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Flu and measles vaccine reports – Expert Reaction

The Ministry of Health has released two reports into this year’s flu immunisation campaign and last year’s measles outbreak.

Director-General of Health Dr Ashley Bloomfield said the Ministry recognised there were difficulties with vaccine distribution in both cases, and the recommendations from both reviews were informing the Government’s COVID-19 response.

 The SMC asked experts to comment on these reports.

Associate Professor Helen Petousis-Harris, Vaccinologist, University of Auckland, comments:

“I am really pleased to see these comprehensive reports that highlight the many systemic problems facing the New Zealand public health programme and ability to respond to vaccine preventable diseases crises.

“In particular, the measles report notes that previous recommendations for improving measles vaccine coverage had largely not been implemented. Deficiencies included frequent restructuring within the Ministry that has left them without experience and training in outbreak management or institutional knowledge, coupled with significant under-resourcing of the regional and district public health services.

“Multiple missteps in addressing the evolving measles epidemic have been highlighted, including failures in leadership and communications with no standardised national messages, leaving both the public and health sector confused. The measles experience did not appear to have translated into better preparation for what was clearly going to be an unusual influenza season, given the emergence of COVID-19.

“There are a list of excellent recommendations provided in the reports which, if implemented promptly, will result in significant improvements. Vaccines are a cornerstone of public health and of enormous cost benefit to society. We cannot afford to continue to let the programme slip, especially with COVID-19 to contend with as well. Hopefully these lessons will result in some imminent positive changes.”

Conflict of interest statement: Helen Petousis-Harris is in an investigator on industry-funded studies and has served on expert advisory boards for industry. She does not receive personal honoraria.

Dr Nikki Turner, Director Immunisation Advisory Centre, University of Auckland, comments:

Influenza vaccine supply chain report

“The supply chain problems with the delivery of the national flu vaccine programme this year were hugely challenging, particularly for general practice. This was further aggravated by coming alongside the national lockdown with COVID-19 arrival. The flu vaccine programme is not forecast or purchased and funded the same as other schedule vaccines. As a result, we have a system where there are tensions with purchase and supply of vaccines.

“This system could be reorganised to be much more effective than the current model. This would involve separating out the purchase and delivery of the national schedule vaccines from the private market supplies as is done already with childhood vaccines. This would also enable better forecasting of need.

“There are better ways to order and distribute vaccines than what was demonstrated this year with the flu vaccine. It is timely and important to have this report. Clearly there needs to be systematic change before further flu seasons and prior to the arrival of COVID-19 vaccines.”

Measles outbreak report

“Another important report for how we can improve our system. Last year we had a measles epidemic that could have been prevented if we have acted earlier on the advice that we had many adolescents and young adults at risk of measles from historically being unvaccinated or under vaccinated. The resultant epidemic caused a lot of serious illness and put our health services at many levels under huge stress.

“The key to prevent any further measles is to focus on the equity gaps in our population – who is missing out on vaccination, raise the awareness and call for action in our community alongside ensuring our system offers effective services – particularly our infants, and secondly our adolescents and young adults who previously missed out, particularly Māori, Pacific and migrants.”

Other learnings

“The other learnings in here are around the need to be more systematically prepared at all levels of the system to deal with pandemics – there are lots of learnings in here for COVID-19 and other future pandemics. The important messages are around improving communication with leadership and coordination at, and across, all levels of the system and ensuring we are prepared earlier with clear and standardised outbreak management plans and information for all involved. Better preparation is vital. One thing the New Zealand community is now very aware of is the effect of infectious diseases and why we need to give more attention to pre-planning and readiness, not wait until we are overwhelmed in the middle of it!

“New Zealand is now rolling out a measles catchup programme. While we are all absorbed in COVID issues, let’s not forget the damage to our communities, particularly our children, from measles last year. We can and should remain measles-free. No child in New Zealand should ever again need to catch measles.”

No conflict of interest