The two-year anniversary of New Zealand's adoption of the elimination strategy and a lockdown that successfully stamped out the first wave of Covid-19 was recently marked. It was the week that the government announced a major relaxation of Covid-19 control measures in response to the Omicron variant wave sweeping the country.
The New Zealand Covid-19 response has been one of the most successful in the world. It got the country through the first 18 months of the Pandemic, and it had low Covid-19 mortality rates. Life expectancy increased during this time. It has been found that protecting public health has resulted in good economic growth and low unemployment.
The shift to mitigated was supported by the lower severity of Omicron. The current Omicron wave has pushed the number of patients in the hospital to over 1,000 at its peak and the cumulative deaths are approaching 400. Many thousands of future cases of long Covid seem plausible in adults and children. In the months ahead, New Zealand will need to strengthen some controls. What can it learn from the past two years?
Principles matter. The New Zealand government emphasizes that the response is focused on protecting public health. A number of key principles have been reinforced by this starting point, notably: leadership that listens to the science, use of the precautionary principle in the face of uncertainty, and creation of legacy benefits for our healthcare and public health systems.
Communication matters. Pandemics are a threat.
People's behavior affects others. The elimination strategy was able to celebrate the benefits of working together. Given the nature of Omicron, it is understandable that an alternative framing of learning to live with it is emerging. The framing puts too much responsibility on to individuals and vulnerable groups to manage the risks they face. We need to emphasize the value of shared health security, the benefits of collective action and the role of government.
Political consensus and transparency matter. Efforts were made to achieve multi-party agreement during the initial phase of the response. The agreement has now fractured, with the response becoming more politicized. The lifting of some safeguards two weeks ago was a sign of this. Politicians need to revisit mechanisms that strive for transparency. This is important for Covid-19 but would be essential for worse pandemics.
Infrastructure matters. New Zealand has struggled to manage a number of public health problems, including a contaminated drinking water outbreak and a national measles epidemic. The erosion of public health infrastructure is one of the reasons for these problems. The establishment of a Public Health Agency and the Māori Health Authority are two things that may be addressed with health sector reform.
This is a good time to build on the infrastructure that was assembled during the response.
Pandemic tools matter. New Zealand has to quickly develop a new set of tools to manage the threat. There are systems for border management, a national immunisation register, vaccine mandates/passes, a national case and contact management system, and frameworks to manage physical distance and mask use.
The importance of funding service providers has been highlighted by successfully rolling out vaccination. The response has been supported with improved information tools. There is need for continued investment in these areas.
Safe indoor environments are important. The Pandemic has shown the importance of the indoor air environment for the transmission of respiratory infections. The value of using masks has been highlighted by this awareness. It's still necessary that high-quality indoor air quality is year-round and cost-effectively combined with thermal comfort.
As part of a future official inquiry into the Pandemic response, accessible and effective health care services will hopefully be considered, as well as other things that also matter.
The response to Covid-19 has taught us a lot, but the future threats will remain challenging. New Zealand needs to keep its focus on core principles, effective communication, building consensus and continuously upgrade its public health systems and tools.
Prof Michael Baker and Prof Nick Wilson are epidemiologists at the University of Otago.
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