While governments are now mandating many people to take Covid19 vaccines, government hesitancy towards vaccines and vaccination – much of it seemingly due to overprioritisation of perceived 'cost' issues – remains a problem of significant consequence.
The most obvious ongoing problem relates to revaccination – regular boosters – for which governments (and our government in New Zealand in particular) have been long 'dragging the chain'. I am expecting an announcement – maybe even this afternoon – that will see the formal beginning of revaccination for vaccinated people whose immunity status is equivalent to (at best) a single dose of covid vaccine.
What beggars belief is that Ministry of Health officials had been initially so resistant to the idea, and that people in the know had to have many 'conversations' with the penny-pinching booster-hesitant bureaucrats in order to bring them around. It seems to have been a two-stage process, in which initially, under pressure from people with factual information, the officials decided to roll-out a revaccination program in 2022. "Too slow", the informed said. So, it's now looking like – after a process much like pulling teeth – a formal revaccination process will get under way at around the end of this month.
Australian hesitancy and the 2021 New Zealand outbreak
This is only part of the government vaccine hesitancy problem, and how it has contributed to New Zealand's present state. This first issue to comment on is that of Australia and its ambivalence towards its AstraZeneca vaccine. Earlier this year, there were reports of a very small number of people dying or otherwise becoming unwell from a blood-clotting problem. While the official talk was that the risk was very low, the result was that many Australians who still wanted to be vaccinated were denied their choice, by state officialdom; these were middle-age and younger people (circulating people) who had done their own personal cost-benefit analyses.
The result was that Australia – Sydney in particular – got its 2021 wave of Covid19. The Australian population – from the initial middle-class spreaders to the vulnerable communities in western Sydney – were largely unvaccinated, creating an outbreak that should not have happened. The outbreak happened because New South Wales officials were hesitant about allowing informed potential vaccinees to make their own choices.
Where did New Zealand get its 2021 Covid19 outbreak from? Sydney.
(It is important to note that, while there was that niggling concern about AstraZeneca, it should never have been mandated by any government. But, acknowledging that issue of concern, state officials in Australia were wrong to deny AstraZeneca to those who worked out for themselves that the downside risk of covid was higher than the downside risk of that vaccine.)
Denial of Vaccines to many people in vulnerable New Zealand communities
The other area of vaccine-resistance on the part of government – in New Zealand – was the denial of vaccines (until the last week of August) to many people in vulnerable communities; vulnerable both in terms of their poverty, and in their (justifiably) low levels of trust in government agencies. The excuse for this denial was mainly that these denied people were young (or youngish!), and that older people were being prioritised. We also know that some DHBs were particularly slow to get vaccination under way: a mix of being under-resourced, of distrust on the part of the overseeing Ministry of Health towards regional and community initiatives, and of the post-1980s' government management culture that emphasised financial prudence ('saving money') rather than health outcomes as an indicator of manager performance.
The bigger problem of 'distrust' has always been the distrust on the part of the Wellington bureaucracy towards devolved solutions; creative solutions that were always out there, solutions advanced by both social and business entrepreneurs.
We now know the cost of the reluctance of officialdom to engage with – and share information with – Māori and Pasifika communities. But there are still major problems. Officials overreacted to these issues. There was never anything innate about Māori or Pasifika to disengage from the ever-changing rules issued from Wellington. There are many communities – eg in south and west Auckland, Northland, the central latitudes of the North Island, and West Coast Tasman (including the alternative life-stylers in Golden Bay) – which don't react too well to edicts from on high. Further, many officials do not well understand the 'composition effect' – a statistical phenomenon that's basically commonsense – that an ethnic group (say) with a lower headline vaccination rate may actually be less vaccine-averse that another group with a higher headline vaccination rate. Indeed, I understand that this effect is true of Pasifika, whose vaccination rate is almost certainly the highest of all groups, once properly adjusted for age and socio-economic decile.
(On the composition effect, I was once looking at wage rates in the 1980s in New Zealand. For one year at least, both male and female hourly wages increased by about three percent for the year. But, when both sexes were combined, the average wage increase turned out to be minus 0.1 percent! The reason for this apparent discrepancy was that the number of female employees increased that year, while the number of male employees had fallen or was static; and that, for a variety of reasons – for example, most females were junior in their jobs while most male employees were not junior – female wage rates were substantially lower than male wage rates.)
I finish this by noting that in my own wonderfully diverse suburb of Glen Eden, a man the same age as me – in his case, head of a large Muslim immigrant family (about 20 years in New Zealand) – died in his home with Covid19. (Refer: Covid 19 Delta outbreak: Glen Eden father-of-seven dies at home, daughter says he tried to get help, NZ Herald 12 November.)
This is the kind of family I have been well aware of for a long time, having been a teacher at Unitec for many years. This kind of family (and community), vulnerable by any definition, has not received anything like priority during the Auckland outbreak of Covid19. Further, while teaching at Unitec, our mandate from the Ministry of Education was to deprioritise the success of students from such families; the priority groups were Māori, Pasifika, international students (distinct from immigrant students), and students under 20.
In Glen Eden, we get buzzed by the police 'Eagle' helicopter, pretty much twice every day and at any time of the day or night. On Tuesday, on my afternoon walk, I had to walk past heavily-armed police, part of a stake-out of a neighbourhood street. (Refer: Armed police in west Auckland suburb take man into custody, NZ Herald, 9 November.) After an hour of police helicopter circuits, an arrest was eventually made; then we were left in peace for a few hours. The story didn't even make the television news.
(I might also mention that, for people in Glen Eden, our 'local' base hospital is in the far away suburb of Milford; indeed, this North Shore Hospital is, for us, Auckland's furthest public hospital. In normal times, it's an intrepid journey indeed to attend a specialist appointment at NSH at 9:00am! It will be worse when above-normal traffic resumes, given that most Aucklanders will shun the buses, given the covid risk.)
We are only now starting to discover that there are many vulnerable New Zealand residents who are neither Māori nor Pasifika. How many of these are unvaccinated? (Most people in West Auckland are vaccinated, fortunately.) Does the government care about the deprioritised vulnerable? Certainly SARS-Cov2 does not discriminate.
Help us to make good choices about keeping ourselves safe – including maintaining high immunity levels – rather than making our choices for us.
Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.