Two years since NZ first locked down – Expert Reaction

Prime Minister Jacinda Ardern announced Aotearoa would enter strict lockdown on 23 March 2020 – two years ago this week.

The Prime Minister’s speech signalled the start of the country’s elimination approach to COVID-19, giving two days’ notice before New Zealanders collectively launched into Alert Level 4 lockdown. Looking back over the first two years of the country’s pandemic path, how do experts sum it up – and what do they want to see next?

The SMC asked experts from a range of academic areas to comment:

1. Epidemiology and public health
2. Māori health
3. Pasifika health
4. Child and family health
5. Infectious diseases and microbiology
6. Modelling
7. Genomics
8. Technology
9. Economics and public policy
10. Psychology
11. Food insecurity

EPIDEMIOLOGY AND PUBLIC HEALTH

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow and Co-director, HEIRU Research Group, Department of Public Health, University of Otago, Wellington, comments:

“Two years ago Aotearoa New Zealand was facing an explosive outbreak of a new, serious infection for which there was no vaccine and no effective treatment. The elimination strategy saved thousands of lives and gave New Zealanders many months of freedom in their everyday lives. Although there were areas where New Zealand’s response could have been much more effective and equitable, the strategy was sound and it worked. However, vaccines didn’t deliver the end of the pandemic as we had hoped because so many places around the world that could have chosen a similar strategy to New Zealand instead allowed the virus to spread, generating new variants.

“Emerging knowledge about the SARS-CoV-2 virus is changing our idea of the shape of this pandemic and what needs to be done. This is not a simple respiratory infection where you quickly gain immunity from vaccination or from a disease episode. Instead, it’s now understood that Covid-19 is a multi-system inflammatory condition with potential to cause lasting damage to health. Vaccines have a crucial role in protecting health, but the protection is incomplete so people can be infected and re-infected. What that means for now is that we need to minimise the number of times we become infected, including children, while more effective treatments and vaccines are being developed.

“In New Zealand we have outstanding outbreak control infrastructure and expertise and we have many effective tools in the toolbox, including effective ways to prevent airborne transmission. But we need to choose to control the virus. At the moment New Zealand’s pandemic strategy seems unclear and reactive when it could be clear and proactive. This lack of clear strategic direction is a bigger threat to population health than the virus itself. Everyone is exhausted after two years of crisis management: we need to pivot now to a sustainable strategy that protects New Zealanders from Covid-19 and from the other infectious diseases waiting to make a comeback. This is a highly feasible goal, but it has to be an active choice.”

No conflict of interest declared.

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:

“New Zealand needs to continue investing in public health and pandemic control infrastructure: Colleagues and I have summarised some of the key lessons from the first two years of the pandemic in a Conversation article to mark the two-year anniversary of the first confirmed Covid-19 case in New Zealand. Our major conclusion is that taking a highly proactive public health response to the pandemic has given New Zealand some of the best health, wellbeing, and economic outcomes seen globally.

“New Zealand was the first country to publish an elimination strategy for responding to the Covid-19 pandemic. This response minimised harms to the population and economy during the first 18 months of the pandemic until effective vaccines became widely available.  Since then, New Zealand has shifted its response in a highly strategic way to suppression and now mitigation. This strategic approach has given the country the lowest Covid-19 mortality in the OECD and increased life expectancy.

“As the Omicron pandemic wave will soon start to recede, it is appropriate to lessen many pandemic control measures, such as border entry restrictions and the ‘Traffic Light’ system. At the same time, New Zealand needs to maintain a set of key control measures that can be turned up or down depending on the future evolution of the pandemic. Such a ‘pandemic tool kit’ should include the following:

• A sustainable border biosecurity system, potentially including purpose-built quarantine facilities;

• A successor to the Traffic Light System / Alert Level System to provide a framework for organising control measures for a full range of current and future pandemic scenarios;

• An enhanced national immunisation register that is flexible for new vaccine requirements;

• Maintenance of vaccine passes to support situations where individuals need evidence of vaccination status, e.g., for international travel and potentially high-risk environments like visiting aged care facilities;

• Refining vaccination requirements (mandates) for agreed workforce groups in areas such as health and aged care, and first responders;

• A national mask strategy with requirements (mandates) for specific settings, such as health care and public transport in winter;

• A core contact tracing system that can be expanded if needed;

• Updated, evidence-based protocols and guidelines for all aspects of pandemic management, including case isolation and maintaining safe indoor environments (including workplaces, schools, transport, hospitality, and healthcare).

“This is also the time to develop and enhance our public health infrastructure, including: a) an effective Public Health Agency and Māori Health Authority (underway); b) developing a national pandemic response centre to continue coordinating the Covid-19 response and building capacity for managing future major public health emergencies (could be located in the Public Health Agency); c) building national disease surveillance and research capacity to support an improved response to pandemics and other infectious diseases threats, with expanded capacities in key areas such as epidemiology, genomics, disease modelling, and information dissemination (potentially within a national CDC-type agency); and d) updating public health legislation to provide a coherent legal framework for current and future needs.

“An official inquiry into the pandemic response would be valuable to identify some of the medium- to long-term system improvements needed to enhance our public health infrastructure for managing such events. This strengthened public health infrastructure and ‘pandemic tool kit’ can be described as ‘legacy benefits’ of the pandemic response. Our successful response has cost billions of dollars so it is important to obtain these lasting benefits to improve New Zealand’s health security for decades to come.”

No conflict of interest.

Dr Jennifer Summers, Senior Research Fellow, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, comments:

“The ongoing COVID-19 pandemic has had an impact on every aspect of Aotearoa New Zealand society. We came together as a nation in 2020 to achieve elimination of COVID in our communities, and by doing so we were one of the leading examples globally of how public health interventions protect ourselves. This approach also highlighted the ability of interventions in terms of reducing infectious diseases that could be adapted in the future to address ongoing health inequalities.

“When we compare New Zealand internationally, there is evidence that by pursuing an elimination approach our economy was also shielded from the more dramatic impacts of the pandemic. However, there were negative impacts felt both as a nation, but also at a whānau/community level. The use of MIQ facilities created a barrier to the outside world, but it was also this very barrier that protected New Zealand and its most vulnerable while the vaccination rates increased. This is why our excess mortality rates have declined and our life expectancy has increased; an achievement that is still undervalued.

“New Zealand is now in a vulnerable position with the emergence of Omicron in our communities while many public health protections are being reduced or removed altogether. Therefore, it is hard to envision what the Government’s strategy for managing the pandemic is going forward. However, it is worth remembering that our ancestors emerged from the devastating 1918 influenza pandemic by strengthening the health system with a goal of learning lessons from their pandemic response. So too can New Zealand; with the hope that our society will recover with a strengthened resolve to improve the health and wellbeing for all those in our society.”

No conflict of interest.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“Two years since the dramatic lockdown in New Zealand to control the Covid-19 pandemic is a good time to reflect on what has happened and where to from here. The country is probably near the peak of hospitalisations from the current Omicron wave but will sadly keep seeing deaths on most days for some weeks to come. Overall, however, the prevention of Covid-19 deaths with the country’s elimination strategy has been a remarkable success story with New Zealand having the lowest excess deaths in the OECD group of countries. Overall economic performance since the start of the pandemic has also been relatively good compared to other OECD countries when considering GDP and unemployment levels.

“Many lessons around pandemic control have been learnt and going forward we will need to consider keeping those that continue to protect health at low cost in terms of inconvenience and basic freedoms. For example, over coming months it would probably still make sense to keep certain mask requirements (e.g., on public transport and in hospitals). Similarly, some vaccine mandates should probably be kept e.g., for health workers and aged care workers (including the need to update passes as booster requirements change). Specific venues and workplaces could be left to decide for themselves if they wish to have mask and vaccine requirements – according to what is most appropriate for the safety of their workers and customers (albeit with evidence-based guidance provided by health authorities).

“Another key move is to capture the lessons learnt through a Royal Commission of Inquiry into the pandemic response (as we argued for in June 2020). This is particularly important as the world could face future pandemics far worse than Covid-19 in the future e.g., from bioengineered weapons. These lessons might even help us reduce the annual health burden from winter respiratory illnesses, including seasonal influenza.”

Conflict of interest statement: Nick Wilson has no competing interests. He gets no funding for any of the research he does on Covid-19.

Dr Matthew Hobbs, Co-Director, GeoHealth Laboratory, and Senior Lecturer in Public Health, School of Health Sciences, University of Canterbury, comments:

“New Zealand’s pandemic response may not have been perfect, but it has been world-leading. Initially, the ‘go hard and early’ approach rapidly escalated the use of non-pharmaceutical interventions to a national lockdown. Without vaccines, a combination of movement restrictions, physical distancing, hygiene practices, and intensive case and contact detection and management was used. New Zealand was able to successfully control COVID-19 in the early stages of the pandemic. It also had unexpected benefits like the unprecedented reduction of influenza and other respiratory viral infections.

“The evidence supports New Zealand’s response so far:

• Evidence showed that reductions in life expectancy in men and women were observed in all the countries around the world studied except in New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020.

• Other research has shown that COVID-19 deaths per 1 million population in OECD countries that opted for elimination (i.e., Australia, Iceland, Japan, New Zealand, and South Korea) have been about 25 times lower than in other OECD countries that favoured mitigation.

• There is also increasing consensus that elimination was the preferable approach to mitigation in relation to a country’s economic performance. Research shows that elimination was superior to mitigation for GDP growth on average and at almost all time periods. GDP growth returned to pre-pandemic levels in early 2021 in the five countries that opted for elimination, whereas growth was remained negative for the other 32 OECD countries for much longer.

• Among OECD countries, civil liberties were most severely impacted in those that chose mitigation, whereas swift lockdown measures—in line with elimination—were less strict and of shorter duration.

• The elimination approach New Zealand used, not mitigation, of COVID-19 created the best outcomes for health, the economy, and civil liberties.

“The journey was not without difficulties: It is important to acknowledge that these early measures included difficult decisions like closing the border and, opening but then closing the Trans-Tasman bubble. Despite these difficult decisions, these measures bought New Zealand crucial time to increase vaccination coverage and wait until potentially life-saving treatments are developed.

“Where to from here? Before Omicron arrived, New Zealand was rather remarkably, very close to eliminating Delta. If you remember, even as Auckland opened up, hospitalisations and case numbers dropped. However, the course of the pandemic clearly transformed with the appearance of Omicron. New Zealand was better prepared than most countries to tackle it, but inequities in terms of vaccination levels and the safe reopening of schools are just some challenges that still persist. In addition, alarm bells are now slowly beginning to quietly sound again beyond our borders. Cases and hospitalisations are increasing in the UK perhaps due to waning immunity, the emergence of BA2, and the removal of restrictions. Cases are also increasing in China, which may have important long-term economic knock-on effects around the world should Omicron take hold there.

“How does this end? While some countries, including New Zealand, have had domestic success at controlling COVID-19, the arrival of Omicron has changed the course of the pandemic. Wealthy countries around the world continue to hoard vaccines. Ultimately, this gives the virus more opportunities to replicate and mutate elsewhere. History teaches us that relying on only COVID-19 vaccines to control the pandemic as some countries are doing, is extremely risky due to their uneven roll-out, and especially in this case due to their time-limited immunity and the emergence of new variants. Research indicates that the eradication of smallpox required concerted, decades-long efforts, including vaccination; communication, public engagement; and test, trace, and isolate measures. Until we have an effective and coordinated international strategy, it is plausible that it may take some time to emerge from the ongoing effects of this pandemic.”

No conflict of interest declared.

Professor Nigel French, Co-Director, One Health Aotearoa; and Chief Scientist, NZ Food Safety Science and Research Centre, comments:

“In March 2020 I was visiting the European Centre for Disease Control in Sweden and witnessed the early response to the growing pandemic in Europe. This was just a few days after the first case was seen in New Zealand. After arriving home on the 9th March 2020 I was contacted by the Ministry of Health and told to self-isolate – I had sat next to one of our first confirmed cases on a flight from Dubai. What followed has been at times horrifying, fascinating, moving and inspiring.

“It’s easy to lose sight of how the situation unfolded, as both the virus and our response evolved at remarkable speed. We successfully eliminated the first wave, characterised by multiple cross-border incursions, some of the strictest border control and lockdown measures in the world, and no available vaccine. This was followed by a long period where we were the envy of the world – society was able to function relatively normally, albeit with strict border controls, and we effectively bought time to plan for the next phases of the pandemic.

“The emergence of Delta in August 2021 was an important wake-up call. Our initial response was effective but did not result in elimination. However, it did buy further time to expedite the vaccination programme ahead of the next challenge: the global emergence of the highly transmissible Omicron variant. The current situation now couldn’t be more different – the total number of confirmed cases in the entire first wave was just over 1000; we are now recording roughly 20,000 cases a day, and that is likely to be a considerable underestimate of the true number. In contrast to the first wave, we now have one of the most immunised populations in the world, with no lockdowns in place and our borders are re-opening. It is quite mindboggling.

“As an epidemiologist I have been fortunate to be involved in several aspects of the response over the last two years. It’s been heartening to see how science has advanced and directly informed decision making, and how effective public health interventions have been. Difficult and rapid decisions have been made in the face of huge uncertainty about the impact of the pandemic on public health and the economy. These have been informed by scientists engaged in many disciplines including diagnostics, genomics, modelling and social science. Many have become household names as a result of their effective and courageous communication to the wider public, often in the face of unintentional misinformation and deliberate disinformation.

“Even more heartening has been the professionalism, courage and dedication of front-line health workers, and others working in high-risk settings. We owe a huge debt of gratitude to them. There have been inequities in the response, businesses have suffered, kiwis have been unable to return home, and many have lost loved ones in the most distressing of circumstances. Undoubtedly things could have been done better, but we can be encouraged by the fact that, despite the raging Omicron outbreak, our high vaccination coverage has so far limited our rates of hospitalisation and death among cases to much lower levels than those seen in earlier outbreaks, both here and overseas.

“We face many challenges over the coming months. It is very difficult to anticipate how the virus will evolve, what the longer-term impacts of infection will be, what new technologies will be developed, or how public opinion will change. What we do know is that we have a remarkable ability to adapt and respond to new challenges as they arise, and this should help us maintain our international reputation as a country that has led one of the most effective public health responses to COVID-19.”

Conflict of interest statement: Nigel is a member of the Ministry of Health COVID-19 Technical Advisory Group, a member of the peer review team for Covid-19 Modelling Aotearoa and a member of the team responsible for reporting on the genomic epidemiology of Covid-19. He is an academic at Massey University and Co-Director of One Health Aotearoa.

Professor Peter McIntyre, medical advisor, Immunisation Advisory Centre, and University of Otago, comments:

What’s been learned from NZ’s pandemic approach and its contribution to academic fields?

MĀORI HEALTH

Dr Rhys Jones, Public Health Physician and Senior Lecturer in Māori Health, University of Auckland, comments:

“Two years ago I wrote about the grave concerns many of us had in relation to New Zealand’s response to Covid-19: “that it will reproduce racist outcomes and end up being another chapter in the long history of health-related Treaty breaches.” (Spinoff, 18 March 2020) Those concerns were well founded – while there is clearly a lot to be grateful for in New Zealand’s approach to the pandemic, it has well and truly fallen short when it comes to equity and honouring Te Tiriti.

“The successes have come from following an evidence-based public health approach, and from enabling and supporting communities to protect themselves. The failures have come from ignoring the science and expert advice, including decisions that appear to have been influenced more by business lobby groups than by public health experts and community advocates. They have come from the government’s insistence on a paternalistic approach rather than sharing power authentically with communities, as highlighted by the shocking inequities in the vaccine rollout. And they have come from failing to prioritise investment in protecting Māori and Pasifika communities, particularly in South Auckland, despite clear warnings about the potentially devastating consequences of Covid-19 in these communities.

“An important lesson is that equity has to be central in every decision, and our approach has to be based on mana motuhake. There’s actually a really simple message for government – listen to Māori and Pasifika experts and communities, listen to disabled experts and communities, and listen to other structurally oppressed groups. Then do exactly what they say and invest the necessary resources and support to make it happen.”

No conflict of interest declared.

Dr Clive Aspin, Associate Dean Māori, Faculty of Health, Senior Lecturer, School of Health, Te Herenga Waka – Victoria University of Wellington, comments:

“In their haste to deal with the uncertainties of the impending pandemic, health officials failed to listen to experts who warned about the one certainty we could expect if warnings were not heeded.

“From the very early stages of the pandemic, leading experts in Māori health warned that there would be worse outcomes for Māori if measures were not taken to protect the health and well-being of Māori communities. As they pointed out, disadvantaged communities who struggled to access health services were at increased risk of Covid-19. They emphasised the importance of engaging early with vulnerable communities and providing priority access to vaccinations against Covid-19.

“Ministry officials were blind to these warnings and instead focused on other vulnerable populations such as the elderly and relegated Māori communities to lower levels of priority.

“By the time vaccinations were rolled out to Māori communities, anti-vaxxers and fake news sources had got into the ears of Māori, and especially those of rangatahi. The end result is that we now have lower levels of vaccination within Māori communities and higher rates of Covid-19 infection.

“If Ministry officials had been in tune with the people they purport to serve they would have known right from the start that they needed to pay attention to the needs and vulnerabilities of marginalised communities, and especially indigenous peoples.

“As well as the voices of Māori experts, they needed to engage with and listen to those who have knowledge and understanding of the impact of pandemics on indigenous peoples.

“Those of us who have intimate lived experience of the HIV pandemic know that indigenous peoples, including Māori, have experienced significant disparities, and it is sobering to see these playing out four decades later with Covid-19. Māori experience worse outcomes because of late testing for HIV and now the same thing is happening with Covid-19 and one wonders if we will ever learn.

“The disparities caused by Covid-19 over the last two years will affect Māori for generations to come because of long Covid, and will be a major contributer to ongoing health and social disparities in Aotearoa.”

No conflict of interest declared.

PASIFIKA HEALTH

Associate Professor Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“It is an opportune moment to reflect on the two-year anniversary of Alert Level 4 lockdown. The New Zealand response to the Covid-19 pandemic is regarded as one of the best in the world, informed by science with strong political leadership.  Early and decisive public health restrictions, including lockdowns, played an important part in the success of the New Zealand strategy.  Limiting the movement of people limits the spread of the virus.  We have been extremely fortunate that safe and effective Covid-19 vaccines have been available within a year of the outbreak and the uptake of the vaccines have been exemplary.

“Despite the recent increase in the number of deaths, hospitalisations and large numbers of new cases, the New Zealand response remains world class. A critical gap in our response has been the failure to address inequities in the vaccine rollout where the most at-risk population groups have had the lowest uptake of the Covid-19 vaccine. One hopes that the reform of the health system would lead to more and better investments to reduce ethnic inequities in health.

“It is also apparent that the prolonged nature of the pandemic and high vaccination coverage has led to economic considerations overtaking the importance of protecting the health of the public.”

No conflict of interest declared.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

“A strong health response was our best response to fighting Covid-19, with early measures and steps in Aotearoa New Zealand helping keep people safe and protected while vaccines were being generated against the SARS-CoV-2 virus.

“The generation of Covid-19 vaccines through effective global collaboration, co-operation and knowledge sharing efforts and with appropriate funding/resourcing, clearly demonstrated what could be possible when barriers were removed to allow scientific research and researchers to make progress with their work. This timely development of Covid-19 vaccines was an important step in the global fight against the pandemic.

“Achieving global vaccine equity with more equal Covid-19 vaccine distribution and availability however, remains a challenge. Vaccine inequities will contribute towards the ongoing generation of new Covid-19 variants, while unaddressed.

“Across Aotearoa New Zealand, Covid-19 vaccination levels increased rapidly after early challenges, however inequities affecting vulnerable groups that included Māori and Pacific communities were evident, with some areas across Aotearoa New Zealand also having much lower vaccination coverage than others.

“The burden of Covid-19 would be experienced unequally across Aotearoa New Zealand, with Māori and Pacific communities vulnerable to being disproportionately impacted and affected by Covid-19. Focus and prioritisation efforts for Māori and Pacific peoples and their whānau, aiaga and kainga with respect to Covid-19 vaccination, boosters, testing and prevention were needed.

“Equity-based approaches that reduced barriers and built trust for vulnerable communities, helped address accessibility issues associated with the Covid-19 vaccine. Māori and Pacific teams and community groups in particular worked tirelessly to drive up general vaccination levels and protect our communities, whānau and kāinga using equity approaches to help people get access to vaccines, information and health services, while building trust at the same time within a supportive environment.

“Although it has been encouraging that Covid-19 vaccination levels have increased overall across Aotearoa New Zealand, vigilance is still needed. We remain in the process of protecting vulnerable communities that include our children, tamariki and tamaiki aged 5-11 years, and getting people boosted to protect them from Omicron. Vaccination inequities with respect to Māori and Pacific peoples, tamariki and tamaiki are again evident in booster and vaccination levels for our children, tamariki and tamaiki aged 5-11 years, must be addressed.

“The Covid-19 pandemic has exacerbated pre-existing inequities in health for vulnerable communities in Aotearoa New Zealand, a strong equity focus is needed moving forward. Equity in action has been clearly demonstrated by Māori and Pacific health teams – this work must be supported to continue.

“In the meantime, our collective fight against Covid-19 is not yet over, and we still need to do everything we can to slow down the spread of Omicron while our children, tamariki and tamaiki get vaccinated, and for people to get their boosters.

“Monitoring for new variants of the SARS-CoV-2 virus will be an important step moving forward particularly with easing border restrictions.

“Stay safe and take care – keep others around you safe also by getting vaccinated, boosted, tested, isolate when needed, have a plan, have a medical kit, follow the rules and guidelines, and reach out to help others do the same.”

No conflict of interest declared.

Dr Edmond Fehoko, Health Research Council of New Zealand Pacific Postdoctoral Fellow, Te Wānanga o Waipapa | School of Māori Studies and Pacific Studies, University of Auckland, comments:

“The COVID-19 pandemic has shifted the way people plan research, conduct research and, at times, fund research. For Pacific peoples, such opportunities need to be given to more than just the public health experts, epidemiologists and other health-related experts. A holistic approach is needed from a Pacific perspective.

“Key strengths include the significant amount of funding that was provided for Pacific peoples and communities to address COVID-19 information and increasing vaccination rates. Such funding would have not been made available for Pacific peoples pre-COVID-19 times. At the same time, the government, academics, church, and community leaders failed to counter the substantial number of COVID-19 misinformation and disinformation, which has resulted in slow rates of Pacific peoples being ‘fully vaccinated’.

“In terms of the current outbreak and situation, Pacific peoples live in big households and at times, overcrowded, which means longer periods of home isolation, which is time Pacific peoples cannot afford.

“Unprecedented times has seen unprecedented funding poured into Pacific peoples and communities to address the COVID-19 pandemic. However, it is hoped that such efforts, resources and funding opportunities need to be made available to address other health and social inequities that Pacific peoples have and may continue to face today and in the future.”

No conflict of interest declared. Member of the CARUL Collective, and Member of the Auckland Council Pacific Peoples Advisory Panel.

CHILD AND FAMILY HEALTH

Dr Hiran Thabrew, Child Psychiatrist and Paediatrician, and child mental health researcher, University of Auckland and Auckland District Health Board, comments:

“The COVID-19 pandemic has proved challenging and rewarding for many children and young people. While some have enjoyed spending more time with their families, experienced less academic and social pressure and become more socially-minded, others have not been so fortunate.  From the early days of the pandemic, fuelled by traditional and social media, people of all ages experienced anxiety about COVID-19 and its potential impact.  Children were more likely to develop clinical levels of anxiety in the context of pre-existing anxiety, parental anxiety and direct exposure to the virus.  Those with neurodevelopmental issues such as autism experienced confusion, emotional dysregulation and behavioural difficulties amidst rapid changes to their routines.

“For young people, the multiple stresses of lockdown, limited peer contact and family disruption have led to an increase in a few key issues.  Rates of emotional dysregulation and presentations to hospital following self-harm have increased in New Zealand and overseas.  Lockdown appears to have exacerbated these effects, with a 25% increase in self-harm related admissions in the Auckland region. Rates of eating disorders among young people have also increased and inpatient admissions with anorexia have doubled in major centres.  Due to previous primary care education and specialist service limitations, young people with eating disorders have been presenting late, with greater complexity and waiting for months following inpatient medical stabilisation for follow-up care.

“There’s nothing like a crisis to expose existing health service issues.  While suicide rates among young people have gone down for the first time in a decade, New Zealand continues to have the worst suicide rate (19.3 per 100,000 young people) among OECD countries with Maori and Pacifika youth disproportionately represented (36.4 per 100,000 Maori).  Over the coming years, rates of all mental health problems, especially anxiety and depression, are predicted to rise and there will be a ‘long tail’ to the pandemic.  These will pose more of a challenge in the context of specialist workforce shortages and burnout.

“While the Government’s focus has been on boosting primary healthcare, investment into school-based health education, screening and early intervention will be important to contain the psychological impact of the pandemic on New Zealand children and young people. So will urgently increasing financial and workforce support for specialist clinical services, actively embracing and integrating evidence-based and culturally congruent e-mental health interventions, and addressing economic stressors that impact parent/whānau well-being.  To preserve the prospects of the next generation, the team of 5 million will need to remain united against the effects of COVID for a while to come.”

No conflict of interest.

Dr. Kate Prickett, Director, Roy McKenzie Centre for the Study of Families and Children, Victoria University of Wellington, comments:

“Lockdowns and family and parent wellbeing: The goal of the first and subsequent nationwide lockdowns was to save lives and protect our health care system, which they did, and with New Zealand’s elimination success rightfully touted around the world. 

“Another important success that was less highlighted, however, is the role that policy supports, such as the employer wage subsidy programme, played in protecting people’s jobs during lockdown, and in particular, mothers’ jobs. 

“For example, while we did see a small dip in women’s employment rate during and just post-lockdown, this pales in comparison to mothers in the US and UK, for example, who have seen mass labour-force dropout due to dragged out “soft” lockdowns and school closures, with women more likely to be working in industries impacted by these trends, and mothers, specifically, who are most likely to take on the brunt of homeschooling and caregiving.

“The economic impact of lockdown on families despite these supports more generally, however, was not felt equally. Our research found that low-income families with children were more likely to have a parent lose a job or income during the lockdown than families with higher incomes. They were also more likely to report they hadn’t returned to work or had their incomes recover by the time New Zealand was back in Alert Level 1. In short, those with the least to lose, lost the most and were still carrying the cost of the burden post-lockdown.

“Hard and fast policy was necessary, and saved lives and jobs. But the lessons from that first lockdown that highlight the inequities in the economic and health burden of this pandemic call for an equity-lens when the next crisis hits.”

No conflict of interest.

INFECTIOUS DISEASES AND MICROBIOLOGY

Associate Professor Siouxsie Wiles, Microbiologist, School of Medical Sciences, University of Auckland, comments: 

“Controlling the entry of COVID-19 into the country has been an important part of Aotearoa New Zealand’s success. That enabled us to embrace our ‘go hard and early’ elimination strategy and stamp out any cases that leaked through the border. While this approach was hard on many people and industries, it has meant New Zealand has had one of the lowest mortality rates and one of the best economic responses to the pandemic. Our genomic sequencing and contact-tracing efforts showed the world how the virus can be transmitted on international and domestic flights and even through the simple act of briefly opening hotel room doors.

“Our elimination strategy also allowed us to learn from other countries’ missteps and mistakes, and it bought time for safe and effective vaccines and antivirals to be developed and for medical professionals to better understand how to treat COVID-19 patients.

“I think the main weakness of the government’s response has been in the way existing inequities have been exacerbated by the types and levels of financial support provided to businesses and individuals and in how the vaccine was rolled out. Now that our response relies on individuals to manage their risk of getting COVID-19, we can expect these inequities to continue and for specific communities like the disabled and immunocompromised to become even more isolated and impacted.

“Two years ago, Aotearoa New Zealand did something unexpected, bold, and brave. Rather than return to the status quo, I want us to remember that. We shouldn’t be afraid to be bold and brave again so that we all have better outcomes not just for Covid-19 but for all the other big challenges we face like antimicrobial resistance and climate change.”

No conflict of interest.

Professor Kurt Krause, Infectious Diseases Physician; Professor of Biochemistry, University of Otago, comments: 

“It’s hard to overstate how dramatically the Covid-19 pandemic has affected us. It has resulted in major changes in travel, tourism, education, commerce, healthcare, and daily life, and it is the most significant pandemic in our lifetime. Covid-19 compares in many ways to the 1918 influenza pandemic. Some will point out that the estimated mortality was greater in 1918 but healthcare was much more limited at that time and most authorities feel that Covid-19 mortality has been undercounted several-fold.

“During this time of great upheaval and great loss of life we have also seen many great successes. The rapid development and delivery of vaccines against Covid-19 was a great success as was the development of effective monoclonal antibodies and effective direct-acting antivirals. The anti-inflammatory treatments used against severe Covid-19 are a great success. The ability of the nation of New Zealand to stamp out strain after strain of Covid-19 was a great success.

“Covid-19 is on our landscape now and seems likely to be sticking with us, but we have learned that working together will allow us to endure. I think we knew that all along. That message remains the same. Kia kaha.”

No conflict of interest declared.

MODELLING

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“Two years on from New Zealand’s first lockdown, a comparison of our death toll with virtually any other country in the world shows just how well we have done in managing the pandemic.

“Our response has been far from perfect and unfortunately there will be more deaths to come. But by keeping the virus at bay until the vast majority of over 12s had been vaccinated, we avoided the horrors of pre-vaccine Covid-19 that many countries have suffered. If we had followed the trajectory of countries like the UK and USA, New Zealand would have had over 12,000 Covid-19 deaths and spent more time in lockdown than we did.

“However, the pandemic isn’t over and we still need to do more to ensure vaccine equity globally. While rich countries roll out boosters, many people in African countries still haven’t received a single dose.

“It’s clear the elimination strategy, as hard as it was at times, was absolutely the right one for New Zealand. The challenge is to take these lessons and apply them to preparing for the next pandemic. All pandemics are different and there’s no guarantee that what worked before will work again. But it’s likely decisions will need to be made quickly in a highly uncertain situation.

“Evidence-based decision making in a crisis means having good systems for collecting high quality data, the right scientific tools to analyse that data, and good relationships to ensure the data, the science, and the decision makers are brought together. We need to invest in all these areas to make sure that when the next pandemic (or even the next variant) comes along, we’re ready to respond.”

Conflict of interest statement: Michael Plank is partly funded by the Department of Prime Minister and Cabinet for research on mathematical modelling of COVID-19.

GENOMICS

Professor Mike Bunce, Principal Scientist (Genomics), Institute of Environmental Science and Research, comments:

“As a scientist working with the Prime Ministers Chief Science Advisor, the COVID-19 directorate within the MoH and ESR, I offer up two reflections after two years of working within the country’s COVID-19 response:

“Science collaboration and impact:  At its core, ‘science’ is about the sharing of ideas and data. The pandemic has seen scientific data and findings shared at breakneck speed. The first genome of SARS-CoV-2, in Jan 2020, was freely shared to a global database. This enabled two key developments: (i) the rapid development of PCR tests, and (ii) the ‘code’ to build new RNA-based vaccines. The extra toll that this pandemic would have exacted without the timely sharing of scientific data, protocols and ideas does not bear thinking about.

“When I look around the scientists that work on COVID-19, I see a lot of tired people. But below these tired exteriors also sits a deep sense of pride that the science they have practised has truly made a difference. As a scientist, I have often wondered if the community ‘value’ science investments – I think (and hope) that the learnings from this pandemic help us to engage the public in the need and value of science. On a personal note, as a scientist that works with DNA, it’s impressive our country is led by politicians who now know what a CT value is and can read a tree built from SARS-CoV-2 genomes!

“Science communication: At times science, as a field, can be eye-wateringly complex. In this pandemic the speed and volume of science that underpins our decision making has thrown up a raft of new challenges. For COVID-19 it is often the case that if a ‘science voice’ does not address the news of the day, then somebody else may fill that space with – well, to be honest – nonsense or misinformation.

“Over the past two years we have seen science communication ‘come of age’. From elegant cartoons from Siouxsie Wiles and Toby Morris to complex modelling data written for key Cabinet decisions, there has been a drive to make science engaging, or at least palatable. A key learning is that we don’t need to sugar-coat or oversimplify science messages – sometimes we just don’t know (yet), and a state of uncertainty might be where we currently sit.

“From dealing with the ongoing pandemic to tackling climate change, the ability of Aotearoa New Zealand to respond to some pretty gnarly challenges – and yet remain agile – will, in my opinion, be dependent on our collective ability to understand science-based evidence and to reject misinformation.

“So, after two years at the pandemic coal-face, I raise a glass to our scientists and science communicators, but also to our politicians and the public who welcome and absorb science, and see its critical role in making good decisions.”

No conflict of interest.

Dr Andrew Chen, Research Fellow, Koi Tū – Centre for Informed Futures, University of Auckland, comments:

“As we continue through the omicron wave, we find ourselves in new territory for digital contact tracing. Evaluations of these tools around the world have shown mixed results, with poor performance generally tied to low participation rates. In New Zealand, we saw relatively high rates of participation through the delta outbreak and the early parts of the traffic light system, and most people were keeping an eye on the locations of interest. However, in recent weeks, with contact tracing being pared back as case numbers skyrocket, the way that we use digital contact tracing has changed.

“Through the delta outbreak, we saw messaging from the government that scanning into venues was effectively mandatory even if it was unenforced. This led to the highest level of participation in digital contact tracing we’ve seen, with almost 4 million QR code scans a day just before Christmas, and with almost 2.4 million devices participating in Bluetooth Tracing. While the level of QR code scanning has dropped (which is in part attributable to reduced mobility under omicron), Bluetooth Tracing participation has stayed strong, which speaks to its passive nature (turn it on and leave it on).

“With locations of interest no longer being published, the QR code-based system has lower utility. It is still helpful for people to keep their own record of where they have been, and to contribute that information to public health officials for analysis if they test positive for COVID-19, but they won’t get notified about potential exposures based on where they have been. However, Bluetooth Tracing has become more significant, with hundreds to thousands of cases uploading their keys, and thousands of people being notified about potential exposures each day. Its effectiveness in the New Zealand context remains to be evaluated, but we are now using the Bluetooth tool in a more similar context to what was seen in other jurisdictions earlier in the pandemic.

“If there is one thing that is constant in the pandemic, it is change. We’ve seen the use of NZ COVID Tracer and associated digital contact tracing tools change a lot over the last couple of months, including shifting from interaction-heavy contact tracing calls to self-reporting through digital forms. Digital exclusion is still a significant challenge for our ability to use technology to assist with the public health response, and we have to be very careful not to further exacerbate health inequities by relying solely on digital technology. But beyond a lack of access to the technology, we have seen what happens with disparities in technical capacity and skill – there are a lot of misunderstandings about how the technology works, from members of the public to government officials. Educating people on how these technology tools actually work, so that they can be used in a trusted way, remains a challenge and there are many lessons to learn for other public sector technology projects.”

Conflict of interest statement: I have had interactions with the Ministry of Health around digital contact tracing in an academic capacity, but am not employed or paid by them.

Dr Murat Üngör, Department of Economics, University of Otago, comments:

“The adoption of digital technology to transform businesses has been one of the characteristic features of the lockdowns. New Zealand’s acceptance of multilateral cooperation on digital trade has been an important component of economic resilience, and one of the strengths of the country during this global pandemic.

“Chile, New Zealand and Singapore signed the Digital Economy Partnership Agreement (DEPA) in a virtual ceremony on June 12, 2020. The DEPA establishes rules and procedures to engage in digital economy and digital trade. Canada and South Korea already expressed their interests in the DEPA. Recently, New Zealand signed a free trade agreement with the United Kingdom. One of the chapters of the agreement is on digital trade.

“Data, knowledge and innovation are strategic assets for the future of New Zealand. Digital trade is inclusive: all people and businesses can participate in, contribute to, and benefit from its opportunities. This is particularly important for disadvantaged groups’ involvement in economic activities. Small- and medium-sized enterprises, and Māori and Pasifika entrepreneurs, can explore business opportunities. Low socio-economic groups and rural consumers can explore lower prices and more choices with better information. Economic prosperity can be enhanced and sustained with embracing the digital economy and digital trade.”

No conflict of interest.

ECONOMICS AND PUBLIC POLICY

Professor Ilan Noy, Chair in the Economics of Disasters and Climate Change, Victoria University of Wellington, comments:

“The COVID-19 pandemic has killed, officially, about six million people globally, but the excess-death counts point to an actual number of around 20 million deaths. Here in Aotearoa, we were fortunate not only to have possibly the lowest excess mortality rate in the world, but also to avoid the health/wealth trade-off that we were worried about. Through a combination of good decisions by ‘the team of five million’, a lot of luck, and the successful introduction of vaccination that has allowed us to start opening up again, our economy proved robust to the series of unprecedented lockdowns and restrictions our government imposed. While incomes collapsed in the first few months of the pandemic, they rebounded very quickly thereafter.

“There were, however, some significant costs, these were not evenly distributed, and not every policy decision was the right one. Now that the pandemic is ebbing elsewhere, and will hopefully soon do so in New Zealand, we need to remind ourselves that we won’t always be so lucky. We need to better prepare much better for the next pandemic by, first, analysing what we did wrong and what we did right in this pandemic, and start planning accordingly for the next one.”

No conflict of interest declared.

Professor Arthur Grimes, Professor of Wellbeing and Public Policy, School of Government, Victoria University of Wellington; and Senior Fellow, Motu Research, comments:

Note: These comments draw on two sources – see here, and the soon-to-be published: Grimes, Arthur (in press). “Measuring pandemic and lockdown impacts on wellbeing.” Review of Income and Wealth.

“New Zealand’s initial response to Covid-19 relied on stringent lockdowns which enhanced physical health outcomes but had negative side-effects such as increased loneliness. Did overall wellbeing rise or fall given these conflicting responses – in aggregate and for different population groups?

“We can answer this question based on wellbeing surveys run by Stats NZ before the pandemic (the 2018/19 General Social Survey – GSS) and via quarterly supplements to the Household Labour Force Survey (HLFS) that started during Level 3 lockdown in May 2020. Survey respondents rate their overall satisfaction with life plus other aspects of wellbeing, including their degree of loneliness.

“The responses show unambiguously higher degrees of life satisfaction in each of the 2020 (pandemic) surveys relative to 2018/19. Furthermore, if we split the responses by 32 separate demographic groups (by sex, age-group, labour force status, migrant status, ethnicity, and region), we see a rise in life satisfaction (with the first lockdown) for 30 of the groups; none fell. However, loneliness also rose, particularly for sole parents.

“These results do not mean that lockdowns themselves contributed to higher wellbeing. Analysis of the Auckland-specific lockdown in 2020 shows that the second lockdown reduced life satisfaction (and increased loneliness) for those locked down relative to others.

“How do we make sense of these apparently contradictory results? It seems that people, on balance, welcomed a lockdown to prevent the initial spread of Covid-19. The results of the Auckland lockdown nevertheless show that lockdowns have a negative impact that must be weighed against physical health and other benefits of a lockdown. Experience after 2020 suggests that the positives wain while the negatives strengthen as lockdown-fatigue becomes prevalent.

“Overall, the initial lockdowns were an unambiguous wellbeing success; the task for future pandemics is how and when to transition out of them.”

No conflict of interest declared.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Wellbeing, comments:

“From a psychological point of view it has been encouraging to see the emphasis on, and interest in, the mental health aspects of the pandemic. In the past two years we, as a nation, have discussed the social isolation of being in lockdown, people’s health anxiety and fear about becoming unwell, the impact of COVID-19 on children and young people’s wellbeing and education, how to cope with boredom and frustration when you can’t go out, and ongoing issues around compliance with lock-down rules. All of this demonstrates that in New Zealand we have taken a more holistic view of the pandemic than in some other countries, one that considers not only the physical effects of the coronavirus but also the mental, emotional, and psychological side-effects that it brings. It shows a mature approach to thinking about wellbeing and our ability as a society to discuss mental health issues.

“As we look to emerge from the biggest public health crisis in a century there are still psychological challenges ahead of us. The impact of long-COVID on our brain and psychological functioning is only beginning to be understood. So too are the long-term psychological impacts of job losses, income reductions, family relocations, and years of disrupted schooling and peer-relationships for children that the virus brought with it. The recent anti-mandate protests at Parliament have highlighted issues around the psychology of understanding and dealing with misinformation and disinformation. Even once we have dealt with the immediate physical effects of the COVID-19 virus itself, we may well be dealing with a long-tail of psychological side-effects for many years to come.”

No conflict of interest. Dr Sutherland is an associate at Umbrella Wellbeing.

Jacqui Maguire, Registered Clinical Psychologist, comments:

“The COVID-19 journey in this country has been an emotional roller-coaster, pivoted by virus variants, vaccination hope, societal division and border lines. From my vantage point, we have transitioned as a country from a position of strength (team unity, national pride and a sense of gratitude) to one now flavoured with anger, distrust, worry, and overwhelming fatigue.

“The majority of these ups and downs could be predicted by looking at the research. The psychological impact of a long-term crisis generally sees an initial downturn in wellbeing, followed by a positive rebound. Then when the crisis continues and stress hormones deplete, disillusionment, grief and burnout show up (Myers + Zunin, 2000) until people are in a position to reimagine and construct a new normal.

“Unfortunately, what I think has occurred over the past 12 months is that New Zealand has not been in any position to reimagine or rebuild. Omicron mentally, emotionally and economically whiplashed us. Mandates and people’s viewpoints of these segregated society. Closed borders continued to separate us from the rest of the globe, and prevented our Grounded Kiwis from returning home. A societal underbelly of anger and hatred rose to the surface for all of us to witness. And consequently, I believe people’s wellbeing has decreased.

“As Omicron peaks and mandates lift, our national task is to heal. Healing from worry and fear as people re-emerge from their homes back into society. Healing from anger and division, as we learn to get along with our neighbours that do not share our views – our communities are reliant on our ability to be adult in our interactions, which requires mature respect and tolerances for diversity, including of thought. Healing from economic crisis as our businesses attempt to stay afloat amidst the most challenging of circumstances.

“It is hardwired into people to soak up the negative, to hold onto what went wrong. This is one of our bodies’ evolutionary survival mechanisms. We have to purposefully look hard to shift our attention towards what we have done well and towards the hope. As we re-emerge from this phase and enter the future, not one of us can predict what that will look and feel like. Compassion, care, hope, support for New Zealand locally, and a stance of no-judgement will help us to move forward. It will help us heal.”

Note: Image to illustrate mental health impacts of the pandemic’s first two years in NZ, by Jacqui Maguire. Click through for the full-size image.

No conflict of interest.

FOOD INSECURITY

Emeritus Professor Elaine Rush, Professor of Nutrition, Auckland University of Technology, comments:

“We have seen two years of increasing food insecurity, cost of living increases, and rising inequity in Aotearoa. It’s time to focus on prevention not treatment.

“We know that a diverse diet of wholesome foods from conception is the best way to health and prevention of disease. New Zealand produces a surfeit of food, more than enough for food sovereignty and self-sufficiency but…we import 90% of the grain we need for bread, feed animals most of our cereal and grain crops and do not produce enough green leafy vegetables or legumes to enable New Zealand people to eat well locally. In addition, food access is not equitable, it impacts life-course health and immunity, and it is getting worse because of the increasing costs of food and competing costs-to-live such as housing and petrol.

“Over the last two years, food insecurity in New Zealand has worsened. Accelerating climate change – and now the invasion of Ukraine by Russia – has increased the fragility of the global food supply, fuel prices and food shortages add to Covid-related stresses. Through 2020 and 2021, New Zealand participated in preparation for the UN Food Systems summit in September 2021. Much was said about sustainability but little has happened. It is time to boldly transform the food system of Aotearoa from the ground to the table so human well-being is the priority. Feed New Zealand first then export – it is important to future proof.”

Conflict of interest statement: I am on the Health Research Council and also am Scientific Director of the New Zealand Nutrition Foundation.