David Skegg This article is an edited version of the Sir Frank Holmes Memorial Lecture delivered by Sir David Skegg at Victoria University of Wellington on 12 November 2020. The Covid-19 Pandemic lessons for one of the founders of the Institute of Policy Studies at this university. Returning to the University of Otago to receive an honorary degree, 50 years our future after his student presidency, Sir Frank said that he had been told how one of his It is a pleasure and a privilege to be giving this lecture. academic colleagues saw him: A pleasure, because I have always had affection and respect At the end of a conversation about my for this university, ever since I was billeted here as a student propensity to move in and out of the in the University of Otago debating team. And it is a privilege university and to take on advisory to be giving the Sir Frank Holmes Memorial Lecture. assignments for governments and others while I was employed there, he Frank Holmes was the president of the three current members of Parliament, said: ‘He’s not really an academic, is he?’ Otago University Students’ Association including the deputy prime minister and in 1947. Speaking from experience, I must a new member of the Cabinet, Ayesha Fortunately, universities have a broader admit that vice-chancellors don’t always Verrall. view of their mission today. see their student presidents as destined Frank Holmes, during a long career as As we face the challenge of rebuilding to become notable scholars or leaders in an economist here at Victoria, was not only our future in the midst of the Covid-19 public life. Yet the list of OUSA presidents a respected university leader, but also pandemic, it is a great pity that we cannot contains many distinguished names, someone who helped to chart New Zealand’s draw on the vision and wisdom of Frank including that pioneer of anthropology social and economic future. He served on Holmes. I will say a few words about likely and Mäori health improvement, Sir Peter an astonishing range of public advisory effects of this pandemic on our national Buck (Te Rangi Hïroa). There are also bodies and corporate boards. And he was life, but I cannot pretend to be an economist or a social scientist and so will focus largely David Skegg, an epidemiologist and public health physician, is an emeritus professor at the University of Otago. He was previously the vice-chancellor of the university. As well as advising the on the health of the people. World Health Organization for more than three decades, he has chaired many government bodies, That is my first disclaimer. The second including the Health Research Council and the Public Health Commission. He was also the president disclaimer is that everything I say must be of the Royal Society Te Apärangi. In 2020 he served as a special adviser to Parliament’s Epidemic seen as provisional. We are learning more Response Committee, and he was called as a witness by the equivalent select committee of the UK House of Commons. about Covid-19 every day, and the global Policy Quarterly – Volume 17, Issue 1 – February 2021 – Page 3 The Covid-19 Pandemic: lessons for our future Figure 1: Capacity of intensive care beds (per 100,000 population) has described this as ‘the greatest science in selected OECD countries policy failure for a generation’ (Horton, 2020, Germany (2017) 33.9 p.41). Delayed and inadequate action has led Austria (2018) 28.9 United States (2018) 25.8 to hundreds of thousands of deaths in Europe Belgium (2019) 17.4 and the United States. Sadly there will be France (2018) 16.3 Canada (2013-14) 12.9 many more, and perhaps an even greater OECD 22 12 number of people afflicted by chronic effects Switzerland (2018) 11.8 Hungary (2018) 11.2 of infection that are still being clarified – the Korea (2019) 10.6 so-called ‘Long Covid’. England (2020) 10.5 Poland (2019) 10.1 Meanwhile, a number of Asian Spain (2017) 9.7 countries were being far more successful Australia (2019) 9.4 Italy (2020) 8.6 in controlling the virus. They had learned Norway (2018) 8.5 much from the SARS epidemic in 2003, but Denmark (2014) 7.8 Chile (2017) 7.3 Western countries were reluctant to follow Netherlands (2018) 6.7 their advice. The fact that the United States Japan (2019) 5.2 Ireland (2016) 5 and Britain, which have led the world in New Zealand (2019) 3.6 Mexico (2017) 3.3 medical and public health sciences, failed so miserably in responding to a known Source: OECD (2020) pandemic threat has been a supreme irony pandemic is still rampant, so things might effort in history’ (WHO, 2020, p.16). of this pandemic. David King, a former change here as early as tomorrow. Meanwhile, Chinese doctors published, in chief science adviser to the UK government, international journals, crucial observations blamed ‘arrogance’ and ‘hubris’ The emergence of Covid-19 on the clinical features and range of (Kirkpatrick, Apuzzo and Gebre, 2020). On 6 November 2019, the prime minister outcomes of the illness. unveiled a national memorial to 9,000 The WHO was notified about the Early responses in New Zealand New Zealanders who died in the 1918 outbreak at an early stage, and it worked Hubris was not an option in this country, influenza pandemic. I doubt if she closely with the Chinese authorities. It because health professionals knew only envisaged that a new pandemic was about arranged for a joint mission of experts too well that we were ill-prepared. The to be unleashed on the world. Perhaps from eight countries to spend nine days in country has no public health commission we should not have been surprised, as China from 16 February. Their incisive or centre for disease control, and the scientists had been warning for years report is a landmark document that Ministry of Health did not even employ that viral pandemics were becoming informed control efforts in all countries, epidemiologists. A Global Health Security increasingly likely. Some countries including New Zealand (WHO, 2020). Index, published a few months before the had recently dealt with epidemics of The WHO has been criticised, especially pandemic, ranked New Zealand as 35th infectious diseases new to humans, such by American politicians, for being in the world for pandemic preparedness as SARS and MERS. Moreover, New complimentary about the Chinese response (Cameron, Nuzzo and Bell, 2019). Zealand has been part of the ongoing to the outbreak. Yet it was a major Spending on public health services in HIV/AIDS pandemic, which the World achievement to persuade the communist New Zealand shrank markedly between Health Organization (WHO) estimates authorities to host a fact-finding mission 2010 and 2018 (Crampton, Matheson and has killed about 33 million people so far. of experts from other countries, even if Cotter, 2020). The public health units in It was in late December that reports restrictions were placed on the scope of our district health boards (DHBs) have emerged about a mysterious new disease their enquiries. Imagine if this epidemic been underfunded for years, so they had in Wuhan, China. There has been justified had started in the United States, as may only a limited capacity for contact tracing. condemnation of attempts by the Wuhan well have been the case with the 1918 But the DHBs had a more compelling authorities to suppress this unwelcome influenza pandemic – even though it is concern. They knew they lacked the surge news, but less acknowledgement of the often mistakenly called the ‘Spanish flu’ capacity to cope with an influx of critically remarkable progress made by Chinese (Crosby, 1993). How would President ill patients, as seen in countries that were doctors and scientists. A coronavirus was Trump have reacted if the WHO had only a few weeks ahead of us in the identified as the cause of the illness by 8 proposed that a posse of scientists from pandemic. Our hospitals have often been January 2020, and the genome sequence of other countries should come and try to get dangerously stretched, even by routine this virus was made public only four days to the bottom of things? winter outbreaks of influenza. Among 22 later. The disease spread quickly to all What is remarkable is that health OECD countries, the provision of intensive provinces of mainland China, but the authorities in many Western nations were so care beds (per capita) in New Zealand has country then mounted what has been slow to recognise the gravity of the threat, been less than one-third of the average described as ‘perhaps the most ambitious, despite repeated warnings from the Chinese (OECD, 2020). New Zealand is in 21st place, agile and aggressive disease containment and from the WHO. The editor of The Lancet followed only by Mexico (Figure 1). Page 4 – Policy Quarterly – Volume 17, Issue 1 – February 2021 On 5 March 2020, after New Zealand’s Baker and Nick Wilson, became strong to commit to it publicly. They could see third case of Covid-19 had been confirmed, advocates for an elimination strategy. that the best health response would also be the prime minister gave an assurance In many countries, including the best for society and for the economy. Why which indicated that she had been badly United Kingdom, the initial strategy for was the decision courageous? Because we misinformed. She said that New Zealand’s dealing with Covid-19 could be described all knew that failure was entirely possible. ‘world-class’ health system was geared up as ‘mitigation’.