ANALYSIS: Revelations that the Ministry of Health opposed efforts to require masks on public transport have highlighted the department’s long-time backwards attitude towards the public health measure, experts say.
Amanda Kvalsvig, an epidemiologist at the University of Otago’s Department of Public Health, told Newsroom that New Zealand “has been unusually slow to adopt face masks compared with the rest of the world”.
And fellow Otago epidemiologist Michael Baker said the ministry “appeared to be a very long way behind the evidence throughout the pandemic”.
The Ministry of Health insists its position has evolved as more evidence has emerged around the effectiveness of masks.
The comments come after Newsroom reported last week that the Ministry of Health and its Director-General, Ashley Bloomfield, had wanted to revoke the requirements to wear masks on public transport in Auckland and across the rest of the country in late February.
The Ministry of Health now says this report was based on a draft Cabinet paper that shouldn’t have been released, as it contained advice written by officials that Bloomfield himself had not reviewed. In the updated paper, which is the version that went to Cabinet, Bloomfield is more equivocal.
He says masks were “not strictly necessary” but there could be other reasons for maintaining the use of face coverings on public transport in Alert Level 1, that support the overall pandemic response. This included the fact that mandatory masks would serve as “a constant reminder to people of the ongoing threat”.
It’s unclear why Bloomfield’s tone shifted so significantly between the draft and final documents. This could indicate Bloomfield had, in February, greater faith in the effectiveness of masks than his officials.
However, documents released to Newsroom under the Official Information Act show that prior to this incident, in mid-December, Bloomfield also opposed mask restrictions in advice to Covid-19 Response Minister Chris Hipkins. Following the November quarantine cluster, when masks were temporarily mandated on public transport in Auckland and on domestic flights around the country, Bloomfield recommended that these measures be revoked by the end of the summer at the latest.
On masks on public transport in Auckland, Bloomfield wrote, “there is no strong public health rationale for requiring the use of face coverings at Alert Level 1, since the risk of undetected community transmission of COVID-19 is low”.
He went so far as to say that this requirement “is unlikely to be a justified limit” on New Zealanders’ free expression rights under the Bill of Rights Act. These restrictions should be withdrawn immediately, he said.
In response to a request for comment, a Ministry of Health spokesperson said the ministry now considers “the use of face coverings on public transport is justified on the basis that the limitations on the freedom of expression are likely to be minor and fleeting; that a precautionary approach plays a part in preventing resurgence of community transmission; face coverings are a rational method for reducing risk; they’re targeted; restrictions only apply during periods of prolonged close contact and essential communication can still occur”.
In December, however, Bloomfield argued that even masks on domestic flights should only be required through to February 9, to provide additional protection amidst the uptick in travel expected over summer.
Doubts about mask effectiveness
It appears this advice was rooted in a broader disbelief in the effectiveness of masks.
“There is currently a lack of strong evidence demonstrating that face coverings prevent transmission of Covid-19,” Bloomfield wrote in the December briefing. He cited two recent studies that found masks were of limited effectiveness in this regard.
Kvalsvig said these studies were outliers.
It suggested Government strategy on masks might have been “strongly shaped” by two studies that went against the mainstream and didn’t detect a protective effect. “They caused controversy at the time and were talked about a lot so they were highly visible. But the evidence has moved on and we should too.
“In not using masks routinely we’re becoming increasingly out of step with best practice in countries with more experience of community transmission, where there’s a strong body of evidence that mask use dampens viral spread.”
When asked whether Bloomfield’s statement on the lack of evidence was true, Baker said simply: “No”.
The Ministry of Health spokesperson said the department now “acknowledges there is increasing evidence of the effectiveness of masks for protecting against Covid-19, especially when there is evidence of community transmission.”
In June of last year, Kvalsvig was the lead author of an editorial in the New Zealand Medical Journal that recommended mass masking as a tool to help prevent lockdowns. At all alert levels, masks would be required in airports and on airplanes, with similar requirements on public transport and in health settings during winter.
With the evolution of new, more infectious variants of the virus, Kvalsvig now argues even more widespread masking is needed.
“Some concerning new variants are spreading globally and countries that have managed to stay Covid-free so far are struggling with outbreaks. The next one could be us,” she said.
“We have a good alert level system but it was designed for a virus that’s no longer in circulation. The current variants are over twice as infectious and we need to react proportionately. That means upgrading the alert level system urgently – and we really need to step up now and prevent airborne spread by optimising indoor air quality and using face masks.”
Baker described significant frustration in getting the ministry to heed the evidence on two issues: Masks and the risks of airborne transmission. For months, the Government maintained that fomite (or surface) transmission was the most likely cause of an infection between different people in a Christchurch MIQ facility in September. This was despite public doubts raised by Baker and others.
In the end, a study found that airborne transmission was the most likely suspect in this case.
“The Ministry’s position on this important area of public health – among others – has evolved as this further scientific evidence has come to light,” the ministry spokesperson said.
“Our current stance reflects the increasing evidence of aerosol transmission of Covid-9 and the importance of appropriate ventilation and strengthened PPE in addressing this risk of transmission in our managed isolation and quarantine facilities.”
