133 Molesworth Street
PO Box 5013
Wellington 6140
New Zealand
T+64 4 496 2000

23 May 2023

Al

By email:  [FYI request #22640 email]
Ref:
H2023024475

Tēnā koe Al

Response to your request for official information

Thank you for your request under the Official Information Act 1982 (the Act) to Manatū
Hauora (the Ministry of Health) on 1 May 2023 for information regarding COVID-19 booster
shots and domestic vaccine passes. You requested:

“I'd like to understand the history of why boosters were never added to my vaccine
passes within New Zealand - if you google it, there are news stories from January and
February 2022 when domestic passes were in use, saying it was a likely possibility.
Could I please request request a document on that I came across in the Ministerial
briefings page Called: Requiring COVID‐19 vaccine booster doses to maintain
vaccination status in the New Zealand context (Ref 20220254).”

Please find the document requested attached to this letter as Appendix 1. Some information
has been withheld under the following sections of the Act:
•  Section 9(2)(a) to protect the privacy of natural persons; and
•  Section 9(2)(b)(ii) where its release would likely unreasonably prejudice the
commercial position of the person who supplied the information.

Where information is withheld under section 9 of the Act, I have considered the
countervailing public interest in releasing information and consider that it does not outweigh
the need to withhold at this time.

I trust this information fulfils your request. Under section 28(3) of the Act, you have the right
to ask the Ombudsman to review any decisions made under this request. The Ombudsman
may be contacted by email at: [email address] or by calling 0800 802 602.

Please note that this response, with your personal details removed, may be published on the
Manatū Hauora website at: www.health.govt.nz/about-ministry/information-
releases/responses-of icial-information-act-requests.

Nāku noa, nā

Jane Chambers
Acting Deputy Director-General
Public Health Agency | Te Pou Hauora Tūmatanui

Appendix 1
Briefing
Requiring COVID-19 vaccine booster doses to maintain vaccination status
in the New Zealand context
Date due to MO:  17 February 2022
Action required by:
18 February 2022
Security level:
IN CONFIDENCE
Health Report number:   20220254  ACT 1982
To:
Vaccine Ministers
Contact for telephone discussion
Name
Position
Telephone
INFORMATION
Maree Roberts
Deputy Director-General, System Strategy  s 9(2)(a)
and Policy
Wendy Illingworth
General Manager, Public Health System  s 9(2)(a)
Policy, System Strategy and Policy
Minister’s office to complete:
☐ Approved
☐ Decline
☐ Noted
☐ Needs change
☐ Seen
☐ Overtaken by events
☐ See Minister’s Notes
☐ Withdrawn
Comment:
RELEASED UNDER THE OFFICIAL

Appendix 1
Requiring COVID-19 vaccine booster doses to maintain
vaccination status in the New Zealand context

Security level:
IN CONFIDENCE
Date:
17 February 2022
To:
Vaccine Ministers
Purpose of report
1982
1.
Fol owing a request from Vaccine Ministers for further information, this paper provides advice
ACT
on the implications of requiring a COVID-19 vaccine booster dose to maintain an up-to-date
vaccination status. It does not seek a broad decision but sets out the practical and inter-
related implications of any decision for Ministers to consider.
Summary
2.
In November 2021 Cabinet agreed to commence the rollout of the booster programme, for
people 18 years of age and over  (CAB-21-MIN-0475 refers). Cabinet requested further
information be provided to Vaccine Ministers on the implications of the COVID-19 booster
INFORMATION
programme for:
a.  the definition of ‘fully vaccinated’ (maintaining vaccination status)
b.  vaccine passes, and
c.  the COVID-19 Response (Vaccinations) Order 2022 (Vaccination Order).
OFFICIAL
3.
When Vaccine Ministers met in late January 2022, discussion was held regarding when it
would be reasonable and practical to include COVID-19 vaccine booster doses (boosters) in
the  “definition of fully vaccinated”.  T
THE  his paper provides the further information that was
sought at that time and sets out the implications of any future decision for Ministers to
consider.
4.
This paper discusses the broad public health aims of requiring boosters as well as the practical
implications that would flow f
UNDER rom any future decision. These include implications for vaccine
passes, international arrivals, Vaccination Orders, international travel certificates and vaccine
supply.
5.
It includes up to date advice from the COVID-19 Vaccination Technical Advisory Group (CV
TAG) on whether there is scientific evidence to support a decision to require boosters in
further  vaccination requirements. CV TAG has expressed the view  any extension of the
requirement for a booster dose beyond those already covered by Vaccination Orders would
RELEASED
require a change to the intent of requirements (away from reduction of transmission) in order
to be justified.
6.
It also sets out options for My Vaccine Pass implementation, should boosters be required,
and considers options for international arrivals and people on alternate vaccine pathways.
7.
The Department of Prime Minister and Cabinet (DPMC) is currently undertaking a review of
the use of My Vaccine Passes (MVP) the details of which the Minister for COVID-19 Response

Appendix 1
will report back to Cabinet on in early March 2022. The outcome of the review wil  support
any decision to include boosters in further vaccination requirements, and the Ministry wil
provide advice immediately fol owing the report back on the review, to help support that
decision.

Recommendations
We recommend you:
a)
Note that in November 2021 Cabinet agreed to commence the rol out

1982
of the COVID-19 booster programme and requested further information
be provided to Vaccine Ministers on the implications of the programme
on the definition of “fully vaccinated”, vaccine passes and Vaccination
ACT
Orders. Following this in late January 2022, Vaccine Ministers requested
further information to support considerations of including boosters in
vaccination requirements.
b)
Agree to a recommendation from the Ministry of Health (the Ministry)
Yes/No
that we  shift  away from  a set definition of ‘fully vaccinated’ against
COVID-19, to focus on ‘maintaining an up-to-date vaccination status’.

INFORMATION
c)
Note  CV TAG has expressed the opinion that extension of the

requirement for a booster dose beyond those already covered by
Vaccination Orders would require a change to the intent of
requirements (away from reduction of transmission) in order to be
justified.
OFFICIAL
d)
Note that should Vaccine Ministers decide in future to require boosters

to maintain vaccination status, the Ministry recommends current
vaccine passes continue to be valid until their current expiry date, but
THE
with new passes made available as people become due their booster
dose (or available as soon as the system changes are in place for those
who already have received their booster – proposed to be in place by 1
April 2022).  UNDER
e)
Note the Ministry’s Data and Digital team has begun the work necessary

to prepare  the My Vaccine Pass system to recognise boosters and
produce renewed passes, acknowledging this may not be required.
f)
Note CV TAG has expressed a strong view that no vaccine requirements

(formal or informal) should be applied for those under 18 years of age.
RELEASED
g)
Note  the addition of a booster requirement to maintain a valid My

Vaccine Pass, wil  not impact affected workers under the Vaccination
Order as these workers are already required to receive a booster.

Appendix 1
h)
Note that now Omicron is established as the dominant strain circulating

in New Zealand,  the rationale for more stringent requirements for
international arrivals has weakened, and  any changes to vaccination
requirements for arrivals to New Zealand must consider the domestic
context, be evidence based, proportionate and justifiable.
i)
Note the COVID-19 Vaccination and Immunisation Programme (CVIP)

continual y updates the forecasts and modelling on vaccine supply and
will continue to keep Vaccine Ministers updated.
j)
Note the Ministry wil  continue to consider the most appropriate way

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to manage people on alternative  vaccination pathways,  and work to
have options developed for Vaccine Ministers to consider, should any
decision be made to include boosters in vaccination requirements.
ACT
k)
Note  the Ministry wil  provide further advice to support decision

making, to Vaccine Ministers in early March 2022, once the Department
of Prime Minister and Cabinet reviews of the use of My Vaccine Pass and
the COVID-19 Protection Framework are complete.
l)
Note the information provided here is relevant and up to date at this

time, but as the situation could change rapidly, different or additional
INFORMATION
considerations may need to be taken into account by the time the
DPMC review is complete.
m)
Note officials are available to meet to discuss the contents of this paper.

OFFICIAL

THE

Dr Ashley Bloomfield

Director-General of Health
UNDER

Hon Grant Robertson
Ministry of Health

27/02/2022
Date: 18 February 2022


RELEASED

Appendix 1
Requiring COVID-19 vaccine boosters  to maintain
vaccination status in the New Zealand context
Background
8.
The Omicron variant of COVID-19 is now spreading in New Zealand communities and has
been established as the dominant variant circulating. We are currently in the second stage of
our Omicron response strategy, where cases are continuing to be confined as much as
possible, but numbers are increasing rapidly. High uptake of COVID-19 vaccine booster doses
will  help  to  reduce  the number of people with symptomatic il ness, those who require
1982
hospitalisation, and the burden on the health system.
9.
The Government has utilised a number of tools to manage the spread of COVID-19 over the
ACT
course of the pandemic. Tight border settings, domestic restrictions and public health
measures have served us well. More recently high uptake of vaccinations has been critical to
maintain our low hospitalisation and death rates, relative to other countries. With the borders
beginning  to re-open this month, and with the Omicron variant established in the
community, we must continue to adapt our response to the changing circumstances.
10.  As at 14 February 2022, 94 percent of the eligible population have completed a primary
course of a COVID-19 vaccine schedule, and  approximately  61  percent  of the (currently)
eligible population have received a booster dose.
INFORMATION
11.  International studies show that vaccine induced immunity against symptomatic illness (from
the Pfizer and Moderna vaccines), wanes from three to four months after completion of a
primary course, and particularly by six  months. Booster doses of Pfizer  (and Moderna)
vaccines have been shown to lift vaccine induced immunity again to provide levels of
protection that significantly reduce hospitalisations and death, including from the Omicron
variant.
OFFICIAL
12.  This paper provides advice on the implications of including a booster in further vaccination
requirements and provides options for implementation should Vaccine Ministers decide to
THE
require boosters to maintain up-to-date vaccination status.
Comment
Replacing the term “ful y vaccin
UNDER  ated” with “maintaining up-to-date vaccination status”
13.  International y recognition is growing that referring to being “fully vaccinated” against
COVID-19 is no longer helpful in an environment where an ongoing COVID-19 vaccination
programme may be required. For example, Australia wil  replace the term ‘fully vaccinated’
with ‘up to date’ in respect of COVID-19 vaccination status for domestic use. The date of
entry into force has  not yet been determined but “by the end of March” has been
recommended by
RELEASED   ATAGI.
14.  For the purpose of the New Zealand context, the Ministry recommends a shift away from a
set definition of “fully vaccinated” against COVID-19, to a focus on “maintaining up-to-date
vaccination status”.
15.  This shift wil  help future decisions on updates to vaccination requirements to remain flexible
and help to communicate that vaccination against COVID-19 is not an end point, but a

Appendix 1
potentially  ongoing vaccination programme. Additionally, “vaccination status”  is more
inclusive of people who are exempt from COVID-19 vaccinations, or who require different
dose or vaccine schedules.
16.  We seek agreement from Ministers that we shift away from a set definition of “fully
vaccinated” against COVID-19, to focus on “maintaining up-to-date vaccination status”.

With  arrival of the Omicron  variant, boosters  are  intended to maintain population
protection and minimise its spread
17.  In line with the aims of the Government’s COVID-19 Protection Framework (CPF), the intent
of the booster programme is to keep the spread of COVID-19 and hospitalisations as low as
1982
possible, protect people from the virus, minimise  significant health impacts,  and support
infection prevention and control. Vaccination, including boosters, is a key tool in the CPF.
ACT
18.  The arrival of the Omicron variant has required us to respond rapidly, and to do everything
we can to increase booster uptake to help maintain population protection and to protect our
most vulnerable, particularly as we have moved away from the elimination strategy to one
where we aim to minimise the impacts of COVID-19 in our communities.
19.  Cabinet’s recent decision to reduce the dose interval for a booster, to three months from
completion of a  primary  vaccine  course,  demonstrates the need for the vaccination
programme to be agile and responsive, and introducing a requirement for booster doses
would support the intent of that decision.
INFORMATION
20.  However, we need to consider whether introducing further booster requirements (beyond
those already in place for affected workers under the Vaccination Order) is strictly necessary
to achieve the overall public health aims as outlined above.
21.  As the Omicron variant spreads throughout the community and more and more people are
exposed, infection induced immunity becomes an addi
OFFICIAL tional factor to consider.

CV TAG has expressed the view that intr
THE oducing a booster requirement to maintain an up-
to-date vaccination status would be difficult to justify
22.  The Ministry has received advice from CV TAG this week as follows.
23.  CV TAG’s view is that vaccine mandates, vaccine passes, and different isolation/testing
UNDER
requirements for arrivals to New Zealand have been previously justified through the
protection of others mainly via a reduction in transmission.
24.  The Omicron variant is highly transmissible, and vaccination (primary course or booster)
appears to provide less protection against infection with Omicron than against previous
variants.1 This is important because protection against infection is one way a vaccine can
reduce transmission. There are no data currently available about whether the vaccine
prevents or red
RELEASED uces onward transmission of Omicron once a vaccinated person is infected,
which is the other way a vaccine could reduce transmission.
25.  However, data to date shows that protection against symptomatic and severe disease caused
by Omicron is restored (to levels similar to or higher than a primary course) after a booster.
1 COVID-19 Omicron Update – 03 February 2022.

Appendix 1
This wil  result in increased personal protection for vaccinees against il ness and could
potential y reduce strain on the healthcare system at the peak of an Omicron wave if a
substantial number of people are boosted.
26.  Additionally, it is anticipated that in the coming weeks, many people will be infected with
Omicron and this is likely to produce an immunological boost in these people.
27.  Because of these issues, CV TAG has expressed the opinion that introducing boosters to
maintain up-to-date vaccination status would be difficult to justify on the basis of a reduction
of transmission. They consider any extension of the requirement for a booster beyond those
already covered by Vaccination Orders would require a change to the intent of requirements
(away from reduction of transmission) in order to be justified.

1982
There are a number of interconnected implications of any decision to require booster
doses to maintain up-to-date vaccination status
ACT
28.  Decisions on whether to introduce, and when to introduce a booster requirement to maintain
vaccination status, is not straight forward and has a number of interconnected implications:
  Managing the validity of vaccine passes – including for those under 18 years of age
(noting the passes’ central role in the COVID-19 Protection Framework).
  Interactions  with  requirements for international arrivals  and the timing of the
Reconnecting New Zealand (border opening)  stages  (and meeting international
vaccination certificate requirements)
INFORMATION
  Ensuring any new requirements are no more burdensome than the worker mandates
under the Vaccination Orders, and
  Securing vaccine supply – ensuring we have adequate supply of the right vaccines to
meet demand.
OFFICIAL
29.  Each of these implications are discussed below.
Implications for COVID-19 Vaccine Passes
THE
30.  The Department of Prime Minister and Cabinet (DPMC) is undertaking a review of the use of
My Vaccine Passes (MVP) the details of which the Minister for COVID-19 Response will report
back to Cabinet on in early March 2022. This review wil  cover the immediate operational
chal enges of the use of the pass system, focussing on key themes and issues related to the
UNDER
operation of MVP to date and whether there are changes that could be made, either to the
passes themselves or the policy surrounding their application, to address these concerns.
31.  DPMC is also undertaking a broader review of the CPF. As part of this review, the future use
of MVPs wil  be considered. Drawing on information from the above-mentioned preliminary
review, and latest public health advice, DPMC wil  assess whether restricting freedoms based
on vaccination status continues to be a justified and proportionate element of our COVID-19
RELEASED
response.
32.  Vaccine passes have served a public health purpose up until now to help prevent the spread
of COVID-19 and to support the COVID-19 Vaccine and Immunisation Programme (CVIP) to
achieve population protection.

Appendix 1
33.  With a now highly vaccinated population, consideration needs to be given to whether vaccine
passes are stil  serving their intended purpose. The DPMC reviews, informed by ongoing
advice from the office of the Director of Public Health, wil  help support these considerations.
34.  The current passes expire starting  from mid-May, and all of them by 1 June 2022. The
pandemic has taught us the situation on the ground can change rapidly and our response
must remain agile. For that reason, we recognise that by mid-May the situation we are facing
may be quite different. We may be facing a new variant, or we may be seeing the end of the
Omicron ‘wave’, with the need for vaccine passes fal ing away.
35.  Equally, with Omicron currently spreading rapidly in the community we anticipate there may
be a need to re-new the passes, and therefore work is required now to prepare for renewal.
1982
System changes will be needed should boosters be included which will require a ‘newer version’ of
vaccine passes
ACT
36.  The MVP system can be updated to recognise booster doses and auto-generate a new pass
to  be downloaded, auto emailed, or  retrieved  through assisted channels (cal  centres or
vaccination sites).
37.  A minimum viable product with changes for a ‘new version’ of a My Vaccine Pass could be
put in place within two weeks of a decision being made to proceed (note preparations have
already begun as noted below). This would include minimal visual changes to the pass to
support visual verification and changing the ‘system rules’ which will shift the pass expiry to
align with any new rules related to boosters.
INFORMATION
38.  Learnings from the launch of My Vaccine Pass allow us to see the greatest chal enge will be
getting the population through the renewal process without overloading the system and
causing frustration.
39.  There are two options for implementation of the ‘new version’ of the vaccine passes.
OFFICIAL
  Option one [recommended]: new version of passes will be issued or accessible based
on the new rules and wil  be delivered to phase out or replace current passes once
they reach their current expiry
THE  dates – either mid-May or 1 June 2022).
  Option two: require passes to be expired earlier than their current expiry dates, with
the new version of passes to be requested/reissued with new expiry function based
on the ‘new rules’ outlined above.
UNDER
40.  The Ministry advise the public would require 3-4 weeks to replace their vaccine passes once
available. This would give people time  to get  their  booster  dose,  and then request  and
download the ‘new version’ of the pass. This would also al ow for support services to be in
place for those who require assistance to access a new pass.
41.  This would also allow time for a public communications campaign to explain the updated
system and requirements, and time for businesses to update their systems, especial y those
who have integr
RELEASED  ated the vaccine pass verifying scanner into their own operating systems.
42.  A total of 5-6 weeks is estimated to enable al  changes and embed the new passes, which wil
require a reprioritising of resources.
43.  When My Vaccine Pass was released people had just 17 days to get their pass before the
traffic light system began, which created significant chal enges for the Ministry and a certain
level of anxiety among the public.  Therefore,  should a decision be made to introduce a

1982
ACT
INFORMATION
OFFICIAL
THE
UNDER
RELEASED

Appendix 1
53.  Should booster doses become a requirement to maintain vaccination  status,  the
requirements for 12 to 17-year-olds would need to be different from those for 18 years and
over (i.e requirements for 12-17 would remain as they are).
54.  Differentiation of pass types will  add complexity to the current service and would take
additional time to develop and implement.
55.  Booster requirements international y vary, but at this stage most countries are not requiring
booster doses for 12-17 year olds. A handful of countries such as Australia have approved
booster doses for 16 – 17-year-olds, and the United States and Israel have approved the use
of boosters in 12-18 year olds.
Additional issues with vaccine pass renewal - and potential solutions
1982
56.  As outlined above, the situation for 12-17 year olds with regard to vaccine passes is not
straight forward. Consideration needs to be given to whether the public health rationale
ACT  for
requiring vaccine passes is still relevant for 12-17 year olds.
57.  Should the decision be made to require boosters and renew vaccine passes, one potential
solution for the 12-17 age group would be to maintain passes for them with a rolling expiry
in case the vaccination requirements for this age group change in the future.
58.  A further concern is how to manage the expiry of passes for the cohort of people who wil
already have reached six months since their booster when the current passes expire on 1 June
2022. Many border and health care workers received booster doses in November 2021, and
INFORMATION
many others, including many over 65-year-olds will reach six months since their booster by
the end of June 2022.
59.  This means a large cohort of people could have a very limited expiry on any new passes.
There is stil  very limited evidence and data on providing a second booster dose, and few
countries are doing so.  Therefore,  rolling out second doses of boosters is not currently
planned.
OFFICIAL
60.  One solution for this problem would be to provide an automatic 90-day extension to those
passes that would auto-generate and
THE   take them through to September 2022. This would
provide time to gather further evidence and data to support any future booster decisions, or
alternatively by September (with the peak of Omicron infections having passed), the need for
vaccine passes may have fal en away.

UNDER
Implications for Vaccination Orders
61.  On 20 December 2021  Cabinet agreed to an amendment to the COVID-19 Response
(Vaccinations) Order 2022 to require affected workers under the Order to receive a COVID-
19 vaccine booster dose by 6 months from completion of their primary vaccine course.
62.  The addition of
RELEASED  a booster requirement to maintain a valid My Vaccine Pass, will not impact
affected workers under the Order as these workers are already required to receive a booster
dose. Some employees have used their My Vaccine Pass to provide evidence of vaccination
to employers, but they can also use other methods such as showing employers their My
Covid Record, providing a letter from their General Practitioner,  or some employers are
utilising the COVID-19 Immunisation Register to verify employee vaccination status.

Appendix 1
63.  It is important that should the booster requirement be extended to the wider public, that the
requirements are no more burdensome than those for affected workers as set out in the
Order.
Implications for international arrivals
64.  On 20 January 2022 DPMC provided the Minister for COVID-19 Response with advice on
implementing a booster requirement for international arrivals in light of the sharp increase
in cases being detected at Managed Isolation and Quarantine (MIQ) via the air border, and
to further mitigate the risk of Omicron entering the community. [DPMC-2021/22-1201 refers].
65.  The advice noted that any strengthening of vaccination requirements for arrivals would need
1982
to be justifiable and proportionate. It would need to weigh up the likely public health benefits
against the ability of travellers being able to meet the requirements and operational
chal enges of verifying the booster requirement.
ACT
Globally boosters are not widely available, and exemptions will need to be in place if boosters were to
be required for international arrivals
66.  As booster programmes are not yet widely available global y, there would also need to be an
exemptions system in place which would have disproportionate impacts on travellers from
some countries. Information compiled by the Ministry of Foreign Affairs and Trade (MFAT)
suggests there are only 77 jurisdictions where it could be reasonably considered that there is
access to a primary course of vaccination and where booster programmes have s
INFORMATION tarted to be
rol ed out. A booster requirement would also impact arrivals from some Pacific countries,
most of which are stil  focused on rol ing out primary courses to their populations.
67.  Limited access to booster programmes would prove even more chal enging for any New
Zealanders needing to travel to New Zealand at short notice, and for those travelling from
countries where the systems and procedures for  recording of booster doses on existing
OFFICIAL
certificates are not established.
The rationale for more stringent requirements for international arrivals has weakened as community
THE
cases of Omicron escalate
68.  There is currently no data on the effectiveness of boosters for the vast majority of vaccines
on the approved list for arrival to New Zealand. If a booster was to be required, it would need
to be defined for each of the a
UNDER  pproved vaccines (currently 33) in the context of the Omicron
variant, including the timing and number of doses, consideration of heterologous (mixed)
schedules, and the impact of previous infection.
69.  Instead, officials recommended that consideration be given to introducing a requirement for
a maximum interval between a final primary course or booster and arrival in New Zealand.
70.  The Minister for COVID-19 Response considered the briefing on 29 January 2022, but did not
RELEASED
sign any recommendations, instead noting “…it will be hard to justify boosters for CVC access
but not for people visiting New Zealand. If equity of access is the issue, could we require boosters
within a window of arrival?”
71.  Over the past three weeks the domestic  situation has changed considerably, and Omicron is
now established as the dominant strain circulating in New Zealand communities. This means
the rationale for more stringent requirements for international arrivals has weakened as

Appendix 1
community cases escalate. It is important that any changes to vaccination requirements for
arrivals to New Zealand consider the domestic context, are evidence based, are proportionate
and are justifiable.
72.  In terms of  managing different vaccination schedules  and booster requirements for
international arrivals, CV TAG have advised that evidence of three doses of a World Health
Organisation (WHO) listed vaccine should be adequate to meet the ‘boosted’ standard in the
New Zealand context.
73.  The requirements for international arrivals are being kept under review and further advice
wil  be provided to Ministers in due course.
Implications for COVID-19 vaccine supply
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74.  Booster uptake is now well established and is running at 61 percent of eligible people (as at
ACT
14 February 2022).
75.  The COVID-19  Vaccination and Immunisation Programme (CVIP)  continual y updates the
forecasts and modelling, and currently estimates a potential supply gap from March 2022 of
up to 115,000 doses as well as continued supply pressure in the first half of 2022.
76.  On 1 February 2022, Vaccine Ministers agreed to work with Pfizer to bring forward delivery
of 1.25 million doses into the first quarter, and an additional 0.25 million doses in the second
quarter (meaning 1 million doses will be delivered in the second quarter). Fol owing further
advice on the amendment agreement, the Director General of Health wil  be invited to sign
INFORMATION
the agreement.
77.  There wil  be a two-week period when availability of Pfizer across New Zealand is under
300,000 doses (average 162,000 doses). This may pose an operational risk of slowing the
administration of the programme.  However, the programme is able to mitigate this by
managing central distribution of stock, monitoring doses per vial utilisation, and through the
OFFICIAL
timing of our donations to countries in the Pacific region.
78.  Further advice wil  continue to be provided to Vaccine Ministers to manage New Zealand’s
potential COVID-19 immunisation need
THE  s in 2022.
Implications for people on alternative vaccination pathways
79.  The ‘typical’ vaccination pathway of a two or three dose primary course with subsequent
UNDER
booster, utilising the Pfizer vaccine, may become chal enging to complete for an increasing
number of the population who need more flexibility.
80.  This need for flexibility primarily reflects their clinical characteristics, such as experience of
COVID-19 infection between vaccinations, serious adverse event, or pre-existing clinical
condition. In these situations, specialist clinicians may reasonably recommend reduced doses,
alternative vaccines, extended dosing intervals, or that future COVID-19 vaccines are contra-
indicated altoge
RELEASED  ther.
81.  The need to accommodate alternative pathways wil  also become more pressing as increasing
numbers of people vaccinated overseas come into the country. In addition, we want to ensure
we support New Zealanders to contribute to our vaccine clinical trials occurring here.
82.  Currently a proportion of these scenarios are managed through a Temporary Medical
Exemption panel. This may not be the appropriate mechanism to manage the scale and

Appendix 1
complexity of these alternative pathways, and the variety of scenarios that may be presented.
Other options would be to support an individual’s clinician to make an assessment around
vaccination requirements (with or without oversight from the Ministry), or to expand the
current Ministry of Health medical exemption framework and infrastructure.
83.  The Ministry will continue to consider the most appropriate way to manage alternative
vaccination pathways and work to have options  fully  developed  for Vaccine Ministers to
consider should any decision be made to include boosters in vaccination requirements.
Looking ahead and managing vaccination requirements beyond the next
six months
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84.  As the pandemic wears on the social licence to maintain public health and vaccination
requirements wil  likely wane. The DPMC reviews wil  help to provide insights on public
acceptance of continued use of the MVP system to manage people’s vaccination status ver
ACT sus
effectiveness to maintain population protection.
85.  Consideration needs to be given to the social license risk to the policy intent of the
vaccination programme, and the resource risk to the ongoing  management of the
programme.
86.  Additional y, continual amendments to regulations such as the Vaccinations Order may not
be sustainable and a modified method of updating requirements as we respond to any
further COVID-19 variants and each new stage of the pandemic may be required.
INFORMATION
87.  There is evidence to suggest that the next variant of concern may come from a country with
high immunocompromised rates and low vaccine coverage.  As we race to maintain high
vaccination coverage domestical y, we also need to consider global vaccine inequity and that
it has a direct impact on New Zealand’s own interests to end the pandemic.
88.  Advice is being prepared for Vaccine Ministers on any potential setting changes that may be
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required under Phase 3 of the Omicron response strategy.
Human Rights
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89.  This paper does not seek any decisions but provides an update on the further advice being
sought and further considerations being undertaken. Any consideration of requiring booster
doses domestically to maintain vaccination status will have human rights implications similar
to those considered under the
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90.  Whether or not a booster requirement is placed on non-citizens before they are able to come
to New Zealand, no human rights issues arise. Non-citizens do not have a right to enter New
Zealand, and they do not have rights under the New Zealand Bil  of Rights Act 1990 (BORA)
until they get to New Zealand.
91.  If a booster requirement was put in place, non-citizens could not be forced to be vaccinated
if they managed
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medical treatment, affirmed by section 11 of BORA. However, it would likely be a justified
limit on that right to deport anyone who attempted to enter New Zealand without meeting
such a requirement, given the importance of avoiding the creation of outbreaks in New
Zealand that would have the potential to overwhelm the healthcare system.

Appendix 1
Equity
92.  Eligibility and access to boosters will be a key consideration of any discussion regarding
including booster doses in the requirements to maintain vaccination status.
93.  Current experience from the CVIP shows that additional levers are required for Māori and
Pacific peoples to achieve the same vaccination targets as non-Māori, non-Pacific people.
94.  CVIP  has highlighted that the factors below are key to contributing to equitable vaccine
uptake by Māori and Pacific people:
a.  access to vaccinations,
b.  access to trusted information sources to mitigate misinformation, and
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c.  Māori health and Pacific health providers are well resourced and supported by their
District Health Boards (DHBs) to deliver to their communities
ACT
d.  Non-Māori and non-Pacific health providers working to achieve equitable outcomes
in their community and supporting a whānau ora approach.
95.  We know that historical y Māori and Pacific have been disproportionately affected by vaccine
preventable diseases and that in general, Māori and Pacific peoples have low vaccination
rates.
96.  Including boosters in the requirements to maintain COVID-19 vaccination status may have a
positive  effect  by  protecting  Māori  and  Pacific  people,  who  are  in  roles  affected  by  the
Vaccination Order.
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97.  This change may indirectly protect people at high-risk of contracting COVID-19 such as
tamariki and rangatahi who are not or yet to be vaccinated; particularly given the young
demographic of Māori and Pacific people.
98.  There may also be employment implications for Māori and Pacific peoples if not boosted as
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termination of their job wil  lead to loss of income, and in some cases this would be the sole
income for the household.  THE
Te Tiriti o Waitangi implications
99.  In considering booster dose requirements, we need to be clear about how we would be
protecting Māori to honour our Te Tiriti o Waitangi (Te Tiriti) obligations. We can use the Te
Tiriti principals to guide this w
UNDER  ork.
a.  Tino rangatiratanga
b.  working in partnership with iwi and Māori health stakeholders particularly as they
would have insights into issues and improvements to vaccine uptake for Māori.
c.  It is likely that an amendment to include boosters to the fully vaccinated definition
wil  support health system resilience, minimise community outbreaks and any
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associated ‘Red Light’ setting restrictions. This is critical to minimising and addressing
existing inequities and is consistent with Te Tiriti principle of active protection.
d.  Equity by ensuring that no changes would impose on the existing leverages made to
achieve equitable vaccine uptake for Māori.

Appendix 1
100.  As COVID-19  has  more  disproportionate  effects  on  Māori,  it  is  important  that  there  is
targeted support for Māori in the domestic booster vaccination campaign, particularly in light
of Omicron and the higher risk of transmission.
Next steps
101.  The Ministry is working on further advice to support decisions on whether to require COVID-
19 boosters to maintain up-to-date vaccination status.
102.  The Ministry wil  continue to prepare for a renewal of vaccine passes, (understanding they
may not be required) pending  any  decision to require boosters to maintain up-to-date
vaccination status.
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103.  The  Ministry will also  continue to develop options to manage alternative vaccination
pathways, and work alongside DPMC to provide options for international arrivals.
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104.  We will provide further advice to Vaccine Ministers in early March 2022, once the DPMC
reviews referred to above are complete.
ENDS.

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