Science New Zealand’s not-so-secret weapon Life has largely returned to normal in a nation where logic and resolve, not politics, have carried the day By: Dan Lett Posted: 7:00 PM CDT Friday, May. 14, 2021 Last Modified: 8:02 PM CDT Friday, May. 14, 2021 Updates

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This article was published 13/05/2021 (1324 days ago), so information in it may no longer be current.

The aerial photographs of an April 24 rock concert at Eden Park Stadium in Auckland, New Zealand flickered across computer and television screens of the pandemic-weary all over the world like some sort of Photoshop hoax.

But this was no joke. An astounding 50,000 fans of the soul group Six60 jammed into Eden Park, the country’s largest sports stadium. Almost no one had a mask on and no one was required to show proof they had been vaccinated.

“Next time they tell you it’s impossible, show them this,” the band wrote below the photo when it was posted on their Instagram account.

When compared with the state of the pandemic in the rest of the world, what is happening right now New Zealand seems impossible from an epidemiological perspective. An island country of just five million people, New Zealand has somehow managed to eliminate the virus that causes COVID-19.

At latest count, New Zealand has logged just 2,644 cases and only 26 deaths. Other than fairly severe restrictions on travel, New Zealanders are allowed to go and do anything they want, in any numbers they want.

For comparison, with roughly one-quarter of New Zealand’s population, Manitoba has had 43,700 confirmed cases and 1,002 deaths as of Thursday. And the province has entered a dangerous third wave of the pandemic that has, once again, forced schools to close and severely restricted social interactions.

Beleaguered political leaders and confounded public-health officials in other countries may dismiss New Zealand’s success as some sort of remote island fluke, but this tiny country is where it is today because its leaders realized early on that COVID-19 was different from other viruses and needed a whole new playbook.

Specifically, New Zealand joined a handful of other countries and sought to eliminate COVID-19 within its borders, rather than just mitigate the virus and let it run its course.

There were risks with this approach, of course. But if the elimination strategy could be successful, public-health experts both inside and outside government believed citizens would be rewarded with a return to normal life much quicker than the rest of the world.

“We felt that if the government framed this strategy in the right way, it could be sold and we’d get huge buy-in,” said Joe Stockman, who served as strategic communications manager within New Zealand’s crisis-management centre in 2020.

“And we were right.”

A triumph of science over politics

It is a testament to Kiwi culture that in the midst of the country’s battle against COVID-19, a play was written to dramatize the moment when the government and its charismatic leader, Prime Minister Jacinda Ardern, boldly embraced a strategy to eliminate the novel coronavirus.

Transmission, which premiered in late April at the BATS theatre in Wellington and is still available via video on demand, tells the story of the debate and deliberations that took place between Ardern and key advisers in the prelude to the country’s first national lockdown, which started March 25, 2020, less than a month after its first confirmed case of COVID-19. It is a verbatim play, which means that all dialogue was taken directly from interviews the playwrights conducted with key decision-makers, including Ardern.

Rather than simply glorifying the success of the elimination strategy, the play revealed the prime minister’s reluctance to go too quickly into lockdown and her concern restrictions would inflict more suffering than they would prevent.

In one memorable scene, she lashes out at Michael Baker, an epidemiologist at the University of Otago, one of the foremost proponents of a swift, aggressive elimination strategy.

Baker, who remains one of the dominant voices on the New Zealand government’s pandemic Technical Advisory Group, said the play accurately captures the reaction he and other experts received when they began to vigorously press the idea of elimination strategy.

Baker said the pandemic plans that existed in most countries — if they existed at all — were based on mitigating an influenza outbreak. COVID-19, however, is a much different virus with different properties, he noted.

Although it takes more time to spread than influenza, it generally infects a greater number of people and causes a much higher number of cases resulting in serious illness and death. In general, based on the speed at which it spreads, infectious-disease experts do not believe influenza can be contained or stamped out. The novel coronavirus, on the other hand, can be isolated through border controls, testing and contract tracing and ultimately “stamped out” with strategic use of economic and social restrictions.

Baker said an elimination strategy got a huge boost when China began to report initial success in the Wuhan region — where COVID-19 first appeared — in containing the virus. Then, other countries, including Taiwan, Hong Kong and Singapore began to report that an elimination strategy was working.

That lent considerable weight to the idea that “mitigation” and “bending the curve,” which are staples of pandemic response strategies, were only going to lead to mass infections and deaths.

That did not mean Ardern and other key government officials were initially keen to hear Baker’s advice.

“Admittedly, people in the government looked at me like I was a madman,” Baker said in an interview.

“But we kept telling them the (influenza) plan they had was not supposed to be used for a threat like this. The modelling kept telling us that unless we went into a total lockdown right away, there would be an exponential increase in cases and our health-care system would be completely overwhelmed.”

Still, there was a lot of pressure to forge ahead with the tried and true influenza-mitigation strategy inside government, even with forceful advice coming from Baker and others. And then, a moment of clarity at the top of the power structure in the New Zealand government.

New Zealand’s prime minister had already become an international sensation. Her youth and activist mentality set her apart from many leaders in the region. She earned her popularity demonstrating empathy and compassion in the face of a series of crises: devastating wildfires; deadly volcanic eruptions and the horrific terrorist attacks on two mosques in Christchurch that left 51 dead and another 41 injured.

Ardern had already shown that her government could respond swiftly to the pandemic challenge. Less than two weeks after confirming the country’s first case of COVID-19, a 14-day quarantine requirement was placed on all incoming travellers to New Zealand, including citizens and permanent residents. On March 19, the country closed its borders to all non-citizens and non-residents.

And then, in a remarkable demonstration of administrative agility, New Zealand unveiled a complex, four-tier pandemic response system just 28 days after its first case of COVID-19. Manitoba also has a four-stage pandemic alert system but it took until August, when the province was already facing a significant outbreak in the Prairie Mountain Health Region, some five months after our first confirmed case.

With the system in place, Ardern put the country into a Level 4 alert, locking the country down on March 25 with shelter-at-home orders and the closure of all public facilities and non-essential businesses.

At this point Ardern and her government advisers were largely committed to a mitigation strategy; in early March, Ardern told the New Zealand Parliament the government had an established influenza-pandemic plan in place that was “designed exactly for these situations.”

That would change in dramatic fashion over the course of a month.

Key to the change was Ardern’s decision to assemble an all-star panel of COVID-19 experts from outside government, the Technical Advisory Group.

In a December interview with the Guardian newspaper, Ardern said she met with her chief science adviser at the end of March to review the most-recent epidemiological modelling. At that meeting, Ardern saw the pointlessness of a mitigation strategy.

”I remember my chief science adviser bringing me a graph that showed me what flattening the curve would look like for New Zealand. And where our hospital and health capacity was. And the (pandemic) curve wasn’t sitting under that line. So we knew that flattening the curve wasn’t sufficient for us.” – New Zealand Prime Minister Jacinda Ardern in and interview with the Guardian

“(The influenza plan) was where we started, because there just simply wasn’t really much of a view that elimination was possible,” she said.

“I remember my chief science adviser bringing me a graph that showed me what flattening the curve would look like for New Zealand. And where our hospital and health capacity was. And the (pandemic) curve wasn’t sitting under that line. So we knew that flattening the curve wasn’t sufficient for us.”

On April 1, the government published a position paper that clearly outlined its plans to shift “from migitation or ‘flatten-the-curve’ approach to the current stamp it out and elimination strategy” that will focus on leaving restrictions in place long enough to “break the chain of community transmission.”

“You just have to get on with it,” Ardern said in the Guardian interview. “There’s a job to be done. Any self-doubt I ever have, just as a human being, doesn’t mean that always translates into doubt around what needs to be done.”

 

A transparent government

It is hard to have a conversation with a Kiwi involved in the pandemic response and not have them volunteer a disturbing fact: by all reasonable measurements, New Zealand was not well prepared when COVID-19 struck.

That opinion is based largely on a 2019 report by the Global Health Security Index, a joint project between the John Hopkins Center for Health Security and the Nuclear Threat Initiative funded in part by the Bill and Melinda Gates Foundation. Using open-source data, the GHS ranks countries on a broad array of metrics that measure how well a country can prevent, detect and respond to health crises.

New Zealand ranked 35 out of 190 countries on the index. Canada was ranked fifth and the U.S., which has suffered more COVID-19 deaths than any other country, was ranked first.

New Zealand’s health-care system had one of the lowest hospital and intensive-care capacities among Organization for Economic Co-operation and Development countries, the government did not have a national centre for disease control or a true and independent public health agency.

For many involved in advising the government on pandemic strategy, the GHS Index and the unmitigated willingness of key decision-makers to own the country’s shortcomings may have spared the lives of hundreds, if not thousands, of Kiwis.

“I think that report really saved us,” said Prof. Siouxsie Wiles, a biochemist from the University of Auckland and adviser to Ardern who became known as the “COVID lady” for her constant interviews and public statements on the government’s pandemic response.

“The countries that thought they were prepared have done very badly. We knew our testing and hospital capacity were really bad. And we also knew that countries all over the world were scrambling to get testing materials. We knew we couldn’t just rely on testing and contact tracing.”

A willingness to admit to the country’s systemic weaknesses was not the only factor at play. The New Zealand government also gave its citizens unrivalled access to the inner workings of the pandemic-response process.

While other jurisdictions such as Manitoba have consistently overstated their preparedness, obscured the decision-making process and rationed the release of public information on things including contact tracing and epidemiological modelling, New Zealand decided it would not do any of that.

All of the members of the Technical Advisory Group were allowed to speak freely and publicly about government policy. And, many did, in fact, offer pointed criticism whenever they thought it necessary, even while they were still advising Ardern.

As well, within a few weeks of the first confirmed case, the New Zealand Parliament created the Epidemic Response Committee, a group of MPs meeting regularly to question key scientific experts and government officials. Remarkably, Hansard was produced for all of the committee’s virtual proceedings, which were webcast and are still accessible through a video archive.

The committee’s origin is likely linked to Ardern’s coalition government and her need to defer to the opposition more than if she led a majority. Still, the ERC gave New Zealanders real-time insight into the people directing the pandemic response and — perhaps most importantly — the thought process behind major decisions.

“I think that report really saved us.” – Prof. Siouxsie Wiles on the 2019 Global Health Security Index report

However, the greatest act of transparency and accountability may have been Ardern’s insistence on holding firm to the guidelines established in the four-tier pandemic-alert system.

Although Manitoba’s pandemic-alert system also features a range of social and economic restrictions that can be applied when each alert level is triggered in any region of the province, Premier Brian Pallister repeatedly made concessions to placate various groups, even when they could not be justified on an epidemiological basis.

Despite evidence showing that we should have been locked down, Pallister allowed unfettered travel to and from western provinces, kept bars and restaurants open for indoor service, provided churches with expanded capacities and the ability for congregants to go maskless during services, and allowed social interactions between multiple households. All these concessions not only fuelled outbreaks, they ultimately undermined public confidence in the government.

According to Stockman, Ardern and her government understood early on that the “social licence” they had from the public to impose restrictions was dependant on their ability to hold firm to the restrictions listed in each tier of the alert system.

In short, the prime minister refused to make concessions to individuals or groups on political or personal grounds out of a concern that it would undermine her authority and prompt people to resist, Stockman said. Although there were some anti-restriction protests in New Zealand, there have been far fewer than other places, including Manitoba.

“The prime minister made it clear that the rules were the rules, no exceptions,” Stockman said.

Wiles added that from the beginning of the pandemic response, Ardern was resolute she was not going to give in to those in New Zealand who opposed the lockdown on philosophical grounds.

“It was really clear that you cannot loosen those restrictions even for economic reasons because cases will start to rise again very quickly,” said Wiles. “If you do that, then you start to lose your social licence.

“People start losing faith in what the government is doing. We were quite convinced you had to leave the restrictions in place until the problem was completely under control.”

 

Closed borders and shock-and-awe

After seven long weeks of lockdown (Levels 3 and 4), New Zealanders returned to some degree of normalcy on May 13, when the country was put into a Level 2 state.

This allowed the full reopening (with social-distancing requirements still in place) in all retail, malls, restaurants and bars, movie theatres, gyms, playgrounds, museums, markets and other public spaces.

Notably, no general indoor mask mandate was included. But that was less about New Zealand abandoning its cautious approach and more about the fact that it had eliminated the virus, generally.

There were a few confirmed cases here and there, but the majority involved travellers who were contained within the country’s airtight-managed quarantine system. New Zealand’s efforts to limit travel may have been its single-greatest public policy achievement during the pandemic.

Starting even before the country was locked down, New Zealand restricted travel. First, focusing on all incoming traffic to the country and then, when the Level 4 lockdown was instituted, all travel within New Zealand.

In stark contrast to the approach used in North America and Europe, the country invested in a complex mandatory quarantine structure that prohibited non-residents and non-citizens from boarding planes to the island, and required all authorized citizens and residents to spend 14 days in a government quarantine hotel.

Starting in mid-March 2020, Ottawa barred non-citizens and non-residents from travelling to Canada and banned non-essential travel to and from the United States by land. However, Canada’s restrictions failed to meet the level of rigour imposed by New Zealand.

The 14-day quarantine requirement for travel to and within Canada has largely been voluntary, save for a three-day mandated quarantine for international travellers imposed by the federal government in January 2021.

Some provinces, including Manitoba, provided quarantine hotel rooms to anyone who felt they could not adequately isolate in their own households. The Manitoba Alternative Isolation Accommodation program has been used by 5,500 returning travellers.

“It was quite clear early on that for this to work, we had to manage the borders.” – University of Otago epidemiologist Michael Baker

Apart from those measures, the provinces took a hands-off approach to managing domestic travel, allowing people to move freely back and forth for most of 2020 with no restrictions and allowing them to voluntarily complete their quarantine. The exception was the Atlantic travel bubble which, at times, stopped people from entering from any province west of the region but allowed limited inside.

That stands in stark contrast to New Zealand’s approach, where the government operated a network of 32 quarantine hotels for people to complete a required two-week isolation. Only citizens and permanent residents were allowed into the country, and all had to show proof that they had pre-booked a room in a quarantine hotel before they were allowed to board a plane in another country.

“It was quite clear early on that for this to work, we had to manage the borders,” Baker said. “It’s critical for elimination. Other countries that have eliminated the virus, like Vietnam for example, have used hard border controls…. I think we’ve shown that a tough line on borders can and does work.”

New Zealand also applied significantly different thinking when it came to the pandemic-alert system.

In a mitigation strategy, public-health officials increase the level of restrictions as daily case counts and community transmission increase. That has certainly been the approach in Manitoba, where the government has celebrated its strategy of applying the “least-restrictive means” at any stage of the pandemic.

Dr. Brent Roussin, Manitoba’s chief provincial public health officer, has been the foremost proponent of this approach. In courtroom testimony last week during a constitutional challenge of Manitoba’s pandemic restrictions, Roussin said unequivocally that he is “bound” to use the least-restrictive means to control COVID-19. That translates into an overall strategy where increasingly harsher restrictions are introduced as case counts rise.

Many epidemiologists in Manitoba and around the world have condemned that strategy because it does not reflect the challenges posed by COVID-19. In particular, a single person infected with COVID-19 tends to infect two to three times the number of other people than is the case with influenza.

In New Zealand, rather than waiting until daily case counts threatened to overwhelm the hospital system, the country repeatedly locked down regions at the first sign that community transmission — new cases for which there is no known source — had returned.

On June 9, New Zealand was moved into Level 1, the least-restrictive tier, but all international travel restrictions remained in place. Then, the country had two months of relative normalcy without any significant evidence of community transmission.

On Aug.12, four new cases involving a single family prompted Ardern to move the Greater Auckland Region into Level 3 while the rest of the country was put into Level 2. On Sept. 21, after 40 days of lockdown, Auckland was downgraded to Alert Level 2 and on Oct. 7, downgraded again to Level 1.

The same approach was used in February 2021. After seven new community-transmission (no known source) cases were confirmed in people outside the quarantine network, on Feb. 14 Auckland was put into Alert Level 3, and the rest of New Zealand into Level 2.

“I think by being strategic in our use of lockdowns, we’ve been able to have much more freedom than anywhere else.” – University of Otago epidemiologist Michael Baker

After 72 hours of intensive contact tracing, the outbreak was declared to be contained. On Feb. 17, Auckland was downgraded to Level 2 and the rest of the country back to Level 1.

This response was repeated again on Feb. 27. After a single new case of community transmission was confirmed, Auckland was again upgraded to Level 3. Aucklanders were also told to wear a mask any time they left their homes. Auckland was downgraded to Level 2 again a week later, on March 5.

Epidemiologists such as Baker believe the shock-and-awe approach to new outbreaks — where government responds with the full force of social and economic restrictions at the first sign of a resurgence — kept the periods of lockdown much shorter than other countries, with a higher rate of positive outcomes.

“I think by being strategic in our use of lockdowns, we’ve been able to have much more freedom than anywhere else,” Baker said.

 

A cautious comparison

It is easy to dismiss the success New Zealand has enjoyed as a byproduct of its natural advantages: it’s a small, remote island nation. And many governments around the world have done just that, dismissing or mocking the Kiwis for what they’ve accomplished.

In August, former U.S. president Donald Trump declared New Zealand was suffering through a huge surge in COVID-19. “It’s terrible. We don’t want that.”

Trump’s attempts to mock and discount the New Zealand experience coincided with Ardern’s decision to lock down Auckland when a handful of cases of community transmission were confirmed. Ardern responded with appropriate anger, noting that Trump’s assertion was “patently wrong.”

Baker said what New Zealand has done cannot be solely attributed to being an island, or that it’s relatively small or that it’s relatively isolated. As an island, it was easier to control the borders, but that does not mean other countries couldn’t have done the same thing.

However, New Zealand did not invent a single new strategy, tool or intervention, he said. It merely picked from the tools that all countries had at their disposal, and did it in a much more logical and effective way.

“From a public-health point of view, there are strategies and then there are interventions. Strategy is high-level stuff, and interventions are the things you roll out along the way. The biggest failing that other countries have made is choosing the wrong strategy.” – University of Otago epidemiologist Michael Baker

When other countries were reluctant to impose restrictions, New Zealand acted swiftly to extinguish small eruptions of new cases before they triggered an outbreak. While most countries could only advise against travel, New Zealand showed the political resolve to close its borders and maintain one of the most sophisticated quarantine systems for anyone returning to the country.

After digging into the fine details of the New Zealand response, it’s easy to see where places such as Manitoba went wrong. The province applied outdated strategies using outmoded thinking that is out of step with the challenges presented by the novel coronavirus. The evidence of that wrong-headed approach is clear: soaring daily case counts, an overwhelmed health-care system and a new round of social and economic restrictions, including the closing of schools.

Faced with the exact same challenge, New Zealand has had fewer cases and deaths, less time in lockdown and — now — far greater social and economic freedoms.

Baker said when the pandemic is over, the world’s political and public-health leaders should gather to look at where they went wrong and commit themselves to a better path the next time a threat such as this arises.

“From a public-health point of view, there are strategies and then there are interventions,” he said. “Strategy is high-level stuff, and interventions are the things you roll out along the way. The biggest failing that other countries have made is choosing the wrong strategy.”

dan.lett@freepress.mb.ca