COVID-19 vaccination update 16 November 2021

Kia ora koutou katoa.

Welcome, everyone to our live stream session this morning on vaccination and our vaccination program.

And particularly, welcome to our media who are here in the room with us.

Thanks for making the effort to come along.

Nau mai haere mai ke te Manatū Hauora.

Very pleased to be joined today by at least someone who's a very familiar face to all of you, I'm sure-- Professor Nikki Turner, the director of the Immunization Advisory Center at the University of Auckland.

And on my left here, Tamati Shepherd-Wipiiti who's our general manager of equity for the COVID Immunization Vaccination Program.

It's quite hard to get Tamati in Wellington, because most of the time he's out on the road and has been doing some extraordinary work over the last few weeks, which he'll get a chance to talk about.

So we're in the countdown now to the end of 2021, in particular I guess to Christmas.

We've now got-- we've hit that 90% of our eligible population in New Zealand having had a first dose of our vaccine-- our Pfizer vaccine-- and 81% of people fully vaccinated.

Now, you might have heard me say in the last few days, I well remember this time last year when we were just kicking things off-- that people were desperate for me to put a figure on what we hoped we would achieve.

And the number being bandied around internationally was around 70%.

Well, we now know because of delta we need to get higher coverage than that, but I don't think any of us would have imagined that we would have got to 90% and climbing.

It's not a target.

It's a milestone, because we intend to keep going here.

And I think it's a profoundly important milestone, and it represents an enormous amount of hard work on the part of many people.

So I want to acknowledge that first up, and also everybody who has come forward and been vaccinated so far.

For those of you who haven't yet had your second dose, don't wait.

If it's at least three weeks, do go and get that second dose.

So there will be the normal 1:00 media release today, which will have all the facts and figures for today and an update on what's happening with the response.

But this morning, I want to specifically cover three things-- first of all, just where we are in the vaccination program and what that means for our outbreak-- our response to COVID.

Secondly, a focus on our ongoing efforts to reach our vulnerable people and communities.

And whilst there has been a booster program announced, let me be clear.

Our first priority continues to be finishing the job, and that is ensuring that as many people as possible, including in our vulnerable communities-- in fact, particularly in our vulnerable communities-- get two doses, even as we start to roll out the booster program from the end of this month.

And third, just a little bit of a conversation about why and a couple of graphs or pictorials to show why as we get high coverage in the population we expect to and are already seeing an increasing proportion of our cases and hospitalizations will be people who have been fully vaccinated-- an explanation of why that is.

And I do hope that the media will be able to use the graphics we're providing to help explain that to the public as well.

So we are making very good progress, but also some of those people who haven't yet had their first vaccination-- and what I would say, though, is we are still seeing at least 5,000, maybe 6,000 or 7,000 people, every day across the Motu having that first vaccination.

So we are still making progress, which is excellent, even as we have passed that 90% first dose milestone.

There is, as people are aware, misinformation and disinformation out and about.

Some people are looking at that, and it will be raising questions for them.

Now, I know that a number of media attempted last week, on Tuesday the 9th, a Science Media Center briefing around disinformation.

So we can answer some questions here, and Nikki in particular is very good on that, if there are particular key messages you think it's worthwhile us getting out there.

We're often asked why 90%.

Well, we do know with delta that our modeling shows 90% coverage gives a very high level of protection to our population, and therefore is imperative in terms of our ability to really manage our response to the ongoing delta outbreak.

Nikki, of course, brings a wealth of scientific experience.

She will be able to answer a number of questions, and she's got in particular some of the latest evidence from studies around household transmission and the role of vaccination in greatly reducing the risk of household transmission.

But I want, first of all, to hand over to Tamati to just give an update on some of the excellent work that has been happening and that will continue to reach out to our more vulnerable communities.

So Tamati, Kia ora.

Ashley, whakawhetai koe.

[SPEAKING MAORI].

Look, I really want to start with just a bit of a celebration around all the firsts we're having in our vulnerable communities.

I'm regularly on the phone to Australia, America, Canada, and looking at how we're working in other vulnerable communities.

And we're really leading the way.

And if I pick a disability community to start with, I find that we're doing really well.

Those on the DC system, there are over 80%-- second dose over 70%.

We had an amazing thing happen on Super Saturday, where we thought maybe these big events aren't necessarily for our whanau who will struggle with accessibility.

But 3% to 4% uplift on Super Saturday, and that whanau-- that was really amazing.

Our Pacific whanau-- I just want to take my hat off to all of our communities around the country, our churches, our Pacific organizations, and our big organizations, like whanau in the Western Auckland and South Seas in Otara.

They are just absolutely smashing their targets.

We're going to have a record number of Pacific vaccinated across the Motu.

And we're going to break records, and that's all of that good community work supported by churches and supported by the DHBs.

We're getting great results.

But the real thing I want to focus in on today is actually our Maori population, and share with you the number of firsts in the Maori population.

So the first vaccination in New Zealand was a hauora in Auckland.

The first mobile service in New Zealand was a hauora.

The first service to have our kaimahi be trained to vaccinate under nursing supervision was a hauora in [INAUDIBLE]-- a number of firsts in our Maori providers who have been with us since the beginning and by design, helping vaccinate our population.

And I guess the key thing is they're not alone.

They're doing that together.

And if I take Northland as an example-- if you look at Northland over the past four weeks, you'll see thereabouts figures that look like this.

The DHB clinics are getting in about 48% of our population.

In the hauora, it's about 25%, 28% of our population.

And in general practice and pharmacy, it's about 20%, 22%.

So together, the system is working to together-- primary care, our DHBs, our hauora, and all backed and supported by iwi and often Whanau Ora Navigators who are helping get our whanau through that journey.

So what does that mean in terms of net results? Well, for Maori, we're sitting on 77% first dose and 61% second dose.

And you need to really understand how we got to this figure to understand how it works.

We were tracking it over-- you know, heading to 90%, and now we're over 90% for 65+.

But then the 1st of September happen, and finally, we love having kids, and we're a young population.

And on the 1st of September, I think the bottom line increased by some 289,000.

So we have a massive number that is between 12 and 34 of our rangatahi that we now need to work with.

And they're doing a really good job.

About 200,000 have come in for a dose one and dose two, about-- my figure's about 139,000.

We've seen a massive uplift since Super Saturday and our rangatahi.

It really showed that what we needed to do was have rangatahi talk to rangatahi about coming out, because they came out in the thousands, and they've continued to.

So we were averaging at about 2,000, 2,300 a day Maori across the country before Super Saturday.

We're averaging at about 5,000 a day now, so that gives you a sense of the uplift that's going on in the community.

We've got more work to do, but we're really going to have a good hard crack at getting to 90% in some of our DHBs before Christmas.

For some it'll be a little bit slower, but we're with them, and we're supporting them to get there.

I think the real key question on your mind-- well, if it isn't, it should be-- is will there be a second Vaxathon.

Now, it's a bit like a second movie.

You know, the second one's never as good, so there probably won't be.

But we will probably do something around second dose, because we can see the bottom number at 61 for Maori.

We might need to do something.

But I think we're thinking that through.

So we'll be able to talk about that later.

But I think what we're seeing around the Motu-- what I'm seeing is a bit of a flip.

We're going from big national things to more regional things.

So on Friday in Kaitaia and Gisborne, I'll be with the minister launching Fry Bread Friday.

So come get your vaccine, whanau, and you'll get a fry bread.

And we're also seeing, I think, a flip from fixed sites and big large drive-throughs as we get to our vulnerable communities, hard to reach, need a conversation near their home-- a big flip to mobile.

I was with [INAUDIBLE] Jean if you-- oh, the whole country knows Jean's the most wonderful Maori midwife in [INAUDIBLE].

I was with her in the van last week, and we went round to whanau's houses.

And they can dial the 0800 number and the van comes to them-- break out the seats on the path, and Jean's out there with her staff doing the driver and [INAUDIBLE], the nurse.

And we're vaccinating whanau.

And just to give you this whole idea, it's trusted relationships, right, that brings the whanau out of the house.

Jean got out of the car.

She said, I birthed these two.

They were 22 and 24.

So she's done the community effect that she knows.

She birthed half the babies, and now we are helping them through their vaccine journey.

I think the other flip we see is a lot more door to door-- a lot more door to door.

And I was on the ground on Waitara two weeks ago with the minister.

We were helping our whanau there with the efforts.

And we had community workers, Whanau Ora Navigators, Maori wardens knocking on the door.

And the first question was how are you? How are you, whanau? And then eventually they got to the vaccine-- had a discussion about that.

And when they were ready, there was a van parked outside with two nurses, and they were able to vaccinate whanau who were ready to take that part of the journey.

Really important that they were using data that could be-- show them down to which streets.

We had lots of whanau that weren't vaccinated.

Now the hauora, they were able to see the data down to an individual level, so they knew who was vaccinated, who wasn't.

But actually, the Maori wardens, the Whanau Ora Navigators and the community workers-- they didn't want it.

They wanted the street level, said I'd just like to have the conversation with people in their house and see how that goes.

So yeah-- so that's been working really well.

And then the last one, I guess, in terms of flip is we really, really are saying our whanau think about COVID in the community.

When it's in my community, what should we do? And I guess the key message there has been well, let's go back to the basics.

Let's follow the public health advice.

Let's keep our masks on.

Let's not hongi, but let's use our elbows.

Secondly, let's get our whanau vaccinated, and that's really the big effort.

And lastly, and [INAUDIBLE] has really focused in on this in our Maori communities-- because if we do that whanau, we'll have far less a chance of ending up in hospital, and we'll be able to be cared for in our own homes.

And I think on that point, Dr.

Bloomfield has actually got some further insights to add.

[MAORI] and thanks for your amazing work-- you and the team.

And he doesn't necessarily like to admit it, but I think you were the person that had the initial idea of the Vaxathon, and I certainly enjoyed being part of that day.

And it was great to see we just create that 130,000 doses delivered on the day.

And I think it gave us a huge-- really reinvigorated the program and gave us a huge sense of momentum.

We know we've got a really good vaccine here.

The Pfizer vaccine is highly effective at preventing deaths and hospitalizations, and in fact people getting symptomatically unwell with COVID.

You may have seen recently that the UK Office for National Statistics reported that the age adjusted risk of death is 32 times higher in unvaccinated compared with vaccinated people.

Now, that's in the UK, where they've got a mix of vaccines being delivered.

Our program as we know is-- it's to-date being based on Pfizer, which is among the very best and most effective vaccines.

But that is a profound difference.

There are very few things I can think of in my public health and medical career where they have been so protective and reduced the risk of death so much with such a simple and cheap intervention.

So 32 times higher risk of death in unvaccinated people, age adjusted in the UK.

So to all those who have come out and been vaccinated, you are doing yourselves a huge favor.

But we also know as we get higher proportions of people vaccinated that this does create the sort of counter-intuitive thing, where we get more vaccinated people becoming cases.

But I have got a couple of graphs I want to present, and as I said, we will have these available as a handout.

So we're just going to put the first of those up, I hope.

Here it is.

So it wasn't long ago when we had been thinking about our eligible population an equal split between those who were vaccinated and unvaccinated.

And this graph shows that.

So with 50% of people vaccinated, what we saw-- if we had, let's say, 10,000 people exposed to the virus, not all of those people would be infected.

But based on the protective effect of the vaccine, at that time if 5,000 of those people were unvaccinated, about half of those unvaccinated people would become symptomatic cases.

Some would get what we call a subclinical or asymptomatic infection, but about half-- 2,500 would become symptomatic cases, leading to 250 hospitalizations at a 10% hospitalization rate, which is about what we've seen in the Auckland outbreak.

On the other hand, our 50% of vaccinated people-- because they are protected by the vaccine over 90% of them don't get symptomatic infection.

So they don't even know they're a case.

And even if they do get-- the virus comes in contact with them, their body is able to get rid of it before they either become infected or infectious to others.

So that would have led to around 375 cases, based on what we know of the effectiveness of the vaccine, and around 13 hospitalizations.

So if we move on to the next figure, we can see what happens now that we're well on our way to having 90% of the population fully vaccinated.

So hence of our 10,000 people, 9,000 are fully vaccinated, and just 1,000 are unvaccinated.

From those 1,000 unvaccinated, at the same rate of symptomatic infection we see 500 cases and 50 hospitalizations.

But here we see a larger number of symptomatic cases amongst our vaccinated people.

It's just simple maths.

But even then, less than half the number of hospitalizations amongst those cases.

So it's just explaining why we are seeing already the proportion of cases each day, and the proportion of hospitalizations is growing amongst our vaccinated population.

But the key thing here is not only does vaccination greatly reduce the likelihood someone will be a symptomatic case, it has a very protective effect on hospitalization.

And as I led out with, its hugely protective in terms of death.

So what I'm going to do is hand over to Nikki now, who will pick up on this and has got some other really important very recent data around the protective effect of the vaccine, particularly in household settings.

Nikki.

Thank you.

Thanks, Ashley.

Kia ora, and thanks for the opportunity to come and share a bit of our wonderful science today.

So I just wanted to bring a few thoughts from the science going on in the world.

As you can imagine, we're accumulating data very rapidly at the moment.

So firstly, just to back up Ashley's point, from my background interest in measles and MMR for many, many years, this proportion argument was always misunderstood-- that if you vaccinate a population with MMR, you get enormous control over measles.

But the few that break through-- the relative proportion will be more vaccinated.

So your overall disease reduction is way down, but in a highly vaccinated population the proportion who get disease will be more vaccinated.

This is a very common myth that we've had with measles, and we can see it coming with COVID-- that we will expect to see the relative proportion of people ending up with COVID in New Zealand both in the community and in hospital-- relatively more will be vaccinated, but absolute numbers-- very big reduction.

So I think that's a really important point for us going forward as we hit high immunization rates.

Now just to think about the science and step back a bit, I was looking at the use of COVID vaccines.

And this is like a year-- only a year more than.

7.

4 billion doses of COVID vaccine have been used around the world.

I have never seen anything like that in vaccinology.

It's extraordinary.

The Pfizer vaccine, which we are very fortunate to have-- thanks Ashley.

The Pfizer vaccine, which I still think is up there as one of the best vaccines in the world, if not the best performing, is now used-- it's been used in over a billion doses in 148 countries.

So in terms of how's this vaccine acting, how is it working, are we happy with the safety profile-- we now have extensive data in such a short period of time, because there was such a need in the world.

We now know the side effect profile of the vaccine.

It doesn't come with no side effects, but we now have delineated very clearly the side effect profile.

I think it's a reflection on the safety monitoring that we have picked up the incidence of severe side effects.

So we the incidence of anaphylaxis, severe allergic reactions with this vaccine-- about 5 to 7 per million.

We know the incidence of myocarditis across the different age ranges, which is particularly more common with young men-- possibly up to 1 in 25,000 in young men.

So we know that because of the safety monitoring is working.

In a way, I can't say you see it working with any other products around the world that we've got so much safety data.

So that is very reassuring that we know the product we're working with.

The next thing is why are we doing this? What is the purpose of vaccination? And to re-ground us in the fact that the data is really clear that if you catch COVID, 1 in 5 people will have it severely and need support in hospital to breathe.

Around 1% to 2% will die, and from the more recent data, over 50% still have symptoms up to six months and longer after having COVID.

So that is why we need a vaccination program going forward.

And also, I reflect on the concern around myocarditis.

The incidence with COVID disease is 4 times higher than with the vaccine.

So this is a disease you see with the disease.

So looking at the importance of vaccination going forward, as Ashley has mentioned, 90% is not a magic bullet.

We're not going to get rid of COVID with 90% coverage.

So what we're looking at going forward is obtaining as high coverage as possible.

The higher we get, the less hospitalization we will see, the less death we will see.

There's not a magic number.

And the other important figure is have we got high coverage through all our communities? We could get really high coverage over there, but if we've left this community behind, when COVID arrives it'll find that community.

So hence the importance, as Tamati was talking about, around looking at all our communities.

Who is missing out? Who's been left behind? There is no point in having a highly vaccinated central Wellington when small rural towns are missing out.

COVID will find them-- so the importance of getting coverage across the population.

So 90% higher-- you know, let's go for it, but there's not a magic number.

I think the importance of continuing to focus on offering vaccination to every individual that we can.

Now the outcomes from COVID vaccination-- I think Ashley's really well delineated the reduction in severe disease.

I do want to stress New Zealand will continue to see severe disease and death, but the higher and the more equitable our vaccination rates, it will be less.

And that's what we have to hang on to.

All the data is really clear.

A two-dose vaccination program will reduce severe disease and death by more than 90%.

That is hugely important to me as an individual and to us as a community.

But the other data I wanted to share today is the utter importance of not just protecting myself, but why we're doing this as a community.

And so the reduction in mild disease and spread means that we know that a vaccinated person can still get COVID, but they're much less likely to spread it to someone else.

And I just want to reflect on a recent Swedish household study of over 800,000 families.

When they looked at within these households, if one member of the household was immune, such as if they were vaccinated or recovered from COVID, they reduced the spread to the household by somewhere between 45% to 61%.

Now, that goes up the more immune members there are in the household.

So by two people, it's up to 75% to 86%.

By 3 people, the immunity within that household is over 90% for the unvaccinated.

And when you get to 4 people, it's over 97%.

So within New Zealand situations, with big households, with children who we can't yet vaccinate, with people who may have immune system problems that don't respond so well to the vaccine-- the more vaccinated, the dramatic the reduction spread in that household is.

I think that's key information for New Zealand.

Now, that study wasn't actually when they had the delta variation.

So just to reassure you that it does follow through to the delta variant, there's a very recent Dutch study that was shown when a vaccinated person was infected-- so they're carrying the infection fully vaccinated-- they've got a nearly 2/3 less likely to infect unvaccinated households.

That's even when they've got the vaccine.

So that's even when they've got disease.

So a vaccinated person who catches COVID has got around about a 63% less likely chance of transmitting to household.

Now, if you add in the fact that most vaccinated people don't get disease, then the modeling suggests that more than 80% reduction in household transmission.

So if you think about that in the New Zealand context, that's delta data.

That's hugely significant.

So what I'm saying is we're vaccinating to protect ourselves from dying, but we're also vaccinating to protect our community from dying.

I just wanted to touch briefly on boosters.

There's been a lot of conversation about boosters.

The data is really clear that first and second doses matter the most-- that we must continue our primary focus on keeping up the first dose and the second dose.

That's what will protect our community the most.

But what the data is showing now is that we do see waning immunity, which is no surprise.

I think you're all aware that people can get COVID disease again and again, so you don't get lifelong immunity.

It's not that sort of disease.

Waning immunity starts from maybe four to six months.

It's more likely with elderly.

It's more likely with slightly older immune systems, rather than some of the more young immune systems in the room.

And it's more likely with people with significant medical problems.

So it's not like you suddenly stop becoming protected at six months.

It's not like that at all.

It's just your immunity starts to drop off a bit.

So an added benefit to the New Zealand population is to boost.

But I can't stress enough that we have to focus on every individual we can support to get vaccinated-- will make a difference to all of us, and then boosting will follow there.

So I just wanted to finish at this point and just-- I really want to thank all the services we work with-- have done an extraordinary job.

Because you can imagine there's a real tension out there at the moment about people who feel their individual rights are being walked over versus our health services, who are facing COVID disease and struggling to support our communities.

There's a real tension there.

And I really want to support the services who are out there talking and supporting local communities-- trusted health care providers within communities.

People aren't going to trust me as an unknown person coming through media.

They're going to trust their local people and the local health care services, and that's who I want to support.

They are the people doing the work out there today, day in day out, supporting people through real concerns and real fears-- people who have had bad experiences in the past, people who are uncomfortable with health services, people who are dispossessed for all sorts of reasons.

We need a huge amount of understanding and compassion as to why the last 10% of people are scared about getting vaccinated.

I think we have to be very careful we do not polarize the argument, but we talk with our communities and support people through, and keep our eye on the bigger picture that we are going to reduce death and dying from COVID within the New Zealand community.

Kia ora.

Thanks, Nikki.

That's great.

Let's open it up to questions now.

Just a little bit about the 5-11s, just in the context of what you were saying about coverage and how important that will be.

Because if you look at the September modeling, even at 90% of the eligible population, once you add those 5-11s, deaths, hospitalizations actually reduced quite significantly.

Yeah, well I'll start, and then I really value Nikki's comments on this, too.

So yes, around 90% of 12+ equates to 76% of the total population.

So if there is that opportunity to vaccinate under 12s, then that's a really important consideration.

And we also know that children can tend to be-- for a number of infectious diseases and the flu is a good example-- the group that is transmitting it around the community, even if they themselves are not becoming unwell.

The most important thing here, though, is that we take a really good look at what the balance of risks and benefits are for 5 to 11-year-olds in the future.

Yes, we've got randomized controlled trial evidence now-- relatively small study, 2000 to 3,000 kids.

So what's very important here-- and this is why it's important we don't rush into this-- is because that vaccine is now going to be used in this age group in the US, we can look carefully at what emerges from-- in terms of safety profile-- in its use in the US.

So that's going to be really important in terms of informing our discussion.

And our technical advisory group, and I think, Nikki, you're a member of that, is already giving us some consideration.

So you might want to just talk to the sort of issues that are being weighed up.

Thanks, Ashley.

So firstly, remembering the modeling is always very clear that two doses on 12 years and up makes the most difference.

So we cannot take our eye off the ball-- that we need to keep working on immunization coverage for 12 years and up.

There is a gain then from looking at vaccinating 5 to 11-year-olds.

And as Ashley said then, it's a balance about the gain for reducing spread across the community versus have we got secure data that we're confident to be able to offer this to 5 to 11-year-olds? Once again, we're in the privileged position of not being the first country in the world to lead off.

So there is early clinical data that looks very good for 5 to 11-year-olds, but I'm very pleased that America has decided to roll it out first.

So we're already getting large numbers of children being vaccinated in America.

There's a privilege of America puts a lot of effort into monitoring both safety and effectiveness.

I am keen that we see the early American data to reassure ourselves that the vaccine for this age group is looking as good as so far it does look.

I think that's important.

And then there is a place in New Zealand, I expect, once we're sure about the data, to consider for our children.

You know, in terms of the booster, why is it only 18+? Is it priority, or is that a safety element? That's licensure.

Yeah, it's actually what the license application was for, and that's because the booster studies have been done in 18+.

[INAUDIBLE] potentially extend that to the 12+ once that data comes in, or is that up-- You have to get the data coming into Medsafe first.

Once the data comes in, and Medsafe is secure about the data, then yes, it can be rolled out younger.

Remembering that boosters are more important for older immune systems, not for younger immune systems-- so that is not a very urgent issue at this stage.

[INAUDIBLE] potentially in six months, 12+ eligible for the booster-- I'm putting a time frame on it-- but in the future, once they [INAUDIBLE], it's not the cutoff point [INAUDIBLE]? It's very emergent evidence around the role of boosters and the immunity waning.

But one of the things that is clear now, and Nikki mentioned this, is it's definitely in the over 65s that we do see immunity waning more quickly.

And so that's a really important group for us to target.

And as I mentioned yesterday, actually our program was highly successful early on and getting high rates amongst our over 65 Maori and Pasifika.

So actually, many of them will be becoming due for-- eligible for a booster over coming weeks and the next month or two.

And so we're really tuning our efforts to make sure we're capturing high rates of booster doses amongst over 65s, and particularly for Maori and Pasifika who were early leaders in this area.

Yeah.

Has any modeling being done on what the hospitalization rates will look like when Auckland is opened up? Well, we have modeling that has been used in Auckland to inform the response there.

And yes, that has been extrapolated out to the wider country.

Well, what it shows is that the most important determinant of what hospitalization rates will be will be the level of the vaccination rates.

And one of the important things here is that the ability to reduce the likelihood of super speader-type events and spread in settings where we know the virus spreads-- that is in close, confined crowded spaces-- it will be really important for protecting communities.

And that's where the new COVID protection framework is really important, because it does restrict unvaccinated people from accessing the sort of settings where you're likely to see spread.

And we know this from our analysis of the data in Auckland.

So one of the things we'll be taking into account and our advice, which we're working on to inform decisions about where parts of the country might go to in the new framework, and decisions around moving between the different levels, is not just vaccination rates, but obviously vulnerable communities and those [INAUDIBLE] health services capacity and their ability to cope with, if there was an outbreak there.

So all these things need to be taken into account, and we can use that new protection framework to sort of help protect local communities in addition to vaccination.

Tamati, did you want to comment at all on-- Just that I used the stats on that very point from the COVID Ministry of Health website last night.

I was in a room with iwi from the Western Bay of Plenty.

And two questions came up about if I have a vaccination, will I end up in hospital? And so I just shared the stats, because the stats are live every day on the website.

And they tell the story that Nikki and Ashley have walked through.

But I think it really hit the community that actually one, that were so effective, and two, they hadn't actually had the time or to engage in that data.

And for me, that's sends the message that-- to our Maori communities actually, we need to find a better way to communicate that, because it really hit them.

But the second one is the Swedish study.

For our Maori communities, a number of them feel-- and our Pasifika communities.

A number of them feel guilty.

I don't want-- the core error I hear is I don't want to come in if I can't vaccinate my kids.

And I think that's what the Swedish study is showing, is that actually you can take the first step to protect your kids.

And we know in our Maori and our Pacific whanau, these are not houses with 2.

3 people and a dog.

There are a number of people in these houses, and the study clearly shows that the more people are vaccinated, the more we put protection around our kids.

And from the weekend where we've had cases in the north-- mom and a couple of kids-- this rips the heart out of our communities-- that our kids are getting COVID here.

So taking that first step to have their vaccination, we've now got international evidence actually it's going to help.

So that will help me in terms of a dialogue the ground, because it's one extra question that whanau want to have answered before they ready to take the journey.

What are you seeing on the ground with Whanau Ora with their request for data? What are you what are you seeing? What I see on the ground-- and I mentioned Waitara, but I see this is Flaxmere-- I'm going to be in Opotiki tonight.

We'll be with Dr.

Rachel.

We'll be at Kaitaia the day after-- is the health providers have been working with Whanau Ora Navigators, Maori wardens, and community volunteers, and often iwi staff to look at the data from a area level, look at the data from a suburban street level, and in the case of the hauora, they can see the individuals who haven't been vaccinated.

And so they're able to use it in the way that they need to to target the communities.

What I've also seen is that many iwi don't want to have the data below that street level-- what we call-- the technical terminology is SA1, SA2, mesh block level.

I always found I sound like a character out of Star Wars when I say that.

But they actually are OK to stay at that level, because they want to respect, I guess, the [MAORI]-- the autonomy of each of their communities.

And so they're OK to work at that level.

And they're doing a great job.

I was in Waitara.

They were door knocking, chased by a few dogs, asking lots of whanau how they were.

And for many of those whanau, they were ready to take the journey.

So they brought them out to the van.

And the clinicians in the van can see the data from the PHI.

And from the whole order, they can see it down to an individual level.

So what I'm seeing around the Motu is many of our communities are getting on with it.

And I just want to call out the great work that Northland DHB did, because we had to build a data system to help them do that.

I'm not sure if the story's been told yet, but two years ago, Dr.

Bloomfield and I were on this floor.

Let me tell you, we had no national systems to work with.

We had faxes flying in from airlines.

We had cruise ships telling us when they were arriving.

We had 12 different public health unit systems around the country.

And over a year, we've had to build a national booking system, a national contact tracing system, a new immunization system, apps on our phones.

Choose and Book in the UK took 2 1/2 years to leave one trust.

That's one area.

We did it in New Zealand in one year.

And once we built the systems, we then built the systems to share the data.

And we did that-- piloted that with Northland about seven weeks ago.

That's now available to anyone in the country.

It's got a funky name, called Clipper.

And we've worked in partnership with iwi in particular through our data sovereignty group.

I just want big ups to Karen [INAUDIBLE] and the work that Kerri and Karen and [INAUDIBLE] and [INAUDIBLE] has done from the Bay of Plenty to help our iwi access to their own data.

They've got the toolset ready if the iwi need a user ID.

They're ready to go.

So what I see, to answer your question, is community working together really well, empowered by data.

But in the Maori world, that's not just data.

That's our whanau.

And so in order to use it, you need a conversation with whanau-- with hapu, with iwi.

And so you can use it in the right way.

There's a [INAUDIBLE] around that, and I see people doing beautiful things to help our whanau get vaccinated.

[MAORI] [INAUDIBLE] is the data going to be shared with [INAUDIBLE] in this latest [INAUDIBLE]? Yes, it is.

Where those conversations have happened locally, and already we've done that in [INAUDIBLE] and Kerikeri Roa last week.

We're looking at that all here now, and I've already signed off the sharing of that data, not just with the Whanau Ora Collective Agency, but also with their providers directly on the ground, and with iwi and Waikato.

We're just getting through finalizing that for [INAUDIBLE].

But yes, it will be shared where those appropriate conversations have happened, as Tamati has outlined.

Kia ora.

[INTERPOSING VOICES] What's being done to ensure with that roll out we don't see the inequities from Maori we've seen and other [INAUDIBLE] groups? How are we going to ensure that doesn't happen [INAUDIBLE]? So Tamati will be able to comment as well.

What I would say is that for all our age groups, right from the start we have had specific initiatives and a strong focus on equity.

But I think as Tamati has described really well, it does require additional and specific initiatives in some of those more vulnerable communities.

Tamati, you'll be involved in some of the early thinking about rolling out to 5 to 11-year-olds? Yeah, I think the key thing around the equity component is to realize that a Maori whanau and Pacific whanau-- these will be whanau-based events.

It won't just be kids in schools.

People want to come, as they have throughout the whole vaccination program, as a whanau.

And that's what they're planning for.

We have a number of keen teachers, some of them my aunties, saying I want to do it now before Christmas.

But they put the plans in place, and they're ready to go.

And the first two months-- all the processes have been finalized.

Whanau events will be the first one.

And actually lining up the kids in a way that is a celebration of the event.

And I don't know if any of this, but in the primary schools this year, [INAUDIBLE] for the primary schools was canceled because of COVID, and there are kids all over the country that have practiced, practiced, practiced really hard.

And their national event was turned off.

And so I'm aware that the Principals Association have got an idea that they're going to bring all the kids together-- do their vaccination.

They're going to race-- first school to get to 90%-- and then perform their [INAUDIBLE] online as a live stream as a national competition.

So they're looking to really embrace the sense of celebration in whanau, and plans are quite advanced.

We've been working quite closely with the Ministry of Education on this, but actually down in [INAUDIBLE], whether it's a [INAUDIBLE] or a mainstream school with high Maori population or Pacific population, plans are afoot to make that happen.

What do you make if reports that it would be 6,000 Maori struck down with COVID by Christmas? Well, what I make of that is, of course, we want to do our best to prevent that-- in fact anyone, but obviously particularly Maori.

And hence the ongoing efforts to vaccinate, but also testing and identifying cases and then preventing further spread.

And what we have seen in Auckland over the last couple of weeks is high testing rates amongst Maori.

So actually, the highest testing rates of any group in Auckland, because we know that's where most of the cases are.

So again, I want to acknowledge this is work by general practice, by our DHBs, but also our Maori providers up there.

So getting the testing out there, and then being able to isolate people who are close contacts will help us really keep those numbers down as low as possible and keep pushing the vaccination rates.

What will that mean for the-- sorry-- the hospitalization rates though, if we do see thousands of Maori, you know, infected with COVID by Christmas? Well our modeling so far shows that by the end of this month, we're expecting in Auckland around 200 cases a day on average over a week.

And we've seen in the last few weeks that around 50% of our new cases have been Maori-- 50% or even higher.

I think yesterday was higher.

So there may well be several thousand Maori who have been infected.

But what we're wanting to do is just continue our really strong public health efforts with contact tracing, with testing, with isolation.

Because that's just as important in terms of our ongoing efforts to reduce the number of Maori who do get infected, and also to prevent spread within Maori whanau as well.

[INAUDIBLE] ability, doesn't it? Because the [INAUDIBLE] should be moving into the traffic light system, and we're not going to [INAUDIBLE] consistent coverage in some Maori communities.

They're not going to have their protection of the vaccination.

Well, actually the COVID protection framework offers a higher protection of-- a high level of protection than current level two does, and even one would argue Auckland as it moves down into further sort of-- if it's in 3.

2 at the moment, if it's moving down further.

And the key thing here is that it restricts unvaccinated people from going to the places where we know the virus spreads.

We've got really good data from our Auckland outbreak that shows we haven't seen people infected in supermarkets and some of those large settings.

We're not seeing people getting infected outdoors.

It's in household gatherings, so whanau getting together.

And that's just ongoing work, and education, and testing, and contact tracing.

But also in those settings, like hospitality settings-- that actually that's where transmission occurs.

And the COVID protection framework prevents unvaccinated people from actually going into those settings.

And so it actually affords a high level of protection in those [INAUDIBLE] around the country that are currently in level two than they are currently afforded.

[INAUDIBLE] big households, and if we have, for example, children who can't be vaccinated, and then adults who won't be vaccinated.

Again, isn't that, because of the larger households and the community nature, again, a bigger risk for Maori, and we don't have that underpinning vaccination rate that the traffic light system [INAUDIBLE]? I think one of the other elements is don't underestimate Maori's ability to plan and get ahead of the game.

I come from the beautiful iwi where we shut the border.

My cousins were on the border, and each in the [INAUDIBLE], because they wanted to manage their own border.

You know, last week I was in [INAUDIBLE] with the paramount chief.

And the planning that they've gone through-- the infinite detail.

They said at the table next to-- described to me, we know if uncle gets COVID, which houses the three people that live in that house are going to go to-- the testing protocols to get there.

We've worked out the social services that need to be around them, and we've worked out how the dominoes will stack.

Because we realize that if someone gets COVID, we remove that domino and isolate them really well.

And we keep everybody else safe.

Once COVID arrives-- once COVID arrives in some of these communities, and they start seeing uncle [INAUDIBLE] getting sick, is it going to help-- those vaccination rates-- do you think from what you see on the ground? My point was our communities are not sitting still and waiting for that to happen.

They're planning amongst iwi.

The planning-- who are leading really the way in this front.

The planning, the connection they're doing for DHB-- it's quite advanced to work through, just the real practicalities of living with COVID in the community.

It's not a case that it's just going to sit there and wait for that to roll in.

Yeah, yeah.

[INAUDIBLE] from Maori.

We've had hauora providers and iwi saying that they've been trying to plan for months, and they've been held back [INAUDIBLE].

You know, community level things and [INAUDIBLE] are hardly a revelation for a moment.

Yeah.

I've actually come here this morning from the Bay of Plenty, and I wouldn't describe what they're doing on the ground there as being held back.

They've had great progress in particularly the areas you just talked about in [INAUDIBLE].

And through a-- where I'm actually in [INAUDIBLE] or [INAUDIBLE] tonight.

Not all of setting have been right, but they're on the way to correct that.

And a lot of that is because they needed that additional funding the government announced at about four weeks ago.

And some of that's flowing in now to some of the wrap around supports that they needed.

We had a really big health effort in that area, but actually we needed some more support for our whanau on that journey.

And some of that looks like transport.

Some of that looks like [MAORI].

Some of that was just some additional support-- someone to talk to and have that conversation-- and sometimes three or four of them-- about their vaccine journey.

Yeah, so I wouldn't describe it like that now.

I would say that there were some issues, but I definitely got an energy in the room that the momentum was heading forward.

Sorry, we've just got just a couple more minutes, and I just want to come over to this side of the room, because I don't think we've given a chance for maybe one or two quick questions and quick responses.

Yeah.

Nikki, you talked about wanting to see the data on 5 to 11s from the United States before being comfortable signing off on decisions and sending it to cabinet.

Do you have a timeline of how long that could be, and Dr.

Bloomfield, a rough idea even if this were to get the sign off from all the right people, when the rollout might be able to start for 5 to 11s? So from my perspective from the data, the Americans are moving very fast.

So I think even within weeks, we will have a data coming out of the States.

So from our perspective-- you know, like I said before about the huge numbers going on, that we're collecting data faster than we ever have before.

So I think the data will come fast.

It's then up to Medsafe to look at it very closely and scrutinize, and that's up to them to decide how quickly they can do that.

The rollout, as you mentioned-- The rollout will be 2022, and we would imagine if all the decisions are made and cabinet approval comes through, it will be in the first quarter of 2022.

But we will commit to us giving regular updates on how the processes are going.

Can you describe a little bit what the risks are for children in that age group who aren't currently vaccinated from COVID, acknowledging that more than a third of cases in the current outbreak have been under 20? A sixth have been under the age of 10, and therefore unvaccinated.

Yeah, so the relative risk to a child is much lower than the relative risk to an adult.

But because New Zealand is not immune, all our children are at risk.

So any one child is it quite low risk of COVID, but the numbers are big, because all our children could be exposed.

So there's two reasons for considering children vaccination.

One is to protect their whanau, but the other is because the numbers game will be big.

So even though any one child is at low risk, most of our children will end up getting COVID.

And that's what you've seen in other countries, where they've got beginning to get control over COVID disease in other age groups, and then it runs through the children.

So I think that's the way we're looking at it at the moment.

I'd just like-- and excuse my ignorance with this question, but I'd just like to get a sense of how GPs and pharmacists are being used to reach unvaccinated people.

I don't know if you could explain that a little bit to me.

Do different GP clinics have data that says these patients are vaccinated and these ones aren't, so they can-- if they have the resource, which they might not-- pick up the phone and say, hey, just noticed you don't have your vaccine.

Do you want to come in and get it? I can speak as a GP.

So my own clinic, and I think pretty well every other practice in the country, on our practice management system we've got this little fuzzy virus sitting there.

And if he's red, the person's not vaccinated.

And if he's green, they are.

So the moment they walk in the door-- I was doing a clinical day yesterday.

I could instantly see who and wasn't vaccinated.

We have then been ringing around, trying to reach all our people.

We're in the privileged position of then being able to refer them to others if we can't find them.

Pretty well every practice in the country is doing variations of that.

It's different with the pharmacy.

General practice have a database of all their patients.

So we're able to go through every single person in our database and reach out to them.

Pharmacy-- different models, slightly different.

They're doing great on just allowing open walk-ins, and that's been very useful in a different way.

Great.

Sorry-- Just a quick follow up on that.

I mean, GP clinics might be pushed in terms of staff and so on.

Is there anything that the Ministry of Health could do to perhaps help support clinics? I don't know how effective that sort of method is, because I guess people trust their GP presumably, and that phone call might be quite meaningful.

Yeah, so it's a whole of system response really, and we're using [INAUDIBLE] Healthline, our Maori and Pacific providers.

The Whanau Ora Collective has been doing already calls out, particularly to the people who are already enrolled on their services.

So it's really a joint effort.

General practice is not on its own, but for those that are enrolled with general practice that haven't yet had a vaccination, most practices will be calling out.

I've got a question here.

But can I just say, the Ministry has offered funding to general practice to support reaching out to our people, too.

I just want to reflect that.

Sorry.

[INAUDIBLE].

We've seen during this vaccine rollout how Pacific providers and Maori and iwi providers are serving their own communities.

Has there been discussions about the rollout interactions between Pacific providers and Maori and iwi providers about how they can help each other throughout the rollout? And is that still being imposed during the rollout? It's a great question.

Once we have a boat, I'll take you to South Auckland, and you'll see this in action.

But I'll use [INAUDIBLE], [INAUDIBLE], and [INAUDIBLE] at South Seas as an example.

They are working very closely together, our Pacific and Maori providers, to address the vaccine challenge.

And I have to say the broader health challenges that we're going to face now because we're behind on prevention, we're behind on screening-- they're working really closely together, and that's part of the reason why we are being so successful in those communities.

Because if you look at the breakdown of who's turning up to, for example, South Seas, you'll see there's a high proportion of Maori that are going into that service.

There are similarities, though, right? We've included manaakitanga.

We've got frontline workers from the community who we know in the community who we trust.

There's often a band.

I don't know about bands, but Maori and Pacific people-- we love a band when we're getting vaccinated.

And there's always [INAUDIBLE].

There's even a hongi or there's a supper for you to pick up on your way through.

So around the country, that's happening.

And I see them working together.

I can also see in the stats, and they're really high.

I can see a number of paki preferencing the Maori and the Pacific health provider.

I was in [INAUDIBLE] at Jeff [INAUDIBLE] practice.

And I was chatting to the people who've just been vaccinated.

And a number of them were paki.

And I said, oh, I'm interested.

Have you got a GP.

They said yes, we've got a GP down the road.

So you can go to your GP for your vaccination.

I know the Maori Health Service has a [INAUDIBLE] event, and we get a cup of tea, and six of us got together.

I said it would be a nice way to catch up.

And so they all got on the [INAUDIBLE] then down to the practice and had time to catch up.

So we can see a lot of Pasifika and I think Maori health providers really coming to the forefront of health care services delivery.

It's just a beautiful thing to see.

So I'm sorry.

I'm afraid we're going to have to just close things off here.

We've already gone over time.

There will be an opportunity, perhaps, if there are still residual questions afterwards.

We can answer those [INAUDIBLE].

But I do want to just thank my co-panelists here, Nikki and Tamati.

Great job.

I hope we've had an opportunity to give you some further insights into how the program is going and what's coming next.

Thanks also to our wonderful sign language interpreters for their ongoing mahi, and thank you to those who have joined us in the room here and for those of you who have joined us online.

Thank you also.

Kia ora, and have a good day.