Aide-Mémoire
Cabinet Papers: Updates on the COVID-19 Vaccine Strategy and
Released
Immunisation Strategy and Programme and Support for Pacific Access and
Roll-out
Date due to MO: 26 November
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
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☐ Withdrawn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
Update on the COVID-19 Immunisation Strategy and Programme and
Support for Pacific Access and Roll-out
Released
Date:
26 November 2020
To:
Hon Andrew Little, Minister of Health
Hon Chris Hipkins, Minister for COVID-19 Response
Hon Dr Ayesha Verral , Associate Minister of Health
Security level:
IN CONFIDENCE
Health Report number: 20202009
under the Official Information Act 1982
Details of Meeting
2 December 2020
Cabinet Committee
Cabinet Business Committee
Purpose of Meeting/ This note provides you with information and advice in advance of Cabinet’s
Proposal
consideration of three Cabinet Papers on the COVID-19 response:
•
COVID-19 Vaccine Strategy: Update on Vaccine Purchasing (Vaccine
Strategy paper), brought by the Minister of Research, Science and
Innovation, the Minister for COVID-19 Recovery, the Minister of
Health, and the Minister of Foreign Affairs.
•
Update on the COVID-19 Immunisation Strategy and Programme
(Immunisation Strategy paper), your paper.
•
Support for Pacific and Global Vaccine Access and Rol -out (Pacific
Access paper), from the Minister of Foreign Affairs.
The
Vaccine Strategy paper provides an update on the COVID-19 Vaccine
Strategy, current purchasing, and projected expenditure. In August,
Cabinet established a $600 mil ion contingency to cover initial costs of
vaccine purchases, therapeutics and the immunisation programme [CAB-
20-MIN-0382 refers]. Cost estimates have been revised and Cabinet is now
being asked to approve the appropriation of the remaining $277.85 mil ion
of the tagged contingency into a new multi-category appropriation, plus
additional new funds of $450m for vaccine purchasing and $357m for the
Immunisation Programme. This funding wil enable us to build our portfolio
of vaccines and support delivery of a COVID-19 immunisation programme.
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
information about a draft 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
Pacific Access paper seeks approval for a multi-year funding envelope
of up to $75m to support Pacific and other developing countries to access
Released
and rol -out COVID-19 vaccines. This amount wil be reprioritised within
Vote Official Development Assistance.
These papers are being considered together because they are linked –
the Vaccine Strategy is about ensuring we can purchase the right vaccines
and the Immunisation Strategy and Programme 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 paper seeks
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to put in place mechanisms to support Pacific countries to access and
distribute COVID-19 vaccines.
Talking points
Introduction: Overview
• This Government is committed to both the health response to
COVID-19 and the economic recovery from its wide-reaching
impacts. The purchase and distribution of COVID 19 vaccines in
New Zealand and the Pacific is a key part of our work to achieve
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.
• This is why Cabinet agreed the COVID-19 Vaccine Strategy in May
2020. The objective of the Vaccine Strategy is to
ensure access for
New Zealand to a safe and effective vaccine in order to implement
our preferred immunisation strategy at the earliest possible time.
• A tagged contingency of $600m was established in August 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, including significant
financial decisions.
The Vaccine Strategy Paper
• We have been proactive in ensuring that we wil be able to access
vaccines, even in an environment of global competition. Our
current approach is to spread our risk by entering into a range of
different agreements to pre-purchase vaccines. This “portfolio
approach” was approved by Cabinet in August.
• COVID-19 vaccine purchasing and the Immunisation Programme
consumables and administration are funded through a common
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tagged contingency set up in August. This contingency was
intended to cover advance purchases of vaccines over the election
and government formation period.
• Since August we have further developed our portfolio approach
and purchasing pathways, including entering into Advance
Released
Purchasing Agreements with vaccine developers. We have also
done significant work to more ful y understood the likely nature
and scale of any COVID-19 Immunisation Programme, which wil
likely be the largest and most complex immunisation campaign
ever undertaken here. Costs have become clearer and we need to
make new decisions.
• The Minister of Finance has agreed to the establishment of a new
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multi-category appropriation (MCA) cal ed “Implementing the
COVID-19 Vaccine Strategy”. The Vaccine Strategy paper seeks to
appropriate the remaining $277.85 mil ion of the tagged
contingency into the MCA, plus new funds of $450m for vaccine
purchasing and $357m for the Immunisation Programme.
The Immunisation Strategy Paper
• The Immunisation Strategy paper outlines progress on our
strategy for COVID-19 immunisation and gives assurance that we
can successful deliver the largest immunisation programme in
New Zealand, learning from previous immunisation experience.
• A safe and effective vaccine provides the best opportunity to
protect individuals from COVID-19. Once enough individuals are
immune, the virus wil be unable to spread through the
community. In this way a vaccine can support both the health and
the economic response to COVID-19.
• The COVID-19 Immunisation Strategy is being developed in
paral el with vaccine procurement and is evolving rapidly. The
COVID-19 Immunisation Programme is supported by strong
governance arrangements.
• We have learnt from previous immunisation experience, especial y
the 2020 Influenza Immunisation Campaign. A National
Immunisation Solution is under development that wil give us
accurate, real-time information about who has received the
vaccine.
• The Immunisation Programme wil uphold and honour Te Tiriti o
Waitangi obligations, through our governance arrangements and
strong community partnerships, and by leveraging off the
Updated COVID-19 Māori Health Response Plan.
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• We may need to sequence access to the vaccine if we do not have
sufficient doses to make it available to everyone immediately. An
approach is proposed, based on relative 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.
Released
• At present there are no approved vaccines for COVID-19. Al
those we are purchasing are stil in development and although
promising, may not turn out to be safe and effective. This means
that not every vaccine we are purchasing now wil be eventual y
deployed. Decisions on which wil be used wil be made against a
decision-making framework that is to be developed. My paper
proposes a report-back on this work early next year.
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• We wil be supporting vaccine access for the Pacific, and this is
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.
• Implementation timeframes are stil uncertain, as this is
dependent on when a vaccine is ready for use, but we are
ensuring that we are ready for many eventualities. We are actively
managing a number of risks, and developing clear and effective
communications.
• Financial implications of the Immunisation Programme are
considered in the Vaccine Strategy paper.
Pacific Access paper
• Minister Mahuta’s paper seeks agreement to reprioritise $75m 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. This wil ensure that we
can support a safe, stable and resilient Pacific where our interests
and influence are safeguarded.
• I recommend that you 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.
Our advice
Background to the three Cabinet papers
Cabinet agreed the COVID-19 Vaccine Strategy in May 2020 [CAB-20-MIN-
0229.01 refers]. The objective of the Vaccine Strategy is to
ensure access for
New Zealand to a safe and effective vaccine in order to implement our
preferred immunisation strategy at the earliest possible time.
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In August 2020 Cabinet agreed to a purchasing and funding strategy for
COVID-19 vaccines [CAB-20-MIN-0382 refers]. The key approach
approved was the “portfolio approach” whereby we wil seek to purchase
vaccines from a range of technology platforms and developers with
different delivery timetables in order to maximise the likelihood we wil
have access to a safe and effective vaccine as early as possible.
Released
At this time Cabinet invited report-backs in November 2020 on
expenditure and commitments against the tagged contingency and any
new relevant information about likely future expenditure and the
development of an immunisation strategy, including a prioritisation
framework. The Vaccine and Immunisation Strategy papers being
considered at this Committee meeting respond to this report-back.
Vaccine Strategy Paper (Joint Ministers, being led by Minister Woods)
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We have worked closely with the Ministry of Business Innovation and
Employment (MBIE) on their preparation of this paper and endorse its
contents.
Immunisation Strategy Paper (Joint Ministers, being led by Minister Little)
The Ministry of Health led the preparation of this paper and have worked
closely with MBIE and the Ministry of Foreign Affairs and Trade to ensure
alignment between the three papers. on the development of these papers.
Financial recommendations
The initial contingency was established to cover only initial purchases,
particularly during the election and government formation period.
New funding is being sought for vaccine purchasing now because the
remainder of the tagged contingency wil not cover deals for vaccines
currently being negotiated. The cost of this could be that we have
insufficient volumes of vaccines or lack choices about which vaccines to
deploy, and this results in it taking longer to safely reach the point at which
our other public health controls (eg. border settings) can be adjusted.
In addition, cost estimates have also been adjusted upwards for the
Immunisation Programme to December 2021, based on more detailed
analysis and model ing. Additional funding for the Immunisation
Programme may be required after that, depending on how the current
unknowns resolve, for example, around vaccine characteristics which effect
implementation such as course length, the length of immunity conferred,
and storage requirements.
Pacific Access Paper (Minister Mahuta is responsible Minister)
The Ministry of Health provided feedback on Minister Mahuta’s paper and
we support its recommendations as an appropriate way to address the
presenting issues.
We note that 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
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factor in decisions on quantities of the different vaccine candidates for
advance purchase. Further assessment, undertaken in discussion with
Pacific countries, the World Health Organization and others, wil occur as
more detailed information becomes available. This further assessment wil
cover such matters as regulation, monitoring and adverse event
surveil ance for New Zealand-supplied vaccine, and how suppliers wil be
Released
indemnified, as wel as risk assessment for immunisation programmes.
The Ministry is in regular communication with the six Polynesian Health
Corridors countries whose health systems have close ties with New
Zealand’s health system. These conversations have helped to support the
COVID-19 health response, including preparation for vaccines, and wil also
help inform suitability assessment. This does not imply that it wil take
longer than suitability assessment for New Zealand – the intention is to be
able to offer vaccines equitably to Pacific countries, at similar times to New
under the Official Information Act 1982
Zealand communities. However, some particular assurances wil be needed
for safe delivery to Pacific populations.
Ashley Bloomfield
Director-General of Health
Ministry of Health
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Appendix: Cabinet Papers - Background Information and Summaries
COVID 19 Vaccine Strategy: Update on vaccine purchasing
Background
In May 2020, Cabinet agreed the COVID-19 Vaccine Strategy [CAB-20-MIN-0229.01 refers]. The
objective of th
Released e strategy is to ensure access for New Zealand to a safe and effective vaccine, in order
to implement our preferred immunisation strategy at the earliest possible time and contribute to a
range of health, economic and other outcomes. Vaccines wil be in high demand and supply limited.
Purchasing
Our strategic approach to achieving these goals has been to enter into a range of purchasing
agreements for vaccines that are currently under development, through two major pathways: Advance
Purchase Agreements direct with manufacturers and participation in the COVAX Facility1. We need safe
and effective COVID-19 vaccines that can sustain a wide-reaching immunisation programme, and the
under the Official Information Act 1982
portfolio approach spreads our risk. Al vaccine candidates are stil in development and may not turn
out to be safe and effective, and there is stil uncertainty about the duration of immunity that may be
conferred by COVID-19 vaccines.
Negotiations for the vaccine portfolio are expected to be completed in coming months. An additional
approximately $450m is required to purchase the appropriate core portfolio.
The Minister of Finance has agreed a new multi-category appropriation (MCA) be set up, and the paper
seeks to appropriate the remaining $277.85 mil ion of the tagged contingency into the MCA, plus
additional new funds of $450m for vaccine purchasing and $357m for the Immunisation Programme.
The tabled Vaccine Strategy paper provides detailed financial implications.
Update on the COVID 19 Immunisation Strategy and Programme
Purpose
This paper provides an update on progress on our strategy for COVID-19 immunisation and gives
assurance we can successfully deliver the largest immunisation programme in New Zealand to date,
learning from previous experience, particularly the 2020 Influenza Immunisation Campaign.
Background
This Government has two key overarching priorities regarding COVID-19: to continue the health
response to keep New Zealanders safe from the virus; and to drive the economic recovery. The COVID-
19 Immunisation Strategy wil support the health response and the Elimination Strategy by enabling
the best use of any approved vaccines, while upholding and honouring Te Tiriti o Waitangi obligations
and promoting equity. Over time, this could support the economic response to COVID-19 as wel . This
can be achieved because COVID-19 vaccines wil offer individual protection to at-risk individuals
initial y and, over time, some form of population immunity can be achieved as more people are
immunised. Other public health measures wil continue to be an important part of New Zealand’s
approach to managing the risks associated with COVID-19.
1 The Facility is a multilateral initiative to ensure fair and equitable access to COVID-19 vaccines for countries across the
world, administered by GAVI, the Vaccine Al iance.
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Progress on a COVID-19 Immunisation Programme
Key workstreams include sequencing and defining populations to ensure the right people get access
to the right vaccine at the right time; workforce planning; distribution and inventory management; and
post-market monitoring. This wil help us achieve the purpose of the Immunisation Strategy, which is
to make best use of any vaccines. The COVID-19 Immunisation Strategy wil honour and uphold Te
Tiriti o Waitangi obligations through several mechanisms, including governance, community
Released
partnerships, and by linking to the COVID-19 Māori Health Response Plan.
A robust information col ection and monitoring platform is essential for the safe and effective operation
of an immunisation campaign of this scale and scope. The National Immunisation Solution (NIS) is
under development as a replacement for the current National Immunisation Register. It wil enable us
to have accurate real time information about who has received the vaccine. Funding for the NIS has
been al ocated and work is progressing at pace, with preparations underway in case COVID-19 vaccines
arrive earlier than expected. An interim solution wil be complete by January 2021 and wil remain
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available for use until a minimum viable product is finalised by March 2021.
Sequencing access to a vaccine
The Immunisation Strategy paper also includes initial advice about the proposed approach to
sequencing vaccine al ocation. This wil be needed if we do not have sufficient doses to make a vaccine
available to everyone immediately. The proposed approach wil ensure that the right people are
vaccinated at the right time with the right vaccine while upholding and honouring Te Tiriti o Waitangi
obligations. A methodology, principles and criteria are attached, which wil support appropriate
sequencing in three epidemiological scenarios: low/no transmission, control ed outbreaks and widespread
transmission.
Access for the Pacific
We wil also ensure that Realm countries (Tokelau, the Cook Islands, and Niue) have access to a vaccine,
and wil support other Pacific countries (Sāmoa, Tonga and Tuvalu) to rol out successful immunisation
programmes.
Implementation and risks
Timeframes are uncertain because of the uncertainties around when safe and effective vaccines wil be
available. We are managing key main risks around supply chain; public perceptions of the vaccine;
workforce; adverse health reactions; and new IT platforms in tight timeframes.
Financial implications
We estimate that the Immunisation Programme wil cost $423.28m to December 2021. The Vaccine
Strategy paper discusses the financial considerations including setting out how much of the funding
made available initial y remains, and how much new funding is required. It is proposed that al funding
be appropriated into a new multi-category appropriation cal ed “Implementing the COVID-19 Vaccine
Strategy”, within Vote Health.
Supporting the Pacific and Global Vaccine Access and Roll-Out
Background
Most Pacific nations have managed the risk of introducing COVID-19 exceptional y well but the strict
border controls needed for this approach have inflicted severe economic damage particularly to
tourism industries. Resultant unemployment and other social issues are on the rise. New Zealand wants
to ensure early access to vaccines, in alignment with New Zealand’s timing if possible, with full
population coverage. Supporting Pacific access to a COVID-19 vaccine and Pacific immunisation efforts
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are key objectives of the Vaccine Strategy. We have already taken steps toward this goal through our
purchasing approach but we need to pursue multiple pathways to ensure Pacific access to a safe and
effective vaccine. We also want to be able to reassure Pacific nations that they wil not fal to the “back
of the queue”, and do not need to consider sourcing unproven vaccines in an attempt to ameliorate
the massive economic losses that they have incurred as a result of the pandemic.
Thus far we have contributed to the COVAX Advance Market Commitment (AMC), a global multilateral
Released
arrangement to pool resources to access a range of vaccine candidates, to support access for
developing countries including Pacific nations. We have advocated for the eligibility criteria of the
COVAX AMC be expanded to include most Pacific nations, and included the Realm’s population in New
Zealand’s population for the purposes of COVAX al ocations. We are working with regional agencies
and partners through the World Health Organisation-led Joint Incident Management Team (JIMT), and
preparing to implement a pandemic support package through the Health Corridors Programme.
Proposals
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We need to be able to be adaptable and responsive as the situation changes. A flexible, multi-year
envelope of $75m is proposed to be reprioritised from Vote Overseas Development Assistance. This
wil be al ocated to several initiative including to the COVAX AMC and the WHO-JIMT and the Pacific
Health Corridors Pandemic Preparedness Programme (to prepare for rol -out). We are also retaining
the option to purchase up to 360,000 additional doses of at least one suitable vaccine candidate for
Polynesia. This may cost between $6 and $25m. A public announcement wil be made in the coming
weeks.
Existing delegations wil apply to initiatives that seek to use this funding, and any initiatives over $25m
wil require approval of the Ministers of Foreign Affairs and Finance jointly.
Ministry of Health role
The paper also proposes a role for the Ministry of Health to approve the suitability of any vaccine for
the Pacific. For example, Medsafe approval of vaccines may be conditional, such as requiring enhanced
adverse event monitoring and surveil ance since these are very new vaccines. Suitability assessment
wil include preparedness for use, monitoring and surveil ance, workforce training and support, and
other factors.
Indemnity
Pharmaceutical companies are requiring recipient countries to indemnify them against product liability
claims. Officials are exploring the best way of handling this, which could involve establishing “back to
back” arrangements for Pacific recipient countries to take on some or al of their indemnity. This issue
needs to be resolved as if it is not there is a risk that we wil not be able to pass vaccine doses on to
the Pacific.
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