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New Zealand needs better plan for next pandemic, researchers say

Paper calls for public inquiry to inform planning for future crises

The pandemic plan that New Zealand had in place at the start of the Covid-19 pandemic was not the right way to deal with the crisis, researchers from the University of Otago have said.

The country’s next pandemic control plan will need to “make as few limiting assumptions as possible”, the researchers say in a study. Although New Zealand’s response was largely successful, the existing plan, from 2017, was based on “the past experience of influenza” and it was only attention to early evidence from China that led to the adoption of an “elimination” strategy.

The article, by Amanda Kvalsvig and Michael Baker, was published in the Journal of the Royal Society of New Zealand on 9 March. It says that at the start of 2020, the country was “largely unprepared to deal with a major infectious disease threat” and had been rated only 35th in the world for pandemic preparedness.

“When the Covid-19 pandemic arrived, the New Zealand government did have a pandemic plan…but the plan was for a different emergency: pandemic influenza.” It notes that more than 1 per cent of the whole New Zealand population was killed in the 1918 influenza pandemic and that the country had missed several opportunities to improve its planning since 2017. The official strategy was “mitigation”, but New Zealand “rapidly developed an elimination strategy for Covid-19—a different plan, for a different virus”.

The country’s six-step plan from 2017 assumed that an outbreak of the next pandemic disease would be unstoppable and that vaccines would be available. “The 2017 plan, therefore, ruled out adoption of an elimination strategy without explicitly saying so.”

However, New Zealand recognised as early as February 2020 that it needed a different approach. “The insight from China that ‘it is not Sars and it is not influenza’ was transformative in shaping the subsequent Covid-19 response” in New Zealand, the authors say. Lack of contact-tracing ability and a “relatively low” number of intensive care unit beds led epidemiologists to recommend border closures.

“The experience with Covid-19 has demonstrated the risk of having a pandemic plan that is too pathogen-specific,” the authors conclude, adding: “We now also need to consider deliberate introduction of a known or novel (engineered) pathogen.

They propose a response framework with an emphasis on reviewing scientific evidence and adjusting strategies accordingly. The transmissibility of the disease, its severity and impact on the population and the resources available to control it all need to be taken into consideration, they say.

A national public health agency should be set up and a public inquiry should be carried out into the early phases of the country’s response, both to improve how New Zealand deals with Covid-19 and to identify where preparation for the next pandemic is needed, they say. “Revision of the existing pandemic plan should not wait until the Covid-19 pandemic is over, as the next pandemic could already be in train.” 

“Decades of underfunding have resulted in a small and overstretched public health workforce, with the result that the contribution of pandemic epidemiology expertise to the Covid-19 response has operated largely on donated time.”

The research was partly funded by a Health Research Council of New Zealand grant.