Aide-Mémoire
Cabinet  Papers:  Update  on  the  COVID-19  Immunisation  Strategy  and
Released
Programme,  COVID-19  Vaccine  Strategy:  Update  on  Vaccine  Purchasing
and Support for Pacific and Global Vaccine Access and Roll-out

Date due to MO:  3 December 2020
Action required by:
N/A
Security level:
IN CONFIDENCE
Health Report number:  20202009
under the Official Information Act 1982
To:
Hon Andrew Little, Minister of Health
Copy to
Hon Chris Hipkins, Minister for COVID-19 Response
Hon Dr Ayesha Verral , Associate Minister of Health

Contact for telephone discussion
Name
Position
Telephone
Dr Ashley Bloomfield
Director-General of Health
9(2)(a)

Maree Roberts
Deputy Director-General, System Strategy  9(2)(a)

and Policy

Minister’s office to complete:
☐ Approved
☐ Decline
☐ Noted

☐ Needs change
☐ Seen
☐ Overtaken by events
☐ See Minister’s Notes
☐ Withdrawn

Comment:

Aide-Mémoire
Cabinet  Papers:  Update  on  the  COVID-19  Immunisation  Strategy  and
Programme,  COVID-19  Vaccine  Strategy:  Update  on  Vaccine  Purchasing
and Suppor
Released  t for Pacific and Global Vaccine Access and Roll-out
Date:
3 December 2020

To:
Hon Andrew Little, Minister of Health
Cc:
Hon Chris Hipkins, Minister for COVID-19 Response
Hon Dr Ayesha Verral , Associate Minister of Health
under the Official Information Act 1982
Security level:
IN CONFIDENCE
Health Report number:  20202009
Details of Meeting
7 December 2020
Cabinet Committee
Cabinet
Purpose of Proposal  This note provides you with information and advice in advance of Cabinet’s
consideration of three Cabinet Papers on the COVID-19 response:
•  Update  on  the  COVID-19  Immunisation  Strategy  and  Programme
(“Immunisation Strategy paper”), your paper together with Minister
for COVID-19 Recovery and the Associate Minister of Health.
•  COVID-19  Vaccine  Strategy:  Update  on  Vaccine  Purchasing
(“Vaccine  Strategy  paper”),  brought  by  the  Minister  of  Research,
Science and Innovation, Minister for COVID-19 Recovery, Minister
of Health, and the Minister of Foreign Affairs.
•  Support for Pacific and Global Vaccine Access and Rol -out (“Pacific
Access paper”), from the Minister of Foreign Affairs.
The Immunisation Strategy paper outlines progress on New Zealand’s
strategy  for  COVID-19  immunisation  and  gives  assurance  that  we  can
successfully deliver the largest immunisation programme in New Zealand
to date, learning from previous immunisation experience. It also provides
anticipated  delivery  schedules  and  information  about  a  Sequencing
Framework  for  use  if  there  are  not  enough  vaccine  doses  available  to
vaccinate everyone who wants it immediately. This is likely to be the case
during the early phases of delivery.
The paper seeks Cabinet agreement to increased stakeholder engagement,
a  Decision  to  Use  Framework,  agreement  in  principle  to  a  Sequencing
Framework, and agreement for the COVID-19 vaccines to be free to the
New Zealand population.
Updated modelling estimates COVID-19 Immunisation Programme costs
of  $423.28  mil ion  to  December  2021,  with  $66.3  mil ion  already  drawn
down  from  the  Minimising  the  Health  Impacts  of  COVID-19  –  Tagged

Operating Contingency. The Vaccine Strategy paper seeks to appropriate
the outstanding $357 mil ion.
The Vaccine Strategy paper provides an update on the COVID-19 vaccine
purchasing approach, current purchasing, and projected expenditure.  In
August  2020,  Cabinet  established  a  $600  mil ion  contingency  to  cover
initial costs of vaccine purchases and the immunisation programme [CAB-
Released
20-MIN-0382 refers]. Cost estimates have been revised and Cabinet is now
being asked to increase the existing tagged contingency by $450 mil ion
for vaccine purchasing and to appropriate an additional $357 mil ion to
support the Immunisation Programme.
The Pacific Access paper seeks approval for a multi-year funding envelope
of up to $75 mil ion to support Pacific and other developing countries to
access and rol -out COVID-19 vaccines. This amount wil  be reprioritised
under the Official Information Act 1982
within Vote Official Development Assistance.
These papers are being considered together because they are linked –
the Vaccine Strategy paper is about ensuring we can purchase the right
vaccines and the Immunisation Strategy paper is about ensuring we can
successfully deliver any safe and effective vaccines we purchase. Both are
essential to our recovery from the COVID-19 pandemic. The Pacific
Access paper seeks to put in place mechanisms to support Pacific
countries to access and distribute COVID-19 vaccines.
Talking points
Introduction: Overview of the three papers
•  This Government is committed to both the health response to
COVID-19 and the economic recovery from its impacts.
•  The purchase and distribution of COVID 19 vaccines in New
Zealand and the Pacific is a key part of achieving these aims.
•  A vaccine could mean that we can start moving towards a future
where COVID-19 is a managed disease that our health and
economic systems can accommodate.
•  A tagged contingency of $600m was established in August 2020
to fund the initial purchases of vaccines and consumables
required for the Immunisation Programme. At that time, it was
noted that total costs would eventual y be higher than this.
•  These three papers represent the next set of decisions we need to
take to implement our agreed approach to purchasing and
distributing COVID-19 vaccines, including significant financial
decisions.
•  I  support  the  recommendations  in  these  three  papers.  Together,
they represent our best efforts to understand, quantify and respond
appropriately to the variety of risks and benefits associated with
accessing  a  safe,  effective  vaccine  for  COVID-19  as  soon  as
possible.

Health Report: 20202009
2

The Immunisation Strategy Paper
•  The Immunisation Strategy paper outlines progress on our
strategy and COVID-19 Immunisation Programme and gives
assurance that the government can successfully deliver the largest
immunisation programme in New Zealand, learning from previous
Released
immunisation experience.
•  The COVID-19 Immunisation Strategy and Programme is being
developed in paral el with vaccine procurement and is evolving
rapidly.
•  Preparations are underway so that the COVID-19 Immunisation
Programme can be ready to be implemented from March 2021.
•  Being “ready to implement” includes having in place a trained
under the Official Information Act 1982
vaccinator workforce, consumables and infrastructure, inventory
management and distribution systems, and services to deliver the
vaccines.
•  The COVID-19 Immunisation Strategy is underpinned by Te Tiriti o
Waitangi and the Elimination Strategy principles of equity and
wellbeing.
•  Robust governance structures are in place and include external
advisory groups, with strong Māori and Pacific provider
representation, as well as senior leadership groups within the
Ministry of Health.
•  The aim of the COVID-19 Immunisation Programme is to make
best use of any vaccines. Factors that contribute to “best use” of
the COVID-19 vaccines that wil  be available include:
o  ensuring that the right infrastructure is in place to store
and distribute COVID-19 vaccines efficiently
o  using the proposed Decision to Use Framework (to be
developed) and Sequencing Framework (for which
agreement is being sought in principle) to use any vaccine
to:
▪  respond to the key risks based on the transmission
or epidemiological scenario
▪  promote equitable outcomes by protecting Māori,
Pacific peoples, older people, disabled people and
other population groups at particular risk of the
negative health impacts of COVID-19.
▪  maximise value, by getting the most from the
resources available
o  encouraging uptake in order to achieve population
immunity. For example, through a communications

Health Report: 20202009
3

campaign and designing delivery mechanisms that wil  be
responsive to different groups
•   The COVID-19 Immunisation Programme is comprehensive and
includes:
o  a communications and engagement strategy to deliver key
Released
messages to encourage vaccine uptake and build
confidence in the COVID-19 Immunisation Programme
and the immunisation system more broadly
o  distribution, inventory management and immunisation
scheduling
o  post-market monitoring of uptake to enable the Ministry
of Health to adapt its approach as it learns more
under the Official Information Act 1982
•  The Ministry of Health has learnt from previous immunisation
experiences and is making a variety of changes and improvements
to ensure the COVID-19 Immunisation Programme is a success.
Already, significant changes to the immunisation system are being
implemented to enable the successful delivery of the COVID-19
Immunisation Programme, such as the development of
o  an inventory management system for COVID-19 vaccines
to ensure the Ministry of Health has accurate information
about where vaccines are located, and
o  the National Immunisation Solution that wil  give us
accurate, real-time information about who has received
the vaccine.
•  The COVID-19 Immunisation Programme wil  uphold and honour
Te Tiriti o Waitangi in a variety of ways, including through:
o  robust governance that includes external advisory groups
with strong Māori and Pacific provider representation as
well as senior leadership groups within the Ministry of
Health
o  partnering with Māori communities and organisations
including Māori health providers
o  leveraging off the recent success of the Updated COVID-
19 Māori Health Response Plan.
•  The Ministry of Health has work underway to ensure that service
design responds to the needs of al  New Zealanders, including
groups that the system has historical y failed.
•  There is also work underway to identify trusted spokespeople to
ensure the messages about the benefits of receiving a COVID-19
vaccine are well understood by the community.
•  We are also using the COVID-19 Immunisation Programme as an
opportunity to create a legacy and make meaningful

Health Report: 20202009
4

improvements to the immunisation system, which wil  have long-
term public health benefits.
•  We may need to sequence access to the vaccine if we do not have
sufficient courses to make it available to everyone immediately.
•  This paper proposes a sequencing approach, based on relative
Released
risks of different cohorts in different transmission scenarios, that
wil  ensure that the right people are vaccinated at the right time
with the right vaccine.
•  The Sequencing Framework wil  be a living document that wil  be
updated as information and evidence evolves. It identifies
characteristics that, depending on the transmission scenario,
could be used to prioritise different groups:
under the Official Information Act 1982
o  in a low or no transmission scenario, the objective is to
prevent transmission so groups like the border workforce
would likely be among the first to be immunised.
o  in a control ed outbreak, the objective is to reduce
transmission and protect people closely connected to the
outbreak, so close contacts would be among the first to be
immunised.
o  in a scenario where we have widespread transmission, the
objective is to protect those most vulnerable to negative
health outcomes, so groups such as older people would
be among the first immunised.
•  At present there are no vaccines approved for use in New Zealand
against COVID-19. Al  those we are purchasing are stil  in
development and although promising, stil  need to meet our
regulatory requirements for safety and effectiveness before they
wil  be used in our COVID-19 Immunisation Programme.
•  Decisions on which wil  be used wil  be made against a Decision to
Use Framework that is to be developed. I wil  report back on this
work early next year.
•  It is important to note New Zealand wil  be supporting vaccine
access for the Pacific, as discussed in Minister Mahuta’s
accompanying paper.
•  The Ministry of Health wil  work with Pacific governments on their
immunisation planning, but Pacific governments wil  make final
decisions.
•  Decisions on the funding for the Immunisation Programme are
considered through the Vaccine Strategy paper. My paper notes
that the costs of the COVID-19 Immunisation Programme to 31
December 2021 are expected to be $423.280 mil ion, of which
$66.3 mil ion has been drawn down already.

Health Report: 20202009
5

•  In the Prime Minister’s Speech from the Throne, she noted that
the COVID-19 vaccine would be free. This paper seeks formal
Cabinet agreement to that position.
•  Stakeholder engagement on the COVID-19 Immunisation
Programme is already underway and, subject to your agreement,
Released
wil  intensify once Cabinet has considered my proposals.
•  I have asked officials to provide further advice on eligibility, the
approach to any co-payments and other related matters in early
2021.
Talking points to
The Vaccine Strategy Paper
support papers led
(Brought by the Minister of Research, Science and Innovation, Minister for
by other Ministers
COVID-19 Recovery, Minister of Health, and the Minister of Foreign
under the Official Information Act 1982
Affairs.)
•  COVID-19 vaccine purchasing and the Immunisation Programme
are funded through a common tagged contingency set up in
August 2020.
•  This contingency was intended to cover advance purchases of
vaccines and preparing for immunisation over the election and
government formation period.
•  Since August, the Government has further developed its portfolio
approach and purchasing pathways, including entering into
Advance Purchasing Agreements with vaccine developers.
•  There has also been significant work to more ful y understand the
likely nature and scale of any COVID-19 Immunisation
Programme, which wil  likely be the largest immunisation
campaign ever undertaken. Costs have become clearer and we
need to make new decisions.
•  The Minister of Finance has agreed to the establishment of a new
multi-category appropriation (MCA) cal ed “Implementing the
COVID-19 Vaccine Strategy”. The Vaccine Strategy paper seeks
Cabinet agreement to:
o  increase the tagged contingency by $450 mil ion for
vaccine purchasing, and
o  appropriate $357 mil ion for the Immunisation Programme
into the new MCA.
Pacific Access paper
(Brought by the Minister of Foreign Affairs)
•  Minister Mahuta’s paper seeks agreement to reprioritise $75
mil ion of existing funding within Vote Overseas Development
Assistance to support Pacific vaccine access and immunisation
efforts, with a primary focus on Polynesia and the Realm.

Health Report: 20202009
6

•  The paper seeks Cabinet agreement to the Ministry of Health
conducting an assessment on any New Zealand-sourced vaccines
to ensure they are suitable for use in the Pacific.
•  Preliminary assessment of suitability for the Pacific (such as
amenable storage conditions) has been a factor in decisions on
Released
quantities of the different vaccine candidates for advance
purchase.
•  Further assessment, undertaken in discussion with Pacific
countries, the World Health Organisation and others, wil  occur as
more detailed information becomes available. This further
assessment wil  cover such matters as regulation, safe delivery,
monitoring and adverse event surveil ance for New Zealand-
under the Official Information Act 1982
supplied vaccine, and how suppliers wil  be indemnified, as well as
risk assessment for immunisation programmes.
•  I support the recommendations in this paper, as they wil  ensure
we can support a safe, stable and resilient Pacific where our
interests and influence are safeguarded.

Ashley Bloomfield
Director-General of Health
Ministry of Health

Health Report: 20202009
7

Document Outline