10.2 The context for our lessons for the future Te horopaki mō ngā akoranga mō ā muri ake

Our collective experience of COVID-19 may have brought challenges and loss, but it also gave us some valuable resources – new knowledge and tools, a renewed awareness of the things we value most as individuals and societies, deeper understanding of the systems and services we will rely on in a crisis, and a broader portfolio of response and support options.

As a result, the national and international context within which the next pandemic arises will be different from the start of 2020. In particular:

COVID-19 expanded international understanding of pandemic pathogens.

We may never know the source of the COVID-19 virus. Whether it arose from the virus spilling over from bats or another mammal to humans, or – less likely but still possible – from a pathogen leaking from a virus research facility.

Both scenarios can be prevented – or at least the probability of either occurring again can be reduced. Prevention is the best form of pandemic preparedness, and Aotearoa New Zealand actively supports many of the key international pandemic prevention efforts now underway. They range from reducing risks at wet markets and discouraging incursions of human settlement into high-risk areas, to improving global surveillance systems so cross-species jumps can be stamped out as early as possible. Work is also underway to build strong and effective mechanisms that encourage countries to report worrying outbreaks early, and fully, to the World Health Organization (WHO) and the global community.

COVID-19 also significantly changed the world’s understanding of how respiratory viruses spread. Before COVID-19, it was not entirely certain which of the three main forms of transmission (droplet, aerosol and fomite or surface transmission)ⁱ was the most significant. But definitive evidence emerged during the pandemic that SARS-CoV-2 (and probably other respiratory viruses as well) is mostly spread through aerosol transmission. Aotearoa New Zealand and Australia played an important role in demonstrating this phenomenon, providing compelling evidence from MIQ facilities of international arrivals in hotel quarantine becoming infected by ‘air’ wafting from one room to another via hotel corridors when doors were opened.

This knowledge underscores the critical role of ventilation and air flow in a pandemic and has implications for the design of many indoor environments – including schools, hospitals and quarantine facilities. It demands that more attention is given to limiting aerosol transmission in high-risk settings, from doctors’ waiting rooms to hospitality venues.

Here again, COVID-19 reinforced the growing understanding that, if worn properly, masks are effective in limiting the spread of respiratory viruses. Even if the next pandemic pathogen has a shorter incubation period (making contact tracing less effective), decision-makers now know that masking, ventilation and air filtration will go a long way towards dampening transmission. Much can be done ahead of time to ensure these measures are in place and ready to use.

Finally, the pandemic was a powerful reminder of the ability of pathogens to change their stripes. What we saw from 2020 onwards was a virus being constantly selected for a fitter variant that could infect people more easily, spread faster and evade immunity (due to previous infection or vaccination). The extraordinary capacity of the COVID-19 virus to mutate had consequences; the arrival of the highly transmissible Omicron variant saw immunity from vaccination begin to wane just as high levels of population coverage were achieved. Luckily the Omicron variant was less virulent than earlier strains. But Aotearoa New Zealand should not rely on lucky breaks in the next pandemic: we need to be prepared for a similarly sophisticated future pathogen, and one that is more deadly.

The mutability of the COVID-19 virus points to the importance of scenario thinking in pandemic preparations and response. Drawing on all the new and enhanced knowledge about pathogens now available, experts need to identify a range of potential pandemic scenarios and their likelihood so decision-makers can consider the implications and possible mitigations. In addition, there must be open public discussion of possible pandemic scenarios, what response options are feasible and cost effective – and what trade-offs may be required. Our lessons draw on this insight.

Pandemics require a different kind of response from most other emergencies because of their scale and duration.

Aotearoa New Zealand is well practised in responding to natural disasters like earthquakes or severe weather events. Our civil defence and emergency management system has been designed to provide an integrated approach to managing emergency events at any local or regional size. The system is underpinned by the Coordinated Incident Management System (CIMS), allowing all those involved to use a common tool and ‘speak the same language’.

But responding to a global pandemic has differences, in terms of both scope and scale. While a pandemic may present as a public health crisis, it has ripple effects across many aspects of society that the response needs to address. In Aotearoa New Zealand, this meant the response involved a much broader range of agencies, non-governmental and community groups than was typical of other emergencies; including many people who were unfamiliar with CIMS and other practices.

Moreover, unlike other emergencies, people are usually the vector in a pandemic. As we saw with COVID-19, stopping the spread of an infectious disease may require protective measures that affect the whole population – whether or not they are sick or symptomatic yet. A precautionary approach in the next pandemic may require blanket restrictions to be put in place before fuller information about how the virus spreads becomes available.

This situation puts decision-makers in something of a bind. Successful pandemic responses rely on high levels of social trust and cohesion. When they are present, people are more likely to comply with public health measures, trust decision-makers and evolving scientific evidence, support each other through lockdowns and other challenges, and accept their own freedoms being restricted in order to protect others. Yet if a pandemic response requires measures that are all-encompassing and drastic, these are likely to erode trust and cohesion over time. During COVID-19, Aotearoa New Zealand experienced both high social cohesion and then its gradual erosion. The country’s starting point for a future pandemic will be different as a result.

It is important to act fast at the start of a pandemic and adopt a ‘least regrets’ approach – but it is also important to keep an eye on the long-term social and economic consequences of decisions.

Throughout a pandemic response, governments must constantly balance the short- and long-term effects of their actions and policies. Keeping people employed and maintaining their incomes so they can feed and house their families is obviously an immediate goal in a people-centred pandemic response. Underdoing initial economic and social support can impose unnecessary costs and losses that risk creating longer-term harms for people, business and communities: at this stage, a ‘least regrets’ approach is justified.ⁱⁱ However, overdoing the level of support will create long-term costs (in the form of debt, cost of living increases and productivity losses), and may require longer-term consolidation or even austerity – with all their associated hardships. In the early days of a pandemic, it is hugely challenging to make the right decisions that ensure the response is neither underdone nor overdone.

Governments will be judged not only on how many lives they save in a pandemic or how well they achieve their initial strategic objectives (very well, in the case of the early success of New Zealand’s elimination strategy) but also on the country’s long-term economic and social health – including whatever scars the response may have caused (or exacerbated). Decision-makers must therefore distinguish between short-term and long-term priorities when formulating policies; they should not let the urgent and immediate undermine the important and long-term.

Decision-makers should also be prepared to adjust their thinking about risk as the pandemic response evolves. As the initial uncertainty diminishes, it makes sense to move away from a default precautionary and near-zero risk tolerance for infection to a more balanced approach to risk. Knowledge about the characteristics and risks of the pathogen (for example, how easily it transmits through the air, or who is most at risk of dying if infected) will continuously evolve. This will change how the effectiveness of potential policy response options is assessed (for example, whether masks and ventilation reduce transmission risk, or whether contact tracing will be effective). As more time passes, the risks associated with the supporting economic and social measures will start to increase. Even in the shorter term, various ‘non-essential’ activities – such as horizontal construction, certain outdoor activities and access (albeit regulated) to a wider range of retail outlets – may be able to operate in relative safety as more is learned about managing the risk for a new pandemic pathogen.

It is of course important that the pandemic response avoids causing harm to key areas of the economy and society. This makes good long-term sense. Similarly, as the pandemic and the response evolve, some adjustments should be considered to reduce potential harms including, for example, impacts on productivity and disengagement of learners from the education system.

Resolute, clear and strategic leadership is a formidable asset during a pandemic emergency, coupled with strong social cohesion and trust.

Aotearoa New Zealand’s unified collective response to COVID-19, especially in the first year, was a source of strength and a significant factor in the success of the elimination strategy. It was made possible by strong, consistent and clear leadership, combined with deep reservoirs of social cohesion and trust in government and experts that had built up over time. Other countries that lacked this kind of social capital and trust in institutions did not fare as well.

Our country’s experience of COVID-19, and the international evidence available, together suggest that going into a pandemic with high stocks of trust and social cohesion may be just as important as large stockpiles of PPE and a strong national balance sheet. But equally, the New Zealand experience showed the extent to which a pandemic can erode trust in institutions within sections of society, and cause polarisation. The extent and speed of that erosion could be held in check if decision-making during the response is transparent, seen to be fair by the majority, and respectful and accommodating of the minority. This is where strong leadership and effective communication – about decisions, their objectives and the trade-offs involved, as well as listening carefully to those affected – is paramount.

Even so, leaders and decision-makers everywhere face real challenges when it comes to establishing and maintaining social trust and cohesion. Unsurprisingly, the COVID-19 pandemic confirmed the extent to which societies have changed since the last major global pandemic in 1918. Attitudes to authority, public trust in governments and public institutions, faith in science and religious institutions, the proliferating sources of information people rely on, and even the fundamental concept of truth – all have been shaken or changed profoundly.

Populations are now vastly more diverse and heterogenous, meaning one message or form of communication may work well for one group but not for another. Trust levels vary hugely between population groups, as do attitudes to compliance. Some people like to be told precisely what to do, while others want to know the desired outcome and find their own way to best achieve it. Such factors have major implications for regulation and sequencing.

The increasing challenge of misinformation and disinformation is an issue for pandemic responses.

The way that people share and consume information has been transformed over the past 20 years. While the rise of digitalised media has offered considerable benefits, it has also propelled the spread of false or misleading information across the world. This comprises both misinformation (incorrect information which is shared by those who honestly believe it is factual) and disinformation (false information which is deliberately shared, sometimes by state actors, to cause harm or achieve a particular aim). In Aotearoa New Zealand, the circulation of false information – whether on direct pandemic matters such as vaccines, or other societal issues – added to the social fractures we saw developing over the course of the pandemic.

Of course, this dynamic is not unique to pandemics. The contexts in which it occurs, and the underlying causes are many and varied.¹ So too are potential ways to counter it, and technology companies, the education system (which can equip citizens to be more discerning) and experts all have roles to play.

At the same time, it is vital to preserve freedom of speech – including the freedom to express views that may run counter to what the Government of the day is proposing – and the ability to robustly critique knowledge. The value of both was repeatedly underlined throughout the COVID-19 pandemic. For example, it was important for experts and citizens to ‘speak up’ on issues like vaccine mandates, which were opposed by some school principals and healthcare providers. Similarly, it was vital for experts to help inform the public on important issues relating to COVID-19.

No society has yet ‘solved’ the problem of misinformation and disinformation. In our Inquiry, we discussed the issue with many people and heard a wide range of views. We have no definitive solutions to propose. But we do think it is important that society keeps working to tackle the issue – including by listening empathetically to those who take this information seriously and by disagreeing respectfully if others hold to different views from ourselves. In another pandemic, it is also important that decision-makers balance whatever response measures and restrictions they are considering against the value of free speech and valid scientific and expert debate.

Pandemics require anticipatory governance, and long-term planning and investment.

Like climate change, a pandemic is an example of what is sometimes called a ‘wicked’ policy problem: unclear, complex, cutting across different systems, underpinned by unclear causal relationships, and liable to result in unanticipated consequences.

COVID-19 amply demonstrated the difficulties of responding to problems like these. The lack of straightforward (and politically palatable) solutions is perhaps one reason why so many countries were ill-prepared. Before 2020, many countries had already categorised pandemics as a highly probable risk. Yet, globally, there had been little consideration of plausible scenarios or the potential ripple effects that restrictive public health measures could have across wider society and the economy.²

Responding better to the ‘wicked’ problems which pandemics raise will require a shift in thinking towards what the OECD terms ‘anticipatory innovation governance’ – taking a proactive approach that embeds foresight, innovation and continuous learning into policy and investment decisions.³ Such an approach means decision-makers preparing for a range of future pandemic, economic and social scenarios, helping to stress-test response options, identifying vulnerabilities and opportunities, investing wisely and cost-effectively for the long term, and being prepared to respond swiftly and flexibly as required.

Tools are available to help decision-makers make these difficult judgements – particularly scenario thinking, planning and modelling. Before and during the next pandemic, we think these should play a much stronger role in preparation and decision-making.

We also believe we need to shift the default thinking (among experts and across society more broadly) from ‘we do not know when the next pandemic will occur and what it will be like’ to ‘we can assign probabilities to future pandemic scenarios and the frequency with which they might occur; therefore we can quantitatively prioritise investment and planning before the next pandemic and optimal response options during it.’ While there will always be uncertainty about the next pandemic – where it will come from, how severe it will be – we can still quantify scenarios, response option costs and consequences, and therefore manage risk.

One tenet of anticipatory governance which is especially relevant for future pandemics is the value it places on managing crisis and strategy in tandem:

“One excellent technique is to manage chaos and innovation in parallel: The minute you encounter a crisis, appoint a reliable manager or crisis management team to resolve the issue. At the same time, pick out a separate team and focus its members on the opportunities for doing things differently. If you wait until the crisis is over, the chance will be gone.”⁴

Elsewhere in this report (see especially Chapter 2), we have described what this ‘separate team’ would look like in a pandemic response. We envisage a strong, strategically-focused group which – while others deal with immediate and operational matters – is thinking ahead, considering scenarios, and developing options to respond to them. It will also be using dynamic learning techniques, and documenting response lessons as it works. The need to have and protect this strategic function has been highlighted in other countries’ⁱⁱⁱ COVID-19 inquiries.⁵

A highly connected world has changed how pandemics are experienced; this creates both risks and opportunities when managing them.

As we have already acknowledged, since the world last experienced a pandemic on a similar scale to COVID-19, global connections between people, institutions and markets have grown exponentially. We have become accustomed to living in a world in which capital, goods, knowledge, people, cultures and trends cross borders at dizzying speed – even for countries like Aotearoa New Zealand, which are geographically isolated.

The COVID-19 pandemic confronted us with a virus that could travel round the world far faster than ever before. This brought home to us the many consequences, positive and negative, of New Zealand’s isolation and reliance on international connections. We also saw the importance of connectedness at a national level, and what could happen when vital connections were disrupted. For example, an industry not designated as essential may have to stop making a by-product required by another industry that is considered essential, significantly affecting that industry’s ability to operate until a solution can be found.^iv

Our size and geographic isolation were undeniable assets when it came to stopping the virus, giving us response options that were not available to other countries. However, the same factors also created vulnerabilities. The pandemic exposed Aotearoa New Zealand’s heavy reliance on international supply chains that were long, thin and complex. New Zealand has a small, open economy that depends on trade and the easy movement of people (workers, students and others) and goods and (increasingly) services in and out of the country. We are often at the furthest end of the supply chain: something we use every day might have been designed in Italy, funded in London or New York, machined in Thailand and finished in Australia before it reaches New Zealand. With borders effectively closed, and delays to ships being able to unload their cargo and manufacturing scaled back or completely halted, we saw the fragility of that chain. Disruption to just one part was shown to have consequences for the whole.

Aotearoa New Zealand’s supply chain vulnerability was heightened by its use of ‘just in time’ delivery which, though efficient in normal times, meant goods that were essential in the pandemic (PPE, for example) were sometimes in dangerously short supply or had to be used past their expiry date. We return to the challenges of maintaining strong supply chains in a pandemic in Lesson 4.

People’s ability to move freely across international borders – a routine expectation in our highly-connected world – was also a casualty of the pandemic. In 2021, only 800,000 traveller movements were recorded across New Zealand’s border, the lowest in 50 years, and only around 5 percent of the 14.2 million movements in 2019. The curtailment of international travel inflicted considerable damage on sectors like tourism and hospitality, and highlighted New Zealand’s economic reliance on the international trade in services. Moreover, it exposed the fragility of the rights of New Zealanders living overseas to return home, and the ability of foreign nationals in this country to return to their country of origin.

On the plus side, however, it was thanks to greater global connectedness that the latest scientific knowledge and research about COVID-19 became available almost immediately. The speed with which it was disseminated meant it could inform countries’ pandemic responses and planning, while also helping to counter misinformation and disinformation. In addition, international relationships and collaboration were instrumental in the development and distribution of effective vaccines. And since the worst of the pandemic has passed, we have seen multilateral efforts to better prepare the world for future pandemics – such as the revised International Health Regulations, ongoing work to forge a global pandemic accord and various initiatives to improve poorer countries’ access to vaccines. Developments like these demonstrate how international connectedness can be a force for good when it comes to building resilience to future pandemic shocks.

COVID-19 expanded the strategic response options that can be deployed in a pandemic.

COVID-19 demonstrated that countries – especially island states, which enjoy the additional benefit of geographic isolation – have options about how to respond to pandemics, including pursuing elimination (‘stamp it out’) or exclusion (‘keep it out’) strategies. Until COVID-19, it was assumed that in a global pandemic, the pathogen would inevitably sweep through all countries and could not be kept at bay. ‘Keep it out’ was a relatively short-term tactic to buy time to plan and prepare for the inevitable, and not envisaged as a strategy to create enough time for the population to be vaccinated before opening up. This assumption was reflected in New Zealand’s pandemic plan,⁶ similar plans in other countries, and in WHO guidance. But the COVID-19 experiences of Aotearoa New Zealand and some other countries, such as Australia and Taiwan, showed otherwise. Providing they act early and fast enough, countries can opt to keep the pathogen out or (repeatedly) stamp it out. They can keep doing so until they are ready to let the virus in and exit from an elimination strategy on their own terms and at the time of their choosing.

This option is especially feasible when the pathogen in question sits in what might be called the ‘goldilocks’ zone – when it is sufficiently virulent and infectious to have major adverse effects if a country aims only to mitigate or suppress it, but not so infectious that it cannot be eliminated or stamped out when outbreaks occur. The COVID-19 virus was in that goldilocks zone.

However, such an approach comes with costs – particularly the economic and social impacts of shutting down or severely restricting the flow of people across borders, which need to be carefully weighed up when deciding to pursue either elimination or exclusion approaches. Nonetheless, the COVID-19 experience has empowered governments to at least consider the option of imposing tight border restrictions. Not only was that prospect almost unimaginable before COVID-19 – it also contrasted sharply with WHO’s initial view that keeping border restrictions in place for the medium term was unfeasible and too much of a barrier to international trade and mobility.

Is it really feasible to exclude a pandemic pathogen like the COVID-19 virus by effectively closing the borders before any infection has the chance to become established? We argue ‘yes’, if it has been carefully considered and planned for in advance. Aotearoa New Zealand’s experience in 2020 and for much of 2021 demonstrated that an elimination strategy is an effective medium-term strategic option for pandemic pathogens of sufficient severity; with the right combination of public health measures, and high levels of public support, we saw that such pathogens can be eliminated even after they have gained a foothold in the country.

From there, it is only a small step in counterfactual thinking to consider what could have happened if we had restricted entry at the international border earlier and more stringently. If the WHO’s declaration of the novel coronavirus as a ‘public health emergency of international concern’^v on 31 January 2020 had come a week earlier, and if Aotearoa New Zealand had planned for the possibility of closing borders faster, the COVID-19 virus might not have entered New Zealand at all in February and March – and we could have avoided the first national lockdown entirely. Even if we did not completely stop the virus from arriving, with well-prepared contact tracing, quarantine and isolation systems in place, it would have been possible to ‘stamp out’ the odd outbreak (though the occasional soft or hard lockdown might still have been needed).

In the next pandemic, rapidly deploying an exclusion strategy early on may well be a viable option for Aotearoa New Zealand – providing the necessary plans and investment decisions are made in advance. Implementing such a strategy in the uncertain initial days of a pandemic would not be easy. There is inherent risk in deciding to close the border swiftly – namely, that the pandemic pathogen turns out to be less severe than originally thought, and neither exclusion nor elimination strategies are warranted. But such risks do not lessen the need to engage in scenario thinking, planning and modelling before the next pandemic. Decision-makers need to be better-equipped to gauge the likely balance of benefits and harms of such a strong precautionary approach.

There are many ways to respond to a pandemic, even within a single strategy

The tools and tactics at Aotearoa New Zealand’s disposal in a pandemic include vaccines, therapeutics, public health and social measures (ranging from encouraging physical distancing through to mandating hard lockdowns), masks, contact tracing, isolation of cases, quarantine of contacts and international (and even inter-regional) arrivals, regional borders, school closures, restricted gathering sizes, and better ventilation and filtration of air in buildings. The global experience of COVID-19 showed that the better these tools and tactics are prepared – and the greater the willingness of the population to collectively implement them – the more likelihood that our chosen strategy will succeed and deliver greater benefits with less harm.

For example, if excellent contact-tracing, isolation and quarantine capacity and capability are in place before the next pandemic (providing the virus in question is amenable to such things), there will be less need for New Zealand to use measures such as lockdowns that people found more unpalatable or were more harmful in the COVID-19 pandemic. Likewise, decision-makers may choose next time to prioritise people attending tangi and funerals – which we know was a contentious and distressing issue for many during COVID-19 – and ‘offset’ that risk via another response measure (such as encouraging and requiring more high-quality mask wearing). Or they may choose to take a little more risk by allowing schools to stay open more and offset it by encouraging as many adults as possible to work from home.

Given the array of tactical choices which leaders can use in various combinations to achieve their chosen strategy, the challenge will be to arrive at the ‘sweet spot’ that maximises the benefits and minimises the costs. Developing better understanding of the choices to be made, the impacts of each and the settings required to implement them should be part of Aotearoa New Zealand’s preparations for the next pandemic (see also our discussion of anticipatory governance).