Part 1: Introduction
1.1
In May 2020, the Government initiated work to procure enough Covid-19 vaccines to vaccinate the New Zealand population. The Ministry of Health (the Ministry) is leading the nationwide roll-out of the vaccine and started planning for the Covid-19 Vaccine and Immunisation Programme (the immunisation programme) in August 2020.
1.2
By December 2020, the Government had entered into agreements with four pharmaceutical companies to supply vaccines, subject to their approval for use in New Zealand. The Pfizer-BioNTech vaccine (the Pfizer vaccine) was provisionally approved1 for use in February 2021. In March 2021, Pfizer agreed to provide New Zealand with enough doses for the whole population.
1.3
The Pfizer vaccine will be supplied in instalments. Pfizer expects to provide all of its vaccine to New Zealand by the end of 2021. The Government’s aim is to vaccinate as many people as possible, aged 16 years and over, by the end of 2021.
1.4
The Government has indicated that it will vaccinate the population in four main groups:
- Group one consists of border and managed isolation and quarantine workers and the people they live with. Vaccination of this group started in February 2021.
- Group two consists of high-risk frontline health workers and people living in high-risk settings. This group also started receiving vaccinations in February 2021.
- Group three consists of people who are at risk of getting very sick from Covid-19. This group is estimated to include about 1.7 million people with vaccinations scheduled to start in May 2021.
- Group four consists of the rest of the population aged 16 years and over – about two million people. These vaccinations are due to start from July 2021.
1.5
The Pfizer vaccine is being rolled out through a nationally co-ordinated and locally delivered model. District health boards will decide how they will run vaccinations for their communities and where the vaccination sites will be. There are four types of location for vaccination sites: hospitals, temporary sites (such as workplaces, marae, churches, residential care facilities, or mobile clinics), community sites (such as general practitioner hubs), and fixed-community vaccination centres.
1.6
The Ministry is responsible for getting the vaccine to the vaccination sites, and district health boards are responsible for managing these sites. Managing the sites includes storing the vaccine, securing the right staff, identifying and inviting people to be vaccinated, recording their details, and administering the vaccine.
1.7
There is public pressure to deliver the immunisation programme quickly. Other countries are moving ahead with their vaccination programmes. In our view, it is important for the Government to maintain public trust and confidence by ensuring that New Zealand does not fall significantly behind.
1.8
Although New Zealand has not experienced the same level of Covid-19 outbreaks as many other countries, there is pressure to reopen borders as soon as possible to aid economic recovery. Being able to do this depends, in part, on the success of the immunisation programme.
1.9
In this Part, we describe:
What we looked at
1.10
Our audit looked at how well the Government is preparing for the nationwide roll-out of the Covid-19 vaccine. We did this to provide the public and Parliament with an independent view on how well positioned we consider the immunisation programme is for the nationwide roll-out scheduled for the second half of 2021. We carried out our audit as the immunisation programme was being developed so that the Ministry could act on our recommendations as soon as possible.
1.11
The primary objectives of our work were to:
- describe how the Government is approaching the nationwide roll-out of the immunisation programme, including any early progress;
- assess how well the immunisation programme has been set up, and how well associated processes and systems appeared to be working to date; and
- identify any areas for improvement to enable action to be taken if appropriate.
1.12
We looked at how vaccines have been procured and how the purchase agreements are being managed, the Government’s strategy and planning for rolling out the Pfizer vaccine nationwide, and how well risks to the immunisation programme are being managed.
1.13
We did not look at:
- the safety or effectiveness of any of the vaccines purchased, or any other matter requiring clinical expertise, because we are not clinical experts;
- the likely effectiveness of the contracts related to vaccines that have been entered into by the Government;
- wider procurement matters, such as for information systems or other equipment or supplies;
- the cost-effectiveness of the immunisation programme overall, including the value for money of what is spent on vaccines, given the necessity to vaccinate and the limited supply options;
- the appropriateness of the Government’s sequencing approach to vaccination; or
- the adequacy or security of the information systems used to support the vaccine roll-out or privacy controls on these systems.
1.14
This work has focused on the governance and management arrangements for the immunisation programme only. We have not assessed any of the wider governance, quality assurance, or review arrangements related to the all-of-Government response to Covid-19. However, we have a wider work programme under way that includes other aspects of the Covid-19 response.2
1.15
This audit is the first phase of work we intend to carry out on the immunisation programme. We also intend to carry out further work as the roll-out progresses.
How we carried out this audit
1.16
Most of our fieldwork for this audit was carried out from mid-February 2021 to mid-April 2021. Although we have done our best to ensure that the information in this report is up to date, it is likely that the immunisation programme will have made further progress by the time this report is published.
1.17
To carry out this work, we spoke with a range of people and groups. These included government agencies involved in the procurement of vaccines. We spoke with Ministry staff, including senior management. We interviewed members of the different governance and advisory arrangements that are in place to support the immunisation programme, as well as key members of the programme team.
1.18
We spoke to staff at some district health boards and members of professional bodies and advocacy organisations for different groups of health care workers, such as general practitioners (GPs), nurses, and pharmacists. We also spoke with Māori and Pasifika health care providers, disability advocates, communications specialists, vaccinator training specialists, and others in specialist roles.
1.19
We reviewed and analysed documents about the immunisation programme, including Cabinet papers, planning and programme documentation, and documents provided to Steering and Governance Groups. We looked at a sample of plans that district health boards provided to the Ministry.
1.20
We also carried out work to understand the process from purchase through to use of the vaccine, and to see whether:
- vaccine purchase contracts were properly authorised; and
- all vaccines are accounted for by comparing reported vaccine stock on hand against the stock movements.
1.21
We have also obtained a general understanding of the Covid-19 Immunisation Register and how it will work to support the immunisation programme.
Structure of this report
1.22
Part 2 describes the complexity and scale of vaccinating the New Zealand population. It sets out the challenges that the Ministry and the health and disability sector are dealing with. It also sets out the progress that had been made in the immunisation programme at the time we prepared this report.
1.23
Part 3 explains the process that the Government followed to procure vaccines. We consider whether good procurement practice was followed and describe the uncertainty that remains about delivery of the Pfizer vaccine.
1.24
Part 4 looks at how the immunisation programme had been set up and the supporting governance that is in place. We describe the approach that has been taken to strategy and planning and how effectively the immunisation programme is managing risks.
1.25
Part 5 sets out how the immunisation programme is progressing towards scaling up to vaccinate larger groups of people, the work that has been done, and what was left to do at the time our audit was completed. We discuss how ready we consider the immunisation programme is to scale up.
1.26
Part 6 looks at the approach the Ministry has taken to communicating the roll-out. We discuss communications to people involved in the immunisation programme, stakeholders and the wider health and disability sector, and most importantly the public.
1: Provisional approval means the pharmaceutical company must still meet certain conditions, including supplying more data from its clinical trials, and related to manufacturing quality standards. This will happen at the same time as the vaccine is rolled out. It is not unusual for vaccines to be rolled out with provisional approval. See Common questions about the COVID-19 vaccine rollout at www.healthnavigator.org.nz for more information.
2: More information about our work on the Government’s response to Covid-19 is on our website at oag.parliament.nz.