INDEPENDENT NEWS

A Slow-motion Death Sentence

Published: Fri 15 Oct 2021 01:35 PM
Our government currently seems determined to make this country follow in the footsteps of other countries who have seen deaths, illness, loss of freedom and economic disaster. Their only rationale seems to be that vaccines will make everything better so we don’t need to worry any more. There is talk from ministers of “modelling” but any such self-evidently more contingent and far less certain than the sort of modelling has helped shape the alert level settings used in elimination.
The two most laudable aspects of our government’s response to the pandemic up until a month ago were an intolerance for avoidable death and disease, and an intolerance for avoidable uncertainty (and hence risk). Suddenly that does not matter any more to the government and continuing to do what we have done successfully so far is now unthinkable because we have to return to “normal”.
Some would say that the government has been worn down by the relentless sabotage of the “opinionists” in the media whose relentless irresponsible, irrational and sometimes completely unhinged reckons have recently been surveyed by Josh Drummond. The pandemic has seen them seize every opportunity to practice PDA – Public Disservice Announcements.
Reckons aside, though, I believe that much of the government’s current willingness to accept the virus into our homes and our hearts is because of a long-standing irrationality when it comes to the subject of Covid vaccines. A combination of magical thinking about the benefits of vaccination, a political calculation that people will accept the pandemic more if they feel less personally endangered, and the ability to morally hand-sanitise (like a 2021 version of Pontius Pilate) by making it seem that those who suffer and die will only be those who have the agency plus a few unlucky ones with breakthrough infections who were probably old and sick with other things anyway.
Everything we have seen and decried overseas seems to have arrived on our doorstep at once. From blaming minorities to justifying political decisions on the fact that some unspecified future time all of this will be over. We also hear that with a vaccine this is just like a ‘flu and that eventually we have to accept that some level of death and disease is inevitable.
Three things horrify me – that we are demonising the unvaccinated so that we will deny them their full humanity when they die as a result of government policies; that we are wasting the advantage that widespread vaccination could give us in maintaining an elimination strategy with more liberal border restrictions and less reliance on lockdowns except as an occasional stop-gap; and that we will be far more vulnerable to the arrival of vaccine evasive mutations in the future.
The allegory I would use is this:
We are on a road-trip, doing a figure eight up and down both coasts of Te Wai Pounamu and Te Ika a Maui. We have finished the southern half and we are sick of the inconveniences of our 2019 Honda Leaf. The sense of self-righteousness is great, but having to plan around charging stations and sometimes boring waits in unappealing places begins to pall, even though we a heading across the strait to a land of more plentiful chargers.
Eager for change and sick of the back-seat whinging our driver has pulled over suddenly on seeing a rusty 1974 Holden Belmont (or rather “B lmo t” according to the name badge) with a “for sale” sign in Blenheim. With determination and trademarked compassionate cheerfulness our driver negotiates to a direct swap of the annoying Leaf for the capacious B lmo t. Of course, it has no warrant of fitness, won’t go into 2nd gear, and the vendor told us that we should avoid any downhill driving if possible because the brakes have “issues and problems”, but our fearless leader has packed us into the new car with extreme haste. Andy has called shotgun, while Chris, clutching the road map in his hand, is packed unceremoniously into the back passenger-side seat, seeming quite confused as he starts to wonder how he is supposed to navigate when he can’t even see the road ahead.
Doing the second half of the roadtrip in a decrepit Holden will be dangerous, irresponsible, kinda yucky, and really really expensive; but it will give us something that the Leaf never could deliver – the chance to pretend we are not living in 2021 – also known as FREEDOM!
Some of you will die, but that is a sacrifice Andrew Little is willing to make
Andrew Little has been cast in the role of Lord Farquaad. His weasel language on RNZ’s Midday Report (14th October) emphasised that vaccines would “lower the risk” of serious illness and death, but he is deliberately emphasising the individual risks in order to make the listeners feel more reassured while proposing policies that will ensure, rather than “risk”, that people will get sick and people will die. He also emphasised an optimism that we may reach a rate of 90% of eligible people vaccinated. Talk of what may happen in the future is always to be suspected, even when supported by modelling, but the most weasel aspect of Little’s claim here is the word “eligible”.
“Eligible” vaccine recipients do not include children under 12, and this allows a deceptive use of figures. In this context there is no intellectually valid reason to prefer the use of the “eligible” population over the actual population. 90% simply sounds more impressive and far more reassuring than the reality of around 75% of the total population that it would represent. Given that our most vulnerable populations have the highest percentage of young children and are so far the most vaccine resistant, Little’s vapid happiness about a 90% vaccination rate which we have not even reached yet, is infuriatingly blasé.
Singapore has a 78% vaccination rate out of its 6 million people (as high a rate as we can realistically hope for). This led them to relax Covid restrictions and now Singapore’s death chart looks like this:
Little’s assurances that the transition to suppression will not occur until all groups have reached 90% also ring hollow because if that was really the condition that they considered sufficient they would be issuing a grovelling apology and putting Tāmaki Makaurau/Auckland back into level 4. Any other approach is just hollow rhetoric so that when the outbreak spreads to the point where elimination is abandoned in the rest of the country, they can claim that their hand was forced by unforeseen circumstances, and that having 98% of Fendalton and Remuera vaccinated somehow balances out what is happening in Aranui and Pomare.
They are not us
Despite the certainty that a move to what Little inanely describes as “normal” will lead to suffering and death, it is presented as happy news. Whatever our vaccination rates, if we abandon elimination people are going to die. Children are going to die. Vaccinated people are going to die. Unvaccinated people are going to die. But the subtext is that we aren’t supposed to care about these people. They are the statistically unlucky and the self-selected unfit. People die all the time, so who cares if a few more get added to the pile, especially if they choose death by refusing to be vaccinated. Surely we can’t be expected to forego our precious freedoms to save people who won’t save themselves, right?
I know several people who are not likely to get vaccinated against Covid. Two or possibly three of them are of an age and health status where there is a scarily significant chance that they will die when they contract the virus and they are quite likely to become seriously ill, with a high chance of long-term debility.
I can not and do not wish to share private details of all the people I know who are against taking the vaccine, but I feel that people must understand that any move away from an elimination strategy is an immoral act, and that simply washing your hands of the deaths of the unvaccinated is callous and cruel. Aside from the fact that there are people with physical health problems that prevent them from being able to choose to be vaccinated, those who choose not to be vaccinated cannot simply be discounted as the authors of their own peril.
We are all products of of circumstances and a disproportionate number of those who do not get vaccinated are those who are disadvantaged. Let be also make clear that being “disadvantaged” is policy not the result of making poor decisions or being less able. In this country at this time, despite what many would like to believe, disadvantage is something that is mostly acquired at birth.
For these reasons I feel I have to tell you about a friend, “T”, who is determined not to be vaccinated and whose death may well result. To say that it is their choice is only true in a narrow and morally meaningless sense. When I detail this person’s story, which in many ways is just a more stark version of a story the pertains for many others, you will understand that they need and deserve protection.
Going Off-road
During the 13th of September press briefing Jacinda Ardern said “For now the strategy is vaccinate, vaccinate, vaccinate.” She used the term “vaccine” or “vaccination” about 30 times, and, as can be seen in the quite where it is “the strategy” her rhetoric leans far more towards vaccination as a solution rather than vaccination as a tool. I will return to this issue, but suffice it to say at this point that it is a radical departure from the very successful policy and communications combo that saved lives, protected the economy, and gave us an often unequalled level of freedom during the first 18 months of the pandemic.
On October 4th the PM spoke to “confirm” a “road map”. In that press conference she used the term “transition” (or derivatives) more than 25 times and it was very clear that she was talking about an ongoing process: “This is a change in approach we were always going to make over time. Our Delta outbreak has accelerated that transition, and vaccines will support it.” The subtext is very clear despite having since been walked back somewhat: Aotearoa has moved from elimination to suppression. This was not stated overtly, creating some confusion and diffusion of opposition to the change which was clearly a purposive communications strategy which gave a lead time to establish facts on the ground while delaying open debate.
Note that, according to the PM, the current Delta outbreak did not delay the transition, but rather “accelerated” it. Assuming that they were intending this transition when it was safe, one must conclude that an accelerated transition involves more negative outcomes for individuals, more aggregate economic damage, and more risk of uncontrolled cumulative harm such as might occur if health resources become stretched and/or if meaningful contact tracing becomes impossible. In contrast, another fortnight in level 4 might have led to the end of the outbreak. Even if there was an uneradicable chain of transmission among vaccine resistant and lockdown non-compliant people, the higher vaccine rates of a delayed level change might have made all the difference given Delta’s proclivity for casual transmission.
For the week after the move to Level 3 in Auckland “transition” seemed to be Ardern’s favourite word, even as her health minister kept using the language of elimination. The figures, however, have been speaking louder than both. On RNZ National 11th October epidemiologist Rod Jackson retrospectively supported the move to level 3, remarking that he felt that the “tail” of the outbreak was due to those who did not obey the rules anyway. Even if this were true it is somewhat puzzling that he did not recognise that this “tail” would be preferable to a second wave in the outbreak and spread to other regions, both of which were evident by the time of his comment. The fact is that regardless of Jackson’s rationale at the time, and the government’s at that time, no one could say for sure that elimination could not end the outbreak and no one could reasonably claim that a move to level 3 would reduce the likelihood of that , if not render it impossible.
The numbers paint a simple unambiguous picture – after the transition to Level 3 there was a continued decline in case numbers – showing that Level 4 was still working at the time that it was abandoned. Community case numbers dropped to single figures until 8 days later, almost exactly when you would expect the results of the level change to begin showing, then community cases began to rise and have continued to do so ever since.
Could Jackson have been right in thinking that non-compliance would have meant that changing to level 3 made little difference and this rise would have come anyway? It seems vanishingly unlikely for the simple reason that it is far easier to to break the rules in level 3 than level 4. The disease does not target special naughty people, it spreads through risky behaviours. Both the ideologically non-compliant people and those who are part of the normal spectra of selfish, lazy and skeptical rule-breakers will have given the virus many more opportunities for transmission than would have occurred under level 4.
Under a steadfast elimination policy using the same calculus as prior outbreaks, Tāmaki Makaurau might now be in level 3, but with a much lower completely traced case rate and with a well understood “road map” to level 1 along a path already travelled. Instead the very insistence on a “road map” that can be laid out through crystal ball gazing has led us off-road. We risk repeating the same inane process of overshooting our marks out of arrogant optimism and then being forced to retrace our steps (losing time, money, and people) that has plagued the UK (where a new report described the early response as “naive”, “arrogant” and “one of the UK’s worst ever public health failures”). The outbreak now seems to be threatening to become uncontrollable in a way that we have not experienced in this country. The increase in unlinked cases is also highly alarming, with 32 unlinked cases announced on 14th October alone.
Delta Déja-vu
In practical and moral terms we are facing a situation very similar to that facing the world at the beginning of the outbreak. Delta is a game-changer, and so are vaccines. The two don’t exactly cancel each other out but they create enough uncertainties that the situation facing our government is actually very similar to that facing them at the time of the outbreak (though they seem not to recognise this).
Vaccines are good at preventing individuals from getting seriously ill and dying in comparison with the unvaccinated, but the reduction in transmission they provide is largely offset by the increased infectivity of Delta which can occur from the unvaccinated (including children) and from breakthrough infections. Outcomes for fully vaccinated people who do get breakthrough infections, while improved, can still be terrible – a lot worse than not getting Covid in the first place for example.
Those who are completely sanguine about Covid becoming an endemic disease should consider that in Wales recently the BBC reported that 80% of hospital admissions for Covid were fully vaccinated. This does not mean that the vaccine is worthless because in Wales 95% of the elderly are fully vaccinated (and probably a similar number of those with other risk factors). What it does show is that breakthrough infections are very dangerous. The UK has been sitting on weekly totals of 700-plus deaths for two months now with little sign that anything will get better and winter looming ever larger. Is that what we want here? In fact we might be lucky if our suppression works that well because there are high levels of immunity in the UK community among those who have already caught the virus. Our government anticipates perhaps reaching 5,300 cases a week in just Auckland and Northland alone
The people who would die most from breakthrough infections are the sick and the elderly and they will be joined by the unvaccinated. Every Covid death also betokens numerous people with long-term illness and debilitation. Given the infectiousness of Delta, if we do not return to an elimination strategy, there will be shocking amounts of death and sickness – almost certainly it will eventually be worse than what is currently occurring in the UK due to our lack of naturally acquired immunity.
As John Donne Potter, Graham Le Gros and Rod Jackson wrote recently: “Allowing the virus to become endemic would mean the regular closure of schools and businesses and thousands of deaths each year.” The closures they describe mean, of course, that even if the virus is endemic, there would still be a need for suppression measures – serious and disruptive measures:
If Covid-19 becomes endemic, we will live with a stressed, often overwhelmed healthcare system, with schools subject to unpredictable closures, with unsafe workplaces, with a disrupted economy, with our children under threat, with death and disability at a persistently higher level than we have known – probably for decades.
We do not care what the current strategy is called as long as we persist with border protection and public health measures until we achieve close to universal vaccination. Otherwise, many thousands of New Zealanders will be hospitalised, die or experience long Covid.
T’s Story
As things stand at the moment my friend T is unlikely to get vaccinated. T is in their 70s. T is overweight. T lives alone. T’s diet is not great.
If T contracts Covid-19, the outlook is grim.
As a young child T was institutionalised, then put into various foster homes with periods of hospitalisation. T was diagnosed as “retarded” and was treated as intellectually disabled. T is almost certainly not intellectually disabled, but presents as intellectually disabled in most people’s eyes. T was poorly educated and even more poorly socialised. T has never had a normal family life. Relationships are difficult for T, trust is even more difficult. T has a very understandable tendency towards paranoia and resentment.
Does this person deserve to die? Is it really their “choice” to be unvaccinated? And really how different are this person’s experiences from those of other people who will not trust authorities that may have harmed or failed them in many ways?
Everyone has reasons for their choices and much of the resistance stems from the inequalities in our society and the inherent distrust that comes with the “democratic deficit” - the repeated tendency of elected governments to enact policies in direct opposition to the clear will of the majority.
We are all products of our circumstances. There is a growing sense that some people would like to end elimination because only those who choose to be unvaccinated will suffer and die. This is factually wrong and morally indefensible.
We will undoubtedly reach higher vaccination levels than less democratic, more divided, and more corrupt societies who shall remain nameless, but we will never get the safety and normality that politicians promise unless we understand that vaccines aren’t magic beans, and they are not a valid excuse to end stringent public health measures when they are needed.
Vaccine Tragics
Right from the earliest days of the pandemic some people have been irrationally one-sided about the potential for vaccines to be the miracle cure, so to speak, that ends the pandemic. Long before any vaccines had even gone to stage 3 trials politicians and experts alike began referring to vaccines as “the only way out” and as vaccine rollouts got underway in rich countries, it became a common editorial refrain.
It is not rational to refer to a single measure as “the” solution to a problem of this magnitude. It is like claiming that “the only way out” of climate change is electrification of all motorised transport which is a not a solution at all if you build coal-fired power plants to power them in the self-righteous certainty that you are doing the right thing.
Some analysts use the term groupthink to describe a phenomenon that distorts decision-making in groups of people. Among those with authority and status, groupthink often manifests in logic being distorted by a fallacy known as an “argument from consequences” in which things are argued to be true because if they were false the consequences would be bad. Under this sort of groupthink certain transformations or changes in the status quo become unthinkable, and the idea that old methods and institutions might need to change to meet new demands is heresy. Weirdly, it often seems that elites in this regard are more comfortable with the notion of the world coming to an end through nuclear war or climate disaster, then they are with the idea that radical change (such as nuclear disarmament or a green new deal) is needed that might upset the hierarchies of power on which their power rests.
Elite groupthink is also characterised by Panzaism. This is the antithesis of Quixotism which the sort of overdramatic thinking noticeable among Qanon believers and millenarian religious zealots who see portents of the end-times in every deformed cornflake and silly internet trend. Panzaism, by comparison, is epitomised by the meme dog drinking coffee in a burning room remarking “this is fine” or Officer Barbrady telling everyone “nothing to see here” as a giant reptile-robot Mecha-Streisand eats whole buildings and incinerates screaming townspeople.
If groupthink is a disease then the original “alpha” or “covidiot” strain infected Trump, Johnson, Morrison and Bolsonaro to name but a few. It attacked Trump with particular virulence, causing him to say things like “It’s going to disappear. One day, it’s like a miracle, it will disappear.” Which is absolutely true, of course, in the same sense that one day the Earth will disappear, as it boils away in the expanding photosphere of our ageing sun billions of years from now. Miraculous stuff the passage of time. Pretty good at making things disappear.
The “delta” or “vaccine tragic” strain of groupthink almost exactly mirrors the thoughts of the covidiot strain with the caveat that complacent rosy assumptions are now explained with “because vaccination”. This strain has actually come to supplant and dominate even those originally infected with the covidiot strain. Some months ago when the UK had managed to bring case numbers and fatalities right down with lockdown measures while rolling out a pretty successful vaccine programme Johnson decided to ease restrictions even though delta had caused the R rate to creep up significantly above 1 again. His reason for easing restrictions while still in a growing wave? Because vaccines.
“In fact, an R value of between 1.2 and 1.3 suggests... [that] ...over a two-week period you may see a doubling in cases, but it very much depends on whether we sit closer to 1.2 or 1.3. We do need everyone’s help to continue to comply with those restrictions, but also we are seeing the impact of vaccinations.”
The above quote is from Jacinda Ardern during 12th October’s 1pm press conference, but it could have been from Johnson in one of his more cogent moments a few months ago. The UK has gone from at that time of lockdown ~10,000 cases per day and ~10 deaths per day to current levels of ~35,000 cases per day and ~100 deaths.
One of the Johnsonesque things about Ardern’s words is the quibbling over numbers – it has strong “well, actually” energy and if you read it with Johnson’s voice and manner in mind you can almost taste the pontification. Yet if you watch her, she seems more as if she is sweetly concerned that anyone might stray into error and go away thinking that the R rate is definitely 1.3 when it might actually be closer to 1.2 – which would be a pitiable state of ignorance. (Incidentally, the 7-day rolling average case number on October 1 was 21, and on October 14 it was 45, which is more than double. I am also certain that the case numbers will hit 90 on the 7-day average days before a fortnight is over, just as the daily numbers will be in three figures significantly before the fortnight mentioned by Ardern on the 12th and McElnay on the 14th).
Numerical details can be used to illustrate the scale and the fearful power of exponential increases, or they can be used as they are by politicians, by trivialising and distracting people; and by tricking them into narrowing their perspective into a tight set of assumptions. Ardern is joining a woeful club of leaders throughout history who have spun horrific suffering into some sort of sick relativistic calculus of “bad news” and “good news”. With “good news” now redefined as being less people died today than expected, or even as the increase in people dying is less than expected. It is not just bad moral calculus it is bad differential moral calculus.
What bell? I can’t hear a bell tolling,
or,
5 million teams of one
Another thing of note in Ardern’s above quote is the final remark about the impact of vaccinations. She is placing that observation in the context R values, and I am sure that that is intuitive to her, but it does not belong there. She is almost certainly basing that remark on the anecdotes of extremely close contacts who have avoided contracting Covid (though perhaps there is also some modelling). However, as we know from the UK, the demonstrable driver of when infection rates dropped, was the lockdown measures.
The PM’s remark about “seeing the impact of vaccinations” has a surface plausibility in that it seems to suggest that things could be worse without vaccinations and that even more vaccinations will prevent even more suffering. Ultimately, though, the underlying rationale the same as Little’s comment about “rates”. It is not about how many people die altogether, it is about your personal chances of dying. We are not a team of 5 million, we are now 5 million teams of one. This is inevitably so because the pandemic in not a neutral setting wherein we are all given equal exposure by, say, all being forced on a 2 minute speed-date with a coughing Covid sufferer. Our exposures are determined by policies and if the government lets us all be exposed to the virus, even if we are highly vaccinated and even if they use suppression measures to make sure not too many people get sick at once, the results will be that many thousands will die.
Like the “free-market”, the notion that there is an exposure risk that is independent of government policy is a patent fiction. In those circumstances trying to cast yourself as saviours of the living rather than agents of death akin to me telling a person whose mother has died that things are okay because my mother is still alive, and so is my neighbour’s mother, and so is her daughter’s. (Three alive people surely balances out one dead person doesn’t it? That is just maths.)
If everyone in this country is exposed to Covid-19 the result will be catastrophic, even at the highest possible vaccination levels. No responsible government could think that this is an acceptable outcome. The most obvious answer is therefore that vaccinations should be used to increase herd immunity and thus bolster and facilitate an elimination strategy. Instead they want to allow the virus to circulate in the community, while suppressing it so that constantly inflicts pressure on our health system, our social fabric, and our economy; while always threatening (but hopefully never managing) to spiral into uncontrolled exponential catastrophe in one or all of these areas. Doesn’t that sound like a fun way to live?
Death of a thousand cuts
One of the striking things about Aotearoa’s experience of this pandemic so far is the lack of economic damage. Compared with an elimination strategy suppression is a never-ending drain that has been hitting other countries very hard. Despite thus, we have heard endless complaints from the most short-sighted business people. Some are understandably desperate and cannot think beyond their own dire circumstances but others are clearly blustering fools who simply refuse to accept that there is no going back to “normal” because there is a pandemic happening.
The media and business community seem ridiculously obtuse to the efficiency of elimination in contrast to suppression. Each case of Covid is a burden on resources, and cases cause further cases which cause further cases ad infinitum. Stopping cases from occurring in the first place with any reasonable measure will pay for itself.
Elimination costs are like overheads, but even if suppression has lower overheads (which is not clearly established) the running costs of dealing with active cases under suppression are potentially insane. This affects us all, including the business community. While some industries have been hit hard by elimination the pain of suppression will be far more widespread. The government should not cave to specific industries, but should rather should be offering assurances and direct support, bringing their interests back into line with the rest of us and establishing the same sense of social contract that they achieved in the first lockdown by a combination of broad action and soothing rhetoric.
Our government now seems determined to make us go through what other countries have been through. Perhaps our leaders are scared that having no naturally acquired immunity will make us more vulnerable to vaccine evasive mutations. That doesn’t make a lot of sense, but the only other rational explanation for their actions would be that this is all just to scare us into taking Bill Gates’s vaccine full of 5G enabled nanolizards. More likely, though, there is no rational explanation for this transition to suppression. They have been nursing a latent case of aristocratic hubris for a long time, and the vaccine programme has potentiated it.
A cynic would say that the only reason that Aotearoa’s initial response was so good in the first place is that our ICU situation was so dire that the pandemic would have caused unacceptable levels of death. It would follow that for some politicians (such as Little and, despite her rhetoric, Ardern) there has always been an acceptable level of death that is worth the price of not having to remain at odds with neoliberal norms of maintaining a certain level of social Darwinism. Andrew Little showed John Key levels of relaxedness about, according to him, the smooth and certain way we are going to deal with the pandemic going forward. He claimed that we will be treating most people at home and blithely assured us that people can just visit their GP when they get the virus. The few people who are at special risk from this formerly deadly disease (that is now really just like the ‘flu and not really that deadly) can then stay home with an oximeter and if things get too bad they’ll be zipped right off to hospital as quick as boiled asparagus. Anyone listening to him would think that we did not have an ongoing health crisis in primary care and hospitals and that none of this apparently orderly and controlled disease rollout will affect other services. Anyone would think that you can get a doctor’s appointment whenever you want without a 2 month wait. Anyone would think that the health system is not full of overworked staff, already struggling at the edge of breaking point.
In contrast to Little’s clearly risky if not obviously doomed proposal, a highly vaccinated population could ease the ongoing burdens of maintaining an elimination strategy and would put us in a very good position to deal with dangerous mutations as they arose overseas. Of course, a Covid-free Aotearoa would be an ongoing embarrassment and rebuke to those countries that have already had disaster inflicted on them by their governments, and maybe their politicians have been working on ours, gaslighting them into joining the madness.
Reegardless of their motives, our government is currently enacting policies that will kill people. None of those people deserve to die, and none of them deserve to be dismissed as insignificant statistics, unavoidable collateral damage, or people who simply made their own bed to lie in.
Experts are pleading for the government to return Auckland to level 4 and Te Pāti Māori are joining the call. Co-leader Debbie Ngarewa-Packer said, “Maori are now presenting over half of daily cases. We need to be placed back into a level that will break the circuit of this outbreak for Māori.”
There is also a petition asking the government to re-commit to elimination.
This is not okay. Our government is betraying everything that it achieved and all of the fine principles which has continually espoused in this and other crises. They are being callous, reckless, naive and arrogant, Thousands of people are going to die if they remain on this course. It is not too late for us to change. Vaccinations can help us return to an elimination strategy, but every day of the current increase in cases makes it easier for the government to declare an end to elimination as a fait accompli. We need an immediate return to level 4 in Auckland and a re-commitment to the principles of elimination.
Kieran Kelly
Twitter: @keiyarkelly

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