GUEST BLOG: Ian Powell – Has the government mishandled New Zealand’s vaccine rollout?

If one were to accept the statements of National Party leader Judith Collins and her Covid-19 spokesperson Chris Bishop, along with other critics, the Labour government has badly mishandled the Covid-19 vaccine (Pfizer) rollout in New Zealand.

To assess whether this claim is fair cop or not one first has to understand what mishandled actually means. One meaning is to manage or deal with something wrongly or ineffectively; another is to manipulate something roughly or carelessly.

This claim should also be seen in the context of the vaccine manufacturing and supply market and the effectiveness of the elimination of community transmission strategy linked to the value attached to human life. Underpinning all of this is the unprecedented nature of the pandemic which meant that the normal system of vaccination through general practitioner clinics couldn’t be used.

Overwhelmingly criticism of government handling of the vaccine rollout is based on how New Zealand compares with the other 37 countries that make up the Organisation of Economic Cooperation and Development (OECD). Certainly if this data were the only indicator to draw upon the mishandling criticism would appear to be justified; we are close to rock bottom.

But the OECD immediately cautions about drawing quick conclusions. It warns that that the comparison is per 100 people which excludes multiple doses per person. New Zealand has religiously followed the Pfizer three week period before the second dose but the OECD data doesn’t factor this in for comparative purposes.

Context required

Nevertheless this isn’t a good look if vision is restricted to this comparison. However, context is required. Under the eye-catching heading ‘A rocky road from lab to jab’ the OECD provides an important perspective concerning challenge of rollouts (https://www.oecd.org/coronavirus/en/vaccines).

It advises that between “…50% and 75% of the world population will have to be vaccinated before the pandemic has ended. This requires building manufacturing and distribution capacity, making a new vaccine affordable, deciding who should get access first, and planning massive vaccination campaigns. The production, delivery and administration of COVID-19 vaccines poses significant logistical challenges and involves many actors.”

The OECD also makes interesting observations about how long it takes the 33 most advanced economies to recover to pre-pandemic Gross Domestic Product per capita (https://www.oecd.org/economic-outlook/).

Ten countries are expected to achieve this before the end of this year. New Zealand isn’t one of them. But it is part of the next six who are expected to achieve this by the end of the year. Germany is another. The other 17 advanced economies follow next year and beyond including Australia, Canada, United Kingdom and France. Vaccinations are critical to pandemic economic recovery but not the only factor.

Vaccine supply control

Full context also includes vaccine supply which is controlled by the larger international pharmaceutical companies (‘Big Pharma’). Big Pharma is driven by profit maximisation. Prior to the pandemic, vaccine development and manufacture wasn’t a priority investment not because it wasn’t profitable but because it wasn’t profitable enough compared with other return on investment opportunities.

The coronavirus pandemic dramatically changed the pharmaceutical market but profit maximisation continued to dictate implementation priorities. New Zealand does rank very low on the OECD rollout data. But it also ranks very low on economy size with a population of only five million. We were never going to compete with economies the size of the United States, European Union or United Kingdom.

With Big Pharma controlling the market through manufacture, production and distribution a small economy like New Zealand was always going to be a lower investment return and therefore lower priority. Consequently it was an achievement for the Government to have negotiated early purchase agreements, subject to regulatory authorisation, with different vaccine producers before settling on Pfizer (an American multinational pharmaceutical and biotechnology corporation headquartered in New York).

The rollout target was based on the known supply dates and quantities determined by Pfizer’s capacity and priorities. New Zealand has negotiated above its weight but with obvious less influence than bigger and less isolated economies. We have met the target determined by the agreement with Pfizer. Further, our supplies are now significantly increasing consistent with this agreement and we are now developing a valuable back-up option with the single-dose Janssen vaccine.

Criticisms

This doesn’t mean that there aren’t legitimate criticisms. While the Government has recognised that vaccine rollout is subject to overseas supply it hasn’t persistently hammered this important message to ensure it is a key part of the public narrative.

District health boards have been frustrated by Ministry of Health interference (including pressuring some to slow down vaccine distribution so the supply wouldn’t runout before the arrival date of the next supply (rather like trying to land a plane on a postage stamp). Unfortunately DHBs have been scapegoated for confusion and glitches which they inherit because they are at the implementation frontline. They have been criticised for communication failings. Some of this appears justified. But DHBs have also been thwarted by sometimes poor (or lack of) communication from the Ministry. They can only communicate what they know.

Canterbury DHB has been criticised because of where it sits below the national vaccination average even though it is on schedule to achieve its time frame previously agreed with the Ministry. Comparing DHB performance based on a national average is misleading because of differences in their populations including density, deprivation and location.

Value of human life

The vaccine rollout should also be assessed in the context of the way in which human life is valued. New Zealand is one of the few countries that adopted an elimination strategy (instead of mitigation) to combat community transmission. Crudely speaking elimination gives greater primacy to the value of human life than the mitigation alternative.

The best indicator of the effectiveness of elimination (compared with mitigation) is provided by a comparison of Covid-19 deaths rates (deaths per one million people) as of 8 July: https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/.

The following OECD large economies adopted various forms of mitigation at least for much of 2020. Their death rates per one million were: United Kingdom (1,915.73), United States (1,838.57), France (1,628.25), Germany (1,096.41) and Canada (701.16). Australia’s strategy varied from state to state between elimination and mitigation. Its death rate was 35.88.

So what was New Zealand’s death rate? It was an extraordinary low 5.29 deaths per million. In addition to saving hundreds, perhaps thousands of lives, we have been better placed to learn from vaccine rollouts early and we have learnt much.

Learnings include vaccine safety, Pfizer’s refrigeration requirements being less stringent than previously required, the gap between its first and second doses can still be safe (perhaps safer) when longer than three weeks, vaccine effectiveness against the new more dangerous variants such as Delta, and the efficacy of the Janssen vaccine. GPs are now better placed to reassure apprehensive patients which is critical for achieving herd immunity.

Has rollout been mishandled?

Half a million New Zealanders are fully vaccinated against the coronavirus while more than 760,000 have received at least one dose. Further we are on schedule to fully vaccinate all those who want to be vaccinated by the end of the year.

Given the exceptional circumstances of this unprecedented pandemic, the power of Big Pharma in vaccine manufacture and supply, our small economy, and the success of our elimination strategy including higher value on human life, the Government has handled the vaccine rollout correctly and effectively. Further, it hasn’t manipulated it (give or take a little spin) either roughly or carelessly.

The vaccine rollout has been handled well; not perfectly or without some confusion and uncertainty but well, nevertheless.

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion.