Two public health experts from the University of Otago, Professors Nick Wilson and Michael Baker ,whom have been challenging the government’s approach to managing covid19 throughout the year, have now called for an inquiry into our management of the pandemic.
In Professor Wilson’s opinion, “our success has just been luck”. He says “on some things like border control initially we scored highly, but on several others , low or sub-optimally. There has been a lack of strategic thinking and a lot of tactical areas that have been deficient”. Like “on the promotion of wearing of masks”.
He says“ it is such a rapidly changing problem, we need an independent group able to continuously review things and give the government advice.” Professor Wilson added “ we have to get things fixed up or there could be more outbreaks.”
As of September the 1st, New Zealand ranked 35th in the world for infection or death rates. Countries that have done better include several close to and highly connected to China, like Taiwan (just 7 deaths).. Why have they done so well?
Professor Baker: “these countries knew how to respond because of their experience with SARS and in the case of South Korea, MERS.”. They acted quickly; Taiwan started boarding planes from China to test people on the 31st of December and sent anyone with symptoms home to isolate immediately. They gave them a government cellphone and monitored their condition and their movements daily and quickly upgraded health interventions if necessary. Vietnam , Thailand and Taiwan closed their borders early– and immediately set up tracing and testing systems. Elimination was achieved earlier there than in New Zealand and without the economic hit of a lockdown.
Professor Baker said “New Zealand’s response was the best in the OECD, but that’s a very low bar”.
After SARS, the coronavirus epidemic of 2003, Taiwan set up an interlocking set of agencies in it’s government, geared towards early detection of pandemics, with containment plans and supply stockpiles. They established a Central Epidemic Command Centre ,which they activated on the 20th of January , with 120 actions in place by the 10th of February. When the pandemic hit they integrated their health database with their travel database to identify people most at risk and went to extraordinary lengths to secure PPE.
By contrast, in New Zealand, pandemic preparedness amounted to only having a plan for influenza, no central agency to manage any outbreak, no PPE stockpiles and “a very low
testing or contact tracing capability” said Professor Baker. “We had a very low base of capacity” he stated.
Professors Baker and Wilson and other experts had been warning the government for years that we had a problem of unpreparedness. In a paper they co-wrote this year they said “In 2019 New Zealand was given a score of only 54% for pandemic preparedness on the Global Health Security Index “ which they agreed with , “given New Zealand’s poorly developed epidemiology workforce and underfunded public health infrastructure”. They had advised Ministry of Health officials of a need for a border control plan in 2019 but officials replied saying “we are never going to close borders.” According to Professor Wilson, MoH officials were “not interested in anything other than influenza,” and “had learnt nothing from SARS and MERS”.
Initially, MOH officials advised the government to use a mitigation strategy for covid19, keep the borders open and to ‘flatten the curve’. In March, Professor Baker and colleagues from the University of Otago showed this would likely result in thousands of deaths and that elimination was a much better strategy. The government listened and changed course, “just in the nick of time”, according to Professor Baker.. Professor Wilson said “We succeeded at elimination, but since then complacency set in” He said “We didn’t adopt good contact tracing technology and we tested random sections of the population instead of incoming New Zealanders and border officials”.
In a report on last year’s measles epidemic the Professors concluded that we needed a strong public health agency to prevent or minimize disease outbreaks. They say “This lack makes responding to large complex issues difficult”.
The chronic underfunding of our public health system, with low numbers of ICU beds per capita, and a stressed and overworked medical workforce, meant “had the epidemic been a bit worse, we could have been in trouble” said Professor Wilson.
He and Professor Baker argue we need a public health agency with “a strong critical mass inside the Ministry of Health” staffed by a range of experts.
Until then, they say we need an expert independent inquiry , functioning as an advice body for the government, “providing updated revisions on surveillance of the disease, testing systems, etc.”. Professor Wilson added “we could have an inquiry every two months or so and update advice frequently”. Professor Baker said “the review could be split into two parts, with the high priority questions looked at now and lower priority questions later”.
“Also”, he said, “we need to invest in public health infrastructure for 5 -10 years and train an epidemiology workforce” to be ready for future crises.
Professor Wilson says “we must be ready for future novel disease incursions, especially considering the probability is heightened by climate change; or synthetic bioweapons”.
Let’s hope the government listens to them before the next crisis hits.
Joseph Dougherty