The announcement today that New Zealand will introduce vaccination certificates by November is welcome news. Whether by “carrot” or “stick”, vaccination rates should continue to climb, as case numbers are now likely to climb under Alert Level 3 conditions in Auckland.
We’ve seen an increasing number of mysterious cases over the past few weeks – people testing positive after going to hospital for non-COVID reasons, or from essential worker surveillance tests.
These cases suggest that there is a significant amount of undetected community transmission, and this makes it very difficult to stamp it out.
While the slight easing of restrictions announced yesterday may or may not accelerate the rise in cases, it is unlikely to slow down. This has sparked some debate about whether the government has abandoned its elimination strategy in favor of suppressing cases.
To some extent this is a meaningful argument. Elimination is defined as “zero tolerance” for community transmission, as opposed to zero cases. The fact that New Zealand was able to achieve zero cases in the last 18 months has essentially come to define what elimination means in practice.
Before vaccines were widely available, having zero cases was crucial in allowing us to enjoy the freedom of Level 1. But New Zealand is now transitioning into a new phase of the pandemic, and that was always going to happen. Borders can’t stay closed forever and the virus was always going to be late.
There is still a possibility of a return to strict restrictions
In an ideal world, our border security would have kept Delta out and New Zealand would be able to remain at Alert Level 1 until the vaccine rollout is complete. But Delta’s wrath has forced our hand somewhat.
Whether another week or two at level 4 will be enough to end this outbreak is impossible to know. Given that the outbreak is spreading in very hard-to-reach communities, it is extremely challenging to stamp out every chain of transmission.
As we move from elimination to suppression strategy, the country will have to tread a very narrow path to avoid overwhelming its hospitals and throwing its at-risk population under the bus.
This includes Māori and Pasifika, who, despite being at high risk of severe COVID-19, were effectively placed at the back of the vaccine queue due to their young population.
Read more: NZ needs more urgent vaccination plan – almost 80% now with single-dose, most will support it
We are now relying on a combination of restrictions and immunity through vaccination to stop the rapidly rising number of cases. As vaccination rates increase, restrictions can be progressively eased.
But if we rest too much, there is a risk that the number of hospitalizations may spiral out of control. When the R number is above 1, cases will continue to rise until either greater immunity or stricter restrictions bring it back under 1.
Raising vaccination rates is important, but it will take time, so the government may be forced to tighten restrictions to protect our health systems.
Read more: New Zealand can’t give up on its COVID eradication strategy, while Māori and Pasifika vaccination rates remain very low
New Zealand has always had to grapple with these difficult decisions, although Delta has forced us to do so more than ever before.
But our eradication strategy has given us a significant advantage – about 70% of the total population has received at least one dose of the vaccine before experiencing any large-scale community transmission.
We still have a lot of work to do, but having access to a vaccine before being exposed to the virus is not a luxury people have.
A lot can happen between now and Christmas. Currently, there are more than 100 people in intensive care in the Australian state of Victoria, which is equivalent to about a third of New Zealand’s total ICU capacity. Those ICU beds are usually filled with patients with conditions other than COVID-19.
The implications for the health system are clear. If New Zealand goes via Melbourne, perhaps harsher sanctions will be unavoidable.
no white flag
The more optimistic scenario is that a combination of restrictions, vaccination and contact tracing is just enough to keep a lid on case numbers. This will increase in almost unavoidable cases. But if it’s not fast enough and hospitals can keep up with the demand, it could haunt us until we need higher vaccine coverage.
Read more: New Zealand government takes a calculated risk of easing Auckland’s lockdown while new cases continue to emerge
And while vaccination rates aren’t high enough yet, they’re still helping a lot, halving the R number that would be without a vaccine. The country is now in a far better position than if Auckland’s outbreak had occurred in May or June.
Everyone can do their part by doing two things: help and encourage people around them to get vaccinated, and follow the rules.
We need to keep the community transmission rate low to help keep pressure on our hospitals and reach the next phase of the road map. Moving away from the literal interpretation of abolition does not mean waving a white flag.