Ayesha Verrall says the Ministry of Health had "good intentions" when it planned a massive measles vaccination catch-up campaign that only reached 7 percent of the estimated 300,000 people eligible.
A new report from the Auditor-General, released this week, said most of the blame for poor rollout can be blamed on the Covid-19 pandemic, which saw it stopped, restarted and ultimately canned when the vaccine doses expired.
But it also said the Ministry of Health failed to set a specific target for the number of vaccines to be administered, and "could have given more thought to structuring the campaign funding arrangements to reflect that uncertainty and minimise waste", considering DHBs continued to receive funding for it even when it was put on hold.
The $32 million campaign was launched in July 2020, after New Zealand had successfully eliminated the first outbreak of Covid-19. The ministry ordered 350,000 doses in October 2019, following an outbreak that saw nearly 800 people hospitalised. The virus spread to Samoa, where it killed dozens of people.
By the time the vaccine campaign ended on 30 June, 2022, only 23,751 people had received doses - putting the cost of each at about $1300. About $8 million worth of vaccines were discarded.
"Even more shocking was the vaccination rate for Māori in places such as Tai Rāwhiti, a high risk area, where only 28 people were vaccinated across the whole two years," said National health spokesperson Dr Shane Reti, echoing comments he made in August last year when the poor result was first revealed.
Reti sent his concerns to the Office of the Auditor-General, which responded this week after seeking explanations from the Ministry of Health and Te Whatu Ora, "including information about how the campaign was planned, what the goals were, a detailed cost break-down, and general information about the campaign".
Dr Shane Reti. Photo: RNZ / Samuel Rillstone
Preparations for the campaign were interrupted in March 2020, when the first Covid-19 lockdown happened. Resources were reallocated to the Covid-19 response, "leaving minimal resources for the [measles] campaign".
The then-district health boards (DHBs) resumed the campaign in October 2020, but by December it was clear "the number of vaccinations administered was tracking at or below rates from previous years". The campaign got more funding and resources in January 2021, but in March the Director-General of Health ordered DHBs to prioritise Covid-19 and childhood immunisations.
Measles was seen as lower priority, with the borders shut and little risk of an incursion.
In December 2021, the Director-General restarted the measles campaign, which lasted until the disestablishment of the DHBs in June 2022.
"The campaign was launched at a time when the healthcare system was significantly under pressure by the Covid-19 pandemic," Te Whatu Ora told the Office of the Auditor-General. "As a result, the campaign had to slow down and scale back-up several times leading to unforeseen challenges in implementation, reduced uptake, and ultimately the challenge of already stretched services to deliver on set goals."
The Ministry of Health said there was no central vaccination register before 2005, so it was not sure how many people actually needed a measles vaccine - the 350,000 doses an estimate of what was "needed for the campaign to meet the needs of the population - including those populations where immunity status was unknown".
The Office of the Auditor-General said the ministry, when it made the order in 2019, could not have foreseen the disruption the Covid-19 would bring. Also, the lack of measles cases thanks to the border closure would have "reduced vaccine uptake", it said.
A decision was also made not to promote getting the measles vaccine alongside the Covid-19 vaccine.
"Although Covid-19 didn't help the campaign, Labour's incompetence was a contributing factor," said Reti.
'Didn't deliver'
Speaking to Checkpoint on Tuesday, following the release of the Office of the Auditor-General's letter, Verrall said the focus on Covid-19 "saved the lives of 20,000 New Zealanders in 2020 and 2021", but she admitted the measles campaign "didn't deliver the results".
"I think the key issue that the Auditor-General identified in their report was that [setting targets] was an incredibly difficult thing to do with the poor information systems that we had at the time.
"Now, on the upside, one of the good things about Covid is that we've used the fact that we invested so much in information technology for the vaccination register, Book My Vaccine and the contact tracing.
"We've now built all of those systems to also incorporate measles, so we have that technology now, we're much more able to reach out and find the people who we need to vaccinate, and to be able to reach out to them and to develop systems where Māori and Pacific providers are also enabled, through good data, to be able to serve their communities, too."
Verrall was not Minister of Health at the time, but was an advisor to the government on contact tracing as part of the Covid-19 response.
Verrall with then Director-General of Health Dr Ashley Bloomfield. Photo: RNZ / Angus Dreaver
As for the binning of more than 300,000 vaccine doses, Verrall said it was "not ideal… but nor is it safe to keep them on the shelf beyond their use-by date".
The measles campaign's poor result was in contrast to the Covid-19 vaccine rollout, which after a slow start saw New Zealand with one of the highest initial two-dose coverage rates in the world.
Verrall said getting the two vaccines together - while perfectly safe - might have put some people off getting either.
"Sometimes we get advice that the types of messages that we're putting out to appeal to people for Covid wouldn't appeal if we put another vaccine in the mix with them, and I'm not certain about that instance with measles, but I know that that is the advice we've had, for example, with Covid and flu - for people who have received a lot of Covid misinformation we're advised not to offer the flu vaccine, to pair it with Covid, because that will put some people off.
"So for that reason, we offer the vaccines separately - though of course you could get them on the same day if you chose."
Only 28 Māori in all of Tai Rāwhiti, a high-risk area, got the measles vaccine during the campaign. Verrall said it was a "priority" as part of the region's recovery from Cyclone Gabrielle.
Measles vaccination rates for children have been falling in recent years. A recent University of Otago study found not enough children under the age of five in New Zealand are protected against measles to stop a potential national outbreak.
"From the end of 2017, the immunisation rate of children aged 24 months was 92.4 percent," said Reti. "Compared to the end of 2022, that number has dropped to 82.9 percent."
"You know, we set targets, we work through the data that we have on who is and who isn't vaccinated," said Verrall. "We feed that information out to providers, there's vaccine available. We've brought up a real workforce of vaccinators that is not nurses in order to be able to fill those gaps, there is a lot of work underway across the country."
