Patience Required For Vaccine Supply In New Zealand

Sunday, 31 January 2021, 2:43 pm
Opinion: Ian Powell

Andrea Vance is a journalist I respect highly and make a point of reading both her columns and more in-depth pieces. I also admire her preparedness to call the government out for failings in the application of our internationally successful elimination of community transmission response to the Covid-19 pandemic.

In an environment where so many New Zealanders support the government’s response, including the leadership of Prime Minister Jacinda Ardern, Vance’s approach does lead to some emoting retaliation by those offended. From my perspective calling out a popular government is vital for democracy even when on occasions it might be premature or lacking a fuller context.

On 24 January her Sunday Star Times column Vance discussed the vaccine rollout in New Zealand. Commencing with the eye-catching opening sentence “Is this the year the country falls out of love with Jacinda Ardern?” she argues delays in the vaccine rollout could become high risk for her Labour government.

Astute observations yes but knock-out punch?

Vance makes some astute observations such as her reference to last September’s election “Labour won a historic victory despite little progress on the core of the policy agenda it promised in 2017.” She then discusses how since 2017 the government has fallen short on delivering on affordable housing and, even more so, improving the performance of our health system.

This leads into her hard-hitting conclusion:

“Ardern’s leadership is now indelibly tied to Covid-19. That’s a blessing: while the virus rages around the rest of the world, the public will continue to be indebted to her for keeping them safe. But, it’s also a curse. If the Government fails to implement a swift and effective immunisation programme, leaving New Zealand closed off as other populations start to return to some form of normality, voters will very quickly lose patience.”

Ouch! Knockout punch? Certainly the Government isn’t helped by some out-of-character gungo comments before Christmas by cabinet ministers Megan Woods and Chris Hipkins that New Zealand would be at “the front of the queue” for getting a Covid-19 vaccine.

This was a surprising and unwise claim from two normally competent and media precise ministers. They may have been on an understandable high after the Government had successfully negotiated purchase agreements with a number of companies working on vaccines. We were near the front of the queue with this which deserved acknowledgment in Andrea Vance’s column. But these ministerial sound-bytes were premature.

Complexity of vaccine production

Vance’s column is challenging and raises an important point. But missing is the recognition of important external factors that the Government can’t control. Further, there are practical advantages and ethical considerations of New Zealand not being near the front of the pack in vaccine delivery.

Delivering vaccines in order to respond to a global pandemic is a massive and complex task. Not only does it require unprecedented mass production, but it also requires unprecedented mass distribution through yet to be developed global supply chains. All this makes delivery very difficult to predict even with the best will in the world.

But then throw into the mix the pharmaceutical companies drive for profit maximisation. These companies gave vaccine research and development low priority before Covid-19 not because it wasn’t profitable but because it wasn’t profitable enough compared with other products. The pandemic upped the profitability returns and the negative public relations consequences would have been bad if they hadn’t changed tack once the pandemic arrived.

Even now with vaccines prioritised, profit maximisation creates the risks of generating commercial behaviours that lead to unintended delays regardless of whether they are venally driven.

Then there are other external disputes that can cause delays beyond the Government’s control. Already we have an acrimonious conflict between AstraZeneca and the European Union over supply agreement requirements. Whether this or other pharmaceutical company-government(s) disputes impact on supplying New Zealand remains to be seen but isn’t implausible. Government authorities are understandably concerned.

Advantages of delay

There isn’t a level playing field for a small country like ours. But, on the other side of the ledger, there are practical advantages of delay given the success of our elimination strategy towards community transmission.

Recently the world has been experiencing new more contagious and challenging Covid-19 variants that are posing questions about the efficacy of approved vaccines. There is a question-mark about all approved vaccines to date about their effectiveness in preventing infections and transmission of the virus as distinct from mortality.

Norway has raised an interesting issue about one approved vaccine for their older people with other medical conditions. This doesn’t ring an alarm bell but justifies caution (there has been alarm raised in Germany although this appears to be based on misunderstood data). It may lead to general practitioners to exercise greater discretion whether to vaccinate their older patients. GPs would benefit from time to learn more about this matter.

Owing to the Government adopting an elimination rather than mitigation or suppression strategy New Zealand is well placed to monitor these developments and learn from them. By waiting longer the effectiveness of vaccinations may end up being greater than if we vaccinate earlier.

Advantages of DHBs

Furthermore, through our district health boards, New Zealand is better placed than most economically developed countries to efficiently coordinate mass vaccination. DHBs are responsible for the community and hospital care of geographically defined populations. They know their populations well including through possessing good data and are not impeded by institutional barriers found in other countries. DHBs will need to be supported by a well-managed communications strategy from government.

Ironically we are better placed to undertake mass vaccination than we would be if the restructuring recommendations of the Heather Simpson review of the health and disability system were implemented leading to a more centralised and distant bureaucratic system.

Don’t forget ethical considerations

There is another reason for New Zealand not being near the front of the vaccine queue. I can express it no better than the head of the World Health Organisation Tedros Adhanom Ghebreyesus. He said the world is on the edge of a "catastrophic moral failure in distribution of Covid-19 vaccines with just 25 doses administered across all poorer countries compared with 39 million in wealthier ones."

Surely this ethical consideration alone justifies patience!

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Salaried Medical Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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