It is clear that high and equitably-delivered immunisation coverage will significantly minimise rates of COVID disease in our community, particularly severe disease and death. To what extent will broadening vaccine mandates support improvement in immunisation coverage? International evidence for the effectiveness of vaccination mandates is mixed – if they are poorly directly, implemented in isolation, or without supportive community approaches in place, they are at risk of backfiring by polarising communities, creating entrenched attitudes and potentially marginalising further.

As NZ has now chosen to introduce broader mandate approaches, this needs to walk with balanced supportive strategic approaches. It is vital that we continue to focus on genuinely listening to local communities and the range of reasons why some are not taking up vaccination options, and being compassionate to the historic and current reasons behind why some communities have lower trust and lower engagement with health services to avoid wherever possible further marginalisation.

The recently announced extra funding into local service delivery particularly for Māori communities is important to allow communities to create their own solutions with their own local health services. Successful immunisation uptake across multiple diverse communities is a complex balance.

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Vaccination is key right now. It was announced today at the post-Cabinet update that vaccine mandates will be required in workplaces that require a certificate of vaccination for entry – once a shift to the new COVID-19 Protection Framework/traffic light system takes place. This will extend vaccine mandates to workers in high risk / close contact workplaces such as hospitality, events, gyms, hairdressers and barbers.

That employers will be encouraged to permit staff to be vaccinated during work hours and also provide other measures to facilitate their staff members to be vaccinated, is an important step to help some with vaccine accessibility, particularly for those who may not be able to get to a vaccination clinic easily during daytime hours.

The new traffic light system and COVID-19 protection framework will apply once DHBs have reached 90% vaccination rates. To ensure no-one is left behind, vaccination target details for Aotearoa New Zealand needed to include at least 90 – 95% full vaccinations for Māori and Pacific peoples. This would help keep our most vulnerable communities safe from COVID-19 – and also includes protecting our children and young people.

Although improving, Māori and Pacific vaccination rates remain behind the overall rate as more time was needed to catch-up with other groups given the initial vaccination roll-out in Aotearoa New Zealand prioritised other groups to get vaccinated first. Accessibility issues persist for hard-to-reach communities and more vaccination outreach activities and events that are resourced appropriately are needed.

Leaving any of our most vulnerable behind and unprotected, given the adverse health impact already seen for vulnerable groups in Aotearoa New Zealand, will have far reaching consequences. It will be important for DHBs to ensure an equity focus for their vaccination efforts that results in appropriate and targeted approaches for people that reduces barriers and builds trust, to get help and assistance out to those who need it most.

The 12-15 year old age group is the most recent cohort to be added to the vaccination programme, and if the Pfizer–BioNTech COVID-19 vaccine is approved for use in children aged 5-11 years, both these young groups must be supported to get vaccinated. The best way to protect our children who currently don’t yet have access to a vaccine approved for them, is for everyone around them to get vaccinated. Of those affected by the current Delta outbreak, a total of 466 were or 17% were children aged 9 years and under, who were infected by the virus and ended up with COVID-19 – this also included babies.

In the meantime, we must protect those who cannot protect themselves right now, and this includes our children, who still don’t yet have access to a vaccine that will keep them safe from COVID-19. Getting vaccinated demonstrates our commitment to keeping others safe – including our most vulnerable.

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The recent announcement that workers in a business that requires vaccine certificates for visitors also must be vaccinated makes a lot of logical sense – there would be a negative impact on public health risk if individuals could be unvaccinated and work in these high-risk venues.

It is clear that the proposed framework minimises infringement on essential rights by ensuring that vaccine certificates cannot be required for essential services like supermarkets and healthcare facilities. The human rights case for access to venues like gyms and hairdressers is significantly lower than access to essential services.

However, it is important that the government does not get lost in a focus on increasing vaccination rates as the ‘be all and end all’, particularly with language around using mandates to incentivise vaccination (or disincentivise not being vaccinated). We should acknowledge that vaccination is to reduce public health risk as the ethical basis on which these mandates are introduced. It is not just about individual rights, but also the rights of the community, not just from individuals getting sick, but also the demands on our healthcare system that everyone relies upon.

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When we move to the new traffic light system, we will be relying more on vaccination and less on blanket restrictions to manage the spread of Covid in the community. This is a good thing because nobody wants more lockdowns. But it means that the health risk we all face in our day-to-day lives will depend on whether people we come into contact with are vaccinated.

Vaccine certificates and the new vaccine mandates for workers announced today are first and foremost a tool to reduce the spread of Covid and to protect people’s health. If an unvaccinated person goes to a venue, an event or a workplace, they are putting the health of those around them at risk. They are also adding to the overall burden of Covid on our health systems.

There is no magic bullet to get rid of Covid so we have to do what we can to minimise its impact. We can either use blanket measures like lockdowns which place restrictions on everyone. Or we can use vaccine certificates which restrict the freedoms of the small minority of people who choose not to be vaccinated.

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From a business perspective, the move to make vaccination mandatory for high risk / close contact workplaces shows the government taking responsibility rather than leaving the risk on employers. This is a complex area that requires combined input from a range of disciplines, including health, employment and law. If the decisions had been left with employers, it would have resulted in the courts having to determine the nation’s pandemic response.

The move is likely to polarise workers. The pressure will now be on welfare agencies and unions to find ways to support those workers who lose their employment.

Employers in other industries should now be looking to proactively educate and support their staff so that workers can make an informed choice now, of their own volition. The first measure should always be encouragement rather than mandates. Compulsion takes away a worker’s sense of control to make their own choices, which makes some threatened and more opposed.

There needs to be specific provisions for people who are genuinely unable to be vaccinated for medical reasons. They should not lose their employment.

The government must also strengthen the internal borders in order to protect businesses and workers. Australia shows that this can be done, so that issue needs to be revisited. The country cannot afford to have businesses in other parts of New Zealand also locked down in the way that the North is. The $4.8 billion of government support paid since August is only a portion of the losses involved. Vaccination targets are good but stronger border-protection actions are needed now – to protect businesses, jobs and livelihoods throughout the rest of Aotearoa NZ.

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Mandatory vaccinations are long overdue and in line with many other behaviour change strategies.

Many organisations want to affect behaviour change. The first step to behaviour change is typically raising awareness and offering something that individuals value, so they freely adopt the desired behaviour. Think advertising for highly successful brands. They never go on sale. They are so well designed, consumers simply want them.

However, awareness and intrinsic value are not enough to affect the desired behaviour change in all individuals. Other individuals require incentives for adopting the behaviour or disincentives for not adopting the desired behaviour.

Mandatory vaccinations are long overdue because those who remain un-vaccinated or under-vaccinated impact everybody else in New Zealand. The more people are negatively affected by a behaviour, the more important it is to make the behaviour mandatory and to have clear rules in place for those who may flout those rules. It seems uncomfortable and risky. But it isn’t.

This is where the government can take comfort from how they handle other mandatory behaviour change strategies: speeding in one’s car, driving while under the influence, or causing an environmental disaster as a business. The rules are clear as are the incentives for adopting the desired behaviour: speeding and drink driving: to live, arrive safely and continue to drive; not causing an environmental disaster: to be well respected by the community and to continue to operate as a business. The disincentives are also clear: fines, possible loss of being to operate a vehicle or not being able to continue to operate as a business.

Therefore, mandatory vaccinations have to be supported by clear incentives and disincentives. This will maximise how many New Zealanders will be doubly vaccinated and how quickly they will do so.

The only remaining question is why the desired behaviour is not mandated across all businesses. Collectively we stand to lose too much to make vaccinations optional.

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