Planning for the Covid years

Dr Eric Crampton
6 July, 2021

By the end of the year, all going well, everyone in New Zealand who wants to be vaccinated against Covid-19 will be vaccinated against Covid-19.

All of the developed world barring Australia is rolling out vaccination more quickly than New Zealand. But almost ninety percent of infectious disease experts surveyed in February expected the virus to circulate globally for years to come.

At the start of the vaccine roll-out, the Prime Minister said that, when the vaccination programme had completed, New Zealand could begin reopening. This weekend, the government’s former Chief Science Advisor, Sir Peter Gluckman, asked for a few more details on that plan.

The Australian government has provided more information about how it is thinking about the years ahead.

In the short term, it will be harder for those outside our bubble to get into Australia, with fewer spaces available in their leaky quarantine system. But over the longer term, it will be easier for vaccinated travellers to enter Australia – if trials of home quarantine for vaccinated arrivals prove successful. And a “back to normal” phase is planned, where vaccinated travellers could enter Australia without quarantine.

More detail on how the New Zealand government is thinking about similar issues would be rather helpful. Firm plans with fixed timetables would surely tempt the virus to evolve in new, exciting, and plan-defying ways. But it would be good to know about the scenarios for which the government is planning, and what those involve.

And some measures are worth implementing across every plausible Covid-scenario.

All else equal, vaccinated travellers are less risky than unvaccinated travellers. While vaccines are not perfect, those vaccinated with either the Pfizer or AstraZeneca vaccines are not only far less likely to catch Covid but are also much less likely to transmit the virus if they catch it, even after a single dose.

Being able to distinguish vaccinated from unvaccinated travellers will then matter.

And while paper vaccination records can easily be forged, vaccination passports are feasible so long as governments are tracking who has received the vaccine.

In March, the Association of Southeast Asian Nations began discussing common digital vaccine certificates. In April, Singapore was negotiating mutual vaccine certificate recognition with Australia. And the International Air Transport Association (IATA) has launched an app-based travel pass that presents a traveller’s vaccination status and Covid test results as verified by registered labs.

For the IATA travel pass to work as a vaccine passport, travellers would need official vaccination records to be available through the app. Air New Zealand is a partner in trialling the Travel Pass. Will New Zealand vaccination records be able to be accessed by the Travel Pass? Will other countries’ vaccination records be available through the Travel Pass? Would the New Zealand government consider vaccination records provided through the Pass as accurate, or are they working on another system?

At least while New Zealand’s population remains almost entirely unvaccinated, a resumption of normal travel by those who have been vaccinated and tested would remain risky. But more risk-sensitive treatment of vaccinated and tested travellers, between now and December, could allow more Kiwis to return home and more critical business travel to resume.

Australia is considering home-based isolation for those returnees. Is the government considering any similar moves? Home-based isolation of vaccinated travellers, after negative Day Zero and Day Three tests in managed isolation, could allow more people to travel while sharply reducing the costs of isolation for returnees.

After the vaccination rollout has completed, what processes does the government expect will be required for incoming vaccinated visitors from places with high vaccination rates? If more worrying Covid variants have not developed, will vaccinated visitors providing negative tests be able to enter without quarantine requirements? Will additional safety measures will be put in place – for example, requirements that visitors test negative on arrival, present for testing again a few days after arrival, and use the Covid-tracing app? What measures might be considered for unvaccinated arrivals who will necessarily present far more risk?

So long as vaccination reduces risk, being able to tell whether inbound arrivals have been vaccinated allows for better border systems. It would be good to know what progress is being made.

Similarly, better Covid testing methods will help regardless of the tricks the virus develops over the coming years. And Covid testing has progressed considerably since the swab-based PCR testing that forms the costly backbone of New Zealand’s testing regime.

Rako Science’s saliva-based PCR test has been available since January, is considerably less costly than swab tests, is at least as accurate as swab tests, provides results in hours rather than days, and can quickly scale up to test far more people. Singapore has provisionally approved a Covid breath test that is not as accurate as Rako’s saliva-based test or existing swab tests, but provides results in about a minute. Two negative breath tests in five minutes could be vastly more useful in airport passenger screening, and for testing during any outbreak, than current methods. But the government thus far has seemed actively hostile to different testing approaches.

What role does the government see for improved testing methods both in the short term and in the longer term, if any? If New Zealand moves to more open travel once vaccination has progressed, being able to rapidly and accurately test inbound travellers will matter. Current swab-based testing methods that require skilled nurses to collect samples simply cannot scale up.

Finally, New Zealand’s slow progress on getting vaccines points to the importance of contracting early for vaccine delivery. So far it looks like the Pfizer and Moderna mRNA vaccines provide reasonably long-term protection, but new variants may yet require new vaccines. Those vaccines have not yet been developed because vaccine-eluding variants have not yet emerged. But mRNA vaccines can be very speedy: the initial Covid vaccine was developed within two days of the public release of Covid’s DNA sequence.

That suggests that existing mRNA production lines could be quickly flipped to producing vaccines against new variants. Is the government contracting for those doses now, well in advance of their being needed, so that New Zealand really can be at the front of the next queue?

For those who worry about stealing vaccines from places that might need it more, fear not! The government could contract for twice as much as New Zealand might need, with extra doses to be sent to poorer countries via COVAX.

Richer countries paying now helps build more production lines for delivering a lot more vaccine to the whole world in a far bigger hurry. It would leave the world much better prepared for new variants as they emerge. Far from being stingy about such things, economists have urged governments to spend a lot more to get vaccines rolled out and broadly distributed far more quickly.

The government cannot provide certainty about the years ahead. Too much yet can change. But it could provide a more comprehensive picture of how the government is planning for those years ahead.

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