Analysis: The Government's decision to make the Pfizer/BioNTech vaccine the centrepiece of New Zealand's rollout has a number of significant implications, Marc Daalder reports
From the second half of the year, every adult New Zealander will have the opportunity to be immunised with the Pfizer/BioNTech vaccine, after the Government secured a deal to purchase an extra 8.5 million doses.
Given the Pfizer course requires two doses per person, that's enough to immunise 4.25 million people. A previously lodged order for 1.5 million doses, which has already begun to arrive and be administered to border workers and their families, means that full vaccine coverage could be achieved with just the Pfizer shot alone.
Jacinda Ardern said New Zealand would review its purchase agreements for other vaccines in light of the deal and could either ask for delivery to be deferred or even give them away to other countries. However, a small number of doses of options like the single-shot Janssen jab could be kept on hand in the event they are needed.
The Pfizer vaccine poses some logistical difficulties, particularly because of a requirement for it to be frozen at -70 degrees until five days prior to injection at most.
Read more: How Pfizer vaccine works: From freezer to immunity
Rollout may not be as smooth
One of the key implications of the Government's choice to go all in on Pfizer is the potential for the rollout to face more obstacles. In particular, our rollout could be more exposed to delays than the programmes in other countries - but that's a risk the Government sees as worth the reward of using what has been hailed as one of the leading vaccines for Covid-19.
Vaccine producers around the world have struggled to meet promised quotas for delivery. AstraZeneca jabs produced in Italy and meant to be shipped to Australia have now been held back by Italian authorities over concerns the company had so far failed to deliver the number of vaccines it had promised.
In countries like the United States or much of Europe, where multiple different vaccines have been approved for use, issues with delivery timelines from one company can be smoothed over by the continuing arrival of other vaccines.
New Zealand will forego that advantage, but the Government doesn't expect the rollout to be much rockier than elsewhere. Covid-19 Response Minister Chris Hipkins said he had an expectation that vaccines would be delivered on a continual basis from the second half of the year and that there wouldn't be a stage where New Zealand runs out of vaccines and has to pause the rollout while waiting for more to arrive.
"At this point the delivery schedule has not been locked in, but what we know from our experience around the first half of the year is that they find it useful to be sending us progressive shipments rather than big chunks of vaccine all at once," he said.
Helen Petousis-Harris, an associate professor in vaccinology at the University of Auckland and former chair of the World Health Organisation's Global Advisory Committee on Vaccine Safety, said the Government's willingness to use the other shots it had purchased if needed could also smooth out the rollout.
And Peter McIntyre, a medical advisor at the Immunisation Advocacy Centre, said New Zealand could cope with a delayed rollout if needed.
"New Zealand's in the privileged situation of not having hospitals bursting at the seams. It doesn't have the kind of pressures that exist in Europe or North America and so it can take more time, in terms of getting this all done," he said.
"Having said that, I don't think we're talking about a delay of a year or anything like that. You might just be talking about the possibility, with one supplier, that there could be gaps."
Booster shots
One of the key advantages of the Pfizer vaccine is that it can be quickly altered to adapt to new variants of the SARS-CoV-2 virus. In an interview with Axios this week, Pfizer CEO Albert Bourla said that a new version could be on the market in as little as 16 days.
McIntyre said that meant it was possible that New Zealanders could be receiving a slightly different vaccine in the second half of the year than what's being given to border workers and their families today. The new versions would deal better with new variants of the virus.
"The variant question is of course one that's on everyone's lips at the moment," he said.
"We've been concerned about current vaccines not protecting [as well] against infection with the variants and there's certainly good evidence of that, particularly with the South African strain. But the jury's still out about whether people who receive the earlier version of the vaccine are protected against severe disease [from new variants]. I think there's some early evidence starting to creep out that they are."
In other words, new vaccines might only be needed if the new variants are not just capable of infecting vaccinated people but actually having them come down with severe disease resulting in hospitalisation or death.
The Government's willingness to postpone the arrival of its other vaccines also opens the door for the non-Pfizer shots on order to be used as booster shots in future years. When she announced the purchase of 8.5 million more Pfizer doses, Ardern said that booster shots against Covid-19 may be needed for years to come.
"I’m not sure that I’m seeing enough, the conversation about this being an ongoing pandemic that we’ll need to fight. So, you know, I will keep likening it to the flu, she said.
"It won’t be a matter of once you’ve had one shot it’s done. This is likely to be something that every year we’ll be asking people to be vaccinated to look after themselves. That’s the way we’ll deal with additional variants."
Bourla also said he expected people to need an annual booster shot for the next decade.
Petousis-Harris and McIntyre both said that a mix-and-match strategy where Pfizer vaccines provided initial immunity in 2021 but other jabs were used from 2022 onwards could still be effective.
"There's quite a lot of work going on looking at the mix-and-match of different vaccines because that is going to be a reality all around the world where we are potentially going to be able to access different brands at different times," Petousis-Harris said.
"Should some of these variants prove to be a problem and have changed enough to evade our immunity, we may need to provide some sort of booster in the future. But the less of the virus there is around, the lower the chance of that being required."
International aid
The Pfizer announcement has also opened up the opportunity for the Government to go harder on international aid than it had previously hinted at. Although New Zealand has donated millions of dollars to the COVAX facility and worked to secure some vaccines for Pacific Island countries, human rights advocates had criticised the Government for its reluctance to back developing countries asking for intellectual property rights on vaccines to be stripped away.
See Newsroom's two-part series on vaccine equity:
Part 1: At the back of the vaccine queue
Part 2: 'May I see your vaccine passport?'
The request for a waiver to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) has become a flashpoint at the World Trade Organisation. India and South Africa have led the charge for a TRIPS exemption, backed by groups like Amnesty International and Oxfam, while developed states say the proposal would disincentivise future medical research.
The Green Party is among those supporting the TRIPS waiver.
"Our Government has done the right thing by making vaccines available free for everyone in New Zealand, starting with border workers who need it most," Greens human rights and foreign affairs spokesperson Golriz Ghahraman said in February.
"With this is mind, it has been deeply disappointing that our Government has refused to support a call by India, South Africa, and other nations to ease trade rules that would make the Covid-19 vaccine affordable to developing world nations."
While New Zealand hasn't come out in favour of or opposed to the waiver, observers say it is unlikely to throw its full weight behind the proposal.
However, the Pfizer announcement on Monday was accompanied by a reveal that the Government would be reviewing what to do with its surplus vaccine purchases.
"Consideration will be given to how we best use doses that are not used in New Zealand. Options include delaying delivery here for some until 2022, when we will need to update our vaccination programme. This, of course, could free up supply for other countries in the short term," Ardern said.
"We’re currently working alongside our Pacific neighbours, talking with them around their vaccination preferences. That includes whether or not Pfizer will be a possibility for rollout or whether or not they would prefer something that has slightly fewer logistical challenges.
"Ultimately, though, we are committed to ensuring that any doses not needed here are put to good use elsewhere, and that includes donation of surplus vaccines to others. Because no country is safe until all countries are safe."
