
Not all prepared for another pandemic, inquiry told
The week-long Royal Commission of Inquiry into the government's Covid-19 response has finalised its first session of public hearings in Auckland.
The inquiry aimed to look at lessons learned from the government response in order to prepare for future pandemics.
Friday's fifth and final day of evidence in Auckland included testimonies from mandated industries, nursing and midwifery sectors and researchers.
Autism New Zealand research and advocacy adviser Lee Patrick said today the impacts on disability support staff for the autistic community were still being felt.
Patrick said while there were some resignations due to the mandate, other staff left due to the pressures of childcare and lockdown.
However, she said Autism New Zealand was in favour of vaccine mandates.
"Where I think the vaccine mandate did hit quite hard was disability support workers - and that's because there weren't enough to begin with.
"It's an understaffed area. The few disability support workers that chose to resign or who couldn't keep their jobs after refusing to be vaccinated had an enormous impact.
"These are people who work intimately with disabled people - [they] come into their homes, in some cases help them bath and use the toilet, in other cases help them cook meals and clean their homes - it's a very close relationship.
"Losing that relationship particularly for an autistic person or a person who struggles to communicate, who relies on that predictability and routine is an enormous blow."
Patrick said many in the community wanted exemptions for their support workers and were willing to accept the risk of having an unvaccinated person in their home because of that important relationship.
Many of those workers who left the sector during the pandemic had not returned, she said.
Johnny Mulheron, general manager of ambulance operations for Hato Hone St John, said they lost 1% of their front-line staff during the pandemic.
He said in general, most workers within the ambulance service were supportive of the vaccine and mandates.
"Prior to the mandate we have 65 percent of our people get vaccinated - that's over 8000 people.
"Our technical advisory group supported that mandate and its not unheard of in health to have vaccination and immunisation evidence... we have a policy and immunisation schooled and an expectation."
St John had since re-engaged with the majority of those people who had left because of the mandates, he said.
But others within the health sector issued warnings to the commissioners.
Anne Daniels, president of the New Zealand Nurses Organisation, said they were not prepared should another pandemic hit.
She said she had concerns around resourcing levels in public health, especially considering there were suggestions within the sector another pandemic could arise in the coming years.
"It seems we might have a pandemic within the next two years and we're not ready for it. More recently, the funding of our health infrastructure has been decimated in my opinion - particularly in public health."
Daniels believed it could be difficult to implement findings and recommendations from this inquiry in time, considering they were not expected to be released until next year.
Claire Macdonald, of the New Zealand College of Midwives, said Health New Zealand was not prepared for the end of the vaccination mandate in September 2022, despite the government emphasising that the mandates were a temporary measure.
Macdonald said it caused the health service to be "starved unnecessarily of staff".
"There was no policy in place within Health NZ to re-employ those who had left - midwives or any other health profession - under the mandate and it was advised that so-called mandate would remain in place until a national vaccine policy was put in place.
"That was initially expected to take two to three weeks. It took nine months and there was no re-employment in just about every hospital of unvaccinated health workers until that national vaccination policy was put in place in July 2023."
Macdonald said they provided intensive support for some midwives "to be able to go back into those facilities and work as locums or contractors or anything that meant they could provide midwifery care but not be under an employment contract which is a work around and completely ridiculous".
The inquiry would continue next month in Wellington and provide a second session of public hearings.
These would gather evidence from key decision-makers who led and informed the government's response to the pandemic.

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Otago Daily Times
12 hours ago
- Otago Daily Times
Alcohol guidelines 'outdated, understate health risks'
By Guyon Espiner of RNZ The country's official low-risk drinking guidelines are outdated and "understate the health risks" of alcohol, according to Health New Zealand documents. Efforts to update guidelines were halted after alcohol lobbyists complained to a Ministry of Health general manager Ross Bell. Bell, who works within its Public Health Agency, says he intervened to clear up confusion about whether HNZ or the Ministry of Health (MOH) should manage the guidelines. He said the MOH would manage them now but that work was on hold while it considered its priorities. Documents released to RNZ under the Official Information Act show why HNZ considered updating the safe drinking guidelines was crucial and that it saw "scrutiny from the alcohol industry" as a risk factor in the process. New Zealand's drinking guidelines say that to stay low-risk, men should have no more than 15 drinks per week and women 10. The maximum number of drinks recommended per week to stay low-risk (for men and women) is set at two in Canada, 10 in Australia and 14 in the United Kingdom. Canada, Australia and the UK all significantly reduced their safe drinking guidelines in recent years as evidence emerged about the health risks of alcohol, which is linked to seven types of cancer. A November 2024 memo from HNZ alcohol harm prevention manager Tom Devine said New Zealand's guidelines, written in 2011, were now out of date. "The evidence around alcohol and its risks to health has evolved since then and other countries like ours, such as the United Kingdom (in 2016), Australia (in 2020), and Canada (in 2023), have updated their Alcohol & Health Advice, resulting in much lower recommended drinking limits," Devine wrote. "The current advice is complex (and) out of step with other jurisdictions." Current guidelines also did not meet the needs of pregnant and breast-feeding women and young people, he said. "A review and update are necessary to ensure the advice is clear, inclusive and based on the most up-to-date evidence." Another HNZ document, written in January 2024, said: "The current advice does not reflect the latest scientific evidence meaning that it understates the health risks from alcohol." The documents show HNZ commissioned Massey University to work on the first phase of a review in February 2024 - at a cost of about $130,000 - but later that year MOH's Bell intervened. Emails obtained by RNZ show a lobbyist with the Brewer's Association emailed Bell in October 2024 asking why a HNZ website was reporting that the drinking guidelines were under review. He emailed again a month later complaining that references to the review were still on the website, run by HNZ, and also took issue with the fact the site linked to Canadian drinking guidelines. Bell emailed HNZ in December 2024: "All work on this project will now pause. You will update relevant Health NZ websites to remove references to the review and also to other jurisdictions' guidelines (including the Canadian one)." Bell has declined requests for an interview with RNZ, but in a previous statement said material was removed from the website to avoid confusion, as the drinking guidelines were now led by the Ministry of Health not HNZ, which runs the website. He said that was an internal decision by the MOH and that a review of the drinking guidelines was now on hold while the ministry considered its priorities. But the documents released to RNZ show HNZ believe it is crucial to update the guidance. A memo from HNZ alcohol harm prevention manager Tom Devine said health professionals relied on accurate guidelines, which were "foundational" for screening, interventions and referral for treatment. "This is where health professionals ask patients about their alcohol consumption using the advice as a baseline to assess risk, which informs the need for brief interventions or referral for counselling or treatment." Devine's memo said one of the risks in reviewing the guidelines was "scrutiny from the alcohol industry" and his mitigation strategy included "a strategic communications plan to articulate the evidence base and reasoning". Associate Professor Andy Towers, the co-director of the Mental Health & Addiction Programme at Massey University, worked on the initial stages of the review for HNZ and said current guidelines understated the risk. "There's more and more evidence now, especially with longitudinal health data, to show that even low levels of alcohol use over a long time can result in some significant alcohol related harms." He said sticking with the 2011 guidelines could lull drinkers into a false sense of security. "For us to set low risk advice thresholds that are quite high, much higher than other countries, means that we will continue to have serious alcohol related harms occurring across the country, in communities, and that will flow through into hospitals." Cancer Society evidence and insights lead Emma Shields said a review of the drinking guidelines was needed to bring them into line with the latest evidence and international guidance. She said alcohol caused seven different types of cancer including breast, bowel and oesophageal. "When it comes to cancer risk, there is no 'safe' level of alcohol use, and even small amounts of alcohol increase the risk of cancer."


The Spinoff
16 hours ago
- The Spinoff
Counting the true toll of the Covid-19 pandemic in New Zealand
As the Royal Commission of Inquiry into New Zealand's Covid-19 response continues, modelling expert Michael Plank presents a new study on the country's excess mortality rate. How many people died because of the Covid-19 pandemic in New Zealand? It sounds like a simple question, but the answer depends on more than just counting reported Covid-19 deaths. My colleagues and I recently published a study in the International Journal of Epidemiology looking at excess mortality – the number of deaths above what we would have expected if there hadn't been a pandemic. Excess mortality helps us to measure the overall impact of the pandemic, not just from Covid-19 itself but also from things like delayed medical care or the side effects of lockdowns. And because it's based on the total number of deaths from any cause, it doesn't depend on how the cause of death was determined, nor whether the death was recorded as being due to Covid-19 or not. Many people will have seen the Our World in Data Covid-19 dashboard, which allows users to compare excess mortality between countries. This dashboard shows that New Zealand's total excess mortality up to the end of 2023 was less than 1%. In other words, the number of deaths during the pandemic was less than 1% higher than expected. But not everyone agrees with this conclusion. A 2024 study by John Gibson argued that the excess mortality in New Zealand was actually much higher than this. Our World in Data's method missed a crucial factor: New Zealand's population growth ground to a halt in 2020 due to pandemic travel restrictions. With fewer people in the country, Gibson claimed, we should have expected fewer deaths; so the excess mortality was actually higher. We wanted to know if this was really true. Could the Our World in Data dashboard be inadvertently hiding a swathe of excess deaths in New Zealand? To answer this question, we built a statistical model that estimated trends in the death rate in different age groups over time. We then used this model to calculate how many deaths would have been expected if the pandemic had never happened and pre-pandemic trends had simply continued. Our model accounts for changes in population size and ageing to ensure a fair comparison. We looked at excess mortality up to the end of 2023 because we wanted to include the period after New Zealand's elimination strategy ended and the virus became widespread. Was New Zealand's pandemic death toll higher than reported? The answer from our work is a resounding 'no'. We estimated the total number of deaths between 2020 and 2023 was somewhere between 2% higher than expected and 0.8% lower. In other words, we can't be confident that more people died during the pandemic than would have died anyway. We can be confident that the number of deaths was no more than 2% higher than expected. In 2020, the number of deaths was unusually low, mainly because border closures and lockdowns inadvertently wiped out influenza as well as Covid-19. In 2022 and 2023, deaths increased as Covid-19 became widespread. The timing of excess deaths matched very closely with reported Covid-19 deaths, with the highest death rates occurring during the biggest Covid-19 waves of 2022. This suggests that the virus itself was the main driver, rather than indirect factors. Overall, New Zealand's estimated excess mortality of less than 2% is far lower than that in countries like the United Kingdom (10%) or United States (11%) over the same period. And although our study only covered the period up to the end of 2023, the overall age-standardised mortality rate in 2024 was below pre-pandemic levels. This shows that there is no mystery factor causing large numbers of unexplained deaths. Reported Covid-19 deaths appear be an accurate measure of the pandemic's death toll. So why the controversy? Gibson was right that New Zealand's population growth stalled during the pandemic. But that's only part of the story. Most deaths happen in older people, and this part of the population continued to grow during the pandemic. So, even though total population growth slowed, the number of elderly people – the group at highest risk of dying – still increased as expected. In other words, New Zealand's ageing population was a more important driver of the expected number of deaths than the number of immigrants, who tend to be relatively young. Why does this matter? The next pandemic is a question of when, not if. If we are to respond better to future pandemics, it's essential that we understand the full impact of our response to Covid-19. Some critics argue that New Zealand's elimination strategy just delayed the inevitable. Deaths that were prevented in 2020 and 2021 – the argument goes – were simply delayed until 2022 or 2023, when the virus became widespread. But the data tell a different story. Our response bought time for people to get vaccinated before they were exposed to the virus. And that massively reduced the fatality risk. New Zealand's response was far from perfect, and there were undoubtedly harms as a result of lockdowns and other measures that are not reflected in mortality statistics. But there can be no doubt that the response saved thousands of lives compared with the alternatives. Michael Plank led a group of researchers who were commissioned by the New Zealand government to provide modelling in support of the response to Covid-19 between 2020 and 2023.


Otago Daily Times
18 hours ago
- Otago Daily Times
After a drawn-out battle, triumph beckons
The United Kingdom finds itself, once again, in the uncomfortably sweaty embrace of a heatwave. Edinburgh, a city built for haar, drizzle and existential melancholy, now shimmers with the heat. The grey stones of Leith have acquired a new hue in the golden sunshine. Pale Edinburgers have shed their woolly layers and have emerged, blinking, into the sunlight. I have no doubt the Meadows is currently a patchwork of charred sausages and sunburned students lazing out on the grass. Alas, I do not have the time to ascertain this myself. Instead of frolicking by the seaside or lying stretched out under a tree in Pilrig Park, I am trapped inside the cool quiet of my room, hunched over my desk, typing away furiously on my battered laptop. I am not deranged; I am a university student once again, making a final attempt to finish off a master's thesis I abandoned four years ago. Four years ago I was desperately depressed, anxiety-ridden, and seriously ill with ME/CFS and Long Covid. I was in the final stretch of my second master's degree — this one in global and imperial history — at the University of Oxford. The expectation was clear: to produce a well-researched and original thesis of 15,000 words. I was decidedly not capable of this. I was barely capable of showering or feeding myself. I was, of course, not merely a victim of my circumstances. I certainly could have been a better student; I could have applied myself more, drunk less, spent more time in the library instead of bars. But my father had just suffered his first heart attack — the second would end his life, two years later — and I was far from home, unable to return to New Zealand because of brutal Covid-19 border restrictions. Add to this my family's Luddite tendencies (I went several days without receiving news of my dad's health status), and you can perhaps understand why I wasn't best placed to meet the demands of an Oxford thesis. I can understand why some readers might view my struggles at Oxford as indulgent, ungrateful or pedantic. After all, I was awarded the immense privilege of a Rhodes Scholarship, an opportunity sought after by many but afforded to few. I am deeply aware of how fortunate I am. I could never have afforded to study overseas, let alone at a university as prestigious as Oxford. But those who are quick to judge often overlook — or choose not to understand — that gratitude and suffering can coexist. I have struggled with chronic depression for the better part of my life. When I arrived in Oxford, I was also grappling with CPTSD following the death of my brother by suicide only a few years earlier. I was also physically unwell with ME/CFS, battling thick, weighty fatigue. I could barely stay awake in lectures, and my brain fog made it nigh-impossible to form coherent sentences, let alone write postgraduate essays. My gratitude for the opportunity was — and still is — genuine, but it doesn't negate the deep and debilitating reality I was living through. After withdrawing from my studies, I felt a complex mix of relief, confusion and freedom. Most of all, I felt like an abject failure. Up until that point, my sense of self-worth had been almost entirely dictated by my academic and professional successes. And yet here I was, giving up on my Oxford dreams. I was a flop, a Rhodes Scholar with nothing to show for it but a glut of doctor's notes, joint pain and an unfinished thesis. In the intervening years I returned to working on the "other side" of academia, in administration, event-planning and communications. I rediscovered how much I enjoyed science communications. Translating complex research into accessible language, telling the human stories behind the data, and building bridges between disciplines has felt like a fresh alternative to the solitary grind of academia. At times it's been somewhat awkward, having to explain my incomplete degree and the gaps in my CV. But I've also learned to be a bit kinder to myself. I have learned that rest is not laziness, that asking for help is not a sign of weakness, and that my resumé does not determine my self-worth. I'm 30 now, and I've finally learned that I cannot bully my mind or body into health. But now, to quote the immortal words of The Human League, I'm coming back — back to my studies, back to Oxford, back to that dratted thesis that has haunted me for so many years. The University of Oxford, Rhodes House, and my wonderful college (Trinity) have graciously allowed me to return to my studies, and for this, I am deeply grateful. In a nutshell, my thesis is an intellectual history of Sir Frederic Truby King (1858-1938). King, a prominent New Zealand doctor, mental health reformer, and public health campaigner, is primarily remembered for his pioneering work in infant and maternal welfare with the Plunket Society. I am exploring King's life and legacy, focusing on his time as medical superintendent at Seacliff Asylum, where he developed ideas about moral treatment, environmental determinism and discipline in mental healthcare. In 2019, I wrote a column mildly questioning the sainthood of Captain Cook, arguing (hardly originally, I might add) that his voyages, whilst remarkable, also helped lay the foundations of a violent colonial order. A few days later, Emeritus Professor Erik Olssen published a rebuttal, dismissing my claims as "specious" and suggesting that I would surely fail my studies at Oxford. (Spoiler: I did drop out shortly after — but not, alas, for the reasons he thought.) The funniest thing about returning to my studies is that I am now poring over Olssen's (admittedly excellent) work on Truby King and the Plunket Society. The irony isn't lost on me. Academia has a long memory, but it also circles back in strange ways. The professor who once prophesied my failure now resides in my footnotes. The best thing about returning to my academic studies however has been the support of my supervisor. It is a somewhat revelatory experience to realise that a supervisor can actually be a wonderful mentor. My supervisor is not only brilliant but also kind, offering generous, thoughtful feedback and taking my disability support needs seriously. I'm now only two weeks away from my submission date, and the pressure is weighing on me once again. But I feel (relatively) calm and steady. I know that just pressing "submit" will be a personal triumph, even if I receive an abysmal grade. Just having got it done will be enough. Now, if you'll excuse me, I have some footnotes to tidy up, and then I might go for a walk in the park. — Jean Balchin is an ODT columnist who has started a new life in Edinburgh.