Epidemiologist Tony Blakely believes Covid-19 boosters will be needed in the future, but who gets them and when is an "equity argument".
He told Q+A Pfizer waned in the immune system after six to eight months and Israel rolling out three doses of the vaccine was evidence of this.
However, Blakely said countries like New Zealand needed to be wary of when to start providing boosters as other nations around the world struggled to get a hold of the vaccine and vaccinate their own populations.
He said the rolling out of boosters would need to be "on balance" with the rest of the world.
Before boosters could even happen in New Zealand, the country needed to reach a vaccination rate of 80 or 90 per cent , which needed to involve those over 5. He said this was "critical".
Blakely felt when and if boosters were given, those who were immunocomprised needed to go first.
For the rest of the country to receive boosters, he reiterated it needed to be remembered what was happening in the rest of the world.
Covid-19 Response Minister Chris Hipkins told Q+A ahead of Blakely's appearance New Zealand would be able to access boosters and the Government knew they would be needed in the future.
Hipkins said advance purchase agreements with Pfizer gave the Government access to a "portfolio" of vaccines over the coming year and into the future for this purpose.
"So however the science shapes up, we can make sure that we're ready."
A Melbourne-based Kiwi, Blakely said New Zealand had "challenging decisions" ahead around its response to Covid-19.
This centred around opening up with the virus still circulating in the community.
He pointed out there was only so long people could stay in lockdown and the outbreak in Auckland was seeing a "challenging" tail of 10 to 20 cases per day.
"We've seen in the ACT, Canberra, that you can't eat that out once it's there."
The alternative was to stay in "hard lockdown" until the vaccination rate reached 90 per cent.
"I don't think the public tolerance will last that long."
Australia had realised it needed to pivot to living with the virus, but "alternatives" and "innovations" were needed to move away from lockdowns, Blakely said.
However, he warned an 80 per cent vaccination rate of adults was not "tickety-boo".
"Eighty per cent of adults vaccinated you still spend half your time in lockdown."
If a country were to "step up" from this and introduce minimum public health restrictions such as mask-wearing — Alert Level 2 or a "tad less" in New Zealand — it means the virus would not take off and contact tracers would not lose control.
"You do those two things, things are looking a lot better."
"Alternatives", "innovations" and "tweaks" for living with the virus could include improving ventilation/air filtration, better contact tracing apps, rapid antigen testing in high-risk areas and again, mask-wearing at lower levels.
"We need to have innovations we pull out of the toolkit that aren’t just lockdown."
Hipkins had earlier told Q+A ending the use of Alert Level 3 and 4 depending on vaccination rates was a "progressive thing".
"As I’ve said all the way along dealing with Covid, there won’t suddenly be a magic day where we just wake up in the morning, cut a ribbon at the airport and say that’s it, the pandemic’s all over.
"You’ll see a series of progressive changes, so even the fact we moved to Alert Level 3 earlier than we might have done in the past, vaccinations played a role in that. It’s always changing."
Hipkins said a high rate of vaccination would not spell an end to the country's elimination strategy, it would just make it look different.
"It means where cases pop up, it doesn’t mean there’s a public health emergency every time ... but it does mean we respond quickly and we work to stamp it out where we see cases, but we’ll have different tools available to do that.
And of course with high rates of vaccination, even if people get it, there’ll spread it to fewer people. There won’t be as problematic as it is now, but only if we get those really high hates of vaccination. So I think we’ll start to see changes between now and the end of the year."
In the wake of this, however, Hipkins had a few words of warning: "But I do want to say there’s still always uncertainty here. If another variant emerged, that was vaccine-resistant, for example, then we would have to rethink. But Covid-19 continues to evolve, to mutate, so the challenges we’re faced with continue to change."
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