Coronavirus Covid 19: Why NZ needs a new pandemic plan

New Zealand urgently needs an updated plan to deal with the next global pandemic – which could be beginning right now, leading epidemiologists say.

“It’s a horrible thought, but the next pandemic could already be starting up – there’s no reason why pandemics would line up in an orderly fashion and wait for their turn,” said Otago University’s Dr Amanda Kvalsvig.

“Human patterns of travel and contact, together with habitat loss and the climate emergency all work together to amplify the risk.”

She said it wasn’t hard to imagine that the planet’s next pandemic could be even worse than Covid-19, which has so far infected nearly 120 million people, and killed more than 2.6 million.

“As infectious as measles, say, with a risk of death similar to Ebola.

“Human-manufactured pathogens are now technically feasible and those are a particular concern because they would be designed to do as much damage as possible.”

Nearly two years before the outbreak of Covid-19, Otago University researchers published a paper arguing New Zealand wasn’t prepared enough for a pandemic the scale of 1918’s Spanish flu disaster.

That was ultimately proven when the country’s existing pandemic plan, focused on influenza, proved unsuited to a more dynamic threat like coronavirus.

“It was a close-run thing in Aotearoa,” Kvalsvig said.

“The influenza model unintentionally put the pandemic response into a cage that severely limited the choices available to decision-makers.

“We were very lucky to have public health experts like Michael Baker and Nick Wilson who were able to think outside of that cage. We changed direction just in time.”

She said that experience motivated her to develop a new framework, which has just been published in a new study in the Journal of the Royal Society of New Zealand.

An updated pandemic plan could apply to a wide range of organisms, provided they were at least moderately transmissible and severe, required extra controls, and hadn’t been fully characterised.

“The challenge is to build a pandemic strategy very quickly at a time when evidence about the new pathogen might be changing every day and there are many unknowns,” Kvalsvig said.

“Some of it involves technical decisions based on transmission characteristics of the pathogen.

“But it is also about flexibility: the plan should be a living document that evolves with the pandemic.”

Its four main objectives would be to identify and extinguish transmission chains, prevent undetected transmission, stop the seeding of new clusters, and reduce the pool of susceptible individuals in the population.

Officials would choose from three approaches: mitigation or suppression, which were the two influenza-focused options New Zealand originally assessed early in the Covid-19 pandemic, and total elimination.

“This new plan is also needed for the Covid-19 pandemic,” Kvalsvig said.

“There are still many unknowns. We need a strategy that can adapt to this dynamic environment and help us navigate the next one to two years, without losing sight of the values that we started with, including a resolve to put public health first.”

Along with an overhauled plan, Kvalsvig and co-author Professor Michael Baker called for a national public health agency to deliver it – and to rebuild capability.

“Our public health workforce and infrastructure have been underfunded for years and the epidemiology contribution to the Covid-19 response has been run on a shoestring,” she said.

“The next plan will need people with pandemic experience and expertise to guide decisions and make difficult calls in a volatile situation.

“Another key requirement is that decision-makers must be representative of the populations at risk.

“We need to ensure that this vital workforce is ready to go when the next pandemic comes along.”

Baker said that, while New Zealand’s elimination strategy has been a success, it was much more difficult and expensive to deliver than it needed to be because so much vital infrastructure was lacking when the pandemic arrived.

“Even with an improved pandemic plan, we still need a public health system to ensure it is regularly updated, adapted and rapidly implemented when needed,” he said.

“New Zealand needs to invest in essential public health systems now to continue delivering our successful pandemic response and to build long-term capacity. A key component is a dedicated public health agency.”

The researchers also called for a top-level review into New Zealand’s Covid-19 response.

That’s now under way, with the Government this week appointing a special advisory group, led by business executive Sir Brian Roche, to help ensure it “learns and adapts”.

Kvalsvig said it was important to remember that, over the past year, New Zealand had still managed to stop a highly transmissible infection in its tracks – “something that many people said was impossible”.

“We have an excellent toolkit for managing infectious disease outbreaks and the control measures are improving all the time. We need to recognise those gains and keep building on them.”

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