Speech to the Internal Medicine Society of Australia and New Zealand conference

E nga mana, E nga reo,

E nga iwi,

Tēna kotou katoa.

Ka huri ki nga mana whenua o te rohe nei. Tēna koutou.

He mihi hoki ki a tatou kua tau mai nei I raro I te kaupapa o te rā.

No reira tēna koutou katoa.

Introduction

It is a pleasure to join you for the Internal Medicine Society of Australia and New Zealand Conference.

I would like to take this opportunity to acknowledge IMSANZ for their work putting together this conference in these challenging times.

I would also like to thank all Internists for the resilience and grit you have demonstrated.

You are at the coalface of high need medical hospital admissions, stretched at times with high patient to physician ratios.

The last two years have undeniably been difficult for all, but I want to specifically acknowledge your contribution to the country’s COVID-19 response and management.

In addition to delivering world class care, your profession has provided vast expertise in shaping and developing guidance resources for the sector. I am grateful for the profession’s technical expertise in developing the clinical practice guidelines - Clinical Management of COVID-19 in Hospitalised Adults. A living document that helps clinicians all over NZ best treat patients with COVID.

As we look to a new Health System, ensuring we have a workforce that meets our population’s demand for care is a priority.

The Ministry is working to ensure the NZ Health and Disability system has the workforce that is required to meet the health needs of the population. I know that for our workforce to fill current vacancies and to be sustainable, we must work within the capability and capacity of our hospitals (DHBs) to increase and retain the number of New Zealand trained specialists.

In addition, we will continue to engage with professional bodies to best understand how professions can work collaboratively to provide the best care for our patients, while still respecting and appreciating your specialist expertise.

Growing up in Te Anau and becoming a doctor and transition to politics

I grew up in beautiful Te Anau and I’m sad I can’t make it there to be with you now. I frequently visit Te Anau to see my parents, both retired teachers in their 70s. As it happens they are writing a history of the Te Anau Medical Centre. It might look humble but doctors at the practice are accomplished in retrievals and developed the PRIME response system for emergencies in remote locations.

I left Te Anau for medical school at Otago and when I graduated from Otago, I worked as a junior doctor at Wellington Hospital and specialised in infectious diseases. I didn’t plan a career in politics before the pandemic but if I did, I couldn’t have thought for a better grounding in the realities of so many New Zealanders lives than working in our public hospitals. The comradery of medicine and the dedication caring for vulnerable are a privilege. I'm immensely proud to have worked in the health sector alongside wonderful colleagues. Our health system is often stretched, but our healthcare workers' professionalism, compassion, and good humour always carries the day.

Government’s priority on public health and prevention

Improving the health and wellbeing of all New Zealanders is a key priority for this Government. This includes strengthening public health action to improve the health status of all New Zealanders.

Today I would like to talk about some of the initiatives I’m responsible for in public health. I’ll then discuss the COVID-19 response.

This is where my passion lies, and where I’m determined to make a difference.  

When I was a physician trainee nights on call inevitably included the admission of multiple COPD patients. Their unfortunate circumstances, confined to their homes, unable to walk as far as the letterbox is a constant reminder of the harm tobacco does. That’s why I am drafting tobacco legislation that will markedly reduce retail outlets, denicotinize cigarettes and ensure the next generation can never legally purchase tobacco.

Change cannot wait, and on 9 December 2021, I launched the Smokefree Aotearoa 2025 Action Plan; unapologetically bold policies that will be delivered at pace to get us to our goal.

The launch of the plan and its bold measures marked a historic day and a significant milestone in the kaupapa of tobacco control in New Zealand.

This plan is a culmination of decades of hard mahi from champions across Aotearoa including community workers and public health workers.

We have three outcomes. The first is to eliminate inequities in smoking rates and smoking-related illnesses, the second is to create a smokefree generation by increasing the number of children and young people who remain smokefree, and the third is to increase the number of people who successfully quit smoking.

To achieve these three outcomes and ultimately our smokefree goal, we have six game-changing focus areas to radically reduce the appeal, addictiveness and availability of smoked tobacco products. 

Because we know smoking is a social issue, not an individual issue, our focus areas also include plans to mobilise communities, provide better stop smoking support for individuals who smoke, and change the smoking environment to help people quit and stay quit.

Alongside policies in the action plan that will become law, we are prioritising practical support measures to help smokers on their quit journey and some of this work is already underway.  

The leadership of the healthcare workforce, especially our public health experts, is integral to the success of the plan. It will take all of us working together to tackle smoking and I thank you for your support and hard mahi.  

We are on the cusp of one of the most significant changes to our approach to health in New Zealand, with the health reforms just a few months away.

Our future health system will have a stronger focus on public health, with the establishment of a new Public Health Agency, which will be responsible for public health policy, strategy and intelligence. It will help us better understand and respond to threats to public health and put scientific expertise at the heart of policymaking.

Health NZ will include a national public health service, bringing together our Public Health Units under a national banner. This means we’ll be better able to coordinate public health services, responding to threats like COVID-19, measles outbreaks and smoking and obesity.

A key feature of the reforms is long term health and financial plans map to tackle long term challenges and investment.  Of course, transformational change won’t happen overnight, and it will take time for some of the deeper issues such as resourcing and inequities to start to improve, but from where I sit, the future of health in New Zealand looks very exciting.

While those changes sit on the horizon, there has been plenty of other work happening in the here and now.

Fluoride

One of the other key achievements in public health is the Fluoridation Bill. The new legislation which came into effect in November gives the Director-General of Health the power to issue a direction to local authorities to fluoridate drinking water supplies.

As a result of the new legislation, there is the potential for community water fluoridation coverage to extend from about 50 percent to over 80 percent.

The Ministry of Health has already started engaging with local authorities to understand their fluoridation ‘readiness’. I anticipate that the Director-General of Health could start issuing directions to fluoridate some suppliers from mid-2022 onwards.

Folate

Another area of progress has been the mandating of folic acid fortification of non-organic bread-making wheat flour. In February 2021, I sought Cabinet approval for a mandatory approach to folic acid fortification, in my role as Minister for Food Safety.

The evidence is clear that consuming folic acid is important for healthy development of babies early in pregnancy and to prevent neural tube defects.

The new policy, announced last year, will require all non-organic bread-making wheat flour in New Zealand to be fortified with folic acid within the next two years.

This is another public health measure for which the science was unequivocal. We will be joining the long list of 80 or so countries, including Australia, the United States and Canada, many of which made the change decades ago.

COVID-19

Our strategy

In March 2020, New Zealand committed to an Elimination Strategy in response to the COVID-19 pandemic which provided a sustained approach to keep it out, find it and stamp it out. This was a strategy focused on a continually evolving virus, with a goal to keeping New Zealanders safe from COVID-19.

Extensive testing using high sensitivity PCR, contact tracing and isolation and lock down.

This strategy allowed New Zealanders to maintain freedoms and a quality of life in the face of COVID-19 that few other countries have enjoyed. The elimination strategy served us well in the pre vaccine era.

Vaccines changed…

The tools that were effective against the original variant including the world’s most stringent lockdown, wide-scale testing and contact tracing - have not been as effective against subsequent variants. Therefore, we shifted from the strategic goal of elimination to minimisation and protection, under the new Covid Protection Framework - colloquially known as the traffic light system. Vaccination is the foundation of this new protection framework and we have access to one of the world’s most effective vaccines.

The CPF allows other priorities such as the importance of livelihoods and social connections, even in the context of a circulating virus, to be upheld. The CPF was very successful against the Delta variant.

Omicron – another challenge

Protection means that we won’t just treat COVID like a seasonal illness. We will protect people from it with vaccination and boosters, active public health measures including testing, isolation and contact tracing, and a response that focuses on minimising the significant health impacts we know it can have.

How the position of health care workers is vastly improved now since the beginning of the pandemic

I remember the apprehension felt at the beginning of the pandemic. Especially when the WHO estimates that between 80 000 and 180 000 health and care workers could have died from COVID-19 in the period between January 2020 to May 2021 alone.

New Zealand protected the healthcare system for 2 years, enabling numerous measure to protect healthcare workers to be implemented. Including:

  • Vaccines and Healthcare worker mandates
  • Knowledge of Covid transmission that enables good infection prevention and control (IPC).

Access to tools to care for people

I think many of you will be interested about what COVID-19 treatments we are looking to access. I can give you a little bit of detail around this.

Pharmac is taking a portfolio approach to secure access to a range of COVID-19 treatments. The approach Pharmac is undertaking is unique given the urgency, global demands on supply and the early stage of development for many treatments. We are assessing treatments and supply as soon as information is available, prior to Medsafe approval.

Pharmac is currently working to assess and secure eight COVID-19 treatments.

Two different pharmaceuticals, tocilizumab and remdesivir, which are administered by intravenous infusion, have already been funded explicitly for the treatment of COVID-19 in New Zealand. Tocilizumab is currently being used for the treatment of moderate to severe COVID-19 in hospitalised patients. Pharmac is securing more stock of remdesivir, and seeking further clinical advice on earlier use in hospitalised patients, as well as the suitability of remdesivir for use in the community.

Baricitinib, an oral tablet, which can be used as an alternative treatment to tocilizumab, has been purchased. Baricitinib is  available for those that meet the criteria from 1 February 2022. Pharmac secured an initial supply of 1000 treatment courses and is also negotiating further supplies of baricitinib for delivery in 2022.

Pharmac has secured 12,800 treatment courses of casirivimab/imdevimab (Ronapreve), through an advance purchase agreement. Ronapreve was approved by Medsafe in December 2021. Ronapreve will be available for those that meet certain access criteria from 1 February 2022.

Available evidence suggests that baricitinib and casirivimab/imdevimab are effective against the Delta variant of COVID-19. Emerging evidence suggests casirivimab/imdevimab may not be effective against the Omicron variant of COVID-19.

We will continue to monitor the COVID-19 situation in New Zealand and the developing evidence about treatments, and make changes to the access criteria for COVID-19 treatments as necessary.

The impact of omicron will be much less due to us having very high vaccination rates, particularly amongst older people.  The vast majority of people who get symptomatic disease will have a mild to moderate illness. Many many people will not even know they have had an omicron infection.

Hospitalisation rates will be manageable – albeit large in number due to high number of cases.

Closing

I’m incredibly proud of the way we, as a nation, and you, as the health workforce, have managed and adapted throughout these challenging times.

The pace of change has been staggering, and I appreciate the vast challenges COVID-19 adds to an already exceptionally challenging workload.

As a country, we’re in a much better position, relatively speaking, than many others, including our close neighbours. That is in part due to your ongoing commitment, dedication, and expertise. Thank you. It is also because this government has taken the hard decisions to protect lives and the health system. These decisions have sometimes provoked strong opposition.

Throughout all this, we’ve continued to make steady progress on various public health initiatives, and the health reforms are set to create a smarter, simpler, better system to carry the momentum.

It’s certainly not over yet and we have plenty more work to do, but I am confident that we are equipped to face any challenges that come our way.

Ngā mihi nui kia koutou katoa.