9.2 The story of the response He kōrero mō te urupare: te ohorere, te angitu me ngā whakawhitinga uaua

Although the rapid spread of COVID-19 around the world had caused concern since the start of 2020, the magnitude and pace of events in March shocked Aotearoa New Zealand. The global pandemic was no longer happening elsewhere and to other people: it had reached our doorstep. Things that had been unimaginable only a few weeks earlier quickly became reality – international borders were effectively ‘sealed’, businesses and schools closed, and the nation was locked down.

Initially, it was thought Aotearoa New Zealand’s best hope was to try delaying COVID-19’s arrival and suppress any outbreaks for as long as it could – a goal made more achievable by the country’s natural advantages as an island nation distant from its nearest neighbours. Delay and suppression would give the country time to prepare, especially the health system which (as had happened in Europe) would otherwise be rapidly overwhelmed.

But, encouraged by the example of countries like Singapore, Aotearoa New Zealand instead chose a more aggressive path: a complete national lockdown accompanied by stringent public health measures, with the possibility of eliminating the virus until a vaccine was available. Early signs of success prompted decision-makers to move away from suppression as the backstop strategy and instead fully embrace the elimination strategy. With the initial shock passing, Aotearoa New Zealand resolved to keep going hard.

9.2.1 The pursuit of elimination

Once the elimination strategy was formalised in early April 2020, it provided a coherent, easily understood national goal that was clearly communicated and found widespread acceptance. So too did the ground-breaking Alert Level System supporting it, which set out four levels of increasingly restrictive public health measures. At Alert Levels 3 and 4, when ‘soft’ and ‘hard’ lockdowns were required, these measures were undoubtedly stringent and created significant stresses that escalated over time. But – in combination with border restrictions and other tools – they were highly effective at preventing the virus from entering the country and, when it did, stamping out chains of transmission. By the start of June 2020, community transmission had been eliminated, at least for the time being. This was a remarkable achievement.

People took heart from this initial success. And, despite the difficulties of lockdown, they drew a sense of common purpose and collective achievement from the knowledge that – by complying with the restrictions until most of the population was vaccinated – Aotearoa New Zealand could return to normality more quickly. This community solidarity was one factor in the effectiveness of the elimination strategy throughout 2020 and much of 2021. Strong leadership was another. Ministers and public health officials, most notably Prime Minister Jacinda Ardern and Director-General of Health Ashley Bloomfield, were exceptional in their public communications, something that was acknowledged domestically and internationally.

The success of Aotearoa New Zealand’s elimination approach during 2020 and into 2021 has earned global praise, and deservedly so. It stopped widespread COVID-19 infection until most of the population was vaccinated and the virus became less deadly. It prevented the premature deaths of thousands of New Zealanders and ensured the health system was never swamped.

Importantly, the response’s benefits went beyond public health. Holding fast to the elimination strategy allowed Aotearoa New Zealand to spend less time in lockdown than many other parts of the world. It allowed society and the economy to function comparatively well at a time when many other countries were facing extreme disruption. The elimination approach was buttressed by economic and social support measures that were rolled out quickly, generously and on a ‘least regrets’ basis, effectively cushioning many people and businesses from the pandemic’s worst impacts while normal life remained on hold. These supports meant that, once the initial shock had passed, economic activity and growth bounced back quickly. There was no large-scale unemployment and workers largely stayed connected to their jobs and workplaces, despite the lockdowns. The potentially devastating effects of the pandemic on individuals and families – both those already facing significant disadvantage and others who had never needed to rely on social services before – were mitigated by government-funded supports and services, and by the efforts of the network of agencies, non-governmental and local organisations, iwi and Māori groups, volunteers and many others who took them out into their communities. There is much to be proud of.

However, as we discuss further, the longer-term human, social and economic cost of pursuing elimination was high. With the benefit of hindsight, it is possible to see that some harm might have been avoided or at least reduced if things had unfolded differently. While of course we cannot be certain how other response scenarios would have played out, they are worth reflecting on as we look to the future. For example, had there been a higher level of preparation before the pandemic, the goal of elimination might still have been achieved without such a long and stringent initial lockdown.

The success of Aotearoa New Zealand’s elimination approach during 2020 and into 2021 has earned global praise.

9.2.2 The all-of-government response

Before COVID-19, Aotearoa New Zealand had a well-established civil defence and emergency management system, led by the National Emergency Management Agency. The Officials’ Committee for Domestic and External Security Coordination could be activated in an event where all-of-government coordination was required, and legislation was in place that gave the Government appropriate powers to respond to an emergency.

However, while in principle this system was capable of managing the response to a pandemic, in practice most agencies’ previous experience, tools and plans were geared towards natural disasters and were not suitable for a national emergency of the scale or duration of COVID-19. At the start of the pandemic it quickly became apparent that the crisis was too big and multi-faceted for the Ministry of Health to manage as the lead agency, and that a new all-of-government response structure would be needed.

Ministers and officials, working at pace to put in place an all-of-government response to COVID-19 in March 2020, described feeling as if they were flying a plane at the same time they were building it, at speed and under extraordinary pressure. While the pre-existing influenza pandemic planⁱ had some useful elements, there was no manual for dealing with something like COVID-19, and little in the way of ‘muscle memory’ that could be activated.

Despite this, officials and agencies were remarkably quick in standing up the systems, services and supports that would allow Aotearoa New Zealand to pursue elimination. This is a particularly impressive achievement given that before 2020 New Zealand had not fully prepared all the measures that would be needed for responding to something like COVID-19. For example, New Zealand lacked large-scale contact-tracing and testing capacity, options for quarantining and isolating large numbers of people, adequate building ventilation standards, and sufficient capacity in hospitals to care for many sick people and patients on ventilators. While some economic and social support schemes had been set up for previous crises, they were not sufficiently developed – especially in terms of targeting, delivery and accountability – for a response on the scale the COVID-19 pandemic required.

In the event, the Government succeeded in maintaining the supplies and services needed for life in lockdown. A generous wage subsidy scheme was announced even before the borders closed. The first managed quarantine facility opened within hours of compulsory quarantine for air travellers being ordered. The contact-tracing workforce – from a low starting point – was rapidly scaled-up into a national operation, equipped with a digital contact-tracing system, database and trained staff.

Throughout the pandemic, decisions had to be made and implemented at pace, in rapidly-changing and stressful circumstances, often with limited information and little time to consult stakeholders and other agencies. In ensuring decisions were informed by the latest public health intelligence, there was often limited time to integrate other perspectives into advice. Agencies that needed to operate collectively did not always have strong pre-existing relationships and had to build these as the response was underway. Responding to COVID-19 required ministers and officials to draw on unprecedented levels of commitment, effort and fortitude – not just once, but repeatedly over many months.

The quality of agencies’ relationships with groups outside government was also critical. The effectiveness of the response depended not only on public servants and politicians, but on the private sector, iwi and Māori, Pacific and other ethnic communities, non-government social service and health providers, volunteers and many more. They could often do what central government could not. They were known and trusted; they understood local or sector-specific needs; they could reach individuals and families who might otherwise be overlooked. Yet these groups were not always adequately consulted or relied on by government, especially early on. The strength, leadership and capacities found within these groups cannot be over-stated as prime enablers of the ‘government’ response.

The effectiveness of the response depended not only on public servants and politicians, but on the private sector, iwi and Māori, Pacific and other ethnic communities, non-government social service and health providers, volunteers and many more.

9.2.3 Human impacts

A pandemic like COVID-19 affects everyone and every aspect of life in some way. Negative consequences can never be entirely avoided, although their impacts may be anticipated and mitigated to some degree.

Aotearoa New Zealand’s pandemic experience bore this out. Despite the success of the elimination strategy, despite the evident effort within and beyond government, and despite the introduction of measures to cushion the pandemic’s effects, there was undoubted harm. In the first two years when COVID-19 infection rates were low, this harm came less from the virus than from the pandemic response itself. While delivering many benefits, the response had negative impacts on the economy, society, individuals and families that were significant, cumulative and unevenly distributed.

The pandemic had different impacts for different groups of people. Some were impacted unequally and in ways that have been deep and lasting. Those who went into the pandemic already experiencing health, economic or other inequities were often disproportionately affected, such as Māori and Pacific peoples. Others, were impacted in unique ways or suffered specific disruptions to their life plans, such as essential workers, New Zealanders overseas or people needing treatment for non-COVID-19 medical conditions. Some people fell into multiple of these groups, such as those living in South Auckland, working in essential industries (including managed isolation and quarantine (MIQ) and the border), and with higher co-morbidities. Groups such as children and disabled people were particularly impacted by certain restrictions. Aucklanders did it particularly tough, spending more than twice as long in lockdowns as the rest of the country.

The elimination strategy was the best way to protect all New Zealanders and look after those at highest risk from a pandemic. By delaying widespread transmission until most people had been vaccinated, the elimination strategy prevented thousands of premature deaths from COVID-19 – particularly among the elderly, those with existing health problems and those living in disadvantaged circumstances.

9.2.4 Challenging transitions

The elimination strategy was one of the major strengths of the pandemic response, and moving away from it was one of the biggest challenges. Once Aotearoa New Zealand reached the point when elimination was no longer required or viable – because the population was largely vaccinated, and the arrival of more easily spread variants made elimination infeasible – a new strategy and set of public health measures was needed. However, in the event, developing and communicating a new goal post-elimination, and transitioning to a new way of managing COVID-19 that did not involve a ‘zero-risk’ approach to transmission, was not discussed or ‘socialised’ early or well enough. This proved to be one of the most challenging periods of the pandemic.

For much of 2020/21, planning for recovery, preparing exit strategies and considering possible future scenarios received less attention than they should have. Complex and urgent operational decision-making absorbed the time and energy of ministers and officials. The focus on ensuring the most up-to-date public health intelligence and processes for providing advice under urgency meant there was less scope for Cabinet to consider the trade-offs and longer-term impacts that would normally form a key part of the decision-making process, or to consider possible new pandemic and response scenarios.

The health system experienced similar challenges. The need to preserve capacity in case of a surge of COVID-19 cases – and the increased demands of new infection control measures – made it difficult to judge when there was scope to resume more non-COVID-19 services (surgeries, other planned care, screening). In managing the risk posed by COVID-19, the health system reduced provision of services for other health issues – with consequences for those whose care was delayed or missed.

Once the more virulent Delta strain reached Aotearoa New Zealand in August 2021, the country returned to lockdown. In most regions, it lasted a matter of weeks. But Auckland (and sometimes neighbouring regions) stayed locked down for months. In a city with the largest Polynesian population in the world, Māori and Pacific peoples were hit especially hard. They were more likely to live in overcrowded housing and work in essential industries (including MIQ), and they had lower vaccination rates than other groups – all factors that increased their vulnerability and made it hard to eliminate Delta transmission by means of the usual public health measures. The decision to keep Auckland locked down until all population groups had adequate vaccination coverage was laudable in intent, but the costs (individual, social, economic, educational) were high and they were borne by all Aucklanders and some in neighbouring regions.ⁱⁱ In addition to thinking about coverage as a target for ending lockdowns, decision-makers needed to be considering other matters at the same time – including waning immunity and what that meant for average immunity across the population, and the impact of time lags (given vaccination coverage can still be increasing once a lockdown finishes and ‘catch’ any resurgence of infection rates).

As the economic and social costs mounted across the country, community support for continuing restrictions began to wane. Businesses and families were struggling, children’s learning was impacted, and people’s mental health was affected. Many who had been quick to get vaccinated and had always complied with restrictions now felt their efforts counted for nothing: they were still in lockdown and a return to normal life seemed as far away as ever.

Even though the pandemic response was losing social licence, and eliminating transmission of the virus was becoming more challenging, the Government remained publicly committed to the elimination strategy. The discussion started to change in early October 2021 when the Prime Minister suggested the elimination strategy might be phased out – although without indicating what could replace it or when. Then on 22 October, the Government announced that Aotearoa New Zealand would shift to a suppression strategy in December, which it described as ‘minimisation and protection’. Alert levels would be replaced by a traffic light system.

This unheralded announcement was contentious, for many reasons. People felt unprepared to start moving in a new direction, and the goals of the new strategy were less clear (unsurprisingly, as suppression is an inherently messier strategy than elimination). Many people who had felt protected by the elimination strategy were now anxious about the health risks if COVID-19 was allowed to become established, and there was not good information about what ‘living with’ the virus might look like for people. Some criticised the timing of the shift. Vaccination coverage among Māori and Pacific peoples was still below the 90 percent level which the Government’s health advisers had recommended should be reached before adopting the ‘traffic light’ system.

After the transition to the suppression strategy, the pandemic response never regained its initial clarity of purpose or the public support it had earlier enjoyed. There was also increasing resistance to compulsory public health measures – face masks, vaccine passes and especially the Government-issued occupational vaccine ‘mandates’ and employer-issued vaccine rules. These rules were expanded to cover more categories of workers, with new guidance assisting employers in setting their own workplace vaccination policies. Earlier in the pandemic, there had been clear public health reasons for making certain measures compulsory for specific settings or occupations, even though doing so constrained individual rights. But vaccination was now being required in sectors or workplaces where the public health benefit was less clear but where many employers and employees considered them necessary for workplace health and safety.

The case for vaccine requirements (employer policies, vaccine passes and some Government-issued mandates) became more finely balanced once the highly transmissible Omicron variant became New Zealand’s dominant COVID-19 strain in early 2022. International evidence was starting to show that vaccination, including the Pfizer Comirnaty vaccine specifically, was considerably less effective in preventing transmission of Omicron compared with previous variants, meaning it was unclear how much vaccine requirements were increasing people’s protection from being infected with COVID-19.

In light of this evidence, the Government might have considered removing vaccine passes and mandate requirements in January and February 2022. However, like most decisions made in a pandemic, this move would not have been risk-free. Even if vaccines were not as good at stopping the transmission of Omicron as other variants, it is likely they would have helped to flatten the first wave to some degree. Vaccine requirements would also have helped dampen down any outbreaks of the Delta variant, which it was feared could return.

Occupational vaccine mandates were updated to include a third dose, in line with the Government’s decision to rapidly roll out vaccine boosters as Omicron was arriving – a decision that saved many lives and relieved pressure on the health system.

While some people were anxious about ‘living with’ the virus, for others the persistence of measures such as vaccine requirements had a corrosive effect. People became increasingly outspoken about the consequences they or others were suffering – unemployment, loss of income, fractured relationships and more. For some, the requirements became a symbol of a pandemic response that had lost its way, becoming increasingly heavy-handed and devoid of compassion. These sentiments partly fuelled the Parliamentary occupation that ended violently in March 2022.

By this stage, core measures that had long scaffolded the pandemic response were already being dismantled. Border restrictions and MIQ were gradually reduced starting in February 2022. Employer vaccine policies, vaccine passes and occupational vaccine mandates were progressively rolled back from April 2022.

9.2.5 The long tail

By the time most pandemic response measures were removed, Aotearoa New Zealand was in a significantly different place from where it had started in March 2020. Collectively, the global pandemic and additional shocks like the war in Ukraine left a legacy of economic, health and social after-effects, many of which remain with us – cost increases, global supply chain problems, the high cost of living, loss of learning, long COVID, poor mental health, loss of income, business failures, broken relationships and widening inequalities among them.

From an international perspective, Aotearoa New Zealand’s pandemic response was comparatively a positive one. New Zealand had one of the lowest health losses from COVID-19 and fared comparatively well economically and socially, at least in the short term. But the response could have been better still, thereby preventing or lessening some of the long tail of consequences which this country is still reckoning with. This provides the impetus for the lessons for the future and recommendations we set out in Part Three Moving Forward.

New Zealand had one of the lowest health losses from COVID-19 and fared comparatively well economically and socially, at least in the short term. But the response could have been better still.