Sir Ashley Bloomfield. Photo: RNZ / Angus Dreaver
Sir Ashley Bloomfield has given evidence at the Scottish Covid-19 inquiry alongside Sweden's former state epidemiologist professor Anders Tegnell.
As well as providing written reports, Sir Ashley answered questions about the pandemic response alongside his Swedish colleague for about six hours, with the aim of providing a foreign perspective.
Sir Ashley, who was a key figure involved in the health leadership of the pandemic response, previously provided evidence to New Zealand's Covid-19 Royal Commission of Inquiry.
He told the Scottish inquiry his communication with the New Zealand public via daily briefings alongside politicians became a key role that health leaders also relied on to understand what was happening in a rapidly changing response.
Health, he said, was - "and this is still an issue for New Zealand" - underinvested in after the global financial crisis and subsequent earthquakes.
"So there was insufficient capital put into the system for a number of years which left us in a position where probably we didn't have sufficient hospital beds, and we certainly have one of the lowest number of ICU beds per capita in the OECD.
"That's not to say that our hospital care and our ICU care is not of a very, very high standard - because it is - but this became a particular concern ... at the start of the pandemic, when we could see what was happening in Northern Italy and in the UK and in New York in particular.
"We had the triumvirate of ageing infrastructure, insufficient hospital and ICU bed numbers, and probably insufficient workforce to provide care ... this was one of the key drivers of decision making around the New Zealand response."
However, he said it became apparent that it did not matter to some extend the level of preparedness.
"Once your system got overwhelmed, it was overwhelmed. And that was a very important driver of the decision then for the government to look at other options, initially, suppression ... then that changed into an elimination approach."
That elimination approach was, however, not the initial goal.
"We had intended to take a suppression approach, but it quickly became apparent we could eliminate the virus - and we moved into an elimination approach that became the basis for our decision making at actions subsequently for around 18 months."
Elimination had been intended to limit the health, social and economic effects of the pandemic until there was sufficient effective vaccine coverage, he said, which in the end arrived much faster than anticipated.
"We were expecting years ... if you had asked me in March 2020 to put money on there being safe and effective vaccines before the end of the year, I think myself and ... the experts ... wouldn't have put any money on that at all.
"It was an amazing achievement, possibly one of the most extraordinary achievements of this century to date, at least, to have developed not one, but more than one, highly effective vaccines within a much shorter period of time than we had anticipated."
The pandemic plan that was in place when Covid arrived was "very much predicated on" an influenza outbreak, he said. This was partly because of the effects of the 1918 flu, including the effect on Māori populations and the way it had then transmitted to Samoa, leading to widespread deaths.
However, this meant it did not have much flexibility.
"It proved to be valuable for the first few weeks of response to the pandemic, but then after that, we were 'learning it forward' would be a euphemistic way of saying it ... if anything, we had done too much detailed planning around a specific potential virus, rather than thinking about what are the core public health responses that should be there."
Lack of PPE a problem
One thing New Zealand - and many other countries - soon found, was a lack of sufficient protective gear or PPE.
The stockpiles that existed were inconsistent across the country both in total supply and whether they were up to date, and the plan had not really considered the need for PPE for wider use - that is, by the public, by testing staff, emergency responders, and at aged care facilities rather than just in hospitals.
Other lessons included that mask use specifically was very useful for preventing the spread of the virus - whereas spread by touch was less of a problem than anticipated.
Photo: AFP
The concerns raised by some experts about using the correct technique for putting on a mask was also "probably a red herring".
"Using a mask just putting one on - it transpired - was one of the most useful things that could be done ... I think this is one area where I think many countries are considering ensuring they have capacity to manufacture on shore should the need arise."
Sir Ashley praised the alert level system announced just days before the first lockdown.
"This alert level system, I think, was an outstanding tool for communicating to the public ... during what was a really extraordinary, unprecedented and quite frightening time for everybody.
"The response was really as soon as we found that first case [in a given outbreak] to go immediately to either an alert level three or four - so very tight restrictions until we found out what was happening and then we could ease them quite quickly after that, and people had become used to them and knew what to do and what to expect."
However, the later traffic light system brought in after a high level of vaccination "wasn't as well received, or perhaps as useful because it was much more challenging coming out of an elimination approach than it was going into it".
Questioned about the legal framework, he acknowledged the government may have gone further in imposing lockdowns than the law initially prescribed - as was later confirmed in a case in the High Court.
"I guess as the subsequent court case showed we didn't let, perhaps, the lack of a bespoke law stop us from taking quite significant actions including - what transpired was - a request for people to go home and stay home until otherwise told.
"Any law requires public trust in the purpose of a reasonable law or a reasonable instruction ... the legal framework provided a very adequate basis for the initial response in New Zealand - however, it was also felt that bespoke legislation was required, and that was enacted quite quickly."
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