Pandemic plan doesn’t mention shutting borders
The plan that guided New Zealand's response to Covid-19 never even entertained the option of shutting the borders, Marc Daalder reports
New Zealand's pandemic plan doesn't present border closure as an option in even the most severe pandemics, raising new questions about whether the country was prepared for Covid-19.
On Wednesday, Newsroom reported that New Zealand scored just 54 out of 100 on an international pandemic preparedness assessment late last year and that it ran its early response to Covid-19 off the ill-suited Influenza Pandemic Plan.
Because a person with influenza becomes contagious just a few days after contracting the virus, measures like contact tracing and testing are ineffective in combatting pandemic flus. The Government's reliance on the influenza plan meant the country was late to scale up its testing and tracing infrastructure, even though these strategies are incredibly effective against coronaviruses with longer incubation periods.
In recent days, criticism of the Government's early response has mounted. University of Auckland Professor Des Gorman told the Epidemic Response Select Committee that New Zealand was "caught with its pants down" by Covid-19.
Gorman was particularly concerned with the borders, pointing out that if they had been closed earlier, then few or no cases would have entered the country and a lockdown could have been avoided.
"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.
"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."
Questions around New Zealand's preparedness will only be amplified by the news that the country's pandemic plan didn't call for a wholesale closing of the border in any situation.
The most drastic measures the plan called for were refusing travel from "areas of concern", advising "all people intending to travel to New Zealand by air of the escalating situation regarding the threat of an influenza pandemic, and [warning] them that, should it be deemed justified, they may be placed in mandatory quarantine for a certain period on arrival", and considering "the use of enhanced quarantine (the quarantining of large numbers of people in the absence of symptomatic people but where there is good reason to believe those people may have been exposed to pandemic influenza, due to where they have travelled)".
At the same time, the plan acknowledges the importance of keeping out pandemic pathogens.
"In a potential or actual global pandemic, New Zealand may be able to prevent the virus from entering the country or to delay its entry, allowing other response measures to be put in place (during the Keep It Out phase). Such an intervention may be feasible because of New Zealand’s geographical isolation, its limited number of entry points and its well-coordinated border management systems," the plan states.
A Ministry of Health spokesperson disputed the notion that the pandemic plan doesn't mention border closures, emphasising the plan's focus on "keep it out" and pointing to a line in which the plan states, "the extent and level of border controls (sea and air) to be implemented will be determined by the actual and potential degree of severity of the pandemic and its ongoing development overseas". However, this still doesn't explicitly address the possibility of border closures, whereas other measures are featured in a much more detailed manner.
The spokesperson also highlighted two other pages on the Ministry website. One of these, on border health measures, only briefly discusses border measures, saying "travel to and from selected countries or areas can be prohibited (eg, by refusing international flights), in order to prevent or delay the introduction of a disease into a non-affected country. In practice, this measure is very unlikely to ever be applied, given the range of other controls that can be used."
The other, a set of 2016 guidelines for "responding to public health threats of international concern at New Zealand air and sea ports", engages with border closures in more detail but comes to a similarly dismissive conclusion.
"Today, global travel is commonplace and large numbers of people move around the world for business and leisure. Limiting travel and imposing travel restrictions would have to be proven to be effective in stopping the disease of international concern from spreading as it would be highly disruptive to the global community," the document states.
"Scientific research based on mathematical modelling shows that restricting travel would be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with severe acute respiratory syndrome (SARS), validate this. The global response should focus on minimising the impact of the disease by identifying cases promptly and providing infected individuals with appropriate care."
The 2016 document goes on to rubbish the notion of "keep it out" altogether.
"Given the speed and volume of air travel, it is likely that any public health emergency of international concern would only be notified a short time before potentially infectious or contaminated travellers or contaminated goods arrived in New Zealand. It is extremely unlikely that the public health emergency response phase 2: Keep It Out could be implemented, and so border closure and diversion of aircraft or ships are unlikely to be viable measure," it says.
"This involves implementing measures at our borders to try and prevent (which is very difficult to do in many cases) or at least delay (often a more realistic goal) a disease or threat from entering New Zealand. A key focus of any response at the border is to gain as much time and gather as much information as possible to enable our health system to gear up for a national response. This phase is not simply a case of closing the border. A full border closure is an extremely unlikely scenario given that most public health threats can be effectively managed with less restrictive measures and such a move would result in widespread social and economic disruption."
University of Otago epidemiologist Nick Wilson has long called for the Government to be more willing to close its borders in a serious pandemic situation. Cost-benefit analyses by Wilson that found border closures would in most modelled severe scenarios be worth the cost were sent to the Ministry but met with a stony response.
"Reading the Influenza Pandemic Plan [...] I knew that was a silly thing. They had to plan for the future with potential developments in biotechnology, with synthetic bioweapons, even if some terrorists released smallpox, that would be justifiable closing the border for at least a few weeks to get a chance to prepare," he said.
"So we published these cost-effectiveness analyses which showed that, yes, most times it’s not worth closing the border, but in extreme situations, it is. And we gave that material to the Ministry and then we went in and met with them, but they said, 'Oh, it’s WHO advice never to interfere with borders so we’re ignoring this'.
"I knew that that meant they just hadn’t thought it through, because obviously, if you have smallpox breaking out somewhere or a new bioweapon, it has to be part of your armoury to close the borders, and they weren’t seriously engaging with this topic," Wilson said.
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