ScienceOctober 22, 2021

Covid traffic light framework: the experts respond


Jacinda Ardern this morning outlined a new approach to NZ’s Covid response, conditional on vaccination levels (read our explainer here). The new system received a mixed reaction among the experts.

New Zealand’s most prominent epidemiologist, Michael Baker of the University of Otago in Wellington, saw “some positives” in the new system, particularly in relation to vaccination targets. He welcomed, too “the commitment to keeping a tight border around Auckland”.

Baker pointed to three weaknesses, however, First, “I don’t think it’s nuanced enough,” he told RNZ. Second, it failed to account for the risk of new variants or unexpected twists. “We know this virus still has surprises for us,” he said. Third, he was concerned about potential for confusion with three separate systems in play: the alert level system, the “stepped” exit from alert level three for Auckland, and now the traffic light framework. “We could have taken the existing alert level system and easily upgraded it … I don’t understand the need to introduce two other systems at this stage.”

In spite of recommendations from some of those consulted, the 90% threshold is based on DHB breakdowns, rather than also requiring Māori and Pacific communities to first make that target. That was “extremely disappointing”, said Rhys Jones, a public health physician and expert in Māori health at the University of Auckland. “This flies in the face of minister Andrew Little’s assurance, reported this morning, that Covid-19 restrictions would continue until all groups reach 90% vaccination rates.”

The government had “rolled out a vaccine programme that systematically privileged non-Māori, non-Pacific populations”, said Jones, and was now using “vaccine coverage predominantly among those populations as the basis for easing restrictions. Not only have Māori in particular been neglected in the vaccine rollout, our communities may now be exposed to extremely high risk due to the failures in that rollout.”

Significantly easing restrictions while vaccine coverage for Māori and Pacific were “dangerously low” was unethical, he added. “The announcement of additional funding to boost Māori vaccination rates is welcome, however this investment is too little, too late. This should have been the singular priority from day one. Māori should have been at the centre of the Covid-19 vaccine programme, and should have been leading the programme, the whole way through.”

With Covid on the brink of becoming “a runaway event in Auckland”, the 90% trigger point presented an unacceptable risk to Māori, independent researcher Rawiri Taonui told RNZ. “There is a high risk that Māori will end up falling behind and we could pay a huge price in terms of numbers of cases and multiple deaths.”

While there had been “constructive consultation” with Māori, “I don’t really think the majority of cabinet have listened,” he said. Māori would be better served by a 95% target, he said, and given the current trajectory a better option would be to move Auckland to level four. 

Ministers make the announcement at parliament’s banquet hall. Photo: Getty

Dianne Sika-Paotonu, an immunologist at the University of Otago, questioned whether the system sufficiently considered impacts for Māori and Pacific communities, who “continue to be heavily impacted as a result of the current Delta outbreak … Although improving, Māori and Pacific vaccination rates remain behind the overall rate as more time was needed to catch-up with other groups given the initial vaccination roll-out in Aotearoa New Zealand prioritised other groups to get vaccinated first.”

She added: “We need to drive vaccination rates up even further as quickly as possible, and to give more time for our hospitals to be ready. It would be incorrect to assume those who have yet to receive their Covid-19 vaccine are just all against the vaccine, accessibility issues persist for hard-to-reach communities and more vaccination outreach activities and events that are resourced appropriately are needed.

The traffic light system signalled the importance of vaccine certificates in the months ahead, said Michael Plank, a member of the Te Pūnaha Matatini modelling team, based at the University of Canterbury. “This will hopefully create a strong incentive for people to be vaccinated if they want to enjoy freedoms like going to restaurants, bars, gyms, gatherings. No jab, no fun. This approach is justified because unvaccinated people going to these busy locations would put other people’s health at risk.”

Even the red setting on the new system ”may not be enough to control a large outbreak that was threatening healthcare systems”, he added. “So, we should keep some of the stricter measures like business closures or localised lockdowns, and appropriate economic support packages alongside them, in the toolbox in case they are needed.”

“Impressive,” was the assessment from Tony Blakely, a New Zealand epidemiologist at the University of Melbourne. Unlike the plans in Victoria and New South Wales, it offered a path out without accepting high case numbers, he told RNZ. He commended the “equity” involved in requiring all DHBs to reach the 90% target before moving to the new system and the “emphasis on Māori in getting those levels up”. 

It was rare in the world for remaining “very risk averse” and “playing peek-a-boo with the virus”. New Zealand faced an unknown risk, he said, having had such low case numbers and therefore low natural infection immunity. But New Zealand could “slowly relax and start living with higher levels of the virus and segue over at that point”.

There were dangers in “building a pandemic response around vaccines”, warned Amanda Kvalsvig, an epidemiologist at the University of Otago. The risk was that “the plan may very quickly go out of date”, she said. “Population protection from vaccines is likely to change over the next few months. A third Pfizer vaccine dose will probably be required to maintain immunity, and new variants could make current vaccines less effective.”

She was concerned, too, about a lack of specificity on indoor ventilation and pay support for workers, “public health and social measures hardwired into the system”. She concluded: “These factors raise a concern that the current plan will increase health inequities and that it hasn’t been explicitly designed to uphold Te Tiriti o Waitangi. The current settings are likely to put children and young people at risk in public spaces; and it’s concerning that the plan doesn’t seem to look further ahead than the next few weeks: we don’t know when the next variant will be along.”

A similar point was made by Lesley Gray, from the Department of Primary Health Care and  General Practice at Otago. “Vaccination as a strategy is hugely important, however it is not the only strategy and in itself for Covid-19 we need to look beyond first and second doses to sustain levels of protection,” she said. “We must not lose sight of the importance of the other measures (masking, hand hygiene, physical distancing etc) … 

“The prime minister spoke of our levels of vaccination being some of the highest in the world: when we look to other countries who have highly vaccinated populations that are still experiencing high case numbers, hospitalisations and deaths (e.g. UK) this signals some levels of acceptability or ‘collateral damage’ … Populations already identified as most vulnerable should ever be seen as ‘collateral damage’ in any strategy for a Country moving out of restrictions.”

“For the first time since August 17 2021 there is a glimmer of hope,” said clinical psychologist Jacqui Maguire. “Until now there has been no clear pathway out of level 3/4 restrictions, especially for those living in Auckland … People’s mental health and wellbeing is precious, and Covid-19’s restrictions have been a very real threat to this. Today’s traffic light system announcement has for the first time provided some clarity about how New Zealand plans to live with the virus. It also provides real benefit for those that have chosen to get vaccinated. From a behavioural psychology perspective, this system increases people’s perceived ‘reward’ for vaccination and compliance.”

Clinical psychologist Sarb Johal commended “an explicit statement of intent”. The framework would “help shift individual behaviour for the collective good, sharing responsibility, but also offering protection for those who are more vulnerable,” he said. “However, we need to take care to understand how particularly vulnerable communities will be protected with general DHB targets to ensure that they are not left unprotected, while striking the balance in opening life experiences up again for those who are fully vaccinated.”

Where unspecified, the source is via Science Media Centre.

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