COVID-19 update, 24 March 2022 1pm

Kia ora koutou katoa (SPEAKS TE REO MAORI).

Welcome back once again to the Ministry of Health for today's update.

Thank you for coming.

Today I will provide an update on the Omicron response, as ever.

And also our continued use of some of the tools available in the COVID protection framework.

I will then hand over to the Ministry's Deputy Director- General of Maori Health John Whaanga to provide an update on the Maori component of the Omicron outbreak.

On the latest numbers today we have 18,423 new community cases of COVID-19, with 913 people in hospital.

28 of whom are in the ICU or high dependency unit.

That is quite a drop from yesterday.

The majority of that drop is in the Auckland region.

Quite a big drop in the cases there which fits with the drop in hospitalisations there.

Sadly today we are also reporting an additional 11 COVID related deaths, and that takes our total number of deaths we have reported to 221.

The seven-day rolling average of COVID deaths is now 10.

I want to pass on my condolences to families, whanau and friends of those who have passed.

You will have heard the Prime Minister yesterday update everybody on the changes to the COVID protection framework.

The latest analysis we provided, as I outlined on Tuesday, confirms that significant drop in case numbers across Tamaki Makaurau and in all three DHB areas.

That has been accompanied now a few days later, a week later, with the drop in hospitalisations .

The drop in total case numbers across the motu is reflecting that significant drop in Auckland.

So in the seven days to 20 March, there were 24 new cases per 1000 people in the country compared with 27 per 1000 the week before.

So saying, that pattern varies across the motu.

Tairawhiti is 44 per 1000, and Hawke's Bay is 38 per 1000.

They are the two DHBs with the highest rates at the moment.

It's clear that case numbers are on the increase, in particular in the South Island.

From the ethnicities perspective, Maori have the highest rate of 35 per 1000, then Pasifika and their rate is 28 per 1000.

The Pasifika rate was the highest but it has now dropped.

The rates for New Zealand European and Asian ethnic groups are currently 21 per 1000.

A little more detail on some of the rates for the Maori population.

There has been a decrease in the number of cases amongst Maori reported nationally for that week to 20 March.

Just over 27,000 cases, as opposed to around 30,500 cases the week prior.

However, despite that drop in case numbers, it has increased during the week with the number of Maori hospitalised.

There was 232 in that week in March, compared with 202 in the week prior.

We do tend to always see this lag in terms of hospitalisations versus case numbers.

In terms of case rates for Maori, they are the highest in Tairawhiti.

Around 112 cases per 1000.

Next highest is Hutt Valley DHB, followed by Hawke's Bay and Bay of Plenty.

So saying, most other DHBs in the country, at the moment, case numbers are showing an increase for Maori.

In particular DHBs with large rural areas where we are seeing case numbers in those rural areas increasing and in particular higher case numbers amongst tamariki and rangitahi.

So that will represent a lot of work for whanau, for the iwi, the communities and our Maori providers.

So a huge thank you to our Maori Health and disability providers across the motu.

Working hard, they will also have their own staff down affected by the disease or whanau members with the disease so thank you for the huge work you are putting in.

We are going to continue to identify individuals, whanau and population groups who are more vulnerable to severe illness through our community hubs and primary care, and our Maori and Pasifika providers and ensure our resources are focused on assisting them to manage at home, or that they get hospital care if required.

At the moment around 97% of our cases are managing at home, without any particular support either from the healthcare system or from disability support, or indeed from our social development colleagues.

I will now hand over to John Whaanga.

(SPEAKS TE REO MAORI)

Today I will be providing an update on the Maori response to COVID, highlighting the work we have been doing across the sector to support whanau (SPEAKS TE REO MAORI) and keep our community say -- safe.

We have released a plan that focused on two key outcomes that remain central to our work.

Firstly, protecting Maori communities by increasing vaccination coverage.

Secondly, building the resilience of (SPEAKS TE REO -- the resilience of Maori providers.

Implementation of the plan is underway with progress in several areas, including gaining insight into vaccine hesitancy, looking at how we can ensure our providers are supported to sustain their work, and supporting the delivery of clear, tailored communications for our whanau.

For the Maori vaccination rollout we continue to work closely with Maori health providers, DHB, and iwi to increase vaccination coverage amongst Maori especially our tamariki.

Our communications and engagement focus covers a range of efforts to promote vaccination.

Booster advertising activity continues with the It's Time to Boost Your Whanau Protection campaign.

This campaign has replaced the earlier Big Boost campaign with more holistic messaging that focuses on the key motivator of protection, and the need to ensure all of our whanau members are vaccinated.

The Karawhiua campaign continues and I want to acknowledge all involved for continuing to share positive content with whanau Maori in a way that encourages them to make informed decisions about their health and well-being.

In addition to our booster and paediatric campaigns, Maori Health providers have been partnering with DHBs across the motu to implement sprint strategies to support the Maori vaccination rollout.

in Tairawhiti, the sprint event titled Super Shot Kids was staged at three locations including a marae.

Events were also hosted at other maraes.

And a drive-through also at Whakarewarewa village car park.

In the Bay of Plenty, events were held across a number of areas.

Events were also held to reach more remote whanau and increase vaccination uptake.

Testing remains critical to the Maori COVID response.

To ensure the equitable distribution of rapid antigen tests to whanau Maori, a network of 29 Maori-led providers have been established.

Approximately 1000 community partners have received their RATS also, with also over 300+ iwi and Maori organisations engaged in the portal to provide supplies.

I want to acknowledge all of our kaimahi hauora Maori providers across the motu.

You have been working tirelessly to ensure our whanau are vaccinated.

To make sure providers can continue to support whanau throughout the Omicron response nearly $27 million has been allocated under the recently announced Maori and Pasifika Omicron response package.

A portion of this is focused on supporting workforce capacity and well-being, which is a significant issue we have heard about from the sector.

In the interest of getting funding to relevant providers quickly, a streamlined closed commissioning process is underway and the Ministry has provided over 140 Maori health and disability providers to apply and funds will be distributed in April.

As mentioned by Dr Joe Bourne on Tuesday, the COVID care in the community framework has been updated and is available online.

Equity remains at the heart of the program and equal expectations of the hubs are laid out in the framework.

So far 54 hubs have been set up, and the majority are Maori integrated.

Many are also Maori lead.

An example is Waikato, which is one central hub and 11 Maori lead hubs.

All the hubs across the motu are providing a range of services for whanau including the delivery of kai packs, medication, financial support, alternative accommodation coordination and manaaki services where whanau are supported to report their RAT results.

A lot of work is already underway as part of our Maori response to Omicron.

Much of this work is being led by our Maori health providers and partners.

Before I hand back to Ashley, I thank each and every one of you.

Thank you for your resilience throughout our response.

Thank you for your innovation and the way you deliver services to our Maori communities.

And thank you for your commitment to the continued protection of Aotearoa.

You have been central to our response since the first outbreak, and we would not have been able to achieve these gains we have made so far without your outstanding efforts.

As Ashley said, please know the work that you do is recognised, valued and crucial.

(SPEAKS TE REO MAORI) >> Kia ora, John.

Thank you very much, and I want to acknowledge the leadership you and your team have provided over these two years.

It wouldn't be a stand-up without giving the booster is a plug, so if you haven't had your booster, please go and do that today.

For those who have had COVID recently, and if you have not had a booster, we are advising a three-month gap.

However, book your booster three months from today.

Now is the time to do that, book it in and make sure you get it.

It is still important to do it and very worthwhile doing it.

Finally, two years ago yesterday, we announced our first cases of community transmission of COVID-19 which triggered our lockdown and started our whole of government response to COVID-19 in earnest.

The Ministry of Health's media statement that they said, "We are preparing to move to Alert Level 4.

There is clear consensus the sooner we do this, the better.

this gives New Zealand the best chance of breaking the chain of transmission.

This will require all our efforts and we strongly urge all New Zealanders to play their part.

Two years on I would like to thank New Zealanders for playing the part over those two years, through adhering to the lockdowns, staying at home when sick, kidding tested when needed, getting vaccinated including being boosted, scanning with the NZ covert tracer app at least until this Friday -- NZ COVID tracer app, at least until this Friday.

Wearing masks, and maintaining physical distance.

Many of these actions remain just as important now as they were then, as we navigate this next period of the pandemic.

If we keep doing the basics well, we will help to protect not only ourselves but our most vulnerable people.

They were young children, older people, Maori and Pasifika communities, disabled people, pregnant people and those who are immunocompromised perhaps because they are having treatment for cancer.

We all know and care about someone in these groups, and our actions to date have helped protect these very people.

Let's keep caring about them.

I also want to acknowledge the many sacrifices made by New Zealanders who at different times have not been able to visit loved ones in hospital, to be with them in their dying moments, or to grieve them at funerals and tangihanga.

It is thanks to all of our combined efforts we are in the position we are in today, where despite our high number of cases and the high number of people in hospital, we continue to have a low number of people requiring care in the ICU, and one of the lowest death rates in the world.

(SPEAKS TE REO MAORI) We are now open for questions.

I will invite John to join me as well.

>> (SPEAKS TE REO MAORI) Why has it taken so long for the MOH to roll out this strategy knowing full well that this has been needed since 2020?

>> In fact, the current plan is the third strategy we have had in place.

We had an initial strategy in 2020.

We revised that strategy in 2021.

And late last year we revised the strategy again.

So we have had a plan in place.

We mightn't have done as well advertising it so that people knew it was in place, but it has certainly driven our response to equity.

The current plan is not just a recent creation.

It builds on the foundation we developed over the last two years.

>> There is still talk that resources are not hitting the ground especially in rural areas.

A lot of it has been about the engagement with hapu and iwi.

There are some pockets still not getting these resources.

>> Put it this way there are still pockets of the country where we have to do better to increase access to vaccination services and COVID-related services.

But we have also built strength and foundations.

If you look at the range of mobilised services we now have in place compared to 2 years ago, not only providing benefits for COVID but reaching out to those communities, like you said, that have found it difficult in the past to be able to access.

So we do recognise there are areas of the country where we continue to need to do well, not only the rural areas, I might add, but there are some urban areas where we need to continue this work as well.

If you look at the range of services in place, the range of mobilised services we have, the different ways of delivering health services related to COVID, it is a huge improvement on two years ago.

>> (INAUDIBLE) rates amongst Maori the same as the modelling (INAUDIBLE), and when does your modelling show that will decline?

>> I'm not sure if there is a difference between the two modellings, Ashley can talk about the detail.

But what I would say is we are trying to make sure we get the best advice from our experts in country, both Maori and otherwise.

So we are always up for hearing about advice from some of our scientists, academics, and how we can improve.

I don't see those things is necessarily working in competition with each other.

We draw advice and guidance, and we often are challenged by people to do better, so all of those things add to the mix and the range of advice to make sure we have the best program in place.

>> When we see a decline in the rates?

>> My understanding from the consolidation of the expert advice we have received is that we will continue to see peaks around the country for the next two or three weeks.

I think the other big message from our experts is that we will continue to see peaks as we move into winter, for instance.

Possibly not as severe as what we are currently experiencing but we will see them come in.

>> Why has it taken until April to get that targeted Omicron testing, the 27 million ready in April?

>> We have invested quarter of $1 billion in Maori development.

We are building on top of that but we also need to make sure we have a good process.

It's not just about getting funding and throwing it out the door.

We have to engage with providers, make sure we understand their needs, so we can provision for that in contracting and that is not something you can do in a five- minute phone call.

>> Yesterday, the loosening of restrictions, are you concerned that will disproportionately affect Maori?

>> I think off the back of the advice from Professor Skegg, it's clearly based on science and our ability to continue to protect the country.

In the fact that things have changed.

As we have seen in the last two years, the way COVID has presented itself has changed.

And in the same consequence, we have to change our response.

So we have confidence that on the back of that advice, the settings we are moving to going to enable us to move to an environment which is a bit different from where we have been in the past but still has relevant protective measures in place.

>> (INAUDIBLE) Maori behind that rate the entire time, whether it is vaccinations, boosters.

(INAUDIBLE) to get to a point where equitable delivery is happening?

>> Is an ongoing challenge, it's not a one-off challenge related to COVID.

There are a number of health determinant areas where we have significant challenges and in equity for Maori.

-- inequity.

We are often starting from a position where the Maori position is not doing as well as the rest of the population.

If you look at the first and second doses for the over 12s, six months ago we were worried about whether or not we would be able to get anywhere near 90%.

And we have done that.

In the same way we have to follow through with the same focus and challenge on boosters and paediatric vaccines to follow through and deliver on that.

>> You spoke about doing work around vaccine hesitancy in Maori, what is that work showing?

>> That work is showing us two broad things.

One, there is a comparison or comparisons between what is making Maori hesitant to get vaccinated versus the general population and then there are also particular factors for Maori.

Some of it is the experience that Maori have currently and have had previously with government, and the lack of trust around that.

Some of it is around Maori family experiences with the health system.

So there are things with vaccine hesitancy which the Maori population shares in common with others.

For instance, parents wanting some assurance that the vaccine is safe for the children.

That's a general concern for both Maori and non-Maori.

Then we have particular areas that are a feature of our work with Maori.

As I said, one of those things is the experience of Maori families currently and in the past with government and government services, and how it is we can rebuild trust with them.

>> The amount of money gone out through the Ministry of Health in particular around Maori led initiatives was 78,000,000/120,000,000.

You mentioned 27 million going out in April, is that out of that 120 million or is it separate?

>> This is separate.

It is part of the $140 million package announced by Maori ministers led by Minister Davis about two weeks ago.

>> (INAUDIBLE)

>> I can only talk for the health funding component of that which has been administered.

If I think I'm on the same pathway as you, you are referring to the $120 million announced as part of the Maori COVID community response fund last year.

My understanding is our health funding has gone out to our providers.

And our providers who can develop and lead Maori COVID responses.

>> Are you comfortable at this point with the amount of money that has gone out, the fact that the rates are still behind for Maori, and John spoke earlier about maybe the message didn't get out to Maori earlier on.

Does that sit comfortable with you that the Ministry of Health has delivered well enough for Maori over the last couple of years?

>> I think John made the point it is an ongoing effort.

The area of equity, particularly Maori and non- Maori inequities is something I have been interested in for my entire career.

What I would say is that the delivery of vaccination programs to adults in this country, for all of our groups, has been higher than I might, or as high as I might have aspired to, but certainly higher than I might have expected.

Through that, as John said, we have made a significant investment in Maori provided development that we can build from.

That's the first comment.

The second, and John laid this out, this is ongoing work.

There are initiatives and we have reported to us every week the sprint activities that are underway to try and reach further into these communities, particularly to get our tamariki vaccination rates up.

Interestingly in January, 70% of parents both Maori and non- Maori said they intended to get there 5 to 11-year-olds vaccinated and we are still not there with that.

And it is much lower for Maori.

Ollie Mack parents are more -- Maori parents are more likely to wait because they wanted assurance around safety, gives us an idea of what is possible and therefore we are aspiring to get the rates for children for all groups up to that 70%.

>> Dr Bloomfield, can you admit that the MOU doesn't know how to talk to Maori?

>> If you mean Manatu Hauora, I have a different view.

I think we do know how to talk with Maori.

When I took the role on four years ago was re-established our Maori Health directorate and I'm really pleased I have had John Whaanga leading that for the last 3.

5 years and it is stood asked in good stead through what has been a profoundly challenging couple of years during the pandemic.

One of the things we were absolutely clear about at the start was we didn't want to repeat what we saw 100 years ago when we had the Spanish influenza pandemic.

That we wanted to protect our communities, in particular our Maori communities who were by far the hardest hit 100 years ago.

That's an ongoing journey and we don't intend to stop now.

>> I think it is working.

Again I will point to, as John made the point, 90% of our Maori 12 and over are vaccinated.

Which is excellent.

We are still doing more of that, and we want to get the booster rates up.

There has been significant investment in our Maori providers and those providers have done incredible work to protect our Maori communities.

In just a comment on those rates, that I talked about, Maori infection rates in this outbreak were slower to start.

So they were lower for the first part, and they have just started to increase.

And over the last week or two they have surpassed the rates of other ethnic groups.

Our Pasifika rate was by far the highest first of all, and then that is declining.

So we will see those Maori rates come down as the outbreak makes its way through those areas of the motu where there are high Maori populations.

>> (INAUDIBLE) work on Bak-san hesitancy.

-- vaccine hesitancy.

Why is that work being done now when a lot of those reasons were historical and known to years ago, why was the work on vaccine hesitancy not done then?

>> The work has actually been done.

We have been doing monthly quite big population surveys since the start, actually since before the vaccination program started.

So we started that in late 2020.

In preparation for the vaccination program.

We have monitored throughout, and it has been very interesting to see.

Of course, if you recall when we did those first surveys, the proportion of people who intended to get vaccinated was a lot lower than where we have landed.

So it's been interesting.

And we have watched the development of people's attitudes towards the vaccine through that period of time.

And you will have seen a lot of the concerns they held initially have in fact dropped away.

I think specifically with the vaccination for children, parents and guardians do have specific issues around safety.

And they want to make sure of them, and that in my mind explains some of the slow uptake amongst tamariki.

But we are still intent on getting higher rates for those groups.

>> So if you had this data at the start of 2020, how do we still have an inequitable vaccine rollout?

>> I want to make two points there.

First, that information informed of the rollout from the start.

One of the things I want to point out here is, right from the start of the rollout we made vaccines available to and supported our Maori and Pasifika providers to vaccinate through a whanau-based approach.

If you look at the vaccination rates up until about July, the rates for the over 65s were higher for the Maori and Pasifika than they were for anyone else.

That reflected our knowledge, the work and the resourcing of those providers to do that.

As the vaccination program progressed and new age groups came on, we saw slow uptake amongst Maori and Pasifika especially in the younger age groups.

So we kept the research going to inform what were the drivers, the barriers, for those younger age groups as it was rolled out to the wider population.

So it was a journey and we are still on it.

In particular, we are really keen to make sure we get our booster rates up for younger Maori.

At the moment, for the 18 to 34-year-old Maori, only about 40% of them are eligible because many had their course quite late in the year last year.

And around 30% have taken it up.

So actually about 75% of those eligible at the moment in that 18 to 34-year-old age group have done so, which is about the same as the uptake across the population.

But we will be continuing to focus on that group to make sure we get those booster rates up.

>> Are you concerned that the infection rates are higher given that Maori (INAUDIBLE) so is the concern the rate is actually higher?

>> It is likely higher across the population.

There is no data we have that suggests one group or another is less likely to test and/or report their infection.

The reason we know that rates are highest amongst Maori at the moment is because they are testing and reporting, and we will keep encouraging that.

As John outlined, there are a lot of rapid antigen tests with our network of providers and iwi to make sure those communities that need them have got them.

>> (INAUDIBLE)

>> I couldn't say.

We can't really say that.

What we can do is on the assumption that the proportion of people who are testing and reporting remains pretty constant, then we can monitor that rate over time.

We know it is highest at the moment and we will be looking for it to come down.

>> On the eventual decision around the shift from red to orange, what factors will you be looking at when giving advice on that, and specifically what impact would removing indoor gathering limits have on things like case numbers and hospitalisations?

>> We have a range of criteria, and forgive me but I will have to come back to you on this on just what the criteria are because that assessment is led by the Director of Public Health.

Dr Caroline McElnay.

On Tuesday, we got all our regional hubs around the motu I going to provide input in terms of what they are seeing around care in the community, the proportion of people accessing that, what their needs are, vulnerable groups who are particularly affected at the moment around the country, and we will get inputs from our public health units as well and we will look at hospitalisations as well as what is happening in general practice and in the community.

That will inform the advice around that move, potential move down to orange.

And the advice we provide to Cabinet.

We are comfortable given the current high vaccination rate and where we are in the outbreak that the move to removing indoor gathering limits, remembering with the continued use of masks appropriately, and most importantly people continuing to stay home if they are unwell, will continue to provide a high level of protection.

And of course very comfortable with the removal of that limit on outdoor gatherings.

>> You are saying you're comfortable with that now?

>> Well, we are comfortable.

Friday night, there is the change in limits even under the red setting.

The indoor limit goes from 100 up to 200.

And the limit on outdoor gatherings is removed.

We are also comfortable that when a move to orange is made, that we will be confident that the risk doesn't increase a lot with that removal on the limit on indoor gatherings.

>> (INAUDIBLE) increasing case numbers and hospitalisations?

>> At the moment, we are still in red.

Red to orange.

But it is not scheduled to happen for another 10 days or so, I think.

And it will be on the basis of our advice.

>> If you were asked today, should the country move to orange, would you advise it?

>> Not today.

We are still in an outbreak.

It is waning quickly in Auckland but it is still quite active in the rest of the country.

>> It sounds like you are saying the shift could be made today.

>> No.

I am not confident.

But I am confident when the decision is made based on what is happening with the outbreak, and the question was around the removal of indoor gathering limits, that it won't create a big jump and increased risk.

>> (INAUDIBLE)

>> We don't think they will make a marked difference.

Remembering we are still in red settings.

And for the time being COVID vaccination certificates are still required, masking is still required, there are rules around social distancing and what you can do in hospitality venues.

Those remain part of the overall package of protective measures.

>> (INAUDIBLE)

>> It doesn't bother me in the sense that we have made available for people who wanted it, who either couldn't have the Pfizer vaccine or preferred a different one.

Around 3200 people have taken up that opportunity.

In the last two days, there haven't been any doses administered.

When it expires, we will be providing advice.

But our view is we have provided that opportunity and we don't know that we need to continue to provide AstraZeneca.

In terms of Novavax which has more recently become available, we have just passed around 1000 doses of that administered.

Again not huge demand but they all helped to contribute to our protection across the population.

But we have been really clear the Pfizer vaccine is the mainstay of our program and that is what we continue to base it on.

>> (INAUDIBLE)

>> It's very close to being completed.

We are just finishing off some work around the implementation of that, of the decision, when it is finalised by ministers.

>> (INAUDIBLE)

>> In the next couple of weeks.

>> There was a change around 17-year-olds, a couple of weeks ago.

Is that definite, 17-year-olds can get the booster?

Has that message gone out?

>> Yes.

It wasn't a change.

All I did was clarify that with the vaccine, as with any medication, it can be prescribed off label.

I think I said it was under Section 29.

It is actually under Section 25 of the Medicines Act.

Any prescriber can prescribe a medication off label.

And it would be off label because it hasn't been approved in under 18s as a booster, this is the Pfizer vaccine in New Zealand.

But any prescribing practitioner can, after a conversation about the risks and benefits, prescribe and/or administer medication to someone off label.

And that would apply to the vaccine for anyone under the age of 18, but in particular there was interest for 17-year- olds who might be going to university and at higher risk.

>> So you are comfortable these people administering it are aware that for the 17-year-olds, it's fine to get it.

>> Yes, we sent a communication out to our primary care sector clarifying that they could do this on a case-by-case basis.

It is on restriction.

-- prescription.

>> You said you were looking at a fourth dose of the vaccine, where are you out with that?

>> On Tuesday I said we were expecting advice this week.

On Tuesday afternoon I said the technical advisory group would like another week to consider it.

The main reason is the evidence is quite scanty, it is emergent.

It will be looking at what other countries are doing.

So saying, I am approaching this from the point of view of, is there a good reason not to offer a fourth dose if there is evidence of waning immunity?

And there is some evidence of that.

So we would be offering the fourth dose to our vulnerable communities especially older people.

>> (INAUDIBLE) >> I am concerned about people with COVID anywhere.

It is not unexpected.

One of the interesting things, if you look at Christchurch Hospital, I think today they have 53 people in hospital.

Whereas Auckland Hospitals, two of them were up over 200 yesterday.

So far the hospitalisation rate has not gone up so much.

In part, I think it is because they are keeping people out of hospital.

For example, older people in aged residential care and the DHB has about 30, 40 staff supporting A's residential care every shift -- aged residential care every shift because they have got staff off so they are doing great work supporting people to stay home all be looked after in residential care.

>> (INAUDIBLE) even though Canterbury has over 500 staff off work?

>> It is a concern and that is exactly the picture we saw in Auckland and we are seeing in other places as well.

Like all of our DHBs, we have planned for it and we have contingency plans in place.

>> (INAUDIBLE) >> Their instructions have not yet been lifted.

We are still in the red zone.

The only thing that changes is from Friday those gathering limits increase up to 200 indoors.

>> (INAUDIBLE) >> I'm comfortable with it.

We looked at this hard and gave our advice.

>> (INAUDIBLE) delay that shift to allow time for people to get boosted, vaccinated, and (INAUDIBLE) >> Well, we've had our booster program going since December.

There has been a huge effort.

We are up around 74% of eligible people have been boosted, and we are continuing to do that, and our childhood vaccinations are increasing.

Let's see what the risk assessment shows next week.

>> They are saying to strengthen the mask exemption scheme, get rid of masks and retail spaces, would that be a safe option getting rid of masks inside?

>> Two things.

We have been working with Retail New Zealand and some of the major supermarkets and our disabled community on the issue of mask exemptions.

There has been a pretty clear and constant call for masks to be a legal requirement in retail and particular supermarket settings.

We haven't ever had that.

However, what I would say is it is really clear that masks are a really important part of our ongoing protection.

Not just of ourselves but of each other.

Yes, our vulnerable people can wear a mask that provides them some protection.

But one of the most protective things any of us can do is wear a mask to help protect others and ourselves.

And masks remain a feature, a strong feature, of the CPF, including in the adjusted orange setting so we will keep supporting and pushing the use of masks, and providing them through our providers, so communities can access them.

>> Are the masks fit for purpose, though?

That's part of the issue.

>> That is part of the issue.

We have been looking at this for a month or so and we put some options to the ministers about how they can be strengthened, trying to balance the different experience and expectations of retailers on one hand and also our disabled people on the other hand.

>> Tairawhiti, is there anything targeted going that way given it had the 44 per 1000 cases and the highest Maori case rates.

>> That just happens to be the DHB at the moment with the highest rates.

And of course it also had some deluges in the last couple of days.

At the moment they have a low number of people in hospital.

Which is good, and they had done their planning.

All the plans are in place with the added challenge of the weather.

>> We have had a few deaths in recent weeks of people in their 20s and 30s, can you comment on the circumstances?

>> I don't want to and I won't comment on individual deaths out of respect.

I don't think it is appropriate.

What I would say is we know, and we saw that tragic case in Australia reported this week of a previously well to your old -- previously well two-year old who died from COVID.

So we do know the people who are more likely to die are the vulnerable and the older people, but also younger people who might have pre-existing conditions, or living in circumstances, poor housing circumstances and so on.

So it hoofs all of us to do what we can for everybody.

-- behooves.

>> (INAUDIBLE) was there a missed opportunity to head that off at the pass before it escalated?

>> I think the measures in place were designed to protect everybody, including strict requirements under the CPF.

It may well be the reason it was slower to take off in Maori was because those measures were working.

But we have seen with all of our ethnic groups, there has been an increase in cases at some point in time and then they decline.

It is just happening at different times in different groups.

>> (INAUDIBLE)

>> I think the opportunity was taken for everybody, which was to have in place our COVID Protection Framework which was designed to protect everyone but in particular our vulnerable groups, Maori, Pasifika, our vulnerable and older people.

They has helped us a lot.

Again, our hospitalisation numbers are quite high.

But our case fatality rate and our total number of deaths remains low and we plan to keep it that way.

>> On the COVID deaths, is there any more on whether these people are very sick in hospital, are they in the homecare, or rest homes?

Have you got any more information?

>> You will see from the age breakdown, we have that in each day in our media release what the age was of those who have died and their gender.

Most of the deaths are in people in older age groups, 60s, 70s, 80s, 90s.

This is very typical of what we see with influenza each year as well.

Influenza-related deaths.

Some of these people are dying, being looked after in aged residential care, some at home, some in hospital.

Some of those in hospital will have been in the ICU, and would have had quite a lot of input and then subsequently died.

Sorry, the second part of your question?

>> (INAUDIBLE)

>> Again, we are now publishing that where we know, on our website each day, we are updating that as we get more information.

The breakdown of people who definitely died from COVID, those for whom it was incidental, and the biggest group is still those for whom it is under investigation.

Because it can take time sometimes because of the Karin -- coroner's process.

>> Given the distrust of the system, what has gone on in the past with Maori, vaccine hesitancy (INAUDIBLE), do you look back and feel like it was always going to be hesitancy and disinformation in those communities because there was always going to be a period where Maori were left feeling uncomfortable with the vaccine rollout?

>> The misinformation and disinformation was already there.

Our job was to ensure we had really good information out there for people, and really good communication campaigns.

And I think if you just look at in the round, we have been incredibly successful with our program here across the population group.

We have got rates that are amongst the highest around the globe.

Even though we had to counter, overcome, and work through with whanau, with communities, that misinformation, that disinformation, and some very sophisticated efforts by those who are anti-vaxxers to try to stop people getting vaccinated.

So what we have turned around I think is what might have been vaccine hesitancy into a very high level of vaccine acceptance.

And we plan to springboard off that to get our rates of childhood vaccination up again where they need to be and to support our MMR catch up campaign, and our influenza vaccination campaign this year.

So we have learned a lot, and given what we were facing, I think the levels of vaccine acceptance we have achieved are remarkable.

>> What would an epidemic look like in New Zealand (INAUDIBLE) given what we know when they are there?

>> That's a big question.

If you don't mind, maybe we can work on that and cover it at one of the stand-ups next week.

I will make two comments.

We are not in an endemic situation yet.

There is still a global pandemic full WHO expert advisory group meets again on 11 April and will reconsider this question.

But there is nothing to suggest globally that we are anywhere near the end of this pandemic.

So we are not in an endemic situation.

Even if we were, it's clear that endemic COVID is a different prospect from endemic flu.

So we need to maintain all the actions we have got in place at the moment, even as we navigate, as I said, this next period of the pandemic.

Thanks very much, and thank you, John, for your contribution.

Kia ora.