Frequently you see comparisons, both favourably and unfavourably, on how New Zealand compares with the rest of the world in its response to the covid-19 pandemic.
These tend to be moment-in-time comparisons that can be misleading.
What is the most revealing data to help provide valid comparisons? Infection rates are important because they can indicate trends and what might follow. Hospitalisation rates reveal the more serious consequences of virus spread (even more serious are intensive care unit admissions).
But the data I have found the most revealing for summary comparative purposes since the arrival of the pandemic nearly two years ago has been per capita mortality rates.
As vaccine manufacture and supply has increased around the globe in recent months, vaccination rates also become important comparators.
Overall, the state of NZ’s health system prior to the pandemic is one of rundown under successive governments, largely reflected in severe workforce shortages that continue to be ignored today.
So, what has been imperative to the country’s pandemic response has been preventing high hospitalisation levels, to protect public hospitals from being overwhelmed. This depended on the success of a zero-tolerance approach to covid-19 known as elimination of community transmission, based on four alert levels, where the higher two levels involved lockdowns.
Comparing covid mortality rates
So how do we compare on mortality rates? As of Jan 7, deaths per one million for all countries were 695. However, this data is of limited value for comparative purposes.
Countries without universal health systems, particularly low-income countries, have limited capacity to access, treat or code patients. It is not a question of incompetence or malevolent intent. Rather it is one of capability due to health system fragility.
What about economically developed countries that have attracted a higher profile for different reasons, such as the United States, United Kingdom and Sweden?
Their respective death rates per million are among the highest in the world – 2,513, 2,197 and 1,513. These are exceptionally high, but they are also outliers.
The US does not have a universal health system and was further undermined by the callousness and incompetence of President Trump and the subsequent obstruction of vaccination and public health measures by several Republican-led states.
The UK government’s response was based on a mix of indifference to public safety, indecisiveness and incompetence. It has a good health system that has been derailed by ideological political decision-making and fiscal austerity for several years.
Sweden’s response was based on miscalculated and dogmatic advice on the effects of ‘herd immunity’ through infection, although its health system is stronger than ours.
The European Union (EU) offers a useful comparison in that it is a mix of larger and smaller economies. Its death rate was 2,047. Overwhelmingly, EU countries followed mitigation rather than elimination of community transmission strategy.
Developed economies with much larger populations offer some comparative benefit.
By international standards, Australia appears impressive with 91 deaths per million (for some months in the early days of the pandemic Australia and NZ had similar mortality outcomes). Canada is worse with 807.
But much worse was a country once lauded as one of the most successful pandemic respondents in Europe – Germany recorded a death rate of 1,357.
Whereas Canada and Germany largely followed mitigation, Australia had a mix of mitigation and elimination.
The most insight, however, for comparing NZ’s coronavirus mortality rate comes from countries with developed economies closer to us in size.
The worst of the six I have selected is Ireland with 1,194 deaths per million. It is followed by Denmark (575), Finland (295) and Norway (247). Singapore is the second best with 153 deaths but the top of the six is Taiwan with 36. Singapore and Taiwan both had elimination strategies.
So where does NZ rank?
An incredible 10 deaths per million. The mortality data speaks for itself. Of all the economically developed countries it appears that only China has done better, with 3 deaths per million.
Vaccination rates
My other main comparator for assessing NZ’s covid-19 response with the rest of the world is vaccine rollouts. Using for comparison the full vaccination rates (excluding boosters) effective on 8 Jan is revealing.
When vaccination percentages are currently used in NZ they are for the eligible population (currently teenagers and adults) and consequently much higher than the figures discussed below, which are for whole populations – including those ineligible.
When NZ implements vaccinations for 5 to 11-year-olds from 17 Jan, we can expect an initial decline in the percentage vaccinated, even though the numbers will increase.
The vaccination rate for the whole world’s population is 50% (there is another story to be written about this). Of the three outliers, the US was 62%, the UK was 70% and Sweden the best, with 73%.
Note that it is not that long ago that NZ’s vaccination rate was unfavourably contrasted with the UK’s, while Sweden has a better-resourced health system than ours.
The EU, which was able to negotiate with the vaccine producers for its member states as a powerful bloc, was 70%.
Of the three larger economies I compared for mortality rates, Germany’s vaccination rate was the lowest at 71%. Australia and Canada were 71% and 78% respectively.
Finally, let’s consider the six selected similar countries. From best to worst, Singapore was a very high 87% (possibly the highest in the world), followed by Ireland (77%), Finland (75%), Denmark and Norway (72%), and Taiwan (69%).
So where does NZ rank?
Our fully vaccinated rate was 76%. To complete the picture China's was 84%.
So, despite being a small country with limited leverage in negotiating with pharmaceutical companies compared with much larger economies and blocs like the EU and despite being much further away from vaccine manufacturing countries, we have done very well.
We have done better than the EU, better than the big economies of the US, UK and Germany, and a fraction behind Australia.
Why did we do so well?
These two comparators (mortality and vaccination rates) show that NZ has been outstanding compared with the rest of the world. For me, there have been three main reasons behind this.
First, the zero-tolerance elimination strategy towards community transmission has served us very well. The government did trip itself up by lowering the alert level too early in Auckland in late September and its subsequent confusing messaging. But, by international standards, this was a relatively small failing and now the delta variant is under control and may soon be eliminated.
Much of the government’s success was due to it ‘following the science’ and recognising that much of this expertise resided outside the health ministry.
This is not a criticism of the ministry but a recognition of where so much specialised expertise resides. When the government started to lose public confidence in its pandemic leadership from last Oct was when its decision-making and messaging started to depart from this expertise.
Second, our unitary political system has been a big plus. Many countries with pluralist systems have had big problems because of decision-making tension between federal governments and states or provinces. Australia, Germany, Canada and especially the US immediately come to mind.
Last (but definitely not least), our district health board system (DHBs) has done us well.
DHBs are rare in universal public health systems, which generally have separate statutory bodies responsible for community and hospital care.
In contrast, DHBs are much more integrated, due to their statutory responsibility for both community and hospital care for defined geographic populations.
To the extent that DHBs have had difficulties in the vaccine rollout, this has been largely due to decision-making within the central government.
