New Zealand has enjoyed a charmed life in the first 18 months of the global Covid pandemic. Along with Taiwan, it is the only country to have recorded an actual improvement in health, while at the same time its economy has barely missed a beat, and, paradoxically, it has had almost the least time under movement restrictions (other than the border, which has been closely controlled).
All this has changed with the arrival of Delta, and now New Zealand is moving from a largely successful strategy of elimination to one of active suppression involving contact tracing, testing and vaccination, vaccination mandates, masking and social distancing. The country looks set to reach vaccination levels of over 90 per cent by the end of the year. But nothing is sure in this Covid world.
The pandemic is the second major deadly infectious disease outbreak New Zealand has had in the last half century, aside from outbreaks of meningococcal disease and measles among the young. I have been present through both, as a citizen and as a researcher. There are parallels, differences, and lessons to be learned from each of them.
The first case of AIDS was diagnosed in the United States in 1981, and the first case in New Zealand was identified in 1984. What was striking about the social impact of HIV/AIDS as it unfolded in New Zealand through the 1980s and beyond was that the groups it brought to public notice were marginalised according to the social norms of the time. These included men who have sex with men, sex workers, and people who inject drugs. In each case the key transmitting behaviour was either officially illegal, or in the case of drugs it was associated with a criminal offence of possession or procurement.
For all three key at-risk groups, it was vital that a public health rather than a punitive approach was adopted in order to define, contain, and reduce the epidemic. In two of those three cases, New Zealand changed its legal framework. Injecting drug use is the one which still remains in the legal shadows, and law reform there is urgent.
What, then, of the current COVID–19 pandemic, particularly as it manifests itself in the Delta Variant outbreak? Again, it reveals features of our society and social functioning which are rarely canvassed publicly. In the first New Zealand outbreak last year, we were reminded of the vulnerability of the elderly in aged care residences, particularly where staffing levels, management oversight, and infection control are weak.
But the current Delta Variant outbreak reveals another set of vulnerabilities – the low-paid “essential” workers, the temporary migrant visa holders, disadvantaged Māori and Pasifika communities, the poor in general, the homeless and poorly housed, the multi-generational households in congested living circumstances, those with issues of mental health and substance abuse, and the gangs and wider criminal underworld.
As a research sociologist I am reminded again – just as I was in the 1980s – how an infectious disease can dramatically reveal features of our social fabric usually hidden from public view. And we know so little about them. In my immediate neighbourhood I am aware of two hostels, two half-way houses, two small parks – one where alcoholics gather and the other seemingly with drug dealers and users – a drug and alcohol treatment centre, and a handful of people living rough on the streets. Covid has also entered my street and one of the hostels within yards of my front door. But, as a research sociologist, I too have to admit to knowing almost nothing about these aspects of New Zealand society, features – among others – that are being brought to our notice at our high-profile COVID-19 briefings.
There are policy consequences and lessons to be drawn from our experience with COVID-19, if we are prepared to learn and apply them.
From the HIV/AIDS epidemic of the 1980s we learned to work on a partnership model with the key at-risk groups. We established that working through community organisations based in and near those groups was the best approach (for example, through the New Zealand Aids Foundation, and the Prostitutes Collective). We changed the law. We established a taskforce within the Health Department (as it then was). We invested in research and prevention.
We could draw on all these lessons with COVID-19, but there is more.
There is much talk of the need to build more intensive care units, ramp up hospital facilities, and vaccinate, vaccinate, vaccinate.
All of these make sense, but they must not preclude prevention at source through necessary interventions beyond the health sector by: attacking poverty and homelessness; supporting community-based organisations, including Māori and Pasifika health and social agencies; providing emergency and long-term housing solutions; dealing with substance abuse; and being able to liaise with gangs and addressing the deprivation which largely drives their recruitment.
In Auckland, a city of a 1.5 million, we identified over 800 boarding houses and hostels, many of them unregistered. Furthermore, in a supposedly well organised national health service, we found that ten per cent of those being vaccinated – that’s 100,000 adults – were not registered with our health system.
And let’s not forget primary care and public health. Two phrases communicated to me anecdotally from my current role as an elected member on the Auckland District Health Board (DHB) haunt me – the (child) immunisation register “is on its last legs”, and the Auckland regional public health services “is on its knees”. These speak to years of a “soft” austerity and cost-cutting.
Furthermore, In the most recent budget for the Auckland DHB, for every 100 dollars spent, exactly five dollars were allocated to primary care and fifteen cents to public health. In times like these, this is the thin red line that stands between community disadvantage and dysfunction, and the rest of society.
Margaret Thatcher is said to have claimed that there is no such thing as society. John Donne, the poet, by contrast said “No Man is an Island”. COVID-19 brings to our attention our need to take Donne’s insight far more seriously than we have if we are to keep the worst of the COVID-19 pandemic at bay.
Peter Davis is an Emeritus Professor of Population Health and Social Science, and an Honorary Professor in Statistics, at the University of Auckland. He is also an elected member of the Auckland District Health Board, and is Chair of The Helen Clark Foundation, an independent public policy think-tank. He has a website which hosts his media items and published research, plus street art – https://peterdavisnz.com/.