Wednesday, 24 November 2021

Missed opportunities

Kate MacNamara keeps digging into New Zealand's botched vaccine procurement last year. 

Things could have been so different.

Labour Minister David Clark was sent a key Pfizer letter on June 30 last year, in which the drug company pressed the head of New Zealand's "vaccine taskforce" to meet and discuss its vaccine candidate.

Taskforce officials, however, were not equipped at the time to begin talks with the drug company, and over six weeks elapsed before a first meeting took place.

The Cabinet finally armed the taskforce with funds both to contract specialist negotiation expertise and to make vaccine purchases on August 10; officials signed a non-disclosure agreement with Pfizer on August 13 and a first meeting with the company took place the following day, on August 14.

Clark, the then Health Minister, refused to answer questions about the letter, including whether he read it at the time and whether he made any effort to hasten the readiness of the taskforce to begin meetings and negotiations with the drug company.

Clark was beset by calls to quit his post at the time the Pfizer letter arrived and he resigned as Health Minister two days later, on July 2. An upcoming election, then scheduled for September 19, added sensitivity to Clark's predicament.

...

Pfizer's June letter noted: "We have the potential to supply millions of vaccine doses by the end of 2020, subject to technical success and regulatory approvals, then rapidly scale up to produce hundreds of millions of doses in 2021.

"I would welcome an opportunity to discuss our candidate vaccine development in more detail, and open discussions on how we might work together to support planning for potential Covid-19 vaccinations in New Zealand and continue to build a strong partnership for the future," the letter said.

...

It's unclear whether earlier engagement with Pfizer could have secured a larger quantity of early vaccine doses for New Zealand.

New Zealand contracted to buy 1.5 million doses of the Pfizer vaccine candidate on October 6, 2020.

Earlier this year an Auditor-General Report noted that "the Taskforce wanted to purchase more doses of the Pfizer vaccine [in its first contract] but, at the time the agreement was signed, Pfizer was in negotiations with other potential purchasers and could not commit to supplying more doses of the vaccine to New Zealand. However, the purchase agreement included an option to purchase further doses of the vaccine if they became available."

By October, New Zealand lagged many of its peers in signing so-called bilateral advance purchase agreements with drug companies for vaccine candidates.

The delay in starting negotiations, because Clark was distracted and because, for incomprehensible reasons, the bureaus hadn't prepped themselves to think about vaccine procurement, meant we were competing against other places for supply. 

If we'd started when Pfizer sent the letter, decent odds we could have started the vax rollout with a lot more doses a lot sooner.  

Think about what that means.

The government made a laudable effort to push vaccines out to elderly Māori in remote communities. But they had hardly any doses at the time and were also trying to vaccinate border and health workers. They could have made that push a vaccination event, vaccinating whanau at the same time. The vax rates by ethnicity by age, at least when I'd last looked at them, had no particular ethnic gap for Māori at older ages - because of that push. But the gap at younger ages is substantial. How much of that gap could have been bridged if they'd had enough doses to vaccinate the whole community while they were out there? 

Here's the most recent data.

The lowest vaccination rates are for younger Maori in more remote places. 

But their grandparents are vaccinated. 

They could have been vaccinated at the same time, or at least everyone 16+ could have been.

But the government didn't have enough doses. 

And it's awful likely that that's because Clark, Bloomfield, and Crabtree sat on a letter from Pfizer for 6 weeks.

When the letter was released, only its main recipient was noted: Dr Peter Crabtree, the chair of the vaccine taskforce.

However, in response to a subsequent written question by Bishop last month, Hipkins revealed that the letter, delivered by email, was copied to Minister Clark and also to Bloomfield.

You'd think they'd have learned by now. But while Canada's vaccinating 5-11 year olds, and the US has been for weeks, New Zealand just isn't. And the odds-on bet on why we aren't is that they screwed up procurement again, because they didn't see any need to hurry.  

Tuesday, 23 November 2021

NIMBY tears

The taste of NIMBY tears. It's palpable in Simon Wilson's latest Herald column. 

But by my reckoning this new bill subverts the NPS-UD in at least nine ways.

Julie Stout, a leading architect and member of the Urban Design Forum (UDF), a coalition of design professionals, calls it "a slum enabling act".

Those nine factors:

1. While "up to three" dwellings can be built on any site, there are to be no minimum section sizes. You could put two extra dwellings on your section, or subdivide it into two, or three, or more, and put three dwellings on each new site.

That allows for more housing so more awesomeness. 

2. The "do it anywhere" provision is an invitation to developers to build where it's easiest and cheapest.

That also enables more housing so more awesomeness.

That, says Auckland Council, "would see widespread intensification dispersed across the city in places not served by essential public transport, water and community infrastructure and in areas located far away from employment centres. This includes smaller coastal and rural towns on the outskirts of the city." It's an invitation to urban sprawl.

The nice thing about bus routes is that you can redraw them if people move to different places. 

The Environmental Defence Society (EDS) says this could even lead to "areas with significant landscape and environmental values, like Waiheke Island, being destroyed".

The map of Waiheke already has piles of land cordoned off as sites of ecological significance.

3. Developers will no longer be required to consider sunlight, privacy, safe pedestrian access, access to nature, servicing and the interface with the street.

Buyers of the properties will consider those. Along with whether the house is comfortable, well-built, and everything else. 

4. There are standards governing size and location, but even they are flawed. They'll encourage what's called "sausage flats": rows of apartment blocks running back at right angles from the street, with little usable land for a garden or backyard.

The Coalition for More Homes submission encouraged getting rid of setbacks so that perimeter blocks could emerge as alternative. 

5. Want to object? Sorry, it's all "permitted activity". The council can't do much, either. Even on matters of national environmental significance, there's no recourse to the Environment Court. The minister for the environment will decide.

Housing should be a permitted activity. 

6. Will developers have to include any social housing in their projects? Nope. What about universal design standards, so at least some of the units are fit for people with disabilities? No again.

If you allow building everywhere, housing costs come down. Social housing issues will all get easier. Developers wanting to sell houses will build them to suit what people want. Shifting from housing scarcity to ample housing means developments compete for buyers. We have an aging population. Plenty of developers will want to cater to those needs to attract more buyers. And even if none of them did, there would still be far less pressure on existing accessible homes as buyers who didn't need those amenities would be looking elsewhere. 

7. Are they preserving environmental standards or keeping up with the demands of a changing climate? Also no. Encouraging urban sprawl fails that test. So do the lack of standards for construction techniques and emissions over the life of the building. There's no requirement for trees or other vegetation, either on sections or in public spaces near larger projects. "The first casualty," says Stout, "will be the trees of the city."

Oh come on. The building code still applies. That covers construction techniques. The Emissions Trading Scheme covers urban emissions, including building and transport. The city can put trees on the verges by the sidewalk if it wants. If a developer is putting in a larger project with public spaces, and figures the sections will have an easier time selling if there are trees in the public spaces, there'll be trees in the public spaces. 

8. The "rules and standards one might expect to find in a district plan", as the EDS puts it, now rest with the Government. It means councils could become bystanders in the development of the cities they are supposed to be running.

The rules and standards that one might expect to find in a district plan are the problem the legislation seeks to fix. 

9. Why the rush? The announcement was just over a month ago and already the deadline for submissions has passed.

Here I won't disagree. I will note though that this is a general problem. Lots of legislation is going through in rather hasty fashion. 

Our submission on it all is here. We're supportive of the legislation, and propose a few measures to make it even better. 

Update: the more I look at this piece, the weirder the framing is. The column's structure is "Here are a pile of people who initially said nice things about the legislation but then, on reading it, recanted or had second thoughts. The first half of the column cites politicians (Woods, Collins, Parker, Willis), organisations (NZ Initiative, Coalition for More Homes, and Infrastructure Commission), and an academic (Tookey) as supportive.

Then there's the bridge. It initially read, "Then they all read the bill. And were appalled." It's since been updated to "many" being appalled. 

After the bridge, it cites an architect, Stout, who says it enables slums. It cites Auckland Council/Mayor in opposition, along with EDS. 

It cites Tookey noting an urgent need for more "strategic investment, skills training and availability of finance. That's what the NZI said too." That's about right on our side, but hardly counts as opposition. It's more of a "Yes, and". I can't speak for Tookey, who may or may not have changed views. I don't know Tookey. 

And it cites Coalition for More Homes supporting the intent of the bill but wanting some tweaks.

I wonder whether a single one of the people or organisations cited at the outset would agree that they were appalled. 

International Ed

Australia's reopening to international students.

New Zealand isn't. 

This is just getting crazy. 

There are safe protocols that can be run here. 

New Zealand could allow travel from safer countries, with a pile of testing and vaccination requirements. 

Start by requiring up-to-date full Covid vaccination for getting a student visa. That's pretty simple. Vaccination requirements have been part of international student visa requirements all over the place long before Covid. 

Then add in some testing. Require the standard PCR test a couple days before travel. Add a requirement that travelers pass a rapid antigen test administered at the gate before boarding, with Covid-positive students denied boarding. Add another RAT on arrival, with any remaining positive cases shunted into isolation. Remember that this is the protocol that was used in a trial for travel between the US and Italy late last year through early this year. There were just under 10,000 travelers. The RATs caught 4 positive cases at the airport before boarding and one more on arrival - among a group of people who'd all recently passed a PCR test. The folks running the trial concluded the RATs were pointless because 5/10,000 wasn't that risky. But we could do it. We could require it for airlines departing for New Zealand. 

And we could make it even safer. Take a saliva sample on arrival for PCR testing, require everyone to get the Covid tracer app, and require them to provide contact details. Add in a requirement to present for a Covid test a few days after arrival. 

Sequences of tests make it increasingly less likely that anyone passing all the tests are infected. There's just no way that someone coming in on that regimen is more risky than the random-draw person in Auckland currently. 

Or do all that and have the universities run a few days of MIQ, as they proposed doing back at the start of all this. It's far less risky now that vaccination is available. 

The borders are looking increasingly absurd. There are safe ways of doing all this. 

Friday, 19 November 2021

Risk assessment of risk assessment

Great piece out today in Science on vaccination for kids.

I've copied it below, with a couple of updates for New Zealand. The strikethroughs are mine. So are the bolded bits. 

Earlier this month, the US Centers for Disease Control and Prevention (CDC) recommended Pfizer’s COVID-19 messenger RNA (mRNA) vaccine for children between 5 and 11 years of age—that’s 28 million children. Yet surveys show that 42 to 66% of parents of these children The Ministry of Health and MedSafe are reluctant or opposed to happy to impose substantial delays on seeking this protection. Without vaccination, it is likely that almost everyone—including young children—will be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at some point in their lives. So, the question for parents and caregivers The Ministry of Health and MedSafe is: Which is worse, vaccination or natural infection?

Make no mistake—COVID-19 is a childhood illness. When SARS-CoV-2 entered the United States early in 2020, children accounted for fewer than 3% of cases; today, they account for more than 25%. More than 6 million US children have been infected with SARS-CoV-2, including 2 million between the ages of 5 and 11. At the end of October 2021, about 100,000 children per week were infected. Of the tens of thousands of children who have been hospitalized, about one-third had no preexisting medical conditions, and many have required the intensive care unit. Almost 700 children have died from COVID-19, placing SARS-CoV-2 infection among the top 10 causes of death in US children. No children have died from vaccination.

Many parents New Zealand officials are concerned that Pfizer’s mRNA vaccine was not adequately tested in young children. In a study of approximately 2400 children between 5 and 11 years of age, performed when the Delta variant was the dominant strain, vaccine efficacy was 90.7% against symptomatic disease. However, Pfizer’s phase 3 study in adults involved about 40,000 participants. How could the CDC be certain that the vaccine was safe in children given the small size of the study, specifically regarding the problem of myocarditis? In postauthorization studies, myocarditis occurred in approximately 5 per 1,000,000 individuals receiving mRNA COVID-19 vaccines, possibly as high as 1 per 10,000 in young men. But context is important. Vaccine-associated myocarditis has been relatively mild and self-limited—an outcome fundamentally different from the cardiac effects associated with acute COVID-19 or multisystem inflammatory syndrome, which typically involve cardiac dysfunction and require critical care. Moreover, both in Israel and the United States, the incidence of myocarditis in children 12 to 15 years of age receiving mRNA vaccines is less than that in the 16- to 25-year-old age group. And because the dose of Pfizer’s mRNA is one-third that given to older adolescents, myocarditis in the younger age group will likely be even rarer.

Myocarditis is only one piece of the risk-benefit analysis. Children need to go to school, play with friends, and participate in extracurricular activities for their social and emotional development. This is their life. Since August 2021, more than 2000 schools in the US have been forced to close because of COVID-19 outbreaks, affecting more than 1 million students. The disruption of school activities has harmed children more than any detectable vaccine side effect, including worsening of mental health, widening education gaps, and decreased physical activity. These harms have disproportionately affected people of color, Indigenous persons, and individuals of lower socioeconomic status, further exacerbating inequities. Avoidance of routine health care and routine vaccination has also emerged, with potentially devastating future consequences. Furthermore, children live closely with and rely on adults to whom they can pass SARS-CoV-2 infection—adults who can be overwhelmed by this infection. And children grow up. Countries are going to need a highly protected population for as long as COVID-19 exists in the world, which will likely be for years if not decades. Vaccinating all children against SARS-CoV-2 could be among the most impactful public health efforts the US New Zealand has seen in decades.

Although it is true that most children experience asymptomatic or mild disease, some will get quite sick, and a small number will die. It’s why children are vaccinated against influenza, meningitis, chickenpox, and hepatitis—none of which, even before vaccines were available, killed as many as SARS-CoV-2 per year.

Some parents regulators are understandably hesitant to allow parents to vaccinate their young children. However, a choice not to allow children to get a vaccine, or to delay vaccinating kids until 2022, is not a risk-free choice; rather, it’s a choice to take a different and more serious risk. The biomedical community must strive to make this clear to MedSafe the public. It could be one of the most important health decisions a parent Medsafe will make.

In the past two weeks, almost 10% of American kids aged 5-11 have been vaccinated. 2.6 million children

Canada is expected to approve on Friday, and they expect to receive about 3 million doses in the next few days

MedSafe might have a risk assessment paper ready in the next two to three weeks. We might get a small number of doses in December. 

I can understand wanting to delay a broad rollout until we had more data out of the US, if only to increase confidence.

I can't understand not making it available to those eager for it.

Thursday, 18 November 2021

MoH and Testing

I wasn't particularly kind about the Ministry of Health's approach to Covid testing in this week's Dom Post. 

A snippet.

The Ministry of Health’s approach to Covid testing is going to kill people.

For the past year, the ministry has been horribly wrong about Covid testing systems. It has ignored substantial reviews of testing policy.

And it has allowed petty resentment against the only appropriately validated provider of rapid saliva-based PCR testing to drive its procurement policies.

A new Covid case popped up in Christchurch yesterday. 

Christchurch has about 400k people on over 1400 square kilometers. People can get a Covid test through their GP, but that's a substantial barrier for a lot of people. 

The city has two testing sites running limited hours taking swabs.

One is out near the airport, which will be impossible for anyone without a car to get to. It is open 9 am to 4pm, seven days a week, and can run later "if demand requires". I take that to mean that they'll stay open if they still have a queue to serve. 

The other one is on Pages Road in Wainoni, I believe at the National Marae. Unless you live nearby, you're not going to be walking there. It's about an hour's walk from downtown. It runs 9am to 3.30pm, 7 days a week, with the same "or later if demand requires" note. 

If the kid comes home from school with a sniffle, you'll be waiting until 9am the next day to get a test. And you're forbidden against using a rapid antigen test in the meantime. 

The University of Illinois's Urbana campus serves about 50,000 people and sits on some 2500 hectares. Presumably students there could also choose to go to their GP for a Covid test. But the University runs four different testing sites on that campus. You can be tested from 6 am to 6 pm, Monday to Friday, 8-3 on Saturday, and 10-3 on Sunday - but not all sites run the longer hours. 

So if it is between 3 and 3.30 on a weekend, and you live really close to a testing site in Wainoni, you may have an easier time being tested in Christchurch than at the University of Illinois. 

If it is between 6 am and 9am, or 4 pm and 6 pm, on a weekday, or between 8 am and 9am on a weekend, or if you do not have access to a car, it is far far easier to be tested as a university student at Illinois. 

Why can the University of Illinois run testing like this? Because they have a testing system built around simple saliva collection. Saliva collection isn't nearly as complicated as the swabs. It's easier to train people up to do it. That makes it easier and cheaper to have stations running all the time. 

That also then makes it easy for Illinois to have fairly comprehensive testing requirements. Vaccinated students only need to be tested if they've been in contact with a case (or have symptoms, or in case of outbreak). Unvaccinated students need to be tested every other day. You can do that when testing is cheap and easy. 

We could have it here too. It's the testing system that Rako Science here runs under licence. But the Ministry of Health isn't interested. 

FWIW, I have zero conflicts of interest here. Rako isn't a member of the Initiative, and neither is APHG.  It wouldn't affect how I've read this stuff in any case. 

The Ministry of Health's procurement panel sure cannot say the same thing.

Multiple poorly managed conflicts of interest, no formal procurement plan, and a failure to properly appoint a probity auditor are among the failings in the health ministry’s procurement of saliva testing in a report published today by the Office of the Auditor General (OAG). 

The watchdog makes a number of damning findings and expresses “serious concerns” about the way the ministry conducted the highly controversial $60 million contract to provide saliva testing that was awarded to Asia Pacific Healthcare Group (APHG) in May. 

Among key findings was that four of the five people on the panel selecting the saliva testing provider had declared possible conflicts of interest, including “past and current employment relationships with staff from potential respondents or associated laboratories”. 

The OAG also caned the ministry over its approach to the appointment of a probity auditor to oversee the process, as is required by public sector procurement rules.

From TEU to FSU

Jack Heinemann's take on academic freedom in New Zealand provides an excellent on-campus recruitment opportunity for New Zealand's Free Speech Union. 

The Free Speech Union, as a registered union, has rights to enter workplaces to talk to workers. They should plan a round of campus visits.

Here's Jack:

Making conscience central in all activities of a critic and conscience of society might avoid some future clashes in Aotearoa. Academic freedom is the right to bring forth unpopular or controversial opinions, not to promote opinions popular with those who have social or financial privileges.

For example, white/Pākehā academics making comment on mātauranga Māori in defence of “science” don’t need to use academic freedom because the westernized institution of science already has disproportionate power and influence in any clash with indigenous knowledge systems. So when a university takes a neutral position, treating the academic protagonists and academic responders equally based on narrow ideas of a right to free speech, the institution stumbles as critic and conscience of society. Moreover, it fails to both preserve and enhance academic freedom.

Other examples include attempts to use university campuses as platforms for racially or genderised “forums”. Those without power or privilege don’t need tertiary institutions to criticize them, turn their backs on criticisms of them, or to host it. The desire of majority members of white paternalistic societies to have their ideas spoken on campus is not equal to the right of minority ethnic and non-binary groups to feel accepted and safe there.

Privilege is an asymmetry of power that marginalizes and excludes others. No history of academic freedom is consistent with the notion that it speaks privilege to power.

So. If your research shows that claims of oppression in the case you're studying are overstated, or that an institution isn't as colonialist and evil as others have suggested, you should probably shut up about it because that doesn't count under critic and conscience. Because it reinforces power or something. 

If you haven't joined the Free Speech Union yet, and you're a New Zealand academic, they may be more likely to have your back than the TEU, if it comes to it.  

Monday, 15 November 2021

Teetotaling documentaries

The latest anti-drinking documentary will be on tonight. Would for a world in which we'd also get documentaries from former teetotalers extolling the merits of light to moderate drinking. Instead we just get ones going the other way. 

In anticipation of some of what we might expect to hear:

  1. Price elasticity of demand varies by whether you’re looking at moderate or heavier drinkers. Heavier drinkers are less price responsive. Hiking excise does more to get moderate/light drinkers to cut back than it does to get heavy drinkers to stop. It doesn’t make sense to use a linear excise tax to address a harm that’s heavily nonlinear in consumption. It’s like trying to stop speeding by increasing petrol excise on the theory that speeding uses more fuel. Excise on spirits in New Zealand, if we were ranked against the European Union, would have New Zealand at third or fourth highest.
  2. When you’ve got something that has minor baseline costs but harms that rise sharply with consumption, you need some kind of two-part tariff structure. Basically, use excise to offset the low-level stuff but use other targeted policies for the rest. There are available proven policy tools that directly address harms. The 24/7 sobriety project, run in South Dakota and then expanded to other states, imposes a monitored non-consumption condition on parole/probation for offenders who’ve shown a pattern of alcohol-related crime. In South Dakota it was aimed at repeat drink drivers. The thing just works. New Zealand is set up to do it. We have the Drug & Alcohol Courts that could be perfect for it. But the thing that makes the project work in the US is the certainty of spending a night in the cells if you breach the condition. Here it’s all airy. You’ll have to talk to your probation officer who may or may not do anything, and if he does something, who knows whether the judge will impose a night in the cells or not. It’s the certainty of a very small penalty that drives better outcomes elsewhere, and here we’ve just been reluctant to do that for whatever reason. I think I’m the only one the country that beats the drum for this one, and it’s just bizarre. It works. When Mark Kleiman talked with the NZ Drug Foundation about it circa 2014, he noted that some parolees coming off the programme asked to be kept on it to help them stay on the straight and narrow. There are some folks who just have a very very bad relationship with alcohol. Excise isn’t the way to solve that. 
  3. Measures of social cost are kinda dumb just on their own. You might as well tally up all the money people pay for skis, lift tickets, food while they’re at the hill, the time off work, the ambulance and hospital and ACC bills and call that the social cost of skiing. Would it help with anything? No. You certainly wouldn’t ban skiing on the basis of it. But regardless of the number you come up with, it’s entirely possible that some safety measures pass cost-benefit analysis. Whatever the social cost of skiing, it might make sense to put padding around the pillars that hold up the chair lifts so people don’t hurt themselves too badly when they crash into them. If the measure is cheap, it could be worth doing regardless of whether the social cost of skiing is a big number or a small number. And even if the cost is a big number, putting a $1000 per lift ticket tax on skiing would be stupid. Similarly, regardless of some shonky tallied total social cost figure that ignores benefits, some measures could easily be cost effective. Like 24/7. They have to be evaluated on their own basis. Why spend time and effort on a process that’s just designed to come up with a big number to drive blunt policy measures when you could instead weigh up whether particular promising interventions really stack up?
  4. There's likely to be complaining about alcohol advertising and such. That's all already regulated. And it's hard to see that more regs would pass muster - at least on the evidence I'd seen as of 2014 when I wrote this
I worry that watching tonight's show might require heavy drinking. And it's late enough at night that my usual barman will be in bed (it's a school night) and unavailable to make me a Manhattan. Maybe I could request one earlier in anticipation.