Misplaced Attack On New Zealand's Response To Covid-19

Sunday, 24 January 2021, 7:19 pm
Opinion: Ian Powell

Peter’s Covid dunne-over misplaced

Former longstanding minister, including associate health, in both National (mainly) and Labour led governments Peter Dunne has earned a deserved reputation for his measured and methodological approach to matters. I experienced this personally over 40 years ago in student politics at Canterbury University. This included him being the student association president and myself the student newspaper editor in the same year – an interesting year! Despite being different political animals we maintained a friendly occasional rapport over the many years that passed.

Now out of Parliament Dunne has become a political commentator and columnist continuing his measured and methodological approach from a usually well-written right-wing perspective.

Falling Short

Sadly he has fallen well short of this standard with his recent online article published in Newsroom.

Peter Dunne’s essential argument is that there has been an unhealthy refusal in New Zealand to listen to different voices on how to respond to the Covid-19 pandemic. Certainly if there had been a refusal it would have been unhealthy. He attributes the country’s success to “…public fear, and skillful communications accompanied by sheer good fortune.” This is misplaced.

Certainly there was public fear; it was an unprecedented threatening and highly contagious pandemic after all. Yes there was skill in the communications. But the communications were also based on the best evidence available and delivered with both empathy and plain language.

New Zealand had the advantage of geographic location but our success in combatting the pandemic can’t be simplified to “sheer good fortune.” This would not have prevented us from swamped by the virus and our rundown public hospitals being overwhelmed if we had not adopted the strategic direction we did. This is the greatest omission from Dunne’s expressive choice of words.

Importance of strategy

It is fair to stay that New Zealand’s initial response was equivocal but that was because the Ministry of Health was faithfully following the advice of the World Health Organisation. This is understandable in the absence of drilling down further. However, that WHO itself was equivocal over the alternative strategies of elimination or mitigation (including suppression) of community transmission. By March the global coronavirus epicentre had shifted to Europe which was largely going down the mitigation path (try to control but not eliminate). Unfortunately WHO is prone to Eurocentrism.

Fortunately our epidemiologists were instead looking at Asia and in particularly the success China was achieving in its response – elimination. This enabled them to give good advice to government including scenarios on death rates if we were to follow Europe. Look at the evidence (as of 3 January) now about the effectiveness of the alternative strategies.

WHO reports the cumulative death rate per million to be Europe – 631, Western Pacific – 10 (includes Asian countries bordering the Pacific Ocean such as China, Thailand and Vietnam), New Zealand – 5, and China – 3. Our result was not the result of sheer good fortune, skilled communication and public fear. It was good strategy.

Peter Dunne makes too much of the Prime Minister’s subsequent acknowledgement that she was initially far from confident that the elimination strategy would work. This was unsurprising. It was a pandemic of the kind that that not been experienced for a century. It was unprecedented. The only lessons available were limited epidemic experience in Asia and China’s response following the Wuhan outbreak.

Looking to Asia (what to do) and Europe (what not to do), epidemiologists advising government on elimination were providing the best empirical advice available but even they couldn’t be absolutely confident it would work. What they did know was the mitigation would most likely be worse (and they were right).

Unhelpful demonisation

Unfortunately Dunne’s keyboard then come under an attack of accusative rhetoric at the expense of measured methodology. He refers to and names (Professors Baker, Wilson and Hendry and Dr Wiles) as a small “circle of academic experts” that have the “ears” of government and the media. This circle appears to him to be “increasingly tight and uncritical”. Alternative views don’t get a look in.

What is ignored in this apparent demonisation is that this small circle is situated within the mainstream of epidemiologists and other experts including the ‘granddaddy’ of modern epidemiology in New Zealand Professor David Skeggs.

Opponents of the elimination strategy are by contrast on the margins. Of course they shouldn’t be ignored. But proportionality is required. So is the evidence. They began by advocating the Swedish path which has been subsequently discredited and a cumulative death rate of 864 compared with our 5.

Their economic reservations were expressed as if there was no government wage subsidy and other financial support for businesses. The evidence suggests that New Zealand’s economic performance is better than expected and better than it would have been if we had followed mitigation or herd immunity. These opponents haven’t been “howled down by the favoured coterie of academics.” Instead they have been measuredly and methodically rebutted by evidence.

Ignoring facts

But Peter Dunne also ignores facts. Epidemiologists such as Baker and Wilson have been sharply critical of aspects of the implementation of the elimination, particularly with reference to delays in introducing full border testing (including in quarantine facilities), in testing essential workers in these facilities, and in introducing mandatory face masks. Early deficiencies in contact tracing can also be added to the list.

But they do criticise in an evidence-based rather than dramatic way. When Professor Baker is asked by Radio New Zealand if our border protection has failed, he deftly responds that there have been some “failings”. I can still vividly recall the barely controlled anger towards the Health Ministry of Professor Skeggs on Radio New Zealand last year when commenting to one of these “failings”.

As recently as today the Sunday Star Times has published a longer article assessing the government’s response to Covid-19. While broadly positive about its approach Professor Baker is quoted describing it as “sluggish”. If this is uncritical my mind boggles over what he would be like if he were critical.

Stronger ground but

Peter Dunne raises some valid concerns. He’s critical of cabinet minister Megan Woods saying last year that New Zealand would be at “the front of the queue” for getting a Covid-19 vaccine. This assertion was premature, but not malign as implied, because of external factors beyond our control. We were certainly near the front of negotiating agreements with potential vaccine providers. This is a positive.

But the complexity of supply chains, a small country’s ability to compete with bigger ones, given ‘Big Pharma’s’ drive for profit maximisation, and other countries with greater needs will make delivery difficult to predict. It isn’t a level playing field.

Dunne is on stronger ground when he criticises the release of the damming Heather Simpson-Brian Roche report on border management systems following the Auckland lockdown in late December. This is a common technique of successive governments. I can’t see any political advantage to the government for this decision because they are seeking to reduce the role of the Health Ministry and greater exposure of the report would have helped this agenda. Rather than any devious motive I suspect it is the result of an overconfident ‘too clever by half’ mentality.

Peter Dunne’s accusation about “days of genuinely good behaviours masquerading as optimistic half-truths” is the wrong description of the response to Covid-19. Instead the strategic response has been very successful but, in these unprecedented times, there has been too much sluggishness.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

Contact Ian Powell

• Website - Otaihanga Second Opinion