The future is notoriously hard to forecast. Just dial the clock back two years and try finding an expert predicting a year after the start of the pandemic that New Zealand would be suffering labour shortages. But one thing is almost certain. New Zealand will one day hold a Royal Commission of Inquiry into the country’s pandemic preparedness and response.
The 2020 election served as a form of scrutiny for the initial pandemic response. Judged by the outcome, the Government’s actions were a resounding success.
Since then, troubling cracks have merged. The slow vaccine rollout. Last year’s agonisingly long lockdown in Auckland and parts of the Waikato. Harsh (and still ongoing) border restrictions. The decimation of the tourism and international education sectors. The ongoing fragility of the health system. A perplexing array of weird decisions from the Ministry of Health, including over Rapid Antigen and PCR saliva testing. And the fraying of the so-called “team of five million,” of which the protest in Parliament is only the most obvious symptom. The past year or so has brought a litany of grumbles. Nothing less than a Royal Commission of Inquiry will suffice to evaluate them.
The starting point for the Royal Commission should be New Zealand’s preparedness for a pandemic. This requires an assessment of our health system’s resilience, the extent of pre-pandemic planning, and the institutional framework for directing the pandemic response.
On the first of these, the Royal Commission will doubtless focus on New Zealand’s ICU capacity. The verdict is unlikely to be good. At the onset of the pandemic, New Zealand had one of the lowest levels of ICU beds-per-100,000 people in the OECD. Consequently, we were acutely vulnerable to the ravages of Covid-19. This lack of resilience dictated New Zealand’s pandemic response, at least in the first phase of the pandemic.
On pandemic planning, New Zealand’s 193-page Pandemic Action Plan is certainly weighty. It claims to establish “a framework for action that can readily be adapted and applied to any pandemic, irrespective of the nature of the virus and its severity.”
Yet when Covid-19 first emerged in early 2020, the plan left the government scrambling when it decided to implement a nationwide lockdown. So much so that for the first nine days, the lockdown had no valid legal basis.
There are two particular aspects of the plan a Royal Commission should consider carefully.
Under “Public Information Management,” the plan’s first “key objective” is to “maintain public confidence in the response and in agencies’ competence and capability.” That might suit the Ministry of Health. But such an objective encourages cover-ups and spin from both officials and politicians.
Was this objective behind the claims about the ready availability of PPE (or flu vaccines) in March and April 2020 when the medical profession was saying otherwise? Or that border staff were being regularly tested for Covid in mid-2020 when in fact, they were not? Or about New Zealand’s allegedly “gold standard” contact tracing? Or that New Zealand was at “the front of the queue” for vaccines when it was anything but?
The future Royal Commission must address whether health officials and politicians were sufficiently open and transparent in their communications with the public. And, if not, whether this has any adverse implications, including for the trust Kiwis have in their public institutions.
Costs and benefits
Second, the plan conspicuously omits any policy framework to guide key decision-making. It lists issues, agencies, and statutory powers but not the analytical methodology to ensure the best decisions are made.
Important public policy decisions should be guided by cost-benefit analysis. What are the harms that a policy will cause? What are the benefits it will bring? Do the benefits exceed the costs?
Welfare economics has developed remarkably sophisticated tools to assist with this type of analysis. Nobel Prizes have been awarded to those responsible for developing the necessary techniques. And cost-benefit analysis informs everyday decisions made in both the health sector and elsewhere in government. Which drugs should Pharmac fund? Which roads should be made safer? And so on. Yet the Ministry of Health’s pandemic response plan appears blind to this science.
Time constraints at the onset of the pandemic may have prevented all but the most high-level cost-benefit analysis. But the absence of any such assessments in Official Information Act releases from the Government suggests the Ministry’s myopia has remained throughout the pandemic.
Yet, based on Ministry of Health advice, New Zealanders have suffered the most serious restrictions to their freedoms outside of wartime. Lockdowns, domestic and international border restrictions, vaccine passports and mandates, the list goes on and on.
Was each of these restrictions justified? Were the costs, including the risks to social cohesion from infringing personal liberties, properly assessed? Were the predictions from the Government’s modellers of the numbers of lives saved adequately scrutinised?
Few Kiwis will question most of the decisions. Most Kiwis will question some of them – including (ongoing) border restrictions and the continuation of vaccine mandates. The future Royal Commission must address whether key pandemic response decisions were subjected to appropriate cost-benefit assessment and, if not, why not.
Proactive or reactive?
The Government was always going to be on the back foot at the onset of the pandemic. Every government was. Yet, after the initial scramble, the national pandemic response should have balanced responding to the pandemic’s challenges with proactively anticipating them.
Despite the initial success of the elimination strategy, there are signs the Government got the balance wrong. Too often, the Government appeared to be reactive: Delaying decisions on vaccine procurement till the last minute; failing to integrate rapid antigen tests into the Covid testing regime during 2021 as a complement to PCR tests as they were elsewhere overseas; resisting calls to construct purpose-built MIQ facilities out of Auckland’s CBD to ease pressures at the border. And, perhaps most inexplicably, failing to build up health system capacity (as other countries, including Australia, did at the outset of the pandemic).
The future Royal Commission must evaluate New Zealand’s Covid response to assess whether it could – or should – have been more proactive.
That brings us to the Ministry of Health itself. The Ministry’s expertise lies in policy and regulation. Was it ever sensible to task it with complex operational tasks like testing, contact tracing and vaccine rollouts?
A future Royal Commission should consider whether New Zealand would be better served by a new communicable diseases agency dedicated to pandemic management. As I have written in a previous Herald column, such an agency could be led by a board with multi-disciplinary expertise. This could be drawn from both the public and private sectors. With appropriate leadership, the agency would have the self-confidence to call on outside expertise where needed - and to marshal the resources required for a whole-of-government pandemic response.
Covid-19 has caused grave hardship in New Zealand as it has overseas. On some measures, we have performed better than most. But the pandemic’s scars will still take a long time to heal.
If any good comes from this pandemic, it will be the future Royal Commission of Inquiry helping us better manage the next one.