traffic Light System and that vaccine mandates would be lifted for some, and remain for health and disability, aged care, corrections and border workforces from 11:59pm Monday 4th March 2022.
“Although it has been encouraging that Covid-19 vaccination levels have increased overall across Aotearoa New Zealand, care and caution is still needed especially for vulnerable communities. Omicron continues to spread across Aotearoa New Zealand with high number of Covid-19 case numbers placing added strain and pressure on our health and other support systems in Aotearoa New Zealand.
“The actual Covid-19 case numbers in Aotearoa New Zealand are likely much higher than those being reported, with estimates indicating as many as 1.7 million New Zealanders may have had Covid-19. The BA.2 Omicron subvariant of the SARS-CoV-2 virus has higher transmissibility and is continuing to spread across Aotearoa New Zealand – with different areas peaking at different times.
“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 the rapidly spreading Omicron variant of the SARS-CoV-2 virus. 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.
“Of those affected by the current outbreak in Aotearoa New Zealand, a total of 161,743, 32 per cent (nearly 1/3) were children, tamariki and tamaiki and rangatahi aged 19 years and under, with this group also making up 13 per cent of all hospitalisations. Of those children aged 5-11 years, 53.8 per cent of the general population have received their first Covid-19 vaccine dose, and for Māori and Pacific tamariki and tamaiki, vaccination levels for first doses are at 34.6 per cent and 46.8 per cent respectively.
“Pacific peoples currently make up 18 per cent of COVID-19 cases, and nearly double, 35 per cent, of all hospitalisations. Of all those currently eligible for a booster dose of the Covid-19 vaccine, 72.8 per cent of the general population have been given one, and for Māori and Pacific, booster levels are at 58.6 per cent and 59.5 per cent respectively.
“The definition for being fully vaccinated ideally should now include a booster shot, and for overseas travellers entering Aotearoa New Zealand who have yet to receive a booster injection, the opportunity to get boosted must be encouraged.
“Compared with those who have been vaccinated and received a Covid-19 booster dose, unvaccinated individuals have higher risk of becoming sick and unwell from Covid-19 and passing on the SARS-CoV-2 virus to others and also becoming hospitalised.
“Monitoring for new variants of the SARS-CoV-2 virus will be important moving forward particularly with easing border restrictions. It will be difficult to prevent rapid spread of a new SARS-CoV-2 variant once reaching the community, if capable of evading the protection given by currently available Covid-19 vaccines.
“Achieving global vaccine equity with more equal Covid-19 vaccine distribution and availability remains a challenge. Vaccine inequities will contribute towards the ongoing generation of new Covid-19 variants, while unaddressed.
“In the meantime, 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.”
No conflict of interest.
Dr Emily Harvey and Dr Dion O’Neale, co-leads of the Contagion Network modelling programme, COVID-19 Modelling Aotearoa, comment:
Joint comments:
“The COVID Protection Framework (CPF) — AKA the Traffic Light System — was designed in November 2021 in response to the Delta variant. In order to achieve the desired transmission reduction at the different levels, the CPF relies heavily on COVID Vaccine Certificates (CVCs).
“Against the Delta variant, recent two-dose vaccination offered good protection against both initial infection and against onward transmission from vaccinated people when breakthrough infections did occur. (This meant that, if everyone at a gathering was vaccinated, there was a reduction of around 20 times of an infected person being present and passing on the infection.)
“Since November, the arrival of the Omicron variant, which escapes much of the protection against infection, means that the two-dose CVCs are no longer a good indicator of someone’s reduced infection risk (although three doses do offer decent infection protection for a few months).”
Dr Emily Harvey’s comments:
“This means that in order to achieve the same effectiveness in terms of transmission reduction against Omicron as the CPF originally intended, the Red and Orange settings need strengthening.
“As an example, in order to match the ‘safeness’ of a 100-person event with vaccine passes against Delta, with Omicron we would need to be introducing transmission reduction measures that reduce the risk of infection 10-20 times. Otherwise, we should be reducing the limit at Red to the 25-person limit that was in place for unvaccinated people. The best way to produce this level of transmission reduction is through only allowing events over size 25 to go ahead if they are outdoors, or are indoors in a setting that meets good ventilation and filtration standards (greater than six air changes per hour).
“It takes time and resources to upgrade the ventilation and filtration indoors in schools and businesses, but it’s something that needs to start now, and needs to be supported by the government. As with vaccination, it could be incentivised if businesses that met ventilation and filtration standards were able to stay open at periods of higher case numbers, and it would encourage customers to return if they knew the environment was safer.
“The fact that the Red setting for Omicron has been relaxed, allowing event sizes of up to 200 people with no ventilation or air quality requirements is going to increase the potential risks. COVID-19 is an airborne disease and the ‘seated and distanced’ rule for hospitality at Red does not directly have any effect on keeping people safe – the main impact is if the rule indirectly improves air quality by reducing capacity and thus reducing the proportion of air you breathe in that someone else in the room has breathed out. Overseas we have seen numerous ‘super-spreading’ events where close to 100 per cent of the large number of attendees became infected when the environment was indoors, crowded, and poorly ventilated (including bars, nightclubs, Christmas parties at restaurants, and birthday parties).
“Thankfully, the New Zealand public have been making their own risk assessments and getting takeaways, meeting up outdoors, and not having lots of 100-person indoor gatherings. This has been making a big impact on reducing the spread of infections. Hopefully this continues despite the relaxation of the rules on Friday night.”
Dr Dion O’Neale’s comments:
“The vaccination status of the population that was doing the heavy lifting in the CPF has much less effect on transmission at the Red setting than other public health measures that are not specifically part of the CPF levels.
“This means that the main risk in changing CPF levels, comes not from a shift down from Red, but from the message it might send that things have become safer, when in fact case numbers and hence infection risk are still high.
“Many of the public health measures that do have an effect of reducing infection currently are things that have changed over the three phases of our Omicron response. These include things like test processing and availability (PCR vs RAT), the definition of who is considered a close contact of a case, and isolation periods for both confirmed cases and their close contacts.
“COVID-19 is an airborne disease but a comparison with diseases spread through contaminated water is useful when thinking about the timing and role of different response interventions. (The spread of cholera from contaminated water is also one of the earliest examples of an effective public health response to an infectious disease.)
“The first response for waterborne disease is a ‘boil water’ notice. The equivalent intervention for an airborne disease is mask wearing – an action that prevents the spread of infections (though in the case of mask wearing if I wear a mask, it not only protects me, but also makes things safer for others around me). Longer-term measures involve systemic changes, such as infrastructure for clean water or, in the case of COVID, infrastructure for clean air through ventilation and filtration.
“However, the time to remove short-term response measures, such as boil water notices or mask wearing, is not when case numbers are peaking, or even when they have plateaued at a few thousand new cases per day. It is when there are sufficient systemic changes in place to keep people safe — clean water supply in the case of waterborne diseases, or ventilation and filtration in schools and workplaces in the case of airborne disease like COVID-19.
“Similarly, isolation periods are intended to stop people infecting others in the community when they are confirmed or probable cases. Previous studies suggest that for Omicron, half of all cases were still infectious on day five, with the estimate of the infectious period being as long as ten days (e.g., this research and other references from the Ministry of Health’s Omicron update).
“When Aotearoa responded to rising case numbers from Omicron infections in February, we shortened our required isolation period from 10 days down to seven, not because we believed it was safe to do so — in fact the risk of infection was rapidly increasing as case numbers rose — but in order allow people to return to work for business continuity reasons, in spite of the increased infections this shorter isolation period would generate.
“With case numbers now beginning to fall in several regions, there is the opportunity to return to the original, safer isolation period of ten days. At the same time, with wider-spread availability of rapid antigen tests, and falling pressure on PCR testing, there is the possibility of combining isolation requirements with a test-to-return policy. This would require people to return a negative test before leaving isolation.
“We could also complement isolation periods that might be too short on their own with additional transmission reduction measures for people in the days immediately after their isolation period. This would give a mixed model such as that used in some other countries where a shorter isolation period is followed by a period where people are allowed to end isolation but are required to reduce their risk of onward transmission by wearing a mask for the following five days and avoiding situations where masking would not be feasible (e.g., restaurants) or where they might interact with high-risk individuals (e.g., older individuals, unvaccinated young children, and health care settings).”
Conflict of interest statement: “We both receive funding from the DPMC to provide modelling and analysis to govt officials on Aotearoa’s COVID response; and from the NZ Health Research Council for a project on modelling and equity for COVID in Aotearoa.”
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