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Not all the lessons learned from Covid-19 have been incorporated into the Ministry of Health’s new pandemic plan, infectious diseases professor David Murdoch and former director-general of health Sir Ashley Bloomfield write in the New Zealand Medical Journal published on Friday.
Murdoch, who advised the previous government on its Covid-19 response and served on two advisory panels during the pandemic, told Newsroom that New Zealand is better prepared for a global health emergency now than it was in January 2020.
“We are definitely ahead of that. There’s a recognition that it’s not just about influenza. We now know a lot more about masks. The lived experience is still real. In terms of some of those public health interventions, we’re much more comfortable about that,” he said.
There is still, however, room for improvement.
“We can be better, of course. No question about that.”
The editorial in the medical journal follows the publication of an interim, updated pandemic plan by the ministry in July. It’s the first substantive update to New Zealand’s plan for a pandemic since 2017, but experts say it doesn’t go far enough.
It’s a view shared by Murdoch.
“I’ve been harping on for a long time, as others have, that we just need to get on with getting this plan in. There is information out there, we just need to do it,” he said.
The changes made in July largely reflect the reform of the health system and the consolidation of the District Health Boards into Health New Zealand, although there are also mentions of the possibility of eliminating some pathogens and of closing the borders, which were absent from the original plan.
A spokesperson for the ministry told Newsroom that understanding of pandemics had developed since the original plan was written in 2017.
“The interim updated plan has expanded to cover respiratory illnesses in general, not just influenza, to ensure the plan can be used in wider range of possible pandemics. It also embeds other lessons from COVID-19 response, such as doing regular public health risk assessments and adopting a flexible testing approach,” they said.
As it stands, the ministry is waiting for the public release of the first stage of the Royal Commission into the Covid-19 response before updating the plan further. Newsroom reported in September that this report may be withheld from the public for months after it is received by ministers.
While the Royal Commission has yet to report back, Murdoch said there are clear lessons that can be incorporated into the pandemic plan now.
“I understand how we get distracted by other priorities but the longer we leave it, the harder it is to capture all of those lessons…. In terms of countries getting prepared, we are lagging behind. I’m always going to say we need to have as much as we can, yesterday,” he said.
In the editorial, Murdoch and Bloomfield (who is now a public health professor at the University of Auckland) outline three key lessons from Covid-19.
First, they recommend avoiding reliance on an influenza-centric plan.
“The immediate challenge in the early stages of the Covid-19 pandemic was that existing pandemic planning, both in New Zealand and most other countries, was largely focused on influenza,” they wrote.
“It became quickly apparent in early 2020 that Covid-19 was not behaving like seasonal influenza, and a shift to the ‘manage it’ phase of the plan would likely overwhelm the health system and result in unacceptable loss of life, as was being witnessed in many countries at the time.”
Murdoch said the revelation by World Health Organization researchers dispatched to Wuhan in early 2020 that the lockdown was stopping the spread of the virus showed it behaved differently to influenza, which traditionally has too short an incubation period to be effectively controlled by such measures.
Clear leadership and decision-making structures were also crucial parts of a successful response.
“Each country’s response varied significantly, and in New Zealand it became clear early on that leadership structures envisioned in planning frameworks needed to be rethought rapidly to respond to the evolving situation and the emergence of elimination as the overall strategy. Rapid, highly co-ordinated cross-government leadership and decision-making were needed,” Murdoch and Bloomfield write.
Third, pandemic responses needed to go beyond the health system and the health dynamic.
“Both Ashley and I feel that given the wide societal, economic impacts, this is more than just a health security issue. This is a security issue, a national security issue, so it needs to be managed at that level,” Murdoch said.
The editorial recommends the national security apparatus should lead a future pandemic response like the Covid-19 group within the Department of Prime Minister and Cabinet (DPMC) did from part-way through 2020.
The Ministry of Health spokesperson said DPMC is currently undertaking a review of the national security system more broadly.
“Along with other relevant agencies, the Ministry of Health is actively engaged in this process. Pandemic preparedness requires whole of government preparedness and response. The updated pandemic plan is only one tool for developing health system’s preparedness and complements preparedness work across health services and wider society,” they said.
One aspect of the new plan that has Murdoch and Bloomfield feeling optimistic is the possibility of regular updates. The promise of future changes “signals that pandemic planning is dynamic and will continue to evolve…. We consider that the plan should be updated at least annually and that there are at least biannual exercises to test it against different potential pandemic pathogens,” they wrote.
“Currently, the plan focusses on respiratory pathogens; recent and ongoing outbreaks of mpox remind us that we need to prepare for diseases caused by pathogens predominantly spread through other routes as well.”
The health ministry spokesperson said the plan could still be used for a non-respiratory pathogen.
“Respiratory pathogens, including Covid-19 and influenza, account for the pandemics that have had the biggest impact on New Zealand in the past century. We acknowledge that there are other non-respiratory pathogens that have the potential to cause a pandemic. While the interim updated New Zealand Pandemic Plan does not consider these pathogens specifically, it will provide a useful reference to support the planning and response to a non-respiratory pandemic or outbreak.”