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Experts call for comprehensive mitigation strategy for Covid-19, RSV & influenza – Expert Reaction

A group of 16 New Zealand researchers say we should start treating illnesses such as influenza and RSV more like COVID-19, rather than the other way around.

In a Viewpoint article in the New Zealand Medical Journal, they call for a single, comprehensive mitigation strategy to tackle all serious respiratory infections, including key measures such as improving indoor air quality, increasing sick leave support, masking in healthcare settings and exploring the advantages and disadvantages of mandating masks on public transport, especially in winter.

The SMC asked authors of the article to comment. 

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

Note: Professor Baker is a lead author of this article.

“As a large group of scientists and doctors who have spent much of the last three and half years working on the Covid-19 response, we thought it was important to summarise where we have reached with the pandemic, and where to from here.“The pandemic has now caused an estimated 29 million excess deaths across the globe and lowered life expectancy in most countries. The only comparable event in our recorded history was the 1918 influenza pandemic that killed almost one percent of the New Zealand population in a few weeks. By acting decisively, Aotearoa New Zealand has avoided much of this harm and remarkably kept cumulative excess mortality down around zero.  This achievement should be celebrated.

“Now is the time to build on this success and consider how we can minimise the harms caused by respiratory infections more generally. Covid-19 has not gone away and is now established as our leading infectious disease killer, followed by influenza. The pandemic has demonstrated the need for a comprehensive respiratory infection strategy, as described in this article.

“For me personally, the pandemic response has shown the best of New Zealand. We can be a world leader in protecting our people by using the best available science, and aiming to maintain a strong, inclusive society. As a scientist I hope that we apply this approach to other major challenges such as ending the climate crisis and eliminating poverty.

“We also need to recognise and resist the huge threat from misinformation and disinformation. As this article notes, there was no increase in excess deaths associated with vaccination. The data showed the opposite trend. Fortunately, most New Zealanders trust science and take a pragmatic approach to using evidence to help them find the best solutions to life’s challenges.”

No conflict of interest.

Associate Professor Amanda Kvalsvig, epidemiologist in the Department of Public Health, University of Otago Wellington, comments: 

Note: Associate Professor Kvalsvig is a lead author of this article.

“The Covid-19 pandemic has caused a huge scientific and cultural shift in how we think about respiratory health. During the initial phase of the pandemic, a number of familiar infections simply disappeared, showing that airborne infections are much more preventable than we thought.

“Now that we know this, we must never go back. Improved indoor air quality, wearing masks as extra protection in closed, crowded places, and having the right support to stay home when sick are all highly effective measures against the viruses that we encounter every day. Embedding these protections into our daily lives will also be our insurance against the variants and pandemics of the future.

“We have the knowledge and capability to stop the spread of airborne infections, but there needs to be a strategic decision by Government to apply that knowledge. All New Zealanders should have safe access to work, education, and social settings, allowing us to experience winters without constant infections circulating in the community.

“This transformative change in our health should be an enduring legacy of the tremendous pandemic response delivered at all levels by Aotearoa New Zealand.”

No conflict of interest declared.

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

Note: Professor Turner is a co-author of this article.

“While I am sure the world, and New Zealand, are heartily sick of COVID-19, what it has taught us is not to underestimate respiratory illness.

“It is important to not rapidly forget and put the pandemic behind us. There is a critical need for ongoing focus, and to not just quietly ignore the amount of people continuing to be affected by COVID-19, along with flu and the other important respiratory viruses.

“We know we cannot eradicate these diseases, but we can significantly minimise severe disease and death.

“An integrated strategy is vital at this point to ensure our scarce resources are pitched appropriately to the most effective strategies.

“Vaccines work. The COVID-19 pandemic showed us the ability to share resources, science and knowledge to safely produce and monitor incredible vaccines that significantly mitigated the effects of the pandemic.

“However, vaccines are never going to work 100 percent of the time and immunity will continue to wane, particularly for those at highest risk of disease. We need to continue to understand the evolving world of these viruses, and the need for vaccines to evolve with them.

“We are also now in a new phase post-pandemic. If communities don’t continue to access vaccines, then the gains are lost. Our resources need to be more focused on vaccine uptake rather than just the science of making newer vaccines. We also now have the technology for better delivery mechanisms – for those who are somewhat needle-phobic or who feel needles seems ‘not natural’, we can shift to a patch on the skin for delivery (intradermal), or a squirt up the nose.

“We know from COVID-19 that a focus on community engagement alongside vaccine literacy helps trust and engagement in vaccination programmes. How we engage and support communities integrated with health services functioning is critical.

“Alongside vaccines, a combined approach across our communities and health sector is needed to protect ourselves. The ability of families to stay at home when sick, wear masks in higher risk situations, maintain social distance from those at higher risk, and keep sick children at home varies considerably based on circumstances. These strategies work but need to be applied with compassion, pragmatism and flexibility for our  communities.  An integrated approach is needed to ensure we don’t lose our learnings to date, and to build upon them to protect all our communities into the future.”

No conflict of interest declared.

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

Note: Professor Plank is a co-author of this article.

“New Zealand’s pandemic response delivered one of the lowest death rates of any country in world. By far the biggest factor in our success was ensuring that most people were vaccinated before being exposed to the virus.

“An elimination strategy was not a feasible option for many countries. And it came at a high cost – border closures and snap lockdowns were incredibly disruptive and harmful. But many other countries also had similar or even more prolonged restrictions yet suffered a much higher death toll.

“The situation we find ourselves in now is very different to 2020-22. With high levels of hybrid immunity hugely reducing the burden of disease, Covid-19 is no longer an emergency but one public health issue among many. Nevertheless, it is continuing to take a bigger toll than other respiratory diseases such as seasonal influenza.

“This means we need a joined-up surveillance and response strategy for the range of endemic diseases in our communities. Any control measures need to be cost effective and acceptable to the public. Sustainably reducing the long-term number of infections of a highly transmissible endemic virus like SARS-CoV-2 is not an easy task.

“Vaccines are still the most effective tool we have to reduce disease. New Zealand would benefit from a clear strategy for accessing updated vaccines and rolling them out to eligible groups. And we still have a lot of work to do to eliminate pervasive health inequities and raise childhood vaccination rates for other diseases like measles, which have become dangerously low.

“The pandemic response put huge strain on our systems, from frontline healthcare to backroom science like testing and genome sequencing labs. The system was operating in emergency mode for over three years which is unsustainable and led to high levels of fatigue and burn out. But Covid will not be the last public health emergency. So now is the time to invest in science, research and public health so we are better prepared for the next pandemic.”

Conflict of interest statement:  “I receive funding from the Ministry of Health for mathematical modelling of Covid-19.”