The ever-shifting sands of the Covid19 vaccination programme are increasingly eroding the credibility of this government. 

In January the Prime Minister proclaimed that 2021 would be the “Year of the vaccine” – much the same way as she had promised 2019 would be the “Year of Delivery”. But, just as the idle promises of 2019 quickly dissolved into dust, as this year has unfolded January’s bold proclamation is looking more and more like a soothing optimistic wish rather than a statement of achievable intent. 

As the seventh month of the year passes the blunt truth is that only 17% of the New Zealand adult population has been fully vaccinated. This compares extremely poorly with the United Kingdom (nearly 56%); Spain (55.3%); Germany, Italy and the United States (all just under 50%). Nor is there any real sign that New Zealand’s vaccination level is likely to come anywhere near that of those countries anytime soon. Indeed, the government no longer talks as it used to of everyone who wanted to being vaccinated by the end of the year – now it speaks of everyone having the opportunity to book a time, rather be vaccinated, by the end of the year. This is another re-writing of its own previously set-out timelines. 

Despite increasingly Goebbelesque announcements that the vaccination rate is running well ahead of schedule there continues to be a steady stream of media stories about people wanting to be vaccinated, but not being responded to. To date, according to official statistics, about half of those over the age of 65 have been fully vaccinated, but two-thirds of those in Group 3, the group considered by the Ministry of Health to be those “at risk of getting very sick from COVID-19” are still waiting to be vaccinated. 

Yet now, those in Group 4 – basically the rest of the population who are not border, or managed isolation and quarantine workers, and those in other high-risk occupations – are now being invited to “apply” for vaccination, while the bulk of the most vulnerable population are still waiting to be vaccinated. It makes no sense. Meanwhile, despite reports of so many people being desperate to be vaccinated, a mass vaccination event planned for Manukau this weekend has struggled to sign up enough people. 

The upshot is still only a small number of eligible people will be fully vaccinated over the next five months, meaning the prospect of the restrictions New Zealanders still live under look certain to be with us for most of next year, at least. And the government appears to think this is acceptable. It is a pity that it is not heeding the advice of President Biden who, last week told Americans, that the only way life would return to normal in their country was through comprehensive vaccination. Yet there does not appear to be anything like the same sense of urgency to achieve that in New Zealand. 

Rather, the government here seems content to meander along, assuring us all will be well, and that we are safer here than any country on earth, so the requirement for vaccination is less urgent, even though we are just one transmission away from a mass outbreak here. It is beginning to look increasingly like the government is quite happy to drag the Covid19 situation out for as long as possible for fear of resolving it and then having to address more intractable problems like housing, increasing child poverty rates and climate change, all of which it made bold promises about but has similarly failed to deliver on. 

Aside from the politicians whose promises have been wilfully optimistic to keep the public happy and content, the real blame for New Zealand’s current situation lies with appalling strategic leadership by the Ministry of Health and the district health boards. 

The chasm was highlighted recently by a reminder from the Prime Minister that the rollout of the vaccination programme was largely in the hands of the district health boards, and there was not much the government could do to push them along. So, why did the government give them that responsibility in the first place, especially since it has already acknowledged that they are an inefficient and cumbersome structure, which it intends to replace with a more centralised Health New Zealand? 

A far better approach would have been to have bypassed the district health boards altogether and instead engaged with general practitioners, pharmacists and specialist health providers right at the outset and given them direct responsibility for the vaccination programme and the funding to do it properly. After all, they know their patients best and could have got to those with the greatest urgency more quickly and directly. Working that way would have cut out much of the duplication now occurring where patient information held by GPs cannot be passed on to district health board vaccinators, meaning patients have to provide it all over again, when they turn up to a vaccination centre. 

All the district health boards’ handling of the vaccination rollout to date has done is reinforce the case for their abolition as soon as possible. 

As for the Ministry of Health, it has lacked leadership from the day its Director-General became more a media star than a departmental chief executive. Under a genuinely operationally and healthcare delivery focused leadership, which it currently lacks, the Ministry would never have recommended that the government hand over the vaccination programme to district health boards and would have instead focused on community-based delivery mechanisms that work and deliver the most immediate assistance to the public. As the vaccination rollout becomes more problematic and the public more frustrated and disenchanted, the Ministry needs to get back to basics. Its focus from now on must be getting many more jabs in arms as quickly as possible, by the best practical means. 

For its part, the government needs to stop all the pious waffle, soothing noises, and increasingly blatant self-justifying half-truths and simply get on, without all the accompanying fanfare, with making sure the vaccination programme at last starts to work, otherwise it will feel the needle starting to twist in a most uncomfortable way.

 

An unpleasant aspect of our current national character has come to light in recent times. When it comes right down to it, no matter what our pretences to the contrary, tolerance for a different point of view, or approach to things, is not a commodity in great supply at present, right across the political spectrum. Of course, there are moral absolutes like upholding universal equality and freedom from discrimination to which most of us adhere, but whereas previously we accepted other diverse views as either a person’s prerogative, or a harmless quirk, we now seem far less willing to do so. 

In part, this is due to the pandemic and the monolithic, support the “team of five million” approach we have been constantly exhorted to follow over the last year or so. By definition, anyone who is not part of nor wholly embraces what the team is about has been sidelined as uncooperative, divisive or any other negative epithet one cares to use. Think about how those academics and medical experts, let alone other community leaders, who have raised questions from time to time about our pandemic response have been dismissed and sneered at for daring to question the prevailing orthodoxy, as an example. 

But it goes far deeper than the pandemic, even though it has been fuelled by that. Public discourse generally has become far less tolerant, and our national capacity to absorb and assess different ideas and thoughts has significantly reduced. Increasingly, there now seems to be a prevailing “right” view, with no willingness to accept any alternative, or that the truth is far more likely to lie between the extremes. 

Here are some examples. The housing crisis we have today is generally held to be the fault of the baby boomers, who, at the same time, are considered to have no legitimate experience, or even right to be involved when it comes to resolving it. Their life’s work, saving in times of prolonged high inflation and the 20% mortgage rates of the 1980s, to provide decent housing for their families, not only is seen as the cause of today’s problem, but counts for nothing when it comes to its resolution. And any complaints from them are greeted with insults increasingly far worse and strident than the “OK, boomer” retort uttered in Parliament last year. 

The current hate speech debate is another case in point. A legitimate concern about the impact of inciteful, racially or gender-oriented attacks on vulnerable people risks becoming an all-out assault on the right to express political views, however innocently, that may deviate from the newly established norm. And those who express concern about this possibility are derided as out of touch, and part of the problem. 

However, this new intolerance is not restricted solely to the left wing of politics. Our political right is just as culpable, even though the topics it focuses on are different. But, like the left, the right is seeking to sharpen attention around particular issues that it can then use to convey a wider message to society about what it thinks overall.   

For example, in recent weeks the National Party has vigorously criticised the Human Rights Commissioner for going to a meeting with gang leaders and proffering a $200 koha, and the Prime Minister for committing around $2.5 million to a gang run methamphetamine addiction rehabilitation programme. National claims both moves show the government is soft on the gangs (a refrain every Opposition has uttered at some time during the life of every government of the last fifty years). It now wants the Auditor-General to investigate the legitimacy of both these items. 

The claim about the Human Rights Commissioner is frivolous and unlikely to go anywhere with the Auditor-General. There may be more substance to the claim about the methamphetamine addiction rehabilitation programme, although it would depend on the nature of any contract or other formal arrangement the government has with the gang agency carrying out the programme. In any case, the programme is not new – it was established by the previous National-led government during its last term of office. 

Not to be outdone by National’s moves and realising for itself the potency of using the gangs as a political prop, the ACT Party has now proposed its own strategy for dealing with the gangs. Casting aside its previous fundamental commitment to upholding personal liberty and freedom, ACT is now proposing gang injunction orders under which the Police could seek Court approval to prohibit a gang member from being in certain places or associating with certain people, and restricting their expenditure on alcohol, gambling and tobacco, if they were on a benefit. Beneficiaries who were gang members would be able to spend their benefits on food and clothing only. 

For both, the basic message is no different. Like the left, both National and ACT are using particular circumstances to promote a view that not only is their rigid view uncompromisingly the correct one, but that, correspondingly, everyone who does not wholeheartedly agree with them is not worth paying any attention to. 

In what seems to be a rapidly diminishing minority, I am one of those who stands between these extremes. For me, there are no inherently right or wrong answers on all of the great questions vexing contemporary society. Rather, there are only questions and challenges to be pursued. I instinctively rebel against those who present things as absolute and demand unquestioning support in response. Belief in an evidence-based approach to issues, which I support, does not mean uncritical acceptance of that evidence, but rather the opportunity to ask more questions and pose more challenges. 

In the difficult times we have today, people are craving certainty to overcome their fear and anxiety.  So, it is understandable that acceptance of broad, overall solutions in an uncritical way has wide appeal. But we cannot allow that to override our tolerance for the expression of different views the way we are at present.

 

 

The British Medical Association calls it “irresponsible”. The British scientific community’s “overwhelming view” is to move “slowly” and the country’s Opposition thinks it is a “fatalistic” move. Meanwhile the Chambers of Commerce say businesses will be “sighing with relief”. In New Zealand the Covid19 Minister dismissed the move as “not realistic” and one New Zealand would not be following. 

They are all referring to British Prime Minister Boris Johnson’s decision, for better or worse, to lift most of Britain’s Covid19 restrictions from 19 July. This move, which Johnson seems determined to carry out, despite the criticisms at home and abroad, will change the Covid19 game forever. Already, countries like Singapore and Australia are looking to move in a similar direction. The solid consensus on the elimination of the virus is starting to break down, and, like Humpty Dumpty, will become impossible to put back together, no matter what future developments there may be. 

Whatever one may think of the desirability or timing of the British move, it is going to be extremely difficult for the rest of the world to ignore, or not be impacted by it. Even isolated countries like New Zealand that are still pursuing an elimination strategy will be caught up in this, especially, if in our case, travel bubble partner and closest neighbour Australia follows the British lead, as Prime Minister Scott Morrison has strongly hinted is likely. 

So, while New Zealand may continue for its own legitimate national safety reasons to adhere to the elimination strategy that has worked for us to date, we are, as Professor Michael Baker observed a couple of weeks ago, likely to become the “last man standing” in that regard. And the blunt reality is that as other countries abandon the elimination approach in favour of learning to live with the virus it is going to become increasingly difficult to live on the elimination limb. 

For a start, as restrictions elsewhere are relaxed, and more and more people overseas become fully vaccinated, the expectation will grow that they will be able to travel more freely to countries like New Zealand, without facing the prospect when they arrive of enduring the near permanent quarantine system we seem to be developing. Not all these people will be casual tourists – many will be family members wanting to come home to re-unite with loved ones they have not seen for some time. But none are likely to take kindly to being treated as unwelcome intruders into a hermit kingdom. 

This is not to suggest that New Zealand should immediately follow the British example and remove the restrictions we currently have in place. We cannot even contemplate doing so until we have achieved a much higher level of vaccination than is currently the case, nor should we. Rather, the point is that we cannot remain static in our response, especially as other countries start to move, and that our isolation notwithstanding, we will not be immune to their moves. 

A small chink of optimism that New Zealand is beginning to understand that we are caught up in the changing international tides has emerged in comments this week from the Minister of Finance. Emerging from what he described as his post-Budget round of regional visits (curious of itself in that no Minister of Finance has ever spent nine weeks since a Budget touring the regions to promote it) Grant Robertson promised that the government’s blueprint for moving beyond the current situation would be released in the next few weeks. 

Leaving aside the customary accompanying gloom of his message that a long period of restriction still lay ahead, the Minister’s statement did contain the encouraging recognition that we do need to move on over time towards what might become the new post Covid19 normal. The welcome aspect is that this is one of the first times a government spokesperson has spoken publicly of the next phase. In contrast, as recently as last week the Prime Minister was saying she had not even yet begun to turn her mind to that. So, the Minister’s admission that the government is thinking about a world beyond Covid19 has to be regarded in a positive light, even if the details are still at best limited and vague. 

Britain’s moves make it clear, for better or worse, that we are moving to a new stage in the battle against Covid19. It is potentially the most difficult yet as the countries of the world start to seek ways of interconnecting after around 18 months of disruption – the biggest upheaval to international order since World War II. The new ways of interconnection will be at times be difficult and definitely uncertain. But they will also be inexorable, as more and more countries acknowledge, as Covid19 variants increase, the impracticality of complete elimination of the virus and accept the still unpleasant reality of learning to live as safely as possible with it. 

While New Zealand is still standing reluctantly near the start of the pathway, Grant Robertson’s comments, made with all the enthusiasm of Shakespeare’s schoolboy, suggest that New Zealand is beginning to realise, albeit still mightily grudgingly, that at some point it will need to join that journey.

 

Former United States Defence Secretary Donald Rumsfeld famously observed that, “there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don't know we don't know.” While he was referring specifically to the American allegation that Iraq was harbouring “weapons of mass destruction” his comments could just as readily be applied to the current Covid 19 situation.

While most will be familiar with Covid19’s “known knowns” and the steps being taken by governments around the world to address those, the “known unknowns” and the “unknown unknowns” are a still a different situation altogether. Amongst the “known unknowns” two issues rank highly. The first relates to the way in which the virus is mutating, and the second the best way to move to a post Covid19 environment.

Already, the virus has been through many mutations, a few more virulent than others. The world is currently in the grip of a so-called Delta variant which appears to be more transmissible, cause more severe illness and potentially reduce the effectiveness of vaccines or treatments. What may come next and how potent that will be we do not know, but we do know, consistent with the nature of viruses, that Covid19 will continue to evolve. Nor do we know whether existing vaccines will prove up to the task of controlling all variants, or whether different formulations or combinations may be required. And we do not know what the level and impact of herd immunity will be, as and when it develops, and the extent to which it may vary from country to country.

The decision of countries like Britain and Singapore to move away from government-imposed restrictions towards a greater reliance on vaccination and personal responsibility to curb the spread of the virus is one most countries know instinctively they will have to make at some stage. None but the most rigid believe that humanity can survive indefinitely living in a set of disconnected hermit kingdoms. But what is not known is whether the steps being taken now by the likes of Britain and Singapore are precipitate and will cause even more problems than we currently face, or whether they are the way of the future. In the event it is the latter case, while we might accept that things will need to be different from what we knew before, we do not fully know what those adjustments will be, or how societies will react to their becoming the new normal.

As far as vaccination and testing are concerned we know these are likely to be critical elements of our futures. But will that mean annual vaccinations, like we have for the flu, and how readily will supplies of vaccine be maintained and supplied? What scope will there be countries to take advantage of some of the patent relaxations in place for existing vaccines to replicate or develop vaccines for their own countries, perhaps in concert with regional partners? And how will vaccinations be recognised across international borders?

At some point, international travel for other than essential purposes will resume, and people will expect relatively free movement across borders, although perhaps not to the extent previously. How will that work in practice, and what requirements will governments place on travel companies, airlines, shipping companies and tourism operators to ensure that public safety is maintained? Will they be practical and facilitate the return of international travel, or will they be so restrictive as to stifle it altogether?

Perhaps the biggest “known unknown” is the prospect of another virus, totally unrelated to Covid19, but no less virulent, while the current pandemic remains. Given the ravages Covid19 has already caused, and the international social and economic consequences of these so far, would the world cope with such a situation, or would it simply overwhelm many countries?

However, challenging as many of the “known unknowns’ are, and the uncertainties that still lie ahead in addressing them, they pale into insignificance alongside the “unknown unknowns—the ones we don't know we don't know” as Rumsfeld described them. By definition, our capacity to address these is severely limited because we do not know what they are or when they might arise. Therefore, applying the same solutions to them when they arise as we have to previous situations like the original Hong Kong flu, SARS and now Covid19 is unlikely to work, no matter how successful things were first time around.

What emerges from all this is a need for governments and their advisers to remain forever flexible in their policy responses to the twists and turns of Covid19, its variants and the other viruses that will assuredly come along. Their starting point must be to prevent the next epidemic becoming the next pandemic. In a world of constantly changing circumstances the need for governments to be ever nimble, open to new ideas and challenges to those ideas, and prepared to modify and adjust their approach as necessary is paramount.

There is still a long way to go on this journey. But there is one blunt and pervasive universal lesson, whether the crisis at hand be political, economic or social. Governments that assume they have all the answers and do not need to consider more diverse opinions to understand more widely what is going on around them, nor show any willingness to move from their original position, are most likely headed for failure.

 

Chris Hipkins’ admission that things could get “a bit hairy” if Covid19 vaccine supplies do not arrive as planned in early July could be applied to all aspects of the government’s Covid19 response.

In stark contrast to its approach during the early stages of the pandemic outbreak when it was so certain and assured, the government now looks indecisive, hesitant and uncertain. Very little seems to be going according to plan, and there is even doubt that there is much of a plan anymore.

Last year, New Zealand’s commitment to an elimination strategy was hailed around the world as an example other nations should be following. Now, top epidemiologist Professor Michael Baker says New Zealand is the “last man standing” in still believing that an elimination strategy can work.

Late last year, just before the election the government assured us “we were at the head of the queue” when it came to obtaining vaccines. Now, when we have the lowest rate of vaccination of most of the developed countries, senior Minister David Parker, an intelligent man who really should know better, says the “head of the queue” comment only ever related to the AstraZeneca vaccine, not to vaccination as a whole.

AstraZeneca’s vaccine was approved for use in Britain last December. Since then, it has been approved throughout the European Union, in Asia, Canada and Australia, the Indian subcontinent and even in Brazil whose President continues to deny Covid19 is a problem at all. Meanwhile, according to Minister Hipkins, it is unlikely to be approved for use in New Zealand before the end of the year. Yet Medsafe follows the advice of other regulators like the European Medicines Authority, the United States’ Food and Drug Administration and Australia’s Therapeutic Goods Administration (all of whom have already approved the AstraZeneca vaccine) meaning there is no reason for its approval in New Zealand being delayed any further.

So far, “head of the queue” New Zealand has fully vaccinated less than 8% of its population, well below Israel’s 60%, the United Kingdom’s 48%, or the United States’ 46%. Even denialist Brazil has so far fully vaccinated 12% of its population – just over 50% more in percentage terms than New Zealand. Our approach to date to securing vaccines offers no hope that New Zealand’s relative position will improve any time soon.

Countries across Europe, the United Kingdom, Singapore and others are now well advanced on the development of their own “roadmaps” out of Covid19. In New Zealand, however, although there is a team of officials supposedly working on this, their work appears to be given little priority by Ministers. The Prime Minister has consistently declined to be specific about timeframes for removing Covid19 restrictions, or whether she was even prepared to look at options like vaccination passports. However, one of her senior external advisers, Sir Brian Roche, did observe recently that New Zealand could be facing a further three to five years of restrictions.

Meanwhile, consistent with Professor Baker’s “last man standing” comment other countries are learning how to live with Covid19. Singapore has recently announced a post Covid19 roadmap towards living with Covid19, based on expanding vaccination and rigorous testing, instead of continuing with its strict rules governing social gatherings, mask-wearing, contact-tracing and travel. 

Anyone watching the European Football Championship or the tennis at Wimbledon will have noticed the large crowds in attendance. Yet, we keep being told that although such things have been normal here for some time, it is only because we have done so well in eliminating the virus here. The fact that other countries, where the incidence of Covid19 has been far worse, are now able to return to relative normality, including allowing large-scale public gatherings and opening their borders, through vaccination and testing, seems to be completely ignored here.

The failures surrounding the vaccination programme are unconscionable. Not only have we failed to secure sufficient stocks to ensure the fast roll-out of the programme we were promised, the management of the roll-out has been inconsistent and unclear.  Previously identified key population groups like the frail elderly are still not fully vaccinated, and there is confusion over the timetable for the rest of the population.

Now, with the experts suggesting that a national vaccination rate of 83% to 97% of the total population is required to be certain of herd immunity being achieved, Minister Hipkins refuses to commit to that goal being achieved, let alone by the end of the year. Yet previously we were told that achieving herd immunity was an important step along the way to our returning to normality. Perhaps this is what Sir Brian Roche was referring to when he spoke of three to five more years of restrictions.

When the Prime Minister far too prematurely and quite erroneously proclaimed to the world just on a year ago that we had eliminated the virus and were looking to an early lifting of restrictions, we looked for a brief moment like world leaders. Since then, we have constantly slipped back and now lag behind many countries in adjusting to the new world order imposed by Covid19 and getting back to normal. Perhaps that is why she seems to be playing a far less public role in the government’s Covid19 response these days.

It is surely time for a Covid19 policy reset before things get any more “hairy”. That reset should have two prongs. First, the government and its specialist agencies need to be much more aggressive in securing and approving the vaccines needed to guarantee mass population vaccination by at least the end of the year. Second, the government needs to pay far more urgent attention to the development of the post Covid19 roadmap to get away from the impression we are trapped in some sort of Covid19 time warp we cannot or will not escape from, unlike other countries.

After all, if we really were one of the first countries to eliminate Covid19 as the Prime Minister claimed, we should not be one of the last, as now seems increasingly likely, to escape its clutches.