Preparing for the next pandemic to avoid early national lockdowns should be a no-brainer, argue Philip Hill and Chris Bullen
While Aotearoa New Zealand’s pandemic response has been lauded as a success, it is easy to forget that in parts of Asia an early lockdown was not required, despite being closer to China and having much higher population densities.
Although they were aware of the possibility of a SARS-like virus or another pandemic virus, New Zealand’s public health leaders have acknowledged that they made up our response to Covid-19 “on the fly”.
We weren’t ready.
Having a dedicated ‘unit’ to prepare for the next pandemic should be a no-brainer.
The lack of preparation came with an enormous cost – tens of billions of dollars for an early lockdown.
Another pandemic is inevitable and the timing is unpredictable, so it should be an urgent priority to be ready to avoid an early national lockdown next time.
We need to look no further than the island of Taiwan for an example of where Covid-19 was contained until vaccination rollout without hard national lockdowns.
Taiwan was on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003.
Having learned from that experience, Taiwan established a public health response mechanism for enabling rapid actions for the next crisis.
Well-trained and experienced teams of officials were quick to recognise the crisis and activated emergency management structures rapidly.
From as early as December 31, 2019, Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan.
Surveillance and quarantine procedures were quickly established, a central epidemic command centre was activated, and all necessary inter-agency relationships and systems were put in place.
Innovation was incorporated early across the response, with integration of big data, QR code scanning, and specialised text messaging linked to careful risk profiling.
The government provided food, frequent health checks, and mental health support.
Management of cases and contacts operated at high quality and capacity.
New technology was used, including online reporting of travel history and health symptoms to classify travellers’ infectious risks based on flight origin and travel history in the previous 14 days.
Persons with low risk were sent a health declaration border pass for faster immigration clearance; those with higher risk (recent travel to level 3 alert areas) were quarantined at home and tracked through their mobile phone to ensure they remained at home when required.
Pandemic preparedness, at least for a virus with similar properties to SARS-CoV-2, should be regarded as a failure if a country requires a lockdown in the first six to 12 months.
During that period, the virus will tend to have significant weaknesses before it fully adapts to humans.
New Zealand has made significant progress in its capability during the pandemic, but these may not yet be at the level of quality and capacity needed to avoid an early lockdown in the next pandemic.
The country’s leaders should have a dedicated unit ready.
Given the counterfactual of the huge cost of an early lockdown, the Government should invest more in this unit than it has ever before been comfortable with spending on a preventive initiative.
Hundreds of millions of dollars per year, not hundreds of thousands, may be required to secure our protection.
It needs to be resourced to continually develop and optimise the tools required for the early pandemic response, from the legislative components right through to the activities in the community.
The unit must be founded upon an authentic and appropriately resourced partnership with Māori, drawing on all the knowledge and expertise Māori bring to an optimal and truly equitable response, as witnessed in this pandemic.
Given the disproportionate effect of Covid, and other likely future infectious disease threats on Pacific people, Pacific leaders and providers should also be deeply involved in the unit.
It will need to fit within New Zealand’s health and border systems and have a core plus an ability to stand up an expanded function at short notice, as Taiwan did.
The unit should also connect with vaccine discovery, manufacture, and delivery.
When a pandemic arrives, the people who should lead the response may not necessarily be employees in government ministries.
New Zealand’s most able people will be needed, wherever they are, to lead pandemic responses.
Therefore, they should be actively identified and trained accordingly, ready to be brought in when required.
Aotearoa New Zealand now has the capability and experience, and a nascent unified national public health system, to establish a world-class acute pandemic response function.
People leading the newly restructured health system should be tasked with building a high-quality unit, one that has the resources and authority to act to protect the public health when the next pandemic threatens the border.
In contrast with Taiwan, we are still far from ready.
Taiwan’s early Covid-19 response timeline
December 31, 2019. The World Health Organization was notified of pneumonia of unknown cause in Wuhan, China. Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan for fever and pneumonia symptoms before passengers could deplane.
January 5, 2020. Notification was expanded to include any individual who had travelled to Wuhan in the past 14 days and had a fever or relevant symptoms; suspected cases were screened for 26 viruses including SARS and Middle East respiratory syndrome (MERS). Home quarantine for passengers displaying symptoms of fever and coughing was established and monitoring to assess whether medical attention at a hospital was necessary.
January 20, 2020. Taiwan’s Centres for Disease Control (CDC) officially activated the Central Epidemic Command Centre (CECC) for severe special infectious pneumonia under National Health Command Centre (NHCC). The Taiwan CDC announced the government had under its control a stockpile of 44 million surgical masks, 1.9 million N95 masks, and 1100 negative-pressure isolation rooms. The CECC set the price of masks and used government funds and military personnel to increase mask production.
January 27, 2020. Taiwan’s National Health Insurance Administration (NHIA) and the National Immigration Agency (NIA) integrated patients’ past 14-day travel history with their NHI identification card data from the NHIA; this was accomplished in 1 day. Taiwan citizens’ household registration system and the foreigners’ entry card allowed the government to track individuals at high risk because of recent travel history in affected areas. Those identified as high risk (under home quarantine) were monitored electronically through their mobile phones.
January 30, 2020. Taiwan’s NHIA database was expanded to cover the past 14-day travel history for patients from China, Hong Kong, and Macau.
February 14, 2020. Taiwan launched the Entry Quarantine System, so travellers could complete the health declaration form by scanning a QR code that leads to an online form, either prior to departure from or upon arrival at a Taiwan airport. A mobile health declaration pass was then sent to phones, which allowed for faster immigration clearance for those with minimal risk. This system was created within a 72-hour period.
February 18, 2020. The government announced that all hospitals, clinics, and pharmacies in Taiwan would have access to patients’ travel histories. Taiwan quickly mobilised and instituted specific approaches for case identification, containment, and resource allocation to protect the public health.
