We've had a lot of questions about TOP's position on COVID - both stopping the resurgence and how we build back better as a country.
Generally speaking TOP is focussed on the long term issues. Labour and National tend to do a pretty good job of responding to crises, but not so well on the long term issues. However, COVID has shone a light on several long term issues, so TOP does have plenty to contribute.
This first blog will cover our proposed health response. The second will cover the economic.
Public Health Commission
Note that public health is different to the health system (which is sometimes confusingly called the public health system). Our health system is largely made up of our hospitals which are run by DHBs, and its focus is to help sick people get healthy. Public health on the other hand is all about stopping healthy people get sick.
Having an independent Public Health Commission has been TOP's policy since 2017. While the Government responded quickly to the pandemic outbreak, it was clear that we weren't as prepared as we could be. Also the crisis has shown up that the Ministry of Health really isn't an operational agency - they are a policy agency. Their lack of operational experience has been obvious with issues like the lack of testing of border workers, and the lack of a push to continue contact tracing apps when we were COVID free.
An independent Public Health Commission would bring together our public health workforce around the country and act as a central hub of expertise. It would provide independent advice to Kiwis and the Government about our preparedness for pandemics such as the one we face. And when a pandemic comes, it would help manage our response.
COVID has shown the importance of having public health experts running the show.
The border strategy - where to from here?
Finally, it’s time we talked about the COVID-19 vaccine, and the long-term strategy for New Zealand.
Our current strategy is to maintain very tight border controls to prevent the virus from entering the country. When there is an inevitable slip up, we lock down the areas affected hard and fast to eliminate the virus again. The hope is that this can continue until a vaccine is produced and then everything can go back to normal. The problem is the vaccine is still a long way off and we are likely to have more slip-ups before we can widely administer a vaccine. It is also likely that the vaccine will not be the silver bullet that we hope it to be, but more on that later.
Since we successfully eliminated COVID-19 in May, there have been two events when the virus entered our communities. The first resulted in a large cluster that is now thankfully under control. The second was picked up because of the widespread testing that occurred as a result of the first outbreak. While we don’t have direct evidence of where the first cluster came from, we know it entered the country somehow and likely involved person to person contact.
That brings us to our first point, how managed isolation and quarantine facilities were set up. When Minister Grant Robertson was asked on Newshub Nation recently if the Government “had considered hosting returnees somewhere less risky to the economy, Robertson said no.”
Putting quarantine and managed isolation facilities in the region of our busiest economic zone was done out of convenience and expediency. The refusal to consider an alternative is downright reckless. We cannot afford a lockdown every 3 months. If I had to speculate on why the government is not looking at alternatives, I would have to guess it is because they think that we only need to have this process in place until a vaccine arrives early next year and everything will be hunky-dory after that.
Unfortunately, the vaccine is not likely to be the silver bullet we are all hoping for in the fight against COVID-19. There are several points to discuss here, namely vaccine efficacy, uptake, and availability. The world’s researchers currently have very limited data on how effective the leading vaccines are.
There is some evidence showing that the leading vaccines are eliciting an immune response. But showing an immune response does not mean that a person is perfectly immune. It may mean that they will simply get less unwell and be less infectious.
We are also not sure how long that (partial) immunity may last. The virus has been with us for only eight months, so we don’t know whether a vaccine would be effective beyond a few months. The public needs to come to terms with the uncertainties that surround vaccine development.
Any vaccine that is rolled out is likely to have some side effects attributed to it. Some of these may be due to the vaccine itself, some may be due to coincidental illnesses that are falsely attributed to the vaccine. The public can have confidence in a vaccine that has successfully completed its safety and efficacy trials – but they take many months to complete.
Let’s assume that the vaccine is perfect. Does that mean we are out of the woods? Sadly, no. New Zealand is likely to be a victim of its own success when it comes to vaccine availability. Because we have successfully eliminated the virus from our country once (and hopefully twice, soon), we will be a very low priority to receive doses of a successful vaccines. Some wealthy countries have already bought themselves a place at the head of the queue. There is no way the WHO or any philanthropic organisation will prioritise New Zealand receiving the vaccine ahead of countries where the pandemic is raging.
So it would be prudent for New Zealand to start equipping our vaccine production facilities to ramp up production ready to manufacture a COVID-19 vaccine under licence. We are good at making animal vaccines and we have successfully manufactured other human vaccines. Vaccine development is a very expensive business, but New Zealand can scale up its production to help in the international and national effort to produce vaccines here.
Finally, assuming the vaccine is effective and that we have enough doses, will Kiwis actually take it? In order to immunise the country, we would need at an absolute minimum 60% immunity (about 3 million people vaccinated). This would provide protection to people who can’t be vaccinated because of other health conditions or a weaker immune system.
The COVID-19 vaccines have been developed incredibly quickly, faster than any vaccine, which gives rise to valid safety concerns. But there is a growing trend towards vaccine hesitancy – not just overseas, but in New Zealand. A recent Stickybeak poll for The Spinoff revealed that over 20% of people polled were hesitant about being vaccinated. That caution may hamper our efforts to get the required level of immunity for the vaccine to protect those people in our communities who are most vulnerable.
It is vital that the Government takes the lead with an honest public information campaign about the vaccine, so that the risks and benefits are well communicated. It would be unhelpful to understate the risks and overstate the benefits.
When you put all of that together, it is clear that we need to be planning a border strategy that could last for at least another year or more, not just another few months. In my view, there should be a serious discussion on the location of the managed isolation and quarantine facilities in economic zones that are much less impacted by lockdowns than Auckland.
Such a move may be more expensive, but remember there is an opportunity to charge foreigners to help cover the cost of scaling up our quarantine efforts. If we can eliminate COVID a second time, New Zealand will be a premium destination for the world. We should make the most of that status and ensure that ordinary Kiwis benefit as a result.