The threat of Omicron shows no signs of slowing down as we head into the third year of the Covid-19 pandemic. As cases climb, our health system will continue to grapple with existing challenges, and inevitably face new ones. University of Otago researchers analyse, through a long-term lens, what is ahead for our health system and the virus. Part three of a three-part series on what 2022 might bring for Aotearoa-NZ.
“Māori and Pacific peoples remain vulnerable to being disproportionately impacted and affected by Covid-19” – Dr Dianne Sika-Paotonu, Associate Dean Pacific and Senior Lecturer, Department of Pathology & Molecular Medicine, at the University of Otago, Wellington
Now the Omicron variant has entered our communities, it’s vital we prioritise the needs of the vulnerable and ensure an equitable response moving forward.
Although vaccination levels have increased across the country, vigilance is still needed as areas in Aotearoa remain where there is lower vaccination coverage. In addition, our communities are still in the process of getting their booster injections and our 5 to 11-year-old children, tamariki and tamaiki have only recently had access to their paediatric Pfizer Covid-19 vaccine.
READ MORE:
* State of the nation 2022
* Economy 2022
Evidence indicates that Māori and Pacific peoples remain vulnerable to being disproportionately impacted and affected by Covid-19. Therefore, they will require focus and prioritisation with respect to Covid-19 vaccination, boosters, testing and prevention efforts.
An equity focus that reduces barriers and builds trust will ensure people get the help and services they need at this time. Having an equity focus involves doing what’s needed for people get the care and services they need at the time they need it, rather than applying a one-size-fits-all approach.
We have seen equity in action, with our Māori and Pacific teams working tirelessly to drive up vaccination levels and protect their communities, whānau and kāinga. The teams did this by using mobile teams to take vaccines out to our people and communities, having flexible opening hours for vaccination centres, and creating whānau friendly and supportive environments for vaccination, among other approaches.
The Pfizer Covid-19 vaccine booster gives strong immune protection against Omicron and must continue to be rolled out as quickly as possible with the appropriate prioritisation and delivery that considers our most vulnerable.
There remains work for us all to do in Aotearoa if we want to keep everyone safe and protected from Covid-19. We must avoid our hospitals becoming overwhelmed, as they have become in Australia and other countries.
“Covid-19 has exposed gaps in the system. These will intensify in 2022” – Professor Robin Gauld, Pro-Vice-Chancellor and Dean, Otago Business School; Co-Director, Centre for Health Systems and Technology
This year, health system strengthening must be a focus. It should have been for at least the last two decades but health systems routinely do not receive adequate attention.
The ‘system’ includes all resources involved in providing care. A system view is agnostic of location (such as hospitals or primary care) or health professional; rather, all work collaboratively to build a better system taking a ‘whole of system’ approach to how resources deliver on need.
Historically, in New Zealand, we have focused on individual services at the detriment of strengthening the overall system. Covid-19 has exposed gaps in the system. These will intensify in 2022.
Strengthening requires a will to develop national ICT systems accessible from any point, capable of coordinating multiple parts. Think about how Air New Zealand does this through its app. They put the public at the center of their design processes.
Covid-19 will increase pressure on services, undermining equity goals. It will affect all, but particularly Māori, Pacific and those on lower incomes. Those who can pay will increasingly resort to private treatment, further affecting public capacity.
With health reforms being introduced, it will be timely for the Government to consider social insurance, like ACC, which funds public and private treatment. This would ensure that anyone, regardless of income, could access the care they need.
Last, our health professionals must be empowered to drive these, and other important initiatives required, to strengthen the health system in response to Covid-19 and other demands.
“Let’s leave winter illness in the past” – Dr Lucy Telfar Barnard, Senior Research Fellow, Housing and Health Research Programme, Co-Search Covid-19 Research Collaborative, at the University of Otago, Wellington
The past two years have taught us that winter illness is not the inevitability it has always appeared. We have the opportunity to reduce that burden permanently, by bedding in what we’ve just learnt, alongside what we already knew. We can do that with four key changes, all achievable in the next year.
First, with schools and early childhood education being a key mixing point for infectious disease, we can introduce good ventilation and HEPA filters into every classroom.
Second, we can extend sick leave provisions so people can stay home when unwell. We can also encourage culture change so we see a good employee as someone who stays home when sick, rather than ‘soldiering on’ and potentially infecting others.
Third, we can support winter illness prevention by retaining the 2020 increase to the winter energy payment, so everyone can afford to heat their homes, even with additional ventilation while we build enough homes so that warm, dry, housing is no longer over-priced.
Last, we can introduce mask filtration labelling requirements and make masking a permanent health behaviour. ESR’s excellent influenza tracking system could be used to add a “mask alert level” to weather forecasts, alongside UV risk, so people know it’s time to mask up to help keep respiratory illnesses down.
These changes will provide long term benefits: preventing the costs of lost learning, lost time off work for caregivers, lost potential for those children whose lungs never fully recover from infections, and lost lives as those diseases spread into older age groups. Let’s leave winter illness in the past.
“2022 will be the year when we will all need to learn how to coexist with this virus” – Professor Miguel Quiñones-Mateu, Department of Microbiology and Immunology, at the University of Otago
After more than 350 million known Covid-19 cases and more than 5.6 million deaths over two years, we continue battling the first real pandemic of the 21st century.
The world has responded to the challenge, developing diagnostics tools, multiple vaccines and several antiviral treatments in record time, all the while learning about this novel virus, its biology, transmissibility, epidemiology, and pathogenicity.
However, SARS-CoV-2 is here to stay. It is not a matter or “if” but “when” we will be exposed to SARS-CoV-2. This will be the year when we will all need to learn how to coexist with this virus. SARS-CoV-2 will continue to adapt, selecting for variants with better transmissibility, hopefully with limited virulence.
The virus does not want to kill the host. Morbidity and mortality are unexpected side effects on its pursuit to optimal transmission. Therefore, SARS-CoV-2 will stay with us forever, becoming an endemic disease.
So, what’s next? More and better vaccines will be developed, as well as prophylactic treatments. Covid-19 vaccines will most likely follow a 0, 1, and 6-month schedule, similar to other viral vaccines such as HBV, perhaps followed by annual jabs, like the influenza vaccine. A series of antiviral therapies will also be developed.
This, together with the host immune response primed by the vaccine, will allow us to control the infection, minimising the disease. But we will need to be vigilant. The virus will continue to evolve and, with these added pressures (vaccines, antivirals), we may unwantedly select for variants able to escape these control strategies.
However, the future is not that gloomy. Humanity has been here before. Globalisation helped this virus spread like fire, but other pandemics have been more lethal.
For that reason, we need to learn from our mistakes and continue working on all fronts. It is the only way we will be able to defeat SARS-CoV-2, while preparing for the unequivocal risk of similar viral outbreaks in the future.
