With a week left before larger shipments of Pfizer vaccines arrive, we’re left relying on nurses’ ingenuity to keep the rollout rolling out, Marc Daalder reports
ANALYSIS: New Zealand is on the verge of running out of vaccines – and has been for weeks. Efforts to scale back the rollout to keep us limping along until larger shipments arrive in July have failed. Now, Director-General of Health Ashley Bloomfield says, our only hope is the skill of our nurses on the frontline.
For months now, we’ve known that the end of June and beginning of July could be a bit turbulent.
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The Government was insisting back in April that everything was ship shape, with Associate Health Minister Ayesha Verrall saying the programme had been deliberately slowed “so that we don’t need to unroll the vaccination programme we are rolling out”.
By May, things started to look a little shaky. An iceberg started to float into view as someone realised that District Health Boards were vaccinating more people than they were supposed to, leaving fewer doses for the critical days and weeks before massive relief shipments in July.
This "may mean that towards the end of June, we have to slow down for a little bit. We're not talking about slowing down for a long time. It may be days, it may be a week or two before we start to see big deliveries coming in," Covid-19 Response Minister Chris Hipkins said during a regular vaccine update in early May.
The next day, the Prime Minister went further in lowering expectations.
"I should note, that even with planning in place, there is some risk that we’ll have a period between shipments when we run low, or out of vaccine temporarily," she said.
"If this does happen, it would be prior to the larger deliveries we are expecting in July, but does speak to the difficulty in scaling up smoothly and managing eligibility, demand and supply."
Of course, a temporary disruption to supply wouldn't sink the rollout in the long term. It would still be an embarrassment to a Government which had earlier copped criticism for not using up all the supply it had on hand. The Government's response to that was to argue that slowing the early rollout was preferable to a slowdown or stoppage later in the year. Now, all of that might have been for naught.
Moreover, a temporarily halt to the rollout would throw up logistical issues around cancelled bookings and vaccinator shifts.
Come early June and it was an all-hands-on-deck situation. Or rather, a recognition that there remained too many hands on deck, with DHBs still racing ahead of schedule.
After columnist Matthew Hooton wrongly claimed in the NZ Herald that the country would run out of doses in a matter of days, Bloomfield was forced to issue a rare Friday afternoon press statement rebutting him. In that same statement, however, Bloomfield said he had just ordered DHBs to scale back their rollouts (without cancelling new bookings) because "stocks will be tight for the next five weeks and we have planned carefully to manage our way through".
This never happened.
Vaccinations dipped that week but more as a result of the nurses' strike and the Queen's Birthday holiday. DHBs were now cumulatively vaccinating 7 percent ahead of plan. That rose slightly the next week and dipped slightly this week, but we're still at 107.64 percent of the plan.
As DHBs struggled and failed to turn the boat around, Hipkins grew more dire with his warnings.
"There will be a few sleepless nights around that time," he said of the end of the month.
"We are going to be living for a couple of weeks a pretty hand-to-mouth existence when it comes to vaccines arriving and us pushing them out as quickly as we can ... we have made the decision to run our vaccine stocks down to nothing so that we can keep the vaccine campaign going but it does create quite a lot of pressure on the people who are doing it and some risk if there is a delay in any of the shipments arriving."
On Wednesday, he revealed that the Government's plan indicates we will likely have just a single day's stock of vaccines by the time 150,000 doses arrive on Tuesday at the start of the big Pfizer influx.
However, he told Newsroom that figure was based on DHBs vaccinating according to plan – and we're still 7 percent ahead, or just under 79,000 doses ahead. That's four days' worth of doses.
There are a couple things running in our favour which may stave off the crash. First, we've wasted far fewer doses than we might have expected. The Ministry of Health says just one in 200 doses is going to waste, compared to the World Health Organisation's recommendation that countries plan for 10 percent.
Factoring in the improved wastage rate, we likely had around 116,000 doses in the country as of Tuesday evening. That would fall below zero if we had in fact lost one in 10 doses.
Over each of the past two weeks, we've administered more than that number of doses. This would indicate that, if DHBs don't scale back dramatically this week, we may run out of vaccines before next Tuesday.
The ability of DHBs to scale back may also be constrained by that mandate from Bloomfield that existing bookings not be affected. It's entirely possible there are more pre-booked vaccinations in the next week than there will be vaccines in the country.
Our only saving grace? The ingenuity of our nurses. Bloomfield said the country could still scrape by at 6 or 7 percent ahead of plan because some nurses were managing to get seven doses out of each vial of vaccine. The plan and the stock numbers were all calculated based on an assumption there were just six doses in each vial.
The key determinant of whether we run out, therefore, will be how many nurses can wrangle seven doses out of how many vials.
There's certainly no guarantee we won't run out over the weekend or next week. Time to batten down the hatches and hope the rollout doesn't run aground.