Comment: Jacinda Ardern snuck the most momentous strategic shift in New Zealand’s Covid-19 response since the March 2020 lockdown into her post-Cabinet address like a postscript or an afterthought.
The bulk of the Prime Minister’s speech on Monday dealt with Auckland’s vague roadmap out of lockdown. But the most important parts were the ways in which she discussed the elimination strategy – with past tense language.
“Elimination was important because we didn’t have vaccines. Now we do, so we can begin to change the way we do things,” she said.
Ardern never made it explicit, but the subtext was clear: Elimination is over. The Government is now expecting, even willing, to handle small numbers of Covid-19 cases in the community indefinitely. We are now suppressing the virus, a strategy which brings far higher risks that outbreaks spiral out of control and hospitals end up flooded with more Covid-19 patients gasping for air than they have ventilators to treat them with.
Don’t believe me? Take it from the experts:
“As we transition from an elimination to a suppression strategy, the government will have to tread a very narrow path to avoid overwhelming our hospitals,” University of Canterbury mathematician and Te Pūnaha Matatini disease modeller Michael Plank said.
“We are relying on a combination of restrictions and immunity through vaccination to prevent cases from growing too rapidly. As vaccination rates increase, restrictions can be progressively eased. But if we relax too much, there is a risk the number of hospitalisations could start to spiral out of control.”
Or Siouxsie Wiles, the University of Auckland microbiologist who has been one of the most stalwart advocates of both elimination and the Government’s overall Covid-19 response: “It is clear we have to keep cases as low as possible or we risk overwhelming our healthcare system, especially at the moment while over half of New Zealanders are not fully vaccinated. We all need to be mentally and physically preparing ourselves for what life with Covid-19 in our communities is going to be like.”
Covid-19 is here to stay. After 18 months of keeping the virus at bay and enjoying pre-pandemic freedoms that almost every other country in the world has left behind, we must now prepare ourselves to live with the virus.
This was not an inevitable outcome. Experts are doubtful that, even now, elimination is totally out of reach. The day before Ardern’s announcement, University of Otago epidemiologist Michael Baker told Newsroom that elimination was still achievable.
“Technically, elimination is still possible. It’s just whether there is the political and social will to do it.”
Elimination confusion
Why, then, has the Government chosen to abandon a popular and effective strategy?
The best explanation ministers have been able to provide is that social licence for the restrictions in Auckland is waning. If elimination requires a return to Level 4 – as seems possible – then elimination is now off the table.
Covid-19 Response Minister Chris Hipkins hasn’t quite explained why he thinks that. He said he hadn’t received advice relating to compliance ahead of Monday’s decision.
“We’ve certainly had clear feedback that the mood is fraying,” he said. Feedback from where?
“Correspondence, the mood on the street, the media coverage.”
Of course the “mood on the street” is grim – Aucklanders have been in lockdown for seven weeks. No one enjoys lockdown and everyone wants a swift end to it (which, by the way, suppression won’t provide), but that doesn’t mean compliance is actually down. Mobility data from Apple and Google shows levels of movement in Auckland are similar to previous periods of Level 3 restrictions. People are still following the rules.
The concern about social licence is a legitimate one. New Zealand’s success thus far has been contingent on compliance with the onerous measures because the Government has been clear about why they are needed and has explained what the scientific basis for them is. Our willingness to stay at home in some of the world’s strictest lockdowns has also been bolstered by the knowledge that 2019-style freedoms await us in Level 1.
The Government’s response thus brings up two issues. First, the new suppression strategy could mean we don’t see those Level 1 freedoms again, according to Wiles. This will immediately erode social licence for the current, slowly relaxing restrictions in Auckland.
Second, the opacity of decision-making behind the turn away from elimination is a departure from the previous clear communications and evidence-based policy.
Is elimination still possible? If so, why aren’t we pursuing it? If not, how do we know that? This is something Government ministers have struggled to explain. In fact, some aren’t even sure if elimination has been abandoned.
On Wednesday, Hipkins was clear that something was changing.
“As the Prime Minister said on Monday, getting back to zero cases of Covid-19 in the community is now unlikely. We need to prepare for a gradual transition to the next phase of our Covid-19 response,” he said.
Just 45 minutes later, he contradicted himself, saying, “We aren’t moving away from elimination.”
So much for clear communications.
Transparency sorely needed
Why can’t Chris Hipkins get his head around the strategy? If the Government genuinely plans to continue eliminating the virus, then why is it talking about a transition away from elimination, why is it relaxing restrictions as cases rise in Auckland and why does every expert in the country think otherwise?
The details will be in the health advice that Director-General of Health Ashley Bloomfield gave to Ardern and Hipkins and the documents that they, in turn, took to Cabinet.
Given the Government’s approach conflicts with the best advice from the country’s independent experts, New Zealanders have a right to know what advice underpinned Cabinet’s u-turn into the suppression experiment.
The Prime Minister has said that advice will go through the usual proactive release process, which means it will be dumped on a government website in three months’ time with no notice, by which time it will be far too late for the information to be of any use.
In the first stages of the pandemic, the Government was admirably transparent with its decision-making documents. Less than two months after New Zealand went into lockdown, a vast trove of Cabinet documents was released online, relating not only to the lockdown but to the entire health, economic and border response up until just three weeks prior to the proactive release.
Standards have since slipped. The Cabinet documents relating to the February outbreak were only released at the start of June. On that timeline, it would be mid-January before Monday’s advice is published.
Such a scenario would only further erode the social licence that has upheld our unique response thus far.
That licence will fray even more due to the perception that the end of elimination would seem to be a significant departure from the Government’s evidence-based decision-making process, given the broad opposition from independent health experts. If there is expert scientific advice backing the decision, then the public deserves to see it as soon as possible.
Such a release would also shed much-needed clarity on the Government’s intentions and expectations in transitioning to suppression. How many cases does it expect to get each day? What is the capacity of the hospital system in the event that the virus runs amok in unvaccinated communities? These questions have not been satisfactorily answered.
New Zealand’s hundreds of days without community transmission were only made possible through social licence carefully built up with clear communications, a willingness to take on board feedback from outside of Government and remarkably transparent decision-making processes.
That streak of Covid-free life has come to an end, but the social licence and transparency don’t have to.
