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Shane Reti
Shane Reti, the National Party’s health spokesperson, in his parliament office. (Photo Justin Giovannetti)

PoliticsSeptember 2, 2020

Do no harm: Dr Shane Reti on leading National’s changed Covid-19 response

Shane Reti
Shane Reti, the National Party’s health spokesperson, in his parliament office. (Photo Justin Giovannetti)

Shane Reti has emerged in recent weeks as the opposition’s most capable communicator in the age of Covid-19. Justin Giovannetti speaks with ‘Dr Shane’ about the changes he’s brought to National and how he’d seek to improve New Zealand’s response to the coronavirus.

The National Party’s path to effective opposition on Covid-19 has been anything but smooth. The largest party in parliament has hesitated between being too critical of the government’s handling of the virus under Simon Bridges, and then offering flimsy, muddled promises with Todd Muller.

Then there was a 48-hour tryst with conspiracy theory in early August by leader Judith Collins and her deputy, Gerry Brownlee.

In recent weeks, the party seems to have finally found its footing. And it turns out they had the answer all along in Shane Reti. On July 15, Reti was plucked from relative obscurity by Collins and made the opposition’s chief health critic. Since then, he’s overhauled National’s approach to Covid-19.

Reti’s CV is impressive on paper. From a working class Māori family, he worked as a general practitioner in Northland for nearly two decades before getting a prestigious fellowship in the US. In late 2013 he left a position at Harvard medical school and one of the top hospitals in the world to come home and run for parliament. The full picture of this 57-year-old legislator, who was unknown to so many a few months ago, is even more intimidating.

Going into an interview with Reti in his parliamentary office, one of the questions I had in my notebook was, “Where were they hiding you?” The question was underlined repeatedly as he began talking.

In recent weeks Reti has been everywhere. His party’s Facebook page is now dominated by the man Collins calls “Doctor Shane”. Softly spoken, he’s seen National come out in full support of the government’s elimination strategy. His fingerprints are all over the party’s new border and testing plan. Last Tuesday, he was given an opportunity during a press conference to pounce on Jacinda Ardern’s decision to make masks mandatory on public transit.

The government had spent months being lukewarm on mask use but then changed position rapidly. Where most opposition MPs would have sharpened a knife to attack the government, Reti took on the cadence of the GP he is by training. He explained that the WHO’s advice on masks had changed and the government was changing with it. His response was the best explanation of the government’s new position and it came from opposition.

Fifteen minutes into my conversation with Reti, the health critic had reached for a copy of the government’s modelling that explains how the testing and border system work. He pointed at expectations built into the modelling, percentages, the real nuts-and-bolts of how the border is keeping us safe. His face was all glee and he rubbed his hands as he spoke in exacting detail about the government’s response.

He has whiteboards on the walls around his office covered with notes, ideas and health plans. He’s diagrammed the managed-isolation system at the border and annotated possible failure points. Just over a month ago he was the party’s point-person on a number of files, including skills, drug reform and the Treaty of Waitangi. His day job didn’t really let him deal with Covid-19 at all. Now the whiteboards are filling up.

So: where has he been?

“Yeah, I know. I was down in the engine room,” he said with a smile. He was working, doing his job, feeding his thoughts to the front bench. Now he’s near the centre of the opposition as, in theory, the main critic of everything the government does in health care.

A tough assessment of Reti is that he makes a poor opposition politician in normal times. He has the bedside manner of a good doctor and seeks to comfort. He’s not much at heckling or being abrasive. “When I’m doing interviews I say to myself, switch to doctor mode and do a consultation for the nation,” he told The Spinoff.

“Attack mode is not my style, it’s not my brand, it’s not where I want to be,” he acknowledges. I point to his performance last Tuesday and his explanation on the need to wear masks.

“How would that help us,” he said of criticising the government’s decision on masks. “If our mission is to raise the collective bar and improve the health of everyone, how does that help? If I want to critique, I’d better have a solution as well. Anyone can critique, anyone can poke holes, that’s the easy part. The hardest part is then saying: yes, and this is the solution.”

National MPs Gerry Brownlee, Paul Goldsmith and Shane Reti look on during a press conference at parliament on August 12 (Photo: Hagen Hopkins/Getty Images)

The green monster

Reti found himself in the middle of the US health care system in 2007. What was supposed to be a one year programme at Boston’s Beth Israel Deaconess Medical Center, one of Harvard’s main teaching hospitals, turned into seven. It only ended when he left to run for National in the Whangārei electorate.

He quickly found himself in the US at a “skunkworks”, a lab where researchers were given a lot of leeway and money to make mistakes and attempt radical innovation. They focused on merging together health care and technology.

“It was really cutting edge stuff. It was one of those rare times in life where I could dream anything and then deploy it. My boss was the senior scientist at the [US Centres for Disease Control], we had access to funding and resources I couldn’t imagine in New Zealand,” said Reti.

Harvard started sending him every few months to the Middle East to help overhaul health systems there. “It still puzzles me that they wanted to adopt the US health system, which is kind of broken, but anyways,” he said in an aside. New Zealand’s trade office quickly learned of what he was doing and enrolled him to help introduce local companies to buyers in Kuwait, Dubai and Qatar.

“Every three or four months I’d leave Boston, swing through New Zealand, see the children and fill the pantry, all the stuff you do as a dad. I’d meet with chief executives in New Zealand looking to enter the Middle East market. I’d give them advice and help open doors for them, places like Orion Health and Fisher & Paykel Healthcare. And then fly to Dubai.”

When he heard the Whangārei seat was opening up, he decided to come home. During his time in Boston he became a Red Sox fan, he’d been to Fenway Park, he figured he’d learned all he could. Years later, he still uses those connections and speaks with former colleagues at Harvard every few weeks. “My introduction now in the US is that this is Shane Reti, he’s out of the lab of Warner Slack and Charles Safran at Beth Israel. It’s like my whakapapa there,” he said.

“It sounds geeky. But I was specialising in a form of non-linear modelling, predictive risk modelling with artificial intelligence. I don’t have the resource or the time now to bring those fine-tuned skills to our coronavirus outbreak, but oh boy would I love to get my hands on that,” said Reti.

Shane Reti after graduating with a masters from Harvard.

‘Crikey, it starts to fail too’

While he can’t create new models to tackle the coronavirus, Reti is using his knowledge of New Zealand’s Covid response to find flaws in the government’s response. His latest target is the decision not to make testing mandatory for returnees at day three.

The health minister, Chris Hipkins, has acknowledged in recent days that some people in managed isolation have declined day three tests. Hipkins has said that the earlier tests are “irrelevant” because day 12 tests are mandatory. Irrelevant? Not so, says Reti, sitting in his office and wagging his finger.

“Our entire model is predicated on day three testing being compulsory. I’m getting off track here, sorry,” he said, pulling out the government’s modelling of the border system. We were just talking about the Red Sox.

“We’re probably in the sweet spot now at the border. Less than 1% will get through. That’s highly infectious individuals. Good paper, I love it a lot,” he said, flicking through the pages.

“Here’s the problem,” he continued, pointing towards a chart. “The presumption behind the entire model is that day three and day 12 testing is compulsory. Surprise! It’s not. Day three testing has to happen, without that the whole model starts to fail. I love modelling. I pulled the paper, looked at the assumptions, looked at how the model was tuned, looked at the input parameters and realised we weren’t being consistent. When that isn’t stable, what happens to the rest of the model? Crikey, it starts to fail too. That’s really started to bother me and that’s where the argument on day three testing came from.”

There’s a moment of silence.

I asked why he hadn’t made the argument more forcefully. “Do you even retail it? I’ve bounced it around. I just want Chris [Hipkins] to make the tests mandatory,” he said.

A few hours later, on Thursday last week, National put out a statement calling for mandatory day three tests. In a statement, the opposition called its request an “evidence-based, constructive proposal”. The government hasn’t responded to it.

Reti’s predecessor, Michael Woodhouse, had spent much of his tenure poking holes in the border system with anecdotes of people slipping through and declamatory, censorious rhetoric. That’s not Reti’s brand of opposition. He points out that the biggest problem with the lack of mandatory day three tests is that most positive cases at the border are being caught with the early test. Without it, a returnee can spend nine days walking around a border facility, sharing elevators with other people and staff. A maintenance worker at the Rydges facility in Auckland is believed to have caught Covid-19 from a surface in an elevator — the returnee with Covid-19 that infected him is not believed to have refused a day three test.

The Bloomfield test

Reti says he’s built up a relationship with the director general of health, Ashley Bloomfield, during a number of meetings facilitated by Hipkins. He remembers a conversation during National’s second health briefing with Bloomfield and Hipkins where the possibility of Covid-19 entering New Zealand on a refrigerated package handled by a south Auckland warehouse was discussed.

“The question was asked: What about the virus coming on these frozen peas? Ashley turns to me and goes, ‘I don’t know, Shane, what do you think?’ It’s really rare. Imagine, you’ll go from human to fomite [a surface that carries the virus], that’s rare. Fomite, which is cold — that’s rare, even though the virus’s metabolism is slowed down, it’s rare. And then fomite back to human. That’s kind of rare. He said to me, ‘Yeah, I think so too.’ We had this collegial conversation across the table on the science. I think maybe he felt he was with his tribe for a moment and was safe,” he said.

Reti remembers feeling uneasy because he had to turn his back on Hipkins, his host, to face Bloomfield. The two then went off and had a conversation across the table as others tried to keep up.

At their next meeting, testing was the main subject. “I had to bring it up. ‘Ashley, you need to fess up. You didn’t have a normal nasal. That one you did on television, that was a high-turbinate nasopharyngeal.’ Which is a hell of a lot easier, it’s the one we use with children. He rocked back in his chair and laughed. ‘How did you know that?’ he asked. I know things,” Reti said with a smile.

“All the ministers were looking around the table. ‘What’s a high-turbinate?’ Hipkins was asking, ‘What’s a high-turbinate?’ And Brownlee just rolled his eyes. The technical guys were talking. It was convivial. I think he feels a kindred spirit in me.”

Reti isn’t having a go at Bloomfield, though, for his choice of test. “An adult can do it. It’s totally appropriate for an adult,” he said.

A young Shane Reti.

Making future lockdowns more sophisticated

Between learning about politics during his university days in Auckland and medical school, Reti decided to join the territorials. “Empty space in my hands is dangerous,” he said with a grin.

“Good exercise, esprit de corps. All that stuff worked for me. I learned so much. There have been so many times in my later years I’ve looked back on that,” he said of serving in the medical corps.

“My parents taught me a great singing vocabulary. The army increased that vocabulary, lots of which I could never sing in public. But I had so many great times in the back of a truck with the Māori boys. They’d say, ‘Hand doc the guitar.’ The love of singing and love of camaraderie among Māori really worked for me,” said Reti. He’s pulled out an electric guitar a few times during his political career.

Balancing a number of competing jobs is a skill that has served him well. While he wasn’t well known outside of the National Party, Reti wore a number of hats before ascending to the health portfolio. He held the tertiary education spokesperson role, skills and employment, treaty negotiations, associate health and also wrote the party’s medicinal cannabis reform programme on the side.

He’s now juggling the balancing act of plotting what the future of New Zealand’s Covid-19 response should look like. A lot of what he told The Spinoff last week were still ideas in his head, things he’s not yet ready to critique the government about because he doesn’t have a full alternative worked up yet. His mind and whiteboards are humming away.

One problem now is dealing with teething issues from increased mask use. National supports wearing masks, support that could extend to wearing them in shared spaces in schools. “There are studies out of Milan that show that societies with masks socially distance more than those without. The discipline of using a mask is good for the discipline of coronavirus etiquette,” he said.

I bring up postcode lockdowns. The party’s leader expressed interest in shutting down neighbourhoods or single streets in future outbreaks instead of entire cities. He anticipated my question. “We’re interested in exploring that. The argument you’ll put to me is Melbourne. It failed in Melbourne. The Melbourne failing is that they were late, two weeks late at least. There wasn’t clear continuity in Melbourne, they were cutting through parks, it didn’t make sense,” he said.

“For the Auckland lockdown we’ve gone by the civic boundary. Imagine if we could push that southern boundary up a bit. We had New Zealand steel just on the boundary and that caused a lot of problems. What is the cost-benefit analysis of moving the boundary? Maybe moving it a little further north? I don’t know the answer, but oh boy would I love to have a team of officials look at that. That would be such useful information”.

“It’s about finessing and getting a more sophisticated type of lockdown,” he said.

New Zealand’s next steps to beat Covid-19

National has supported the government’s coronavirus elimination strategy almost completely in recent weeks. Is Reti responsible for the new-found enthusiasm? He points to his whiteboard where there’s a list of subjects to teach caucus about. “It was number four on my list.”

That enthusiasm might not last forever. Reti is look at whether there’s a smarter way to tamp down future resurgences of Covid-19. One way is to turn around the way testing is done. Setting up testing sites in car parks might not be the best way. He is talking with experts in the US and around the world, getting advice on what’s been learned during eight months of battle with the coronavirus.

“We’re supportive of elimination today, but is that the right strategy for spikes four, five or six? We’re thinking on that and what it means,” he said. Part of the solution could be better and more technology, especially integrating bluetooth into the government’s Covid-19 app. But he doesn’t have a full plan for that yet.

However, without prompting, he slowly starts to unspool thoughts about where the system could be improved.

“It doesn’t seem tenable we can keep doing, in spike three or four, what we’ve done so far. The harm is just too much. What does the next spike look like? I’m of the view that it’s a mix of really rapid contact tracing and rapid-response teams that go out to the community. We rely on you to come to us, it hasn’t worked so well for Māori, by the way. We need these teams to go out there, instead of waiting for a lunchtime or a weekend when they can come to community testing sites,” he said.

“We set up testing in carparks for a weekend, we had one in Thorndon here, and they call it surveillance testing. It’s probably testing of convenience. You’ve got a certain demographic that came into central Wellington, that came to Thorndon New World on that day, that’s a demographic,” he continues.

“I’m interested in those who don’t want to be found, or can’t be found, or don’t have a car to come in, or can’t afford to shop at New World. That’s who I want to find. They are going to be Māori in the far north and east cape. We need to go out there and do the surveillance testing because I’m just of a view that some of those in the far-flung areas are thinking, ‘Why do I need to be tested? If I’m positive I’ll be the reason they shut down the community centre for two weeks. I’ll be the one who keeps mum home from work and her job is compromised. Nah, I’ll suck it up. This cough, runny nose and sore throat is going away.’ That’s who I’m concerned about.”

The fluoride cheque

About 70 minutes into what was supposed to be a 30 minute chat, I ask Reti about a story I’ve heard about him that doesn’t quite add up. “What’s this about you and a $70,000 cheque for fluoride up in Northland?” I ask. He stops. “Very few people know about that.”

In 2001 Reti was appointed to the Northland DHB for the first of what would be three terms. The government had set 12 objectives for the health board. Reti looked at all 12 and chose to focus on three, one was improving dental health.

“I looked at it and asked: ‘Could I touch more people than any other intervention, by adding fluoride to the water? No one in Northland was fluoridated. So I made an appointment with the Far North Council. They had some of the worst dental care in New Zealand and I wanted them to consider fluoridation. So I asked them, ‘Go to your population, present them with information and ask them what they think and make a decision.’ They said to me, ‘We understand the merits, but we can’t afford that.’ I took out my chequebook, signed a blank cheque and put it on the table. ‘Now what’s your hurdle?’ There was silence,” he said.

The cost of mailing out a survey to the entire local population, collecting it and putting together the responses could cost $70,000 they warned. He said he understood and pushed the cheque across the table. Months later the response came back as a yes and flouride was added to the water.

“I remember telling my family. That was early in my career and definitely was going to send me into overdraft. My kids were four and five and wanted to understand. I told them that Dad was asked to take on this leadership role in Northland and was concerned that a lot of their friends at Playcentre have poor teeth. I want to help them, but I need to talk to everyone about it. ‘How much will that cost, Dad?’ It’s a big number, I told them. About $70,000. “Woah. Can we afford that?’ That’s a dad problem.”

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