Be prepared

Professor Michael Baker became one of the most public faces of New Zealand's pandemic response. Now he is leading a new research project to help ensure the country is better prepared for the next major public health emergency.

Epidemiologist Professor Michael Baker is widely credited with devising New Zealand's COVID-19 elimination strategy.

He began using the term 'elimination' in March to describe the mix of border controls, contact tracing and lockdown that became the core methods used to prevent the pandemic taking hold in New Zealand.

With colleagues from the University of Otago in Wellington he wrote the world's first COVID-19 elimination strategy and published it rapidly in the New Zealand Medical Journal on 3 April 2020. They also published an article on the New Zealand response and initial success with COVID-19 elimination in the New England Journal of Medicine, regarded as the world's highest impact medical journal. He has disseminated the approach worldwide through research papers, articles and numerous media interviews.

Baker is also leading a nationwide multidisciplinary study of New Zealand's response to the COVID-19 pandemic in order to improve current control efforts and to ensure the country is better prepared for the next major public health emergency.

The programme of work, now called CoSearch, involves more than 20 collaborating researchers, three universities, a Crown research institute, community organisations and an international advisory group, and is funded by the Health Research Council, the Ministry of Health and donations.

CoSearch is based at the Department of Public Health, University of Otago, Wellington, with Baker as director and principal investigator and Dr Amanda Kvalsvig as lead researcher.

Baker has criticised chronic under-investment in public health in the past, so he appreciates the opportunity the funding allows.

“Most research on health disasters is done after the event. This was an exceptionally fast funding round and means that the research can be conducted while the pandemic is happening and used to inform the response.”

He has long warned of the dangers of unpreparedness for national health threats, pointing out system failures such as those involving pandemic influenza (2009), water contamination in Havelock North (2016), measles (2019) and now COVID-19. On the centenary of the 1918 influenza pandemic he highlighted the dangers of Chinese wet markets, now regarded as the source of the latest virus.

In early February he and colleague Professor Nick Wilson urged the government to ramp up its response by preparing the population for a massive upgrade in protective practices, strengthening border controls and improving quarantine procedures.

When COVID-19 arrived in New Zealand the government initially aimed for mitigation – slowing the spread of the virus so that hospitals could cope. Baker and Wilson soon promoted elimination instead, based on a World Health Organization report showing China had used a containment strategy that had effectively stopped the spread of COVID-19 across their country.

As the government wavered between mitigation and elimination, the phones ran hot between the government's science advisers and top science communicators at the Science Media Centre, where Baker is on the advisory board.

Baker had previous experience of influencing governments, helping create a world-leading needle exchange programme during the Aids crisis 30 years ago and, later, initiating regulations that substantially reduced the incidence of Campylobacter contamination in chicken. COVID-19 was a whole new ball game.

"Almost everyone seemed to be sitting on the fence during this critical period,” remembers Baker. “I do think that Nick and I swayed opinion towards the alternative containment view.”

Prime Minister Jacinda Ardern's government adopted the recommendations supported by Baker and Wilson, who wrote in The Guardian: “The … leadership of Ardern was instrumental in New Zealand's rapid change in direction with its response to COVID-19 and the remarkably efficient implementation of the elimination strategy.”

They continued: “It seems frustratingly true that we are poor at learning the lessons of history with pandemics, as with other threats to global health. One key lesson is that more investment in public health infrastructure is critically needed in all countries to better manage pandemics and a range of less severe health threats.”

“We need to learn from the COVID-19 response as there are other threats on the horizon that are far more destructive for all of us.”

It may have taken an international crisis to make it happen, but Baker and his colleagues have seized the opportunity to be heard with the new HRC-funded project. It could be the silver lining of the COVID-19 cloud.

“In the past, pandemic fears have led to health system changes. We might expect new legislation and new ways of looking at the world after 2020. That would be a positive outcome,” says Baker.

CoSearch's main research goals are to describe the pandemic and its impact on population health in New Zealand and the Pacific; evaluate the elimination response to help improve its effectiveness; improve the country's ability to manage major threats; and identify health, equity and sustainability benefits arising from a well-designed recovery.

Throughout the crisis – including after COVID-19 was successfully eliminated and then appeared again in an outbreak in Auckland – Baker and Wilson have continued to advocate for the wearing of face masks in appropriate settings, for improved contact tracing with digital tools, for a cautious science-based approach to border management (including quarantine) and for the need to plan for the introduction of a vaccine.

They have also recommended major changes to the way public health services are organised – such as a new national public health agency for disease prevention and control – and have urged the government to launch an inquiry into its response to the pandemic to identify ways it can be improved.

Baker hopes that New Zealand's success in acting decisively against the COVID-19 pandemic will encourage decision-makers to listen to scientists and act proactively to prevent other disasters.

"We need to learn from the COVID-19 response as there are other threats on the horizon that are far more destructive for all of us. It is easy to say we need transformational change – hard to achieve, but absolutely necessary,” says Baker.