Otago University Professors Michael Baker and Nick Wilson -- authors of a proposal to move beyond elimination

It is time to move on beyond the elimination strategy.

That was a consensus view yesterday among both Opposition politicians and some of the country’s most eminent epidemiologists and public health medical academics.

The only difference is that the medical people want to go in a  different direction to the politicians.

This debate is happening against a background which shows that Covid is still spreading in Auckland and leaking out of the city into the rest of the country.

As a consequence, there is now an Auckland truck driver isolating at a “bespoke facility” in the grounds of Palmerston North Hospital who at some point after September 24 became infected with Covid and continued to drive up and down State Highway One stopping at BP service stations.

But that case raises questions about the frequency and methods of testing and whether our border precautions are adequate enough to prevent Covid from spreading from an infected location.

That will be critical in the future if we go to micro lockdowns when outbreaks occur after there is widespread vaccination coverage.

There were also two connected cases found in the Waikato yesterday though so far, they have not been connected to the most recent Auckland outbreaks.

The cases have meant parts of the Waikato between Auckland Raglan and Hamilton itself, being moved to Alert Level Three for five days.

However, Prime Minister Jacinda Ardern made it clear yesterday that the days of the region-wide lockdown were coming to an end.

But how soon would depend on vaccinations.

Auckland is now in its seventh week of lockdown.

“They are carrying a huge burden and a weight by being in the restrictions that they are, for the time that they have, in order to try and keep this outbreak away from the rest of New Zealand,” Ardern said.

“The way that we can thank them for what they’re doing is making sure that we all get vaccinated.”

As far as ACT leader David Seymour and National Leader Judith Collins are concerned, the new cases and the Auckland lockdown raise questions about the effectiveness of the elimination strategy.

“The five-day Level 3 lockdown of much of the Waikato following confirmation of cases in Raglan and Hamilton shows Level 3 is not containing the virus and the Government has lost control of the situation in Auckland,” said Collins.

“The situation has changed, and elimination seems no longer feasible.

 “We need to know what our lockdowns are aiming to achieve and when they will end. If not elimination, are we buying time while the Government catches up on its slow vaccine rollout?”

Seymour confused elimination and eradication.

Eradication was means the complete eradication of a disease has only been successful once, with smallpox.

Epidemiologists use “elimination” to define a strategy rather than an endpoint.

In August, in his advice to the Government on the future of the elimination strategy, Professor Sir David Skegg said that “elimination” was well established in epidemiology,” it is unfortunately used in different senses even by specialists, and is frequently misinterpreted as meaning “eradication”.

“Elimination does not necessarily mean zero transmission or incidence. In April 2020, the Director-General of Health (Dr Ashley Bloomfield) stated: ‘The elimination approach focuses on zero-tolerance towards new cases, rather than a goal of no new cases, “ he said.

Writing on an Otago University blog yesterday, a group of medical academics, Prof Michael Baker, Prof Sue Cringle, Assoc Prof Collin Tukuitonga, Sarah Helm, Dr Amanda Kvalsvig, Prof Nick Wilson, said the “Reconnecting New Zealand” strategy, which was based on the elimination strategy was reasonably sound but is now threatened by the Auckland Delta variant outbreak.

“Controls operating at Alert Level 4 were not able to extinguish transmission, suggesting that we need a fresh approach,” they said.

“Multiple factors are likely to be contributing to this situation, including insufficient engagement with affected people, families, and groups; lack of trust in officials; and the multiple effects of long-term poverty, deprivation and crowded and precarious housing.”

They have proposed a number of steps to “suppress and contain transmission of Covid-19 to buy additional time to achieve the levels of vaccine coverage needed to limit the health and social harm caused by the current pandemic.”

They would enhance Covid-19 control in groups who experience deprivation and marginalisation.

This would include leadership of Covid-19 control programmes by members of those communities with wider engagement with local community leaders (of all ages) that people trust and a new dedicated Covid-19 strategy for Pasifika and for Māori.

But they would also put considerable focus on borders and testing.

Testing should be expanded to rapid anti-gen testing for people crossing the border for other groups, including all essential and permitted workers along with populations that experience marginalisation such as those in transitional housing   “potentially through mobile and door to door outreach services.”

They also propose widespread vaccine mandates.

These would include “essential and permitted workers in Auckland who travel across the Auckland border or are managing this border, notably police; public-facing workers in Auckland, including retail, food and beverage workers, and those who work in the police, corrections, armed forces, and other security-based occupations and all healthcare and aged care workers across NZ (but especially Auckland).”

And they also said the Government should Indicate that vaccine mandates will be required for a wide range of settings as soon as a valid certificate system can be implemented, notably indoor public places (e.g., cafés, restaurants, theatres, music venues, nightclubs, gyms, faith-based meetings), air travel, and organised events (e.g., music festivals).

“Successful control of Covid-19 in NZ now depends on successful control in Auckland,” the said.

“Slowing, or ideally eliminating, Covid-19 transmission benefits the entire country and buys time to achieve high and equitable vaccination.”

They said New Zealand needed an urgent review of Covid-19 control measures in Auckland and an upgraded strategy.

“This enhancement needs to include leaders of the Māori and Pasifika communities who are most affected by the pandemic and can establish and sustain models of care that are equity-focused and culturally safe across all providers,” they said.

“There also needs to be specialised support for people who have drug and alcohol dependency and may be particularly vulnerable to Covid-19 infection.”

Ardern, however, continues to prevaricate on the question of vaccine mandates.

“We are looking at that issue,” she said yesterday.

Similarly, the Government is not ready to agree to test more frequently than weekly people crossing the border.

“We haven’t considered more frequent testing,” she said.

“ Keep in mind, literally thousands of individuals, for very legitimate reasons, the vast bulk of which is freight, move across that boundary.

“So it probably, I think, would pose some practical issues.”

And the Government doesn’t know whether people crossing the border are vaccinated.

“No,  we don’t, because we would have to  be  able  to categorise someone’s individual occupation, and employers would have to have the ability to request that medical information from their individuals,” she said.

“So no, we don’t.

“We have, however, worked with freight companies to set up workplace vaccination.

“So that has been one of our target areas.”

Ardern said she would outline the next steps in the Government’s war against Covid today.

But from what she said yesterday, they would seem unlikely to get near the proposals put forward by the Otago medical academics.