New Covid-19 playbook for NZ – Expert Reaction

New Zealand will retire its Alert Level system to tackle Covid-19 with a three-tiered “traffic light” system meant to minimise the health impacts of the virus.

Auckland will move out of lockdown into the “red” status when all three of its DHBs reach 90 per cent full vaccinations, while the rest of New Zealand is expected to collectively move to an “orange” status once all other DHBs hit the same vaccination target. Prime Minister Jacinda Ardern said the Government is open to moving the South Island before the rest of the country if all DHBs in the south hit their targets before others.

The SMC asked experts about today’s announcement. Comments have been organised in the following themes for easier navigation:

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“The plans and settings proposed today put a very strong emphasis on vaccination. Having safe and effective Covid-19 vaccines is a tremendous asset in the pandemic. However, there are several risks associated with such a strong dependence on vaccination and putting all of our pandemic safety eggs in that one basket. For example:

  • Children under 12 are not yet eligible to be vaccinated and the trial data on 5-11 year-olds hasn’t been seen and scrutinised. While we hope the vaccines will be safe and effective for young children, we can’t yet make that assumption.
  • Although Māori are rapidly catching up with other population groups, a 90 per cent DHB target could leave many Māori still only partially vaccinated when restrictions are lifted.
  • Building a pandemic response around vaccines means that the plan may very quickly go out of date. Population protection from vaccines is likely to change over the next few months. A third Pfizer vaccine dose will probably be required to maintain immunity, and new variants could make current vaccines less effective.
  • In the new settings, effective measures to limit airborne spread of the virus don’t appear to be calibrated to risk levels. This means that when there’s active community transmission there’s very little protection in public spaces for those who aren’t vaccinated, particularly children. Effective measures include optimising indoor ventilation in schools, workplaces, shops, and entertainment venues; supporting mask use; providing paid sick leave for all workers, and many more. Without these public health and social measures hardwired into the system, we may be vulnerable in future to new Covid-19 variants and to other respiratory infections that are waiting to make a comeback once border restrictions are relaxed.

“These factors raise a concern that the current plan will increase health inequities and that it hasn’t been explicitly designed to uphold Te Tiriti o Waitangi. The current settings are likely to put children and young people at risk in public spaces; and it’s concerning that the plan doesn’t seem to look further ahead than the next few weeks: we don’t know when the next variant will be along.

“Earlier this year, I and colleagues proposed a revision to the Alert Level system. The peer reviewed, published version can be accessed here; there’s a short overview and a longer and more detailed supplement. This version was not intended to be final – instead, it’s a starting point for designing a new Alert Level system. We proposed several ideas for ensuring that the new system would be equitable and uphold Te Tiriti and for continually building in new knowledge, including ways to prevent airborne spread and to provide strong social support at every Alert Level. We anticipated that the new system would need to evolve to provide integrated protection against Covid-19 and other infectious diseases, including the return of familiar infections like flu and meningococcal disease and the arrival of new Covid-19 variants or a new pandemic. We proposed that this version of the Alert Level system should be a legacy of the pandemic, protecting our populations for years to come. When compared with the bigger aspirations of this proposed Alert Level system, there seem to be several missed opportunities in the current system. It would be good to start up that conversation again and discuss how to keep adapting the pandemic response to be more equitable, more knowledge-informed, and more forward-looking.”

No conflict of interest.

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

“Today’s announcements had an appropriately high emphasis on vaccination against Covid-19. The additional economic packages for boosting Māori vaccination activities and supporting the economy, especially low-income workers, seem highly appropriate and will help sustain the response. Having DHB vaccination level targets probably makes more sense than a single national vaccination target – as long as DHBs are appropriately resourced to achieve these targets.

“But while there are some good features in the new Covid-19 protection framework, including the role for vaccination certificates, it ultimately would have been better to amend the existing Alert Level system rather than create a new traffic light system. A revised Alert Level system would have retained the capacity for short, sharp and locally targeted lockdowns that might still be needed in the future if more hazardous variants of the virus causing Covid-19 evolve.

“Also, a revised Alert Level system would have allowed the country to keep testing and refining this system so as to better deal with a wide range of potential future pandemics (including potentially very much more severe ones arising from bioengineered microbes that escape from bioweapons laboratories). It is also disappointing that none of the details that would make for a better Alert Level system, including improved consideration of Māori values, will now be used (as per this article we published in a Lancet journal).

“Persisting gaps with both the new traffic light system and the Alert Level system are the lack of attention to having universal indoor mask requirements and upgrading ventilation in schools and workplaces (see here).

“Finally, it is concerning that there has still been no Government announcement about strengthening internal borders around Auckland and the Waikato, which is critical to prevent the spread of Covid-19 to other regions. The rest of the country needs more Covid-19-free weeks and months to build up vaccination levels. Improved internal border controls should include vaccination requirements for those crossing, a negative rapid antigen test result at the border, and tighter definitions for who is permitted to cross. The success of several Australian States and Territories in remaining Covid-19 free, despite Delta being in Victoria and New South Wales, should be an example for New Zealand.”

No conflict of interest.

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

“It is good to see the government committing to getting 90 per cent of people fully vaccinated in every DHB. If we reach this target, it will make New Zealand one of the most highly vaccinated countries in the world and put us in a strong position to manage the impacts of having COVID-19 in the community.

“It is welcome news that more resources are being targeted towards lifting Māori vaccination rates. There is much more work to be done here and we should be aiming to get 90 per cent of Māori fully vaccinated as well.

“The traffic light system announced today makes it clear that businesses should prepare to use vaccine certificates if they want to operate with minimal restrictions. This will hopefully create a strong incentive for people to be vaccinated if they want to enjoy freedoms like going to restaurants, bars, gyms, gatherings. No jab, no fun. This approach is justified because unvaccinated people going to these busy locations would put other people’s health at risk.

“The ‘red’ setting may not be enough to control a large outbreak that was threatening healthcare systems. So, we should keep some of the stricter measures like business closures or localised lockdowns, and appropriate economic support packages alongside them, in the toolbox in case they are needed.

“For now, the alert level system remains in place and it’s essential everyone sticks to the rules. Keeping cases as low as possible until we reach the 90 per cent target will keep pressure of our hospitals and make it easier to gradually ease restrictions as we progress towards the target.”

Conflict of interest statement: I am partly funded by MBIE for research on mathematical modelling of COVID-19.

Dr Dion O’Neale, Principal Investigator, Te Pūnaha Matatini; and Lecturer, Physics Department, University of Auckland, comments:

“It is certainly possible for Auckland, and other regions, to reach the 90 per cent target by Christmas. Whether we do or not depends on details about the last remaining people to get vaccinated — things like how many people are going to refuse vaccination, and how easy access it is for people who might be willing to get vaccinated but haven’t had good access or incentives until now.

“In terms of whether it will be safe to have travel to and from the Auckland region, the main risk currently is for the rest of Aotearoa who are currently COVID free and who might want to avoid COVID cases being introduced by travellers from Auckland.

“There are two components to the way that vaccines reduce spread: they decrease the chance of vaccinated people becoming infected, but they also reduce the chance of onwards transmission from vaccinated people who are unfortunate enough to have a breakthrough infection.

“To reduce the risk from travel by Aucklanders to the rest of the country we would therefore want to see high vaccination rates, both within Auckland (reducing onwards transmission), and in the regions where Aucklanders are travelling to (reducing new infections).

“We’d also want to see stable, and hopefully low, cases numbers in Auckland before removing any borders to allow wider travel. If case numbers within Auckland are still going up, for a given level of vaccination, then we would expect the same pattern to quickly develop in other regions if there was no longer a barrier to keep cases within Auckland.

“One important factor to keep in mind is that a vaccination target of 90 per cent only applies to the eligible population of 12 and up. Aotearoa has a relatively young population, especially compared with other countries. Vaccinating 90 per cent of over 12s only translates into 76 per cent of the total population — this would mean there are still about 1.2 million people unvaccinated.”

Conflict of interest statement: I, along with others from Te Pūnaha Matatini, are funded by Department of Prime Minister and Cabinet to provide advice on the COVID response and from a Health Research Council grant to look at equity related to COVID in Aotearoa.

Dr Rhys Jones, Public Health Physician and Senior Lecturer in Māori Health, University of Auckland, comments:

“It is extremely disappointing that the threshold used to determine easing of restrictions is based on total population vaccine coverage and doesn’t include a requirement for a certain level of coverage among Māori and Pacific communities. This flies in the face of Minister Andrew Little’s assurance, reported this morning, that Covid-19 restrictions would continue until all groups reach 90 per cent vaccination rates.

“Essentially the government has rolled out a vaccine programme that systematically privileged non-Māori, non-Pacific populations, and then used vaccine coverage predominantly among those populations as the basis for easing restrictions. Not only have Māori in particular been neglected in the vaccine rollout, our communities may now be exposed to extremely high risk due to the failures in that rollout.

“So, I believe it is unethical to significantly ease restrictions any further while vaccine coverage for Māori and Pacific remains dangerously low. Māori and Pacific populations are at much higher risk of serious outcomes from Covid-19 than other ethnic groups, so it is essential that we get vaccine rates up as high as possible.

“The requirement for high coverage is even more important for Māori and Pacific communities – because of our younger populations, approximately 25 per cent are currently ineligible to receive the Covid vaccine. That means we must ensure coverage is as close to 100 per cent as possible among those who are eligible, in order to provide adequate protection for those who are too young to be vaccinated. The plan announced today fails to guarantee that level of protection for Māori and Pacific communities.

“The announcement of additional funding to boost Māori vaccination rates is welcome, however this investment is too little, too late. This should have been the singular priority from day one. Māori should have been at the centre of the Covid-19 vaccine programme, and should have been leading the programme, the whole way through.”

No conflicts of interest declared.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

“At the very least, vaccination target details for Aotearoa New Zealand needed to include at least 90 – 95 per cent full vaccinations for Māori and Pacific peoples, to help keep all of our most vulnerable communities safe from COVID-19 – and includes keeping our children and young people safe.

“Leaving any of our most vulnerable behind and unprotected, given the adverse health impact already seen for vulnerable groups in Aotearoa New Zealand, will have consequences that will be far reaching and will speak to generations to come.

“Māori and Pacific communities continue to be heavily impacted as a result of the current Delta outbreak. It was known from the outset of the COVID-19 pandemic that Pacific peoples and Māori communities were vulnerable to being disproportionately affected by COVID-19 and would require prioritisation to avoid making pre-existing health disparities and inequities worse.

“Although improving, Māori and Pacific vaccination rates remain behind the overall rate as more time was needed to catch-up with other groups given the initial vaccination roll-out in Aotearoa New Zealand prioritised other groups to get vaccinated first.

“Just as we can look back into history and reflect upon mistakes made in the past resulting in irreparable harm for certain groups, others in future may well have the opportunity do the same with our COVID-19 response if we ignore the needs of some of our most vulnerable in society.

“We need to drive vaccination rates up even further as quickly as possible, and to give more time for our hospitals to be ready. It would be incorrect to assume those who have yet to receive their COVID-19 vaccine are just all against the vaccine, accessibility issues persist for hard-to-reach communities and more vaccination outreach activities and events that are resourced appropriately are needed.

“Our Pacific and Māori communities and respective health workforces, have all been doing an amazing job working tirelessly, mobilizing and rallying to continue doing the work that’s needed to reach some of the hard to reach in our communities – and protect our most vulnerable from COVID-19.

“The implications for the COVID-19 situation moving forward for DHB’s must include a continued equity focus for approaching vaccination, testing and prevention efforts – this will help reduce barriers, improve access and build trust with vulnerable communities to ensure people get the help they need, when they need it, whether it be the vaccine or a test or other health and support services.

“Vaccination is key right now. Please get vaccinated and help keep others around you safe.”

Comments in response to today’s case numbers:

“We’re continuing to break records in Aotearoa New Zealand, but just the wrong ones. The highest daily number of COVID-19 cases ever recorded in our country, was today at 129 community cases. The highest hospitalized number of cases was also recorded today, at 51.

“The shift in focus for investigations relating to unlinked mystery cases of unknown origin speaks to a system that’s under pressure and stretched.

“A high degree of risk remains for all in Aotearoa New Zealand, but especially for our most vulnerable communities. Vaccination rates of at least 90 per cent and beyond fully vaccinated – including for Māori and Pacific, are paramount to fighting Delta and keeping everyone safe from COVID-19.

“Please get vaccinated, please get tested, please follow the alert level rules, and importantly, help others around you to do the same.”

No conflict of interest.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“Part of the importance of the elimination strategy was to allow sufficient measures (including vaccination) to be enabled for the population. The lack of early vaccination access for populations most vulnerable to Covid-19 and our most vulnerable rural areas being some of the last to be considered is concerning with the move to opening up areas with active cases in the community.

“Vaccination as a strategy is hugely important, however it is not the only strategy and in itself for Covid-19 we need to look beyond first and second doses to sustain levels of protection. We must not lose sight of the importance of the other measures (masking, hand hygiene, physical distancing etc.) and I remain concerned that the new traffic light levels will include for cases of Covid-19 in the community. As we know, the Delta variant transmits quickly and to many people. The Prime Minister spoke of our levels of vaccination being some of the highest in the world: when we look to other countries who have highly vaccinated populations that are still experiencing high case numbers, hospitalisations and deaths (e.g. UK) this signals some levels of acceptability or ‘collateral damage’ (and was mentioned by Judith Collins the other day). The principles of the United Nations in respect of sustainable development, supported by the Sendai Framework for Disaster risk reduction and the World Health Organization include that no one is left behind. That does not mean leaving most vulnerable people until last, nor should it mean that populations already identified as most vulnerable should ever be seen as ‘collateral damage’ in any strategy for a Country moving out of restrictions.

“Geographic area level protections such as traffic light systems have their place. It is appropriate for a boundary around the Auckland region to continue to minimise transmission of the Delta variant of Covid-19 to other areas and I trust appropriate testing regimes will continue for those workers who have to cross the boundaries for their work.  This will allow most vaccinated Aucklanders to go about their lives and business as freely as possible within the appropriate levels.

“There remain many questions around the timelines and details of the announcement today.”

Conflict of interest statement: Dr Gray is currently part of two Health Research Council grants: “COVID-19 Pandemic in Aotearoa NZ: Impact, Inequalities & Improving our response” (PI Baker, M) and “Te matatini o te horapa: a population based contagion network for Aotearoa NZ” (PI O’Neale, D)

Jacqui Maguire, Registered Clinical Psychologist, comments:

“For the first time since 17 August 2021 there is a glimmer of hope. Until now there has been no clear pathway out of level 3/4 restrictions, especially for those living in Auckland.

“Despite high vaccination rates in the city (89 per cent), those that have complied with all Covid-19 level restrictions and vaccination requirements have received no reward. People have continued to live with low freedoms and restricted social contact. This has been extremely difficult on the community’s mental health and wellbeing, with feelings of powerlessness, hopelessness, fatigue, deprecation, anxiety and low mood reportedly high.

“Simple behavioural psychology showcases that people’s behavioural decisions operate on risk and reward system. If vaccinated, currently people’s personal risk may be perceived as ‘low’ whilst personal reward is also ‘low’. It therefore makes sense that people’s motivation to live within level 3 boundaries has waned. For those outside of Auckland (e.g., the South Island), requirement to operate at level 2 when the ‘perceived threat’ to their community was low (e.g. no cases of covid 19 in the South Island) has appeared to lead to increased frustration and unrest.

“People’s mental health and wellbeing is precious, and Covid-19’s restrictions have been a very real threat to this. Today’s traffic light system announcement has for the first time provided some clarity about how New Zealand plans to live with the virus. It also provides real benefit for those that have chosen to get vaccinated. Again, from a behavioural psychology perspective, this system increases people’s perceived ‘reward’ for vaccination and compliance.

“However, this traffic light system requires a broad 90 per cent vaccination rate to come into effect. For the average New Zealander, they have limited (if no) influence on how and when this target will be achieved. The collective goal needs to be to keep people well (physically AND mentally) whilst we are in limbo waiting. Furthermore, I believe people are still waiting to receive a clear timeframe on when New Zealand’s international borders will open, as for many people there is a significant negative impact of this closure to them personally and professionally. To keep motivation high, this will need to come next.”

No conflict of interest.

Dr Sarb Johal, registered clinical psychologist, comments:

Note: This comment was originally posted on Dr Johal’s blog.

“Here are some of the key points from a psychological point of view.

“Outlining the new structure and how it will work will be helpful for most people. And it is clear that the goal is to carry on vaccinating at speed and scale to ensure that people are protected as much as possible before Covid-19 reaches all parts of our communities.

“In order to gradually and carefully open up, the Government has set high but realistic vaccination rate targets of 90 per cent double vaccinated in each DHB before the new Framework takes effect. The goal is to minimise the spread and impact of Covid-19 while offering broad protection. The approach is formally shifting from elimination to containment, control, and, where appropriate, stamping out clusters of infection.

“Vaccine certificates will be critical for accessing services under a new system. Highly targeted and localised lockdowns will be used if needed. The Government hopes that this new framework helps us to move forward, safely – but acknowledges there will be more cases in the community that we have experienced before. This framework is about reducing impact.

“The Government approach here is to incentivise behaviour change in access to goods and services, other than those that are strictly necessary, e.g., food, and health services. Behaviour change and maintenance now then being approached from several different angles, with multiple nudges and policy settings to shape experience of life if people choose to remain unvaccinated. Life will be more open for those who are vaccinated, more limited for those who choose not to be.

“It’s an explicit statement of intent. And a framework to help shift individual behaviour for the collective good, sharing responsibility, but also offering protection for those who are more vulnerable. However, we need to take care to understand how particularly vulnerable communities will be protected with general DHB targets to ensure that they are not left unprotected, while striking the balance in opening life experiences up again for those who are fully vaccinated.”

No conflicts of interest declared.

Dr Paula O’Kane, Senior Lecturer in Human Resource Management (HRM), University of Otago Business School, comments:

“The traffic light system gives some certainty to retail and hospitality, as well as to organisations generally about how business will operate while Delta is circulating, and the boost to the resurgence payment as well as mental health support will be welcomed. Across all three levels it still leaves the hospitality and events sector being asked to decide whether to “police” vaccination on their premises. This is a potentially difficult situation, with staff being left open to customer criticism and/or abuse. The government should consider mandating certificates instead, taking the controversial decision away from already over stretched small businesses. It also doesn’t answer the question about whether staff are included in the vaccination mandate – can an unvaccinated member of staff serve in a premises operating a vaccination certificate check?

“It is now critical that workplaces ensure that their working from home polices are updated or in place for contingencies across all three levels. They must provide their employees which adequate equipment, software, hardware and internet access, to do their job safely, and that they plan for how to communicate effectively with their staff. Health, safety, and wellbeing are integral, particularly mental health and wellbeing which we know has suffered through these latest lockdowns.”

No conflicts of interest declared.

Todd Krieble, Deputy Chief Executive, NZIER, comments:

“Government is striking the right balance by positioning high vaccination rates as the path to freedom and well-being.  It makes economic sense, especially for weaker regional economies and a fragile health sector that risks being overrun. Waiting for all DHB regions to reach 90 per cent before opening up will bring the cost and benefits of achieving equity into sharp relief in ‘real time’. Getting the untested traffic light system right for business will be crucial. Businesses need to be part of the co-design and be trusted to adapt to their individual circumstances.”

Conflict of interest statement: NZIER is a non-profit organisation that devotes resources to fund our independent economics research on economic issues that we think the public should be debating. We undertake paid consulting projects for a range of public, private and NGO clients. We provide authoritative and impartial economic analysis and advice to give decision-makers greater confidence in their business and policy decisions. 

Dr Andrew Chen, Research Fellow, Koi Tū – Centre for Informed Futures, University of Auckland, comments:

“It has been reassuring to see the rates of vaccination rise over the last couple of weeks, and that will hopefully ease some of the tension in the community as we move towards the new protection framework. However, even if you are now vaccinated, you are not invulnerable to COVID-19. Your risk of getting sick, or ending up in hospital, or carrying the virus and infecting another person, is significantly lower but not zero. Everyone still needs to keep up good behaviours to help minimise the spread of the disease. Other experts will be able to speak more clearly to the importance of getting tested, wearing face masks, and movement/gathering restrictions. It is also important to keep contact tracing records, because contact tracing is one of the last lines of defense to help reduce the spread of COVID-19 in the community. Contact tracing itself happens after someone has already been infected, and public health officials try to identify potentially infected persons to reduce ongoing transmission. But that contact tracing work is reliant on people keeping good records of who they have been near, as well as where they have been and when.

“People can keep contact tracing records in multiple ways, whether that is using pen-and-paper diaries, leaving records at businesses, or using an app like NZ COVID Tracer to scan QR codes and use Bluetooth Tracing. The NZ COVID Tracer app is preferred because the data stays on your device until it is requested by a contact tracer, at which point it is the fastest way to provide your records to the contact tracer. Speed is of the essence with delta and COVID-19, and hours can make the difference between identifying a contact and isolating them, and leaving a case in the community to unknowingly infect others.

“It is important to emphasise again that businesses should not be using open registers (i.e. piece of paper on clipboards) that anyone can read, and should be using ballot boxes where people can drop a piece of paper with their details in, to reduce the risk of privacy breaches. Not everyone can use the app, and so having a pen-and-paper option is critical (and also a legal requirement under the Public Health Response Order).

“It is also important to note that having Bluetooth Tracing on is not a replacement for scanning QR codes. They are complementary systems and provide different data to public health officials. We have seen that over the delta outbreak, significantly more information has been used from the QR code system than the Bluetooth system, indicating that contact tracers are finding the QR code location information more useful. While it would be helpful for the Ministry of Health to review their digital contact tracing tools and to ensure that they are all being used to their full potential, in the meantime if you can do both (scan QR codes and turn Bluetooth Tracing on), please do to provide yourself with multiple layers of protection.

“On vaccination certificates, it is important that the government not just position these as a tool to incentivise vaccination or punish a lack of vaccination, but as a public health risk management tool to reduce the spread of COVID-19. This justification of mitigating risk has a stronger ethical justification than simply increasing some numbers. It moves the discussion from being one of reward/punishment to one of communitarianism and protecting our community.

“However, it is reassuring that the use of vaccination certificates has been tied to a high level of vaccination (i.e., 90 per cent in a DHB) as that reduces the likelihood of people being impacted by structural inequalities in the vaccine rollout meaning that they cannot participate in everyday society. It is also reassuring that there will be a category of services and venues that cannot prevent access on the basis of vaccination certification so that we are not depriving people of their right to access essential services like healthcare and food. The protection framework takes away access to discretionary services where individuals are unvaccinated or venues choose to not accept vaccination certificates, for which there is less of a human rights case and a stronger case to protect public health.

“Importantly, it appears that the Ministry of Health is publishing two different vaccination certificates – one for international use that complies with international standards, and one for domestic use that contains less personal information that is not relevant for venue operators. This is a positive approach as it further reduces the privacy risks for individuals in Aotearoa New Zealand, beyond the low risk that was present with the international standards. Certificates will be available printed or stored on a smartphone in Apple Wallet or Google Pay.

“People will be able to generate and access their vaccination records through My Covid Record – people can sign up for an account now and see their vaccination status, although this is not the certificate yet. It may be a good idea to get the account set up now in case there are any issues, rather than waiting for when certificates are available. While a RealMe option is available for setting up the account, if you are having issues with this then there is an alternative approach based on other identifying documentation like drivers’ licence or passport.”

Conflict of interest statement: I have had interactions with the Ministry of Health around digital contact tracing in an academic capacity, but am not employed or paid by them.