Covid services, MMR vaccination & the consultants behind the curtain

How items developed for Covid have been re-used for other purposes, like telling people to get MMR vaccines with dismal results - is the consultant's shadow pushing their re-use behind it?

Vaccination advertising for the 1st 3 months of this year was $417,946. While almost $250k of that amount was spent on advertising Covid vaccinations - most of the remainder was on standard childhood and school vaccinations.

But I think the word advertising was loosely interpreted by Health Minister Ayesha Verrall in the above official spend. As it doesn’t appear to include the national health system Te Whatu Ora/Health NZ launching a mass campaign to get people to go get an MMR vaccination - which I would call a type of advertising. To do so it used services developed for the Ministry of Health’s Covid response.

Products and services used in Covid have been ‘extended’:

The extension to other diseases and equitable health outcomes - was done with no business cases by Te Whatu Ora/Health NZ. They could decide and invest to extend them by ‘Product Centric Delivery methodology’. A phrase with no meaning, which I assume is by design.

In practice it means sending centralised prompts that were used during Covid to get people vaccinated, to now pivoting to MMR vaccinations via:

And:

The MMR campaign using Covid services

Between mid-February and mid-April 2023, people born between 1989 and 2004 were subject to getting an email or text or phone call to get an MMR vaccination.

The Ministry of Health’s COVID Population Identification & Registration (CPIR) was used to invite the general population to go get a Covid vaccination. It was described as, “…a campaign platform which commonly has the purpose of managing communication to the community. In this context it includes the information held in common across the COVID response which is provided through the integration of services such as vaccination, border management and contact tracing.”

Right - it sent the reminders and prompts for Covid vaccination using data from all the other systems, among other tools like 'machine learning’ and chat bots over text - here’s a screenshot from a presentation on it:

So if you got texts on Covid vaccination and didn’t know how or why - this is it.

While it was developed for and used data sourced for Covid vaccination - 222,678 MMR vaccination text messages were sent using it.

Just the texts cost $66.8k, and this cost doesn’t include the calls (done by several calling centers) or the people involved.

The campaign documents note they contacted close to half a million people, starting with priority regions then going nationwide:

All of whom I doubt realised they would be subject to getting MMR prompts (and then followed up on!).

Te Whatu Ora had targets they wanted to meet with the campaign - to get 1% of people they contacted in for a MMR vaccination dose.

How many people do you think got vaccinated out of that roughly half a million people?

My guess was 0 but I’ve become cynical so I’ll wait for your guess.

It was 800 people.

Which wouldn’t have made much of a dent in the supply - for 2023, there are 205,495 MMR doses that are expected to be distributed.

If it sounds like a good idea to do this - I would respond that good ideas without results are meaningless. Involving time and energy and outright expense on something with no benefit - should mean you need to reconsider your good idea. Especially when it’s a pattern.

The $32 million Catch Up campaign failure

Now that they have this Covid service - I assume they were trying to avoid what happened in the much more costly MMR Catch Up campaign. 350,000 MMR doses were bought as part of a national campaign to support people who’d missed having MMR vaccination.

315,800 MMR doses, out of 350,000 bought for the campaign, worth over $7.9 million ended up being destroyed in 2022. To call it a failure is perhaps not strong enough language, it was abysmal.

The total cost of attempting the Catch Up campaign came to $32 million. District Health Boards and providers at the time received over $12 million of that $32 million to do MMR vaccinations - yet did close to none.

I take issue with this statement by the auditor-general, who gave it a cursory glance, and laid the failure as, “…because the health system was redirected to respond to Covid-19. The outbreak of Covid-19 had a material effect on the Campaign, and this could not have been reasonably foreseen. Resources that would have been applied to the Campaign were instead diverted to Covid-19.”

The Catch Up campaign was launched in 2020. For the majority of the Covid pandemic in New Zealand - the health system wasn’t under extreme pressure in 2020 and 2021, and the general population Covid vaccination rollout only began in earnest in August to September 2021. Why couldn’t during 2020 to 2021 the campaign have tried to achieve its targets?

Whoops, wrong word as it didn’t have any targets! They used their best guess which the auditor-general also accepted, while suggesting they set targets next time.

Well, the next time they set the lowest possible target I assume (1%) and they still couldn’t even achieve that!

This repeated failure is an example of a culture of process over results. The work of bureaucrats continues unabated - with no purpose, and the purpose doesn’t even matter - the circle of government and consultants is complete. It clearly and consistently works for itself and not for others.

The stated reason for the latest MMR campaign was, “Increasing immunisation of those most vulnerable to measles is a priority.”

But perhaps the focus could be on the groups who Minister Verrall said they think are actually most at risk - those under 12 months who aren’t eligible yet for vaccination - perhaps the focus should be on ensuring they receive 1 MMR dose at 12 months when they become eligible through the National Immunisation Schedule.

But you can’t text a 12 month old that easily who was part of the Covid services that could be used.

Process over results, process over anything.

Academic Substacker, eugyppius in Germany, summed up the State’s attitude that has grown from the Covid response as, “…everybody is more or less the same, subject to nudging via the same incentives, requiring the same protections from the same risks, and likely to benefit from the same one-size-fits-all solutions. The highly differentiated lives that people actually lead… are at best ignored, at worst considered a massive inconvenience. There is an unstated, unconsciously harboured bureaucratic vision of a country made up entirely of… the ideal receptacles of bureaucratic solutions, which are of course always correct, except when the people fail them.”

Are consultants pushing Covid services for other uses?

A December 2022 talk was given by Astrid Koornneef, the Director of the National Immunisation Programme at Te Whatu Ora at a health conference on how Covid ‘enabled new models of delivery’.

I guess, “…the challenge transferring these abilities outside of the COVID ecosystem…” was surmounted. As who do you think was doing all this work on the register from Covid? Yup, of course the trail leads to a big 4 consultant - Deloitte.

Here’s 40 minutes of Deloitte tediously telling everyone how successful they are in engaging high priority communities in New Zealand - a sales pitch for everyone else.

Deloitte add it’s been used for flu, measles and yes, other screening programs.

They also pushed the diversity of the Deloitte team behind it which was due to ‘strong women in leadership:’*

(*All of whom were from Deloitte).

Is the ‘methodology’ behind the decision to use Covid services with no business case - really just another reason to have Deloitte run the health system more? The $66k used to send just those 230k MMR texts - must pale in comparison to the amount paid to Deloitte to do this.

They talk big - but they don’t really display how nationwide marketing channels that no one realised they signed up for - drives actual better health outcomes. It attempts to replace people with technology and further embeds consultants in the health system, who do not have skin in the game other than ensuring they can keep invoicing government.

It sits uneasily with me, that something so vast used for Covid - can so easily be used, driven by consultants, with no clear success for it, for other uses.