COVID-19: Elimination strategy for Aotearoa New Zealand

The Elimination Strategy, Aotearoa New Zealand’s sustained approach to keep it out, find it and stamp it out, is continually evolving to keep New Zealanders safe from COVID-19. This has become increasingly important as the country carefully engages more closely with the world.

The continuing role of the Elimination Strategy in New Zealand

New Zealand’s Elimination Strategy has maintained freedoms and a quality of life for New Zealanders in the face of COVID-19 that few other countries have enjoyed.

The vaccination programme is a critical element of building protection against the virus in the community and eventually of allowing safe reconnection with other countries. Reconnecting more fully with the world entails greater risk that the virus will enter New Zealand. While vaccination will help reduce the risk of incursions it won’t be enough in itself to protect all New Zealanders, as not everyone will be vaccinated.

To prevent widespread infections New Zealand will need to maintain some form of border controls and public health measures alongside high uptake of vaccination, to ensure that any outbreaks are swiftly contained even when the virus enters New Zealand. Our Elimination Strategy has proved its worth and remains an achievable goal even when current border restrictions are eased.

Vaccination of New Zealanders is increasingly expanding protection from COVID-19 primarily from our border defences, to using a combination of border settings, vaccination and public health measures to keep the public safe from COVID-19. As our domestic vaccination rollout progresses it will increase our layers of protection and will open up opportunities to change our border settings safely.

Our COVID-19 response has protected lives; as we start to reconnect, we will do so in a way that is consistent with the goals of our Elimination Strategy. This means continuing to keep New Zealanders safe from COVID-19 by stamping out new cases when they arise, but over time vaccination is likely to reduce our reliance on higher Alert Levels.

Since the previous version of the Elimination Strategy (May 2020), there have been a number of key shifts in our understanding of the virus and its impacts, including:

• the emergence of new variants of concern with higher transmissibility;
• new evidence about COVID-19 transmission;
• a complex and changeable global situation, including new waves of infection;
• experience from community outbreaks in New Zealand;
• rollout of vaccines in New Zealand and internationally;
• commencement of Quarantine Free Travel with selected partners; and
• emerging evidence around vaccine effectiveness against new variants of concern.

In response to these changes, the Elimination Strategy’s four pillars - border management, detection and surveillance, quarantine, and community support - have been updated to ensure the strategy remains fit for purpose. The revised four-pillar framework is described below.

Honouring Te Tiriti O Waitangi obligations and upholding equity principles continue to underpin the Elimination Strategy. This is to ensure that Māori, Pasifika, and other higher-risk communities or individuals are protected, and that the burden of combatting the virus and its impacts does not fall too heavily on certain communities or groupings.

Elimination Strategy: Health Response Pillars

Keep it out

Border settings and the managed isolation and quarantine system are key components of the “Keep It Out” element of the Elimination Strategy; designed to keep COVID-19 out of the New Zealand community and prevent onward transmission of COVID-19 from New Zealand to other countries (e.g. in the South Pacific) in the instance New Zealand were to have COVID-19 in the community.

As at August 2021, the Ministry uses the following border and managed isolation and quarantine settings:

• clear advice to people intending to travel to New Zealand;
• measures to manage the flow of people across the border (immigration settings and other rules, with special exemptions) and risk presented by individuals (via pre-departure testing and from very high-risk countries);
• measures to quarantine and isolate potential cases of COVID-19 at the border via mandatory managed isolation and quarantine (MIQ) facilities; with the exception of arrivals from countries with Quarantine-Free Travel arrangements with New Zealand;
• supporting measures at the border to protect higher-risk workers, through vaccination, infection prevention and mandatory testing requirements;
• core public health measures, including hand washing, face covering requirements and physical distancing.

Prepare for it

The success of stamping out previous outbreaks has helped to inform how we continue to ‘Prepare for It.’ The key risk we are attempting to mitigate within the ‘Prepare For It’ Pillar is undetected cases of COVID-19 in the community. The measures within this pillar centre on the Ministry’s surveillance strategy, testing plan, and the following baseline public health measures:

• testing anyone displaying symptoms and instructing them to stay at home;
• having the most sensitive detection systems that will identify cases early and minimise the risk of any further transmission, e.g. through rigorous record keeping to enable rapid contact tracing;
• baseline public health measures and encouragement of behaviours (Alert Level 1 measures) including use of the QR app serve to keep members of the public engaged in activities that support the COVID-19 response and to reduce and mitigate the risk of transmission of the disease in the community.
• Vaccination to build up the level of population protection and reduce the severity of illness.

Stamp It Out

The 'Stamp It Out’ Pillar encompasses contact tracing and case management to eliminate COVID-19 as quickly and efficiently as possible from the community, and the activation of higher Alert Levels to contain the spread of any incursion. The key components are:

• robust case detection and surveillance allows us to identify new cases quickly and take appropriate action;
• a rapid investigation is undertaken with a confirmed case to identify where a person caught the infection and whom they may have passed it on to;
• genomic analysis is undertaken to link cases and help identify potential epidemiological connections;
• tracing identified people or businesses who may have been in contact to inform them of their possible exposure (e.g. close contacts or casual contacts), ‘push’ notifications such as reminders for app users and Bluetooth-enabled users;
• publication of locations of interest;
• a public health assessment contributes to a decision whether to move to a higher Alert Level, and where;
• quarantine of contacts and isolation of cases and testing;
• As part of case and contact management, measures are put in place to check in regularly on health, wellbeing and provide any additional support for confirmed case(s) and their close and casual contacts.

Manage the Impact

The Ministry continues to review and build COVID-19 system readiness and capacity across the health and disability system, and to ensure Te Tiriti of Waitangi obligations and equity are maintained. In addition, the Ministry is committed to continuous improvement to strengthen preparedness and readiness.

Plans are in place to protect New Zealand against future outbreaks, acknowledging that:

• some areas continue to manage cases associated with the border;
• timing and spread remain uncertain. New community cases could be detected at any time;
• the overall size, steepness and duration of subsequent cases and clusters may be different from previous outbreaks, and may react differently with vaccines;
• the severity of the disease and the population groups affected may differ from what we have previously seen especially with different vaccination rates across the population; ongoing vigilance will be needed to detect and respond to any changes in severity or disproportionate impacts on affected population groups;
• some communities, including Maori and Pasifika, may pursue or require increased support for responses and ongoing management appropriate to their particular cultural and social – as well as health and vaccination – contexts.

In addition, the Ministry continues to look at new and emerging evidence around vaccine effectiveness to assess how this may play into reconnecting New Zealand with the world.

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