Credit: NZDF

The plan to keep Omicron away from NZ over summer – Expert Reaction

The government has announced changes to booster jabs, quarantine stays, and the border in an effort to keep Omicron out of the country.

Covid-19 vaccine booster doses can now be booked four months after the second jab, down from six months – and boosters will be mandated for all border and health workers. The phased border opening with Australia has been pushed out to the end of February, and MIQ stays have been increased to 10 days, with the self-isolation component removed. The vaccine rollout for 5-11 year olds will begin on 17 January.

The SMC asked experts to comment. 

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

“I welcome the changes to MIQ to undertake the whole period of isolation in a MIQ hotel/facility rather than the recent change to 7 days plus 3 days at home with a day 9 test from home. It is very difficult to monitor home isolation for international returnees. If we were to identify a case of Omicron in a recent returnee when they had already travelled back to their home or place of self isolation, there is a risk they would have been in contact with NZ community en-route and very real potential for transmission in those important last three days.

“I also welcome the ‘early’ notification that the Australia and Aotearoa New Zealand border opening will be delayed. Whilst I appreciate the stress this will place on people who may have already booked and need to be with their loved ones ASAP, this at least gives some prior notice so that people have time to plan and reschedule. At the time the phased border reopening was announced, we did not know that the Omicron variant of COVID-19 would be highly transmittable and present in Australia so soon. We still await information on how severe this variant may be to more vulnerable populations. Many countries are still dealing with significant transmission of the Delta variant.

“Whilst Aotearoa New Zealand has had very few COVID-19 deaths, each death is significant and our Māori and Pacifica populations are disproportionately represented in the numbers of people infected.

“MIQ is currently a key feature to keep out (and drastically minimise) likelihood of community transmission at this time.

“Finally, currently we have few numbers of active Delta variant cases in the community and MIQ is doing its job.  We have high numbers of vaccinated people now and continue to see increased rates of 1st, 2nd and booster doses.  At the moment, NZers can enjoy their summer break so long as people are taking a ‘vigilant’ holiday (vaccinate, mask up, hand hygiene, scan and track your movements, well ventilated rooms when indoors and lots of outdoor summer time).”

Conflict of interest statement: “I am currently a named investigator on two Health Research Council grants – one looking at the equity of COVID-19 response and the other looking at contagion network modelling.”

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

“The package of measures announced today will help protect New Zealanders’ health from the threat posed by the Omicron variant of Covid-19. There is still a lot of uncertainty about Omicron, particularly how its severity compares to Delta. However, we do know that it can spread extraordinarily fast and that two doses of the vaccine, although still much better than nothing, is likely to be less effective for Omicron than for Delta. Increasing evidence suggests that a third dose of the vaccine restores immunity to a much higher level.

“New South Wales is currently having a very rapid Omicron outbreak and the variant is also spreading in several other Australian states. Going ahead with border reopening plans in January, even with the home isolation scheme, would mean that Omicron would almost certainly get into the New Zealand community within weeks if not days. Delaying reopening plans to the end of February gives us a chance to keep Omicron out until the majority of adults have received their third dose of the vaccine. Increasing the MIQ stay to 10 days and shortening the pre-departure test period from 72 to 48 hours are sensible ways to reduce the risk of the highly transmissible Omicron variant leaking out of MIQ. Adding a requirement for a rapid test on the day of the departure would be a useful extra measure.

“Hopefully these measures will keep Omicron contained at the border. But if Omicron does find its way into the community, the government has said it intends to use the red level of the traffic light system to try and control its spread. It’s unlikely this would be sufficient to prevent rapid spread of the variant if community transmission became established. Rolling out booster doses as quickly as possible is therefore essential to minimising the risk that Omicron overwhelms our healthcare system.”

Conflict of interest statement: “Michael Plank is partly funded by the Department of Prime Minister and Cabinet for research on mathematical modelling of COVID-19.” 

Dr Jin Russell, Developmental Paediatrician, Starship Children’s Hospital and PhD Student, School of Population Health, University of Auckland, comments:

“I’m delighted to hear that 5- to 11-year-old children will be able to be vaccinated to protect against Covid-19 from the 17th of January. Over 7 million doses of the Pfizer vaccine have already been administered to children in this age group in the United States of America and the CDC reports an excellent safety profile.

“Vaccinating 5- to 11-year-old children protects children themselves from illness and reduces the risk of needing to yo-yo in and out of isolation and quarantine. Vaccinating children also protects their families, the wider community, other children who are at higher risk of severe illness, and schools – giving NZ the best chance of keeping children in face-to-face learning throughout 2022.

“While the vaccine is recommended for all children, tamariki Māori, children with pre-existing conditions, children living in crowded or intergenerational homes, and children with vulnerable household members, have the most to gain from the paediatric vaccine programme. Children from minority ethnic groups and indigenous children experience higher rates of hospitalisation and severe illness (e.g. MIS-C) compared to children of European ethnicity.

“The paediatric vaccine rollout is a second shot at equity. We need to learn from the adult vaccine rollout. Māori community health providers need to be substantially resourced to reach their communities. Providing vaccinations at schools in rural or low decile areas will provide the most equitable access.

“It’s good to hear that vaccine passes will not be required for children under 12. Schools are an essential service for children and I wouldn’t want to see children excluded from school or activities on the basis of vaccination status.

“Parents are encouraged to seek good information from the Immunisation Advisory Centre to inform their decision in due course.”

No conflict of interest.

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

“The Government’s continuation of a very cautious approach to Covid-19 is very welcome from a public health perspective. It might even be best from an economic perspective if it prevents large outbreaks of the Omicron variant in NZ – that then result in people travelling less and avoiding retail and hospitality settings. While there is still a lot of uncertainty around the Omicron variant, especially the risk of severe disease, it is wise to try to keep it out of NZ as long as possible and until more is known about this variant. So these specific measures of earlier booster shots, the rollout of the paediatric vaccine, and the adjustments to MIQ are all excellent. But perhaps the most important measure announced today is the delay to loosening international border arrangements for travellers from Australia to the end of February.

“Despite these encouraging moves there are still additional measures that would help. These include: (i) temporarily turning down the tap on international travellers from countries with the worst Omicron outbreaks (at least for 2-3 months); (ii) adding rapid antigen tests at the airport for international travellers coming to NZ; (iii) making further improvements to MIQ facilities in terms of ventilation and avoiding shared spaces such as exercise areas; and (iv) re-designing the Alert Level system so that it can rapidly eliminate any outbreaks of the Omicron variant that arise in the NZ community.”

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

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:

“The reduced booster shot interval from 6 to 4 months is welcome news at this time – Omicron is already at the border. The reconsideration of Aotearoa New Zealand’s planned border openings and settings and phased border opening being pushed out until at least the end of February is an important move. Temporarily increasing MIQ stays to 10 days for all travellers, with no self-isolation component is a reasonable step.”

Note: Dianne commented in more detail on the paediatric and booster vaccine rollouts earlier this morning.

Dr Matthew Hobbs, Co-Director, GeoHealth Laboratory, and Senior Lecturer in Public Health, School of Health Sciences, University of Canterbury, comments:

“Omicron is the fastest spreading variant we have seen. It is becoming the dominant COVID-19 variant in many countries where travellers are coming to NZ from. A handful of daily cases in the community can accelerate to thousands of daily cases within a month without intervention. The UK for instance, has seen records broken in terms of highest daily case totals.”

Transmissibility and severity

“We are now more confident that Omicron is significantly more transmissible than prior variants. However, evidence on severity is very preliminary and mixed. Perhaps of concern, and in contrast to some evidence from South Africa, a recent study from Imperial College London showed no clear evidence that Omicron had lower severity than Delta. However, it really is too early to say this with any confidence and the next few weeks will provide more answers.”

The NZ border

“In New Zealand, the cautious ‘wait-and-see’ approach to COVID-19 has served us well throughout the pandemic. It is apparent this will again be the case when grappling with Omicron. Though it will be disappointing for many, through reviewing and postponing current border reopening plans New Zealand has bought itself some much needed time while it works out how much of a problem Omicron could be – like the last time we closed the Trans-Tasman bubble. Although the government will likely face scrutiny for re-tightening some restrictions, these are essential to keep Omicron out of New Zealand, with many other nations around the world (i.e. UK, Netherlands, France, Germany etc) now re-imposing some restrictions due to Omicron case growth. It also provides us with a few more crucial months to get the booster shots up and roll out the paediatric vaccines.”

Boosters and paediatric vaccines

“A booster dose with Pfizer is very likely to provide better protection than a two-dose course against the Omicron variant. However, this will also be challenging. We will need to shift our mind-set to move from thinking two doses is enough, to three doses. If people still think they’re fine with two doses this is actually a false sense of security with Omicron. Booster shots will be important for those working in things like MIQ, healthcare and for those vulnerable in the population. A strong equity focus is needed in the booster and child vaccination programme to protect the most vulnerable communities. Prior research we conducted last year for more generic childhood immunisation coverage showed that inequities were persistent over time from 2005 to 2017 so this needs to be, and can be addressed within the COVID-19 paediatric vaccine roll-out.”

MIQ and the traffic light system

“While MIQ protocols have been improved these will need constantly reviewing in light of new evidence and may need to be tightened more to reduce even further the risk that Omicron spills out into the community. For instance, the more people with Omicron allowed into MIQ, the higher the chances of a breach so it may be that numbers need to be reduced to more effectively manage our MIQ facilities. Other changes could also be made, for instance, the vaccination requirement for arrivals could be raised to 3 doses of the vaccine to reduce the risk of Omicron coming to New Zealand. Finally, current settings within the traffic light system need updating to better reflect the risk posed by Omicron as parts are no longer fit for purpose if we have Omicron in the community for example.”

The bigger picture

“Let us remind ourselves of the devastation caused beyond our borders and how quickly the less transmissible original strain of COVID-19 spread around New Zealand in March 2020. Overall, the rethink on borders, boosters and MIQ is needed, justified and welcomed. However, protocols will need to be reviewed in light of new and emerging evidence as it develops. We also know that COVID-19 is an airborne disease so we also need to think about other things we can be doing like upgrading ventilation in schools, workplaces, and other indoor environments.

“More broadly, we also need to shift our domestic focus to a global perspective. The root of this issue is that the world isn’t doing enough to stop the spread of COVID-19. While some countries, including New Zealand, have had domestic success at controlling COVID-19, wealthy countries around the world continue to hoard vaccines. This ultimately gives the virus more opportunities to replicate and mutate. Omicron should act as the wake-up call to ensure worldwide equitable vaccine delivery before even more concerning variants emerge.”

No conflict of interest declared.