A transition from elimination to suppression was likely to come at some point, but it would be better it happened next year, and under different circumstances. We now face a new set of challenges, writes Siouxsie Wiles.  

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Like so many in Aotearoa New Zealand, I’ve spent the last week or so watching our new Covid-19 cases slowly grow. By global standards, our daily cases are minuscule. But every new case that wasn’t part of a household already in isolation signalled the possibility of transmission chains we didn’t know about. After keeping the pandemic at bay for nearly 20 months it began to feel like delta was settling in. Was this the end of elimination for us? I spent much of the last week randomly bursting into tears at the thought of what this means.

Aotearoa’s elimination strategy has required two really important things: restrictions that would have seemed completely unthinkable just two years ago, and the social licence to put those restrictions in place. I remember waking up for our first day at alert level four last year. The street was eerily quiet. Most of us stayed home while our essential workers kept the supermarkets stocked and the power on. They kept the hospitals functioning. They removed our rubbish. So many of them not even earning a living wage. Yet their work and the rest of the country staying home, some of us juggling our work with our children’s online learning, saved lives and our economy.

Meanwhile efforts to live with the virus overseas led to mass graves and refrigerated trucks parked outside of overwhelmed hospitals. To cancelled surgeries and delayed cancer diagnoses that in some countries haven’t been caught up. The Economist estimates that the pandemic is responsible for between 9.9 to 18.5 million deaths so far. A health system overwhelmed by Covid-19 patients can’t also look after people having a heart attack or a stroke or any of the other things that happen to people every day.

Here in New Zealand a force of thousands worked hard to keep the virus at bay at our border. Because of their enormous efforts we’ve spent very little of the pandemic living under restrictions. Our children have spent most of the last two years in school. We’ve had concerts and festivals and sports games and indoor dining. And we’ve been able to do all those things safely.

Our elimination strategy also bought us time. Time to learn from the mistakes of others and time for vaccines and treatments to be added to our toolkit. Who would have thought we’d have more than one safe and effective vaccine in widespread use within just 12 to 18 months of Covid-19 appearing? But the dark cloud hanging over that success story is their limited supply which has led to a humanitarian disaster that should not have been allowed to happen. It is an absolute travesty that some countries are rolling out boosters while others haven’t even been able to vaccinate those most at risk of dying.

To the countries who can get them, vaccines are saving lives every day. Covid-19 is becoming a disease of the unvaccinated. But as the virus has become more transmissible, both the modelling and real-world experience is showing that nearly everyone over the age of five will need to be vaccinated to protect those who can’t be vaccinated or who are vaccinated but haven’t made had a good enough immune response. Like people with some forms of cancer.

Because we don’t yet have a vaccine approved for the under-12s no country is able to protect everyone. That’s why the UK’s so-called Freedom Day was anything but for thousands and thousands of people. Those who can stay home have to weigh up the damage caused by indefinite isolation with the risk of getting seriously ill or dying if they venture out of their homes. Those who aren’t privileged enough to stay home take their lives in their hands. Children who can’t be vaccinated have gone back to school only to be infected by their unvaccinated, unmasked teachers. They then take the virus home with them and infect their families.

I was gutted when the prime minister announced on Monday her roadmap out of our current restrictions. To me it signalled a pragmatic transition from the elimination strategy to one of suppression, where we use vaccination and vaccine passports, masks, improved ventilation, rapid-testing, and other tools to minimise transmission, together with testing, contact-tracing, and isolation to control transmission chains and clusters as they emerge. It is clear we have to keep cases as low as possible or we risk overwhelming our healthcare system, especially at the moment while over half of New Zealanders are not fully vaccinated.

Let me be clear. There is nothing intrinsically wrong with moving from elimination to suppression as a strategy. But the safest time to make that transition would have been next year, when vaccines are likely to become available to our under-12s, and at a moment when Covid-19 was not in our community. That it is happening with an active delta outbreak means it is dangerous to grant any part of New Zealand the freedoms of living at alert level one that we’ve all enjoyed for so much of this pandemic. We have ample evidence that the border around Auckland is not impenetrable, so level one freedoms mean the chance of a super-spreader event are too high.

Transitioning to a suppression strategy means we all need to mentally and physically prepare ourselves for what life with Covid-19 in our communities is going to be like. To keep cases as low as possible will require changes to the way we’ve lived through the pandemic so far. As we’ve seen overseas, it will require vaccine passports and mandates. It will require wearing a mask in certain settings, even if you are fully vaccinated. It will likely require regular testing. We’ll need to up our game on ventilation. But the saddest part is that for some people it will require weighing up whether it is safe for them to do things that they would have been able to do in the past.

It probably sounds a bit weird, but I feel like I’ve started a process of grieving for what we are losing. The pandemic has changed our world forever, and that is going to take some getting used to. My worry is that we will see what we have seen in so many countries, and indeed in New Zealand during this outbreak – that the burden of Covid-19 will continue to fall on people and communities inequitably. We will have failed if our transition from elimination to suppression does not actively work to stop this happening.

You know that debating the vaccine probably won’t work and you want to try another tack. So what’s the best way to approach such a tricky conversation? Gerard Barbalich has three questions to get you started.

Under the shadow of delta and leveling out vaccination rates, a summer looms that threatens to be something akin to Bo Burnham’s Inside, marked by loneliness, alienation and fear. I for one am not excited by this future, nor the current reality where everyone seems to have a friend or family member who hasn’t had the jab and doesn’t plan to. All of this frustration culminated in me heading down an internet rabbit hole where I went looking for tools to help steer conversations with the vaccine hesitant in more productive directions.

A note to start

Before we look forward to changing people’s minds on vaccines, we should look back at what we know for sure doesn’t work: relying on the information deficit model. Dating from the 1980s, this model proposed that people’s views on any topic could be changed simply by giving them the right information. But as we sit in 2021, following decades of internet-fuelled political and cultural turmoil, we rightly scoff at the idea that the divisions in society are due to a lack of easy access to facts.

The problem is that people tend to be insular and dogmatic in what they believe. Simply giving them more facts does not reliably change their views. Rather, when offered competing facts, we are all known to experience the rebound effect – a doubling-down and entrenchment of our beliefs. Making a conversation on vaccines a debate over facts will likely lead to an argument about what is true, which rarely ends well. So, the first first principle to follow is: don’t debate facts.

The next principle is: don’t try to “win” the conversation. Especially with a conversation on beliefs, trying to appear the expert only makes you look arrogant. Don’t try to shame people, shame their opinions, or shame their crowd (I promise, we will get to what we are trying to do shortly). If our conversational partner feels any judgement or condescension from us, they will likely stop speaking in good faith and simply disengage. I know that rolling our eyes, scoffing or laughing is an easy way to release a surge of self-righteous pleasure, but I promise you it will not help bring about the fully-vaccinated outcome we’re all hoping for.

The third principle is: set the bar low. As people rarely change their minds on anything in one sitting, don’t expect the conversation on the questions below to end with a moment of realisation, an intense embrace and balloons falling from the ceiling. Can you recall the last time you drastically changed your mind about a topic within one conversation? Neither can I.

The fourth principle is: listen, summarise, reflect and question. As strange as it may sound, the questions below are not trying to change anyone’s mind. Rather the hope is that they will explore a way of thinking and invite reflection.

So where do we actually begin?

Treading lightly

A good place to start is a conversation about the conversation. I will ask my friend (let’s call him Barry) if he is even open to talking about how he feels about the vaccine. I’ll make it clear I’m not out to shame or poke fun, but that I am curious about his thoughts. If he isn’t interested, that’s fine, I’ll try again another time. And lastly, before we begin, if either of our tempers flare, I’ll make a silent commitment to walking away and trying again later.

My first question for Barry is how confident he feels about the vaccine.

“How do you feel about getting vaccinated right now, from one to 10? Ten is that you absolutely do, and one is that you absolutely do not.”

This will give me a sense of where he is, and I may discover that he is more open to vaccination than I thought. My next question builds on the first, and takes a left turn from the usual approach – I want Barry to describe what parts of vaccination he feels positive about.

“You said you’re a five on that scale, why not a lower number, why aren’t you more sceptical? You said five, why not three or two?” 

My sole job at this stage is to listen. Once Barry has finished speaking, I’ll summarise and reflect back all of what he said, which will both make him feel heard and respected. My reflection may go something like this:

“So what I heard is that you are worried about getting Covid, and you are also worried about your family members, especially your grandpa. And you have had vaccines before – for example, you had all of the ones when you were young. Is that correct?”

Again, remember, we don’t debate facts. If Barry does want to repeat his anti-vaccination feelings here, I’ll make it clear that I already understand those, but that is not the purpose of this talk.

“I know you have strong thoughts on why the vaccine may be bad or dangerous. We’ve often talked about your distrust of Bill Gates and the cabal of global elites, but we often get stuck on talking about those. So how about today, we just talk about your thoughts on the potential positives to getting vaccinated?”

Once I understand Barry’s level of confidence in the vaccine, together we can move onto his why – his justifications. Here, again, I won’t debate facts, but I am keen to explore why Barry believes those facts, and how reliable they feel to him.

“I understand how you feel about getting vaccinated, but I’m curious where you got this information from? And do you feel it is a reliable source of information?”

If this gets tricky, remember to listen, summarise, reflect and question. A useful tool for questioning here is the “outsider test”, in which I’ll ask Barry to apply the same logic to a totally separate issue.

“So you are not keen to get the vaccine because your neighbour had a bad reaction to it. They had a headache for a few days, right? What about if your neighbour had got a headache from eating some alfalfa sprouts, but their wife ate the same sprouts and was fine. Would you never eat alfalfa sprouts again? How would you tell what is the right decision to make?”

After a final round of listening, summarising and reflecting, I will step away without applying pressure, ensuring I can come back to talk another time. Remember principle two: we aren’t trying to “win” the conversation.

I know this whole process can all feel quite intellectual. It is drawn from an academic field called epistemology, so little wonder the language seems sterile. The important thing is to take the main idea – ask, reflect, and question why, rather than what, someone believes – and wrap it in your own words and style, for your own community and whānau.

Many of the key points for this article have been taken from a recent episode of the You Are Not So Smart podcast, which I highly recommend. Please listen to it if you would like more in-depth explanations and examples.