Improving NZ Government Communication about COVID-19: Five Suggestions Including a Proposal for Depoliticisation

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Prof Nick Wilson, Dr Jennifer Summers, Dr Leah Grout, Dr Amanda Kvalsvig

The high quality communication by the NZ Government for much of the COVID-19 pandemic has been remarked on. But given that the pandemic situation is very far from over, in this blog we consider five areas in which potential improvements could be made. Potentially the most important of these would be to further depoliticise the COVID-19 response.

Overall, Aotearoa NZ has done very well with its COVID-19 pandemic response and it is typically ranked in the top few performing countries.1 2 NZ’s economic indicators, such as GDP impacts, also compare favourably to other countries using the less successful “suppression” strategy against the pandemic.3 4 Furthermore, the communication by leaders such as Prime Minister Jacinda Ardern has been noted for its level of engagement and high quality both by experts in leadership5 and others.6 7 Scholars have particularly noted the “compassionate” approach of the Prime Minister, combined with an ability to be a strong leader by “enacting tough policies such as closing borders and mandating lockdown measures…”.7 Other successful features included daily briefings (particularly by the Prime Minister and the Director General of Health Dr Ashley Bloomfield), extensive social media engagement, and useful communication concepts that supported collective action (eg, “team of 5 million”, “bubbles”, “unite against COVID-19”, and “be kind”). The Alert Level system was also a very successful communication tool, although we have long argued that it has become out-of-date and needs upgrading.8

Image by Luke Pilkinton-Ching, University of Otago Wellington.​

Despite these successes, there is still scope for improvements in communication. Given that the pandemic is very far from over, in this blog we consider five areas in which potential improvements could be made.

1. Depoliticise the COVID-19 response and aim for a cycle of continuous quality improvement

NZ has a fairly adversarial political system, which is appropriate and necessary for providing democratic oversight of the government by the parliament. But this approach has risks for managing a pandemic. For example, in the NZ context it seems to have contributed to the following problems:

  • Delayed release to the public of important documents on the pandemic response – sometimes with a delay of several months (see below for details);
  • Political manoeuvring at a health select committee to avoid questions about the COVID-19 response,9 along with debates in Parliament that appear to be more about political point scoring than a focus on quality improvements;
  • Government spokespeople being excessively defensive in response to feedback from other politicians and expert commentators, resulting in lost opportunities to maintain an agile pandemic response that is based on up-to-date evidence; and
  • Certain opposition politicians engaging in unethical behaviours (a privacy breach10), not exposing unethical behaviour,11 and making time-wasting accusations about non-existent security breaches.12

Ideally such issues could be minimised if a multi-political party working group assumed the key role in designing the ongoing COVID-19 response. The working group could even have joint leadership from key health/COVID-19 spokespeople from the two major political parties. As a condition of participation in such a group, opposition political parties would agree to engage in constructive criticism solely regarding COVID-19, using an agreed upon code of conduct. These opposition parties would then get appropriate credit for the improvements in the subsequent response. But in particular, these opposition parties should be rewarded with additional opportunities and resources in the Parliamentary system to criticise the government in all non-COVID-19 domains (so that there is no net reduction in the overall capacity to criticise the government and potentially even an increase).

Such arrangements for a time-limited period (eg, for the rest of 2021) could facilitate the necessary cycle of quality improvement that could see the successful roll-out of the vaccination programme, smooth adjustments to border control settings to reduce border failures, and a steady expansion of NZ participation in expanding travel bubbles. Of note is that opposition parliamentarians have been involved in joint “War Cabinets” or similar bodies during World War Two in NZ, Australia and the UK.13

2. Talk about systems – not about individuals or a “tricky” virus

It is human nature not to think in terms of systems, but rather in terms of the “good” or “bad” behaviour of individuals. Yet the prevention of border failures and control of outbreaks is entirely a matter of the design and operation of systems – before flights leave for NZ, at the border and in MIQ facilities, and then with the operation of public health services in the NZ community. As such, when a “border failure” occurs it should be entirely viewed as a “systems failure” and it is of very little value (or even counterproductive) to attribute problems to mistakes or rule breaking by individuals. The system has to be designed with multiple levels of safeguards and to account for the full range of human behaviour (ie, including counterfeit pre-flight test results, lying, oversights, and not following rules). When we focus on systems, just as the airline industry does with safety,14 it means that we can more successfully make continuous design and quality control changes to further improve these systems.

There is also the communication problem of blaming the “tricky” virus which can divert attention from human-designed protections. Yes, the pandemic virus is a highly transmissible piece of biological machinery – but it has no capacity to wilfully evade our defences. What we need to focus on entirely is the continuous improvement of our human systems using robust evidence about transmission mechanisms and effective outbreak control.

3. Strive harder to “be right” around all informational issues

The CDC in the US has issued communication advice around infectious disease crises which includes the key advice of “Be Right”15: “Accuracy establishes credibility. Information should include what is known, what is not known, and what is being done to fill in the information gaps.” While NZ Government communication has generally done this well, we note the persisting problems of the following:

  • Inappropriate concerns about the accuracy of daily saliva testing (PCR tests) of border workers.16 It has been known for a long time that this approach could provide for additional safe guards (even if sensitivity of a single saliva test might not always be as high as with nasopharyngeal swabs, daily testing can work as a highly sensitive screening strategy for early detection of infection in an individual).
  • Factually inaccurate descriptions of making New Zealanders “stateless” if they are required to wait before returning to NZ. It is clear that NZ law allows for conditions of return (including various delays) to be used to protect population health, as per the legal expert views detailed elsewhere.17 These views indicate that such measures in no way render a NZ citizen “stateless”. Article 1(1) of the 1954 Convention relating to the Status of Stateless Persons defines a stateless person as ‘a person who is not considered as a national by any State under the operation of its law’. There are strictly defined and very rarely applied criteria and associated legal processes under which a NZ citizen can be deprived of their citizenship. Revocation of citizenship cannot be triggered simply by a delay in travel.
  • Inappropriate references to limits on incoming air flights to NZ potentially causing problems with access to “medical supplies”.18 This is a potentially alarmist statement given that cargo flights can readily transport such products to NZ.
  • The lack of any official communication detailing the analysis of why hotel-based quarantine is still considered preferable to establishing purpose-built facilities. This deficit is in the context of mounting numbers of hotel quarantine failures in NZ and Australia,19 and increasingly strong calls in Australia to shift to more appropriate facilities from an infection control perspective20 (as per the Howard Springs facility outside Darwin which to date has never been involved in a border failure).

4. Rapidly make available reports about investigations and reviews

Despite transparency on many day-to-day issues, there have been excessively long delays in the release of documents relating to the pandemic response eg, four months for the Roche/Simpson report with a release on the “Friday before Christmas”.21 Furthermore, very few of the investigation reports into NZ’s 15 border failures to date are available online (and even these can be in just a brief summary form22 or after journalists and others have pursued official information act processes eg, the outbreak involving seafarers23 and a response to a request by Prof Skegg detailed elsewhere24). To avoid confusing the public and eroding trust, it is essential that misinformation is promptly corrected. For example, the official “rubbish bin” theory of transmission in an MIQ facility, which had expert critique at the time as being very unlikely,25 took many months to revise. The updated information occurred in the form of the publication of a scientific journal article that included Ministry of Health authors.26

5. Warn the public in advance that further revisions to systems and controls may be required

It is natural to enjoy any return to “normality” as quickly as possible and to avoid thinking about future risks. But it is most definitely the job of government to protect its citizens by planning for future risks, as recently detailed in a report by the former chief science advisor Prof Peter Gluckman and Dr Anne Bardsley.27 With this pandemic being far from over, the public need to be prepared for further surprises and rapid responses by the government. These surprises could include:

  • Even more infectious and/or lethal variants of the pandemic virus.
  • Limitations with vaccines (eg, needing repeat doses every year).
  • Border failures that lead to large outbreaks in NZ (albeit probably a declining risk with increasing vaccination coverage).
  • Difficulties with operating the expansion of quarantine-free travel green zones.

In the long-term we also need to be prepared for far more serious pandemics that arise from synthetic biology (laboratory accidents or purposeful releases of synthetic bioweapons). Therefore, the NZ Government (and any multi-party COVID-19 oversight group), needs to regularly communicate these risks – and prepare the population psychologically for even more extreme interventions being needed on occasions (eg, complete border closure for longer periods,28 and emergency use of digital technologies for quarantine and contact tracing).

 

References

  1. Lowy Institute. Covid Performance Index. Lowy Institute, 2021. (Data up to 13 March 2021). Available from: https://interactives.lowyinstitute.org/features/covid-performance/.
  2. Hong J, Chang R, Varley K. The Covid Resilience Ranking: The Best and Worst Places to Be as Variants Outrace Vaccinations. Bloomberg (26 April 2021). https://www.bloomberg.com/graphics/covid-resilience-ranking/.
  3. Baker M, Wilson N, Blakely T. Elimination may be the optimal response strategy for covid-19 and other emerging pandemic diseases. BMJ 2020;371:m4907. doi: 10.1136/bmj.m4907.
  4. Philippe C, Marques N. The Zero Covid strategy protects people and economies more effectively. Paris-Bruxelles: Institut Économique Molinari, April 2021. https://www.institutmolinari.org/2021/04/03/the-zero-covid-strategy-protects-people-and-economies-more-effectively/.
  5. Wilson S. Pandemic leadership: Lessons from New Zealand’s approach to COVID-19. Leadership 2020;16:279–93.
  6. Cousins S. New Zealand eliminates COVID-19. Lancet 2020;395:1474.
  7. Windsor LC, Yannitell Reinhardt G, Windsor AJ, Ostergard R, Allen S, Burns C, Giger J, Wood R. Gender in the time of COVID-19: Evaluating national leadership and COVID-19 fatalities. PLoS One 2020;15:e0244531.
  8. Wilson N, Kvalsvig A, Baker M. Upgrade of NZ’s COVID-19 Alert Levels Needed to Help Regain NZ’s Elimination Status. Public Health Expert 2020;(3 September). https://blogs.otago.ac.nz/pubhealthexpert/upgrade-of-nzs-covid-19-alert-levels-needed-to-help-regain-nzs-elimination-status/.
  9. Manch T. Labour reprimanded for treatment of National MP Chris Bishop at testy parliamentary committee. Stuff 2021;(15 April). https://www.stuff.co.nz/national/politics/124850506/labour-reprimanded-for-treatment-of-national-mp-chris-bishop-at-testy-parliamentary-committee.
  10. McCulloch CE. Covid-19 privacy leak was ‘deliberate and politically motivated’, SSC inquiry finds. Radio NZ 2020;(30 July). https://www.rnz.co.nz/news/political/422343/covid-19-privacy-leak-was-deliberate-and-politically-motivated-ssc-inquiry-finds.
  11. McNeilly H. Coronavirus: Michael Woodhouse says way Michelle Boag leaked patient information wasn’t ‘normal’. Stuff 2020;(10 July). https://www.stuff.co.nz/national/politics/122097316/coronavirus-michael-woodhouse-says-way-michelle-boag-leaked-patient-information-wasnt-normal.
  12. Truebridge N. Woodhouse’s isolation homeless mystery man claim debunked. Stuff 2020;(11 August). https://www.stuff.co.nz/national/health/coronavirus/300079861/woodhouses-isolation-homeless-mystery-man-claim-debunked.
  13. Wikipedia. War cabinet. https://en.wikipedia.org/wiki/War_cabinet (accessed 25 April 2021).
  14. Cochrane BS, Hagins M, Jr., Picciano G, King JA, Marshall DA, Nelson B, Deao C. High reliability in healthcare: creating the culture and mindset for patient safety. Healthc Manage Forum 2017;30:61-68.
  15. Centers for Disease Control and Prevention. CERC [Crisis + Emergency Risk Communication] in an Infectious Disease Outbreak. Centers for Disease Control and Prevention, USA. https://emergency.cdc.gov/cerc/resources/pdf/315829-A_FS_CERC_Infectious_Disease.pdf.
  16. Radio New Zealand. Covid-19: ‘We need to stop dragging our feet’ on saliva testing – Sir David Skegg. Stuff 2021;(15 February). https://www.stuff.co.nz/national/health/coronavirus/300230690/covid19-we-need-to-stop-dragging-our-feet-on-saliva-testing–sir-david-skegg.
  17. Wilson N, Boyd M, Mansoor O, Delany L, Baker M. Expansion of “green zones” may provide a chance for the global eradication of COVID-19. Public Health Expert 2021;(18 March). https://blogs.otago.ac.nz/pubhealthexpert/expansion-of-green-zones-may-provide-a-chance-for-the-global-eradication-of-covid-19/.
  18. Satherley D. Coronavirus: Positive Auckland Airport worker genomically linked to known imported case of COVID-19 – Chris Hipkins. Newshub 2021;(21 April). https://www.newshub.co.nz/home/new-zealand/2021/04/coronavirus-positive-auckland-airport-worker-genomically-linked-to-known-imported-case-of-covid-19-chris-hipkins.html.
  19. Grout L, Katar A, Ait Ouakrim D, Summers J, Kvalsvig A, Baker M, Blakely T, Wilson N. Estimating the failure risk of quarantine systems for preventing COVID-19 outbreaks in Australia and New Zealand. medRxiv 2021;(30 April). https://www.medrxiv.org/content/10.1101/2021.02.17.21251946v3.
  20. Dow A, Rabe T. Infection control experts call for an end to hotel quarantine in Australia. Sydney Morning Herald 2021;(23 April). https://www.smh.com.au/national/infection-control-experts-call-for-an-end-to-hotel-quarantine-in-australia-20210423-p57lyl.html.
  21. Radio New Zealand. Govt to pump almost $3 billion into its Covid-19 response after report identified failings. Radio New Zealand 2020;(18 December). https://www.rnz.co.nz/news/national/433132/govt-to-pump-almost-3-billion-into-its-covid-19-response-after-report-identified-failings.
  22. Quinn R. Covid-infected nurse ‘did everything right’, report finds. Radio NZ 2020;(6 November). https://www.rnz.co.nz/news/national/429973/covid-infected-nurse-did-everything-right-report-finds.
  23. Canterbury District Health Board. International Mariners Quarantine: Summary of official information request (page updated 22 January 2021). https://www.cdhb.health.nz/about-us/document-library/international-mariners-quarantine/.
  24. Grout L, Summers J, Kvalsvig A, Baker M, Wilson N. To ensure success of the trans-Tasman travel “green zone”, we need to reduce system failures at the NZ border. Public Health Expert. 2021;(30 March). https://blogs.otago.ac.nz/pubhealthexpert/to-ensure-success-of-the-trans-tasman-travel-green-zone-we-need-to-reduce-system-failures-at-the-nz-border/
  25. Williams K. Health Ministry’s ‘rubbish bin spread Covid’ theory not likely – health expert. Stuff 2020;(8 October). https://www.stuff.co.nz/national/health/coronavirus/123019917/health-ministrys-rubbish-bin-spread-covid-theory-not-likely–health-expert.
  26. Eichler N, Thornley C, Swadi T, Devine T, McElnay C, Sherwood J, Brunton C, Williamson F, Freeman J, Berger S, Ren X, Storey M, de Ligt J, Geoghegan JL. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa). Emerg Infect Dis 2021;27:1274-78.
  27. Gluckman P, Bardsley A. The Future Is Now: Implications of COVID-19 for New Zealand – A Koi Tū discussion paper. Auckland: Koi Tū, 2021. https://informedfutures.org/the-future-is-now/.
  28. Boyd M, Baker MG, Wilson N. Border closure for island nations? Analysis of pandemic and bioweapon-related threats suggests some scenarios warrant drastic action. Aust N Z J Public Health 2020;44:89-91.

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2 thoughts on “Improving NZ Government Communication about COVID-19: Five Suggestions Including a Proposal for Depoliticisation

  1. Thank you for this interesting blog. It is possible that the term “failure” is inappropriate if we truly want to develop a culture of continuous quality improvement. “Failure” is a negative term and is often associated with blame. It reinforces the belief that the system will get better by removing the bad apples. Becoming aware of these so-called failures is actually a good thing. They provide valuable information on which we can improve a complex and evolving system. I recommend that we stop talking about failures.

  2. Thanks for this feedback Jonathan. Some of us have had repeated discussions about the appropriate wording to use – but still think in the context of a multi-layered border control system that is specifically designed to keep the pandemic virus out of the NZ community, the words “border failure” or more preferably “border system failure” are still the best. Here are some thoughts on the alternative words that could be used:

    “Event”: This is a relatively neutral word and would seem appropriate in some natural disaster situations. Eg, earthquakes in NZ might be considered “events” as there is no system that is capable of preventing them. Nevertheless, there are often aspects of what might be considered associated “system failures” (eg, poorly designed buildings where the lessons from past earthquakes causing deaths in NZ have not been learnt – as we discuss in this article: https://www.nature.com/articles/s41598-019-41432-6).

    “Incursion”: This is a word in an infectious disease context that might be appropriate in some situations but which doesn’t clearly imply if any “barrier” exists or if it is a natural or human-designed barrier. Nevertheless, this could have been the best word to use at the start of the pandemic when NZ had no significant border controls in place. But this word seems far too neutral when an extensive border control system is designed to prevent the virus entering NZ or Australia as exists now. Eg, it would seem highly problematic to describe the hotel quarantine mistakes in Victoria that resulted in an outbreak with 800 deaths, as being from an “incursion”. Indeed, Australian authorities treated it as a system failure and had a major inquiry with many changes in quarantine processes.

    “Breach” or “leakage”: These words have the advantage of implying that a barrier is in place, but it doesn’t imply if such a barrier might be natural or human-designed. It also doesn’t fit with describing some types of problems that could be relevant to the border control of Covid eg, the problem of not adequately reducing incoming flights from red zone countries, the problems with adequate pre-flight testing, problems with the design of MIQ facilities, and problems with inadequate testing of border workers etc.

    “Border failure” or preferably “Border system failure”: These seem the best wording to cover the situations in Australia and NZ where despite extensive border control systems being in place, there still ends up being occurrences of community transmission or at least returnees released from MIQ facilities who are still infectious (as we detail in this pre-print: https://www.medrxiv.org/content/10.1101/2021.02.17.21251946v3). The inclusion of the word “system” can help ensure focus on the design and implementation of the system and should focus attention on the need to upgrade the system (and not to blame individual workers in the system). Politicians and officials who design and manage the border system need to be able to admit that the system has failed when this has happened – but in the same breadth to say that as part of continuous quality improvement it will be thoroughly investigated and addressed. A near zero failure rate with border control for Covid can be observed with a place like Taiwan which has had around 270,000 returnees since the pandemic started and no major outbreaks or lockdowns (https://www.nytimes.com/2021/03/13/world/asia/taiwan-covid.html).

    “Catastrophic system failures”: This may or may not be appropriate term for Covid in various parts of the world – but it might well have been for the failure to keep pandemic influenza out of Samoa in 1918 – given the subsequent death of around a quarter of the whole population. In contrast the maritime quarantine in neighbouring American Samoa was a completely successful system with no deaths occurring. Fortunately NZ has accepted this as a failure of the NZ authorities at the time – and a NZ Prime Minister (Helen Clark) apologised to Samoa for this (https://www.nzherald.co.nz/nz/full-text-helen-clarks-apology-to-samoa/65TV2LDV6S7HHIYRDCFSC5YOZI/). In the “potentially catastrophic system failure” category might be the most reckless breach of quarantine protocols ever, when NASA broke the rules around preventing potential alien microbes reaching earth via astronauts returning from the moon (https://www.bbc.com/future/article/20210217-the-moments-that-we-could-have-destroyed-humanity). On this occasion helping astronauts who were hot and uncomfortable in their space craft seemed to be considered by NASA to be more important than avoiding a potential existential risk to all humanity.

    Obscure failure terms: As a final note it is interesting to see the elaborate lengths the some organisations go to so as to avoid talking about system failures. Eg, the US military uses the phrase “Broken Arrow” for an accidental nuclear event involving nuclear weapons, warheads, or components which does not create the risk of mass death (https://en.wikipedia.org/wiki/United_States_military_nuclear_incident_terminology#Broken_Arrowps://en.wikipedia.org/wiki/Broken_Arrow). Similarly, “Empty Quiver” refers to the “seizure, theft, or loss of a functioning nuclear weapon”.

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