Credit: Ministry of Health NZ

Priority groups for Covid-19 vaccination – Expert Reaction

Those at high risk of Covid-19 in south Auckland and certain aged care facilities will be priorities for the vaccine roll-out after border and frontline healthcare workers.

Following this group will be over-65s and people with underlying health conditions across the country. The vaccine will then be distributed to the remainder of the population.

The SMC asked experts to comment on the roll-out plan. 

Dr Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“I think it’s fantastic that south Auckland is a priority in the vaccine roll-out. We’ve been lobbying for this to happen for some weeks now. While we do this because we recognise the risk for the communities in south Auckland, they are also adjacent to the airport, so there is a risk of an outbreak to everyone else in the country too. So prioritising south Auckland residents with these conditions and ages will be good for everyone.

“The government have decided not to vaccinate all of south Auckland as a priority, which I consider is a pragmatic response to limited vaccine supply. There are other priority groups as well – the government estimate 230,000 people living in high risk environments.

“I think it’s a fantastic decision to allocate the 40,000 courses to Māori and Pacific providers to distribute to their patients and families. I know from experience that Pacific medical providers have predominantly Pacific patients, so it will improve the chances of the vaccine being delivered to those people that often have difficulty accessing health services.”

No conflict of interest declared.

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

“Whatever decision is taken it is not going to smoothly fit all needs and gaps will occur.

“Essentially this is a mixture of protecting those at highest risk of contact with COVID, those at highest risk of severe disease if they did get COVID and communities at highest risk of spread. There are different priorities in all three areas here and no single answer is ideal.

“Clearly a mixture of all three options is on the table here. I think it is important to keep it simple as possible for all NZers to understand, to focus on equity gaps and not leaving people behind and importantly to be flexible and not rigid in decision making while having enough rules to prevent the traditional ‘worried well’ jumping ahead of those who have higher need.

“Overall so long as NZ can continue to keep COVID out of circulation in our community then we have time to roll out the vaccine in whatever sequencing we go for. We will have to shift rapidly however if we do see any significant community spread.”

No conflict of interest. Note: The Immunisation Advisory Centre (IMAC) has a contract with the Ministry of Health to delivery education and training to the healthcare sector for COVID-19 vaccines.

Associate Professor Ben Gray, Department of Primary Health Care & General Practice, University of Otago, comments:

“I think this is a great plan that first protects those most at risk of picking up the virus in their workplace, reducing the risk of future outbreaks and lockdowns and then protecting those most at risk of getting seriously ill if they get the virus.

“I think we have every reason to continue to have confidence in the Government and its advisors in managing this pandemic.

“The issues about fairness in the order in which people are vaccinated are only important if we have any community spread. If there is no community spread then the goal of vaccination is to vaccinate enough people so that we can dispense with border controls, the order in which we do that is less important. The risk of community spread will now go down further as we vaccinate those exposed at the border and their whanau. The task now is to convince everyone of the value of being vaccinated.”

No conflict of interest declared.

Dr Sarb Johal, psychologist, comments:

“Today we found out more about how vaccinations will be rolled out in New Zealand. This gives a helpful level of predictability in what has been a very difficult year, filled with uncertainty.

“This is really encouraging news. For the vaccination messaging campaign, as well as talking about the risks of people not taking up the vaccine in enough numbers, there is an opportunity to tell the story about the potential benefits that are unlocked through vaccine uptake and continued public health measures adherence in the future.

“Telling New Zealand’s exit story of the pandemic and what needs to happen to get there becomes a story of pragmatic hope, drawing a clear picture of what life might look like post-2021.”

Dr Sarb Johal is a clinical psychologist and author. He has published on his blog today a psychological analysis of the NZ Govt comms campaign so far, and how this could evolve now the vaccination pathway is clearer.

No conflict of interest declared.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“The Government’s vaccine roll-out plan makes a lot of sense in how it combines enhanced border protection along with protecting the older age groups. The plan is fairly consistent with the approach taken in New Zealand around fully-subsidised influenza vaccination (ie. older age groups and those with various underlying health conditions.)

“However, the border protection part of the plan could have been improved upon by putting all the adult population in the Counties Manukau DHB into Group 2 (rather than just the over 65s and those with underlying health conditions in this area.) This is because this population is particularly exposed to border failures via the proximity to Auckland International Airport and various MIQ facilities in south Auckland. Nevertheless, it is to be hoped that such border failures will become less frequent with the vaccination of border workers – along with other refinements with MIQ to reduce mixing of people in shared exercise and smoking areas etc.

“The rollout of this vaccination is a major advance in pandemic control – but there is still much work to do to both improve New Zealand’s border controls (for travellers from high risk countries such as the US), while facilitating quarantine-free travel for people from low-risk “green zone” countries like Australia (potentially with some testing requirements.) Specific other improvements needed include phasing in mandated daily saliva-based PCR tests for all border workers, mandated use of QR codes for high risk settings, and building higher adherence to mask wearing on public transport.”

Conflict of interest statement: Nick Wilson has no competing interests. He gets no funding for any of the research he does on Covid-19.

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington:

“It is a remarkable achievement that only a year after Covid-19 first arrived in New Zealand that we are planning the roll-out of a highly effective and safe vaccine to the entire adult population. It is also remarkable that because we have eliminated transmission of Covid-19 in New Zealand that we can distribute the vaccine in an orderly way without the pressure of being in the midst of an emergency with people getting sick and dying every day, which is unfortunately the situation in much of the world.

“The vaccine prioritisation process is based on logical principles so contains few surprises. It is important to remember that our top priority group of border and MIQ workers is very different to much of the world that has not been able to eliminate the virus. In other respects, our focus on healthcare workers and the most vulnerable groups is very similar to other countries.

“There are some questions that still need to be considered. In keeping with the high priority attached to reducing the chance of future outbreaks it would be useful to consider vaccinating New Zealanders taking short to medium term trips overseas, ie those leaving with definite plans to return. That would reduce the chance of them importing the virus when they come back. It might also be useful to consider vaccinating everyone on arrival in MIQ facilities, though that is a more complex decision as protection from the first vaccine dose would be only partial. It would of course be preferable to vaccinate all returnees prior to their departure to New Zealand, though that is harder to arrange at present.

“The list of relevant underlying health conditions will almost certainly be fine-tuned. One group to consider includes those who are obese, since we know that a high BMI is strongly associated with the risk of having a poor outcome from Covid-19 infection.

“Children are still missing from the list for obvious reasons. We need data from trials that are underway at present to confirm that the vaccine is safe and effective in that age group. Such results are expected shortly.

“One possible adverse effect of this vaccination programme is that it might add to the considerable complacency many New Zealanders are showing in the face of this pandemic. The risk of importation and local outbreaks remains high. Vaccination of border and MIQ workers will help to protect us. However, there is a lot more that can and should be done to reduce the risk of importation of this virus and to prevent future outbreaks in this country.”

No conflict of interest.

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“The plan released today sets out the timetable for vaccinating the New Zealand population. We have really strong data that the Pfizer vaccine provides excellent protection against getting seriously ill with COVID-19. Although the preliminary data is promising, it is less certain how much protection the vaccine provides against getting the virus and passing it onto others. Therefore it makes sense to take a balanced approach like the one outlined in the plan. Vaccinating our frontline workers will provide an extra buffer against COVID-19 getting out into the community. Vaccinating older people and those with underlying health conditions will protect those at highest risk of getting severely ill with COVID-19.

“It makes sense to prioritise at-risk people who are living in south Auckland as this region has the highest risk of border-related outbreaks. This vaccination plan will help reduce the likelihood and severity of future outbreaks in south Auckland. However, we should remember that cases of COVID-19 could appear anywhere, so eventually we will need to see high vaccination coverage across the whole country.

“Māori and Pacific people have a higher rate of needing hospital treatment for COVID-19 after controlling for age. It is a good start that the plan recognises this by prioritising older Māori and Pacific people. It will be important that the government continues to work with Māori and Pacific providers to ensure that there are sufficient doses available for these groups.”

No conflict of interest declared.