Vaccinators are the first people in New Zealand to get the Pfizer/BioNTech Covid-19 jab. Border and MIQ workers and their families will start getting vaccinations next, with the government planning to immunise thousands by mid-March as part of its rollout plan. The SMC asked experts to comment on the rollout.
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I am super excited about this roll out, it marks the beginning of the end of the pandemic in New Zealand as we have come to know it. Vaccination of our border workers and their close contacts will provide firstly, direct protection to them, and secondly an additional barrier against the virus entering the community.
This is not the time to let down our guard, vaccination is an additional tool at the moment, on top of masks, distancing etc. Only when we have achieved the vaccination of a high proportion of our team of 5 million and the threat of COVID has vastly diminished can we let down our guard.
Experience overseas with COVID vaccines is extremely encouraging. In particular, Israel who have vaccinated a higher proportion of their population than anywhere else in the world and have been measuring the effect very closely. They are using the same vaccine as NZ is about to start using. So far, after only seven weeks of vaccinating like crazy, they estimate 94% of infections have been prevented in vaccinated groups when compared with unvaccinated groups. It is worth noting that most people vaccinated in Israel are older folk so clear evidence that the vaccine is very effective in this important group.
Rolling out a national COVID-19 immunisation program is a major clinical, ethical and logistical challenge. This will be New Zealand’s largest immunisation campaign. But New Zealand is in the lucky position of having no or minimal community spread of COVID-19 and therefore has been able to formulate a careful and robust sequencing and distribution plan.
Because we do not yet have sufficient evidence of the impact of vaccination on transmission, for now, we should be focusing on allocating vaccines so as to prevent morbidity and mortality from COVID-19. Distribution needs to balance ethical values (getting vaccines to the right people in the right order) and pragmatic considerations (how to simplify and streamline delivery). So for example, we shouldn’t be trying to identify high risk individuals because this is too burdensome and slow. Instead we need to identify high risk groups – for example, border workers, MIQ workers, front line health workers, or people over the age of 80.
Similar ethical values underpin vaccine allocation plans internationally: these include harm minimization, equity and responsible use of resources. However the relative emphasis on these values differs between counties; for example New Zealand gives higher priority to equity than many other countries. Equity can be defined as the absence of avoidable differences among groups of people, and in New Zealand this means a strong focus on ensuring that Māori and Pacific communities (as well as other high-risk groups) have fair access to the protective benefits of vaccines. Harm minimization is a foundational principle in all vaccine allocation plans; but the high-risk groups will be different depending on the state of the pandemic in different countries. We need to be guided by the epidemiological evidence. In countries like New Zealand, with no or minimal community spread, those most at risk of COVID-19 exposure are people (and their close contacts) working on the borders and in MIQ facilities. In countries with a lot of community spread, those most at risk will be older people and front-line health workers.
Vaccine allocation plans in the US have been criticised for failing to ensure that disabled people are appropriately prioritised. MOH in NZ should continue to work with disabled communities to ensure they have fair access to vaccines here. A common challenge in Western countries (Europe, North America, Australia and New Zealand) is that some communities who are at higher risk of severe COVID – and could therefore get significant benefit from the protection of vaccines – have greater vaccine hesitancy. This stems from both historical and current patterns of bias in the health system that continue to harm or disadvantage marginalized communities, for example people of colour. Equity requires sufficient resources and targeted communication approaches to address trust barriers and ensure Māori and Pacific communities get a fair share of the protective benefits of vaccines. In Singapore for example, the government task force has suggested authorities will likely go door-to-door in a public education campaign to explain the benefits of vaccination and help seniors to make a booking. This approach wouldn’t be feasible in New Zealand given our dispersed population; but the key point here is that addressing equity barriers requires adequate resources and creative strategies to ensure fair access to essential health services such as immunizations.
It is encouraging to see the start of the national COVID-19 immunisation programme today, starting with vaccinators and then moving to MIQ workers. This is an important part of New Zealand’s border defence against SARS-CoV-2. It is worth noting the incredible effort of scientists, manufacturers, and regulators to get us to this point in little over a year since the virus first emerged.
This vaccine has gone through rigorous safety, immunogenicity, and efficacy testing. Tens of thousands of people around the world have volunteered to participate in the clinical trials and we owe them our gratitude. Furthermore, this vaccine has now been delivered to millions of people around the world, and its safety confirmed. The public should have every confidence in the vaccine development process for this vaccine; the rigour of that process has been confirmed by a robust assessment by Medsafe. I look forward to ongoing roll out of the COVID-19 vaccines over the months ahead.
The first COVID vaccines have arrived, so what’s next? New Zealand is in the fortunate situation of not having an epidemic with overflowing hospitals and intensive care units on the news each night, and being able to watch what other countries have done. Our COVID free status also creates difficulties – just as lack of a “clear and present danger” naturally leads many to not see scanning with their COVID Tracer app as a priority, it can also make perceived risks of an unknown vaccine seem more of a worry than lack of protection from an unknown virus. The facts are that the upsides of being in a country with virtually no risk of COVID and one where you can acquire almost risk-free protection through vaccination far exceed any downsides. But we are talking not about rationality, but about motivation – for adults to get themselves vaccinated – always a tougher ask than bringing along their children, and that’s just at the individual level.
New Zealand’s only other experience like this has been the national effort to rollout a vaccine to protect against a specific of meningococcal bacteria – type b – which was causing a home-grown epidemic of life-threatening disease with over 500 cases a year between 1995 and 2003. The vaccine was rolled out very successfully with high quality safety monitoring but the uptake among older children was not nearly so good as among babies. In 2009, the last influenza pandemic (often called swine flu) looked like it might require a whole of population response but turned out to be much milder than feared and both enthusiasm and need fizzled.
This time, like other countries, New Zealand will be aiming to vaccinate all adults down to 16 years, with children down to at least 10 likely to come soon after, with the order of vaccination based on risk. As far as risk of COVID goes, it is just our border workers, so they absolutely need to be first off the block. They will be followed by health and other front line workers, including those involved in transport. Next are those in the general population at risk of severe disease if they were infected with COVID – so older adults and younger ones with other health problems. Finally, moving down to all adults as vaccine supplies become available. Fortunately, unlike the UK or the US, time is on our side, but it is still a mammoth task. Not just for general practice, but also pharmacies and other sites will need to contribute as they do for influenza vaccines (remember them?) to make vaccination as easy to access as possible, especially for adults still in the workforce.
Is it worth it? Absolutely – it may be that some people feel that as they do not plan to travel, and don’t mind if the tourists come back or not, vaccination is not a priority. However, New Zealand needs, and has thrived on, travel. Mobility for visitors and students – coming in and going out – is vital for our ongoing prosperity. As the virus changes and adapts – to keep itself thriving – we need to be one step ahead by being protected against severe illness and the only safe way to do that is through vaccination. After all, we never would have closed borders and put lockdowns in place if the risk of severe disease was not so much greater than for seasonal flu. It’s unlikely that the world, and therefore New Zealand if we are open to the world, will be able to get rid of COVID. But if COVID really becomes “just the flu” – which will only happen with high vaccination rates – we could end up in a better place than we came from, but only if the “team of 5 million” pulls together.
Given the very low levels of community transmission in NZ our rollout approach will appropriately focus first on those most at risk of being in contact with people likely to transmit Covid-19 (our border / MIQ / border-associated workers) and their families. Conversely other countries (such as the UK) experienced high levels of transmission and risk to particular groups such as elderly and those with existing health conditions, so their rollout focused on those at-risk groups.
As I understand it anyone who is a current vaccinator can undergo the Covid-19 specific training – there are lots of vaccinators already in primary health care, and this can include GPs, although we already know that GPs are extremely busy so we need the widest vaccinator workforce for this initial vaccine roll out.