Morning roundup

There are 5 different Chrome windows, each chocka. I can't do every bit justice. So, a roundup while I try closing maybe 2 of them.

• Superb news. Finally. The government is starting to be a bit more flexible about safe alternatives to MIQ. 
• I like how Australia still thinks big. Here's Stephen Kirchner making the case for a large increase in immigration.
• There's a claim that carbon farming, via forest sequestration, starts being costly after a century. I'm still not convinced. If carbon prices are high enough that people can't cut down trees at that point, they may be high enough to warrant digging a giant hole, sticking the cut trees into the hole, covering it up, sticking a pipe in for methane recovery, and replanting it. Maybe there's some price range where carbon isn't valuable enough to do that, but too costly to allow cutting the pine plantation. But should that be the presumption?
• On the merits of not letting Covid become endemic in New Zealand. It is not the flu. I still wonder what the heck happened to Pfizer's talk of a delta-specific vaccine from back in June(ish). I'd understood mRNA to be plug-and-play. It took them only a couple days to develop the vaccine in the first place, on having Covid sequences to play with. Why isn't there a delta-vax yet? 
• Asher Wilson-Goldman on what it will take to get vax out to the last 17 percent. Remember of course that this government is forcing Maori health providers to sue them to get access to the systems needed. 
• Remember how we all got excited when the government made Verrall, who'd written the darned report on the inadequacies of contact tracing, the new Deputy Minister in charge of that? Well, nothing's fixed. Contact tracing still isn't up to the job. Why? The government couldn't imagine elimination failing, so just didn't prepare for it. 
• Lew Stoddart on the end of elimination. He's more than a little too charitable about the Government's record up to the past couple of weeks; the Government had ignored expert calls for all kinds of measures that would have reduced the likelihood of the current outbreak happening in the first place. 
• A month ago, I'd had a podcast with Medicines New Zealand's Graeme Jarvis about how we risked being stuck at the back of another queue - this time on procuring effective antivirals. Looks like Pharmac is now getting on top of this, with an order in for molnupiravir. Fingers crossed. 
• Jacob Grier on respecting the agency of smokers and on the illiberalism of prohibitionism. He's right. 
  

The last month has been utterly mad. There was an old Roger Douglas line about the reforms in the 1980s moving too fast for opposition to them to mount. Labour's basically doing that again, but mostly in the wrong directions, in the middle of a pandemic, while not being appropriately on top of the pandemic stuff. 

It's not ideal. 

Google and the provision of public goods

Anything that makes the Android operating system more valuable to users is good for Google. More people taking up the Android platform means more people in the Google universe, using their apps, seeing the ads that they sell. 

They have rather decent inventive to do awesome things for the platform.

Yesterday, about 2.55pm, I got a push notification on my phone. It made a sound I'd never heard before. I looked over and it noted that there'd been an earthquake, estimated magnitude 5.6, about 100 kilometers away off shore. I'm going from memory here as I didn't screenshot it. 

By the time I remembered that Google had added earthquake warning functionality into the Android OS, and remembered David Hood's skepticism about it, the room started shaking. Somewhere between 3 and 10 seconds. I should have started counting. 

Had the number on the phone been bigger than 5.6, I'd have gotten under the desk. And I've had had time to do it too. 

I kinda hate earthquakes. But now, I'm kinda looking forward to the next minor one. I want to count it down, like the gap between lightning and the thunder. 

Thank you Google!

Contact details

It seemed really obvious, really early, that robust privacy protections were needed around Covid sign-ins. If even some people expect, entirely unreasonably, that there's any chance that police could subpoena that data, then it needs to be bright-line illegal for anyone to hand that data over to police. 

The government can insist all it wants that the police wouldn't do that, but people who don't inherently trust police to do the right thing would rightly insist on stronger protection than that, and especially when Australian police have been up to dodgy stuff.

The people who you most need to be checking in for contact tracing are the ones who are nervous about the thing, because they may be in the cohorts you're going to have a hard time tracking down otherwise.

Newsroom's Sam Sachdeva says Labour is the only party opposing a rule change here. 

A push to provide stronger privacy protections for contact tracing data now has the support of four political parties in Parliament, leaving Labour as the sole holdout for legislative change.

The issue of how contact tracing data is used, and could be misused, has been bubbling away for some time and came into the spotlight again last week in relation to the Covid-positive woman who was refusing to share her movements around Northland with health officials.

When asked by Newsroom last week whether the Government would offer the woman immunity from any criminal charges in exchange for being candid about her whereabouts, Hipkins said public health officials did not use information gathered in interviews for any purpose other than eliminating Covid-19.

“The public health teams are not collecting information that’s then passed on and used in other law enforcement procedures, because to do so would mean that people wouldn’t provide the information in the first place.”

However, the standard of rules governing the use of contact tracing data has been called into question in the past, yet the Government has taken no new action to address those concerns.

In September, an open letter signed by over 100 lawyers, experts and academics said the public health order establishing mandatory recordkeeping had “insufficient" safeguards to protect against the misuse of data collected through either the Covid Tracer app or paper-based records.

Some are concerned that police or other law enforcement agencies could compel the release of the information through a search warrant or production order, while others have said the private sector could also misuse data collected through paper-based records.

The Government is legislating themselves the right to expropriate private covid testing labs, while insisting they won't use that right. 

At the same time, they're refusing to legislate against the use of covid check-in data, because they say that there's no need to because they wouldn't abuse the data and everyone should just trust them. 

Would it be crazy for someone who doesn't trust police or the government to conclude that the government's refusal to legislate here is because they actually kinda want to be able to use check-in data for dodgy purposes?

Further, on taking tests

On Monday, I managed to get a submission in on the Government's awful proposal to give itself the power to requisition tests and testing materials. Was a bit of a rush job, but it's a bit of a rushed legislative process. I hadn't known about it much before a hasty blog post on it on Friday. 

The submission alludes to a few problems in giving the Ministry of Health authority to set quality standards for testing, which the legislation also does, in addition to letting the Ministry take Rako's tests. 

My column at Newsroom, written after the submission, also goes through the problems. Currently gated. [Update: ungated]

A snippet:

If the Government wanted more testing capacity, it could have contracted for that capacity. And it still could. But over the past year, the ministry has repeatedly rebuffed Rako’s offers to provide testing. The Ministry of Health also told Rako not to maintain any extra testing capacity for the Government as its services would not be needed.

Shifting from a view that Rako’s testing was not needed, to that they are so necessary that they could warrant requisitioning, seems somewhat incoherent.

Once the Government has the ability not only to requisition materials away from prudent labs, paying only some deemed market value for the effectively stolen supplies, but also the ability to force those labs to ignore existing contracts and to provide testing for the State instead, bad things happen.

Existing clients would see the obvious threat to the security of their continued ability to undertake testing. That makes contracts less valuable. Labs can purchase sufficient supplies to tide them through shortages and international shipping delays. They cannot purchase sufficient supplies to ensure that they have enough left in the event that the Government decides to requisition all of the testing materials or all of the testing capacity.

And if the biggest thief in Wellington, whose offers are impossible to refuse, sees your prudential stockpile of testing materials as tempting, what incentive do labs have to maintain those stockpiles in the first place? After all, the Government could well instead decide to requisition someone else’s supplies on your behalf, come the crisis.

When all is done, we have a Ministry of Health that, after spending most of the past year seemingly doing its best to thwart Rako Science’s provision of accurate saliva-based, PCR Covid testing, and after telling Rako that its services would not be required for the public health effort, is now preparing simply to take Rako’s testing capacity through requisitioning powers. While saying it hopes not to need to use such powers.

It is not right. It will have repercussions for security of contracting and investing in New Zealand. And it will hinder the Covid response.

Dileepa Fonseca provides further very helpful detail in a piece today at Stuff. It's truly a must read, spectacular scoop. Leaked ESR test validation details, Ministry insider comments on the debacles. 

Here's how it starts. It goes on at length, and only gets worse for the Ministry.

A leaked study into saliva testing shows the Ministry of Health is still trying to figure out how accurate various types of saliva tests are as the Delta strain starts to take hold in Auckland.

The first stated objective of the leaked Institute of Environmental Science and Research (ESR) study is to compare different PCR saliva testing methods used on border workers by Asia Pacific Healthcare Group (APHG) and its partner laboratories.

However, it is the second objective of the ESR study that has people like Yale school of public health saliva testing expert Anne Wyllie worried.

That objective is “to generate clinical sample testing validation data from Covid-19 volunteers for the testing laboratories as requested by IANZ [International Accreditation New Zealand]”.

Wyllie was leaked the data by concerned scientists, and says there are no circumstances under which data gleamed through the study should be used to validate saliva tests.

“This is a preliminary, exploratory study. If APHG is basing their clinical diagnostic claims off of this – this is not at all robust or reliable, and not true validation.”

A spokesman for APHG wouldn’t comment on whether the data from this study had been used for validation purposes, or as part of their previous public statements on the accuracy of their saliva tests.

“We are not interested in commenting further on clinical validation except to say that our labs have had our work on that recognised by IANZ.”

...

“Why is there no clarity in the data that was used for validation? Why no clarity on which tests are being used for saliva? Why all the secrecy,” Wyllie says.

“Every lab in the US has to tell all its patients which test it is testing with and all that data is publicly available.”

The Ministry of Health argues testing validation data is the property of private laboratories and there is no requirement such results be published.

The Ministry of Health set the RFP for saliva-based PCR testing. 

The Ministry of Health could easily have set a requirement that any provider have a validated test, or get its test validated, and provide all data from that validation. 

The Ministry of Health chose not to do that. 

And then the Ministry of Health says "Oh, well that data is property of the labs so we can't ask for it." 

The Ministry of Health absolutely should not be able to set standards on Covid testing. 

Dileepa continues:

The authenticity of the documents, which were published just last month, have been confirmed by a senior Government official, who claims the whole saliva testing roll-out has been mismanaged by Ministry of Health officials right from the start. The official has requested anonymity.

All of this is part of a long-running saga with Rako Science, which was the first to achieve diagnostic validation for their saliva test, but was passed over for a $60m border worker saliva testing contract in favour of Asia Pacific Healthcare Group, which hadn’t been similarly validated at the time.

“They’ve got themselves into a situation with Rako [Science] and I don’t think they know how to manage their way out of it,” the official says.

An IANZ spokesman said it would normally assess things like Covid-19 tests against a fixed set of international standards, however these standards had been modified by the Ministry of Health’s clinical advisory teams.

”We do not set the accreditation criteria, we simply assess the labs against the criteria that are provided to us.

“Because of the rapidly changing nature of the Covid-19 testing environment, these criteria have been informed/modified by MOH clinical advisory teams composed of experts.”

And on the Ministry's competence in setting standards:

The Covid response bill before Parliament will allow the Ministry of Health to requisition testing supplies, and unilaterally set standards, something a senior government official says is equally worrying.

An official who spoke to Stuff sees the new law as dangerous because of the lack of understanding about this type of testing within the Ministry of Health itself.

“There just seems to be so many individual commercial interests now ... it’s hard to find somebody who is not conflicted.”

The official believes ministry officials didn’t understand what they were procuring when the saliva testing contract went out to tender. That meant officials focused on more easy-to-understand issues like the number of collection points available.

“It’s unconscious incompetence. It’s the people at the Ministry of Health in charge of a large procurement programme,” the official says. 

Taking tests

The least-bad potential explanation for what the government is up to, in its rushed legislation that would give it the power to expropriate Rako Science's testing setup, runs as follows.

Suppose that, as Director General of Health, or the Minister of Health (who knows where this came from), you finally FINALLY figured out that most of your advisors on saliva-based testing are, in fact, utter idiots. They have led you astray for almost a year. All that stuff about saliva PCR testing not being that reliable was wrong, even if DG Health announced it as truth from the podium of truth. It's just that your idiot advisors couldn't figure out how to make it work themselves so spent the past year trash-talking it. And suppose you also figured out that there really only is one game in town if you want to scale up to a ton of testing that meets international ISO standards. And you've finally FINALLY figured out that you actually need a metric shit-ton of testing capacity. Because you only decide to do anything about an outbreak when there is an outbreak. Not before.

When you finally realise that you need to contract for tons and tons of testing capacity, and the only possible reliable supplier of an international-standard validated test in New Zealand is the company you have been utterly screwing over for the past year, well, you might just be a bit worried that prices could be higher than you'd like. 

In that case, having backstop ability to requisition testing from them at a price that you deem fair is a bit like the public works act, but worse. But you hope not to have to use it and that some negotiated contract could work. 

That would be the least-evil explanation for the powers the government is giving itself. 

There are, of course, more evil explanations. But I don't think there are less-evil ones. 

They brought the legislation 29 September, without telling Rako. Rako found out about it on 5 October. Submissions close Monday. The government is giving itself the power to steal all of Rako's kit: requisition their materials, requisition tests. 

I wrote it up as this week's Insights column.

There’s an old saying that makes the rounds now and again, with various attributions. “First they ignore you, then they laugh at you, then they fight you, then you win.”

I wonder how this one is going to end for Rako Science. I desperately hope it ends well. If it does not, it will be an utter travesty of justice.

The Initiative has long been keen on better Covid testing methods. They featured again in my report, released this week.

The University of Illinois’s SHIELD protocol saliva-based PCR testing rolled out very successfully in August 2020.

By late 2020, Rako Science had brought it here, under licence. By January, Rako was providing accurate and rapid PCR testing for private clients under contract, with a test validated to ISO15189 standard.

Rako had offered its testing services to the Ministry of Health in December 2020.

First they ignored Rako.

When Rako’s deployment spread through early 2021, the Director General of Health made erroneous statements, perhaps through simple mistake, at 1pm briefings about the accuracy of saliva-based PCR testing.

Then they laughed at Rako.

When it became increasingly obvious that it was impossible to scale up nasal swab-based testing in any practicable way, the Ministry of Health set a procurement process for saliva-based PCR testing. That process is the subject of a complaint by Winston Peters to the Auditor General.

And, for months, according to Rako, the Ministry ignored or denied requests from Rako to link Rako’s test results into the nationally integrated reporting system.

Then they fought Rako.

Last week, on 29 September, the Government introduced the COVID-19 Public Health Response Amendment Bill (No 2) into Parliament.

Rako found out about it on 5 October. Submissions close Monday 11 October.

Section 11 of the Bill provides the Government with the ability to requisition Rako’s materials and services, compensating the company at a deemed “market price”. Existing contracts with private hospitals for testing might need to be voided, come the requisition order.

On a charitable and optimistic interpretation, the Government has finally realised that it needs to contract for a massive amount of testing and does not want to have to negotiate with the provider of the only test validated to the appropriate ISO standard.

On a more frightening one, the Government is preparing to quasi-nationalise the provider they fought for so long.

Let’s hope Rako wins this one. If they don’t, we all lose.

BusinessDesk also has it, because Pattrick there has been the single best journalist in the country in following this file. Here is a snippet, you should subscribe. 

How else to explain parts of the COVID-19 Public Health Response Amendment Bill (No 2), tabled in Parliament last week, which would give the health ministry remarkable new powers to commandeer the use of private laboratories’ testing capacity? 

The bill proposes that the director general of health have power to make an order – and provide compensation – to a private laboratory to “undertake testing solely for the purposes of the public health response to covid-19 while subject to the order ... whether or not the laboratory is contracted by the Crown for that purpose”.  

It proposes the ministry be able to demand that any and all private test results be available for its national database.  

This sort of draconian drafting doesn't happen by accident and has the potential to produce results that could be both highly ironic and commercially damaging, depending on your perspective. 

Imagine, for example, if the Ministry of Health were effectively to commandeer the saliva testing resources of Rako Science to ramp up the national testing effort, having fended the company off by any means possible ever since its highly accurate saliva test became available last year. 

Rather than contracting for the service, the ministry would simply be obliged to "compensate" such a provider for their trouble. Watch this space.

Jonathan Milne at Newsroom also has it here. He quotes Rako's Leon Grice:

"There is other legislation where the Government can come in and expropriate or requisition private property – that's the Public Works Act. But that has more protections, like a process to determine a market rate that the Government must pay.... They can just insist we give up our stock and our reagents and our premises that we need to do our work."

If you care about the rule of law in New Zealand, and about the Covid response, you might consider submitting. 

If you haven't time to do anything else, just telling them that it is wrong to propose stealing the testing system that they spend months and months deriding might be nice. 

If you have more time, reminding them that they ought at least be indemnifying Rako against all of the breach of contract messes that will result if the government steals Rako's testing capacity, taking testing capacity away from the private hospitals and others who have paid for this service, causing a breach of contract, after having told Rako repeatedly not to reserve testing capacity for any government need and not to scale up for it - well, that could be a nice addition too. 

On a straight-econ side, even the least-evil explanation above is terrible. 

If investing in testing capacity is high risk, because the government will spend a year crapping all over you, telling people not to contract with you, telling media at the 1 PM Podium of Truth sessions that your testing system isn't reliable, because you're not their preferred supplier - and then the government FINALLY figures out that they might need to get a ton of testing from you? 

Well, at least some return on that risky-as-hell investment is in order if you want anybody to be willing to take similar risks in future. 

None of the international corruption indices understand how New Zealand works.

I'll be submitting on Monday. I'll probably write more on this for next week's Newsroom column. It stinks. 

The cost of xenophobia

Radio New Zealand has been tallying the numbers on health workers stuck in our immigration system. 

New Zealand relies heavily on foreign medical specialists.

Expressions of interest from skilled migrants for residence visas have been paused since March last year.

Hundreds of doctors and nurses are among those waiting for news.

The association said the current approach created frustration and angst. It raised concerns about the residence delays in June, writing to the Immigration Minister Kris Faafoi.

But its executive director, Sarah Dalton, said there had been "zero response".

"Overseas doctors caught up in this delay say the uncertainty makes it difficult," she said "They feel they can't buy a house, settle their families, or put down roots, and are being forced to reconsider their futures in New Zealand.

"We have one of the heaviest reliances on overseas trained doctors anywhere in the OECD, more than 40 percent of our senior medical workforce trained in another part of the world and then for various reasons chose to come and live in work in New Zealand."

What should those workers do in the meantime?

The immigration minister Kris Faafoi said the government acknowledged the disruption that suspension of Expressions of Interest selections for the Skilled Migrant Category has had.

"We are working through advice on when and how to re-open EOI selections, and will have decisions to announce soon," he said.

Doctors and nurses were likely to be eligible for temporary visas while they waited for EOIs to be selected, he said.

That would be fine, except that Labour has made living in New Zealand as a non-resident very costly. It's clear that non-residents are very much second class. They have no access to the border system if they need to travel and are forbidden against buying a home. If you're a mid-career professional who has moved to New Zealand to work in medicine, being told you're banned from buying a house in the place where you live and that there is no expectation that the immigration system will even begin thinking about giving you residence so that you might do so - it's amazing that so many have stayed here. Australia is just a jump away and pays a lot more. 

And it's all the more insane when staffing is the critical constraint in expanding ICU capacity in a pandemic. They don't have the staff to run more ICU beds. Auckland is already, in a tiny outbreak, sending non-Covid ICU patients to other places and seeking staffing help from elsewhere. What hope would we have in any real nationwide outbreak? 

And here's more from Gill Bonnett at RNZ:

New figures show the numbers of doctors and nurses waiting to apply for residence has balloooned to almost 3000.

Figures released under the Official Information Act show the numbers of doctors who have submitted an expression of interest (EOI) for skilled migrant residence (SMC) has tripled to 675 since May and nurses have more than doubled to 2231.

The Association of Salaried Medical Specialists this week described the process as shambolic,

GPs and specialists are thinking of leaving the country or have already left because they can't get residence.

A consultant radiologist in Hawke's Bay, Phillip Clarke, is worried for the new doctors arriving, including four overseas consultants in his hospital department.

"We've got a new radiologist from Britain, and a radiologist from the States. We've got a radiologist from Germany, who's been with us about a year and we've got a nuclear medicine physician from South Africa. All of these people are on the essential list, and none of them have got residency. None of them have got any idea of when they're going to get residency.

"You're talking about people who are in the mid 30s at the youngest. They've got partners, they've got families, they've got a life. You really are trying to build the rest of your life on no surety whatsoever, and it's very very unsettling.

I know people get upset when I say that Labour just hates immigrants. They want to put it up to incompetence at Immigration New Zealand, or capacity issues, or anything else. It jars with the image they have built of what the Government is like. 

From what accounts one can gather in Wellington, half of Labour's caucus just hates immigrants. They see low unemployment numbers recently, credit the closed border, and are very happy that current policy is chasing non-residents out of the country. They believe that migrants steal jobs.  

If you don't think that Labour just hates immigrants. you've gotta really ask yourself how we can otherwise have gotten into a spot like we're now in. New Zealand has really really low ICU capacity by OECD standards. Health staff is a critical and binding constraint. We could see the pandemic coming from February 2020. For nineteen months, nothing has been fixed in the immigration system. Incompetence or lack of capability in Immigration New Zealand could explain perhaps a few months of this. Be generous and say it might even explain a year's worth of nonsense, and start the timer at the end of last year's lockdown when Immigration NZ wasn't able to process anything. It is still broken with no hope in sight. 

Does Labour really hate immigrants so much that they're happy for the health system to lose critical capacity in a pandemic? All signs so far point to yes. 

Test test test

This week's Newsroom column made the case for freeing up rapid antigen testing for use at essential workplaces during outbreaks and Level 3/4 restrictions. 

There's something like half a million essential workers and perhaps a hundred thousand in Auckland. The government maintains no register of them, and it would be impossible to run daily testing of a hundred thousand essential workers during Level 4 through current testing systems anyway. The PCR swab regime has been buckling under demand and is providing very slow results. Saliva-based PCR testing is far better and far more scalable, but may not be able to get to a hundred thousand tests a day - and may not be cost-effective for broad surveillance testing in lower-risk essential workplaces.

Rapid antigen tests give results in about fifteen minutes. They are not likely to catch cases with low viral loads but are decent at high viral loads - the people who would wind up being infectious. Having workers run a self-test before starting shifts would add an additional layer of protection. But no rapid antigen test has been authorised for use in New Zealand. It is unclear whether MedSafe has even considered any - I have a request in with them for more information. 

The Newsroom column is also available on our website, where all my links to sources are preserved. 

A snippet:

Antigen tests are not as sensitive as PCR tests overall but are reliable when a person is infectious. For high viral loads, the Abbott BinaxNOW test proved as accurate as PCR tests in one assessment but missed one person whose low viral load was only caught by PCR. The test costs about $5 (more in the United States) and gives results in about fifteen minutes. Other antigen tests are broadly available in Europe, at less than a dollar per test. The Canadian government has been distributing packs of tests to small businesses for employee testing, for free.

These kinds of tests make more sense for broad population screening. If there is no reason to suspect someone has the virus, but you want to prevent infectious people from boarding an airplane, a rapid and low-cost test that can be administered in the departure lounge before boarding makes a lot of sense.

The New Zealand government’s testing regime is almost exclusively swab-based PCR tests. The system very obviously cannot keep up with the amount of testing required in major outbreaks. It takes too long to collect samples; samples must be collected by a limited number of trained professionals; it takes too long to process tests; it takes too long to return results to those who have been tested; and, it is rather expensive.

The University of Illinois’s saliva-based PCR test has been available in New Zealand on a private basis since January, thanks to the University’s New Zealand partner, Rako Science. Rako has advertised that it can test up to ten thousand people per day. Its collection method does not require scarce nurses for sample collection and can be scaled up much more readily. Depending how long it takes to get samples to the lab, it can provide results in about four hours. The Ministry of Health, for months, inexplicably refused to consider adding this option to the government’s testing regime.

But the real testing job is an order of magnitude larger still, if we want to turn Delta into Iota.

The Ministry of Health has reported transmission among essential workers in Auckland. This type of transmission has made it difficult for New South Wales to control its outbreak.

The government could, today, order a couple million rapid antigen tests. They are broadly available. It could distribute those test kits to every essential workplace in Auckland and require that every essential worker be tested every day before starting work.

It could be a condition of a Level 4 modified to suit Delta.

Within about fifteen minutes, each worker’s result would be available. Infectious workers could be sent to government testing stations for confirmation. And workplace transmission would be sharply reduced.

Why are employers not doing this on their own as part of normal health and safety prudence? The tests are currently prohibited in New Zealand. In April 2020, the government banned all point-of-care tests unless they are approved by MedSafe, and MedSafe has not seen fit to approve any tests. Pedants might argue that this does not constitute a ban, but banning anything that has not been approved while deciding not to approve any options sounds an awful lot like a ban. It is unclear whether MedSafe has even evaluated any options.