Auditor-General’s overview

E ngā mana, e ngā reo, e ngā karangarangatanga maha o te motu, tēnā koutou.

The Covid-19 Immunisation Programme (the immunisation programme) is critical to New Zealand’s response to, and recovery from, Covid-19.

The Government aims to vaccinate as many people as possible, aged 16 years and over, by the end of 2021. The Ministry of Health (the Ministry) is leading the immunisation programme, which is the largest ever carried out in New Zealand. It is being developed and implemented in an environment of continued uncertainty. Public expectations of the immunisation programme are high.

My report provides an independent view on how ready the Ministry and district health boards are to meet the Government’s vaccination goals, in particular, to scale up to vaccinate the general population.

Our involvement as the immunisation programme has developed has meant that this has been a challenging audit. Our work provides a snapshot of progress at a point in time. I expect that by the time this report is published, further progress will have been made. Reviewing the immunisation programme at this early stage means that my recommendations can assist the Ministry to identify further improvements and make changes to increase the chances of success.

It is important to acknowledge early achievements. The Government has secured enough supply to vaccinate New Zealanders and a number of Pacific countries against Covid-19. It set up a taskforce, developed a procurement strategy, and put New Zealand in a strong position, with agreements to purchase four different vaccines.

The Government chose to invest in the security of supply at a time when there was no certainty that any of the vaccines would be viable. However, this decision may have come at a cost because the Government might have to pay for vaccines it no longer needs.

The immunisation programme is complex. Although the Ministry is leading the immunisation programme, district health boards, primary health care providers, and the wider health and disability sector are all critical to its success. Delivery models, supported by an extended vaccination workforce and appropriate information systems, are still being put in place. The logistics are complicated. The storage requirements for the Pfizer-BioNTech vaccine (which is the vaccine the Government has chosen to roll out) are not straightforward.

The speed at which the immunisation programme has needed to be set up led to an early decision to start rolling out the vaccine in limited settings while more detailed design and planning of the wider roll-out was still to be done. This approach has enabled the Government to show early progress and learn from its experience. Although, as at 12 May 2021, nearly 400,000 vaccine doses have been administered, a significant scale-up is still required to achieve the Government’s overall goals.

Given the significance of the challenge, I did not expect to find a perfect plan. However, to successfully navigate these challenges, a clear strategy, a well thought-out path, and fit-for-purpose governance arrangements are required. In particular, I expected to see a level of planning that matched the public commitments the Government has made.

My audit team found a high-level plan in place. There is a sequencing framework that sets out when specific population groups are expected to be vaccinated and in what time frame. There is information about the different locations where vaccines could be administered, and a range of communications have been developed to support vaccinations.

Early progress has relied largely on existing vaccination staff, a range of manual processes, and locally designed workarounds put in place while national processes and systems are developed. Some of what is in place right now will not be sufficient when the immunisation programme is vaccinating larger numbers.

At the time of this audit, the plan to scale up had not yet been fully developed and the critical path had only recently been identified. District health boards are still working out how they will organise aspects of the vaccine roll-out in their communities. Some are well-positioned, but others have a lot of work to do. Information systems are still being developed. If everything goes according to plan these will be ready, but only just in time. Although a lot of thought has been given to ensure that everyone (Māori and Pasifika communities in particular) can access the vaccine in a way that meets their social, linguistic, and cultural needs, it is not yet clear whether this will be fully achieved. At the time this audit was completed, many in the wider health and disability sector were still not clear about what their role will be or when they will know.

In my view, there are substantial risks around having enough trained vaccinators and establishing distribution and inventory management systems that will get vaccines to the right place in the right quantities at the right time, while minimising wastage. More work is needed to ensure that contingency plans are in place in case the vaccine is not delivered to New Zealand on time or in the quantities expected, or if there are other disruptions such as a further community outbreak of Covid-19 that affects the vaccine roll-out.

I am not yet confident that all of the pieces will fall into place quickly enough for the immunisation programme to reach the level of vaccinations required for the Government to meet its goals. In my view, there is a real risk that it will take more time than is currently anticipated to get there.

I have made recommendations that I hope will assist the Ministry to strengthen aspects of the immunisation programme. In particular, I consider it important that the Ministry remains open with the public about the uncertainty and the challenges ahead.

There will no doubt be some further operational problems and, in my view, the Ministry needs to manage public expectations appropriately. I am pleased to see that the Ministry has recently stepped up efforts to engage with the media about the roll-out, and a public awareness campaign has started. I encourage the Ministry to continue these efforts.

Although my audit team found several issues with the readiness of the immunisation programme for full-scale roll-out, these are not related to the safety of the vaccine. We are not clinical experts, but it is clear that the Ministry has drawn on substantial expertise and taken care to ensure that public safety is a primary consideration in developing and implementing the immunisation programme.

It is also clear that there is a group of capable and dedicated public servants working to get the immunisation programme ready for the full-scale roll-out. That goal will be realised only with the support and involvement of a large number of people across the health and disability sector.

I intend to report on the progress of the full-scale roll-out of the vaccine in the next phase of my work on the immunisation programme.

I thank everyone who spoke with my audit team as we carried out this work. In particular, I thank staff from the Ministry for their assistance as they continued to progress the immunisation programme. I also thank all those involved in the immunisation programme for their dedicated work to help keep New Zealanders safe.

Nāku noa, nā

John Ryan
Controller and Auditor-General
17 May 2021