Vaccine certificates only a start as we eye new normal

Dr Eric Crampton
NZ Herald
6 October, 2021

It has been rather a long time coming.

Yesterday, Prime Minister Ardern announced that summer will bring vaccination passport requirements. Enjoying summer activities, or at least ones involving a lot of other people, will require vaccination.

It is a great start. But it is only a start.

Today, the New Zealand Initiative released a report, The Path to 2022, with a few additional suggestions.

This month saw the effective end of Covid elimination – at least in Auckland. The Government will continue to actively pursue cases and limit transmission, as it should. But easing restrictions in the face of rising case numbers is no longer elimination.

Ideally, elimination would have ended only after vaccination rates had risen considerably. Epidemiological models tell us that vaccination rates must exceed ninety percent of the full population to avoid putting severe pressure on the health system, or to avoid onerous restrictions that help slow transmission.

Models can be contentious. But no modelling is needed to see what happens when low vaccination rates combine with few measures to reduce transmission. We need only look abroad.

On the first of July 2021, Alberta Premier Jason Kenney promised “the best summer ever” to 4.4 million Albertans, lifting most public health restrictions. Unfortunately, vaccination rates were far too low to sustain it – despite Alberta being a very outdoors-oriented place, and despite it being summer.

Just under 72% of Alberta’s population now has had at least one dose – similar to New Zealand’s 67%. And, as of the 30th of September, 263 Albertans with Covid were in intensive care – 89% of whom are unvaccinated.

Alberta’s Covid cases, in ICU, roughly match the entirety of New Zealand’s ICU capacity. Obviously, their health system is no longer able to function in any normal way, with ordinary treatments for other disorders disrupted for vaccinated and unvaccinated Albertans alike.

New Zealand’s vaccination rates need to increase.

Vaccination passports will be part of the solution. Most importantly, they make it possible for venues to operate safely at higher numbers than could otherwise be allowed.

The Prime Minister suggested that the Government is still working through how they could be implemented and where they might be mandated.

But a simpler solution is available.

Currently, venues operating under Level 2 face restrictions on numbers, and venues operating under Level 3 face tighter restrictions.

If it is safe, under Level 2, for a hundred people to meet indoors, when many may be unvaccinated, surely it would be safer for a much larger number of people to be accommodated if all were vaccinated. Venues could have the choice to operate without requiring proof of vaccination, but under current alert-level restrictions on numbers and operations, or to face fewer restrictions if they cater only to the vaccinated.

Churches, restaurants, sports stadiums, universities and others could then decide whether to deal with tighter restrictions on numbers but without the hassle of checking vaccination status, or to require vaccination as condition of entry.

Vaccination requirements will work to reduce transmission. They will also encourage higher vaccination rates.

It is a good start.

But it is only a start. Covid is here and is likely to spread outward from Auckland.

And policy is not set to deal with it.

Currently, employers face legal uncertainties in setting vaccination requirements for staff.

On Monday, Mainfreight’s Don Braid on RNZ’s Checkpoint urged that vaccination be made compulsory for those crossing the Auckland border, because there was no simple way for his company to require it otherwise.

The Government needs to clarify employers’ legal position, ensuring that those employers who see vaccination as important for health and safety can require it.

Schools will soon reopen in Auckland.

Vaccination events at school could help in communities with lower vaccination rates, for children aged 12 and up. Our report also endorses the recommendations of public health experts on improving ventilation in school to reduce transmission.

But the government should also be prepared to roll out Covid testing at schools.

The University of Illinois’s saliva-based PCR test is now in use in half of the K-12 schools in Illinois for weekly testing of staff and students, to prevent school-based outbreaks.

New Zealand’s Government has been very reluctant to see saliva-based testing used for surveillance purposes. But when almost a million teachers and students at over 1700 schools in one US state are part of a weekly surveillance testing system, the New Zealand Ministry of Health’s position seems more than a little obtuse.

The Government has also been strongly opposed to rapid antigen tests because they are less accurate than PCR tests, and because of the risk that people might take undue assurance from a negative result on a less-reliable test.

But rapid antigen testing could be part of a highly reliable overall testing system incorporating both PCR and rapid tests. If a workplace operating under Level 3 restrictions can only arrange staff PCR testing once per week, it should be allowed to complement that testing with daily rapid antigen tests. Catching a lot of cases as they emerge, rather than just waiting for the next scheduled PCR test, would be helpful.

Similarly, rapid tests could be integrated into better systems for workers needing to travel across the Auckland border. A negative recent PCR test is required for those leaving Auckland, but infections might only emerge while drivers are on their routes – as has already happened. Drivers could be supplied with packs of rapid tests in addition to current required tests, so they could test themselves daily while on the road.

But most importantly, Auckland’s border system needs to be able to work for those who must deal with it, while reducing the risk of Covid spreading outside of Auckland. That cannot be done without stronger consultation with New Zealand’s shipping companies, and peak bodies like the Employers and Manufacturers Association.

Preparing adequately for the summer also means preparing the health system. It is impossible to double the size of the health system in a hurry. But effective treatments available abroad that work in keeping people out of ICU have not yet even been ordered in New Zealand. That must change lest New Zealand be at the back of a new queue.

System failures that led to the Auckland outbreak and the forced end of elimination point to the need for better systems for pandemic management. The Initiative’s report recommends the establishment of an Infectious Disease Agency as part of the Government’s ongoing reforms to the health system.

New Zealand is unlikely to follow Alberta’s terrible example. New Zealand’s Government would not hesitate to reimpose restrictions if they prove necessary.

But a bit of preparation could help reduce the risk of broader outbreaks. In doing so, it would reduce not only the misery that outbreaks cause, but also the cost of the restrictions that might otherwise be required.

It would set us on a better path to 2022.

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