A recurring theme in contemporary literature is of the plague that appears suddenly from nowhere and takes hold of the world, destroying or severely damaging life in the process. In 2003 acclaimed author Margaret Atwood’s novel Oryx and Crake was premised on a super-pharmaceutical cutting loose and causing a global pandemic. The 2011 movie Contagion focused on a global pandemic that jumped from animals to humans and spread around the world. Perhaps most eerily of all though the American science fiction writer Dean Koontz predicted in a 1981 novel the emergence in 2020 of a man-made virus called Wuhan-400 with a 100% kill rate, which had been developed in Wuhan as a biological weapon but got out of control.
Although all these accounts are fictional, and while the tolerance for conspiracy theories should be limited even at the best of times, they do draw attention to situations that could become reality at some point. Yet, despite various occasional national and international warnings from researchers and clinicians, the Covid-19 outbreak has shown overall that the world was in a relatively poor state of preparation for such an occurrence.
This was notwithstanding the fact that in the last decade alone a number of global disease threats had appeared – Ebola, Zika and coronaviral diseases like Severe Acute Respiratory Syndrome, known more commonly as SARS-Cov-1, to name just a few. Add to that, the constant threat of influenza related epidemics, and bioweapons, and the world should have well and truly been prepared for an event like Covid-19.
The New Zealand Influenza Pandemic Plan was published by the Ministry of Health in August 2017. It is a thorough and comprehensive document, but it does not appear that all that much has been happening since then to implement it. As early as late 2017, in the wake of the Ebola crisis health professionals were warning that New Zealand’s preparations for dealing with global disease outbreaks needed to be stepped up, both in terms of clinical and research capacity, and wider community response strategies.
The Pandemic Plan calls for “a nationally consistent monitoring and surveillance system during the period between pandemics” as an “essential component of preparedness.” It urges that “overseas trends must be monitored and analysed and surveillance systems in New Zealand maintained to enable the early detection of a novel influenza virus following announcements by WHO, and these systems must be capable of tracking the progress of a pandemic in New Zealand.”
But it is not clear what notice the government has taken of all the warnings. The difficulties we now hear reported almost daily of tracking Covid-19’s spread around New Zealand, and the initially slow and chaotic response, the shortage of essential items like ventilators, masks and gowns, not to mention the confusion over community testing, all confirm that the Plan has not been given the priority it deserved.
While not much can be done about that now, there are lessons for the future about the need to ensure that neglect never happens again, and that we are better prepared for the next global pandemic, whenever and in what form it may occur.
Because, as we have seen, the response to a major pandemic is a whole of government and not just a Ministry of Health issue, the way we deal with it needs to be similarly broad-based. Although the Plan acknowledges that, the response it suggests is a little narrow. It suggests the Ministry of Health should be the lead agency, but these issues are simply too big to leave to any one agency as the lead as is the case now. There needs to a single standing all of government agency, reporting directly to the Prime Minister on a quarterly basis.
That agency needs to have the capacity to review from time to time the overall state of future preparedness, and to be able recommend changes as necessary. It needs to be able to suggest to universities, research institutes and Ministers areas for future desirable research and to recommend appropriate levels of investment to ensure they occur. Also, it needs to be empowered to challenge the operational autonomy of District Health Boards to ensure a consistent range of clinical response is available across the country in such situations. PHARMAC needs to be in this loop as well to ensure funding is available to keep up the appropriate level of medicines and medical devices.
At the civil level, the pandemic co-ordination agency should set the parameters of any Police operations, both at the national and individual levels. For example, it is neither good enough nor acceptable for the Commissioner of Police to be able to say as he did this week, that while detailed operational instructions have been issued to individual Police officers during the current emergency he is not prepared to make those public. The Covid-19 response is not just another (albeit bigger than normal) Police operation so cannot be conducted that way. It involves many more public organisations than just the Police, so in these instances it needs to be clear that its traditional “constabulary independence” from the government has to become both subservient and accountable to the whole of government process.
While the immediate focus is on getting rid of Covid-19 in New Zealand, it would be foolhardy in the extreme to treat this as a once in a lifetime situation. Rather than filing plans like the New Zealand Influenza Pandemic Plan on a shelf, we need to be ensuring they are constantly updated and kept in a state of readiness so that when next required they can be given effect to at a moment’s notice.