Reti ShaneDr SHANE RETI (National—Whangarei): Thank you Mr Assistant Speaker. Today I'm sad and angry for the meningitis outbreak in Northland. I'll be able to salve that sadness by doing everything I can and hopefully joining others from around the House to work with Northland District Health Board (DHB) to get a good outcome. Here and now I'll salve my anger by holding this Government to account.I want to start that by setting the framework of incompetence that feeds through that is symptomatic of the management of this outbreak with what we just heard from the Minister. He said Today Northlanders will be pleased that they will get meningitis vaccines in their arms." He also said the same in oral questions: "Very shortly Northlanders will be able to see the meningitis vaccine in their arms." Here's the problem: you don't give it in the arm for young children; you put it in the thigh. If the Minister had bothered to know his own immunisation schedule and read his own immunisation handbook he would know that in young children you don't put it in the arm—vastus lateralis. So please Minister don't encourage vaccination for young children in the arms of Northlanders; you will make them more ill.Now there's two parts I want to talk about. I want to talk about the missed response and then I want to talk about the poor response. I contend that this outbreak was actually known many months ago—at least 6 months ago right back through to May—and I'd make that case on several grounds.Firstly looking at the ministry's own public health surveillance information shows us several things. First of all in January this year there were four cases of meningitis. That doubled a month later—in February 10 cases. It doubled again a month later—in March 2018 22 cases; in fact two died in that month. In April another 10 cases—up to 29. And in May—which is when I stopped looking because that's when I believe the ministry knew—there were 39 cases of meningitis on the ministry's own site; their information.Now initially at the beginning of the year it was general strains of meningitis. We're interested in meningococcal W. Well in April the ministry was first flagging that 50 percent of their cases in April were actually meningococcal W and the following month it was 100 percent. So way back in May the Minister and the ministry knew that there was an outbreak for meningitis in Northland and in New Zealand. In fact the first two deaths occurred at least as early as March.We shouldn't be surprised then that the microbiologists from Northland DHB in May—about the time I believe the ministry knew there was an outbreak—also said to his staff be it right or wrong "I'm concerned. I suggest you vaccinate." Back in May the Minister and the ministry knew—or they didn't know which is their fault—there was information that there was an outbreak of meningitis in Northland. The Prime Minister agrees from her statement yesterday when the question was raised "If the microbiologist was advising staff do you think the ministry should have done something?" She said this: "on the face of it it should be a trigger to speak to the ministry about a public message." So there were others also saying the red flags were clear and something should have been done.I think really the icing on the cake is the CEO from Northland DHB writing to his board members on Monday saying "We have been strongly encouraging the Ministry of Health for some months"—not some weeks or a few hours; I picked up the phone yesterday—"to approve this campaign as it's the only truly effective preventative measure for our population". This ministry and this Minister had the information as far back in May that there was a meningococcal outbreak in Northland that it was meningococcal W. They also know—which is what we're not hearing—the other areas that have some involvement. For example we should have concerns for our neighbouring DHBs to Northland particularly the South Auckland DHBs. I know how many of you per month developed meningitis in Counties Manukau Waitematā and Canterbury have also had cases. None of that is being discussed here.So there are several things with the proposed solution. Minister not all schools are going to get the vaccine. Which ones are going to be selected? Who's going to make it? Who's not going to make it? And what are we going to do for our people at risk—particularly Māori and Pasifika—in South Auckland? Do something Minister. This needs to be a wider response."