With COVID-19 vaccination comes more than a few challenges around funding, distribution and tracking.

And so with our experience on immunisation for kids, oldies and everyone in between, we’ve been giving some thought to the challenges that a NZ COVID-19 immunisation programme might face.

Funding a vaccine

In the normal course of developing a vaccine (or any new drug), the company involved will have incurred huge development costs, so the end price usually needs to include a fairly healthy margin to recoup those costs. However, in this COVID-19 era, vast amounts of public money have been thrown into the research and development ring, so the usual pricing models should be revisited.

And indeed, they are internationally. There’s a race going on to be first to market and there’s also a lot of cooperation going on between the usual rivals in the interests of beating this virus. Front runner for the European market is AstraZeneca, who have joined forces with the team at Oxford University with a promise of supplying Europe with 400 million doses at no profit. What’s even more promising is that AstraZeneca have made a deal with the Australian government to manufacture their vaccine in Australia, giving them the ability to supply it free to all Australian citizens. Let’s hope this kind of approach extends across the Tasman and that our government is on the front foot to do a similar deal for supply here in New Zealand.

It seems that people are on the same page globally, with many governments around the world making vast sums available ($2 billion in the US alone!). For us, the NZ government has provided $37 million for the development and distribution of a vaccine. PHARMAC has said it’s interested in direct deals with global players and in no fewer than eight local vaccine strategies, but perhaps all of the $37 million would be better spent on effective distribution of one of the global vaccines - the one being made available to Australians seems like a good call.

Our view: The signs are looking positive – but PHARMAC and vaccine manufacturers need to put aside past ways of working, and come together as Kiwis and make sure we get a vaccine, when we need it, at a fair price.

getting it to the people 

GPs, pharmacists or both? Traditionally vaccines have been distributed via a GP practice with patients being recalled, or coming in proactively off the back of a motivating promotion campaign.

The other way is a ‘mass’ vaccination programme, like which is done for the HPV immunisation programme, where high-school aged children are immunised by community nurses (60,000 children are immunised this way each year).

And this made us think. What are the other ‘mass’ activities we do every few years? One is voting. We go to schools and community halls, wait our turn and spend 5 minutes voting.

What if we combined the two and used the same voting organisation model, and married that up with the immunisation model, and did mass COVID-19 immunisations at voting places? Of course it is not so simple as voting, with a much higher skills base needed for immunisation, and requirements such as the 20 minute post vaccination wait times, but the structure is there.

Our view: Yes, it would require some impressive logistics but it could be a good place to start by using the two existing models for HPV and voting.

immunisation TRacking

Finally, there’s the massively important step of monitoring who and who hasn’t been immunised. Tracking is important not just as a personal health record, but also, as a way to reduce the restrictive physical distancing measures we currently impose to help control the spread of the disease. 

A clean bill of health for New Zealand can only be claimed if we achieve close to universal levels of vaccination. It may well be that in the future individuals will be required to show proof of vaccination in order to return to work, travel, attend school and participate in sporting, cultural or business gatherings. 

Draconian as this sounds, the idea of immunity passports has already been mooted by governments from countries including the US, Germany, Italy and the UK for people who have acquired immunity from natural infection. It is almost inevitable something similar will end up here. 

Whatever the new normal is, implementation and tracking of an effective immunisation programme is a cornerstone of any successful post Covid-19 world and New Zealand is brilliantly placed to take a leading role.

Our view: COVID-19 immunisation is so important that it should be an ‘opt-out’ vaccine - so people have to have really thought about why they can’t get the vaccine, and provide evidence to that effect before they can ‘opt out’.

OUR VIEW: keep talking

Of course, there is no precedent for this kind of immunisation programme. So this is a conversation we need to keep having. All ideas should be welcome, and flexibility is the key!