There is an old Yiddish saying, “Der mentsh tracht, Un Gott lacht”, meaning “Man plans and God laughs”. This seems a particularly relevant adage to describe the impact of the COVID-19 pandemic on the world, and the success or otherwise of government efforts to contain and mitigate these impacts.

In New Zealand, the current COVID-19 Delta outbreak has focussed public and political attention on both the suitability of the Government’s elimination strategy in a pandemic era, and also what the Government’s plan is to safely reopen and reconnect New Zealand to the world. Whether you view New Zealand’s elimination strategy through the lens of “Fortress Aotearoa” or at the other end of the spectrum, “Prison Break New Zealand”, the common questions are when should New Zealand reopen its borders and reconnect with the rest of the world – and how will this happen?

This is the first of a series of articles exploring the current state and the issues the COVID-19 pandemic era raises for New Zealand. The series will explore what is being considered, or what should be considered, as we look towards the future. In this article, we examine the recently released advice to the Government provided by the Strategic COVID-19 Public Health Advisory Group (Advisory Group). This advice informs the Government’s current position and its indicative approach to reopening New Zealand in the future.

Strategic COVID-19 Public Health Advisory Group

In March 2021 the Government established the Advisory Group to provide independent advice to the Government on its on-going COVID-19 response, informed by the Advisory Group’s expertise in epidemiology, infection diseases, public health and modelling.  The Advisory Group has six members and two special advisors with expertise in the above areas and is chaired by Sir David Skegg.  Its membership and terms of reference can be found at the Government’s COVID-19 website.

The Government’s current approach to reconnecting with the rest of the world is set out on its official COVID-19 website here. This high level approach is based on five key objectives formulated from the advice received from the Advisory Group.

Recognising the public interest in the Government’s strategy, on 11 August 2021 the Government released the Advisory Group’s advice provided to the Associate Minister for Health, Hon Dr Ayesha Verrall. The advice, in the form of three letters sent in June and July 2021 to the Minister responding to specific questions posed by the Government on the future of the elimination strategy, the future phased reopening of New Zealand’s borders and the timing of such reopening, provides an insight into the Government’s current and likely future approach to reopening and reconnecting New Zealand with the world.

It is worth noting that this advice was provided in June/July 2021, prior to the more transmissible COVID-19 Delta outbreak in New Zealand and so it may be updated at some stage to reflect this major development.

The future of the elimination strategy

When asked if an elimination strategy remained viable as international travel resumes and/or will New Zealand have to accept a higher level of risk and more incidence of COVID-19 in the community, the Advisory Group confirmed on 10 June 2021 that the elimination strategy followed by New Zealand to date has been the right strategy, and that elimination remained the best strategy going forward.

Clarifying what “elimination” means in a New Zealand context, the Advisory Group adopted the Director-General of Health’s April 2020 interpretation that “the elimination approach focuses on zero-tolerance towards new cases, rather than a goal of no new cases” meaning “elimination is a process rather than a permanent outcome.”

The Advisory Group concluded that New Zealand’s experience shows how successful the elimination strategy has been when compared to the experiences of other countries following different strategies. It also concluded that elimination remains viable as international travel resumes, and it is the best option for New Zealand at this stage of the pandemic. The reasons given in support of these conclusions included:

• the protection of the health system from being overwhelmed (acknowledging the system remained poorly resourced to deal with any large outbreak of a disease such as COVID-19);
• the ability for New Zealanders to continue to enjoy a lifestyle relatively unaffected by COVID-19, which is advantageous to the country’s community and economic life – making New Zealand an attractive place to visit or settle in; and
• maintaining elimination now enables the Government to keep its options open in the future, rather than abandon elimination now and irreversibly accept COVID-19 as an endemic infection.

The Advisory Group also noted that the use of the word “elimination” is confusing and ambiguous as different terms for similar strategies are used overseas.  Accordingly, the final recommendation was that after appropriate consultation, the Government should choose a new name in Te Reo Māori to reflect the unique approach of Aotearoa New Zealand to COVID-19 and provide clarity in identifying our strategy for dealing with outbreaks.

The Government’s decision on 17 August to place the entire country into a Level 4 lockdown upon discovering one community case, and its subsequent management of the outbreak, is consistent with the Director General of Health’s interpretation of “elimination” and the belief that the existing management tools such as lockdowns, contact tracing, mandatory quarantine/isolation and physical distancing and mask-wearing requirements remain the best response.

Vaccination rates and phased reopening of borders

The Advisory Group was asked whether a target for the percentage of population vaccinated would be helpful for making decisions on reopening the border and driving vaccination uptake rates, and how would the Government stage a phased reopening of the border taking into account vaccination coverage and the possibility of vaccine-resistant mutants. The Advisory Group responded on 24 June 2021 and advised:

• setting a vaccination target would not assist decisions of when to further open the border;
• border restrictions should not be relaxed significantly until the vaccination programme has been fully rolled-out, and not before early 2022, and this will need to be undertaken in a carefully planned, phased way with continuous monitoring and adjustments as needed to minimise the adverse impacts of an outbreak on the country’s health system and population; and
• the recommended first step to reopen could be to allow quarantine free entry (QFE) or shortened MIQ for fully-vaccinated New Zealanders who have gone overseas for a short trip and are returning.

The letter of advice is interesting to read – particularly in light of the current outbreak. Some of the observations and suggestions the Advisory Group makes regarding vaccinations and the future reopening of the border include:

• reaching a herd-immunity threshold through vaccination is unlikely and new, more highly transmissible variants such as Delta make achieving herd immunity even more elusive;
• once a consistently high proportion of adults are fully vaccinated, outbreaks will be easier to stamp out with public health measures such as testing and contact tracing;
• the focus should be on getting as near as possible to 100% of all adults vaccinated (including in particular groups) to enable New Zealand to reconnect with the rest of the world;
• candidates for QFE or reduced time in MIQ will need to produce evidence of vaccination and pre-departure negative testing will also be required;
• rapid testing should be introduced at the border, with additional frequency of compulsory testing for travellers;
• people granted QFE or early MIQ release should be required to consent to special measures to assist contact tracing such as mobile phone tracking and EFTPOS transaction tracking; and
• QR code scanning should be mandatory at some venues.

The Advisory Group also recommended that the Government use the six month period (it then thought it had) to set-up expert committees to review testing capability, contact tracing capability, public health and social measures and health system capacity and management so that we are better prepared to cope with an outbreak of COVID-19. As the present outbreak has shown, the Advisory Group was wrong about the time available, but prescient on the areas that needed urgent review.

Timing of the next phase of reopening

In a follow-up letter dated 27 July 2021 the Advisory Group responded to additional questions posed to it regarding the possible timing of the next phase of reopening the borders. The Government was wanting to understand whether relaxing entry requirements for returning New Zealanders, who have been fully vaccinated, could commence before completion of the vaccine roll-out, and if so, what additional measures might be needed.

Interestingly, the Advisory Group’s response was provided when the New South Wales (NSW) outbreak was well underway despite its lockdown measures being imposed. The Advisory Group’s response referenced the impact that Delta was having around the world and in particular NSW, and noted that an outbreak in New Zealand was likely.

Given this, the Advisory Group re-emphasised the critical need to complete the vaccination roll-out as a priority and acknowledged that earlier advice may need to be reassessed on an ongoing basis to respond to the specific challenges posed by the Delta variant. The Advisory Group shied away from providing specific advice about reopening, other than to reiterate the importance of attending to the areas of review highlighted in their earlier advice and emphasising the need for caution before opening borders further.

Next steps

Irrespective of anyone’s personal view of the merits or otherwise of the Government’s elimination strategy, there is an increasingly vocal public call for further clarity on what the future holds for New Zealand reopening its borders and reconnecting with other countries.

The Advisory Group’s advice provides some insight on the information that the Government is receiving and upon which it is formulating its approach to reopening the country’s borders. There is a strong correlation between this advice and the indicative high-level statements of direction the Government has recently released about reopening our borders.

While the Government has indicated it intends to move towards reopening, there is no declared timeline to do so, and the current Delta outbreak will no doubt force a re-evaluation of the proposed business QFE/self isolation initiative it indicated would be trialled in the final quarter of 2021.

However, what the advice does highlight, and the current outbreak has emphasised, is the fundamental importance of a successful vaccination rollout. We will discuss vaccinations in the next article of our series on reconnecting New Zealand to a COVID-19 world.