COVID-19 update 23 September 2021

News article

23 September 2021

Prime Minister Jacinda Ardern and Director-General of Health Dr Ashley Bloomfield will update the media today at 1pm. They will be joined by COVID-19 modeler Professor Shaun Hendy.

>> (Speaks Te Reo Maori) good afternoon, everyone.

We have an extra guest, Professor Shaun Hendy, a physics professor from the University of Auckland who will share some modelling that he and his team have completed on the impact that vaccinations can have on COVID-19.

But first let's come to Dr Bloomfield for an update and I will come back for a brief introduction and we will give Professor Hendy a chance to speak. 

>> Tena koutou katoa.

Today there are 15 new community cases to report all in the Auckland region, the total number is now 1123. of those pleasingly 861 have now recovered.

There are also two new cases in managed isolation.

Today's new community cases, most are household contacts of current cases. There are three who are as yet unlinked but investigations continue, including interviews, to determine, yesterday's one unlinked case has now been linked to a case.

Today there are 15 people in hospital with three NICU.

Turning to testing now 19,194 swabs processed across the country yesterday and 8370 swabs taken across Auckland.

37,000 essential workers have been tested since 1 September, thanks to those people.

Suburbs of interest where there is intensive including surveillance testing going on are changing today. Mount Eden Massey are no longer included but Mount Wellington has been added to the list. There are pop-up tested centres at the netball centre in Ferguson Drive and the Mount start Stadium. -- Mount start Stadium.

A great response to testing in the Clover Park suburb in the last two days, 777 yesterday, 10% of the population of Clover Park have been tested just in the last two days. 60% of Clover Park residents have had at least one vaccination and I would urge those who have not yet had a vaccination and are eligible to get out and do that today.

In terms of crossing alert level boundaries there is a new testing requirement for people who need to travel out of Auckland for personal read reasons, that comes into effect at midnight tonight. It is when most people have to travel across the boundary one for personal reasons and they need a negative COVID test within 72 hours of travelling. There are some exceptions to this and the information is on the Ministry and COVID-19 websites.

Generally though people travelling out of alert level III for whatever reason regularly, for example for permitted activities like to take care of an animal, will also need a test within the last seven days. We are updating the information on the website this afternoon but what I would say is there are greater restrictions on travelling across that boundary with Auckland under alert level III this time than they were last time. It doesn't include the ability to travel to your house outside of the region or to travel to school outside the region, they were features last time, there are no exceptions for that this time.

There has been ongoing great response in upper Hauraki, every teacher and student at Mount Maunganui School, have tested negative. The only positive test we've had our from those in that single household.

On the section 70 notice that has been in place, an update, I am lifting that section 70 order for people outside that were covered by restrictions. Those restrictions applied to people who had been in that region between the eighth and 20th of September and had departed prior to 7:30 on the 20th, no evidence of any spread beyond the household that and we have reassured from a significant level of testing in the region as well as wastewater testing that there is no spread.

 Section 70 noticed is lifted and those people who have been isolating, thank you very much, stay vigilant for symptoms but you are released from that isolation, it stays under isolation, up for our key. 

>> We've been talking about why vaccinations are so important and the more people who are vaccinated if you are restrictions we will have to live within the future. What does that look like in reality? How much of a difference does 80% of the eligible population being vaccinated mate compared to 90% or more?

Throughout a response to COVID-19, right back to the beginning we have used the best research and evidence we have available and we have used that to inform what we do as a government. It is included the advice of Dr Bloomfield and his public health team. It is also included the work of people like Rodney Jones and his team.

As part of our preparation for the future we asked the team at the centre of research and complex systems to do a piece of work we could share with everyone.

We receive that work yesterday and a few disclaimers before the wake shared. It belongs to TPM and it is yet to be peer reviewed. It also does not represent inevitable outcome for New Zealand. We see it as a contribution to the debate and a contribution to the work we must do going forward.

To take us through some of the work we have received I will hand over virtually to Professor Shaun Hendy. 

>> On how vaccination could help on the COVID-19 response, when we started awaken much we were hopeful the vaccination could take it back to the pre- pandemic while as we watch countries like the US and UK vaccinate their weight out of large and deadly outbreaks.

However by the time we got to June we were watching the delta variant spread around the globe and it was becoming clear vaccination alone was gone going to do the job.

Today we are updating that work to take into account several new factors. The first is that we are on track to vaccinate upwards of 80% of those aged over 12, that is fantastic. For those over 65 the portion of  people. For those over 65 the portion of people with at least one dose is over 90%. The rate of uptake suggest we could aim high, approaching well over 90% in the coming months.

The second new piece of information is that Pfizer has announced that the vaccine may soon be available and approved for use in children over five.

This means it might be possible to achieve vaccine coverage across the population of more than 90%.

These are not scenarios where dwelt on in our report.

Today's report is to address this and update thanks. I need to emphasise that this is just a modelling study and although we have tried to incorporate the best data from overseas there are many uncertainties. If new information comes to light from overseas, our conclusions would have to be updated to allow for that.

With that said, what does the model tell us about vaccination coverage in the 90s?

The best outcome would be what is called population immunity. This is where enough people are vaccinated that the virus cannot find new people to in fact and outbreaks fizzle out on their own.

This corresponds to keeping the effective reproduction number of the virus, R, that model is like to talk about below one and if we can achieve that the effects of COVID-19 would be greatly blunted.

The model tells us that because delta is so transmissible, population immunity is probably out of reach by vaccination alone. However that A number depends on other things including other public health measures we might put in place.

We looked at what might happen if we used a suite of moderate sustainable public health measures such as a combination of masks, better ventilation, rapid tests, our current approach is based around lockdowns. Without scenarios where it is achievable provided we get high vaccine coverage and it is supported by moderate public health measures as well as effective contact tracing.

There would be a lot of benefits to achieving this. For example, if we got to 90% plus vaccine coverage in those over the age of five, the moderate public health measures could increase the -- reduce their health burden to less than seasonal influenza. Nonetheless there is still scenarios where despite a high vaccination coverage population immunity would not be achieved. This would look like -- likely result in severe health burden is a lot worse than seasonal  influenza. If we only get to 80% of those over five we could still experience 60,000 hospitalisations from COVID-19 in one year and 7000 Fidelity's. How have system could not cope with this level of illness and we would have to continue to lose lockdowns.

The message is that COVID-19 will continue to disrupt our lives for some time yet but we can minimise the disruption by ensuring we all get vaccinated.

There is no magic threshold for vaccination coverage, just the fact that the higher the coverage, the less restrictions we will need in coming years. The report today demonstrates this trade- off.

There are important updates to the work we have released today that we are working on at the moment which will be released in the coming weeks and months and these include a more detailed of what these measures might look like and how they might work best in the community about the border. I will finish by thanking my co-authors on the report, my complaint can as well as the rest of the team who are working on broader aspects of the program.

 Let me stress the need, we need every community to be well covered by vaccination for life to go back to normal, we can't leave anyone behind. Kia ora. 

>> Thank you Professor Hendy.

The work completed by TPM are complex models, a lot of variation and likely changes to them in the future. They've had to take into account a huge range of variables and I expect those will be debated. There are still some strong themes we can take away even at this early point. The first is that vaccinations matter the most and they are cause for hope.

In the beginning of our battle against COVID-19 we used lockdowns because none of us could risk being as opposed to the virus. To control it, we couldn't just isolate away those who had a virus, we had to isolate away everyone.

When vaccines we can turn that model on its head. We can isolate those who have COVID rather than everyone because we have the individual armour vaccine which means if we come into contact with the virus, we are far less likely to get unwell, departed on and then to cause a major outbreak. The second important take-home is that vaccines alone are not enough.

 If you just use vaccines and nothing else and there is an outbreak in New Zealand, could still lead to widespread outbreaks and hospitalisations. That may not have been the case with other variants of covert but delta is more transmissible.

If there is an unvaccinated person, it is very good at finding that person eventually and the next one and the next one until it is quickly found a lot of people, and potentially overwhelm the health system. If you are someone who's been vaccinated, you might think that doesn't matter but it does. Children can't be vaccinated, it will reach them and we've seen them reach them in this .

However, that doesn't mean the public health tools need to be as disruptive as the ones until now. They could be measures as has been referred to in this work as sustainable, a mixture of things like isolating cases, improved ventilation in public spaces, strategic use of masks, vaccine certificates and approach at our border which means we try to catch cases but will not necessarily mean 14 days of quarantine as we know it now but the way we have to use these again will become very much down to how many people we vaccinate. The third point and the one I know people will be looking for is if these tools have to include lockdowns. But we can see is essentially a very high levels of vaccine we can take level IV out of the toolbox and set it aside while vaccines continue to be as effective against variance as they have been to date and I know people will see that as very good news.

Again, though, it all comes down to vaccination.

As we have said from the start of our vaccination campaign, the more New Zealanders who get vaccinated, the more opportunities open to us and the more freedoms we gain. Meaning we don't have to leave it covered. We can stick with the plan we talked about at the beginning of this pandemic which was not zero cases but zero tolerance for COVID.

We can vaccinate, isolate, we can control it and there is reason for optimism. I wanted to finish by finishing in the sharing what comes next. Last week I mentioned our lead level system needed to factor in the new tool that is vaccinations. We have been undertaking work on this and look to share that work when it is complete in the coming weeks. That means before we have the vast majority of New Zealand fully vaccinated, you will be able to see what a difference those vaccines will make to the way we respond to an outbreak in the future.

We increasingly have the research and evidence to underpin that work, a range of sets of modelling, advice from our public health team at the Ministry of health and a set of principles we are working to. I wanted to share those principles with you now.

The first, as we undertake our future work on a vaccine framework, includes vaccinate.

That means good coverage across geographic areas, age range and ethnicity to prevent outbreaks. Aggressively isolate cases when they do arise. Control the impact of potential cases through sustainable, public health measures. Give as much certainty and stability as possible for people and businesses.  Catch cases at the border but work towards removing the bottlenecks. And ensuring our hospitals and public health system are well equipped to care for cases if and when they arise.

 I look forward to sharing that work soon as we look towards the future including the summer with a sense of optimism.

For now, I want to say thank  you again to all New Zealanders.

Your work has meant we have had one of the lowest mortality rates and hospitalisation rates from COVID in the world.

Your hard work is meant over the last 18 months we have had more days without restrictions than almost any other country with COVID.

It is also meant our economy has recovered to see activity back at pre-COVID levels with unemployment among the lowest in the OECD and there is now an opportunity for us all to grasp, to be one of the most vaccinated countries in the world.

The progress in recent weeks has been significant.

 Auckland is at 80% first doses for eligible populations. 90% is in within its sites and now we need to work together to see all our communities get up to those rates and beyond. It is not the Aotearoa way to leave anyone behind and it doesn't feel right. Here is our chance to lead the world again and that comes down to each and every one of us.

We have the supply of vaccine we need, the workforce ready to do the job. Have that conversation with your whanau or friends, help someone make a booking or give them a lift to a vaccination centre.  Each action gets us a step closer to the opportunities and freedoms we all want. In the meantime, cross all the debate you will see amongst modellers and researchers, there remains one simple message get vaccinated. It is the reason we should all feel hopeful.

 Now happy to take questions. 

>> Prime Minister, with the vaccination rates, New Zealanders want something to aim for. What is our vaccination rate? 

>> High. You can see the highest possible vaccination rates to be the most freedoms and you can see that in all of the research that is presented including some you have seen today. The more people that are vaccinated the fewer restrictions we need to live with, the more normal life will feel and the more protection we provide particularly for those young children and babies who cannot be vaccinated. You can see some of the modelling that the higher, the better. You will see Dr Bloomfield said, for instance, 90+. Those are the kinds of numbers that give you the most freedom possible and so that is where we should be aiming for. Let's be top of the table. 

>> Doesn't mean it is a note opening up at 80%? 

>> What you might be distinguishing between is we have our current outbreak we are dealing with in Auckland and we continue to take a Stamp It Out strategy amount. We need to because we are still vaccinating our population. What you see today is the future what the future can look like with a vaccinated population. 

>> At 80% we are still looking at 7000 deaths. Is it to know? SHERIE POLZIN:Will be lots of debate continuing around where you assess the efficacy of vaccinations and so on. What this tells us is with high vaccination rates we do not have to simply accept you have this kind of impact on people's lives that it means we should strive for high vaccine. That will be the golden ticket for New Zealand. It also means we will not have to have baseline public health measures that have been really disruptive to our lives. Vaccines can help reduce those down so it is all our choice. I will come back to you. I will come in the front. 

>> Does this mean that children over five need to be brought into the vaccine program because looking at the numbers to get to that high number, you need to get (inaudible) which is probably impossible. (Inaudible)

>> The decision on those over five and a vaccination will be based on advice from our experts. They will make an assessment around all the data and evidence for that group. It will always be a health decision, always. So that will be aware that decision is made. It demonstrates and makes it easier to hit some targets but will not be the basis of decision-making. I will come to you on that. 

>> A quick additional comment. We are looking at the evidence. It is promising. It will go through the regulatory approval process and then the advice from our technical advisory group and then it is a cabinet decision. Equally we are also watching the studies done on under fives and the key thing here is if the vaccine is effective and safe for the whole population, that is a huge advantage because it helps protect those younger members of the population will stop in the meantime there was a key message there and Professor Hendy said there is no magic number. It is as high as possible but getting vaccinated protects not just you, protects frail older people, our children, immunocompromised people who cannot be vaccinated and our vulnerable communities. 

>> It is a reminder that we have had 13 babies from this outbreak, 13 under ones in this outbreak affected by COVID-19, 253 children under 12, so the vaccine for that age group is about protection for that age group, not just about if it helps us achieve high rates. I will come to Jason. 

>> Is modelling (inaudible) underlying assumptions and would you look at countries like Singapore with quite different results? Share what we are doing is no different to what we did all the way through. Professor Hendy's modelling has been available in different forms and iterations from the beginning of COVID and so has a range of other models and so has international evidence, so has our public health advice. We go through a process of bringing all that in and designing our response. I recall some advice we got from Professor Hendy at the beginning of COVID-19. It helped us design our alert level framework and so we have taken on board a range, not just any single piece of work and that is the same now as it has always been but it is always incredibly helpful as we work through some models. 

>> (Inaudible) very different to the Dougherty modelling in Australia. 

>> And it is different again to Denmark. This is why you hear say these are tools and pieces of information that help inform our decisions. But it is not a matter of, "This is the singular pathway and the inevitable outcome. " I don't think any model intends to be that. They call themselves a guide and the guide you can take is vaccines matter and the help us get freedoms. Perhaps I can allow you to answer that yourself, Professor Hendy. 

>> Yes, even where you use a variety of models to look at this problem and we will continue to do so, and yes, I think it is valid for us to follow what is happening overseas but we have to remember every country is different. It depends on age structures, other measures you might be prepared to put in place and I think it is also important to remember looking at the long- term here and we will have to watch what happens in countries like Singapore and Denmark over the longer term. It would be really dangerous to just simply follow a country based on some short-term results. This is a strategy we will need in place for at least a year, if not several years. 

>> A final thing before I pan around. We received modelling before we adopted our approach at the beginning of COVID-19. We chose a course that meant that that modelling did not come to pass. That is why we get it early, we can make decisions and choices that mean that none of it has to be inevitable. It is about how we guide decision-making and we take from a range of sources. Jason? 

>> The modelling suggest the difference between 80 and 90 could be the deaths of thousands of New Zealanders. You have already essentially ruled out the stick which is mandatory vaccination. Is there any incentive the government will provide to shift the dial at the top level to help save essentially, could be hundreds of thousands of lives? 

>> On your direct contrast, I will let Professor Hendy speak to his own modelling but when  it comes to the issue of carrots and sticks, there have been some areas where we have said, because of the risk individuals we think it is incumbent on us to go a little further and require vaccines and we have seen where been willing to do that and other workplaces will have conversations with employees and what you have seen is some discussion over some tools like vaccine certificates and that  is a live debate for us because it does not preclude you from engaging in life but says if there are certain things you want to do safely, maybe they are a legitimate tool, so things we are discussing and debating. 

>> Did you want to say anything, Professor Hendy, around those different vaccine levels? Cheryl I will command on 80 versus 90%. -- 

>> I will comment on 80 versus 90%. There would be a far less need for lockdowns. That is a big carrot for many people in New Zealand, the fact we would not necessarily have to rely on lockdowns any more I think would be a big bonus. And I cannot speak for the government but I presume that that would remain on the table if we were facing a scenario with thousands of deaths, so if we can get into the 90% range we can say goodbye to lockdowns.  

>> Further to that point, does   lockdowns to be used until over fives are able to be vaccinated? 

>> Not necessarily. When we have an outbreak like an organ currently, we are using traditional tools to take it on because we need to because we do not have high rates of vaccination so don't have individual protection for people so that is why we have to stay at home instead. What this is costing forward to is a future where we have high rates of vaccination and in that future if those rates are high enough, we will be able to move aside from this lockdowns as a tool and instead use things that impact on people's lives much less. 

>> If we do not get to the 90%... We don't need to wait for over fives to be able to be vaccinated before lockdowns become a last resort or you would stop recommending...

>> Keeping in mind for the vast  majority, we have not been in lockdowns because of the suite of tools used and that will continue to be our focus but in the meantime we want people to get vaccinated because then it makes it much more certain we can move away from those tools altogether. Go ahead. 

>> Sean mentioned this, but in addition to vaccination there are two other areas where we  can deploy measures. One is those baselines restrictions and they could be the sort of restrictions we currently have an alert level II. Our preference is we do not have to and we can enjoy alert level I freedoms. The second is at the border, the level of movement across the border in both directions and what we require of people as they come across the border, so it is not just necessarily an 80 or 90, it is also about the baseline restrictions and the extent to which movement is freer or not across the border that can be used to help manage and control COVID-19 in our community. 

>> (Inaudible) the impact on the modelling of not getting to 90% could be on our Maori and Pasifika community.   

>> Delta will be good at finding unvaccinated people and if there is a pocket that includes an age group or a community or town, that is where you will have outbreaks. That's why it's important we have good spread across New Zealand, across ages and towns and cities and ethnicities because that will break the chain of transmission. It's a principle we know well and that applies here. All the way through, I feel wary on behalf of Professor Hendy, models are imperfect beasts but they give us principles to guide our decisions but anyone would be loath for anyone to land to heavily on the precision of numbers when there are so many variables. The principles are clear, vaccination matters and we can get to a point where vaccination carries a heavy load. 

>> The deaf that's, what number of deaths are you prepared to tolerate? 

>> I've always said I don't want a situation in New Zealand where we simply shrug our shoulders and accept we have an infectious disease that takes lives when it can be prevented. That has been our approach all the way through and it has not changed. That is why you will hear in the way we are talking, we want to continue to take zero tolerance approach, if we have an outbreak, we do something about it, we contact rates, we isolate, we don't have a situation where we expect someone in the workplace to arrive with COVID, we take a more aggressive approach so we don't have uncontrolled transmission and the devastation that can cause. However what helps us with that job is vaccines. 

>> He mentioned the influenza fatality rate at the moment is that the level you would feel comfortable with? 

>> I think the reason people tend to use that as a guide is so that people have an idea in their heads about the level of impact that has on our health system and that is why I think it is used as a reference point. I don't think it's useful as a way to think about COVID though, if you have a workmate that shows up to work with flu, you wouldn't react in the way we want to react if a workmate shows up with COVID. It assumes the idea we won't act aggressively with COVID, we always have and we are saying we will continue to. 

>> One of the things about the modelling was continuing to do contact tracing and case isolation in any situation, are you confident contact tracing can keep up with delta, in this high vaccination world. 

>> I'll let Professor Hendy talk about the assumptions they made in their modelling. 

>> That's a really good question and I think the answer depends on the case rate we tolerate. For example, if we tolerate at a high case rate, we would quickly overwhelm any contact tracing system in the world. If we can maintain a low level of cases, then our contact tracing system, although it will need to adapt, it will be a different environment for its working, could operate very efficiently. In the modelling we actually use the observed performance of the contact tracing system during the early stages of our recent delta outbreak. We think that is a pretty realistic benchmark. Nonetheless had that outbreak been much larger, it would have been less effective. I think we are going to need to have emphasis on contact tracing and certainly one of our recommendations is that should be strengthened. And perhaps redesigned for a different type of environment. 

>> Perhaps Dr Bloomfield could speak a little bit around the work that public health are going around what contract tracing looks like in a highly vaccinated environment. 

>> We are doing two things, one is what happened during this outbreak, where we treated many people who usually would be casual contacts as close contacts, we will do a deep analysis to see which one of those converted into cases. That will help guide the way we classify people in the future. Likewise, we will need to have different approaches to people, depending on if they are vaccinated or not or if their households are vaccinated so the length of time we might require them to be isolated, the testing regime they might be required to undertake will change. That is the next iteration of the contact tracing system in the context of what we anticipate will be a highly vaccinated population. 

>> Is a big difference between contact tracing 30,000 people and that staying the same in the future. 

>> Modelling to doesn't talk about a specific public health measure but mentions a couple of options including widespread rapid testing and ventilation. Are those things on the table, for example major -- ventilation systems? 

>> We are looking at what basic principles we can share, whether you are a passenger in a Uber or if you run a venue, useful information to make your space as safe as possible. There are lots of countries around the world doing this work, we can learn from them and share it more widely. So that individual workplace has are empowered. You will see that Professor Hendy has looked at a raft of public health measures and made an assumption in the reduction in transmission that might have. Without landing on anything specific I would put them in the category of being sustainable. In the future framework we are working up, in a vaccinated environment what are the things we can sustain day today that are not too impactful on our lives but will make a difference? That is one of the principles for us because we want it sustainable for people and the economy. 

>> What is your modelling show about when we will reach that 90% plus rate? 

>> We haven't been looking at that in detail, we haven't been trying to model the rate of uptake. There is is a static calculation. We looked in this recent outbreak, we looked to see how the dynamics of the outbreak might be influenced by vaccine uptake. And we could see... The vaccination rate we have at the moment is making a difference in this outbreak. We could also see it starts to make a significant difference if we keep these rates up as we get towards October. But we haven't looked specifically at the date when we expect to hit any of these targets. I think that depends on the population, how willing they are, and there are certainly plenty of vaccines available now. We could get there very quickly if we want to. 

>> We've done a bit of modelling on that and what we know is that as vaccination campaign, we have outstripped many other countries we compare ourselves to in the rates we have delivered very quickly. But what every country has experienced as a point where you reach a certain rate and ours has been higher than most, where it gets a bit harder. The point at which Auckland can hit 90% is anywhere between a couple of weeks or months, depending on people's willingness to come forward. That is where it will take all of us. It's not about just going out and applying pressure to people was a get vaccinated, we need conversations, we need to talk about why it is important and that's what this is about today. 

>> It seems like the government could be doing so much more with advertising campaigns or whatnot, if vaccination rates continue to fall, today it is under 50,000 for the first time on a weekday. 

>> 50,000 was previously where we modelled our high point date of daily, our models have been high, they've beaten the peaks of almost every country we would compare ourselves to. Now we have to put in the hard yards that come with the highest rates you can achieve and every country has experienced that but most countries have experienced it earlier than we have. It is about pulling out all the stops. But we need to get creative too and the government won't have all the answers. This is where we have to work with our communities on the ground as partners, we have to provide the resourcing and allow some creativity. We don't have to control everything here, the goal is to get people vaccinated, let's allow people to do that work. 

>> In the international context, these forecasts are frightening, this amount of death is hard to stomach. 

>> I didn't find it that way. 

>> Maybe you have a stronger stomach. New Zealand is increasingly one of the only countries able to tolerate lockdowns, are you prepared to be one out from the international community and resist calls from your neighbours? 

>> That tells me you haven't picked up one of my key messages today, which is we don't want to use that tool and nor do we have to in the future. We have previously used lockdowns because we don't have individual armour and now we do. We need everyone's help to get us in the best position possible to do that. I would disagree with that assertion because I'm presenting the opposite plan for the future. Generally on the numbers, what they present to us, I think it was hope. I see here a pathway for us to use vaccination to our advantage and to demonstrate that we can actually have a model with vaccinations coupled with public health measures that we are quite used to, that can play a role, that means we prevent those rates and hospitalisation. I'll finish with reminding everyone, I got modelling much worse than this, much more dire than this at the beginning of COVID-19 and as a result of this we designed a plan that meant none of that happened and we have the ability to do that again. 

>> Striving to hire vaccination rates seems to be the goal but is there a point at which concerns and fears around not even reaching 80 or 90% among Maori? 

>> I'm not willing to make that assumption and I don't think any of our providers and partners would either. If you look at our rates for instance for over 65 is for Maori, they are very high, it demonstrates what is possible. I believe those high rates are possible. 

>> We've had rates of childhood vaccination above 90% for Maori and Peacifica until the last couple of years. It shows what is possible. And the onus is on us and those communities to make sure we are working together to get those high rates, it's not acceptable to have different ambitions for different groups. 

>> Prime Minister, can you achieve that 90% plus vaccination rate without government-backed vaccination mandates across the healthcare sector? Other countries have used legislation or regulation to make it legal for companies and restaurants to mandate vaccination, can you do it here? 

>> I've seen a range of different models. Some countries have allowed employers to do that and some have allowed them to incorporate testing. Here the modelling looks at and in some places using more regular testing as part of the toolkit. We should think about the role that place. There are other ways too. I'm interested that in some places that use, for instance, vaccine certificates in the beginning, generated hire vaccination uptake and eventually they've moved away from them. They can be short- term tools sometimes that help create higher levels of protection. We are discussing all those kinds of tools. Ultimately we want people to take up a vaccine because they have chosen to protect themselves and because they've chosen to affect -- protect their whanau in their communities. We are trying to use that as the main motivation plus some other tools we might be able to leverage them, but as for obligation, we've always been careful around that space. 

>> Businesses would love the government to provide guidance so they can say to their workers and customers, we can't let UN because it's a government role. 

>> In some cases when they take their own health and safety assistance, that will be a matter for them. We are seeking guidance and ensuring we have the guidance employers may need to make those decisions for themselves as well. 

>> How can the government help them with legislation or regulation? 

>> We haven't put in place blanket mandates across the board for vaccination in New Zealand and we never have but there will be more nuanced scenarios. 

>> Dr Bloomfield, leaving aside the potential death rates of different scenarios, what is the case rate of COVID-19 that the New Zealand health system would be able to handle?. 

>> They point out the projected numbers of deaths and that would translate to a certain case rate. I haven't seen what the case rate is. 

>> (Inaudible) hospitalisation, there would be regional disparities. 

>> Here is the thing it is clear from other countries it doesn't matter how many hospital beds you have or ICU beds, if you don't control the virus in your community eventually your health system gets overwhelmed. The second is you are making a trade off. Every time you fill a bed with someone who has COVID-19 or an ICU bed, that is someone who else -- also cannot receive that care,  it shows what levels of vaccination restrictions at the border that help us manage and control the virus in our community so it does not impact our health care system to the extent it actually cannot deliver the care that others would need. 

>> (Inaudible) part of your work in consultation (inaudible) for the next little while would be setting a framework around this trade offs. 

>> Right and making our health system is ready in a sustainable manner to deal with the COVID in the community and the way that is least intrusive on the system and that will  mean most people will be cared for in the community in their homes with support from community providers, primary care, general practice. Others will need hospital care as they do for influenza or other illnesses but it also shows actually we are going to have to have as Shaun Hendy has said really good contact tracing, isolation testing in place to help us keep the level of COVID down at a level that is not just so that it does not impact on the health system but it does not impact on our lives and livelihoods. 

>> The one thing I would say again I know Sean has put these disclaimers in his papers these are guides. You look at Denmark now and they are seeing 170 hospitalisations at the moment, relatively low numbers. These are guides for us as we work about future frameworks and our decision-making.  They are not absolutes and there are lots of variables and it tells us which leaders make the biggest difference. That is important. 

>> We have had reports that there was an incident at Middlemore Hospital on Tuesday with gang members that led to perhaps up to 8 staff members that had to self isolated home. Can you tell us more about that? 

>> I have a couple of notes. We had a couple of individuals, one of whom was a close contact and should have been isolating visiting a close contact. There have been staff, four staff, stood down with a couple of security guards. The visitor has returned a first negative test but the appropriate response has been undertaken and reiterates the importance of anyone who is a close contact does need to isolate and there will be follow up with these people to find out why they were not. 

>> So the visitor came in and they should have isolated at home and they came in. 

>> It was someone in the  hospital who was a contact of the case being treated and monitored as such. I understand there were two people, one a contact of the case and should not have been out and about. That person has subsequently returned a negative test so no risk to the start that they are taking a precautionary approach. 

>> Mindful we have the Past coming up so I will come to Benedict and then the front and then will finish. 

>> Aucklanders who have bought homes elsewhere around the country were planning to move before lockdown came around. (Inaudible) not allowed to move to their new homes. (Inaudible)

>> We have taken a strict approach around movement and you can see all the example as to why we have done that. It is about keeping everyone safe. Tomorrow I will ask Minister Robertson to give an update on the way we use the boundary, the way we run our exceptions regime to give more guidance to some of those scenarios which are less likely but nonetheless impactful. 

>> If they had a negative COVID test and were vaccinated, what harm would there be moving across the border? 

>> The accumulation of reasons people are wanting to move around is one. Returning to school or university, relocating, there is already the wide range of business exemptions, people needing to move freight, adding up to a large number of movements. We need to keep those movements as safe as possible. The cumulative risk we are trying to manage but I will have Minister Robertson give you an update on how we are working to manage our exemptions regime for some of the circumstances. 

>> Can you comment on the Death of (unknown term)? 

>> I want to acknowledge his passing and everyone will be familiar with the latter part of his career. Ultimately today his family have lost him and the first Pacific MP in New Zealand and so I want to acknowledge that. And in the front and then we will finish. 

>> (Inaudible) high vaccination rates (inaudible) convince Pacific and Maori who are still vaccine hesitant? If not, what will the government do to overcome that? 

>> The most impactful message is if you are vaccinated you keep your family safe. Time and again that has been one of the biggest motivating factors to get vaccinated. It is often not about them, it is about their whanau and is the biggest message detect your family and your babies. Thanks, everyone. Sorry, Mark. Thank you, Sean.  

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