05 Pre-pandemi­c Aotearoa New Zealand: an overview I mua i te mate urutā i Aotearoa: he tirohanga whānui

In the ‘Looking Back’ chapters that follow, we examine Aotearoa New Zealand’s experience of the COVID-19 pandemic in detail. Before doing so, however, it is important to set the scene and recall the economic, social and historical context in which these events occurred. While the COVID-19 pandemic was universal in reach, the way it was experienced around the world was far from uniform. In New Zealand, as elsewhere, a range of pre-existing and locally-specific conditions shaped the course of the pandemic itself and the response. This will be true of the next pandemic too.

This short section therefore briefly revisits Aotearoa New Zealand’s pre-pandemic landscape, summarising some of the distinctive features, strengths and vulnerabilities that came to bear on how the pandemic and the response unfolded. Some were accidents of geography, history or sheer luck, while others were the result of deliberate policy and design. Some allowed New Zealand to avoid, delay or mitigate some of the pandemic’s worst impacts, while others may have hindered the response – issues we consider throughout the following chapters.

On the eve of the pandemic . . .

As an island nation, Aotearoa New Zealand’s remoteness – along with its thinly-spread population – was set to play a significant part in how COVID-19 would affect the country. Because of its distance from other countries, and comparatively smaller volume of inbound travellers, the likelihood of infected people entering New Zealand early in a pandemic was less than other countries. This proved important as the COVID-19 pandemic played out. Another factor that was likely to affect the spread of any infectious disease was New Zealand’s low population density – at just 19 people per square kilometre, it was half the OECD average.¹⁸

Aotearoa New Zealand’s population (5 million) was fast becoming more ethnically diverse.¹⁹ At the 2018 Census, 71 percent of the population identified as being of European ethnicity, with significant Māori, Pacific and Asian populations (17, 8 and 15 percent respectively). Many people identified with more than one ethnic group – approximately 11 percent.²⁰ More than a quarter of New Zealanders were born overseas, and a significant number (thought to be between 600,000 and one million) were living overseas.

The diversity of the population would present some challenges during the pandemic response, given the pace of events and the need to make information available in culturally responsive ways. Meanwhile, the large expatriate population would be particularly affected by the border restrictions and quarantine requirements in effect during the pandemic.

Overall, the population was also ageing, with the total number of people aged 65 or older growing rapidly. However, Māori and Pacific populations were generally younger and growing faster than the European population. As has long been the case, Māori life expectancy – 77 years for women and 73 years for men – was considerably lower than for non-Māori, although the gap had been slowly reducing.²¹ This disparity pointed to underlying differences in health status across the population – a significant issue the health response needed to take account of during COVID-19.

Te Tiriti o Waitangi | the Treaty of Waitangi, the agreement written and signed by the Crown and Māori in 1840, held an increasingly important place in the life of Aotearoa New Zealand, its laws and government policies – including those used to enable the COVID-19 response. The three articles of te Tiriti | the Treaty set out the relationship between the treaty partners, and their respective duties and obligations, although there are some differences between the te reo Māori and English versions:

• Article One affirms that Māori cedeto the Crown ‘kāwanatanga’ (or governorship); the English version uses the term ‘sovereignty’.
• Article Two guarantees Māori ‘te tino rangatiratanga’ over their lands, villages, and all their properties and treasures. The English version renders this as ‘exclusive and undisturbed possession of their lands and estates, forests, fisheries, and other properties’. But many think Māori signatories understood ‘te tino rangatiratanga’ to mean much more than mere possession – the unqualified exercise of their chieftainship, self-determination, perhaps something more like sovereignty.²²
• Article Three assures Māori they will have the Queen’s protection and all rights (tikanga) accorded to British subjects.

Many statutes, including some relied on during the COVID-19 response, required government officials and agencies to ‘have regard to’, ‘take into account’ or ‘give effect to’ its principles in order to protect Māori interests. Those principles – identified over the past 40 years by the executive branch of government, Parliament, the courts and the Waitangi Tribunal^iv – are sometimes distilled into three broad principles: partnership (often described as the overarching principle, with other important principles embedded within it), protection and participation. The extent to which the Government’s COVID-19 response upheld these principles would be tested in November 2021, when the Waitangi Tribunal held a priority inquiry into the effects of the response on Māori.

Although te Tiriti was an integral part of the national landscape by 2020, and had always been of the utmost importance to Māori, it is fair to say that views on its contemporary status and application differed widely across the community as a whole. Increasingly, public discourse emphasised its articles as well as, or instead of, the principles. Differing expectations of how te Tiriti would be applied in the pandemic, and how iwi and hapū would be involved in decision-making and delivery of services, became apparent during the pandemic response.

The economy was performing moderately well against several key measures, and the Government’s fiscal position was strong, providing head-room for fiscal support and investment during the pandemic response. In 2019, the OECD had rated Aotearoa New Zealand’s levels of both employment and unemployment as ‘very good’ and economic growth – an important driver of wellbeing that contributes positively to jobs and income – had stabilised at around 2½ percent. The same OECD survey also raised concerns about low household incomes, the availability and cost of housing, the unequal distribution of wealth and several other indicators of wellbeing.²³ Pre-existing disparities in household incomes and resources meant some whānau would be more impacted during the pandemic than others, and decisions about support measures had to take account of diverse and complex needs.

The health of Aotearoa New Zealand’s total population had consistently ranked well internationally. For more than 25 years, people’s average life expectancy had steadily increased, as had the amount of time they live in good health.²⁴ Health outcomes and spending levels were in line with other OECD countries.²⁵

However, as the Ministry of Health acknowledged in a 2017 ministerial briefing, the health of some groups – Māori, Pacific peoples, people in lower socio-economic areas, disabled people – was persistently worse than the general population’s. These groups were more likely to have cardiovascular disease, psychological distress, respiratory illness, diabetes and chronic pain; they also faced greater barriers to accessing healthcare (cost, transport, cultural difficulties and more). For Māori, these disparities contrasted starkly with the equal rights and privileges they are guaranteed under te Tiriti o Waitangi.²⁶ Shortly before COVID-19 reached New Zealand, a Waitangi Tribunal inquiry into the primary healthcare system found the Crown had breached te Tiriti by failing to ensure the system addressed persistent Māori health inequities. The pre-existing differences in health status across the population were among the many factors that had to be considered when deciding how best to target and prioritise health services during the pandemic – including access to vaccines.

The healthcare system itself was a large, complex and widely-distributed network of public and private organisations under growing pressure. The publicly-funded system provided specialist and hospital care that was free at the point of use. Public funding also subsidised most primary care, prescriptions and community care services (such as aged residential care, disability supports and maternity care). A fully private system operated alongside the public system, with private providers offering specialist and some hospital care in separate facilities. The entire healthcare system employed the country’s largest single industry workforce,²⁷ comprising approximately 220,000 full-time equivalent staff or 8.5 percent of the total workforce. The delivery of hospital and primary care varied between regions, with no common national approach. Although the health of New Zealanders overall was in line with other similar countries, the Government at the time had acknowledged that the health system was not working for everyone, and ways to reform the system were under investigation. The vulnerabilities and challenges already evident in the health system would become significant pressure-points in the pandemic response.

The public health service was the part of health system that delivered communicable disease control, environmental health and health prevention services. Aotearoa New Zealand had 12 public health units that served the population in each region, in collaboration with local government and healthcare services. They were supported by the Institute of Environmental Science and Research (ESR), the country’s national reference laboratory and provider of national analysis and reporting of communicable diseases. Public health services managed disease outbreaks and responded to reports of notifiable diseases, including through contact tracing: that is, identifying people who had been in close contact with the person originally diagnosed, supporting them to be tested and – if necessary – undergo treatment. Medical Officers of Health (doctors who have specialised in public health) and Health Protection Officers (trained public health workers) had statutory powers under the Health Act 1956 to require members of the public to comply with contact tracing and (if necessary) quarantine or isolation. A national notification and surveillance system collected information on cases of notifiable diseases.

Some urgent social problems and inequalities were confronting Aotearoa New Zealand, including a housing crisis, child poverty, family violence, and mental health and wellbeing. The OECD had recently drawn attention to New Zealand’s high suicide rate (especially among young people), ‘woeful’ child wellbeing outcomes, and high levels of family violence.²⁸ Despite the promises enshrined in te Tiriti and the benefits that treaty settlements had brought some iwi and hapū, Māori experienced worse outcomes than non-Māori in many areas. Other groups and communities also faced persistent disadvantage.²⁹ Critics said funding for social services, and benefits, was inadequate to meet needs. The COVID-19 pandemic would place additional pressure on all these groups, which – as had been decisively demonstrated in all kinds of national and global emergencies in the past – were less able to absorb the shock arising from such crises.³⁰

Numerous programmes and services existed to support individuals, families and communities facing such hardships. Many services targeted specific populations or issues. Some were delivered directly by government agencies, and others by philanthropic and voluntary organisations that the Government contracts with or commissions. Some providers operated in just one location while others had sophisticated national operations, paid staff and multiple contracts with a range of government agencies. In the immediate pre-pandemic period, 22 government agencies were either delivering, contracting or commissioning social services.³¹ Given the complexity of the sector, and the many non-governmental agencies working to meet the needs of local communities during the pandemic, significant coordination and co-operation would be required across funding agencies to support the response.

The education system had three levels: early childhood education (comprising a mix of services, led variously by teachers, whānau, parents and private sector operators), primary and secondary schooling (state, integrated/special character and private schools, including Māori-medium kura) and tertiary education (technical/vocational education providers, wānanga and universities).

All parts of the system faced a common challenge: it was not keeping pace with the educational needs of an increasingly diverse country. Various system-wide and sector-specific reforms were underway. However, statistics consistently showed marked inequities in educational outcomes and participation rates for some groups, including Māori and Pacific peoples. Digital access was also highly variable across the country and between population groups – something that became problematic during the pandemic when many educational institutions switched to online learning.

The lucrative international education sector was important for the country and would be critically affected by the border restrictions in effect during the pandemic. In 2018, international education contributed over $4.9 billion to the national economy and was the country’s fifth largest export industry.³² More than 117,000 international students were enrolled in schools, universities, technical training institutes, polytechnics, private training establishments and English language schools.³³

The emergency management system was under pressure as some familiar hazards became more frequent and severe, while new threats emerged. A ministerial review established in 2018 had recommended modernising the existing national emergency management system so it could better respond to the increasingly complex demands it faced^.34

By the end of 2019, the reforms were well underway and the system was being overhauled to clarify roles, strengthen leadership, better partner with iwi and Māori, and focus on the wellbeing of people in emergencies. A new ten-year National Resilience Strategy was being implemented and a new agency – the National Emergency Management Agency(NEMA) – had been established to providenational system-wide leadership, coordination and stewardship before, during and after emergencies. It replaced the Ministry of Civil Defence and Emergency Management,³⁵ and would play a key role in the response to COVID-19.

In the event of an emergency involving infectious human diseases, the law provided for the Ministry of Health to lead the national response and gave the Director-General of Health certain powers which could be exercised independently of government ministers. The Ministry was thus at the forefront of the response to COVID-19 from the very start.

The various roles and functions already established across the emergency management system would add to the overall complexity of rapidly activating the pandemic response.

Aotearoa New Zealand’s human rights framework included a mix of domestic laws, international laws, and the various United Nations treaties and rights declarations which New Zealand has ratified.^v A key part of the domestic framework was, and remains, the New Zealand Bill of Rights Act 1990. This Act affirms a range of rights and freedoms – including the right to refuse to undergo medical treatment (section 11), freedom of expression (section 14), and freedom of movement (section 18) – all of which were shown to be relevant in a pandemic. The rights and freedoms affirmed by the New Zealand Bill of Rights Act are not absolute. Rather, they are subject to ‘such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society’ (section 5) and to other Acts of Parliament (section 4).

Ethics frameworks also formed part of the landscape for decision-makers. The need to define fundamental values or ethics that should be used to balance different interests when making urgent decisions in a public health crisis such as a pandemic was recognised internationally. The most globally influential ethics framework was developed in Canada, following the 2005 Severe Acute Respiratory Syndrome (SARS) epidemic, and promoted in the Oxford Handbook of Public Health Policy.³⁶ It influenced the development of Aotearoa New Zealand’s first statement of ethical values for a pandemic, Getting Through Together, issued in 2007 by the National Ethics Advisory Committee.³⁷

These ethics frameworks^vi were available to support decision-makers having to make, and communicate, complex decisions about public health measures – including how and when to implement measures to make the best use of available resources and place the fewest restrictions on personal freedoms. In a pandemic, such decisions might include prioritising access to vaccines and hospital beds, and weighing up the benefits of closing borders or lockdowns against the wider impacts on society.

The issues highlighted in this brief overview, and how they played out during the pandemic, are addressed in more detail in Chapters 2 to 9 of this report.