Update to Covid Vaccine Ethics
By: Harry East
Tags: New Zealand, Public Health, Covid 19, Ethics, Vaccines

The last post I wrote here was about Covid Vaccine Ethics. At the time there was rather a lot we didn’t know about how NZ was going to deal with that. A month later and we know quite a lot more. Indeed, let’s just compare what I assume is a sketch of the prioritisation with what I laid out(you must remember, NZ’s bought enough vaccines for the entire team of five million):

“Currently, given we have no community transmission, the first group who would be immunised are those most at risk of being exposed to Covid-19. This includes the border and MIQ workforce, the Covid-19 frontline healthcare workers, and their household contacts. This will further strengthen our border.”

So, that looks to me as though it’s something like:

Border and MIQ workforce Healthcare workers Household contacts

From the phrasing, it actually seems like it’ll be simultaneous and only covers healthcare workers who actually engage with the MIQ system. I hope I’m mistaken about the latter because with the way the system’s currently devised, local GPs are actually frontline workers. In fact, that was one of the problems with the July-September outbreak in Auckland, where a GP was actually among the (thankfully, few) deaths. I don’t want to seem dismissive but let’s not get too bogged down here… what did I say?

Border and MIQ (managed isolation and quarantine) workers Healthcare workers & key public health officials (so they can go overseas if necessary to help other countries) Emergency response workers (NZ has a drowning problem… and also, to an extent, a lost in the wilderness problem) and defence personnel Close contacts of border, MIQ and healthcare workers

I’m not sure how many of the defence workforce is actually covered by the border/MIQ category… one of the last failures of the swiss cheese model revolved mostly around defence personnel. And let me be very clear, that incident had the potential to go very, very wrong (e.g. Sydney’s current problems or, worse, Auckland’s August outbreak). While it was never actually confirmed how (i.e. the epidemiological connection) she caught it, the genomic linkage (a key part of the UK and NZ’s approach to Covid) established that a woman in the community had the same strain as one of the defence workers. The point is, I think my plan is better.

Look, it’s probably not fair to say that the Sydney situation began at the beach (“NZ’s got a drowning problem”) but it’s defined in proximity to beaches. Let me be very clear here… I am 100% trying to claim that my reasoning deserves special credit because of this fact. Look at it… there’s my post from late November specifically identifying the prospect of incidental but unavoidable epidemiological contact in such circumstances as a reason to justify sticking emergency workers high up the roll out hierarchy. This is not a “The Simpsons predicted the future” style coincidence, it’s an actual, reasoned piece of thought that has a very topical justification from a country which likewise thought it had no community transmission. It might seem crude, but the reality is that NZ’s done a lot of things wrong when it comes to Covid. And it’s so easy to forget this in light of the massive cock ups (UK), frequent lies (US), outright incompetence (UK and US) or, and most egregiously, the state sanctioned manslaughter (Sweden) in approaches used overseas. We have been lucky. The defence case I was talking about… that could’ve ended up as a Melbourne situation. It didn’t.

(What isn’t luck is the way we’ve responded to our lucky breaks. It’s hard to imagine, for example, that we wouldn’t have followed Melbourne if the woman’s case had spread to more people. But that woman still went to work whilst waiting for a test… a similar problem to the church goers in Auckland’s second lockdown that, again, we lucked out on in terms of how many cases happened.)

So… I hope that is a sketch outline of the priority vaccination (second quarter), because it’s got gaping problems. As, perhaps, we might expect at this point.