Two weeks ago marked the two-year anniversary of New Zealand’s adoption of the elimination strategy and a lockdown that successfully stamped out the first wave of Covid-19. By chance, it was also the week that the government announced a major relaxation of Covid-19 control measures in response to the Omicron variant wave sweeping the country.
By most metrics, the New Zealand Covid-19 response – the initial elimination strategy which has now transitioned to a mitigation strategy – has been one of the most successful in the world. It got the country through the first 18 months of the pandemic until vaccines became widely available, giving it very low Covid-19 mortality rates. Life expectancy actually increased during this period. Protecting public health has also been good for protecting the economy, resulting in relatively good economic growth and low unemployment.
The shift to mitigation was supported by the lower severity of Omicron and the relatively high vaccination coverage of the population. However, the high infection rate with the current Omicron wave has pushed numbers in hospital with Covid-19 to over 1,000 at its peak and cumulative deaths are approaching 400. Many thousands of future cases of long Covid seem plausible in adults and possibly children. New Zealand will need to maintain and even strengthen some controls in the months ahead. So what can it learn from the past two years?
Firstly, principles matter. During the course of the pandemic the New Zealand government has emphasised that the response is primarily focused on protecting public health. This starting point reinforces a number of key principles, notably: leadership that listens to the science; a focus on equity and partnership with Māori; use of the precautionary principle in the face of uncertainty; and the need to create legacy benefits for our healthcare and public health systems.
Framing and effective communication matter. By their very nature, pandemics are a shared threat.
The behaviour of individuals affects others. This was a strength of the elimination strategy in that it could rightfully celebrate the benefits of working together (the “team of 5 million”). An emerging alternative framing of “learning to live with it” is somewhat understandable given the nature of Omicron. But this framing is problematic in that it puts too much of the responsibility on to individuals and vulnerable groups to manage the risks they face. Instead, we need to keep emphasising the value of shared health security, the benefits of collective action and the role of government.
Transparency and political consensus matter. During the initial phase of the response, efforts were made to achieve multi-party agreement on the response. Unfortunately, such agreement has now fractured, with the response increasingly politicised. The premature lifting of some safeguards two weeks ago was a likely sign of this politicisation. Politicians need to revisit mechanisms that strive for transparency and political consensus. This matters for Covid-19 but would be essential for even worse pandemics, eg from engineered bioweapons.
Infrastructure matters. The pandemic is just the latest in a series of public health problems that New Zealand has struggled to manage, including a disastrous contaminated drinking water outbreak in Havelock North and a national measles epidemic. These problems can be partly attributed to the fragmentation and erosion of public health infrastructure. Fortunately, these deficiencies may be addressed with health sector reform, including the establishment of a Public Health Agency and Māori Health Authority.
This is an important opportunity to build on the infrastructure assembled during the pandemic response.
Effective pandemic tools matter. The pandemic response has required New Zealand to swiftly develop a new set of tools for managing this threat. They include systems for border management and quarantine, a national immunisation register and vaccine mandates/passes, a national case and contact management system, and frameworks to manage physical distancing and mask use.
Successfully rolling out vaccination has highlighted the critical importance of funding Māori and Pasifika service providers. The response has been supported with improved information tools, including better surveillance, disease modelling, genomic sequencing, wastewater testing, evidence-informed policy development and evaluation. Continuing investment is needed in all of these areas.
Safe indoor environments matter. One of the greatest legacies of the pandemic is that it has shown the importance of the indoor air environment for transmission of respiratory infections. This awareness has highlighted the value of using masks and improved indoor ventilation to prevent Covid-19. But much still needs to be done so that high-quality indoor ventilation is year-round and cost-effectively combined with providing thermal comfort.
There are many other things that also matter, such as accessible and effective health care services, and these will hopefully be considered as part of a future official inquiry into the pandemic response and what we can learn from this experience.
Responding to Covid-19 has taught us a lot, but this pandemic and other future pandemic threats will remain challenging. New Zealand needs to keep a focus on core principles, effective communication, building consensus and continuously upgrade its public health systems and tools.
Prof Michael Baker and Prof Nick Wilson are epidemiologists at the University of Otago’s Department of Public Health in Wellington