An expert panel says elimination is still the best approach even after the borders open – in a trio of reports that contain few other details
New Zealanders eager to know when and how the country will at last reopen to the rest of the world are bound to be disappointed with the sparse advice issued by an expert panel tasked with answering exactly those questions.
The first three reports from the Strategic Covid-19 Public Health Advisory Group, chaired by epidemiologist Sir David Skegg, were released by the Government on Wednesday morning. They deal with the possibility of a phased reopening of the borders to vaccinated travellers, what proportion of the population might need to be vaccinated to reach herd immunity and whether the elimination strategy will continue to be a viable approach in the next stage of the pandemic.
Any reopening will have to wait until the vaccine rollout is complete, the reports concluded. New Zealand was still vulnerable to an outbreak of the Delta variant like that which has plagued New South Wales in recent months.
However, Skegg and the other members of the panel – health experts Philip Hill, Nikki Turner, Maia Brewerton, David Murdoch and Ella Iosua – declined to address the first two issues in significant detail. They said that any plan devised now for reopening the borders later in the year or early next year would quickly become overtaken by events, as the virus continued to mutate into new variants and as new approaches overseas provided additional information about the optimal strategy.
“It would be premature to specify detailed arrangements [for quarantine-free entry to New Zealand for vaccinated travellers] at this stage, because we will need to know more about the behaviour of the virus that is prevalent early next year,” they wrote in a late July missive to Associate Minister of Health Ayesha Verrall.
“Given the propensity of this virus to mutate, and the very high rates of replication around the world, it is entirely possible that Delta may have been displaced by an even more transmissible variant (with other unique characteristics) by the end of this year. This illustrates why it is unrealistic for some commentators to be demanding firm plans for re-opening, long in advance.”
In a late June report, the panel said quarantine-free entry to New Zealand or reduced MIQ requirements would likely be limited to people who are vaccinated and returning from low-risk countries. These travellers might also be subject to pre-departure testing requirements or rapid tests on entry to New Zealand and may also have to consent to tracking of their mobile phone or EFTPOS transactions for contact tracing purposes.
Another key recommendation from the panel was that the existing travel bubbles should be narrowed to only cover vaccinated travellers once vaccines were more fully rolled out in each country.
All of this advice was predicated on what was perhaps the most surprising conclusion from the panel: that New Zealand could and should seek to continue eliminating Covid-19 even after it reopens its borders.
While the panel suggested that the elimination strategy be renamed (perhaps to a te reo Māori term) to avoid confusion, it said the principles of the approach in 2022 would be similar to those followed today.
“In our current view, the elimination strategy is still viable and, indeed, optimal as international travel resumes. It does not mean ‘Zero Covid’, but it does mean stamping out clusters of Covid-19 as they occur,” an early June report concluded.
This was based on an assumption that other countries will continue to impose restrictions on their populations during winter surges of Covid-19 and as new variants emerge. By pursuing an elimination strategy – which would probably no longer need to rely on escalated alert levels after the vaccine rollout completed – New Zealand “has the opportunity to continue to enjoy a lifestyle that is relatively unaffected by the ravages of Covid-19”.
Moreover, by maintaining elimination, New Zealand keeps its options open. We can always stop eliminating the coronavirus if it no longer makes sense, the panel said, but re-eliminating it after the virus becomes endemic would be a much harder task.
This is a departure from the position of the Government in recent months. In January, Jacinda Ardern said Covid-19 was likely to become endemic in New Zealand after the vaccine rollout.
“Our goal has to be though, to get the management of Covid-19 to a similar place as we do seasonally, with the flu. It won’t be a disease that we will see simply disappear after one round of vaccine across our population,” she had said.
And in May, Ashley Bloomfield told Newsroom that elimination would likely have to end once the borders reopened.
Skegg’s group came to a different conclusion. They said that it was unlikely New Zealand would be able to vaccinate enough people to reach population immunity – and that even if it hit a certain threshold at a population-wide level, individual communities would still fall short and be susceptible to outbreaks. While the panel didn’t offer a specific number as an estimated threshold, it said additional restrictions would likely be needed.
Those restrictions might not need to be as onerous as in other countries if New Zealand dedicated itself to continued elimination, in which outbreaks would be controlled by targeted testing, contact tracing and isolation instead of population-wide measures to dampen overall spread.
However, the panel’s conclusion that population immunity is likely not possible through vaccination alone doesn’t quite align with publicly-released research from expert Covid-19 modellers at Te Pūnaha Matatini. That study found that, for a variant as infectious as Delta and a vaccine that provides 90 percent protection against becoming infected, 81 percent of the population would need to be vaccinated to reach population immunity.
If the Government decides to allow children aged 12 to 15 to be vaccinated – now that the medicines regulator Medsafe has said this is safe – then that threshold would be possible to meet, if difficult. Of course, new variants of the virus that reduce vaccine efficacy or are more transmissible could change the calculus once again.
The panel had a handful of action items for the Government to prepare for reopening. This included piloting rapid testing at airports, reviewing the readiness of the public health system to deal with outbreaks of Covid-19 and preparing for surges of community testing in winter 2022, when Covid-19 and other respiratory illnesses will be circulating at greater levels due to the looser borders.
The Government is expected to release its response to the advice at a forum on Thursday morning. That response is not likely to be detailed, Ardern’s office has said, and it certainly won’t look anything like a hard and fast plan for reopening.
