Covid 19 coronavirus: Derek Cheng: How vaccination delivery failed to meet expectations

ANALYSIS: Derek Cheng takes a deep dive into why people consider the vaccine rollout to be a shambles, how the Government’s rhetoric matches with the delivery, and what should have been done differently.

Your impression of the rollout may not align with your expectations in March, when the Government unveiled its priority groups to protect the most vulnerable.

Especially if you’re 65 and over, or Māori or Pasifika.

As of midnight Wednesday, there were more than 50,000 people in group 4 – the lowest priority group – who had received one dose of the Pfizer vaccine, and almost 20,000 who were fully vaccinated.

At the same time, there’s the 101-year-old in Bluff whose provider is short of vaccines, the 81-year-old turned away due to lack of space, the residents of a retirement village in Katikati who’ve been told they won’t get vaccinated until October, and the handful of aged care residential centres that are still yet to see the rollout at all.

And while the Government has made a lot of noise about protecting those who face the most severe outcomes from Covid-19, only 5.4 per cent of Māori have been fully vaccinated compared to 9 per cent of European/Other, 9.3 per cent Asian ethnicity, and 7.3 per cent Pacific Peoples.

Then there’s the “front of the queue” statement that Covid-19 Response Minister Chris Hipkins made in November.

It should be seen in the context it was given, when the Government was about to secure purchase agreements with four different vaccines of still largely unknown efficacy.

But it’s easy – though not necessarily fair – for Joe Public to consider those comments in light of New Zealand’s rollout ranking for per capita vaccinations, which is 122nd in the world.

At the same time, it appears the Government has delivered a rollout as quickly as it could have.

DHBs are tracking so far ahead of schedule that they’ve eaten up most of the 100,000 doses of breathing space. There’ll only be one day’s worth of supply by the time the next shipment is due to land.

The Government has also ramped up the rollout to 130,000 doses a week without having to scale back – beyond holding back on vaccinating prisoners and Defence Force personnel.

This should be looked at in the context of a massive and logistically challenging exercise – delivered by 20 DHBs, which inevitably turns it into a postcode lottery – that attempts to balance supply, demand, and many unknowns such as the number of people who will actually book and then turn up.

Where it has fallen short is managing people’s expectations, especially for the 65s and over in group 3, who should have been told months ago that most of them won’t get vaccinated until the second half of the year.

Their expectations for an earlier jab – and others around a vaccinated safety barrier at the border and a South Auckland blitz to be finished by May – were reasonable, given the rhetoric at the start of the year.

'Certainty for 2 million people'

“The Year of the Vaccine,” decreed Prime Minister Jacinda Ardern in January, when the Government was still looking at using all of the four vaccines it had purchased.

But she had chosen Pfizer by February because of its better efficacy, which has also held up against the variants of the virus.

In early March, Hipkins revealed the four priority groups, selling it as starting to give certainty to more than 2 million people – or all of group 1, 2 and 3.

The Ministry of Health then published a chart that showed group 1 would all be vaccinated by the end of March, while group 2 would be finished by the end of May, when group 3 would also start.

Many in group 3 thought they would be able to schedule a vaccination in that month, or shortly thereafter.

Meanwhile, Hipkins and director general of health Ashley Bloomfield began weekly vaccine updates, but without any hint of how many doses were planned, the numbers were meaningless.

On March 17, Hipkins and the ministry responded by publishing a graph of the rollout so far against the rollout as planned – but it only dug a deeper hole.

The graph had no numbers behind it, and was eventually exposed as “illustrative and approximate”. It was actually worse than meaningless because the illustrative curve suggested we were already tens of thousands of doses behind schedule.

Finally, in early April, the Government released a DHB-by-DHB weekly plan so the public could finally see how the rollout was tracking.

It was tracking well – and still is, at 107 per cent of the schedule.

Despite that, March came and went without group 1 being fully vaccinated, May came and went with group 2 far from being completed, and the chart suggesting those timelines disappeared from the ministry’s website.

The timeline for group 4 was then quietly moved from “from July” to the end of July.

Holes in the border

The virus is more likely to leak from MIQ than from ports or airports, and the vaccination rate among MIQ workers is close to 100 per cent.

But the safety barrier at the border that was hoped to be in place months ago remains far from hole-proof.

The latest data, for the week to June 20, shows 1600 unvaccinated border workers, while the number of household members who have been vaccinated appears to be alarmingly low.

Only about 25,000 household members – roughly the same number of current and former border workers in the system – are vaccinated.

We have already seen, from the cases of the port workerand the plane cleaner – as well as the limo driver that sparked the outbreak in locked-down NSW – howthe virus can leak from the border.

The Government also has no idea how many people are actually in group 1.

About 60 per cent of group 2 and 5 per cent of group 3 are fully vaccinated.

And even though Hipkins recently sent a clear message to group 4 to wait their turn and refrain from walk-ins, the number of first doses in that group has almost doubled from 28,000 to 53,000 in the past four weeks.

Meanwhile less than 10 per cent of people vaccinated are Māori (who make up 16.5 per cent of the population), and while about 6.5 per cent are Pasifika (9 per cent of the population).

Equitable access to the vaccine is an issue highlighted in the Auditor-General’s report in May, which noted how the Government declined to take up a recommendation to prioritise Māori and Pasifika aged 50 and up.

'Not good public understanding about uncertainty'

If at times it seemed that the Government was making it up on the fly, that’s because it probably was in relation to some aspects of the rollout.

It has had to balance the need to communicate a plan to the public before finely-tuned details of the plan were known.

The Auditor-General’s report called out the Government and the ministry for not being as transparent or organised as it could have been.

By mid-April, the ministry was yet to complete a detailed immunisation plan, didn’t really know what role GPs and pharmacies would play, and hadn’t done detailed planning around what to do if shipments failed to arrive or resources had to be diverted for a community outbreak.

Other elements of planning, including how DHBs would be funded to deliver vaccines, weren’t decided until after the sequencing framework was announced.

“If you’re not sure exactly how things are going to work, it’s very hard to communicate that effectively and clearly to the public, to DHBs, and other people involved,” senior performance auditor Kate Williams told the Health select committee last week.

“There wasn’t good public understanding about the uncertainty of supply and not knowing when things would be delivered … More could have been done about that.”

The report made it clear that the Government knew, in mid-April, when the majority of people in group 3 and group 4 would get vaccinated.

“Most of the people in group 3 will not be vaccinated before the end of June,” the report said.

“Although the ministry told us that group 4 will start from July 2021, some
planning documents show that most vaccines for group 4 will be administered
between September and November 2021.”

'We could have been clearer' – Hipkins

It’s not as if the Government was hiding the number of vaccine doses that were due to arrive in the first half of the year.

The ministry’s spreadsheet released in April showed that about 1.1 million doses were expected by the end of June.

That’s only enough to fully vaccinate groups 1 and 2, and a tiny fraction of group 3 – yet no one in the Government clearly articulated that expectation.

Instead Hipkins said repeatedly that everyone in group 3 won’t be vaccinated all at once.

“On reflection, we probably could have been clearer that it was going to take some time to work our way through group 3,” Hipkins told the Herald yesterday.

“We certainly could have been clearer right from the beginning that it is going to be a three- or four-month process.”

Hipkins added that using the term “front of the queue”, while not entirely inappropriate with the message he was trying to convey at the time, was in hindsight probably a “poorly chosen metaphor”.

Managing expectations was one of the major considerations for Ardern when, two weeks ago, she announced the timeline for different age cohorts for group 4.

On July 28, the 300,000 people aged 60-64 are expecting to be able to book a vaccination appointment.

Bookings open two weeks later for the 325,000 people aged 55-59, by mid to late August for the 655,000 people aged 45-54, and by mid to late September for the 651,000 people aged 35-44.

The rest – which will be more than 1.5 million people if the vaccine is green-lit for 12 to 15 year olds – will be able to book from October.

But should people expect to get vaccinated within a short timeframe of making a booking?

As is always the case with the DHB system, Hipkins said there will be some variation in times between booking an appointment and actually getting a jab.

“Some people might get them the first week, some people might be four weeks down the track.”

As has been the case for the Year of the Vaccine, we remain totally reliant on shipments arriving as expected.

While shipments beyond July are yet to be confirmed, the ministry’s latest spreadsheet shows about 1.2 million doses are expected to be administered in August, 1.6 million in September, and 2.5 million in October.

By then there should also be a Plan B, with the expected Medsafe approval of the Janssen vaccine.

While Pfizer will continue to be the main rollout vaccine because of its superior efficacy, Hipkins said 2 million doses of the Janssen vaccine could be delivered within two months of Medsafe approval.

That could be rolled out if Pfizer supplies dry up, or to try to quickly ring-fence an outbreak.

Could the rollout have gone any faster?

The Government’s purchase agreements for Janssen, AstraZeneca and Novavax – all of which are yet to be Medsafe approved – mean that they couldn’t be delivered to New Zealand until the second half of the year.

That basically means the rollout couldn’t have gone any faster than it has, even if the Government had decided to run with whatever vaccines it could get its hands on.

The Government is essentially stuck between a rock and a hard place when it comes to the pace of the rollout anyway.

There are those who are appalled that we sit at 122nd in the world, but there’s also a clear case for a slower rollout given how our communities are Covid-free.

So far the rollout doesn’t seem to have dented Ardern’s popularity, and the Government will be heartened by survey results that show vaccine hesitancy continues to wane.

The rollout could still face pressure – in the form of up to 1 million more arms to jab – if those aged between six months old and 15 years old are approved for the vaccine.

That would be countered by however many people decide not to get vaccinated.

Public backing for the Government’s Covid response may also remain intact as long as our communities remain Covid-free, regardless of what happens.

The Government may yet get through the year with the backing of the public, most Kiwis vaccinated, communities free of the virus, and a plan on how to start easing border restrictions.

There remain, however, many rivers to ford to get to that point.

Source: Read Full Article