NZ's totally made up, non-scientific 90% vaccination target
On being the bestest ever in the world based on nothing
In October 2021, the New York Times wrote New Zealand “…set a target of getting at least 90 percent of the eligible population fully vaccinated - a goal, the highest in the developed world”. According to then Covid-19 Minister Chris Hipkins, “Our No. 1 priority here is to stop Covid-19 in its tracks, and that means doing what we need to do to get in front of the virus…”
While the world feted New Zealand and was in awe of it, for its amazing powers of Covid zero in 2020 - it conveniently ignored the cost the elimination policy wrought - both in and outside of New Zealand. As the vaccination campaign ramped up from mid-2021, and the calls to quit it with the hermit kingdom rose, the government’s reconnecting New Zealand with the world work program took precedence.
But how can you be still be the world’s most enviable success when Covid is literally un-vanquishable?
Well, you can be a success at vaccination.
Following the clue trail from meeting minutes
The Covid-19 Vaccine & Immunisation Programme Steering Group (SG), chaired by then Director-General of Health Ashley Bloomfield, provided direction and oversight to the Covid vaccination program, including decision making.
While the group was formally made up of senior Ministry officials, the membership does not reflect the diverse staff that actually attended these meetings. From the head of the adverse events team in the vaccination program, to Medsafe, the Department of the Prime Minister and Cabinet (DPMC) and District Health Boards (DHB) attendees.
The steering group is interesting as its minutes show the evolution of vaccination targets through the course of the vaccination rollout in New Zealand in 2021. As the rollout was being planned, a 2nd February meeting noted:
DHBs were required to submit rollout plans, including their equity targets and how they would achieve them.
In a 4th of February meeting with the Covid-19 Vaccine Technical Advisory Group (CV-TAG) they discussed the advice on immunisation targets for Ministers and the problems therein of having a numerical target.
Key points they were considering are really important to the story ahead so in full, “Lack of information about duration of immunity and efficacy in reducing transmission makes it very difficult to recommend a specific numerical target. From first principles, you would expect some reduction in transmission, but it is unlikely to be equal to the effectiveness of the vaccine in reducing severe disease (as assumed by the modelling).”
And, “Advice should focus more of the benefits of individual protection rather than trying to predict a percentage required to achieve herd immunity, which has many unknowns. However, the concept of encouraging personal vaccination to protect one’s family should not be completely lost – there is likely to be some protection of others and protection of whanau is an important NZ concept…”
The following month in mid-March 2021, the vaccine rollout had slowly begun to some high risk groups, Bloomfield was asked about a vaccination target by the media, his response was - we want to do better than everyone else:
Bloomfield added that survey’s had shown a sizeable percentage of people at the start of the year needed more information about the vaccine. A 23rd of March meeting discussed the DHB rollout plans and “…we know that 40% of the population will need little intervention to get their vaccine. However, a disproportionate effort is required for the rest…”
A 27th of April meeting discussed needing a clear narrative on how they could measure the success of the Covid vaccination program, the group concluded the national goal to vaccinate as many people as possible was both useful and accurate. Because, “…we still don’t know enough about the individual vaccines to have a population immunity target.”
And went on to note, “Given that not everyone is eligible for Pfizer vaccine, if almost every adult who is eligible chooses to be vaccinated it would equate to roughly 76% vaccine coverage of the New Zealand population.” Adult is a key point. Opening up vaccination to the over 12s later in the year was a key reason that the higher rate of 90% became possible.
The discussion largely focused on how to showcase the success of the program through its various components, such as equity, sustainability and efficiency, rather than on a numerical basis such as a target. It went on to say, “…it was stressed that ambitious goals need to be set nonetheless, noting that 95% target is used for many of the childhood vaccines.”
This is a really interesting meeting - it showed that based on the data they had, New Zealand would achieve a high rate of vaccination, they didn’t think a number was helpful, and strangely equated the vaccine to the well established childhood vaccine schedules. Is it petty to point out - that the 95% target hasn’t even been achieved for the childhood schedules for many, many years?
A 1st of June meeting established expectations about services delivered under the vaccination program. It also followed on to state they did not want to set targets for the general population, but again repeated proposing those above success measures of equity etc.
Strategic COVID-19 Public Health Advisory Group advice to Minister Verrall on a target
It’s at this point I need to discuss the Strategic COVID-19 Public Health Advisory Group, chaired until August 2022 by Sir David Skegg.
The independent group of 6 held a lofty place in the Covid zero phase of New Zealand. In mid-2021, they started architecting how New Zealand could reconnect itself with that big, scary world out there. 1 of the 1st jobs they were set as part of that work, was explicitly deciding on a vaccination target.
In response to that request in a 24th of June letter to then Associate Minister of Health Ayesha Verrall, the group did not recommend setting an exact target. Instead suggesting vaccination should be as high as possible, and the question of a target was better suited for marketing purposes:
Back to the Ministry of Health group meetings
Moving back to the Ministry of Health steering group meetings - the tone starts to shift. At this point in late June and July 2021, the vaccination intent research showed more people than ever said they would get vaccinated, and the general population rollout to under 65s was fast approaching.
A 15th of June meeting discussed how to further develop DHB equity targets for Māori, Pasifika and disabled people. These groups were seen to be at higher risk of poor outcomes from Covid. The low rate of uptake in recent years of the childhood vaccine schedules was even more dramatic in the Māori and Pasifika groups. Which I suspect could have been front of mind to avoid criticism of repeating the same mistakes for the Covid vaccination program.
By the group’s 13th of July meeting, 80% of people were ‘willing’ to be vaccinated in surveys. A stretch ambition of 85% was proposed for planning purposes - figuring out how many doses are needed and where would have been a huge logistical challenge across the country.
But planning and equity goal targets are quite different from a firm all of population vaccination target to reach. They mentioned “…previous modelling to reach ‘scale’ has been based on 70 per cent uptake…” This was also an interesting discussion as the minutes say, “International experience shows there is an eight-week window of working at peak before delivery starts to reduce.“
Hitting it hard meant focusing on September and October would be a good idea, especially if they were pushing uptake through mass events. October saw the Super Saturday vaxathon event, further incentives rolled out through various providers and DHBs, as well as the announcement that domestic vaccine passes would be introduced.
Meanwhile, don’t glaze over, we're almost at the pièce de résistance I promise - but the Covid-19 Vaccine & Immunisation Governance Group (IPGG) oversaw the whole shebang.
Chaired by Dame Karen Poutasi, it also had senior Ministry of Health officials from the steering group meetings, such as Bloomfield, alongside the Chair of PHARMAC, the chief executives of MBIE and MFAT (all of whom were likely in the governance group due to their roles on the Covid-19 Vaccine Strategy Taskforce). And er the former chief executive of Deloitte (?!).
Uh moving on, their 13th of August 2021 meeting also discussed that steering group strategy for increasing uptake:
The group discussion following it said, “The Governance Group noted that the current response to COVID-19 by “all of Aotearoa New Zealand” leaves a legacy of built social capital and of trust at a government level, at a service provision level, etc. New Zealand’s unique situation is a significant ‘prize’ for all New Zealanders…”
A prize.
Political pressure builds for a target
On the 26th of August, Skegg was facing up to the Covid-19 Response Health Select Committee and responding to why his group had not recommended a vaccination target in their letter to Minister Verrall. The opposition courtesy of Chris Bishop and David Seymour hammered him on modelling and what vaccination coverage is needed. Skegg’s response was that it’s not that simple and it didn’t make sense to, like the Australians, pluck a figure out of the air, like 70% or 80%.
He added “…we would love to see over 90 percent vaccination coverage” but we couldn’t just rely on vaccinations. He also cautioned against putting too much faith in modelling, quoting, “All models are wrong; some are useful.”
Back in our original steering group, their 31st of August meeting discussed telling Minister Hipkins they were aiming for 75% actual uptake to the end of October (hit it hard):
The references to captive audience is because the country had been put into another lockdown.
In a 7th of September meeting they proudly noted they’d used 4 million doses and 91% of the over 65s group had now been fully vaccinated. 75% of the over 12s (who were now encouraged to get vaccinated) were either booked to, or had, 1 dose.
In a 10th of September meeting the governance group (IPGG) chaired by Dame Poutasi noted:
It went on to say, “We are reviewing behaviour and interventions also and strengthening our messaging.” They noted that communications needed to shift that last remaining 20%. Ideas on being more proactive included a suggestion that government agencies should, when communicating with people, ask “have you had your vaccine yet?”
In a 14th of September meeting the steering group (SG) noted the Ministerial pressure being applied to introduce an express target of achievement.
And 90% slips out again
2 days after that meeting, during a 16th of September press conference, Bloomfield let it out again. ”We need to be at or above 90%, and that is where everybody needs to be thinking about. And that is why we have geared up our system to make sure we can deliver to that level, and every New Zealander, this is mission-critical, every New Zealander needs to take up that opportunity.”
What was this based on? The only explicit reference I could find prior to this 90% statement, was the personal 90% vaccination goal he told media in March.
At a 20th of September press conference the Prime Minister re-iterated we “…would have heard Dr Bloomfield say he is aiming for 90+ of eligible New Zealanders, so that is the range in which we want to see people aspiring to, the kind of range that means we have fewer restrictions. We will take the opportunity…to delve into a little bit more detail as to what that modelling is showing us about what vaccination rates mean for restrictions in the future…”
On the 21st of September in question time in parliament, the Prime Minister got hammered by the opposition on vaccination targets and what the hell they were doing to avoid lockdowns.
The next day, 2 things happened.
1stly, a Zoom based Health Select Committee briefing on the government’s response to Covid 19, had David Seymour battering Hipkins saying there was clearly no official numerical target, but New Zealand’s strategy based on the Skegg group advice, was we would open up when there was a sufficient level of vaccination. But it had also been said the opening up would start when everyone has had the opportunity to be vaccinated - yet Bloomfield was sounding off to the media over a 90% target. Was that actually now the target? Hipkins dodged it saying with many, many words it wasn’t that simple and could be misleading to say a target.
2ndly, Hipkins and Bloomfield did that day’s press conference together. Bloomfield went off and reiterated again that 90% and above was the goal and it was very important not to have groups lagging behind within it. Hipkins agreed saying if New Zealand reaches 90% “…that would give us one of the highest vaccination rates against Covid-19 in the world…”
Fronting up to a press conference herself the next day on the 23rd of September, the Prime Minister said the 90% rate came about from health officials (no, it didn’t) and modelling (sure it did). And on that note to support this political campaign, modelling was, literally, wheeled out during the presser to try and eke out a rationale.
In 1 of the very few takedowns of the pandemic government narrative within New Zealand - the obedient modelling that was used to justify the 90% target - was quickly criticised in both New Zealand and internationally for both it’s underlying assumptions and exaggerated results.
The following month, on the 22nd of October a press release was issued by the Prime Minister announcing that 90% would be the firm target to reach before the country was allowed to move out of lockdown like restrictions towards a new system of ‘greater freedoms’.
Referencing the modelling and comparing Covid vaccination to ‘armour’ - the Prime Minister added, “The choice is clear for anyone who wants to go to a bar, restaurant, gym or to attend gatherings.”
The Ministry of Health’s steering group (SG) meeting on the 9th of November said maximising uptake to 90% and beyond was now their key focus.
And people were trying to achieve it:
Within their 16th of November meeting it was at least noted the modelling was highly speculative but if the whole country achieved it by Christmas it would be an ‘outstanding and ambitious achievement’. It went on to talk about the 2 shots for summer campaign (aimed at 16 to 29 year olds) to help manipulate, I mean nudge, getting to that 90%.
Reaching 90%
Vaccination rates were already high in New Zealand by international standards prior to the 90% target being announced - the over 65s had hit 90% earlier in September. However what wasn’t so high, and still the cause of alot of concern, was vaccination rates among Māori - 1 of the key target groups.
1 media article I found during this period, opined it was the Māori rates that was the problem, and I can see how that could be an issue that would come back to bite the government. It’s plausible - in late November further contracts worth over $120 million were signed with DHBs to raise Māori vaccination rates. But the government couldn’t exactly set a target for Māori to reach to release Covid restrictions.
I also wonder if that 90% target would have been possible without those 12 to 15 year olds pitching in to help out.
It wasn’t until mid-2022 that WHO came up with the idea of vaccinating 70% of all adults regardless of age or health status across the entire world. Many countries did pick up that WHO goal, like the US, but this was not in place when New Zealand decided on the higher rate of 90%, nor did I find any explicit reference to WHO advice mentioned in anything I’ve found. And by the way - WHO have since changed that goal - as they not only failed at it, but it was criticised for focusing on entire populations, not on the people who were at risk of poor outcomes from Covid.
The 90% vaccination rate was clearly a target of political success.
To support the government, the NZ Herald ran a vaccine tracker they called the 90% project, featuring daily stories of overcoming vaccine hesitancy and misinformation, and how when you are on a ventilator, well it’s just too late to get vaccinated!
Meanwhile, Auckland were still under heavy Covid restrictions and the constant research was showing they were fed up. 90% had become the stick to free up their restrictions. In very late November, on the 96th day of continuous lockdown restrictions - Auckland reached 90% fully vaccinated.
Measured by Ministry of Health population data, based on interactions with the health system, New Zealand as a whole hit 90% of the eligible population double vaccinated on the 15th of December 2021.
If 90% wasn’t explicitly a clinical decision, nor based on public health advice, but a political decision - I’d hope the Royal Commission of Inquiry into Covid lessons, investigates the evolution of this 90% target as well as the impact it had on people when it was decided upon.
The interactions with the health department figure was only the previous 12 months so like many I know didnt include them. The one thing we suffered within this was the constant calls and texts from unknown jabbers ( not my medical Dr or hospital) informing us they knew we were not jabbed and should hurry up and get it. I would like to know who breached my medical privacy. Text stooped after I got mad and sent back F... Off
Imagine having a large number of angry people trying to fight back?
That sounds hard.
Uncomfortable.
Tactically difficult.
Perhaps if we weakened them, made them sick they would be too preoccupied trying to care for their dying loved ones.
The best weapon doesn't kill, it maims.