New Zealand’s Approach in Response to the COVID-19 Pandemic

Table of Contents

Abstract

1.0. Introduction:

2.0. Background of New Zealand’s Healthcare System:

3.0. New Zealand’s COVID-19 Key Milestones:

4.0. Lessons from New Zealand’s COVID-19 Response:

5.0. Conclusion:

Bibliography

Abstract

The world has experienced a wide array of influenza pandemics ranging from 1918’s H1N1, Hong Kong’s H5N1 in 1997, Suden Acute Respiratory Syndrome (SARS-CoV) in 2003 to 2012’s Middle East Respiratory Syndrome (MERS-CoV), among others. As the world bade farewell to 2019, news of a coronavirus disease emerged from Wuhan in China. The human disease, which studies have since linked to severe acute respiratory coronavirus (SARS-CoV-2) as its cause, was lethal, unstoppable, and fast propagating; even the severe containment measures, such as, the lockdown, could not halt the increasing number of infections. Global-health scholars argue that there was a lack of a global, coherent response since 30 January 2020 regardless of WHO’s earlier warning through a “public health emergency of international concern” (PHEIC), and hence a lapse in time to respond, cost the world in containing the virus. New Zealand’s COVID-19 response success story points to a clear direction of an early decisive response from health authorities, enabling surveillance systems, targeted testing, and most importantly the involvement of the community through a bottom-up approach. In this paper, we highlighted the responses by the New Zealand government in curtailing the virus and the lessons evident for current and future policy-making.

1.0. Introduction:

As the world bade farewell to 2019, news of a coronavirus disease emerged from Wuhan in China. The human disease, which studies have since linked to severe acute respiratory coronavirus (SARS-CoV-2) as its cause, was lethal, unstoppable, and fast propagating; even the severe containment measures, such as, the lockdown, could not halt the increasing number of infections.¹ Within a short span, COVID-19 had become a global concern. The World Health Organization (WHO) declared COVID-19 as a Public Health Emergency of Public Concern (PHEIC) on 30 January 2020, and subsequently a pandemic on 12 March 2020. Five months later, the virus had spiraled worldwide, with over 25 million COVID-19 cases and over 844,000 deaths.²

The world has experienced a wide array of influenza pandemics ranging from 1918’s H1N1, Hong Kong’s H5N1 in 1997, Suden Acute Respiratory Syndrome (SARS-CoV) in 2003 to 2012’s Middle East Respiratory Syndrome (MERS-CoV), among others.³ COVID-19 (SARS-CoV-2) has thus by far evolved and manifested differently and in different contexts. Some studies attribute SARS-CoV-2 to have originated from an animal host and transmitted to humans.⁴ As the spread of the virus progressed, a high number of human-to-human transmissions was prevalent in families and friends that had at least participated in a social event. It was then apparent that the virus prevailed most in densely populated areas, temperate climates in relatively affluent countries.

Earlier outbreaks, such as, MERS-CoV in 2012, served as a lesson for some countries to put in place preventive protocols and infrastructure that would handle future epidemics. For example, New Zealand had a pre-existing influenza pandemic plan revised in 2017. As a result, New Zealand had the lowest COVID-19 mortality rate in the OECD by August 2020; with 4.4 deaths per million population.⁵ New Zealand has since won praises from the World Health Organization for its effective response to the COVID-19 crisis.⁶ Against this backdrop, this term paper examines New Zealand’s COVID-19 response policies, by underscoring the policy approaches and interventions it applied, key milestones, gaps, and successes for replication. The paper concludes by bringing to light New Zealand's current COVID-19 status, vaccine strategy, and what would be applied from elsewhere to better its COVID-19 policy approaches.

1.1. World Health Organization (WHO) COVID-19 Response:

Global-health scholars argue that there was a lack of a global, coherent response since 30 January 2020 regardless of WHO’s earlier warning through a “public health emergency of international concern” (PHEIC), and hence a lapse in time to respond cost the world in containing the virus.⁷ A case in point is the USA, which banned just a few in-coming flights from China and did not roll-out countrywide testing until February 2020.

A “PHEIC” is a warning through which the WHO advises governments on how to deal with global health emergencies. Since 2005, when the PHEIC alarm system was initiated, the WHO has declared six PHEIC’s, which include: (a) Mexico’s H1N1 in 2009, (b) Afghanistan, Pakistan and Nigeria’s Polio resurgence in 2014, (c) Guinea, Sierra Leone and Liberia Ebola virus in 2014, (d) the Americas’ Zika virus in 2016, (e) the DRC’s Ebola virus in 2019’s, and (f) Wuhan-China’s COVID-19 in 2019. After WHO had signaled that a COVID-19 pandemic was imminent, few countries heeded to WHO’s practical guidelines to strengthen preparedness for the COVID-19 pandemic and beyond. The guidelines had been devised towards providing local authorities, leaders, and policymakers in cities with a checklist that engulfed key actionable areas.⁸

The WHO COVID-19 preparedness checklist comprised of: (a) coordinated local plans in preparation for effective responses to health risks and impacts, (b) risk and crisis communication and community engagement that encourage compliance with measures, (c) contextually appropriate approaches to public health measure, especially physical distancing, hand hygiene and respiratory etiquette, and (d) access to health care services for COVID-19 and the continuation of essential services (WHO, 2020). The argument that the WHO could have responded much earlier, be that is it may, Taiwan and New Zealand, heeded the WHO's pandemic declaration for a swift and decisive response. For example, according to the study by Summers et al. (2020), despite its proximity to Wuhan and a high population density, Taiwan promptly coordinated a national response that ensued into a lower-case rate of 20.7 per million compared with New Zealand’s 278.0 per million.

As a remedy to the WHO's alleged COVID-19 delayed response and to ensure a cohesive response for member states in the future, scholars recommend that the WHO inaugurates a new treaty on pandemics, which integrates the new COVID-19 experiences and revised implementation mechanisms for a better public health response system.⁹

1.2. COVID-19 Implications:

The ravage COVID-19 has done is beyond the direct health impact, as stressed in the aggregate numbers of infected persons and human deaths. COVID-19 has similarly made a substantial indirect impact on people's livelihoods, well-being, and other essential services. According to the second report on progress prepared by the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board, as the world responded to the pandemic, little effort was put in establishing care and treatment for COVID-19, consequently, the burden shifted to front-line workers that are viewed as heroes today.¹⁰ The report additionally featured deficiencies in pandemic preparedness and response that include:

- The public health measures to curb the pandemic should be comprehensively applied. In several countries failure to apply simple measures such as hand washing, physical distancing is continuing to cause unwanted transmission, illness, and death.
- The response to the pandemic has amplified inequalities within and among nations. This has limited or cuts off access to health care, not only to COVID-19 treatment but also to basic care and services in some nations.
- A failed global pandemic alert system, which requires revamping to include information platforms, such as social media to gather real-time epidemic intelligence.
- Several known existential risks from earlier epidemics remain unsolved. The inaction is a wasted opportunity for strengthening preparedness and response.
- The WHO's incentives to arouse cooperation from and effective engagement of member states are too weak.
- The WHO should leverage the COVID-19 crisis to effect fundamental and systematic change, by applying a bottom-top approach in creating an effective pandemic preparedness and response plan.

Ultimately, the COVID-19 crisis is not only a public health concern but also an economic, political, and social crisis. It might have started as a health challenge although currently, it has turned political. Hence, creating a dilemma in the context of policymaking. Examining, analyzing, and drawing lessons from successful models is how policymakers can make their contribution. Hence, by examining New Zealand’s COVID-19 response strategy, this paper seeks to draw light on what was done differently with the intent to inform public health policy.

2.0. Background of New Zealand’s Healthcare System:

New Zealand, a country located south-west of the Pacific Ocean is 2000km off the south-east coast of Australia. It has a natural view of two main islands (the North and South Islands) with other smaller Islands and has a total land area equivalent to that of the United Kingdom. As of December 2020, of the 4,822,233 population, 70-80% are of European origin; the indigenous Maori people, Asians, and Pacific Island make up about 20% of the population.¹¹ New Zealand's economy in the past was characterized by high unemployment, poor housing, and poverty; with a huge rural population and agriculture as the main source of livelihood.¹² According to Tony Ashton, the settlement of the Europeans in New Zealand in the late eighteenth century had a damaging health consequence on the people; with many getting infected with typhoid, tuberculosis, and venereal diseases.¹³ Following the above, the government implemented a rapid program to help position the economy and also help support its social system. The reform pushed for extensive government-funded services, including housing, education, and the health system.

New Zealand's healthcare sector reform, which has gone through four major stages in the last two decades. In the first stage, between 1983 and 1992, it introduced a structural change with a major part being decentralization and health care funding service management. Between 1993/96 the second phase was initiated under a Health and Disability Services Act which aimed at introducing a market model principle into the public sector such as competition.¹⁴ Subsequently, the third phase was introduced from 1996-1999 with the first coalition government re-branding the Crown Health Enterprises as Hospital and Health Services, positioning hospitals to now operate in a relieved environment to make some profit responsibly.

The final stage began in late 1999 under a Labour/Alliance coalition and sought to highlight seven key areas including; resource allocation, coordination of care, responsive services, accountability, expenditure, and promotion of public health. Just like all other health systems in other countries, the New Zealand health sector is constantly undergoing structural changes to curtail current health care challenges. The current health care structure is depicted below.

Figure 1: Health Services Structure, New Zealand.

Abbildung in dieser Leseprobe nicht enthalten

Source: Ministry of Health, New Zealand.

The New Zealand health care system is characterized by a mix of service providers; the government, private and non-profit sectors. Accordingly, the “health system was based upon the English model familiar to the new settlers, including its Poor Laws that mandated local responsibility for the poor”.¹⁵ The health care system funding comes mainly from public funds, and in the 2020/2021 fiscal year an amount of $20.27 billion slightly above 2019/2020 $19.871 billion budget was invested, making up to 5% of the total government budget.¹⁶ There are other sources of funding which include the Accident Compensation Corporation (ACC), government agencies, local government, and private sources such as insurance and out-of-pocket payments.

Accordingly, all residents have access to a broad range of services that are mainly publicly financed through allocations from pooled general taxes, which are collected at the national level. An exception is treatments related to accidents, which are covered by a no-fault accident compensation scheme.¹⁷ Between 2011-2015 more than one-third of adults(35%) and 28% of children were covered by private health insurance showing a sharp decrease among adults from 40% and for children from 31% in 1996/97. Interestingly, tourists and undocumented immigrants, are charged the full cost of services by health service providers. It is noteworthy to share that the Health and Disability Commissioner, which serves as a National Advocate for Patients, investigates patients' grievances, files report to Parliament of New Zealand, and is actively involved in patient quality and safety.

3.0. New Zealand’s COVID-19 Key Milestones:

COVID-19, pneumonia of unknown cause was first detected in Wuhan, China, and reported to the WHO Country Office in China on 31st December 2019. It was subsequently declared a Public Health Emergency of International Concern on 30th January 2020. Its declaration as an emergency was a result of a consented effort by all nations which aimed to limit or eradicate the spread and the subsequent effects on human lives, social systems, and the economy of all nations. Fast forward, on March 26, the New Zealand government announced a wild strategy to respond to the disease. In a briefing, Prime Minister Jacinda Ardern announced(the highest level of a four-level response strategy) the commencement of an intense lockdown.¹⁸

The New Zealand model has been considered by many scholars as a novel model well emulating as it moved from the general mitigation strategy(progressively moving from a slow entry of the pandemic, preventing the initial spread and social distancing) to an elimination strategy(a more aggressive bottom-up approach).¹⁹ These interventions differ in terms of their objective to the level of severity of measures(prevent health system breakdown, curtail incidence to a low level or nill).

3.1. General Information and Statistics on New Zealand’s COVID-19 Outbreak:

Abbildung in dieser Leseprobe nicht enthalten

3.2. New Zealand’s COVID-19 Responses:

New Zealand received global recognition for its successful fight against COVID-19, especially for its first 102 days without infections recorded.²⁰ Regardless of New Zealand’s geographic isolation, COVID-19 was still imminent due to the large numbers of tourists and students arriving from Europe and mainland China.²¹

The New Zealand government was aware of the potential disaster if the pandemic were to spread widely beyond what their health system could handle. Adequate knowledge of their disease model capability greatly influenced their course of action in the earlier days of the pandemic. New Zealand commenced its response by executing its pre-existing pandemic influenza plan, which included preparing hospitals for an overflow of patients. This was followed by national preventive policies, executed per evolving epidemiological situations such as border controls, a lockdown, physical distancing, and case-based controls through testing, contact tracing, and quarantine.²²

According to New Zealand’s Outbreak Observatory reports (2020), COVID-19 response policies were phased according to a four-level COVID-19 alert system, which swapped alternately between levels depending on the prevailing epidemiological. Today, New Zealand maintains the 4-level COVID-19 alert system, whose levels are described as follows:²³

Alert level one requires preparedness in case there is a COVID-19 resurgence in the community. At this level, the following measures are required both locally and nationally: (a) strict border entry measures, (b) intensive testing for COVID-19, (c) rapid contact tracing, (d) self-isolation or quarantine, (e) legal and safe running of schools and workplaces, (f) keep a record of your movements for contact tracing once required, (g) keep records of gatherings for contact tracing once required, (h) stay home if you are sick and report flu-like symptoms; (i) wash and dry hands, cough into the elbow and avoid touching the face; (j) avoid public transport or only travel if sick, (k) keep records while at work, to ease contact tracing once required, and (l) display government-issued QR codes at all times, in workplaces and on public transport, to facilitate the use of the COVID Tracer Application.

Alert level two is when the disease is contained, but the risk of community transmission remains. At this level the following measures are required: (a) if following public health guidelines, only up to 100 people can meet as a group to socialize, (b) physical distancing of two meters while in public and one meter in controlled environments is allowed, (c) hospitality, sports and entertainment businesses and public venues can operate, with up to 100 people and in adherence to the public safety guidelines, (d) health and disabilities care services can operate, (e) it is safe to open early education facilities and tertiary education, (f) people in the “high risk” age bracket and have severe illnesses, are to be cautious when leaving their homes, and (g) wearing of face masks on public transport and aircraft is mandatory, except for inter-island ferries, school buses and children under age twelve.

Alert level three is when COVID-19 is not contained and the risk of being infected is high. At this level, the following measures are required: (a) stay home unless movement is essential, (b) physical distancing of two meters in public or one meter in controlled environments, (c) children should learn home or schools can open but with limited capacity, (d) go to work only when you must, otherwise work from home, (e) business can open but without physical interaction with customers, (f) all public venues are to be closed, (g) up to ten people can congregate while observing the public safety guidelines, (h) healthcare services to be accessed virtually, (i) limited inter-regional travel, except for critical workers, and (j) people in the “high risk” age bracket and have severe illnesses, are advised to be cautious when leaving their homes.

Alert level four is when COVID-19 has spiraled and cannot be contained. At this level, the following measures are required: (a) staying home is a must, except for essential personal movement, (b) safe recreational activity that is within your local area, is permitted, (c) limited travels, (d) no gatherings and access to public venues, (e) only essential business such as, supermarkets, pharmacies, and other lifeline utilities, are allowed to operate, (f) closure of all education facilities, (g) rationing of supplies and requisitioning of facilities, and (h), the reprioritization of healthcare services by the health authorities.

In the early months of the pandemic, the government of New Zealand developed a coherent and comprehensive communication campaign strategy to inform the public about the “why” and “what” was expected of New Zealanders in deterring and containing the virus. Apart from the conventional information channels, New Zealanders have free access to all COVID-19 related information through an online platform.²⁴ Also, a national mental health and well-being initiative was created to provide mental health services.²⁵

Some studies suggest that during the early stages of the pandemic, New Zealand’s response was less vigorous, particularly its border management measures.²⁶ Whereas New Zealand received praises for its swift response, backed by a pre-existing influenza pandemic of 2017, the plan's applicability to other pandemics such as COVID-19 was limited. The plan was also greatly oriented towards mitigation, with a less optimal functionality to handle the high infection fatality ratio of SARS-CoV-2. Hence, New Zealand would have experienced an influx of death and an overwhelmed health system. Additionally, infrastructure for addressing a pandemic of COVID-19 magnitude was not in place until March 2020.

4.0. Lessons from New Zealand’s COVID-19 Response:

Having noted the chain of infection within New Zealand's local population, the government action was highly focused on elimination through an abrasive communication strategy. The communication strategy engaged the minds of the populace into doing the unthinkable by advocating for all to stay home to keep safe. Also, for example, the Lancet reports that many transmission chains started from younger imported cases, with a total of 575 imported cases and 459 import-related cases between Feb 2 and March 13, 2020, whereas locally acquired infections came from lower socioeconomic backgrounds.²⁷ Additionally, the rapid improvements in testing capacity and case management provided an avenue to find existing transmission chains through widespread tracing and isolating with quarantining their contacts.

Another success factor as highlighted by the Lancet shows that the daily number of cases dropped drastically between mid-April with no further case importation observed after the first travel bans and isolation orders. For example "imported cases represented 58% of the cases before March 15 but just 38% of the total cases".²⁸ It is worth noting that the COVID-19 response strategy worked basically because of the effective infrastructure already in existence which made it quite smooth to implement the various strategies.

A response plan that leverages technology achieves more in containing the viral spread. For example, New Zealand used digital applications for contact tracing and monitoring. This initiative was facilitated by the government-issued QR codes inside all public transport.

The New Zealanders had tremendous trust in their government, hence a trust deficit that could have fueled "fake news" into a vicious cycle of disinformation and inadequate response, similar to that in the USA, was non-existent.

5.0. Conclusion:

The New Zealand health care sector has undergone several structural changes some decades now. The changes that occurred in a decentralized environment presented a cost-effective approach to reduce inflation while offering health service providers an equal playing ground. The importance of the changes in New Zealand's health sector cannot be overemphasized.However, just as all other health systems have gaps that need to be filled, health providers are anxious and the public expects more improved services.

New Zealand's COVID-19 response success story points to a clear direction of an early decisive response from health authorities, enabling surveillance systems, targeted testing, and most importantly the involvement of the community through a bottom-up approach.

In conclusion, as New Zealand joins other nations in the vaccine acquisition race, an effective framework ought to be in place to foster equitable vaccine access, deter stockpiling and hoarding, which are likely to compromise the supply chain. At the point of administering the vaccines, applying relevant aspects of the COVID-19 response communication strategy will facilitate the efficient and effective dissemination of vaccines for an optimal public health impact.

Bibliography

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Baker, M. G., Wilson, N., & Anglemyer, A. (2020). Successful Elimination of Covid-19 Transmission in New Zealand. New England Journal of Medicine, 383 (8), e56. https://doi.org/10.1056/nejmc2025203

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‌Maxmen, A. (2021). Why did the world’s pandemic warning system fail when COVID hit? Nature, 589 (7843), 499–500. https://doi.org/10.1038/d41586-021-00162-4

Mental Health – Getting Through Together. (2021). Mentalhealth.org.nz. https://www.mentalhealth.org.nz/get-help/getting-through-together/

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‌ Second report on progress Prepared by the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board. (2021). https://theindependentpanel.org/wp-content/uploads/2021/01/Independent-Panel_Second-Report-on-Progress_Final-15-Jan-2021.pdf

Summers, D. J., Cheng, D. H.-Y., Lin, P. H.-H., Barnard, D. L. T., Kvalsvig, D. A., Wilson, P. N., & Baker, P. M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 4, 100044. https://doi.org/10.1016/j.lanwpc.2020.100044

Van Damme, W., Dahake, R., Delamou, A., Ingelbeen, B., Wouters, E., Vanham, G., … Assefa, Y. (2020). The COVID-19 PANDEMIC: Diverse contexts; Different EPIDEMICS—HOW and why? BMJ Global Health, 5 (7). https://doi.org/10.1136/bmjgh-2020-003098

World Health Organization (WHO. (2020). Sharing COVID-19 experiences: The New Zealand response [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=bLT-XdPRUAA

[...]

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¹ Van Damme, W., Dahake, R., Delamou, A., Ingelbeen, B., Wouters, E., Vanham, G., … Assefa, Y. (2020). The COVID-19 PANDEMIC: Diverse contexts; Different EPIDEMICS—HOW and why? BMJ Global Health, 5 (7). https://doi.org/10.1136/bmjgh-2020-003098

² Summers, D. J., Cheng, D. H.-Y., Lin, P. H.-H., Barnard, D. L. T., Kvalsvig, D. A., Wilson, P. N., & Baker, P. M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 4, 100044. https://doi.org/10.1016/j.lanwpc.2020.100044

³ Summers, D. J., Cheng, D. H.-Y., Lin, P. H.-H., Barnard, D. L. T., Kvalsvig, D. A., Wilson, P. N., & Baker, P. M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 4, 100044. https://doi.org/10.1016/j.lanwpc.2020.100044

⁴ Van Damme, W., Dahake, R., Delamou, A., Ingelbeen, B., Wouters, E., Vanham, G., … Assefa, Y. (2020). The COVID-19 PANDEMIC: Diverse contexts; Different EPIDEMICS—HOW and why? BMJ Global Health, 5 (7). https://doi.org/10.1136/bmjgh-2020-003098

⁵ Summers, D. J., Cheng, D. H.-Y., Lin, P. H.-H., Barnard, D. L. T., Kvalsvig, D. A., Wilson, P. N., & Baker, P. M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 4, 100044. https://doi.org/10.1016/j.lanwpc.2020.100044

⁶ World Health Organization (WHO. (2020). Sharing COVID-19 experiences: The New Zealand response [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=bLT-XdPRUAA

⁷ ‌Maxmen, A. (2021). Why did the world’s pandemic warning system fail when COVID hit? Nature, 589 (7843), 499–500. https://doi.org/10.1038/d41586-021-00162-4

⁸ ‌Maxmen, A. (2021). Why did the world’s pandemic warning system fail when COVID hit? Nature, 589 (7843), 499–500. https://doi.org/10.1038/d41586-021-00162-4

⁹ ‌Maxmen, A. (2021). Why did the world’s pandemic warning system fail when COVID hit? Nature, 589 (7843), 499–500. https://doi.org/10.1038/d41586-021-00162-4

¹⁰ ‌ Second report on progress Prepared by the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board. (2021). https://theindependentpanel.org/wp-content/uploads/2021/01/Independent-Panel_Second-Report-on-Progress_Final-15-Jan-2021.pdf

¹¹ See Worldometer,2020; 2018 Census population and dwelling counts | Stats NZ. (n.d.).from https://www.stats.govt.nz/information-releases/2018-census-population-and-dwelling-counts.

¹² Ashton, T. (1996). Health care systems in transition: New Zealand: Part I: An overview of New Zealand’s health care system. Journal of Public Health, 18(3), 269–273. https://doi.org/10.1093/oxfordjournals.pubmed.a024504.

¹³ Ashton, T. (1996). Health care systems in transition: New Zealand: Part I: An overview of New Zealand’s health care system. Journal of Public Health, 18(3), 269–273. https://doi.org/10.1093/oxfordjournals.pubmed.a024504.

¹⁴ French, S., Old, A., & Healy, J. (2001). New Zealand Health Care Systems in Transition New Zealand. Health Care, 1–136.

¹⁵ French, S., Old, A., & Healy, J. (2001). New Zealand Health Care Systems in Transition New Zealand. Health Care, 1–136.

¹⁶ See Budget 2019: Vote Health | Ministry of Health NZ. (n.d.). from https://www.health.govt.nz/about-ministry/what-we-do/budget-2019-vote-health; Budget 2020: Vote Health | Ministry of Health NZ. (n.d.).from https://www.health.govt.nz/about-ministry/what-we-do/budget-2020-vote-health

¹⁷ New Zealand | Commonwealth Fund. (n.d.). Retrieved 26 February 2021, from https://www.commonwealthfund.org/international-health-policy-center/countries/new-zealand

¹⁸ New Zealand Government. New Zealand COVID‐19 alert levels summary. https://covid19.govt.nz/assets/COVID_Alert-levels_v2.pdf

¹⁹ Ministry of Health. New Zealand Influenza Pandemic Plan: a framework for action. 2nd ed Wellington: Ministry of Health, 2017. https://www.health.govt.nz/system/files/documents/publications/influenza-pandemic-plan-framework-action-2nd-edn-aug17.pdf

²⁰ Praveen Menon. (2020, August 11). New cases end New Zealand’s “COVID-free” status; Auckland back in lockdown. U.S. https://www.reuters.com/article/us-health-coronavirus-newzealand/new-cases-end-new-zealands-covid-free-status-auckland-back-in-lockdown-idUSKCN257197

²¹ Baker, M. G., Wilson, N., & Anglemyer, A. (2020). Successful Elimination of Covid-19 Transmission in New Zealand. New England Journal of Medicine, 383 (8), e56. https://doi.org/10.1056/nejmc2025203

²² Baker, M. G., Wilson, N., & Anglemyer, A. (2020). Successful Elimination of Covid-19 Transmission in New Zealand. New England Journal of Medicine, 383 (8), e56. https://doi.org/10.1056/nejmc2025203

²³ COVID-19 Alert System. (2020, September). Unite against COVID-19. https://covid19.govt.nz/alert-system/

²⁴ Home. (2021, February 28). Unite against COVID-19. https://covid19.govt.nz/

²⁵ Mental Health – Getting Through Together. (2021). Mentalhealth.org.nz. https://www.mentalhealth.org.nz/get-help/getting-through-together/

²⁶ Summers, D. J., Cheng, D. H.-Y., Lin, P. H.-H., Barnard, D. L. T., Kvalsvig, D. A., Wilson, P. N., & Baker, P. M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health - Western Pacific, 4, 100044. https://doi.org/10.1016/j.lanwpc.2020.100044

²⁷ Robert, A. (2020) 'Lessons from New Zealand's COVID-19 outbreak response', The Lancet Public Health. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license, 5(11), pp. e569–e570. DOI: 10.1016/S2468-2667(20)30237-1.

²⁸ Robert, A. (2020) 'Lessons from New Zealand's COVID-19 outbreak response', The Lancet Public Health. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license, 5(11), pp. e569–e570. DOI: 10.1016/S2468-2667(20)30237-1.