10.3 Lessons for the future Ngā akoranga mō ā muri ake
Overview | Tirohanga whānui
With the fundamental global observations and context from the previous section in mind, we now turn to the specific lessons Aotearoa New Zealand can learn for the future. These lessons describe the high-level elements we think are necessary to ensure the country is fully prepared for the next pandemic ahead, and ready to respond in ways that take care of all aspects of people’s lives. In our earlier chapters and reflections, we have been looking at COVID-19 through the rear-view mirror. Now we turn our attention to the road ahead.
The overarching lesson from COVID-19 (Lesson 1) is that we need to manage pandemics to look after all aspects of people’s lives. This means recognising the broad range of impacts that a future pandemic may have on all aspects of people’s lives in Aotearoa New Zealand – and balancing the responses to minimise both immediate and long-term harms. The remaining five lessons for the future flow from the first. Figure 1 shows how the lessons work together.
Figure 1: Lessons for the future and how they fit together
Lessons 2 to 6 reflect what we have learned about what it would mean to prepare for and respond to a future pandemic in a way that looks after all aspects of people’s lives.
Lesson 2: Make good decisions. In order to look after people in a pandemic, decision-makers need to keep sight of the overall purpose of the response while being adaptable in how this is achieved. They also need advice and evidence that helps them weigh up different options and strike a balance between different priorities and values. What is needed to ‘look after people’ will change as the pandemic evolves and the balance of benefits and harms of various policy options shifts over time.
Lesson 3: Build resilience in the health system. Looking after people’s health is a core part of any pandemic response. Strengthening public health capacity will expand the tools available to reduce the risk of pandemic infection. This can reduce their reliance on more restrictive measures (such as lockdowns). Capacity is also needed in the healthcare system so this can meet the demands of safely caring for those who become infected while also delivering other essential health services.
Lesson 4: Build resilience in our economic and social systems. Any pandemic response needs to look after the social, economic and cultural aspects of people’s lives. In order to do this, New Zealand’s social and economic systems need to be resilient and have the capacity to ‘step up’ during a crisis. People are the most important resource, but we also need tools and processes for identifying and reaching those who need support during a pandemic.
Lesson 5: Work together. Looking after people in a pandemic means all parts of society need to be involved. Communities, businesses, faith groups, NGOs and tangata whenua are able to reach people and do things beyond the scope of government agencies. Building relationships and recognising the value of others’ approaches are important preparation for working together in a pandemic.
Lesson 6: Build the foundations for future responses. Looking after people means thinking about what would be needed in a future pandemic response and acting now to ensure this is in place ahead of time. It’s not possible to predict the exact nature of the next pandemic, or the economic and social situation in which it might occur, but there are tools (such as scenario planning) that can give a sense of the range of challenges a future government might need to respond to. These should inform what’s prioritised in the work of pandemic preparation and where Aotearoa New Zealand should focus its resources – including the tools and systems needed to look after all aspects of people’s lives.
Lesson 1: Manage pandemics to look after all aspects of people’s lives | Akoranga 1: Te whakahaere mate urutā hei tiaki i ngā āhuatanga katoa o te ao o te tangata
In brief: What we learned for the future about looking after all aspects of people’s lives
In preparing for and responding to the next pandemic:
- Lesson 1.1 Put people at the centre of any future pandemic response
- Lesson 1.2 Consider what it means to ‘look after all aspects of people’s lives’ from multiple angles
Overview
While pandemics are first and foremost public health emergencies, Aotearoa New Zealand’s COVID-19 experience demonstrated that managing a pandemic is also about much more than controlling an infectious disease. The pandemic – and the Government’s response to it – affected every part of people’s lives – health, social, economic and cultural. Preparing effectively and responding well to a future pandemic will therefore require involvement from across both sectors and society.
The COVID-19 pandemic was also a reminder of what matters most for people. Humans are social beings whose lives are made meaningful by the strength and value of our relationships and connections. Physical health and wellbeing matters, of course, but so do whānau and family, friendships, livelihoods and the freedom for individuals and communities to choose and pursue what is important to them, even during a crisis like a pandemic.
These insights are an important reminder of the core purpose of pandemic preparedness and response – looking after all aspects of people’s lives. In practice, this means:
- Looking after all aspects of people’s health – protecting them from infection, while also looking after their wider physical, mental and emotional health.
- Looking after the broader aspects of people’s lives – looking after their social, economic and cultural interests.
- Looking after people in the future as well as the present – making sure that actions and decisions in the moment take account of what may be needed in times to come.
What’s needed to ‘look after people’ may change over time. Sometimes, multiple objectives may be in tension with each other. Recognising and responding to this will require decision-makers to weigh up different options and balance potentially competing priorities and values. This is covered in more detail in Lesson 2.
When it is understood that the purpose of pandemic management is looking after all aspects of people’s lives, it becomes clear that pandemic preparedness and response need to take a broad approach. The centrality of this purpose was encapsulated by the Chair of our counterpart inquiry in the United Kingdom, Rt Hon Baroness Hallett DBE, in the introduction to her Inquiry’s first report: ‘The primary duty of the state is to protect its citizens from harm’.7 While it will be up to future governments to determine exactly how to prepare for, approach and respond to a future pandemic, and what weight to put on different forms of harm, it is hard to imagine any pandemic scenario in which protecting and supporting people through the crisis is not the primary focus.
Lesson 1.1 Put people at the centre of any future pandemic response
Many people, groups and organisations in Aotearoa New Zealand draw inspiration from the well-known whakataukī: He aha te mea nui o te ao? He tangata, he tangata, he tangata (What is the most important thing it the world? It is people, it is people, it is people). Embedded in this whakataukī is a challenge – before taking an irreversible action, consider: what will it mean for people?
Early in the COVID-19 pandemic, many people in Aotearoa New Zealand had a strong sense that the response was intended to look after them. While daily life was fundamentally changed by the introduction of border restrictions and lockdowns, strong messaging to ‘Unite against COVID-19’ and ‘be kind’ gave many people a sense that the Government was acting in their best interests. Many of our public submitters expressed gratitude for this decisive and empathetic approach, drawing attention to the contrast between the quiet streets in Aotearoa New Zealand during the first Level 4 lockdown in 2020, and images of the devastating impact of COVID-19 in parts of Europe and North America.
Over time, however, this sense of being looked after began to fade for some people. Measures such as gathering restrictions that were intended to keep people safe from the virus became a cause of distress and harm. We heard from some submitters that, in minimising the risk of infection, it sometimes felt as though people were being denied the things that made their lives worthwhile. Some New Zealanders who were overseas felt forgotten or abandoned by their home country.
The challenge for future governments will be to ensure that people – and all the things that make their lives meaningful – are kept at the centre of any pandemic response. Pandemic policies and measures should be evaluated not only for their efficacy in minimising infection, but also for the impacts they have on people’s lives. There will be times when it is necessary to use measures that come with significant costs or restrictions. But COVID-19 has underscored the importance of fully considering the impacts of pandemic response measures on all aspects of people’s lives – both short- and long-term – and taking this into account as much as possible when deciding when and for how long to deploy such measures.
Lesson 1.2 Consider what it means to ‘look after all aspects of people’s lives’ from multiple angles
It is important to take a broad perspective on what looking after all aspects of people’s lives means during a pandemic, and to embed this across all elements of the response. This is partly acknowledged in the recent interim update to New Zealand’s Pandemic Plan, which sets the following ‘key objective’:
“The key objective of this plan is to minimise deaths, serious illness and significant disruption to communities, the health system and the economy arising from a pandemic associated with a respiratory infection.”8
As we learned during COVID-19, people’s lives and quality of life can be threatened not only by a pandemic pathogen, but by the response itself. Mental health may be challenged by long periods in lockdown. Jobs and incomes may be lost. Families may be painfully separated or exposed to damaging stress and violence. Delays in accessing ‘business as usual’ healthcare may lead to people dying or becoming seriously unwell from other illnesses. There may even be longer-term, intergenerational impacts, such as loss of learning from school closures, or lack of housing affordability from response measures accelerating existing economic trends.
There are numerous models and frameworks that future decision-makers and officials can use to inform their understanding of what matters to people and what it means to look after all aspects of their lives during a pandemic. These include (but are not limited to):
- Aotearoa New Zealand’s human rights framework, comprised of a mix of domestic laws and various United Nations treaties and rights declarations which New Zealand has ratified. Te Tiriti o Waitangi is also part of this framework.
- Outcomes frameworks developed by agencies to inform their work, such as Treasury’s Living Standards Framework.
- Models developed for specific population groups, such as children and young people, Māori, Pacific peoples and other ethnic communities.
- Holistic models of mental and physical health, such as the outcomes framework developed by Mental Health and Wellbeing Commission | Te Hiringa Mahara.
Using such models and frameworks can give decision-makers confidence that they have identified a wide range of potential impacts from various pandemic response measures and support sound decision-making about which measures to use and in different circumstances.
Aotearoa New Zealand’s COVID-19 experience demonstrated that a pandemic’s impact will be unevenly distributed – especially if efforts to mitigate unequal impacts are insufficient. As set out in the ‘Looking Back’ section of the report, especially in Chapter 6, even with a proactive policy response, the COVID-19 pandemic and associated response measures disproportionately affected Māori, Pacific people, women, disabled people and others, even with a proactive policy response.
Aotearoa New Zealand’s COVID-19 experience also demonstrated that a pandemic’s impact will be unevenly distributed.
Many actions by policy makers and communities helped to reduce these impacts. For example, food parcels and other forms of grassroots support were part of the tremendous wraparound support provided to many communities during the first lockdown. But some efforts could have been more effective through, for example, earlier engagement of Māori and Pacific providers in the vaccine rollout (see Chapter 7).
Making use of the kinds of models and frameworks set out in this lesson can also help to flush out how different individuals and groups may experience a pandemic differently. Recognising that it will never be possible to completely mitigate every potential negative or unequal impact with an optimal policy response package, a people-centred future pandemic response should nevertheless aim to anticipate these were possible, consider the overarching purpose of the response, apply ethical principles to guide decision-making including trade-offs, and augment population-wide or universal policies with targeted policies as appropriate. Making use of a wide range of models and tools can inform effective planning for how to do this in a way that looks after all aspects of life for a wide range of people – recognising a pandemic is still going to see ‘losses’ in many domains. This will also help to ensure that underlying inequities and existing disadvantages are not exacerbated during a future pandemic.
Lesson 2: Make good decisions | Akoranga 2: Te tuku whakatau pai
In brief: What we learned for the future about making good
In preparing for and responding to the next pandemic:
- Lesson 2.1 Maintain a focus on looking after all aspects of people’s lives in pandemic preparedness and response. In practice, this means:
- 2.1.1 Consider and plan for multiple time horizons simultaneously
- 2.1.2 Make more explicit use of ethical frameworks to balance different rights, values and impacts over time
- Lesson 2.2 Follow robust decision-making processes (to the extent possible during a pandemic). In practice, this means:
- 2.2.1 Seek out a range of advice and perspectives
- 2.2.2 Make use of times when the situation is stable to look ahead and plan for what might come next
- 2.2.3 Anticipate and plan for burnout
- Lesson 2.3 Use appropriate tools when developing and considering policy response options
- 2.3.1 Identify a wide range of possible policy response options
- 2.3.2 Compare the impacts of different policy response options to make good decisions
- 2.3.3 Use modelling and scenarios to inform decision-making
- Lesson 2.4 Be responsive to concerns, clear about intentions and transparent about trade-offs
- 2.4.1 Engage stakeholders, partners and the public in key decisions, to the extent possible in the circumstances
- 2.4.2 Be transparent about how different considerations have been weighed against one another.
- 2.4.3 Clearly signal in advance where the response is heading, to help people navigate periods of uncertainty and transition.
Overview
Good pandemic decision-making must be responsive to changing circumstances and take account of cumulative effects.
In the early days of the COVID-19 pandemic, the Government made many hard decisions (such as imposing border restrictions and quarantine requirements) quickly and under pressure. The elimination strategy, once adopted, provided a clear purpose and touchstone for such urgent decisions. However, as the pandemic wore on – especially in the second half of 2021 – the goal of (re)eliminating community transmission began to move out of reach. This made pandemic decision-making more challenging, especially because there had been limited capacity to consider and plan for other options and scenarios (including how to move on from a zero-transmission target).
Good pandemic decision-making must be responsive to changing circumstances and take account of cumulative effects. In a future pandemic, it will be important for decision-makers to keep sight of the overall purpose of the response, while also having a degree of flexibility about how this is achieved.
Depending on the situation and context, the decisions necessary to look after all aspects of people’s lives may need to shift over the course of a pandemic response. For example, the kinds of actions taken in a situation where no vaccine is available will differ from those required in a situation in which nearly everyone is fully vaccinated. Good decision-making processes that can anticipate and accommodate a changing context, lead discussions with the public to keep them abreast of likely scenarios, and maintain focus on people’s economic, social and cultural interests become crucial in such situations.
Depending on the situation and context, the decisions necessary to look after all aspects of people’s lives may need to shift over the course of a pandemic response.
The role of a lessons-focused Inquiry such as ours is not to stipulate exactly what decisions should be made in a pandemic (either in the now-past COVID-19 pandemic, or in any future pandemics). Rather, our role is to identify factors and processes that will ensure strong options and robust analysis and advice are available to future decision-makers.
A critical tool in the pandemic decision-making toolkit is identifying and planning for a range of likely pandemic scenarios.-This can support good decision-making before a pandemic by helping governments prioritise investment to manage the most likely pandemic-related risks (discussed further in Lesson 6), and during a pandemic by helping decision-makers predict how the pandemic may evolve and plan for changes or transitions in the response. It can also be used to estimate the impact of different measures or policy responses at specific points in the pandemic, helping decision-makers evaluate different options and their likely benefits and harms.
Lesson 2.1 Maintain a focus on looking after all aspects of people’s lives in pandemic preparedness and response
Consider and plan for multiple time horizons simultaneously
At the start of any future pandemic, decision-makers will need to react to the immediate threat and do whatever is necessary to protect people from imminent harm. At the same time, however, they should ensure that planning for the longer term – including for the recovery phase – gets underway as soon as possible. Without this dual focus on both the immediate situation and the longer-term picture, there is a risk that the response remains in a reactive mode for too long, or fails to effectively identify, anticipate or mitigate wider impacts.
An effective pandemic response requires dedicated, future-focused planning to be carried out separately from (but in parallel with) the immediate operational response. Our ‘Looking Back’ analysis suggests that a separate strategic function responsible for keeping the evolving ‘big picture’ in mind as the COVID-19 pandemic evolved would have strengthened Aotearoa New Zealand’s response. This needs to be staffed by people with the right skills and attributes – preferably identified in advance.
An effective pandemic response required dedicated future focused planning to be carried out separately from (but in parallel with) the immediate operational response.
Both before and during a future pandemic, there may be value in mapping out the overall pathway the Government expects to follow in managing the response. Achieving the goals of the response is likely to involve several distinct phases, each with its own strategy and specific aims. Mapping the likely stages on this pathway ahead of time may help decision-makers to prepare to transition between response phases. Such mapping could also help to identify potential indicators or targets that might trigger a change in strategy (see Figure 2 for an indicative example for COVID-19), and help the public, stakeholders and experts to understand the overall direction of the response and prepare accordingly.
Of course, such mapping needs to be alive to the possibility that the anticipated trajectory of the pandemic may change – due (for instance) to changes in the pathogen, shifts in public compliance with control measures, or the early, late or unexpected arrival of a new tool to combat the virus. In Aotearoa New Zealand’s COVID-19 response, for example, the Government had to adapt its strategy when it became apparent that the Delta variant was unlikely to be eliminated. Continually adjusted scenario planning will help the strategic part of the response consider and plan for the medium- and long-term time horizon.
Figure 2: An indicative pathway through the pandemic response (based on COVID-19 experience)
Make more explicit use of ethical frameworks to balance different rights, values and impacts over time
In our view, Aotearoa New Zealand’s leaders generally did well at juggling the ethical complexities during the COVID-19 response. It was clear from our engagements and evidence that ministers and officials were aware when ethical principles were at play and took a thoughtful approach to considering and balancing them. However, it seems the use of ethical principles to inform decisions during the COVID-19 response was largely intuitive.
We think there is value in making more explicit use of ethical principles that can consistently and transparently guide decision-makers. These principles could be applied at all levels of the response – from the allocation of clinical resources to individual cases, through to Cabinet level decisions about prioritising vaccination rollouts, or balancing public health measures, such as lockdowns, against their wider impacts. While the same principles apply to both pandemic planning and pandemic response, the relative importance of each principle may shift. For instance, greater weight may be placed on protecting health and wellbeing in the early stages where there is less information about the virus.
It is generally much easier for people to accept difficult decisions when they understand (or even endorse) the principles and values that sit behind them and see how they have been used to arrive at a decision. As the World Health Organization (WHO) has commented, without such discussion response efforts could be hampered:
“A publicly-discussed ethical framework is essential to maintain public trust, promote compliance, and minimize social disruption and economic loss. As these questions are particularly difficult, and there will be insufficient time to address them effectively once a pandemic occurs, countries must discuss them now while there is still time for careful deliberations.”9
Several existing ethics frameworks have been specifically designed for this purpose. One of the most globally influential is promoted in the Oxford Handbook of Public Health Policy.10 Based on a Canadian model,vi the guiding values from this framework are intended to be useful in any jurisdiction. As this was published pre-COVID-19, and has a strong focus on healthcare settings, it is likely that it will soon be updated to reflect learnings from COVID-19, including the much wider range of impacts a pandemic can have. This approach distinguishes between substantive values (values that guide what decisions are made during a pandemic) and procedural values (values that guide how decisions are made during a pandemic).
Table 1: Values to guide ethical decision-making in a pandemic
| Substantive values (values that guide what decisions are made in a pandemic) | |
|---|---|
|
|
| Procedural values (values that guide how decisions are made during a pandemic) | |
|
|
Source: Based on Oxford Handbook of Public Health Policy, 2019 and University of Toronto Joint Centre for Bioethics, 2005, A report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group, https://jcb.utoronto.ca/wp-content/uploads/2021/03/stand_on_guard.pdf
In 2007, the National Ethics Advisory Committee had also published a set of ethical guidelines for epidemics and pandemics for use in Aotearoa New Zealand.11 After COVID-19, the National Ethics Advisory Committee began updating its pandemic guidance, holding extensive public consultations in 2022.12 There was strong support for a pandemic response that prioritised people’s health and wellbeing, and moderate support for efforts to protect the most vulnerable – including by providing greater support to those with greater needs (such as disabled people, older people and Māori). Submissions highlighted the public’s strong expectation that, in a pandemic, freedoms should be protected as much as possible, and the Government should justify the use of restrictive measures. Responses also emphasised the importance of transparent decision-making and clear communication about the principles and evidence used in making decisions.
The National Ethics Advisory Committee’s guiding principles for a pandemic (shown in Figure 3) are specific to Aotearoa New Zealand and offer localised and culturally relevant guidance. At the time this report was completed, an updated (post-consultation) version of the Committee’s pandemic guidance was due to be published (Figure 3 reflects this latest version).
Figure 3: National Ethics Advisory Committee’s updated guiding principles for an epidemic or pandemic
| Manaakitanga: implementing measures that are intentioned, respectful, and demonstrate caring for others. Establishing mutually beneficial communication and collaboration pathways. |
| Tika: implementing measures that are ‘right’ and ‘good’ for a particular situation, through being open and transparent. Cultivating trust between decision-makers and the people they impact. |
| Liberty: implementing measures that uphold human rights, including liberty and privacy. |
| Equity: implementing measures that eliminate or reduce unjust inequities in health outcomes for different groups of people and achieve Pae Ora for all. |
| Kotahitanga: implementing measures that strengthen social cohesion through empowering local government, leaders and communities to be active participants in the planning and response. |
| Promoting health and wellbeing: implementing measures that protect and uplift the four cornerstones of Te Whare Tapa Whā health model: whānau health, mental health, physical health and spiritual health. Healthy individuals and whānau turn into healthy communities and a healthy population. |
Source: Based on information from the National Ethics Advisory Committee (Ministry of Health), 2022, Ethical Guidance for a Pandemic (Draft report) https://neac.health.govt.nz/
Both the Oxford Handbook and the New Zealand frameworks set out core valuesand principles that can guide decision-makers towards a people-centred pandemic response. It is important that the principles and processes used by decision-makers during the crisis are visible to the public, both before the next pandemic for discussion and input, and during the next pandemic as a framework to progress decisions. It will be important for future governments to regularly engage with the public about what it is that they value, to ensure that decision-makers explicitly consider and communicate these trade-offs in an empathetic and accessible manner.
Lesson 2.2 Follow robust decision-making processes (to the extent possible during a pandemic)
An emergency response often requires decisions to be made quickly and with limited information or consultation. Normal decision-making processes may need to be modified, abbreviated or (in situations of extreme urgency) temporarily set aside to enable a rapid response. For example, in urgently deciding to introduce very tight border restrictions to prevent or exclude the arrival of a new pandemic agent, decision-makers may need to act without receiving comprehensive advice on alternative options or hearing from a broad range of stakeholders.
But there are risks to suspending these processes, and these risks increase over time. Without comprehensive advice and consideration of diverse perspectives, decision-makers may become overly focused on a particular set of objectives.
They may also be less aware of changing public concerns and expectations, or the unanticipated consequences of the decisions they make. This narrowing in focus and awareness is often referred to as ‘group think’ – a situation in which alternative options or important evidence may be overlooked.
Whenever possible more comprehensive consultation, advice and discussion should be brought to bear in decision-making.
A key lesson from the COVID-19 response is therefore the importance of following robust decision-making processes and actively encouraging the expression of diverse points of view, to the extent that circumstances and time allow. When decisions must be made quickly, the range of processes and tools will be limited to those that can be employed by a small group of decision-makers and advisors. Whenever possible, however, more comprehensive consultation, advice and discussion should be brought to bear. What this looks like will depend on the urgency of the situation and is likely to require a degree of pragmatism. But decision-makers must be aware there may be a trade-off between speed and robustness. More comprehensive consultation and advice takes time, but also protects against the risks of poor decision-making, group think and loss of social licence.
While they may sometimes feel slow, the decision-making processes normally followed within Government – including the time needed for comprehensive consultation and the development of advice – are designed to support good decisions. They should be truncated during a crisis only to the extent necessary, and resumed as early and fully as possible to ensure decision-makers have the best advice to inform their decisions.
Seek out a range of advice and perspectives
While the breadth of input will be determined by the time available, Governments should still seek out advice and perspectives on what is happening, what might happen and how they might adjust their approach to meet changing pandemic circumstances. It is important to create a culture where both advisors and decision-makers feel empowered to contest the advice and present different views on how to achieve the best outcomes.
In both preparing for and responding to a future pandemic, decision-makers (and their advisers) should therefore actively seek out:
- Advice from different public sector agencies, including local government, on policy options for dealing with a range of plausible scenarios.
- Data and intelligence (including emerging scientific evidence, modelling, qualitative and quantitative data, and international experience and insights).
- Wide-ranging expertise from many disciplines and sectors – biomedicine, science, economics, behavioural and social sciences, Te Ao Māori, businesses, human rights organisations and more.
- Input from stakeholders and key partners, including iwi and Māori and other community groups who play key roles in designing, operationalising and delivering the response.
- Public opinion data which tracks people’s attitudes to the pandemic and response and indicates how they may respond to future decisions.
Make use of times when the situation is stable to look ahead and plan for what might come next
In the early stages of a pandemic response, when little is known about the pandemic pathogen, a precautionary and risk-averse approach is likely to be the most appropriate. But once the immediate threat has been addressed, and as more information becomes available, decision-makers may find some breathing space where they can consider if the initial approach is still appropriate – and what might come next.
Such a breathing space was available to New Zealand decision-makers in mid-2020, when the combined effect of national lockdowns, border restrictions, quarantine requirements and other public health measures eliminated COVID-19 transmission in the community for 100 days. This was a significant opportunity to regroup, take stock and look ahead – but (as set out in Chapter 2) it may not have been used to full effect.
While it is important to keep the possibility of changing scenarios in mind all the time, in a future pandemic, decision-makers should be alert to opportunities presented by periods of relative stability and ensure they are used well. At these times, decision-makers have more opportunity to take in the ‘big picture’, and review the medium- to long-term strategy to check that the response is still on track to achieve its overall goals.
Anticipate and plan for burnout
Throughout our Inquiry, we were constantly reminded of the extraordinary effort and commitment of leaders, officials and others who – under great pressure – set up the initial response to COVID-19 and enabled the success of the elimination strategy. However, they paid a heavy price. As we saw in Chapter 2, the pressure was relentless, the situation was constantly changing, and people were working for long stretches in unfamiliar and sometimes difficult environments. Burnout was common.
Decision-makers should be alert to opportunities presented by periods of relative stability and ensure they are used well.
It is difficult for decision-makers to remain adaptable and innovative – and to juggle managing the day-to-day pandemic response with planning for the next phase – when they are exhausted. Based on our findings, this was one reason why leaders struggled to develop and communicate a forward-looking plan for moving on from the elimination phase, despite the breathing space that opened up in mid-2020 when Aotearoa New Zealand was COVID-19-free.
The next pandemic response is likely to be no less challenging and the demands on decision-makers will be similarly unrelenting. For this reason, it is vital to embed workforce resilience and sustainability, and plan workforce capacity ahead of time.
Lesson 2.3 Use appropriate tools when developing and considering policy response options
The COVID-19 pandemic presented complex and dynamic problems, and the possible policy responses were numerous. For decision-makers in Aotearoa New Zealand and elsewhere, coming up with bespoke policy options under pressure, and then understanding and comparing the costs, benefits and trade-offs between these options was a constant challenge. Much can be done now to ensure this process is easier in the next pandemic.
Identify a wide range of possible policy response options
Having just experienced the COVID-19 pandemic, we expect many agencies will be better prepared with a set of potential response options ahead of a future pandemic. It is important not to be complacent about this, and to ensure that the lessons learned and future policy options developed in response to COVID-19 are well-documented and regularly reviewed and updated. Preparing options for a future pandemic should be part of the ongoing work of all government agencies, including:
- identifying potential policy and response options (for example, are contact tracing, isolation and mask wearing sufficient to eliminate transmission or do we need to impose lockdowns?)
- anticipating design and implementation considerations (for example, how should geographical boundaries be determined and implemented if regional lockdowns are used?)
- considering the potential flow-on implications for other systems (for example, what implications will border restrictions have for New Zealanders overseas, the labour market and supply chains?)
- estimating the potential impacts on people (for example, what are the health benefits of lockdowns versus the impacts on other aspects of people’s lives – employment, relationships, education, mental health?), and
- identifying potential vulnerabilities and gaps that should also be addressed (for example, how will supply chains for essential medicines and products be maintained in the context of dramatically limited global transportation?).
This work should draw from a range of policy tools and frameworks, including human rights frameworks and te Tiriti o Waitangi. It is important to prepare options with reference to multiple potential pandemic scenarios (considering factors related to the pathogen, as well as economic and social factors), to test how they may perform under different circumstances.
Compare the impacts of different policy response options to make good decisions
With a clear and comprehensive list of options available, it is important to then consider the relative impacts of each option against the goals sought – just like any other business case. Two common tools for systematically weighing up the costs and benefits of different options are:
- Cost Benefit Analysis (CBA) which offers a structured approach to evaluate the economic pros and cons of various options. By quantifying benefits and costs, it supports informed decisions to achieve agreed objectives.
- Multi-Criteria Analysis (MCA) which can accommodate a wider range of criteria, making it suitable for complex decisions involving diverse factors. This method can help to make trade-offs between the different visible outcomes and support options being explicitly assessed against ethical principles.
These tools – and others – can support decision-makers to select optimal combinations of policies by weighing the financial investment in a policy against its likely success at reducing harmful impacts of the pandemic, while also considering the risk of new or ‘unintended’ consequences of the policy itself. Such tools require good data inputs and integrated epidemiological, social and economic modelling alongside expert analysis and advice on qualitative aspects like the impact on people’s freedom and human rights, or likely outcomes for specific groups.
Spotlight: Making complex decisions in a pandemic | Te whakatau tikanga matatini i tētahi mate urutā
While more than 80 percent of people in Aotearoa New Zealand had received two doses of the COVID-19 vaccine by November 2021, it was known that protection from vaccination generally waned over time.
Cabinet was therefore asked to consider rolling out COVID-19 booster doses alongside the continuing drive to get more people to have the initial course. Since the pandemic began, the Government had been clear that maximising vaccine uptake was essential to allow the country to move on from repeated lockdowns and stringent public health measures.
Ministers had to weigh up multiple factors – including the cost of administering additional doses, evidence of booster effectiveness, whether requiring the vaccination programme to roll out booster doses might detract from its efforts to maximise overall vaccination coverage, and the possibility that new COVID-19 variants might emerge just as the country was beginning to open up. Ministers were also conscious that Māori and Pacific people had lower vaccination coverage and were at higher risk of severe COVID-19 disease compared with other groups.
Cabinet received advice from the Ministry of Health, the Treasury, and the Ministry of Foreign Affairs and Trade on the complex factors they needed to weigh up. The advice included explicit consideration of vaccine supply issues and of the implications for Māori, children and young people and older people if boosters were rolled out.
Cabinet ultimately decided to proceed with a targeted booster rollout which prioritised those at highest risk of exposure and illness (including health workers, everyone aged 65 years or over, Māori and Pacific people aged 50 years or over, and people especially at risk from the virus due to other health conditions). It began in late November 2021. The booster rollout accelerated in the new year as Omicron got closer, with the required time to wait between having the second dose and the booster reducing to five months, and then four months, and becoming available to a wider age range. This successful booster rollout ensured those groups most vulnerable to the virus had high levels of protection when the country’s first substantive COVID-19 ‘wave’ arrived in March 2022. This probably saved hundreds of lives and reduced pressure on the health system.
This example illustrates many of the elements of good decision-making we consider essential in the next pandemic response:
- Leaders remained committed to the objective of maximising vaccine-related protection while adapting how this was achieved as the situation changed.
- With support from advisors, they reviewed evolving evidence (on levels of primary vaccination, the duration of protection and groups at greater risk from COVID-19 infection) and weighed up potentially competing objectives (maximising overall population coverage, compared with optimising protection for the most vulnerable).
- While the extent of broader consultation is unclear, as is the use of tools such as cost-benefit analysis, input was sought from several government agencies and explicit attention was paid to the needs of particular groups.
- Finally, the decision to proceed with the booster programme, and the reasons for it, were communicated to the public clearly and transparently.
Use modelling and scenarios to inform decision-making
While modelling is a useful input, it is not a panacea for selecting optimal policy responses.
Modelling and scenario thinking can be particularly useful tools to support good decision-making in a pandemic response. Indeed, they will likely be essential to underpin the tasks set out in this lesson. Modelling can be used to indicate how key indicators (such as rates of infection or hospitalisations) are likely to evolve in response to specific interventions or policy options, helping decision-makers evaluate different options and weigh up the trade-offs involved. The World Bank, OECD and WHO have all recently emphasised the importance of modelling that integrates epidemiology, health and economic domains as part of future pandemic preparedness.13
Modelling was a useful input in many key decisions during Aotearoa New Zealand’s COVID-19 response. Modelled projections of COVID-19’s health impacts under different approaches were a key catalyst for the initial decision to ‘close the border’ and place the country in lockdown, while later decisions about moving up and down alert levels were also informed by modelling. The Inquiry heard that modelling evidence was particularly helpful when it combined projected impacts across multiple domains (for example, economic as well as health indicators). The potential uses of modelling are also expanding rapidly as technology advances, making it faster and easier to test sensitivity to different inputs.
While modelling is a useful input, it is not a panacea for selecting optimal policy responses. Models rely on assumptions about the impact of particular measures and can only give an approximation or estimate of what may happen if they are implemented. Moreover – and especially in the context of a pandemic – the sheer complexity of many policy options and their associated trade-offs cannot be captured in a single quantitative framework. It is therefore important that modelling is treated as a guide and considered alongside other inputs, including the views of key partners, stakeholders, experts and the wider public.
Spotlight example: Responding to changes in risk and vaccine-related protection | Te urupare ki ngā huringa o te mōrea me te ārai ā-rongoā āraimate
A key consideration in any pandemic response is the availability and impact of vaccines.
Based on experience with COVID-19, vaccination rates are likely to be an important consideration in decisions about if and when to use and/or relax strict measures such as lockdowns. But it will be critical to monitor emerging scientific evidence on the effectiveness of vaccination, especially if the pandemic pathogen mutates frequently and/or protection from vaccination wanes over time (as was the case with COVID-19 on both counts).
In situations where the protection from vaccination does wane over time, it is not vaccine coverage that should be the ‘target’ for when to loosen public health measures, but the estimated immunity in the population (see Appendix D). As such evidence on waning emerges, it should be factored into any modelling alongside other variables as soon as possible.
Time lags also matter for decisions about when to introduce or stand down public health restrictions. Experience during COVID-19 in a range of jurisdictions is that it can take several weeks – if not months – for a new epidemic wave to gain momentum after restrictions are relaxed.
While information about vaccination levels often informed decisions about when to end stringent COVID-19 public health measures, different jurisdictions used this information in different ways. In Australia, for example, the states of New South Wales (NSW) and Victoria both moved out of lockdowns when their populations reached 70 percent vaccination coverage on 11 and 22 October 2022, respectively14 – about six weeks before the Auckland Delta lockdown ended. Daily case numbers for Victoria and NSW are shown in Figure 4, and demonstrate that case numbers did not surge following the lifting of restrictions.
Figure 4: Daily cases of Delta in New South Wales and Victoria, and end dates of their lockdowns
Source: Based on data from COVID LIVE Australia, 2024, COVID LIVE, https://covidlive.com.au/
Deciding when to relax public health restrictions is a delicate balancing act. The experiences in New South Wales and Victoria suggest it is possible to remove lockdown restrictions before completing a vaccination rollout without this leading to an immediate resurgence of cases. While there is some risk involved with lifting lockdowns at lower levels of vaccine coverage, relying on a lag in case rate resurgence to ‘bridge over’ to higher vaccination coverages is something that could be considered in a future pandemic response. Appendix D provides further analysis of how consideration of such factors could provide evidence to support decisions about lifting stringent public health measures in future.
Lesson 2.4: Be responsive to concerns, clear about intentions and transparent about trade-offs
While an effective pandemic response requires strong leadership, it also requires a high degree of confidence and trust in public institutions and decision-makers from the general public, Māori, communities of all kinds, businesses, and key partners and stakeholders the Government works with. Decision-makers are more likely to retain this kind of confidence and trust when the reasoning behind their decisions is transparent and clearly communicated, when their decisions are open to scrutiny and debate, and when they demonstrate willingness to revisit and (if necessary) modify decisions as circumstances change. It is important for people to see leaders being responsive to their needs, concerns and recognising the impact of decisions on people’s health, social, economic and cultural interests.
Engage stakeholders, partners and the public in key decisions, to the extent possible in the circumstances
As COVID-19 demonstrated, opportunities for direct discussion are often limited during a pandemic for logistical reasons. This makes it more difficult and time-consuming for government to undertake meaningful engagement with stakeholders, partners and the public. While urgent pandemic decisions can (and often should) be made quickly without broad consultation or engagement, in the longer-term this approach can create the impression that decision-makers are unaware of – or unresponsive to – people’s concerns. It also increases the risk that decision-makers and advisers may misread public sentiment, underestimate the strength of feeling around particular issues, or lapse into ‘group think’.
Taking time to engage the public, Māori, communities, businesses and key partners ensures decision-makers are aware of important concerns and receptive to suggestions about how they might be addressed. It also helps build trust in government and can support better public understanding of the need for decision-makers to balance potentially competing objectives or values. This is likely to be particularly important in a pandemic, when the needs and priorities of different groups must sometimes be explicitly weighed against each another.
Meaningful engagement is more likely to occur when the Government has already built relationships and processes for dialogue. Decision-makers and advisors should draw on these established connections as much as possible to support decision-making in a pandemic. Lesson 5 explores wider lessons about working together with Māori, communities and business to achieve shared goals.
Aotearoa New Zealand’s COVID-19 experience showed that when decisions need to be made quickly, pre-existing approaches to engagement might not be suitable. In such instances, it may be necessary to develop more rapid and pragmatic forms of engagement such as the creation of advisory panels (including representatives from relevant groups). In periods of greater stability, more comprehensive forms of engagement should be undertaken ahead of major decisions, such as changes in public health strategy and longer-term recovery options.
In our engagements with groups who felt alienated by the Government’s response, or who had major concerns with some of the approaches taken during COVID-19, we encountered a wide range of views and some common themes. Some of the points raised with us seemed reasonable (such as calls for greater consideration of and engagement with New Zealanders finding it difficult to return home). In future situations, there could be opportunities to avoid or mitigate some of these concerns.
More direct government engagement with groups voicing disquiet at aspects of the response would be valuable during a future pandemic. Perspectives should be listened to openly as this can help with weighing up the benefits and harms of policy options.
In our view, some more direct government engagement with groups voicing disquiet at aspects of the response would be valuable during a future pandemic. Perspectives should be listened to openly as this can help with weighing up the benefits and harms of policy options. Even when agreement cannot be reached about the preferred overall policy response, such engagement can give people confidence that their point of view or opposing position has at least been listened to, and that their concerns are being considered when weighing up trade-offs as part of the decision-making process. This can in turn reinforce and support social cohesion to some degree. However, such engagements should be carefully considered on a case-by-case basis – we are not advocating that busy leaders should meet with groups that have no real interest in being constructive.
In other jurisdictions, innovative approaches such as citizens’ juries and other deliberative formats are being used to engage members of the public on complex policy issues. Ireland, for example, uses Citizens’ Assemblies to help the government address important challenges. Approaches like these can allow decision-makers to take account of public views and values when assessing options and considering trade-offs.15 However, they take considerable time (including for preparing and selecting participants) and for this reason are unlikely to be feasible during the emergency phase of a pandemic response. As part of the Government’s preparation for a pandemic, such approaches could offer useful insights into how the public want their leaders to make decisions in an emergency.
Be transparent about how different considerations have been weighed against one another
During the COVID-19 response, governments around the world had to repeatedly weigh up different objectives and values, and then judge how best to balance them. This was especially important when making decisions that placed constraints on people’s human rights (such as restricting the return of citizens from overseas, limiting domestic movement, and using vaccine mandates). In Aotearoa New Zealand – as in other countries16 – the judgements underpinning these decisions were not always made public (or done so explicitly and with clarity). This meant people did not always understand why particular decisions were made, or how introducing or removing measures might affect the risks facing specific groups.
COVID-19 showed us that governments need to be willing to share information with the public, however difficult or uncomfortable, in order to retain their trust in government, public institutions and the response.
Decision-makers often had good reasons for not wanting to advertise how they were choosing to balance different priorities in the COVID-19 response. For example, the decision to protect Pacific communities and Māori – who were at greater risk from the Delta variant – was a key factor in the decision to maintain the Auckland lockdown in late 2021; however, leaders were reluctant to make this reasoning public in case of a public backlash against these communities. But deciding not to share the reasons behind such decisions came at a cost. Over time, some people lost trust in the Government or felt it didn’t care about the harm caused by restrictive public health and social measures. Others started to feel the Government was withholding information from them or making decisions based on a hidden agenda.
COVID-19 showed us that governments need to be willing to share information with the public, however difficult or uncomfortable, in order to retain their trust in government, public institutions and the response. This means being upfront with people about the level of risk different groups may face, and why this may influence certain trade-offs. It also means acknowledging that decisions may change or be reversed as the situation evolves and relevant trade-offs are revisited. In the longer term, it is essential for maintaining social licence as the response, and the process of balancing objectives and risks, continues to evolve.
Clearly signal in advance where the response is heading, to help people navigate periods of uncertainty and transition
Experience with COVID-19 – in Aotearoa New Zealand and elsewhere – shows how challenging it is for leaders to retain public confidence through difficult transitions in the pandemic response. While such transitions and changes of direction due to new events – such as a new variant – cannot be avoided, it is easier to retain people’s confidence when they have had prior warning and understand why they are necessary. Failure to do so risks undermining people’s confidence in government in the longer term.
It is important that, at regular intervals, leaders describe their long-term response plans and the steps they anticipate as the country moves towards a new post-pandemic ‘normal’. This involves being honest about the challenges to be navigated in likely future phases of the response (such as learning to live with the virus), and proactively outlining new scenarios that might arise. While noting their intention to carefully plan and manage the transition between these phases, leaders should be clear that the exact timing will depend on many factors and will therefore require a degree of flexibility.
Communicating changes in direction during a pandemic response can be difficult. This is especially true if they involve reintroducing restrictive measures such as lockdowns, or accepting risks that were previously presented as unacceptable. But despite the communication challenges, it is important that leaders move quickly to change direction when circumstances require it. Being transparent about the rationale for a change will help people accept and support it, as will explaining that – even though some may experience temporary hardship or inconvenience as a result – the decision will ultimately support the overall goal of the response: looking after all aspects of people’s lives as much as possible.
Lesson 3: Build resilience in the health system | Akoranga 3: Te whakatipu kia tū pakari te pūnaha hauora
In brief: What we learned for the future about building resilience in the health system
In preparing for and responding to the next pandemic:
- Lesson 3.1 Build public health capacity to increase the range of options available to decision-makers in a pandemic. In practice, this means:
- 3.1.1 Make scaling-up effective testing and contact tracing part of core public health capability
- 3.1.2 Plan for a flexible range of quarantine and isolation options
- 3.1.3 Be ready to quickly implement infection prevention and control measures
- Lesson 3.2 Enhance the health system’s capacity to respond to a pandemic without compromising access to health services. In practice, this means:
- 3.2.1 Build the capability of the healthcare workforce
- 3.2.2 Strengthen intelligence, monitoring and coordination of healthcare to enable adaptability
- 3.2.3 Improve health system infrastructure
- 3.2.4 Strengthen resilience in primary healthcare
Overview
Before COVID-19, Aotearoa New Zealand’s public health system was assessed as moderately well-prepared for a pandemic. With the arrival of the virus, however, it became clear that greater public health capacity was needed. Thanks to impressive effort and innovation, key tools such as contact tracing and testing were quickly scaled-up. But capacity limits remained a challenge, and systems for large-scale isolation and quarantine had to be developed from scratch.
Aotearoa New Zealand’s health system was never overwhelmed by COVID-19, thanks to the success of the elimination strategy (and a degree of good luck). However, the pandemic highlighted and exacerbated the health system’s underlying fragility, with long-standing capacity constraints affecting core areas, including workforce, physical infrastructure, supply chains. These long-standing and underlying issues should be addressed before the next pandemic, as much as it is possible to do so.
A key aspect of pandemic preparation is to build resilience into Aotearoa New Zealand’s health system. The OECD describes resilience as:
“the ability of systems to prepare for, absorb, recover from, and adapt to major shocks. It is not simply about minimising risk and avoiding shocks: resilience is also about recognising that shocks will happen.”17
Having better public health capacity will enable a rapid initial response to any future pandemic, increasing the likelihood that the pandemic virus (or other infectious agent) can be excluded or eliminated before it becomes established. The ability to rapidly scale-up key public health functions such as contact tracing will also give decision-makers more options, potentially reducing the need to use blunt measures like lockdowns.
A resilient health system is one equipped with a strong workforce, secure supply chains (including for medicines and medical equipment) and good infection prevention and control processes (which require well-maintained stocks of PPE and excellent ventilation systems). Having these resources in place before a pandemic arrives will better enable the health system to continue meeting other health needs during a pandemic response, ensuring support for all aspects of people’s health.
Lesson 3.1: Build public health capacity to increase the range of options available to decision-makers in a pandemic
COVID-19 demonstrated the importance of core public health functions such as testing and contact tracing, isolation and quarantine, and infection prevention and control measures. These will provide the first line of defence in the next pandemic, preventing or slowing transmission of the virus and protecting people from serious illness and death.
Importantly, the greater the capacity to deliver these tools and functions (especially at the start of a pandemic), the more options decision-makers will have at their disposal. For example, if testing and tracing systems are ready to be rapidly scaled-up when the first cases of a new pandemic disease are detected, it may be possible to eliminate chains of transmission without the need for national lockdowns. Higher uptake of infection control measures (such as masks) in public spaces may also reduce the need to restrict people’s movement.
The public health response to a pandemic is interconnected with its economic and social impacts. Building public health capacity in key areas can create options for mitigating the health impacts of a pandemic without having to resort to more stringent measures that have high economic and social costs. For example, Taiwan was able to eliminate COVID-19 transmission in 2020 without using lockdowns, due to its well-developed testing and contact-tracing capacity and very high levels of mask wearing in its population.
Of course, even the best-prepared country may need to resort to lockdowns in a future pandemic, and we cannot rule out their use in Aotearoa New Zealand again. However, our analysis of the response to COVID-19 has shown that the need to use more stringent measures such as lockdowns may be reduced by building the capacity and resilience of core public health services and tools.
Make scaling-up effective testing and contact tracing part of core public health capability
Testing and contact tracing are core functions that form part of the day-to-day toolkit used by public health services in Aotearoa New Zealand. In a pandemic response to a pathogen that is amenable to contact tracing, these functions will need to be rapidly expanded to detect and contain new chains of transmission across the population.
For these capabilities to be ‘kept warm’ in case of a future pandemic, planning and investment is needed so they can be rapidly and effectively scaled-up when needed. This includes:
- Investing in the public health workforce, including training and capacity building for the specific skill of contact tracing.
Contact tracing requires a skilled workforce, experience in interacting with members of the public to obtain potentially sensitive information and familiarity with digital record-keeping platforms. COVID-19 showed how contact-tracing capacity can be quickly expanded via recruitment and short-course training of non-public health personnel – but provision of training, oversight and quality control all rely on existing expertise, especially for the core team that will train others. - Enabling public health services to develop and maintain relationships with local communities.
Contact tracing is most effective where public health workers have good relationships with the communities they serve. People can be reluctant to discuss where they have been, and who they have been with, particularly in stressful circumstances such as having been exposed to a virus. Navigating this requires skill on the part of the contact tracers, and trust on the part of those they are speaking with. COVID-19 demonstrated the importance of effective relationships between public health services and the communities they serve – including different ethnic minorities, faith groups, business leaders and Māori. - Maintaining digital platforms, information systems and supporting capability.
The development of effective digital platforms to support contact tracing was one of the successes of the COVID-19 response. It will be important to maintain and strengthen this capacity so that health information can be safely coordinated and shared, both in the context of normal public health activities as well as in a pandemic. Investing in digital and data capacity is a key form of insurance in case of future public health crises. - Establishing mechanisms to facilitate rapid scaling-up of testing capacity.
Testing is an essential complement to contact tracing. It enables people who are infected to be isolated – preventing further spread – and allowing those without infection to go about their daily lives. COVID-19 showed the importance of being able to rapidly scale-up testing capacity but also the difficulties encountered when access to testing is limited. With most of the country’s testing capacity located in private laboratories, it will be important for government to consider how to ensure it has access to additional testing when needed.
Plan for a flexible range of quarantine and isolation options
Border restrictions and quarantine, lockdowns (national and regional) and home isolation were core parts of Aotearoa New Zealand’s response to COVID-19. However, a more flexible range of quarantine and isolation options could give decision-makers more choices for using these measures effectively, while minimising negative impacts – for example, when someone with a right to enter the country struggles to do so because of a shortage of quarantine capacity. Flexible options could include allowing low-risk travellers the possibility of isolating at home, if feasible.
While officials and agencies learned a lot during COVID-19 about how to make hotels work as quarantine facilities, they were not ideal sites for infection control or isolation of community cases. Memoranda of understanding and other arrangements are required to ensure ventilation is of high quality and that facilities can easily be reconfigured to keep cohorts and people separate in hotel facilities. Other options – ranging from a blend of facilities and home-based quarantine, to bespoke facilities and more hospital-level care facilities – should be investigated ahead of the next pandemic so that decision-makers have a flexible range of quarantine and isolation approaches to consider, depending on the nature of the pandemic.
Be ready to quickly implement infection prevention and control measures
Infection control measures such as the use of PPE, masks and physical distancing were often highly effective in responding to COVID-19. However, Aotearoa New Zealand’s ability to use these measures quickly and to good effect was constrained by shortcomings in procurement and distribution systems, infrastructure and information and advisory systems.
These problems were not confined to this country. Globally, the COVID-19 pandemic created both a supply and demand shock for key equipment and materials essential to the response. It created urgent, worldwide demand for things like PPE, tests, medical devices and vaccines, but at the same time, disrupted the national and international supply chains and workforces that provided those goods and services.
As the next pandemic may well be very different from COVID-19, different infection prevention and control measures may be needed. However, some key equipment is always likely to be required – such as PPE – whatever the next pandemic’s characteristics. Ideally, Aotearoa New Zealand would secure, distribute and manage (for example, by rotating) sufficient stocks of such equipment ahead of time so it is ready to use as soon as required.
The need for other equipment and tools such as bespoke tests and specific vaccines cannot be determined in advance as that will be dictated by the specific pathogen. Therefore, ensuring Aotearoa New Zealand has access to what it needs will depend on having established networks of advice and expertise, strong international relationships and good procurement processes in place.
Lesson 3.2: Enhance the health system’s capacity to respond to a pandemic without compromising access to health services
COVID-19 revealed the intense pressure a pandemic can exert on the health system and its resources. It also demonstrated the importance of maintaining non-pandemic health services while simultaneously responding to both the immediate and long-term effects of a virus or other pathogen. Aotearoa New Zealand needs its health and disability system to be sufficiently resilient to meet both of these competing demands.
Building resilience ahead of a pandemic will ensure that, during the response, decision-makers can be more confident in the ability of the health system to cope with the demands placed on it. This gives them more response options, including adopting a different risk tolerance when it comes to using public health measures such as lockdowns and gathering limits. It will also probably provide substantial benefits for non-pandemic health services. What this might mean in practice is addressed further in our recommendations.
Priority areas that should be addressed are:
- Building the capability and flexibility of the workforce so health workers can be more readily redeployed in a pandemic while other health services are kept going.
- Strengthening the systems that allow for services to be prioritised if necessary. This includes the data, intelligence and monitoring systems that enable decision-makers to understand what capacity is available, and the governance and coordination mechanisms needed to make decisions and ensure capacity is utilised as effectively as possible.
- Improving infrastructure so that the health system can continue safely caring for patients during a pandemic (for example, by improving building ventilation and ensuring capacity to separate potentially infectious from non-infectious patients) and can surge additional capacity where needed (for example, by repurposing facilities for pandemic-specific services or by increasing capacity to care for patients needing ventilation).
- Strengthening resilience in primary health care (that is, general practice and community-based care). Discussion of health system capacity often focuses on specialist services such as intensive care and surgery, but primary health care – while less easily measured – is the foundation of the system and the first line of delivery. During the COVID-19 response, primary care was essential in both the vaccine rollout and dispensing antivirals during the Omicron waves, which likely saved many lives. Strengthening the primary health care workforce, data and intelligence systems and other infrastructure, including building design and ventilation, will enhance Aotearoa New Zealand’s ability to respond well to a future pandemic.
Lesson 4: Build resilience in economic and social systems | Akoranga 4: Te whakakaha i te pakaritanga o ngā pūnaha ōhanga me te pāpori
In brief: What we learned for the future about building resilience in the economic and social systems
In preparing for and responding to the next pandemic:
- Lesson 4.1 Foster strong economic foundations. In practice, this means:
- 4.1.1 Continue to build strong relationships between economic agencies
- 4.1.2 Prepare better for economic shocks
- 4.1.3 Strengthen fiscal reserves and maintain fiscal discipline
- Lesson 4.2 Use economic and social support measures to keep ‘normal’ life going as much as possible. In practice, this means:
- 4.2.1 Deploy economic and social measures to support key health measures
- 4.2.2 Design key tools in advance to save time and resources
- 4.2.3 Build on the improvements to social sector contracting and partnership
- 4.2.4 Maintain well-functioning labour markets, including by providing financial support to workers
- Lesson 4.3 Ensure continuous supply of key goods and services. In practice, this means:
- 4.3.1 Build greater resilience into supply chains
- 4.3.2 Maintain food security for a future pandemic
- 4.3.3 Maintain access to government and community services throughout a pandemic
- 4.3.4 Allow the ‘essential’ category to change over time
Overview
The COVID-19 pandemic and associated policy measures impacted all sectors and parts of society, over a prolonged period. This created demands beyond what could be managed via ‘business as usual’. Thanks to extraordinary effort, innovation and investment – and the success of the elimination strategy – Aotearoa New Zealand did not face the kinds of crises experienced in many other countries. But while the country avoided such predicaments as fuel shortages or running out of essential equipment, the stark risks posed by a pandemic (or other emergency that exceeds the limits of essential systems and infrastructure) were very much apparent.
There were also some positive lessons. Overall, Aotearoa New Zealand’s pandemic experience underscored the importance of strong economic and social institutions that have built up reserves and capacity during ‘normal’ times. This gives decision-makers much better options for responding to a crisis. Because Aotearoa New Zealand went into the COVID-19 pandemic in a relatively strong economic position built up over a number of years, the Government was able to provide swift and generous supports that helped with the success of the elimination strategy and protected many people from the pandemic’s worst impacts. Among other things, the Government funded vaccines, provided generous wage and business support subsidies, arranged short-term accommodation support for people who had been homeless or in unstable housing, and ensured air freight capacity was maintained so that time-sensitive and essential goods could still arrive in the country. Where capacity and infrastructure were already in place, it was easier to manage pandemic risk while minimising disruption to essential activities. The reasonably good availability of internet access across most of the country, for example, made it possible for many people to shift to online learning and working.
A resilient economy and social support systems are important to reduce disruptions to normal life as much as possible, during and after a pandemic.
The interconnected nature of people’s economic, social, physical and mental health means resilience in any one area will have benefits in others. A prepared and resilient education system, for example, that enables children and young people to continue to attend school in person as much as possible, will be protective of their mental health and social development. Avoiding or minimising the use of lockdowns will reduce people’s exposure to stress, loneliness and – for some – violence. Ideally, in a future pandemic, better overall preparation will mean decision-makers have more options that reduce the need for more restrictive measures such as lockdowns and school closures.
A resilient economy and social support systems are important to reduce disruptions to ‘normal’ life as much as possible, during and after a pandemic. These sectors provide essential scaffolding of daily life that becomes even more critical – and comes under greater pressure – in times of crisis. Building resilience into this scaffolding is a key part of future pandemic preparedness. While some degree of disruption and adverse impact is inevitable in a large-scale crisis, this can be lessened if core systems and infrastructure are more robust. This can also act as insurance against other types of shocks and stressors.
Lesson 4.1: Foster strong economic foundations
Ensuring the economy is sufficiently resilient to handle major shocks is critical for looking after people through a pandemic. Strong economic foundations and institutions will enable a greater range of options to respond to a future pandemic and reduce the risks of pandemics causing other crises – in the financial sector, for example.
Continue to build strong relationships between economic agencies
The COVID-19 response benefited from the prior existence of strong working relationships between the main economic agencies. These agencies responded promptly and effectively as developments unfolded although – like their overseas counterparts – they were clearly not prepared for the economic implications of an all-of-society crisis on the scale of a global pandemic.
While respecting the Reserve Bank’s independence in the operation of monetary policy and the Treasury’s ability to provide ministers with fiscal and economic advice in reasonable confidence, the two agencies have developed useful forms of collaboration over many years which serve them well in normal times and up to a point proved valuable during the pandemic. We suggest building and strengthening these key relationships, as well as those with other agencies as appropriate, such as the Ministry of Business, Innovation and Employment, Inland Revenue, the Ministry of Transport and the Financial Markets Authority. Good and well-directed engagement can ensure access to a wider range of data, insights and skills when they are most needed.
Having these agencies work collaboratively on preparing possible economic response options based on different pandemic scenarios would be valuable. This would pick up on and capture accumulated experience gained through past crises (such as the Global Financial Crisis, earthquakes, floods and now COVID-19). As such experiences are documented and developed, they help to build ‘muscle memory’ for effective response design in the future.
Prepare better for economic shocks
Determining the appropriate initial macroeconomic response to a pandemic is extremely challenging. As the COVID-19 experience demonstrated, it is not safe to assume that the economic shock from a pandemic primarily works through demand. The economic shock associated with the advent of COVID-19 has emphasised the importance of developing greater understanding of supply shocks and how to respond to them. In this and other areas, Aotearoa New Zealand is not alone. Both the Reserve Bank and the Treasury have built up their relationships with international counterparts and institutions. Continuing to share information and experience on these matters should help us to understand better how to respond.
On the demand side, judging the mix, size and duration of any expansionary policies is an extraordinarily sensitive matter – undershooting can result in lasting damage to people’s and business wellbeing, while overshooting can lead to a long tail of economic aftereffects, including cost of living and inflationary pressures and expanding national debt. Complicating this is the fact that demand is influenced by both the Government (acting on advice from the Treasury) and the Reserve Bank (operating monetary policy independently). Developing a shared understanding or ‘playbook’ between the two agencies of when and how different fiscal and monetary interventions might best be deployed in a pandemic (or similar crisis) would enable them to collaborate effectively while safeguarding their separate roles and accountability. We understand that the two agencies have already embarked on this process and we are confident that this will not compromise either Reserve Bank independence or the Treasury’s ability to provide advice confidentially to government when this is needed (for example, during a Budget process).
Strengthen fiscal reserves and maintain fiscal discipline
Because Aotearoa New Zealand went into the COVID-19 pandemic with low levels of public debt (by international standards) and a strong national credit rating, decision-makers had options to finance a range of health, social and economic measures. Providing a fiscal buffer is one of the intended benefits of running responsible fiscal policies over time, and its use in a pandemic is entirely appropriate, but building fiscal resilience in preparing for future pandemics goes beyond simply building a buffer. Prudent levels of net debt need to be backed up by a strong balance sheet, a sound financial sector and economic settings that encourage productivity and efficient investment – including in research, science and infrastructure that produces positive social returns.
The fiscal reserves that provided important support during COVID-19 now need to be restored. This should be achievable at a sensible pace that does not drive the economy into negative territory.
Some experts we spoke to commented on the current strength of Aotearoa New Zealand’s fiscal responsibility institutions. We heard that a range of proposals for strengthening these have been discussed in policy circles for some time. These matters go beyond our terms of reference, except to suggest that if consideration is given to these proposals at some stage, the implications for pandemic readiness should be factored in.
A pandemic also carries the risk of generating a financial crisis. Keeping relevant financial markets operating smoothly during the COVID-19 pandemic was a direct objective of some of the Reserve Bank’s policy moves. Authorities were generally alert and well-prepared to respond to any looming crises of this sort. This responsiveness illustrates the value of the sort of preparation this report argues for more generally.
Lesson 4.2: Use economic and social support measures to keep ‘normal’ life going as much as possible
Deploy economic and social measures to support key health measures
Mitigating the pandemic’s potential social and economic impacts was a significant component of the COVID-19 response from the start. Similarly, the public health response to any future pandemic will need to be supported by a suite of economic and social support measures. Such measures seek to reduce disruption to people’s lives and to enable compliance with public health measures. This includes specific pandemic tools and support measures developed in advance and ready to use when the situation demands, as well as broader economic and welfare support to keep ‘normal’ life and activity going as much as possible. This will be challenging, because – as occurred with COVID-19 – a future pandemic is also likely to generate an initial and ongoing shock to Aotearoa New Zealand’s economy and society. The best way to deal with the shock is to prepare for it in advance.
A key benefit of financial support for workers, whānau and households and businesses is that they help keep a semblance of daily life going as much as possible. These schemes, appropriately targeted and designed, can substantially assist with living costs, keep people attached to the labour force, and help otherwise viable businesses to continue to operate (or at least survive in the meantime). A strength of the schemes initiated during the COVID-19 response is the positive effect they had on confidence (both personal and business).
Economic and social supports can make the implementation of public health measures more bearable, while public health measures ultimately work to support a healthy economy. The longer a pandemic persists, however, the greater the economic and social costs and the more the costs of financial support accumulate. It is impossible, as time progresses, to avoid significant trade-offs between economic costs and the full suite of pandemic responses, and these trade-offs therefore need to be constantly re-evaluated (see Lesson 2).
Design key tools in advance to save time and resources
It is essential to think in advance about how to ensure economic and social support measures will reach everyone they need to, and that their effects will be fair and proportionate. Viable compliance frameworks and exit strategies should be developed for various measures that are likely to be deployed in a future pandemic, to avoid the risk of them being mis- or over-used, and to ensure reasonable levels of cost-effectiveness. Good use can be made of existing knowledge from previous crises about where impacts are most likely to fall. Such information can support the development of options that target known needs early in a future pandemic and may help to more accurately anticipate wider social and economic challenges that the pandemic may exacerbate.
Resolving in advance the delivery agency and system requirements needed for the range of policy options for delivering support could save considerable time and money in the future.
COVID-19 demonstrated that setting up programmes and initiatives under urgency can sometimes lead to less efficient or effective spending of limited resources. For example, there were limited options for rapidly rolling out the Wage Subsidy Scheme in a more targeted way, because Inland Revenue did not have the systems functionality at the time to deliver it (see Chapter 6). The ability to target funding to different groups, or have a more tailored approach to timing, is dependent on having suitably flexible payment and delivery systems.
Resolving in advance the delivery agency and system requirements required for the range of policy options being developed for delivering support could save considerable time and money in the future and serve the fundamental purpose of looking after people in a crisis. For example, a prepared and resilient education system should have methods and tools in place to deliver effective online education, if necessary, alongside measures that can be implemented to help keep schools open as much as possible, such as improved classroom ventilation, mask wearing protocols and flexible classroom desk arrangements.
Part of designing good tools and options in advance is learning from past experiences. For example, the evidence we reviewed suggests that some, but not all, of the sectoral business assistance provided during the COVID-19 response represented reasonable value-for-money. Relevant agencies should thoroughly review the various supports provided during the COVID-19 pandemic, including sectoral business support, the Wage Subsidy Scheme, and social support packages such as Care in the Community. Based on analysis of what worked well and what could be improved, agencies should identify and develop a range of options that would support a future pandemic response.
Build on the improvements to social sector contracting and partnership
A critical element of Aotearoa New Zealand’s COVID-19 response was the work done by various community groups, service providers, iwi and Māori organisations and social sector agencies to respond to emerging needs in communities. Many government agencies adapted their operating and contracting practices to enable delivery organisations to focus on flexibly meeting the needs people presented with. Generally, these changes were viewed positively. Agencies identified that they should still be in a position to manage appropriate oversight of this more flexible outcomes-based contracting, and the flexibility improved the ability of providers to respond and adapt to the changing needs in their communities.
These adaptations and other positive experiences can be built on in a future pandemic. Agencies contracting in the social sector should review their approaches to cross-agency coordination and governance, and standardise more streamlined contracting arrangements so that these can be put in place quickly. A key improvement would be to ensure that all contracting agencies adjust their reporting requirements at the same time, to reduce confusion and burden on providers who need to focus on demand for their services during a prolonged crisis. This will ensure the good practices developed during COVID-19 can easily be continued or improved, while maintaining effective oversight.
Maintain well-functioning labour markets, including by providing financial support to workers
It is in the shared interests of government, employers and workers to minimise disruption to employment and working conditions caused by a pandemic and its restrictions. The COVID-19 experience highlighted the importance of maintaining depth and flexibility in labour markets for both economic and social reasons. The potential impact on labour markets was a major driver of the economic response to the pandemic and should also be a major focus of future pandemic preparedness.
Minimising disruption allows people to maintain their employment and wellbeing, while ensuring workforce supply. However, there is also a downside to this necessary support, beyond the fiscal cost. Labour mobility is likely to reduce as people hold on tightly to their means of support in very uncertain times. Long periods of subsidisation carry a risk of maintaining unproductive businesses and can reduce the natural forces of change within the economy, gradually eroding productivity. This reinforces the need to adapt over time to ensure shorter-term benefits are balanced against longer-term risks.
Financial support for workers, whānau, households and businesses is critical for the overall success of public health measures. These supports can be very expensive fiscally, depending on the extent to which border measures, lockdowns or other highly impactful measures are implemented and for how long. Nevertheless, international evidence suggests that the economic (and possibly financial) costs of not deploying such measures could be even greater.18
Lesson 4.3: Ensure continuous supply of key goods and services
Build greater resilience into supply chains
Despite the very challenging circumstances, Aotearoa New Zealand was able to sustain domestic and international supply chains and ensure continued access to necessary goods and services for its citizens and to international markets during the COVID-19 pandemic. The government and private sector worked collaboratively to enable this and to respond and adapt to changing circumstances. There were of course still some shortages and disruptions to supply chains but despite early fears, these limits did not have systemic consequences.
The evidence we reviewed on this matter indicated a widely held view (outside of government, at least) that central government agencies did not have a strong understanding of how key supply chains work, prior to the pandemic. COVID-19 highlighted how vulnerable Aotearoa New Zealand is to disruptions in international supply chains (for example, the potential loss of international shipping services, or the reduction in passenger flights reducing light cargo options).
Overall Aotearoa New Zealand was relatively fortunate in terms of supply chain disruptions during the COVID-19 response but should not rely on this happening again.
Knowledge was also variable in the private sector, and we heard evidence of a wider lack of thinking about security of supply chains and how this could be strengthened. Domestically, the use of regional boundaries during the Auckland lockdowns also had unintended impacts, reducing the flow of some goods across the boundaries to and from the rest of the country.
Overall, Aotearoa New Zealand was relatively fortunate in terms of supply chain disruptions during the COVID-19 response but should not rely on the same happening again. Government cannot build resilience to these potential disruptions by itself and, in relation to international supply chains, may have limited direct influence. Joint work by government and the private sector to understand and reduce supply chain risks will be an important part of strengthening economic foundations ahead of a future pandemic or other national crisis.
Maintain food security for a future pandemic
Food is a critical good that people need daily, and it was a topic of great interest during the COVID-19 response. Retailers did a good job of managing hoarding and panic buying, and while there were queues and some people faced challenges in getting their groceries, overall, there were no food shortages. The food supply chains held.
But food security means more than simply maintaining commercial food supply. During the pandemic, there was a significant increased demand for food parcels and food grants. In our view, ensuring widespread food security in the face of these pressures was one of the success stories of the pandemic response.
This was achieved through the combined efforts of government agencies and community organisations and providers. First, the Ministry of Social Development provided some foodbanks with emergency funding so they could stay open. Later, Civil Defence and Emergency Management groups stepped up to support foodbanks and other community food services to meet the demand for food from the community. As the pandemic progressed, the Government also invested strategically in building the capacity and capability of the non-commercial food recovery and distribution network (see Chapter 6). This enabled certainty of supply and a more flexible and sustainable approach to the distribution of emergency food to the social services sector.
Maintaining capability for this support for food security infrastructure will be of significant benefit in a future pandemic (or other crisis). It is important, therefore, that the Government maintains good engagement with and support for the charitable sector which provides the bulk of services in this area.
Maintain access to government and community services throughout a pandemic
As well as access to essential goods and services, such as food, housing and lifeline utilities, a good pandemic response needs to maintain people’s access to government and community services as much as possible. During COVID-19, lockdowns, gathering limits and physical distancing all disrupted people’s ability to access some government and community services, including services that have a significant impact on people’s lives, such as court processes, education and healthcare.
We heard many examples where the efforts of a few individuals were critical to ensure the continuity of essential services and functions. This worked but in future such responses should not be reliant on individuals.
Maintaining accessibility to critical services and supports during a future pandemic will be an ongoing challenge. We heard many examples where the efforts of a few individuals were critical to ensure the continuity of essential services and functions. This worked, but in future such responses should not be reliant on individuals. Key government delivery agencies, such as the Ministries of Social Development and Justice, should review their operational responses to COVID-19 and develop plans and processes based on potential pandemic scenarios, to ensure that they can shift approach and maintain services during a future crisis.
The ability for many sectors, services and communities to switch to remote and online operations was an impressive aspect of the COVID-19 experience. There were many examples of innovation and adaptability in moving the provision of core education, health and justice services online, among others. But we also heard concerns about inequitable access to devices, connectivity and capability being barriers to some people’s participation in these activities. Continual efforts to reduce the digital divide will be important considerations for a future pandemic.
Allow the ‘essential’ category to change over time
The temporary closure of businesses and services during a pandemic can also cause long-term social and economic damage.
The COVID-19 pandemic highlighted that the delineation between activities that are ‘essential’ and those that are not, is seldom clear. A key lesson is that the passage of time significantly impacts what is considered necessary and/or essential. For example, during a crisis of a few days or weeks duration, replacement parts and repairs for plant and machinery may not be considered essential, but over the course of months or years, some equipment will begin to wear out and fail. Without changes to the ‘essential’ category to enable repair or replacement, some businesses may not be able to operate.
The temporary closure of businesses and services during a pandemic can also cause long-term social and economic damage. There are some activities where closure – even for a short period of time – will make it very difficult to recommence business. The costs of preventing businesses from operating can mount up quickly, as can the social costs of missing access to education, childcare and mental health support. These difficulties reinforce the desirability of limiting the use and extent of more restrictive measures such as lockdowns, as much as possible. However, it is likely that some use of the ‘essential’ services category will be necessary in a future serious pandemic.
The costs of preventing businesses from operating can mount up quickly as can the social costs of missing access to education, childcare and mental health support.
We think there is scope in future (and depending on the nature of the pathogen) to designate some activities (such as civil construction or outdoor activities in the primary sector) as ‘safe enough to continue’ rather than ‘essential’. These may well be able to operate safely in a future pandemic (with appropriate requirements in place), reducing some of the social and economic costs of public health restrictions, such as the triggering of force majeure provisions.
Similarly, some of the requirements set by Health Orders during the COVID-19 pandemic were very prescriptive and impractical to apply in the workplace. We suggest agencies give consideration, in advance of a future pandemic, to how principles-based settings that provide for greater flexibility could be used in some cases as an alternative to prescriptive operational settings.
The ‘everything everywhere all at once’ aspect of the COVID-19 pandemic also reinforced that some sectors make a crucial contribution to a well-functioning society both during and after a pandemic, for example mental health services, childcare and construction. In a future response, deliberate steps should be taken to ensure these services can operate effectively to the greatest extent possible.
Lesson 5: Work together | Akoranga 5: Mahi ngātahi
In brief: What we learned for the future about working together
In preparing for and responding to the next pandemic:
- Lesson 5.1 Work in partnership with Māori
- Lesson 5.2 Work in partnership with communities. In practice this means:
- 5.2.1 Work with the community to deliver necessary supports
- 5.2.2 Make use of both locally-delivered initiatives and standardised national approaches
- 5.2.3 Ensure public information is accessible and use trusted networks to help deliver key messages
- Lesson 5.3 Work closely with the business sector
Overview
Everyone has a role to play in responding to a pandemic, and success will rely on people’s collective commitment to each other to get through it together. An effective response therefore needs strong and trusting relationships that bring together the diverse skills, experience, leadership and connections needed to generate collective action. These relationships need to be built and fostered during quiet times so that they can be quickly activated in a crisis.
Government agencies of course have overall responsibility for the oversight and delivery of a pandemic response. To do this well, they need to have established strong external relationships in advance, particularly with the community and business sectors, and to collaborate effectively with each other.
Aotearoa New Zealand’s COVID-19 experience reinforced the critical role of relationships and a culture of collaboration in a successful pandemic response. Time and time again, the evidence we gathered showed that the quality of working relationships at all levels was central to ensuring an effective, efficient and equitable response.
Before and during another pandemic, government agencies need to strengthen and maintain their relationships with communities, iwi and Māori, businesses, researchers, experts and non-governmental organisations – and also with one another. Not having established such relationships in advance will mean the response to another pandemic will start on the back foot and may delay effective action in those crucial first days.
The Government should also ensure that it upholds te Tiriti o Waitangi in preparing for and responding to another pandemic. This requires enabling Māori to participate in decisions consistent with the exercise of tino rangatiratanga, with potential benefits as well to wider communities beyond those in Te Ao Māori.
Lesson 5.1: Work in partnership with Māori
In Lesson 1, we emphasised that the core purpose of pandemic preparedness and response is to look after all aspects of people’s lives. In addition to this overarching responsibility to the whole population, central government also has distinct obligations to Māori under te Tiriti o Waitangi. Indeed, the Waitangi Tribunal has observed that the relationship considerations and partnership responsibilities flowing from te Tiriti were actually heightened during the pandemic:
“given the expansive kaawanatanga powers exercised in this emergency and the need for agile decision-making by the Executive, the Crown’s obligation to actively protect tino rangatiratanga and partner with Maaori is, in fact, intensified.”19
In addition, pandemics – which are known to exacerbate pre-existing inequities20 – have historically had a greater impact on Māori. This was true of the COVID-19 pandemic, although the elimination strategy and a range of deliberate policies mitigated its unequal impacts to a large extent, and represented a significant improvement from previous pandemics and epidemics. Minimising disproportionate impacts on Māori during a future pandemic will require nuanced understanding of likely impacts, and for the response to be designed accordingly. Supporting iwi and Māori organisations to deliver tailored responses in their communities helped reduce the impact on whānau during the COVID-19 response and is an example of practice that is consistent with te Tiriti o Waitangi.
The National Ethics Advisory Committee has described te Tiriti partnership in a pandemic context as ‘ensur[ing] iwi, hapū, whānau, and Māori communities are active partners in preventing, managing, and recovering from the impacts of an epidemic or pandemic’.21 Working closely with iwi and Māori is the best way for the Crown and its agencies to enact this vision of partnership. In planning for and responding to a future pandemic then, government should:
- Work in partnership with Māori in the development, design and delivery of any response.
- Enable iwi and Māori to exercise tino rangatiratanga in both preparing for and responding to a future pandemic (while recognising the right of the Crown to govern).
- Work towards equitable outcomes for Māori as part of an effective pandemic response for everyone in Aotearoa New Zealand.
- Ensure the national pandemic plan, and any future pandemic response, is delivered in a culturally appropriate way.
One important way of ensuring any future pandemic response is consistent with te Tiriti will be ensuring that any ethical principles and decision-making tools used in the response (as discussed in Lesson 2) are developed with Māori so that such tools and principles are applied in ways that help the Crown uphold its te Tiriti obligations.
Lesson 5.2: Work in partnership with communities
Responding effectively to a pandemic (and keeping people safe during any type of national emergency) is a critical function of central government. But – as the COVID-19 response clearly demonstrated – government cannot and should not do this alone. Delivering the range of supports and services people need during a pandemic requires close partnership between government agencies and communities of all kinds. And clearly communities and whānau will draw on their own relationships and partnerships to support people through a pandemic.
During COVID-19, we saw that when strong, trusting relationships were already in place before the pandemic, things worked well. When relationships were patchy, or had to be developed fresh, this often impeded the effectiveness of the response. One way to maintain and strengthen good working relationships is through joint participation in pandemic exercises and other civil defence and emergency management activities.
COVID-19 highlighted how reaching, looking after and communicating with people – including those in the ‘hard-to-reach’ category – requires a wide network of trusted community groups and organisations that are ready and able to respond in a pandemic. This network will include iwi and Māori organisations, community groups, NGOs and business networks. To muster collective action in a future pandemic, the government will need to know this network well.
Work with the community to deliver necessary supports
Delivering the range of supports and services people need during a pandemic requires close partnership between government agencies and communities of all kinds.
Most social support services in Aotearoa New Zealand are delivered by tens of thousands of non-government service providers and community organisations. Delivering social supports during the COVID-19 response required government to trust and flexibly resource community providers. This trust and flexibility should be maintained for the future, and will enable providers to be confident that resources will be available when required in an emergency.
Building and maintaining strong relationships between government and communities for a future crisis also requires system oversight by the lead social sector agencies. These agencies can identify gaps in the network to be addressed in advance of an emergency, including funding to local organisations that face ongoing challenges. Trying to address those gaps during a pandemic risks delaying the response and compromising delivery. There were examples where this was done well during the COVID-19 response: when it became clear that some ethnic minority (including migrant) communities were not receiving important information and support, social agencies worked through the Ministry for Ethnic Communities to support community leaders and groups and ensure support reached those who needed it.
Make use of both locally-delivered initiatives and standardised national approaches
People and groups working in local communities generally have better understanding than central government of what those communities need, want and are likely to struggle with in an emergency. This means they are mostly better placed to design and deliver support. Community-led approaches using local knowledge and leadership often delivered the most effective local solutions during the COVID-19 response. As the Ministry of Social Development has observed:
“A locally-led, regionally-enabled, and nationally supported approach is emerging as a valuable framework for supporting community wellbeing and recovery.”22
Some of the most remarkable success stories of Aotearoa New Zealand’s COVID-19 response involved iwi and Māori organisations exercising tino rangatiratanga as well as Te Ao Māori values like whakapapa, manaakitanga and kaitiakitanga to support not only their own people but the community at large. Many iwi and Māori organisations were well-placed to respond to their communities’ needs and could draw on their cultural protective factors. For example, in Northland, we learned how Māori health providers used their existing knowledge and relationships to meet the unique challenges whānau in rural and remote areas faced during the pandemic.
The key lesson then is that ahead of the next pandemic that strong relationships are fostered, embedded or built and that options for how to respond reflected in sector plans should be developed in partnership or consultation with the community sector.
Ensure public information is accessible and use trusted networks to help deliver key messages
During a pandemic, it is vital that accurate information about what people need to do reaches as wide an audience as possible. This is a significant challenge; the forms of communication that work for some groups will not work for others, and information needs to be culturally appropriate, accessible and rapidly translated into multiple languages. As we discussed in section 10.2, a particular challenge during the COVID-19 response was the rise of misinformation and disinformation, and – among some groups – an accompanying drop in trust in government and willingness to comply with public health measures.
The key lesson then is that ahead of the next pandemic that strong relationships are fostered, embedded or built and that options for how to respond reflected in sector plans should be developed in partnership or consultation with the community sector.
The COVID-19 pandemic demonstrated the importance of working with trusted intermediaries to translate, interpret and disseminate vital information in ways that would work best for their communities. These communication channels should be two-way, allowing questions and feedback to be brought back to government agencies as well as information being pushed out. One example from the COVID-19 pandemic that showed the benefits of trusted organisations relaying important information to their communities was ‘Malu’i ma’a Tonga’ – a vaccination drive set up by the Tongan Health Society and the local community, located on church grounds, attended by prominent Tongan leaders and delivered in the Tongan language. Identifying and working with trusted individuals and organisations should be an element of planning and preparation for a future pandemic.
Lesson 5.3: Work closely with the business sector
When government agencies worked closely with the business sector during the COVID-19 response, this allowed important aspects of ‘normal life’ to continue – in particular, the flow of essential goods and services (including lifeline utilities), ongoing employment and economic activity.
As we saw during COVID-19, businesses were affected differently depending on many factors. In another pandemic, government decision-makers will need to understand the potential impacts on businesses for different-sized operations and various sectors. Business can also have information and networks that are very useful to public servants, if used with discernment.
At several times during the COVID-19 pandemic, Aotearoa New Zealand was short of the skills and capabilities needed for various economic and other activities to keep going. The shortages included some highly specialised engineering skills, many kinds of health workers, primary sector seasonal workers and more. While it is of course essential to ensure appropriate health safeguards are followed in a pandemic, immigration procedures need to be well-tuned, efficient and responsive – without imposing too heavy a compliance burden.
The key lesson then is that ahead of the next pandemic, it is important to look back at the role of partnerships between the public and private sector in the COVID-19 response and reflect on what worked well and what did not. Reviewing what worked well in the past is the starting point for developing effective strategies and understanding needed for the future. There are also opportunities for further learning by looking at sectors that were particularly impacted by the pandemic (such as international education, tourism and hospitality) to better understand the pressure points and problems they faced – and how they could be avoided in the future.
Lesson 6: Build the foundations | Akoranga 6: Hangaia ngā tūāpapa
In brief: What we learned for the future about the foundations of a sound pandemic response
In preparing for and responding to the next pandemic:
- Lesson 6.1: Anticipate and manage the risks posed by a future pandemic (alongside other risks). In practice, this means:
- 6.1.1 Establish an effective national risk management system
- 6.1.2 Ensure central oversight of pandemic preparation across the whole of government
- 6.1.3 Base planning on robust pandemic scenario planning and modelling
- Lesson 6.2: Have key components of an effective national response in place and ready to be activated. In practice, this means:
- 6.2.1 Establish an effective all-of-government national response mechanism
- 6.2.2 Ensure strong cross-agency leadership
- 6.2.3 Prepare fit-for-purpose legislation
- 6.2.4 Build strong international connections
Overview
Aotearoa New Zealand delivered one of the most successful COVID-19 responses of any country. Like most of the world, however, the country was not ready for an event of the scale, complexity and duration of the COVID-19 pandemic, and notwithstanding the successes, there was harm and distress for a significant range of people, some of which may be possible to avoid in the future.
The need for more purposeful pandemic preparation and risk management was a recurring theme in our engagements and evidence. The strong global emphasis on influenza as the likely cause of the next pandemic meant that, prior to COVID-19, the preparation that was in place did not consider all options that might be relevant for responding to a different type of infection. The fact that pre-existing emergency response models were not suitable for a crisis of the scale and duration of COVID-19 meant that much of the all-of-government response had to be built while also responding to the crisis. The lesson from these experiences is that more robust foundations of preparedness and resilience need to be in place before the arrival of the next pandemic.
Usefully, the COVID-19 experience has provided specific, real-life examples of where Aotearoa New Zealand can enhance its preparedness by building stronger foundations for assessing, planning for, and managing the risks associated with pandemics and other national crises. COVID-19 highlighted the importance of having a range of options and tools decision-makers might want to reach for in future to keep people safe while minimising disruption to daily life as much as possible. It also highlighted the need for investment in preparation – and governance and accountability mechanisms to ensure this – to mitigate the risks posed by future pandemics. While significant work is needed to increase the capability and resilience of key agencies and sectors, investment made in preparing for a pandemic will also be valuable in relation to other national risks.
Lesson 6.1: Anticipate and manage the risks posed by a future pandemic (alongside other risks)
Establish an effective national risk management system
Pandemics require a highly coordinated approach to preparedness and risk reduction. Just as many businesses and organisations maintain hazard and risk registers as part of ongoing governance, central government needs to strengthen its preparation for pandemic risk – and other national risks – ahead of time. Once such risks are identified, they need to be managed and mitigated with appropriate plans and policy options, and there should be accountability mechanisms in place to ensure this takes place.
While our brief as an Inquiry was to consider future pandemic preparedness, in practice, it makes sense to consider and address the risks of a future pandemic alongside other national risks. To prepare better for future pandemics and other types of emergencies, current and future governments should therefore invest in a strong national risk management system.
Ensure central oversight of pandemic preparation across the whole of government
We learnt that in an ‘all of everything’ crisis, responsibility should be allocated centrally to oversee, coordinate and evaluate ongoing pandemic planning and preparedness across all relevant government agencies. This will not only ensure that pandemic plans are in place where they are needed, but also that they are coordinated, and that any gaps in pandemic preparedness within or between agencies are identified and addressed. As part of this oversight, scenario planning and pandemic modelling should be used to guide and regularly test Aotearoa New Zealand’s readiness for a future pandemic, including by undertaking regular cross-agency practice exercises, evaluating these, and building key learnings into both national and sector-specific pandemic plans.
Base planning on robust pandemic scenario planning and modelling
The next pandemic Aotearoa New Zealand faces might be nothing like COVID-19. We do not know when the next pandemic will occur, what the characteristics of that pandemic pathogen will be (such as its infectiousness and virulence), or what the social and economic context will be at the time of the next pandemic. However, as outlined in Lesson 2, governments can use a range of evidence and estimates to model what a future pandemic might look like in terms of both the behaviour and impacts of the infectious agent and the social and economic context in New Zealand at the point a pandemic occurs. They can also assess which of these potential pandemic scenarios are more likely, and what specific risks they pose.
In addition to anticipating the range of pandemic scenarios the country may need to respond to, scenario planning helps to ascertain the optimal mix of preparation and response options, so that governments can prioritise investment and capacity-building accordingly. For example, consideration of potential pandemic scenarios will help future decision-makers identify what should be prioritised in terms of preparatory investments (such as strengthening the ventilation of buildings, stockpiling PPE, ensuring standing laboratory and testing capacity and the best mix of quarantine facilities, including whether to invest in purpose-built facilities).
This kind of modelling and scenario planning has been used by the Treasury, the Reserve Bank23 and the Ministry for Primary Industries24 to inform preparation for an outbreak of Foot and Mouth disease (an infection affecting cows, sheep and pigs), which could have serious impacts on Aotearoa New Zealand’s economy. Modelling work helped demonstrate the importance of prevention and the scale of investment that would be needed to support New Zealand’s farmers, rural communities and primary industries if such an outbreak occurred. Despite this, the use of modelled scenarios was not a key input in New Zealand’s pandemic preparedness prior to COVID-19.
Ongoing investment in modelling capacity across multiple disciplines – coupled with the development of pandemic scenarios – is essential to building the foundations for a future pandemic response. See Appendix C for a more detailed discussion of the potential uses of pandemic, economic and social scenarios.
Investment in pandemic preparation: an example from South Korea
Aotearoa New Zealand’s state of preparedness can be usefully compared with South Korea’s. Unlike New Zealand – which, before COVID-19, had not encountered a major pandemic since 1918 – South Korea had dealt with significant outbreaks of severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2015. Following the MERS outbreak, South Korea reformed the way it prepared for and responded to pandemics.25
South Korea learnt from MERS the importance of having strong national leadership and coordination models ready to go. Between the 2015 MERS outbreak and the emergence of COVID-19, South Korea made significant changes to its national infectious disease prevention and management system.26 Key changes included: amending legislation to set out coordination models; improving early detection systems; and investing in their public health system capacity, infection control and public health tools, and surge capacity to handle outbreaks. Pandemic legislation was also amended to provide for stronger governance arrangements, with clear roles and responsibilities across all levels of government and private institutions.27
South Korea’s preparedness activities and investment helped to slow the spread of COVID-19 when it arrived, despite the country’s high-density cities and proximity to China. For example, the availability of universal testing and contact tracing enabled health officials to identify clusters, ensure infected persons isolated and maintain a low rate of infection within hospitals.
Lesson 6.2: Have key components of an effective national response in place and ready to be activated
Establish an effective all-of-government national response mechanism
At the beginning of 2020, Aotearoa New Zealand did not have an all-of-government emergency response mechanism that was suitable for a crisis of the nature, scale and duration of COVID-19. A key learning from this experience is the need to have a structure in place that can be quickly activated to provide oversight, leadership, and coordination of the response. For some types of emergencies, such as earthquakes or floods, this leadership function may be best undertaken locally, or by a specific relevant agency. A pandemic response, however – as we learned during COVID-19 – is likely to require an all-of-government approach, because of the wide range of social, economic and cultural impacts that can occur beyond the pandemic pathogen’s immediate health impacts.
When the next severe pandemic occurs that requires more than just a health-led response, a pre-agreed all-of-government coordination and leadership mechanism should be ready to be activated. Key roles and responsibilities of different agencies should be identified ahead of time, along with appropriate governance arrangements.
The immediate function of this mechanism during the early days of a pandemic should be to lead and coordinate the response and provide immediate intelligence and advice during a fast-moving and evolving situation. Critically, it should lead and coordinate the multi-agency response, and coordinate provision of advice to decision-makers on the impacts of policy response options across multiple criteria (see Lesson 2). At the same time, it should also be prepared to provide long-term strategic analysis and advice on matters such as how a pandemic could evolve over time, and how and when a response might adapt or change course. Even from the early stages of a future response, the coordinating body should have an eye onlong-term recovery, how and when the response will end, and possible exit strategies. As we heard regularly during our engagements with stakeholders, those coordinating the response to a future pandemic need to be able to give decision-makers both the detailed view of what is happening on the ground now, as well as the big picture scenarios that may play out in the future.
Ensure strong cross-agency leadership
When the next severe pandemic occurs that requires more than just a health-led response, a pre-agreed all-of-government coordination and leadership mechanism should be ready to be activated.
As COVID-19 made clear, responding to a pandemic requires effective leadership and coordination across government agencies. Core aspects of the response – such as managing international borders, securing vaccine doses, and providing social and economic support – require agencies to work together. While officials worked hard to do what was needed, Aotearoa New Zealand’s ability to quickly stand-up key pillars of a pandemic response would be substantially strengthened if agency leads worked together ahead of time to collectively plan for, coordinate and lead an all-of-government response.
A recurring theme in the Inquiry’s engagement was the value of trust in a crisis response. By engaging in cross-agency dialogue and preparation for a pandemic response, agency leads have the opportunity to build trust with one another. Clarity around roles and responsibilities, and an understanding of how different agencies will work together, will help enable an effective and coordinated all-of-government response. The importance of working together is discussed in Lesson 5.
Prepare fit-for-purpose legislation
At the start of the COVID-19 pandemic, standing response legislation (the Health Act 1956, Epidemic Preparedness Act 2006 and Civil Defence Emergency Management Act 2002) was sufficient to provide an initial response. This legal framework was supplemented with bespoke COVID-19 legislation, developed at pace and passed under urgency in May 2020, and other legislative changes to mitigate and address the COVID-19 experience.
In a 2022 Law Commission assessment of the legal framework for emergencies, Professor Janet McLean KC noted a number of areas where improvements to the Health Act 1956 and other emergency legislation should be factored into a review of the legislation to respond to a pandemic.28 The Law Commission’s report notes, for example, that the operation of the Epidemic Preparedness Act 2006 should be assessed for its effectiveness and to determine whether more provisions should be embedded in advance to be activated by an epidemic notice.
Given the likely wider-ranging impacts of a future pandemic, in our view it is key that there is central oversight to ensure the readiness of emergency pandemic legislation based on the experiences of COVID-19.
We agree with the need to refresh aspects of legislation to respond to a pandemic. While the legislation in place in March 2020 was sufficient to support the initial response, a key lesson arising from our Inquiry is that there is value in developing an improved legal framework ahead of time to cater for a national public health emergency. Any work to improve the legislative framework should specifically address lessons learned from using the legislation during the COVID-19 response.
Given the likely wider-ranging impacts of a future pandemic, in our view it is key that there is central oversight to ensure the readiness of emergency pandemic legislation based on the experiences of COVID-19. In particular, any future work should review or modernise the Health Act 1956 and the Epidemic Preparedness Act 2006 to ensure they are fit-for-purpose in supporting the immediate response to an emerging pandemic in the future.
For example, and based on the experience during COVID-19, it would be useful to consider the overarching principles in Part 3A of the Health Act 1956 as part of this review. A review of the Health Act should also determine any changes required to the powers of medical officers of health to deal with an immediate threat from an unknown virus and to act on a quickly emerging pathogen that has not yet been identified. The appropriateness of officials exercising powers to make orders that affect national populations, essential services and enforcement provisions should be a focus, to ensure relevant powers are available given the circumstances and timeframes, with the appropriate accountability arrangements. Another aspect for review is the thresholds for modification orders under the Epidemic Preparedness Act 2006.
We recognise that it will be difficult to ensure public health legislation can be refreshed and reformed to address all possible eventualities for a future pandemic, given the way pathogens, public health measures and treatments evolve. It is neither possible nor desirable to try to comprehensively legislate for every future pandemic scenario – this risks legislation that is too wide-ranging and complex and insufficiently flexible to accommodate the ‘unknown unknowns’.
In its 2022 study, the Law Commission noted in relation to writing emergency law that:
“Ensuring that legal frameworks provide governments with sufficient powers to cope with future emergencies while at the same time including effective political and legal constraints on such powers is a difficult balance to achieve.”29
It is important that the existing legislation be updated to provide sufficient legal grounds to enable a speedy and effective immediate response to a pandemic, thus providing adequate time for any bespoke pandemic legislation or legislative amendments to be developed and considered by Parliament. It was beyond the scope of Phase One to identify a comprehensive, specific set of legislative amendments to the existing standing pandemic provisions in the Health Act and Epidemic Preparedness Act, or to the legislation of other agencies who have to modify their operations, or put in place measures, to support a pandemic response.
In addition to updating existing standing legislation, the Inquiry heard evidence that it would be useful for ‘model’ pandemic legislation to be developed and consulted on, but not enacted. This ‘model’ legislation would set out key safeguards, checks and balances for implementing and reviewing the use of various public health measures and ensuring that any limitations on human rights are proportionate and support the rule of law (by providing clear, accessible and enforceable laws). This ensures there is ready-to-go ‘model’ legislation available, which can be modified to ensure it meets the bespoke needs of an emerging future pandemic.
There is an alternative view, however, that such ‘model’ pandemic legislation should in fact be considered by Parliament and enacted. If a future pandemic required specific new bespoke powers or provision because of the nature of the new pathogen, the legislation could be quickly amended at that time to address the emerging pandemic. Ultimately the choice between an enacted or ‘ready-to-go’ model pandemic legislation will be a political decision, but as a first step, development and consultation on potential pandemic legislation should begin right away.
One issue with the bespoke COVID-19 Public Health Response Act 2020 was the number of COVID-19 orders and how often they were changed. Trying to ensure guidance aligned with orders proved challenging, limiting the ability of the public, businesses and even the legal profession to keep up-to-date with their understanding of the emerging law.
It will be important for the development of ‘model’ pandemic legislation to carefully consider which aspects of future pandemic management should be in primary legislation (for example, key health response measures or border restrictions, vaccine or treatment mandates, isolation and quarantine requirements) and what should be in more flexible and nimble secondary legislation (for example, where and how roadblocks would operate, which and how essential businesses will operate, use of mask wearing, and requirements for contact tracing). For example, with regards to border restrictions, the primary legislation needs to provide the ability to quickly restrict the movement of people or craft from particular locations to address the immediate risks of a pandemic or an infectious disease outbreak. In addition, the grounds for longer term, ongoing restrictions governing the movement of craft and/or people across the border should be set out in primary legislation alongside built-in review mechanisms or relevant restrictions incorporated.
Regulatory stewardship means that each agency needs to take responsibility for ensuring their own emergency response legislative frameworks and existing key statutory legislation are fit-for-purpose to meet the challenges of a future pandemic. There is an ongoing need for agencies to continue to consider the application of existing legislation to new and unanticipated circumstances that may arise during a future pandemic. For example, an urgent amendment to the Medicines Act 1981 in 2021 was required relating to ministers’ provisional consent for approval of new medicines such as vaccines.
While individual agencies are responsible for keeping their legislation up-to-date for a future pandemic (or other emergency), there is a role for central oversight and coordination — for example, supporting an omnibus bill for changes across multiple legislation relating to facilitating electronic and online activities that may be necessary during a pandemic.
There is also a role for central coordination to support agencies to reconcile the interface between their key foundational legislative frameworks and the use of public health measures and policies that supported those measures (such as the wage subsidy). For example, determining the extent that legislative change or improved guidance may be needed to clarify the interaction between employment law and public health, or wider fiscal support measures such as the payment of wage subsidies in an emergency, or how sick leave provisions are used when public health requires individuals to self-isolate. Another example is the degree of separation that should be maintained between the health and safety legislative framework (performance-based regime that is flexible and tailored to individual circumstances of risk) and public health legislation in managing a pandemic (rule-based system that sets clear requirements for managing evolving risks acrossa multitude of settings).
Build strong international connections
The pandemic showed the importance of developing and maintaining strong international connections, not only at the ministerial and official level, but also with (and between) businesses, scientists, policy advisors and academics.
During the COVID-19 pandemic, Aotearoa New Zealand was able to leverage existing international connections and alliances in several important ways. Early in the response, strong diplomatic relationships helped with the repatriation of New Zealand citizens from overseas. Later, health officials and politicians were able to liaise with drug manufacturers and other countries to ensure a continued supply of medicines and secure timely and stable supplies of COVID-19 vaccines. Scientists and academics drew on collegial networks with international colleagues to ensure their advice on the virus and the public health response was accurate and up-to-date. Economic advisors and operatives had international relationships they were able to leverage off effectively. Many New Zealand businesses, despite travel restrictions, maintained strong trade and commercial relationships with overseas partners and suppliers.
The pandemic showed the importance of developing and maintaining strong international connections, not only at the ministerial and official level, but also with (and between) businesses, scientists, policy advisors and academics.
International connections were also useful for maintaining key supply chains. Trade officials engaged with other governments, for example Singapore, to remove trade blockages for several essential products. Aotearoa New Zealand’s strong Pacific relationships meant the New Zealand Government was able to provide concrete support for Pacific nations before and during COVID-19.
As these examples from COVID-19 show, many of the foundations are already in place to enable Aotearoa New Zealand to draw on strong international connections in a future pandemic. It is important that these are maintained and, in some areas, they need to be strengthened. In particular, New Zealand should build on the Indo-Pacific Economic Framework for Prosperity initiative as part of broader efforts to improve international and domestic supply chain resilience. Ministry of Foreign Affairs and Trade officials should also explore opportunities to work with other countries (such as Australia and Singapore) to improve collective capacity to respond to the needs of a future pandemic. This could include research partnerships or collaborating on the production of vaccines. In particular, as Australia establishes its new Centre for Disease Control, there will almost certainly be opportunities for New Zealand public health officials to collaborate across the Tasman on pandemic preparedness activities that are mutually beneficial to both countries.
Aotearoa New Zealand should also look to support multilateral efforts to strengthen global pandemic preparedness and responsiveness. This includes initiatives led by the WHO to improve intelligence and technology sharing, to build international coordination and collaboration and to promote global equity in protecting people from the impacts of pandemics.
vi Published in 2005, the Canadian framework was developed by researchers at the University of Toronto following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-2003. The table produced here is a summary only. For a full version including a description of each value, see the sources listed in endnote 10.