Tough decisions we’ve had to make in order to protect NZ from Covid will pale in comparison to those we must make soon. Sir Peter Gluckman explains.
Science has played an essential part in Aotearoa New Zealand’s response to this phase of the pandemic. Astonishing progress in vaccine development and the role of public health science has informed Government’s decision-making. However, decisions that led us to effectively exclude the virus from our shores were simple compared to the tougher decisions that must be made soon. And while science will have a critical role to play, it alone cannot, and should not, answer the questions ahead as we move away from an exclusion strategy.
The costs of Covid-19 extend well beyond the illness itself to continuing impacts of both the virus and our response to it on the rest of the health system, mental health and well-being, and family ties. Sadly, such impacts extend to family violence and economic insecurity as well as ongoing and negative effects on our economy, education, innovation opportunities, international business relationships, and our diplomatic footprint.
The emergence of transmissible virus variants was inevitable and there could be more challenging variants ahead. As seen over the past 18 months, even with tight border restrictions, the virus will repeatedly seep through. The primary goal of total viral exclusion was to buy time to develop an alternative protection strategy, primarily based on vaccines. These have emerged faster than anticipated. The double doses of the RNA vaccine we use now are highly protective. In future years, there will be boosters (possibly needed rather soon), refined vaccines, and antiviral drugs to reduce harm further, but decisions must be made here and now, with what we know, and what we have.
Hopefully we will soon reach vaccination levels of perhaps 85-90 percent of New Zealand’s population over 12 years old. Yet this is only about 75 percent of the total population. Then we will face decisions about vaccinating children under 12 and the need for boosters. Thankfully, international science will inform us on these.
When will such high vaccination rates allow the balance to tilt from efforts to exclude the virus to a different management strategy? This cannot be far away. But it too has costs and risks, especially for those who are not vaccinated. Are incentives now needed to get as many as possible of the hesitant and resistant vaccinated? What else needs to be in place? Do we need both internal and external vaccine passports (with strong legal protections on how they would be used)? Should widespread use of rapid self-testing – now well used in Europe – be adopted? Should employers be able to require masks and/or vaccines, and does that need legislative protection? These questions, which all have ethical and “social licence” dimensions, go hand in hand with the more obvious ones of border triage, rapid testing at the border, modified entry management, ensuring adequate health facilities, and location of quarantine facilities.
Neither science nor politics alone can answer such equations. Whatever choices Government makes will involve trade-offs and time-sensitive decisions. These will necessarily be made in the face of incomplete knowledge and contestable perspectives and values from different elements of our community. “Social licence” and trust will be necessary for whichever choices are made.
Trust, truth and transparency
Fear can undermine democracy. Parliament’s 2020 Epidemic Response Committee – a truly democratic innovation receiving much international interest – played a major role through its transparency, contributing to broad public acceptance of trade-offs required in following the elimination route. Similar levels of truth and transparency will be key for future choices. The Government’s challenge is to ensure trust in the pragmatic decisions it must soon make.
Broader scientific contributions and contributions beyond science will both be needed. Public health expertise is certainly central, but also needed are social sciences, including communication and behavioural sciences, economics, and more. Business, local leaders, iwi leaders, and others must feel that decisions made have considered their interests. Ultimately, the decisions must remain with our elected Government which, by any measure, and putting partisanship aside, has done an outstanding job in keeping New Zealanders safe.
It is much more challenging to ‘open up’ than ‘close down’. In crisis and risk management, the concept of the ‘Red Team’ has emerged. Comprising a group of experienced and skilled people who have no responsibility for managing the crisis but have access to the same data as those who are, it can ask tough questions of the decision-makers, in real time. Given the complexities and the need to get beyond political point-scoring, trust could be enhanced for our ‘team of five million’ through using such a process. After all, we want our Government to continue to do the best job possible on all our behalf.