Expert: NZ caught ‘with our pants down’ by Covid-19
Submitters to the epidemic response committee have raised concerns New Zealand wasn't ready for Covid-19 after Newsroom reported on the country's poor pandemic preparedness.
Des Gorman, an expert in health system design at the University of Auckland, said the country struggled to muster its forces against the Covid-19 threat because of chronic underinvestment in public health and a fragmented health system.
"I think the question has to be asked: Not only how do we do it better next time, but was this failure to plan a natural consequence of the downgrading of Public Health Units across the country? That's an attractive argument. Irrespective of where the blame lies, the truth is, we went into this pandemic profoundly unprepared," Gorman said.
Newsroom reported on Wednesday that New Zealand scored just 54 points out of a possible 100 in an international assessment of pandemic preparedness. The country's response to Covid-19 was run off a plan for influenza, against which contact tracing and testing is less effective.
"I think we were spectacularly complacent. Voices were saying we were scoring 54 out of 100 according to the [Global Health Security Index] and a pandemic is not if, it's when, and how bad will it be? I think our casualness, which is born out of 'that's a problem over there, not here' has left us with our pants down," Gorman said.
The comments are representative of growing pressure for reforming the health sector after the pandemic for a greater focus on public health. Epidemiologists have highlighted the campylobacteriosis outbreak in Havelock North, last year's measles outbreak and the Covid-19 pandemic as reason for a new, centralised public health organisation.
"I know [Covid-19] has really, really stretched [public health physicians]. It's not a matter of capability here, it's a matter of capacity," Association of Salaried Medical Specialists executive director Sarah Dalton told the committee.
"We simply didn't have enough people to easily manage particularly our borders in Auckland and then Christchurch, which are the main places people come and go, in and out of the country. And again, while there are some funded training posts for public health registrars in New Zealand, these things are not guaranteed.
"There are also other things that take a terrible toll on people's health. The measles, the mumps, the syphilis epidemic that has been raging in Auckland for some time now. These shouldn't be happening in New Zealand in the 21st century. Being able to have safe drinking water, as happened in Havelock North, not so long ago. These are core public health functions but they're not fun to talk about."
Veronica Manion, the chief executive of community support group Geneva Health, told the select committee: "With full respect, the Government's done a great job. And I don't think anyone would have thought the whole world would have shut down its borders round about the same time, but I agree that we need to better. We need to do better for the people we look after.
"Des [Gorman] referred to a national approach. Having three big government bodies, one of them with 20 DHBs, all having a different line of communication, a different process for ordering PPE, a different process for funding, some not funding us at all, it's made it really hard for us to focus on the care of the people in the community."
Prime Minister Jacinda Ardern said she agreed public health had been underfunded for years and that the Government had long planned to rectify it, but defended New Zealand's pandemic preparedness.
"Firstly, it is very difficult for the world to have actually been well-prepared for what has become a one-in-100 year global pandemic. And I think you'll see to varying degrees, that has been manifest for all of us," she said.
"But, when it comes actually to public health, I would agree that we do need to rebuild our health system and particularly the investment in public health. That is something that I would have said even before Covid-19 was part of this Government's agenda. But what we're seeing is some specific elements of public health that did need that extra investment and modernisation.
"Previously there probably hasn't been a reason for [Public Health Units], who have operated separately, to necessarily have the national footing that we now see as so, so necessary. Dealing with TB, dealing with rheumatic fever, we may well have had that advice post-measles, but we're still in the aftermath of working through that to have made that determination. But the fact we've managed to change our footing within a month I think demonstrates that we can be agile."
Gorman also took aim at the Government's border policies, saying they were an example of poor pandemic preparedness. He said he had advocated for closing the border in mid-February and beginning a quarantine of returning New Zealanders then, instead of phasing in restrictions between March 16 and April 9.
"In terms of border closure, we went early but soft. It's attractive to argue that the pandemic we've had to manage, we've had to manage it because we simply failed to keep it out, and the opportunity to keep it out was mid-February, not Easter," he said.
"If you have one tenth the number of intensive care beds per capita that Germany does, if you don't have contact tracing in place, then if you don't have that level of resourcing available, you've got to focus very hard on the keep-it-out strategy. The fact that we've had to work so hard to stamp it out can only mean we've failed to keep it out."
Gorman said the model New Zealand used, which relied on people to self-isolate voluntarily, was a "high-trust" model that wasn't as effective as a "low-trust", heavily-enforced model. However, there was no evidence at this point that returning New Zealanders violating self-isolation requirements infected anyone else outside their household.
"When I say we materially failed to have a hard border closure in February, that's a criticism of our preparedness, not a criticism of why it wasn't a hard closure," Gorman added.
Ardern said this would not have been feasible. Tens of thousands of Kiwis entered New Zealand after March 16 - more people than there are hotel rooms across the country.
"I wouldn't have called it simply a 'high-trust model'. There were checks in place - we had police involved, we had Healthline involved. But it became very clear to us that not only did we need a more rigorous approach, we needed to stop household transmission.
"So at a point where we were able to manage a system where everyone was quarantined - keeping in mind we had tens of thousands of people returning in those early days - we moved to that. On the question of timeliness, New Zealand, 20 days after our first case, closed our borders to foreign travellers. That made us amongst the first in the world to have done that."
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