I’ve had the pleasure of Kerry writing for me before and I welcome her as a long-term contributor to this blog. I look forward to reading more of her work! If you’d like to contribute the blog (even if you have no experience), pitch me an idea and let’s start the conversation!
COVID-19 in New Zealand – What Can We Learn?
Over the last few years, a pattern has emerged among UK doctors: instead of entering specialty training directly after the initial two year Foundation Programme, an increasing proportion of young doctors decide to spend a period of time working abroad, taking the opportunity to experience working in a different country and spending some time travelling. Amongst my peers, Australia and New Zealand seem to be the most popular destinations, with the attraction of being English-speaking countries who recognise UK qualifications and have similar healthcare systems (as well as significantly more days of sunshine).
Back in 2015, I was one of those who decided to step out of the UK training system and head off to New Zealand (or Aotearoa). Initially offered a three month post, I ended up staying for nearly a year and half, working and traveling around the islands. I fell in love with NZ: definitely one of the most beautiful countries I have ever visited; I could spend my weekends and annual leave hiking, kayaking, skiing and drinking some of the best wines in the world. Kiwis are some of the friendliest and most chilled out people I have ever met, and I always felt welcomed wherever I went. At a time when UK junior doctors back home were striking due to contract disputes, I was working in a country where I was paid more, entitled to free meals in the hospital when on shift, paid extra for additional cross-cover duties and subsidised for any annual leave dates I hadn’t used: in short, I felt incredibly appreciated as a doctor. It’s not hard to see why for many, what starts as a working holiday turns into a decision to stay long-term, as happened with a significant number of my colleagues. And now, comparing their situation with regards to COVID-19 to ours and so many other countries around the world, New Zealand seems to be once again getting it right. At the time of writing, there are just 18 active cases, all of which are in returning travellers who are being managed in quarantine/isolation facilities. Their total number of confirmed cases stands at 1180, with just 22 deaths – one of the lowest in the world.
In the early days of the COVID-19 pandemic, the situation in New Zealand seemed to mirror that of other similar countries. The posts on my social media news feeds from my Kiwi friends showed similar experiences to mine: people stockpiling toilet rolls and other necessities, long queues to get into shops. This was followed by a comparatively strict lockdown period banning all non-essential personal movement and the closure of all non-essential businesses (I remember my friends telling me that even getting takeaways delivered was not allowed as it wasn’t deemed a necessity, something that was never banned in the UK)! Like in many other countries, GPs quickly adapted and switched to remote consulting via phone and video wherever possible to try and reduce the risks of bringing people into surgeries. Similarly to my experience in the UK, GP surgeries initially saw a fall in demand, with patients staying away. However in New Zealand, where around 50% of a practice’s income comes from patient-chargeable service fees, the reduced patient contact combined with the increased expenditure needed in preparation for the pandemic put many surgeries under financial strain, and the Ministry of Health announced additional funding and subsidies to try and keep practices afloat and avoid laying-off of staff. This is something I’m thankful that I didn’t have to worry about on top of everything else!
Fast-forward a few weeks and the situation has now changed dramatically: on 8th June, the prime minister, Jacinda Ardern, declared that there had been no active cases of COVID-19 in New Zealand for the last 24 hours (40 days since the last case of community transmission), allowing them to downgrade the alert level to 1. Restrictions on domestic travel have been lifted, bars and restaurants are open again and people have returned to work. I’m now enviously seeing my friends down under travelling around the country and living near-normal lives. Even parkrun is being allowed to resume!
So how has New Zealand managed to cope so well with this pandemic?
Undoubtedly, New Zealand owes some of its success to its location and demographics. A relatively remote island nation which isn’t part of major transit routes, their first cases occurred comparatively late on, allowing them some time to prepare and learn from the experiences of the rest of the world. It is a relatively small and low-density population of 4.8 million people, with an average of 18 people per sq km (for comparison, the UK has 281 people per sq km), so isolation and distancing might be somewhat easier. However, there are certainly areas of higher population density: around one third of the entire population live in the city of Auckland in the north island, and early statistical modelling predicted a much higher number of cases, so this cannot be the whole story.
As a leader, I have admired Jacinda Ardern, even pre-pandemic; when she became prime minister of New Zealand in 2017, she was the world’s youngest female head of government, and later became the second female leader to have a baby while in office. Watching her responses to disasters such as the White Island (Whakaari) volcano eruption, Christchurch Mosque shooting and the murder of a UK backpacker she has always seemed genuinely heartfelt and empathetic while at the same time shown strength and decisiveness. The actions taken by Ardern and her government at the start of the pandemic seem to have been key in their success: from an early stage they were clear that their aim would be one of elimination rather than herd immunity, and they have stuck firmly to this aim – ‘going hard and going early’. Borders were closed at an early stage, and the lockdown restrictions were imposed when the numbers of active cases reached just over 100. These restrictions remained in place for 12 weeks, not lifting until they were certain that the virus had been controlled. Remaining open with the public about the measures being taken and ongoing strategy, particularly with such a strict lockdown must have played a major role in helping people to trust the government and adhere to the rules. Even now, the fact that they are able to identify the exact number of active cases is due to the robustness of their border screening, and their track and trace programme allows any new community transmission to be picked up and contained rapidly. Although seemingly out of danger, their COVID-19 strategy has not ended: restrictions have been lifted with caution and there is ongoing work to prevent a second wave. Recent polls show that the popularity of the government is at an all-time high, and that the vast majority of New Zealanders agree with handling of the pandemic.
Given all of this, it would be easy to look at New Zealand and see a perfect pandemic response. However, in spite of its low death rate, as is happening in the rest of the world, existing health inequalities are being exposed: New Zealand’s Māori communities have disproportionately felt the effects of COVID-19. Like many indigenous and ethnic minority populations, healthcare outcomes for Māori patients have long been poorer than pākehā (New Zealanders of European descent), with higher rates of diabetes and cardiovascular conditions, and an average life expectancy still around seven years lower for both men and women. There has been criticism of a lack of Māori representation in the pandemic response planning, and of specific consideration of Māori health needs: when all New Zealanders over 70 were advised to stay home in the initial stages, this didn’t take into account the lower life expectancy of Māoris. Māori cultural practices and traditions have also been threatened by the pandemic: from the tangihanga funeral rites (suspended along with all large gatherings of people and only very recently reinstated) to the hongi greeting of pressing noses together, COVID-19 has impacted on every aspect of life. Now, as GP practices consider which innovations and changes to take forward as the pandemic eases, concerns have been raised that an increase in remote working might exacerbate existing inequalities: those with lower incomes, lower access to technology and living in remote areas with less reliable mobile signal may find increasing barriers to accessing healthcare, and this is likely to include a higher proportion of Māori patients. This is something we are seeing around the world and certainly something that I’ve been thinking about in my practice – as we become swept up in technological innovations for healthcare, we need to ensure that our most vulnerable patients are not being left behind. Although far from perfect, New Zealand has always seemed to me to be more aware of and keen to address the injustices of its colonial past than many other countries, and proud of its Māori heritage. I think there is an opportunity here to learn from this experience and work harder towards equality.
I remember when the 2018 #getnzonthemap campaign launched: a reaction to the fact that New Zealand is frequently omitted entirely from world maps. I think following on from their COVID-19 response, they can be confident that the rest of the world is watching and learning from their example, and their success should put them firmly on the back on the map. I look forward to a time when I can return to the ‘Land of the Long White Cloud’, and in the meantime I’m raising a glass of my favourite Malborough Sav in congratulations to New Zealand.