Sir David Skegg

The Government’s handpicked group of Covid medical advisors is proposing a cautious opening of our borders, starting with vaccinated New Zealanders only sometime in the new year.

The six-person Strategic COVID-19 Public Health Advisory Group is chaired by former Otago University epidemiologist and Vice-Chancellor Sir David Skegg.

Four of its six members are from Otago; Philip Hill, Professor of International Health at Otago University; Professor David Murdoch, Dean of the University of Otago, Christchurch and an infectious respiratory diseases expert; Dr Ella Iosua, a biostatistician and senior research fellow at the University of Otago.

Sir David himself was last year appointed a special advisor by then National Leader Simon Bridges to the Epidemic Response Committee, so his chairing of the Advisory Group is likely to have bipartisan support.

The core of his recommendation to the Government is that Quarantine-free entry be restricted, at least initially, “to travellers from approved countries and to individuals who pass a pre-flight test (as at present) and possibly a further rapid test on arrival.”

“Despite the most rigorous precautions, however, it is inevitable that people carrying the virus will enter New Zealand on a regular basis,” his report says.

However, the report says that it will be at least six months before border entry can be relaxed.

That will be how long it will take for all New Zealanders to have an opportunity to be vaccinated and for the facilities and procedures to be put in place to allow widened quarantine free entry.

The group is also proposing that an alternative to quarantine free entry might be a reduced time in Managed Isolation and Quarantine.

But they warn that the advent of the Delta variant might yet see New Zealand experience a virulent outbreak such as is currently rampaging through New South Wales.

Advertisment

“Even with current settings, New Zealand is liable to experience an outbreak similar to that in New South Wales over the coming months – although presumably, we would go into lockdown more quickly,” their report says.

“Given the information that has accrued over recent weeks, we would be even more reluctant to recommend a relaxation of border restrictions before all eligible citizens have had an opportunity to be vaccinated.

“We are hoping that New Zealand will achieve a very high vaccination coverage, which would make the re-opening of borders less problematic.

“The degree of community protection will be increased if eligibility for vaccination is extended to people between 12 and 16 years of age.”

Because of Delta, the group is opposed to allowing travellers to self isolate at home.

“Earlier in New Zealand’s response to the pandemic, returning travellers who were required to quarantine at home did not do so consistently, and measures to check on their adherence turned out to be largely ineffective.,” they say.

The group says most people do not “self-isolate”; they isolate with other household member and, with the more transmissible variant, other members of the household (as well as any visitors to the home) would l be very likely to become infected themselves – even if efforts are made to keep apart.

So there would be a significant risk of leakage of infection into the community.

“In the early phases of re-opening, a reduced time in an MIQ facility, say for 5 to 7 days, would seem more realistic.

“This could be followed by additional testing once or twice in the second week.”

They suggest an additional test on Day 5.

A key element in the report is the group’s definition of what constitutes an “elimination strategy”.

Last year Skegg told the Epidemic Response Committee that defining the elimination of the virus was a bit like saying New Zealand would be smoke-free by 2025.

“That doesn’t mean every single smoker will have stopped smoking,” he said.

“We won’t eradicate the virus in the way that smallpox was eradicated from the globe over 40 years ago.

“The sense in which the term “elimination” is used in infectious disease control is to get it down to a defined minimum number of cases which can be handled at a local level.”

The group’s report today quotes the Director-General of Health, Dr Ashley Bloomfied, as defining an elimination strategy as one which focused on zero-tolerance towards new cases rather than a goal of no new cases.

“In approaching the present question, our group is happy to follow this interpretation, which treats elimination as a process, rather than as a permanent outcome,” the report says.

“An important advantage of maintaining our New Zealand-type elimination strategy is that it keeps our options open,” the report says.

“ If this policy were to be abandoned now so that endemic infection became established, it would probably never be possible to reverse the change.

“On the other hand, if it became clear over the next few years that the costs of elimination outweighed the benefits, it would be a simple matter to follow the example of other countries.”

However, the group concedes that the phrase “elimination strategy” is confusing and ambiguous.”

 It says that Australia eventually adopted an approach very similar to New Zealand’s, but there it was called “aggressive suppression”.  Helen Clark’s Independent Panel for Pandemic Preparedness and Response used “aggressive containment.”

“The advisory group recommends that the Government, after appropriate consultation, should choose a new name in Te Reo Māori, to reflect the unique approach of Aotearoa New Zealand to this pandemic virus,” the report says.

“Such a name could provide clarity in identifying our strategy for dealing with outbreaks originating from international travellers, in order to prevent the establishment of endemic disease.”

Media were not expecting to see this document until tomorrow when the Government holds an “event” in Wellington to provide its response.

Its early release suggests that it has largely been accepted by the Government.

Beehive sources have contrasted it with the Australian four-stage “roadmap” out of Covid, which defines what relaxations will take place at varying percentages of the total population vaccinated.

The sources say the New Zealand approach is much more founded on science.

The committee rejects the idea that once a specific percentage of the population has been vaccinated, “herd immunity” will have been established.

“This concept of a simple threshold is oversimplified because there is always heterogeneity among groups in the population in the extent to which people are at risk of encountering the virus.

“ For example, Pasifika people in South Auckland often live in crowded housing, and they may attend large family gatherings and church services, where the risk of transmission during an outbreak is enhanced. 

“As a result, their herd immunity threshold will be higher than for the population at large. In other words, a greater proportion of people in that community would need to be vaccinated in order to achieve community protection.”

The groups say that therefore setting a target for the percentage of the population vaccinated would not help in deciding when to start further re-opening.

“Our advice would be merely to explain to the community that getting as near as possible towards 100% of all adults vaccinated (without particular groups being neglected) will enable New Zealand to reconnect with the world with the least disruption, illness and death toll from COVID-19,” the group says.

That is the ultimate answer to when the borders will begin to re-open.