‘Warning-Pull-Up’- Promise Of End Of Year Vaccine Rollout At Risk

This is the year the COVID-19 vaccine rollout, the biggest immunisation campaign in New Zealand history. For the NZ population over 16 years old, the NZ Government has declared that by the end of 2021 the programme will be complete, for those who wish to be vaccinated. Inherent in this undertaking is the assumption that, by 2022, the immunisation uptake will have reached sufficient levels for population immunity to begin to take hold, substantially protecting NZ from further outbreaks. This in turn will allow New Zealand to begin to gradually open its borders. There are several factors that are putting this commitment at risk. These include a slow vaccine rollout performance, vaccine hesitancy, limited public and business sector involvement in vaccine promotion. The following are actions New Zealand must promptly take to salvage the situation.

The Numbers Problem

There are an estimated 4,082,500 New Zealanders over 16 years old. The latest Ministry of Health survey suggests 77% are likely to get vaccinated or already have been, this equates 3,143,525 of us that will have had or will likely get a vaccination. Now with the recent Medsafe provisional approval of 12-to-15-year old’s, there is an additional 265,000 teenagers to add to this equation. Due to parental/guardian hesitancy and younger people’s higher disinclination levels, assume this younger cohort will experience lower levels of vaccine acceptance. A reasonable uptake assumption for this group might be 50%. If so, that brings the total vaccinated or likely to be to 3,276,025. This is 65% of the total population of 5.0M that will probably reach immunity. As the Pfizer vaccine is known to be 95% effective this calculation should be is adjusted down for the 5 in 100 people for which the vaccine will be ineffective. This reduces the percentage of potential immune to 62% which is well below the 80-90% immunity level that could provide any form of ‘herd immunity’ to NZ. It is important to note the Pfizer vaccine is now known to be less effective against the Delta variant with efficacy dropping to 88 to 64% depending on the study.

Execute with Urgency & Promote with Conviction

It is therefore crucial that the vaccine rollout is executed efficiently, effectively and at pace. Above the age of 12-year-old there are nearly 1.0 million Kiwis that are likely hesitant about vaccination. It is essential that the immunisation programme is strongly communicated and promoted by not only Government and public leaders but also by recruiting private sector chief executives, university leaders, national celebrities, and community influencers to help mobilise the country. The May 2021 Auditor General report on the rollout highlighted that there were significant shortfalls in the Government’s communication efforts promoting vaccination. While there have been some improvements since May, overall, it has been a generally lackluster public relations performance. Vaccine hesitancy requires hands-on active management at local community level. This latter point will be especially true for younger adults and children over 12 years old. International experience indicates it is critical to target this younger demographic to get vaccine uptake above 80% plus.

1.3 Million Jabs Given, 5.3 Million to Go, with 177 Days Left

By the end of this year, if the Government is going to deliver on its commitment, two doses must be given to the 3,276,025 vaccine favorable people, that is, 6,552,050 jabs into our arms. As of 6 June, 1,270,719 doses have already been administered leaving 5,281,331 to deliver by the end of the year. As of writing the article, there are 177 days to go to New Year’s Day 2022. This will require the vaccine rollout programme to inject an estimated 29,838 (30,000) doses daily into Kiwi arms through all weekdays, all weekends, and all holidays. The highest daily rate delivered by the rollout thus far was on a weekday, 23 June 2021, which was 24,734. A 21% improvement on this best vaccination day is required to get the performance to the required 30,000 per day every day for the rest of the year.

Immediately Double the Vaccination Rate

Across NZ, since the middle of May the programme has been averaging 16,000 jabs per day. More latterly, since 15 June to this date, 21 days of vaccinations have delivered an average jab rate of 18,181 vaccinations per day. If it is assumed that even with system improvements to an average of 22,000 per day, it will take to the beginning of March 2022, to complete the rollout. Clearly outside of the Government undertaking. The present average rate will have to almost double to get the job done by the end of December.

Jabs Must Increase in Weekends & Holidays - 50 Weekend days & 3 Holidays left to Vaccinate

Further analysis of the Ministry of Health’s data shows the working day vaccination average since 15 June to 6 July is on average 20,590 per day, while the weekend/holiday rate drops by nearly 50% to an average of 9916 per day. To make headway, this weekend/holiday rate must at least double to 19,832 per day. 991,600 doses can be delivered with this higher rate with 50 days of weekends/holidays left until the end of the year. This leaves a remaining 4,289,731 doses to be administered in the remaining 124 workdays. This will require at least 34,594 vaccinations every working day. This combined with the improved 19,832 every weekend/holiday day, it is possible to reach the end of year objective within the days left in 2021. At a minimum the country must nearly double vaccination productivity to reach the end of year objective.

Every day that does not attain this improved productivity will have to be added on to the daily vaccination numbers remaining in the year, making the daily performance targets that much harder.

Plan to Vaccinate 50,000 Plus a Day

Unexpected delays to the programme are inevitable and accordingly there will need to be redundancy built-in to the rollout logistics. Problems such as vaccine delivery delays, inclement weather deterring people from going out to get their jabs, health sector industrial action, December holiday slow-down, and increases in vaccine complacency, are all potentially slowing the rate. Consequently, the country needs to gear up to have to have a vaccination potential well above 34,594 per workday & 19,832 per weekend/holiday rates calculated above. A latent capability must be organised to jab over 50,000 a day to compensate for the inevitable suboptimal vaccination days.

Only 40% of Vaccinator Workforce Vaccinating

Analysis of the Ministry’s vaccinator workforce data shows that as of 6 July only 40% of the vaccinator workforce is being used to vaccinate. Since February to date, deployed active vaccinators have remained on average at 40% of the trained workforce. The data shows these workforce numbers are independent of the available vaccine supply suggesting the pool of trained vaccinators is not being flexed to respond to the flow of vaccine. The information also highlights the active vaccinators are growing in small numbers. Active vaccinators as of 6 July are 3607. These workforce numbers are low when considering the task at hand to deliver millions of jabs. If active vaccinators do not increase substantially the capability to vaccinate 50,000 per day is unlikely to be reached. The deployment of supplementary vaccinator modalities will be critical to success. Greater numbers of GPs, pharmacists, mobile clinics, increased use of supervised unregulated healthcare personnel (such as health assistants) all must be ramped up. It is acknowledged that more vaccinators are planned to come on board and with changes to the Medicines Regulations this with will help increase the numbers and diversify of this workforce. However, with an average of only 70 new vaccinators being trained per day since late February it is vital that this number dramatically increases.

It will also be important that the distribution of this vaccinator workforce is proportional and equitable across the country to ensure all communities gain access to the vaccine. A predominance of urban based staff will risk skewing access towards the larger cities.

Very Low Natural Immunity

Nearly all of NZ’s population immunity will need to be generated from vaccinations. The population will be totally reliant on the vaccination programme to create any form of ‘herd immunity’ much more than other countries that have had much higher levels of ‘wild’ COVID-19 virus infections in both adults and children. In these jurisdictions a significant proportion of individual immunity was inferred from higher per capita community infections. This means NZ will need to vaccinate relatively more Kiwis due to our very low community infection rates to reach population immunity. Paradoxically, due to NZ’s successful elimination strategy the country will need to convince more vaccine hesitants & sceptics and children to get vaccinated than other countries whose hesitants & sceptics and children may have already been inadvertently inoculated in the community with ‘wild virus’. This makes the NZ vaccination rollout absolutely critical to the success of the entire COVID-19 strategy.

The Rise of the Variants

The slow NZ vaccine rollout greatly increases the risk of an outbreak in NZ. The rise of the variants, like the Delta variant, puts this country at significant risk. It is 137 days since the rollout launch and only 10% of the population have been fully vaccinated. Now with 177 days left to the end of the year and Government’s vaccination promise to be fulfilled, there are a number of outstanding issues that must be addressed. This includes; thousands of high risk border workers and their families who are still not or only partially vaccinated, declining QR scanning rates, growing levels of vaccine misinformation, increasing community complacency, and a minimalist ‘mask-use culture’ in New Zealand.

With 90% of the population yet to be fully immunised the probability of a variant incursion into the country must be considered a moderate to high risk. With such low vaccination levels and essentially no natural immunity such an event would be devastating to the NZ population, their health , our health system and economy. It would shake the foundations of the belief that as a nation NZ has so far managed this pandemic well and relegate the country to a failed virus elimination strategy.

Vaccine Supply - No Longer An Acceptable Excuse

While it was initially accepted that the continuity of vaccine supply may have contributed in part to the slower rollout, this can no longer be an excuse for not improving performance. The slow rollout, the worst in the OECD, has been caused by other factors such as poor initial information flows to the health sector from the Ministry of Health, patchwork DHB vaccination plans, lack of public transparency over rollout statistics and logistics. Initial hesitancy to use all available vaccination delivery modalities such as GPs and pharmacies. As for the COVID-19 leadership cadre of the Government politicians and the officials of the various ministries , their public facing attitudes to date has been characterised by an overarching general lack of urgency.

‘Warning-Pull-up, Pull-up’

For now, all these issues aside, the country must promptly ‘pull-up’ vaccination performance or risk crashing out of the year end undertaking to vaccinate the county.

Now, get ready to vaccinate an average of 50,000 per day. Urge everyone, when it is their turn, to get this jab and make getting vaccinated contagious.

Marcus Livingstone

The Health Reformist

Data Source: Ministry of Health Vaccination Data thru to 6 July

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