By Ian Powell
The Government is right in its response to New Zealand’s (Aotearoa) community transmission case of the highly contagious Delta Covid-19 variant. Yesterday, within a few hours of the discovery, it moved fast to an initial hard seven day lockdown in the risk area (Auckland and Coromandel) and three days for the rest of the country.
A day later we now know that the genome is the same as the virus currently out of control in New South Wales and that there have been at least nine further cases. As sure as day follows night, this number will increase for some time (initial modelling suggests between 50 and 120, mainly younger people) before a corner is turned. Consequently it is conceivable that both the national and localised lockdowns will be extended.
On the positive side, the first reported case did the right thing by conscientiously contact tracing and quickly reporting symptoms to his general practitioner. His actions and the Government’s fast and hard response will help combating this deadly variant.
Elimination strategy central
This fast and hard response is central to New Zealand’s elimination strategy towards community transmission. The strategy has been overwhelmingly superior in effectiveness to the alternative mitigation strategy which enables the virus to mutate into more deadly variants thereby causing the second, third and sometimes fourth country-wide waves which Aotearoa has managed to avoid.
The best indicator of the effectiveness of the alternative strategies is mortality rates. As of 17 August, New Zealand had a coronavirus mortality rate of 5 per one million. Compare this with the following countries which have gone with mitigation – United Kingdom (1,955), United States (1,887), Germany (1,105), France (1,638), and Canada (709).
Officially but late in the piece, Australia says it has adopted an elimination strategy. But in some states such as New South Wales, whose government has certain Boris Johnson-type characteristics, has been closer to mitigation. Australia’s death rate per one million is 38.
We should not be too surprised that the mishandling of the Delta variant in New South Wales is behind New Zealand’s situation. New South Wales also appears to be the source of outbreaks in other Australian states, particularly Victoria.
Achille’s Heel perception: vaccines
The Achille’s Heel of New Zealand’s elimination is its vaccination rate. This is an Achille’s Heel based on perception rather than substance. But perception can become reality if encouraged by political opportunism. New Zealand’s vaccination rate is the lowest in the Organisation of Economic Cooperation and Development (OECD).
But New Zealand is also one of the smallest economies in the OECD (smaller European economies were assisted by a whole-of-European Union negotiation with the pharmaceutical companies).
Pharmaceutical companies are driven by profit maximisation. Vaccines to combat a pandemic don’t change this situation; if anything its scale accentuates it. Bigger economies are bigger markets and therefore will always be heavily advantaged compared with smaller economies and markets like New Zealand.
Group 3 (vulnerable)
Given this major disadvantage in vaccine supply, New Zealand has done well with its procurement agreement with Pfizer. We have kept up with our overall vaccination rates which are dictated by supply dates largely beyond the country’s control. There is the contentious issue of low vaccination rates for Group 3 (vulnerable people).
More work needs to be done to understand why Group 3 rates are so low. Perhaps it comes down to what being vulnerable means and logistics. Many of those who are vulnerable are those who have difficulty accessing healthcare. It is possible that access difficulty to healthcare might also mean access difficulty to vaccination facilities.
It might also mean that data on where vulnerable people are located is limited. Further, in contrast with cities with greater critical masses, it might be logistically more effective to vaccinate all those in towns (smaller ones at least).
How is Aotearoa placed to cope
There are some differences between this second national lockdown and the first one around 16 months ago. The first one was very effective. The second is dealing with a much more contagious and therefore deadly virus. On the other hand, we now have mask wearing, water testing and better contact tracing technology.
Critical to the success of a pandemic strategy is winning the trust and confidence of the public. New Zealand’s elimination strategy has been so obviously successful compared with mitigation in North America and much of Europe. Mitigation leads to the virus returning in a more deadly form in large waves.
Mitigation with delayed and light lockdowns undermines public confidence. This has been witnessed by large demonstrations in the United States and Europe defying lockdowns and other public health measures.
This defiance further aids and abets the spread of Covid-19. In this respect New Zealand is much better placed to respond to the Delta variant than Australia, notwithstanding how daunting this threat is.
But, if we are to do this, we must stick to our elimination strategy. Softening this strategy will only strengthen Delta as New South Wales is presently experiencing.
Those who advocate mitigation (or something even less than this) argue that countries need to learn to live with Covid-19. But, as pointed out by Auckland epidemiologist Professor Rod Jackson, this actually means learning to die with Covid-19.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). For more see https://otaihangasecondopinion.wordpress.com/
