Part 6: Communications

6.1
In this Part, we set out the approach that has been taken to communicating the roll-out to people involved with the immunisation programme, key stakeholders, and the public.

6.2
The all-of-Government response to Covid-19 has demonstrated how an effective communications strategy can engage the public and encourage people to keep themselves and others safe. In our view, clear communication about the vaccine roll-out is an important part of maintaining trust and confidence in the immunisation programme. This is important for various reasons, including how it could affect the number of people choosing to be vaccinated.

6.3
At this point in the immunisation programme, we expected to see mechanisms in place to communicate effectively across the immunisation programme with internal and external stakeholders about decisions that have been made and, where appropriate, how their advice has been considered.

6.4
We also expected a clear public communications strategy that included information about when the public could expect to hear more about the roll-out to groups three and four, where they can get a vaccine, and how to make a booking. In line with public announcements in February 2021, we expected that a publicity campaign to raise public awareness and to promote understanding of the importance and safety of getting vaccinated would have started.

6.5
We expected that some consideration would have been given to how best to communicate with different communities, and what were the best communication approaches to encourage uptake of the vaccine.

Summary of findings

6.6
The delay in decisions about core aspects of the immunisation programme, in particular the delivery models, affected communications with the wider health and disability sector and with the public. Adequate communications channels between the Ministry, district health boards, and primary health care providers were not set up early enough. This has meant that key stakeholders have not always felt properly informed about their roles in the programme.

6.7
Early on, the Ministry focused on targeted communications with the groups currently being vaccinated, such as border workers. This made sense in some respects, but it also created a vacuum of information about the immunisation programme more generally, and meant opportunities for Māori and Pasifika health care providers to be involved and communicate early with their communities might have been missed.

6.8
We were told that key communications workstreams were under-resourced, and there was confusion about responsibilities between the Ministry of Health and the Covid-19 Group, a business unit within the Department of the Prime Minister and Cabinet.

6.9
Since our audit, the Ministry has made good progress. Responsibilities have been clarified and more resources have been assigned to the communications team. Significantly more data and information is now available on the Ministry’s website. A public awareness campaign has been launched. The Ministry has also made progress in its plans for communicating with Māori and Pasifika communities.

6.10
We encourage the Ministry to continue to improve communications to ensure that there is a good uptake of the vaccine across all communities.

Communicating with those involved in the immunisation programme

6.11
The pace at which the immunisation programme has had to get organised has made keeping people well informed a challenge. If people involved in the programme (or across the Ministry) do not all have the same information about decisions that have been made, this can create confusion. We saw some evidence of this.

6.12
Some district health boards we spoke to felt that although they were receiving information from the Ministry, the information and messages were frequently changing and they were being told different things by different parts of the Ministry.

6.13
Some groups in the wider health and disability sector were struggling to get information about their role in the immunisation programme. Some told us that they approached the Ministry for clarity about their involvement and were told to go to their district health board, while district health boards were asking them for information. Primary health care providers felt reliant on district health boards for information but told us they did not always get it. The Ministry told us it was aware of these issues and is working on a stakeholder engagement plan.

6.14
Since our audit, the Ministry has made several changes to improve communication with district health boards and the wider health and disability sector. These changes include introducing an accountability framework to clarify key roles and responsibilities and appointing a Sector Engagement Lead to support better engagement with the health and disability sector. The Ministry has also publicly stated it has stepped up engagement with GPs about their role in the immunisation programme.

Communicating with the public

Communications have not kept pace with the roll-out

6.15
People working both within and externally to the immunisation programme commonly described a situation in which the public communications have not kept pace with the vaccine roll-out. As the vaccine started to be rolled out, there was a lack of information on important safety matters, for example, whether people undergoing chemotherapy could get the vaccine. More information about the vaccine and who it is available for is now on the Ministry’s website.

6.16
We also heard that the communications team was under-resourced, and the speed at which the immunisation programme was moving made it challenging to produce communications material in a timely way.

6.17
When we started our audit, the Ministry was responsible for strategy, public health messaging, and health and disability sector engagement. The Covid-19 Group was going to drive the public information campaign, public messaging, and engagement with the public sector. We heard that, in practice, these accountabilities were often confused.

6.18
Since our audit, we understand that a new communications and engagement team has been established and the level of resource has been increased. Some work related to the roll-out that was previously carried out by both the Ministry and the Department of the Prime Minister and Cabinet has been centralised into the new team under a single general manager.

District health boards might need additional communications support

6.19
Although the Ministry is responsible for public health messaging nationally, district health boards are responsible for communicating with people in their areas about when and how to get vaccinated.

6.20
We heard that district health boards have different levels of need. Larger district health boards might have dedicated communications staff to lead this work, but others will not. District health boards are not required to submit communication plans to the Ministry (although some have chosen to do so) and district health boards’ delivery plans do not have a requirement to separately outline a communications approach.

6.21
In our view, it would be beneficial for communications plans to be included in district health boards’ delivery plans to ensure that the Ministry is able to provide support where needed.

Some good work has been done with Māori and Pasifika communities

6.22
The Ministry has recognised the need to ensure that communications are delivered through specific channels for different target groups. A dedicated Māori communications team was established, and $2 million has been set aside to support iwi and Māori communications organisations to work with the immunisation programme. An additional $1 million has been set aside to support communications to Pasifika communities.

6.23
Some good work was under way, even before this specific funding was allocated. From late February 2021, communications were being targeted to specific communities using Māori and Pasifika health professionals, organisations, and other communication channels. The Ministry has been working with Māori health professionals to produce videos challenging misinformation. The Ministry has contracted Māori and Pasifika health care providers to lead the national Māori and Pasifika vaccine campaigns. However, we note that these contracts are nearing their end. Some district health board communication teams have also been active in this area.

6.24
The Ministry has also been working with Te Puni Kōkiri and the Ministry for Pacific Peoples to use their knowledge and networks. For example, the Ministry partnered with the Ministry for Pacific Peoples to develop a joint engagement strategy for Pasifika communities. The Minister for Pacific Peoples hosted a series of fono with Pasifika communities involving Pasifika clinicians to provide information about the vaccine from trusted sources and give people an opportunity to ask questions or discuss any concerns they had. These sessions were reportedly well received.

Opportunities may have been missed because of delay

6.25
At the time of our audit, decisions still needed to be made about the delivery of Māori and Pasifika communications, including how the $3 million of funding would be distributed (see paragraph 6.22).

6.26
Delay means it is likely some opportunities have been missed. We heard that some iwi and Māori organisations were ready to start delivering messages about the vaccine early on but had been held back by the lack of readiness at the Ministry and district health boards

6.27
However, since our audit, we understand that Te Puni Kōkiri and the Ministry for Pacific Peoples have taken responsibility for developing and delivering targeted communications to Māori and Pasifika communities. A process is now under way for distributing the $2 million of targeted funding to Māori organisations.

6.28
During our audit, we also heard concerns about the lack of communications for people with disabilities. Although work on a disability strategy is under way, it is not yet complete. We have been told that the Ministry has now set up a Disability Sector Forum to better understand the sector’s needs and find the best ways of providing information about the vaccine to people with disabilities.

6.29
Communicating information about the immunisation programme has been a challenge in an environment where important decisions were still being made. Information was often not available to communicate to the public and health and disability sector stakeholders, and this has caused some frustration.

6.30
In our view, this could have been mitigated had the Ministry chosen to be more transparent about why information was not being communicated and provided some indication of when it would be.

Raising public awareness is critical to the success of the immunisation programme

6.31
Clear communication to the public is a central component of an immunisation strategy. World Health Organisation guidance is that communications planning should occur as early as possible to ensure that there is acceptance and uptake of Covid-19 vaccines.

6.32
Vaccine communications also need to be informed by an understanding of people’s perceptions of the vaccine. The Ministry recognised this and commissioned Horizon Research and the University of Auckland to survey New Zealanders’ attitudes and sentiment about Covid-19 vaccines. Initial surveys were carried out in September 2020 and December 2020. From February 2021, the surveys have been carried out monthly. There was also a separate survey commissioned in February 2021 that was specifically focused on Māori attitudes to the vaccine.

6.33
The percentage of those who will “definitely not” accept a vaccine has remained steady (about 9.4%) during the past six months. Based on this, the researchers have speculated that it is unlikely to change. The February 2021 survey found that more than two-thirds of respondents who said they are willing to take the vaccine also said they required more information, particularly those aged under 25 years and Māori and Pasifika. The March 2021 survey found that there continued to be a need for more information to be provided to help people decide whether to receive the vaccine. This highlights the importance of providing clear and targeted information.

6.34
The Ministry has only recently developed a communications strategy that sets out roles and responsibilities, an approach to messaging, and how this messaging would be delivered. The first version of the Covid-19 Vaccine Communications and Engagement Approach was developed weeks after the first vaccinations were given.

6.35
At the time of our audit, the public awareness campaign had not started. We were told that this was because decisions about the sequencing framework and delivery models had not been made. The Ministry told us it did not want to initiate a public awareness campaign urging people to be vaccinated until it could provide clear information about when and how people could do this.

6.36
The Ministry decided to focus instead on targeting each priority group as they neared vaccination. For example, it worked with the employers of border workers to encourage vaccinations. There was an initial focus on media events highlighting the individual stories of high-risk workers and their families.

6.37
Since our audit was completed, the Ministry has developed a new public information strategy and launched a public awareness campaign that we were told will increase in intensity as the roll-out progresses. There have also been specific events designed to increase transparency, such as a recent panel discussion with the Director-General of Health, and increased frequency of media briefings about the immunisation programme from the Director-General of Health and the Minister for Covid-19 Response.

6.38
We also note the Ministry has significantly increased the amount of data and information it is publishing on its website, including how district health boards are tracking to planned targets, daily dose volumes, and cumulative vaccinations by key demographics.

6.39
We encourage the Ministry to continue to progress this work. Where there is an absence of information coming from official sources, the risks of misinformation filling the gap are intensified. This could directly affect confidence in the immunisation programme and uptake of the vaccine.