Until a little over a year ago, questioning the Ministry of Health's handling of the pandemic was tantamount to heresy. The country had just celebrated 100 days without a case of Covid in the community. New Zealand's handling of the pandemic was the envy of the world.
The Ministry's halo slipped a little following Auckland's return to lockdown on 12 August 2020. When news broke a day later that 63.5% of all border and hotel isolation workers had never been tested, the halo dropped a little more.
Twelve months later, it is no longer heretical to question the Ministry of Health's pandemic management. Indeed, it is mainstream. The litany of the Ministry's failings is too long for questions about its fitness for purpose to be decried. The delayed start of the vaccine rollout. Ongoing border testing bungles. The inexplicable delays with saliva testing. The failure to scale up ICU capacity. The constant refrains about failures being "frustrating" or "not what we expected." The list goes on and on.
Late last year, researchers from the University of Otago teamed up with public health authorities in Taiwan to draw lessons from the two countries' approaches to the pandemic. Both countries achieved elimination. In Taiwan's case, however, this was achieved without the strict lockdowns used in New Zealand.
The study was published in The Lancet, a leading medical journal. It recommended that New Zealand set up a dedicated national public health agency to manage both prevention and control of pandemics. The authors concluded such an agency would ensure responsiveness to pandemic diseases and similar threats was embedded in New Zealand's national institutions.
Fast forward to July 2021, and the call for a dedicated agency to govern and manage New Zealand's pandemic response has been repeated. The current call comes in an article in the medical journal of the Royal Australasian College of Physicians. The authors are public health experts Emeritus Professor Des Gorman from the Department of Medicine at the University of Auckland and former Treasury Secretary, Dr Murray Horn.
Gorman and Horn observe that the proverbial "Man from Mars" would puzzle at biosecurity in New Zealand and Australia. Both countries have sophisticated and proactive biosecurity agencies to protect against pests and diseases that threaten their agricultural sectors. Yet, when it comes to biosecurity arrangements that protect their populations from pandemics, both have been found wanting.
They have a point. Indeed, the Martian visitor might also wonder why the Government ever tasked the Ministry of Health with operating managed isolation and quarantine facilities. The Ministry’s areas of expertise are in policy, procurement and regulation. It is not expert in complex logistical operations. Little wonder the Government eventually concluded the Ministry was not up to the MIQ task and enlisted the army’s assistance.
Yet the Government repeated the mistake when entrusting the Ministry with managing the national vaccine rollout. Is anyone surprised the rollout got off to such a poor start?
The Ministry of Health's operational ineptitude is perhaps most visible with antigen and PCR saliva testing. Both forms of testing were developed after the nasopharyngeal PCR tests the Ministry has relied on since the outbreak of the pandemic. The Director General of Health likes to call nasal swab PCR tests the "gold standard" test. But the other tests play different – but important – roles.
Antigen tests are cheap and quick. Though not as accurate as PCR tests, they provide results in minutes. And they can be self-administered at home. In countries like the UK, essential workers like teachers test themselves every morning before going to work. If workers get a positive test, they have to stay home and have their health status tested by a more accurate PCR test. This provides a way of picking up some Covid infections at an early stage. Had the Ministry of Health been using antigen tests, the current community outbreak in New Zealand might have been averted.
Saliva PCR testing is not as cheap or as fast as antigen testing, but it is far quicker than nasal swab-based PCR testing. Results come in hours rather than days. And some saliva tests have been clinically proven to be at least as accurate as PCR testing. Because they are "spit" tests, they are not as invasive as swab-based PCR tests. And they do not need a medical professional to administer them.
Some businesses, such as Fisher & Paykel Healthcare and Genesis Energy, test their essential workers with saliva PCR tests every few days (and in some cases, daily). This testing allows these businesses to keep a close watch on their employees’ health.
In September last year, the Ministry of Health received a damning report following the independent review of its border testing regime. Led by Sir Brian Roche and Heather Simpson, the review found the testing regime was “not fit for purpose”. Among other things, the report recommended saliva testing should be implemented “as soon as possible.”
If the Ministry of Health's procurement approach was as robust and objective as the private sector's, it could have been using saliva tests since the start of the year. That would have allowed it to test the health status of all border staff every day.
Yet, the Ministry only started to rollout saliva testing last month. Even then, it has doubts about the accuracy of the particular test it has chosen to use. You could not make this stuff up.
A new agency?
A new agency dedicated to overseeing pandemic management of the sort proposed by Gorman and Horn would allow the Government to sidestep the Ministry of Health's bungling and myopic Covid response.
The agency would need to develop a whole-of-system plan for responding to the pandemic. Such a plan would cover border and quarantine management, testing and tracing strategies and capabilities, vaccination and Covid-treatment strategies, intensive care capacity and so on. The objective would be the overall wellbeing of New Zealanders, including minimising the reliance on costly lockdowns.
Roche and Simpson might be good candidates to lead the agency's board. Their expertise would need to be supplemented by public health experts with the necessary operational experience to avoid both the mistakes that have plagued the Ministry of Health's pandemic response and the hubris that has characterised some of its decision-making.
Such an agency would have the power to procure services from suppliers with the most expertise. And it would have the confidence to do so regardless of whether the services come from the public or private sectors. As Gorman and Horn observe, "we could imagine agreements akin to those between government and industry for biosecurity readiness and response being used to mobilise private expertise and resources in the event of a pandemic."
It is easy to imagine such an agency. But it is light years away from the bureaucratic, “not invented here” approach of the Ministry of Health.
For the good of the country, we can only hope that Gorman and Horn's recommendations find their way to Cabinet.