Covid Vaccine Policy Fail: Priority Groups Under-protected

Wednesday, 13 July 2022, 1:35 pm
Article: Keith Rankin

Keith Rankin, 13 July 2022

Kathryn Ryan: "Why is there a six-month gap between boosters?"
Siouxsie Wiles: "I can't answer that for you. It doesn't make sense based on the data that we have. … In Israel they got it at least four months after, for the over-60s at least. It was really good at preventing hospitalisations and deaths. … I would have thought that, based on that data, we would have been looking at four months. … I'm not eligible for that [just announced] booster dose. If I were I would be getting it."
Science: Covid vaccines saved millions, RNZ Nine-to-Noon, 29 June 2022.

As an over 65-year-old, I belong to a covid-vaccination priority group. So do my parents-in-law. I got my third ('booster') vaccine dose in February. I could have had it in January, but waited so as to be maximally protected for the Omicron-wave which was forecast to take-off in late February or March. And I waited, to give me a five-month gap between my second and third shots, which seemed to be about optimal. I am now waiting to be able to get my fourth shot ('second booster').

Late last month I was happy to hear that second boosters were being offered to priority groups, such as older people; though I wondered why it took the government until the end of June to authorise these vaccinations. After all, there was not a supply problem. I presume there was some official awareness that the school holidays were less than two weeks away, and that a new wave of covid was starting. An important feature of school holidays is that people travel (eg through busy airports); and in the winter school holidays travel is based more on whanau than on tourism. To put it bluntly, July is one month in which children visit their grandparents, or vice versa.

I sought to get a vaccination on 28 June, because I was travelling the coming weekend. My plan had been a mix of long weekend and whanau visiting prior to the school holiday rush. But I was politely turned down. I would have to wait until August. Indeed, when early this week I sought to make a booking for August, the bookings at my local health centre were full-up until and beyond my six-month due date.

The Media and the Booster

On Morning Report this morning (Auckland pharmacist seeing high demand for Covid-19 boosters), Susie Ferguson asked pharmacist Vicky Chan: "What about people who are heading off for holiday or anticipate being at larger gatherings. Are they quite keen to get their fourth shot?" Chan answered that "many had not quite met the criteria for their second booster, so we have to politely reject them." Unfortunately Ferguson did not pursue this point further; rather she then went on to ask about those younger people who are not so much an issue at the moment.

At about the same time on Morning Report, Kathryn Ryan was promising that, in the next hour, she would ask an expert to get to the bottom of this issue. It seemed that, finally, I would get an answer as to why I and my parents in law are not able to access vaccine protection these school holidays.

I was disappointed with the subsequent interview on Nine-to-Noon (New Omicron wave: Why second booster is only for over-50s). The website headline and synopsis indicate that I should not have been too hopeful. The synopsis says: "As Omicron case numbers and reinfections rise, could the country benefit from making a second booster shot more widely available? The answer from one immunologist is a firm, 'no'." The interviewee was Dr Nikki Turner, generally known as a strong advocate for vaccination as a public health measure.

Kathryn Ryan starts: "As Omicron case numbers and reinfections rise, should the country benefit from making a second booster shot more widely available and shortening the six-month timeframe? The answer from one immunologist is a firm, 'no'. … At the beginning of the year the six-month timeframe was shortened first to four months and then to three so that more of the population would be boosted before its peak. So is that option being considered again now, and if not, why not?"

First question to Dr Turner: "What we discussed with the first Omicron wave was that if we are going to reach a peak before everybody was boosted, didn't it make sense to bring forward the booster, even if the efficacy wasn't going to be optimal? Why is it different this time?" After a minute not addressing the question posed, Turner starts to answer as follows: "A second booster, particularly for people over 60, does add more protection … after six months, by about twice to reduce the effect from severe disease. What we see is rapid waning [for protection] from mild disease. … Our focus now is on protecting people from severe disease. … There is an important group of people whose immunity wanes earlier than six months, particularly to severe disease. Those are the ones for which a second booster is worth having." So far nothing about why many of this "important group of people" are being ('politely') denied that second booster at this critical juncture in time. At this point Ryan tried to intervene, but suppressed her intervention as Dr Turner went on to talk about "other [ie non-priority] people".

After nearly a minute, Ryan then asks: "So that's the argument against broadening to people under 50. But I want to just examine again this question of the booster for the over 50s again. Let's absolutely agree that the priority groups … are the priority. But if there's not an issue with vaccine supply, the question is whether there is any benefit for the over-50s being able to access before the perceived second peak, which might be August, some modelers are saying. Now the reason to delay to the six months, do you get a better immune response? … Explain that logic again." Turner: "Yeah, so two different questions, which age group, and second is the gap. … It was obviously [my emphasis] brought forward [in the summer] when you needed to urgently protect people. … Now we have this disease with us throughout our community going forward, for healthy people who have had the primary course plus one booster, protection against severe disease is holding up, hence the six-month gap. That does not hold for people with significant medical problems."

Turner then goes off-track, discussing the age criterion, not the gap criterion. But note that, according to Turner, it would be "obvious" that "people with significant medical problems" should get boosted now, without having to wait six months. And presumably this also applies to those people in the priority groups (like me and my mother-in-law) who do not have 'significant medical problems'. But the other problem on Dr Turner's response is that she appears to believe that Omicron-covid is already an endemic rather than an epidemic disease, and that therefore there is no winter wave, either imminent or taking place right now. So Turner leaves us none the wiser about my predicament, and the current predicament of most older people; and, for that matter, and the present predicament of those grandparents and others with 'significant medical problems'.

Ryan again: "In Israel they did [second] boost after four months, didn't they?" Turner: "It was a mixture … but] yes." The interview goes on for another eleven minutes, in some cases with repetition of the less important points. But even Ryan moved on, except for one brief rhetorical [and hence unanswered] question. "We heard this morning from the pharmacy, you’ve got people knocking on the door saying I'm going on holiday, I'm getting on a plane, can I not bring this forward'? It's a very obvious question to ask, Nikki, and so it's good to answer it." Turner: "Yes, absolutely." Then Ryan cut over any further answer that Turner might have given, taking the interview away from this issue.

I still have no idea why I must wait until August before I can get my booster. New Zealand is on course for more than 400 more covid deaths between now and my scheduled booster date.

Who's Dying?

We are no longer hearing much about the demographics of the many nameless people who are now dying with or of Covid19. But, looking up the raw data on the Ministry of Health's Covid19 website, I see that 61.5% of people dying with Covid19 have had all three vaccination shots. I also note that 63 percent of the population aged over 12 have had three shots; so, at least in the raw age-unadjusted data, the death rate for three-shot-vaccinated people is similar to the death rate for the population as a whole. While this could be interpreted as indicating that the vaccine is ineffective, what it does indicate is that most deaths are of older people (who are more likely to be three-shot-vaccinated) and also that the much of the effectiveness of vaccinations has waned. While the data does not separate people who have died recently from people who died months ago, I have noted that the percentage of deaths being three-shot-vaccinated people is rising; it was below sixty percent last week.

In addition, the website gives death percentages by ethnicity, both for people dying with Covid19 and for people dying of Covid19. Currently, 75% of deaths are Pakeha (a category which includes a few – but not many – people from Africa, Middle East, and Latin America). Thus, in the raw data, Pakeha appear to be overrepresented in the Covid19 death toll; this is confirmed by the fact that 74.5% of those who died of Covid19 are Pakeha. And it should be noted that both of these percentages have increased since last week. And it should be noted that significantly less than 75% of the New Zealand population is Pakeha. (Though it may be the case that over 75% of the superannuation-eligible population are Pakeha.) The narrative that Covid19 is mainly a Māori-Pacific problem is far from reality.

It should be a relatively easy exercise to estimate the cost in deaths this July and August that will arise from vaccine providers having to 'politely decline' many of their requests from older and co-morbid people for winter anti-covid boosters. I would estimate it to be in the 'hundreds', though it could turn out to be in the thousands.

The government cannot plead ignorance. It is fully aware of the problem that delaying vaccinations to willing vaccinees, this and next month, will cost lives.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

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Keith Rankin

Political Economist, Scoop Columnist

Keith Rankin taught economics at Unitec in Mt Albert since 1999. An economic historian by training, his research has included an analysis of labour supply in the Great Depression of the 1930s, and has included estimates of New Zealand's GNP going back to the 1850s.

Keith believes that many of the economic issues that beguile us cannot be understood by relying on the orthodox interpretations of our social science disciplines. Keith favours a critical approach that emphasises new perspectives rather than simply opposing those practices and policies that we don't like.

Keith retired in 2020 and lives with his family in Glen Eden, Auckland.

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