health & science

Requests for national catch-up MMR campaign ignored

Auckland DHBs made repeated calls for a national MMR vaccine catch-up campaign, which might have stopped the deadly export of measles to Samoa. Farah Hancock reports.

Chief executives of three Auckland DHBs jointly requested a national MMR vaccination catch-up campaign in 2017 to plug well-known gaps in New Zealand’s immunisation status, documents obtained under the Official Information Act reveal.

This request, made to the Ministry of Health, was not acted on. Instead, the three DHBs were offered $100,000 each for local catch-up campaigns, along with some advice.

In 2018, global measles cases skyrocketed. By March 2019, measles reached Christchurch, by June the virus hit Auckland. To date it has infected 2093 people, including 1704 Aucklanders. Two unborn babies died of complications possibly related to measles.

In June 2019, the three Auckland DHBs again wrote to the Ministry of Health collectively recommending a national - not local - MMR catch-up campaign. They said this was needed to ensure 15- to 29-year-olds were reached.

“Previously we wrote to the Ministry in October 2017 requesting a national MMR catch-up campaign during the mumps outbreak ... The DHBs' experience was that these local campaigns were resource-intensive and challenging when not supported by a nationally-led campaign.”

The reply, almost a month later, thanked the group for their letter and acknowledged their request. The feasibility of the request was being considered, said the reply from Ministry of Heath director-general of health Dr Ashley Bloomfield. In the meantime, the ministry would “continue to support you through public messaging and monitoring”.

By then it was July and the pressing need for a catch-up vaccination campaign was clear, not just for New Zealand, but so New Zealand didn’t export the virus to other countries.

The National Verification Committee for Measles and Rubella Elimination, which reports New Zealand’s measles status to the World Health Organisation, flagged the risk the outbreak was posing to Pacific neighbours. It suggested targeted catch-up campaigns were needed.

The immunisation gaps were well-known, particularly in Pacific Islanders. A 1991 vaccine coverage survey showed only 42 percent of Pasifika two-year olds were vaccinated.

At the time, the Ministry of Health’s director of public health, Dr Caroline McElnay, said she welcomed the recommendations made by the committee. The focus, however, appeared to remain on business-as-usual rather than a national campaign to plug current gaps.

“The ministry’s immediate priority is to ensure that our national immunisation schedule remains on track. This will prevent immunity gaps developing in the future,” she said.

By the beginning of October it was suspected Auckland’s outbreak had made it to Samoa after an Aucklander travelled to the country not realising he had the virus. By the October 16, Samoa’s Ministry of Health declared an epidemic. The death toll currently stands at 60 and is rising daily.

Measles cases have also been reported in Fiji and Tonga.

How much vaccine is needed to keep New Zealanders safe?

For 2019, Pharmac estimated New Zealand needed 12,500 doses of MMR vaccine per month, adding up to a total of 150,000 doses for the entire country for the year.

This estimate turned out to be wildly off target. The outbreak - which experts had warned was likely - has meant extra vaccine doses have been needed. Around 300,000 doses have been administered this year, with demand outstripping supply. Rationing rules have been relaxed but some still remain in place.

Immunisation gaps in New Zealanders aged 15 to 29 have been well-known. Data source: ESR

Even with the extra vaccines dispensed there are still likely to be gaps in New Zealand's immunisation rates. People aged 15 to 29 have low vaccination rates, and those aged between 30 and 50 may have only received one of two doses.

A paper released as part of an Official Information Act response shows calculations for how many doses of MMR vaccine would be required for the area covered by the Aukland, Waitematā and Counties Manukau District Health boards.

It suggests 152,000 to 186,000 doses would be needed, far higher than Pharmac’s 2018 estimation for all of New Zealand.

Newsroom’s back-of-the-envelope calculations from earlier in the year estimated up to 1.3 million New Zealanders could be under or unvaccinated.

This is not business-as-usual

The paper, which is described as discussing Auckland’s needs for consideration in a national catch-up campaign, takes pains to make recommendations for success.

Leading a list of bullet-pointed recommendations is:

“Needs to be properly planned and ideally start from early next year with school term (Feb 2020) - manage it like a campaign. This is not BAU [business-as-usual].”

Dedicated staff were also suggested.

“We propose these are supported by a dedicated workforce and are not BAU - a ‘Swat team’ approach (six RNs [registered nurses, clinical lead and admin] seemed to work best in the mumps catch-up.”

The estimated cost for the swat team was $75,000 per month. Extending the work to reach households was estimated to cost a further $20,000 per month. A year’s campaign in Auckland could cost around $1.14 million.

To date, Auckland’s measles epidemic is estimated to have cost Auckland DHBs and associated services $1.36m.

In the joint letter sent to the Ministry of Health, the three Auckland DHB chief executives point out that even when this outbreak ends, more measles cases are likely to arrive from overseas which will again lead to “local spread as long as population immunity remains suboptimal”.

A statement to Newsroom from a spokesperson for Waitematā, Auckland, and Counties Manukau DHBs said their long-held view is a national catch-up campaign is needed and they have had formal and informal discussions with the Ministry of Health for a number of years about the importance of this.

"In recent years sustained efforts by the health sector in Auckland have increased the uptake of MMR. This activity has also made it clear there are limits to what can be achieved within our existing resources to restore herd immunity to the levels required to prevent recurrent outbreaks."

The Ministry for Health has not confirmed a national MMR catch-up campaign will take place but also has not ruled one out.

Read more:

Why fully vaxed hospital workers are getting measles

Hospital staff catching measles on the job

NZ ‘could have protected’ Samoa from measles

Take measles vaccine to the people

‘Shameful’ measles outbreak predicted

Why we don’t have enough measles vaccines