A people-led pandemic response

The challenges posed by Covid-19 have driven significant changes in New Zealand’s healthcare system, with the country rebuilding the way it delivers public health care

New Zealand’s policy responses to Covid-19 have given our small country an uncharacteristically high profile on the world stage.

In part this is because the actions we took at the start of the pandemic were particularly strong, including stringent lockdowns, border closures, managed isolation requirements, mandates around testing and widespread contact tracing.

These ‘go hard, go early’ measures have been credited with saving thousands of lives by limiting the transmission of the virus until widespread population vaccination could be achieved, particularly among our most vulnerable groups. They also meant New Zealanders were fortunate to enjoy around a year of relative normality and freedoms without Covid-19 in our communities.

Our response has continued to evolve as safe vaccines have become available and had strong uptake by most of our population, as less lethal variants of the virus supplanted earlier strains, and as we have reconnected to the world.

Ensuring equity

What has received less attention has been the intense focus New Zealand has placed on equity in our pandemic response. We have a unique history underpinned by a constitutional partnership between our Indigenous Māori people and those who settled later. We knew from honest self-reflection about that history that the effects of Covid-19 would be disproportionately experienced by some of our communities, including Māori, Pacific peoples, the wider ethnic communities and disabled people.

Equity does not mean just tailoring government approaches to the needs of communities, but also empowering and supporting those communities to lead their own responses. After the mainstream public health system proved slow to facilitate vaccination uptake by some Māori groups, it was Māori themselves who were supported to take charge of the vaccination campaign through kaupapa Māori (culturally relevant) and iwi-led (tribe-led) health services.

Actually, the equity challenges we experienced reinforced how the fundamental structures of our overall health system needed to change. So, at the same time as responding to the pandemic, we have rebuilt the way our state delivers public health care.

Previously New Zealand’s population of only 5 million received public health services from one of 20 different local systems that struggled to share best practice and work together. The services and care that individuals had access to depended more on where they lived than on what they needed. The result was sometimes significant differences of access within a town, or even a suburb or street.

On 1 July 2022 new legislation came into effect to replace the old disjointed system with a unitary nationwide delivery agency, working in partnership with a new Te Aka Whai Ora/Māori Health Authority that has policy and commissioning powers to address equity issues in the delivery of good health services for Māori. The vision for the new system is to achieve Pae Ora or Healthy Futures for all New Zealanders.

Long-term planning

This year we have also transformed our fiscal management of health, with Parliament for the first time appropriating money for health on a multi-year basis to provide more certainty and greater opportunities for long-term planning by hospitals and providers. Our companion economic response to the pandemic has enabled us to fund the highest combined health and disability budget we have ever had.

It is, of course, early days in a period of profound change. We are fortunate that our location in the South Pacific has already seen us through this year’s winter respiratory illness spike, and now we look forward to warmer months in which to roll out changes.

But we have no illusions about the scale of the challenges ahead. Although New Zealand’s health workforce has been growing – underpinned by rising wages, more training opportunities and streamlined immigration settings – we face the same competitive pressures as others in the globally mobile health labour market. There is a legacy of deferred maintenance for our hospital buildings that must be remediated. Provision of mental health services are being built up from a low base. Despite having among the highest rates of internet penetration, we have lagged in ensuring equitable access to the revolution in digital health. 

And through it all the world economy in which we trade remains fragile, Covid-19 persists with its ever-present threat of new strains evolving, and we must seek to be prepared for the next pandemic whenever it may come.

While government and its policies have played an unusually significant role in New Zealanders’ lives since the start of the pandemic, ultimately the policy decisions we have been able to take have been the decisions of our people. Fortunately there remains a broad political consensus about the need for our country to have a high-quality publicly funded health system, and a special commitment to protect the most vulnerable among us. How we deliver on that consensus remains a topic of lively democratic debate, as it should be.

Much of what has worked in New Zealand throughout the pandemic might not have worked in other places. As we gain a better understanding of the successes of others, we continue to reflect on how we might have or could still apply those ourselves. What is most important now is redoubling efforts to share more knowledge and best practice, and to help each and every one of us to live healthier lives.

There is a whakatauki (proverb) in our Indigenous Māori language: “Ehara taku toa i te toa takitahi engari he toa takitini” – our success is not mine alone, it is the strength of many. For New Zealanders to pick up that wero (challenge) would be a fitting legacy from a period that has so challenged us all.