Response to concerns about the Measles Catch-up Campaign

Dr Shane Reti MP wrote to us with concerns about the Ministry of Health’s Measles Catch-up vaccination campaign, including its cost, the number of vaccines that expired, and its failure to address Māori equity. This is our letter in response.

22 May 2023

Parliament Buildings
Wellington 6160

Tēnā koe Dr Reti


Thank you for your letter dated 15 August 2022 about the Ministry of Health’s Measles Catch-up Campaign (the Campaign). In your letter you raised concerns about the Campaign, including that:

  • Pharmac ordered 350,000 measles vaccinations for the Campaign based on the number of vaccinations the Ministry estimated it would need.
  • The Campaign cost $32 million and vaccinated 23,751 people (out of the purported 300,000 people it was targeting), putting the approximate cost for each vaccination at $1,300. 
  • Over the timespan of the Campaign, $8 million worth of measles vaccines expired.
  • A decision was not made to co-mingle the measles and Covid-19 vaccines.
  • The Campaign did not address Māori equity due to the very low rates of Māori vaccinated through the Campaign. 

What we have done

We sought information from the Ministry of Health (the Ministry) and Te Whatu Ora, including information about how the Campaign was planned, what the goals were, a detailed cost break-down, and general information about the Campaign.

What we have seen

In 2019, New Zealand experienced its largest measles outbreak since 1997. In October 2019, Cabinet approved the Campaign with the goal of increasing the uptake of the measles vaccination for Māori, Pasifika, and young people aged 15-30 (the target groups) as these were the groups disproportionately affected by the epidemic. The plan was for district health boards (DHBs) to be responsible for reaching the target populations. DHBs worked with the Ministry on how to maximise the reach of the Campaign.

The Measles Catch-up Campaign was affected by the Covid-19 pandemic

Preparations for the Campaign continued until March 2020, when the first Covid-19 lockdown occurred. At that point, resources needed for the Campaign were reallocated to respond to Covid-19, leaving minimal resources for the Campaign. 

In July 2020, the Ministry contracted Te Hiringa Hauora/Health Promotion Agency to promote the Campaign. In October 2020, DHBs were contracted to help deliver the Campaign and it began. 

By December 2020, the number of vaccinations administered was tracking at or below rates from previous years. The Ministry developed an escalation plan to support the DHBs. In January 2021, the Campaign was given more resources. Monthly meetings with campaign leads were set up and the Ministry assigned contact people to liaise with each DHB.

In March 2021, the Director-General of Health wrote to DHBs advising them to prioritise Covid-19 and childhood immunisations and reduce their focus on the Campaign because the closed border reduced the risk of a measles outbreak. As a result, many of the resources allocated to deliver the Measles, Mumps, and Rubella (MMR) vaccines, including staff and infrastructure, were diverted to respond to Covid-19 and childhood immunisations. 

This reprioritisation continued until the Director-General wrote to DHBs in December 2021 directing them to refocus their efforts on the Campaign. This had three phases: 

  • Phase 1 – restart and refocus
    • This phase focused on immediately restarting the Campaign through existing service providers and supporting providers to administer the MMR vaccine alongside the Covid-19 vaccine. The Ministry had clinically approved administering both vaccines at the same time – or “co-mingling” – in September 2021.
  • Phase 2 – integrate and strengthen service delivery
    • This phase focused on integrating the administration of the MMR and Covid-19 vaccinations.
  • Phase 3 – on-going and sustainable
    • The MMR vaccination was to be embedded as part of an equitable and sustainable national immunisation programme.

DHBs managed the Campaign until 30 June 2022, when they were disestablished under the Pae Ora (Healthy Futures) Act 2022. This also marked the end of the Campaign.

Te Whatu Ora told us that “the Campaign was launched at a time when the healthcare system was significantly under pressure by the Covid-19 pandemic. As a result, the Campaign had to slow down and scale back-up several times leading to unforeseen challenges in implementation, reduced uptake, and ultimately the challenge of already stretched services to deliver on set goals.”  

Lack of campaign targets

The Ministry had some overall goals for the Campaign, but it did not set a target for the number of vaccines to be administered. The Ministry told us that because there was no central vaccination register before 2005, the Ministry could not determine exactly how many people in the target groups (Māori, Pasifika, and young people aged 15-30) needed to be vaccinated. As a result, it was not possible to calculate a percentage-based target, such as that used for the Covid-19 vaccine. 

Against this uncertainty, the Ministry estimated that 350,000 doses of the MMR vaccine were needed for the Campaign to meet the needs of the population – including those populations where immunity status was unknown.

Campaign costs and outcomes

The total cost of the Campaign was approximately $32 million. We have set out the detail of the costs in an attachment to this letter.

Between 2020 and 2022: 

  • A total of 312,800 MMR vaccines expired, valued at about $8 million. 
  • Nearly 24,000 Māori, Pasifika, and young people between the ages of 15-30 were vaccinated, at a cost of $32 million.

Our comments

The Measles Catch-up Campaign’s goals were not achieved 

The Campaign was not able to achieve its goals, or deliver value for money, because the health system was redirected to respond to Covid-19. The outbreak of Covid-19 had a material effect on the Campaign, and this could not have been reasonably foreseen. Resources that would have been applied to the Campaign were instead diverted to Covid-19.

Vaccine expiry

Maintaining vaccine stock involves balancing the time between ordering the vaccines, how long it takes for vaccines to arrive from overseas, and the vaccines’ “shelf-life” once in New Zealand. As explained above, the Ministry estimated the number of vaccines it would need and ordered that amount (350,000). When the Ministry placed that order in October 2019, it could not have foreseen the impact of Covid-19, which delayed the Campaign. Border closures from 2020 to 2022 meant there were fewer measles cases in New Zealand, which also reduced vaccine uptake. Due to the Campaign’s delays and the significantly reduced vaccine uptake, most of the vaccine stock expired. 

Measuring performance and outcomes

Our Office expects public organisations to set clear programme outcomes and be able to measure whether programmes, and the money spent on them, have achieved those outcomes. In this instance, the Ministry could not accurately calculate the target population as the centralised immunisation register only started after 2005. This information gap is unfortunate, but not one that we consider the Ministry could have resolved.

We accept that there was genuine uncertainty about the target population. The bulk of the funding to DHBs ($10.9 million) was to deliver the Campaign and was not based on costs incurred. After decisions were made to reprioritise resources, DHBs continued to receive funding for the Campaign. Given the uncertain environment due to Covid-19, and lack of data about the target population, I question whether the Ministry could have given more thought to structuring the Campaign funding arrangements to reflect that uncertainty and minimise waste. 

We have suggested key questions that Te Whatu Ora might want to consider when setting goals and developing performance measures for vaccination campaigns or programmes. 

Thank you for writing to us. Given the broader public interest in this, we will be publishing this letter on our website.

Nāku noa, nā

Melanie Webb
Assistant Auditor-General, Legal, Policy and Inquiries

Attachment: Measles Catch-up Campaign costs

Description Costs (rounded)
Purchasing 350,000 Measles, Mumps, and Rubella (MMR) vaccines $8.8 million
Contracting DHBs to deliver MMR vaccines $10.9 million
Payments to DHBs to ensure that children were vaccinated at an earlier age $4.4 million
Reimbursing DHBs for administering the vaccine $700,000
Communications (including Te Hiringa Hauora/Health Promotion Agency contract) $2.2 million
Payments to Māori Influenza and Measles Vaccination programme in 2021 $1.7 million
Payments to Allen and Clark to complete a social marketing evaluation of the Te Hiringa Hauora promotional campaign $85,000
Payments to Pharmac to support staff over two years $600,000
Storage of vaccines by Pharmac  $123,000
Departmental expenses $2.6 million
Total $32.108 million