A coalition of Māori health organisations in Auckland is urging the New Zealand government to return to a covid-19 elimination strategy, saying many Māori will die if it does not.
They say the government’s move to relax restrictions while the number of cases among Māori are rising and the vaccination rate is still low painted a picture of Māori as “acceptable collateral damage”.
The coalition of Hāpai Te Hauora, Te Whānau o Waipareira Trust, Te Hā Oranga and Raukura Hauora o Tainui said the elimination strategy had acted as protective korowai while the vaccination programme caught up, but it had now been dropped.
“That will no doubt result in loss of lives, with Māori being a major casualty,” they said in a statement.
The general manager of Ngāti Whatua provider Te Hā Oranga, Boyd Broughton, said he was incredibly frustrated with the way the pandemic was panning out.
Nearly two weeks after Auckland was moved to alert level 3, the number of cases was steadily growing.
Running vaccination centres
His organisation had been busy across Auckland, running vaccination centres, setting up mobile clinics, helping get in contact with hard-to-reach communities.
Things were catching up, he said, which was what made the shift especially frustrating.
“It’s very disappointing when there’s a shift from the elimination strategy to a suppression strategy and it comes at a time when Māori case numbers are rising, our vaccination rates are still lower,” Broughton said.
“So that’s why we’re left with the impression that Māori are an accepted collateral damage from this government, and this government making decisions.”
Health Minister Andrew Little rejected that assertion.
“No not at all,” he replied when asked on RNZ Midday Report.
“That’s why we have the level 3 restrictions in place for the length of time that we have in Auckland, and we went into level 3 for Waikato and Northland when we thought there were risks there.”
Selah Hart, chief executive of public health service Hāpai Te Hauora … “We want to ensure that … the system doesn’t turn its back on the forgotten people once again.” Image: Hapai te Hauora/RNZ
Elimination more equitable
But public health service Hāpai Te Hauora chief executive Selah Hart said trying to eliminate covid-19 would be more equitable, as suppression would still see the virus in vulnerable Māori communities.
“We as a country have missed many marks in being able to get us on track to ensuring that those who are always most underserved across any health statistics aren’t going to carry the weight of this pandemic on their shoulders,” Hart said.
Hart said it was particularly disheartening to see what Māori health experts had warned about for nearly two years being borne out.
“We want to ensure that those people don’t get forgotten about, that our communities that are now bearing the brunt of this thing are not forgotten about and that the system doesn’t turn its back on them once again,” she said, saying a familiar pattern of history was now repeating.
Broughton said he understood patience with the lockdown was wearing thin, and it was a feeling held by many Māori whānau too. But he said it would be different if there was better support for vulnerable whānau to be able to stay home.
Little said the government was putting significant effort into the vaccine rollout.
“We’ve seen an amazing surge of vaccinations for Māori and Pacific in the last couple of weeks,” Little said.
“That’s great, we want to continue that.”
Restrictions won’t be relaxed
He said restrictions won’t be relaxed further until the government saw sufficient levels of vaccination in all groups, including Māori.
But Broughton said he had little faith.
Māori health providers called for a different type of vaccine rollout early this year, but they were rebuffed and were now playing catch up. He said he had warned that static vaccine clinics would not reach Māori, and now they were having to play catch up with mobile clinics.
Now, he said Māori providers were being dumped in an avoidable catch-up position yet again.
“We raised these issues that where they’ve put things doesn’t work, how they’re delivering doesn’t work, the messaging doesn’t work.
“But the decision-makers are non-Māori and we’re having to tidy up, essentially.”
He was worried the government had buckled too early, putting whānau at great risk.
In the coalition statement, the head of Whānau o Waipareira Trust, John Tamihere, had a warning for the government.
“If Māori lives are lost because of this denial, we will take civil action in manslaughter,” Tamihere said.
This article is republished under a community partnership agreement with RNZ.
All 252 people reported to have died in Papua New Guinea from the covid-19 pandemic have been unvaccinated, says Health and HIV/Aids Minister Jelta Wong.
He also said that 99 percent of covid-19 patients in hospitals around the country were also unvaccinated.
He told Parliament yesterday that “100 percent of the patients are in critical care and requiring oxygen”.
“Official cumulative numbers of those affected by covid-19 stand at 23,365, with 252 lives lost,” he said.
“But the official figures are nowhere near the actual numbers in the provinces.
“Just like other developing countries which have [gone through] a third wave of the covid-19 delta variant surge, the undeclared number of infections and deaths is much higher.”
Wong said some people had died in villages.
Cause of death ‘likely unknown’
“It is unlikely that the cause of their deaths will be known and will not be recorded,” he said.
He said the healthcare system had been underfunded for decades and Papua New Guinea was still a developing country “facing the challenges of data collation”.
Wong pointed out that the increasing number of sick or dead people now was motivating many to get vaccinated.
“Demand is rising considerably,” he said.
“So much so that while a few months ago we had vaccines expiring, now the government [wants] to bring new doses before the end of the year.
“There is a significant amount of personal protective equipment distributed to the provinces.
“But the lack of visibility on usage and remaining stockpiles is proving a challenge and better data and feedback systems are being developed.
“It includes the Health Department building a dashboard to better monitor this data.”
The World Health Organisation (WHO) has developed guidelines on covid-19 therapeutics which is regularly updated, he said.
Miriam Zarrigais a reporter for The National. Republished with permission.
The plan for New Zealanders with covid-19 to isolate at home suggests the government believes the spread is wider than had been thought, epidemiologist Professor Rod Jackson says.
Covid-19 Response Minister Chris Hipkins said home quarantine would be introduced “fairly soon” as a necessary step to prevent MIQ spaces being limited even further for people coming to New Zealand from overseas.
“Last night, there were 75 unlinked cases in Auckland. What that means is there’s a lot more cases out there.”
He said the speed of the spread of delta variant makes this outbreak worse than any previous one.
“I think the government’s clearly signalling that MIQ is going to be overwhelmed, the next thing is hospitals are going to be overwhelmed, everything’s going to be overwhelmed,” he said.
“We’ve just got to got to slow it down as much as we can.”
‘Huge risks’ with home isolation
There were “huge risks” involved with home isolation, he said, “but to me, it suggests that … they believe this problem is much much wider than we thought”.
“We are in a race against time to get everyone vaccinated, we just have to use everything in our power to slow [the outbreak] down as much as possible.”
Dr Jackson said vaccination should be mandatory for more sectors.
“I think it has to be the police, it has to be supermarkets. The other thing is that businesses are crying out for the licence to introduce their own mandates.”
With more than 80 percent of eligible New Zealanders having had at least one vaccine dose he said “the tide was turning” against those who were not vaccinated.
Covid spreading among rule breakers Dr Jackson said he had supported the move to level 3 for Auckland last month, and believed returning to a period of level 4 lockdown may have little effect on the growth of cases.
“Covid is spreading among a group of people who are breaking the rules,” he said.
“You can be really hard on them, but you’re probably not going to ever stop them.”
University of Auckland public health associate professor Dr Collin Tukuitonga is sceptical level 3 had made little difference to the outbreak.
“That’s a very narrow view,” he said.
“The people who don’t obey the rules is only a subset of the total number of people who are likely to move around and spread the virus.
“Yes, these are people that are at most risk of spreading it but if you permit people to move around more than we did before you will no doubt transmit the virus around.
“I can’t see how you can say that level 3 and level 4 are the same risk.”
The drop to level 3 was premature and very risky for Māori and Pasifika where vaccination rates remain low, he said.
“I was on the record as saying tired Aucklanders and business people got the louder voice this time, and those of us in public health had a quieter voice.”
The government should be prepared to go back to level 4 if things got really tough, he said.
Home quarantine ‘not for everyone’ Dr Tukuitonga told Morning Report isolating at home would not be suitable for those living in crowded multigenerational households.
“It’s not for everyone,” he said.
“You’ve got to be quite clear about the criteria, you got to have a group of people you can trust to do the right thing, you need to make sure they have a good understanding of the risks, the facilities at home have got to be up to scratch.
“It can’t be a small state house with three bedrooms and 12 people.”
Dr Tukuitonga said anyone isolating at home must understand the risks involved, could be relied on to follow the rules, and have a suitable home.
He said some may think the move was risky, but it’s going to have to happen with cases growing.
“I know some of my public health colleagues will say ‘absolutely not, this is a highly, highly risky measure’, but as I say, you’ve got to be pragmatic,” he said.
“When we run out of facilities we’ve got to look at different options.”
This article is republished under a community partnership agreement with RNZ.
For me and many others in prison, COVID-19 has been an emotional roller coaster. The Delta variant wave is just one more ride. I made it through the first round, will I make it through this one?
I’m 53 years old and I’ve spent 35 years of life in prison. I’ve long since come to grips with the powerlessness that is every prisoner’s lot. But COVID has taken that powerlessness to another level.
Many of us don’t know if we are going to live long enough to finish our prison sentence no matter how short it is. The vaccine, for those of us who have gotten it, has reduced the risk of death drastically. Many haven’t gotten the vaccine due to lack of trust in the government. But I got it, because after what I have witnessed during the first wave, I felt it may be my only way to get out alive.
But that is not our only concern. An immediate concern now is how the New York Department of Corrections and Community Supervision (DOCCS) is going to respond to the new wave of the pandemic and what policies they are going to enact this time. Throughout the pandemic and long before that, DOCCS has lost trust through its actions. The pandemic only gave more proof of how cruel the prison system is.
COVID Exacerbates Abuse and Neglect of Incarcerated People
In prison, our medical care is subpar to begin with during the best of times. Since the pandemic started it has gotten much worse. The State of New York has used COVID-19 as an excuse to take away our rights and privileges as well as to abuse and assault prisoners. The state also refuses to provide necessary medical care, including in my own case.
I myself had two issues that needed addressing when the pandemic hit: a sebaceous cyst that was pushing against a nerve in my neck and was scheduled to be removed, as well as a molar tooth that broke off at the root. When the pandemic started, all outside appointments were canceled. Over 18 months later, I still have not received treatment for either issue despite multiple requests. I deal with constant untreated nerve pain and chewing my food is extremely difficult and painful.
My story is far from unique. Many people I have talked to have had their medical issues sidelined since the pandemic began. Since the Spring of 2020, all outside medical appointments and only the most immediate emergencies were seen in the prison hospital.
I am known as a guy who writes about what occurs in prison, so people talk to me about what is happening. In addition to medical issues, I hear about physical abuse at the hands of guards, which has increased as well. Neglect and physical assaults of prisoners by guards in New York State has been the worst that I’ve seen in the four states I’ve done time in over the past four decades.
In recent years, these assaults and deaths by lack of medical treatment have led to lawsuits and news stories that have brought attention to the issue. For example, in 2015, Samuel Harrell was killed in Fishkill Correctional Facility by guards known as the “beat up squad.” And more recently, Layleen Polanco died at Rikers while in solitary confinement, after the jail’s failure to treat her medical condition.
The state has placed more cameras in the facilities and mandated that body cameras be worn by some officers. The problem is that the guards know where the cameras’ blind spots are and who is wearing a body camera. They are then able to abuse people out of sight of the cameras, and I have witnessed this several times.
And I have also experienced abuse. I have been relocated to many different facilities throughout the state. The medium-security facilities are worse than the maximum-security ones. There are many more blind spots.
The main “beat down” spot in Franklin Correctional Facility is in the back of a van they use to take you to the box (solitary confinement). The driver takes the long way, and the guards in the back dump you on the floor (while you are handcuffed behind the back) and proceed to “tune you up.” This can include knees, feet, elbows and fists applied to your face, head and torso.
When it happened to me, they pulled my legs out from under me so I landed hard face first, taking most of the fall on my shoulder (by ducking my head and twisting), and then they kicked me once in the kidneys and left me there.
Maybe it was the gray in my beard and possibly my white skin that got me off light. I have heard about and witnessed the results of much worse attacks. When I was in Upstate Correctional, a special housing unit/restrictive housing facility, they put a kid in the cell next to me who had both eyes closed and what looked like a broken nose. He screamed when he used the bathroom to urinate.
As bad as you think you have it these days, try experiencing this crisis from a position where you had very little control to begin with, then having that stripped away entirely. There’s an old saying in prison: Shit runs downhill, and prisoners are at the bottom of that hill. At no time has that been clearer than now.
While things have gotten better since the vaccine was offered, DOCCS has continued to deny people basic rights and privileges. For a long time, there were no regular visits from family and friends or “family reunion visits,” which are overnight trailer visits with partners and kids. These are crucial for families to stay connected. As of September 2021, DOCCS has reinstated family reunion visits. But as a result of not having these visits for a year and a half, people had much less contact with loved ones, and this has led to increased tension, violence and mental health-related incidents.
I am very concerned about what this new phase of COVID will bring. While the Delta variant is much less deadly for those who are vaccinated, we can still get very ill if we catch the virus. Add to that the fact that a large number of people in prison are not vaccinated, partly due to the mistrust generated by DOCCS since the pandemic began.
So we will see what the next round has in store. I’m not optimistic. Just like everyone else in the world, we wonder: Will it ever end? Will I survive? But in prison, we are even more powerless to protect ourselves, especially since COVID is only one of the threats we face. We also contend on a daily basis with abuse from correctional officers and lack of medical care. The pandemic has only exacerbated the poor conditions that I’ve experienced for 35 years in prison.
More than 6 million vaccine doses have now been given in New Zealand, with the vast majority of those who have caught covid-19 during the current outbreak unvaccinated.
Speaking at today’s government briefing – where it was revealed there were 55 new cases today – Covid-19 Response Minister Chris Hipkins said three-quarters of the eligible population were either fully vaccinated or booked in to do so.
Hipkins said just three percent of those in the current outbreak were vaccinated.
He said the best thing people could do to protect themselves and their whanau was to get vaccinated.
The government announced that the current covid-19 alert level 3 response in parts of Waikato and Northland will remain for another five days.
Auckland continues to remain at step 1 of level 3.
Truck driver case
Meanwhile, the Health Ministry said the risk from an Auckland-based truck driver who travelled to Northland on Saturday and had tested positive for covid-19 was low.
At today’s briefing, Director-General of Health Dr Ashley Bloomfield said the case was currently being assessed to identify any exposure events.
He said the case investigation was still in the early stages, initial information suggested a limited scope of exposure in Northland, given alert level 3 precautions within the delivery sector.
“The person was there from 3am to 12pm delivering to a number of places most of which were closed because of alert level 3 arrangements there.”
New Zealand covid media briefing today. Video: RNZ News
Dr Bloomfield said My Covid Record is now accessible to the public via mycovidrecord.nz.
People over 16 years will be able to view their vaccination record on this website by creating a my health account.
“From later November people will be able to access two different types of vaccination certificates: one for use in New Zealand and one for travel overseas.”
Dr Bloomfield said people can also request the Ministry of Health for their vaccination status.
The numbers
There were 55 new cases reported today
Of the new cases, 29 were epidemiologically linked, 26 were yet to be linked
The government said that within three weeks the military could set up 10 intensive care units at the main Noumea hospital and treat between 30 and 60 people over several weeks.
In addition, an air bridge is being set up to France to transport five intubated patients and others needing care in order to relieve pressure on the Noumea hospital, where in the past month 1300 patients have been admitted.
An Aircalin airliner is being modified to carry out this mission.
About 90 percent of critical care units are in use amid concern that a second covid-19 wave is likely to sustain demand while the hospital needs to maintain capacity for patients suffering from other conditions.
Currently, 69 covid-19 patients are being cared for in hotels, mainly in Noumea but also in the Loyalty Islands.
Health pass now needed
The authorities eased restrictions at the beginning of this week while rolling out a health pass now needed to go to restaurants and museums or for domestic air and ferry travel.
They urge the public to be vigilant and prudent, saying the next days will be critical for how the pandemic develops.
Schools are being reopened today, with students obliged to wear masks.
There has been a rush to get the online version of the health pass, clogging and slowing the system producing it.
A demonstration against New Caledonia’s mandatory vaccination against covid-19 and against the health pass. Image: Clotilde Richalet/Hans Lucas/RNZ
However, there have also been demonstrations across New Caledonia against the introduction of the health pass.
The gatherings — sometimes exceeding crowd size limits — were held outside the Congress and government building in Noumea as well as at the SLN nickel plant.
So far 53 percent of those over the age of 12 have been fully vaccinated or just under 46 percent of the total population.
Medical personnel as well as airport and port workers must get vaccinated by year’s end or face a US$1750 fine.
This article is republished under a community partnership agreement with RNZ.
As New Zealand switches from elimination to suppression, those who argue that covid-19 will become endemic and part of our lives either do not understand or ignore what this would actually mean.
Elimination has always been a tricky word because it implies eradication. But we have only ever eradicated one human disease — smallpox — and are close with several others.
For some, the end of elimination now means we should let the virus spread. But semantics matter less than policy.
If we don’t eliminate, we must still aim to contain, mop up, reduce close to zero and thwart this pandemic.
Because we certainly cannot live with endemic SARS-CoV-2.
The delta variant spreads ominously and without controls, every infected person, on average, would infect six more, then 36, 216, 1296, 7776, 46,656 — we would get to more than twice New Zealand’s five million with three more cycles.
“Once the virus gets out and starts spreading, if you struggle to contain it… it will find the most vulnerable communities, and once it makes its way into those communities it’s really hard to stop it,” Chris Hipkins told the guardian https://t.co/Z6bkiTY43M
We must continue to either stamp out the virus or keep case numbers very low. To contain case numbers, we need to keep up border protection, mask wearing, distancing, bubbles, contact tracing, testing of people and waste water, and vaccination.
Delta is nothing like the flu Our most common endemic infections include the common cold (caused by hundreds of different viruses that circulate freely) and the flu (caused by a group of influenza viruses).
Those who dismiss a mild case of covid-19 as being “no worse than the flu” have forgotten how appalling a case of flu really is. They might also have forgotten that, even with effective vaccination, influenza has a case fatality risk of about 0.1 percent — it kills about 500 people in New Zealand each year.
Yet some seem to expect that covid-19 will learn to behave and become endemic. Some even seem to welcome this, claiming a “disease becomes endemic when it is manageable”.
This is not true. Being manageable is not part of the definition of endemic disease. A disease becomes endemic when it is more or less always present in a population. It does not care whether it is manageable.
Seasonal influenza has a basic reproduction number (R0) of about 1.5, meaning one infected person spreads the disease to fewer than two other people, on average. This is why it takes very little to break the chain of transmission.
The annual flu epidemic declines because we have effective vaccines and because seasonal conditions during summer are less favourable to the survival of the virus.
However, as we already mentioned, the delta variant has an R0 of at least six. This will be as low as it gets from here onward. If a new variant supplants delta, it will do so because it is even more transmissible.
There will be no season for covid-19, no breaks in transmission, no declines in infectiousness. We have been struggling worldwide with this virus for 18 months, with spikes everywhere in every season.
School and business closures part of new normal If covid-19 becomes endemic, there will not be one or two people sick in a workplace or a home. We will have waves and clusters and multiple local outbreaks.
Schools and businesses will close for days, even weeks, because too many people are sick. It will cost the world trillions — consider what it has already done to global supply chains.
If covid-19 becomes endemic, the burden on our healthcare system will be immense. It will not involve a predictable, modest increase in hospital admissions. Waves and clusters will characterise endemic covid-19 in the same way they have characterised pandemic covid-19, overwhelming local healthcare without warning.
New: The Government hasn’t increased its surge contact tracing capacity since the start of the outbreak, despite the move to suppression, and daily cases in the low triple digits could see the tracing system overwhelmed.https://t.co/6ymqvcmcD7#nzpol#Covid19#Covid19nz
— Marc Daalder Wear a Mask, Scan QRs, Vaccinate (@marcdaalder) October 10, 2021
If covid-19 becomes endemic, Merck’s new antiviral drug Molnupiravir will be an important addition to the toolkit because it will be much cheaper than monoclonal antibodies, easy to store, easy to transport and people can take it at home.
The as yet unpublished trials suggest the treatment could cut hospitalisations in half, markedly improving outcomes for those already infected. But it will not reduce the number of cases by even one.
Treatment never does — only prevention, public health measures and vaccination reduce case numbers. Those who are less sick and treated at home could spread the virus even more.
If covid-19 becomes endemic, when the healthcare system fails to accommodate the latest wave, more people will die.
Long-term costs to health and economy Even if we managed to get covid-19 down to the severity of influenza (for an individual), endemic delta — with an R0 about five times that of flu and the fully vaccinated still able to become infected and spread — would still mean thousands of hospitalisations and deaths each year.
Just four cycles of delta infection could result in more than 250 times as many cases as four cycles of flu.
If covid-19 becomes endemic, every year, many of us will know someone who dies.
If covid-19 becomes endemic, more than a third of unvaccinated cases, even the asymptomatic, will have symptoms months later.
Flu leaves little lasting damage. Long covid damages the lungs, heart, brain, hearing and vision as well as the insulin-producing cells of the pancreas, causing diabetes.
The cost of covid-19 is so much higher than that of the flu, not just because of higher case numbers, hospitalisations and deaths, but more long-term damage and disability.
If covid-19 becomes endemic, we will live with a stressed, often overwhelmed healthcare system, with schools subject to unpredictable closures, with unsafe workplaces, with a disrupted economy, with our children under threat, with death and disability at a persistently higher level than we have known — probably for decades.
We do not care what the current strategy is called as long as we persist with border protection and public health measures until we achieve close to universal vaccination.
Otherwise, many thousands of New Zealanders will be hospitalised, die or experience long COVID.
Ultimately, we will need a sterilising vaccine (one that protects people from getting infected) because we cannot live with endemic covid-19.
If New Zealand’s border restrictions are loosened for arrivals from countries with high covid-19 numbers, South Auckland will see between 1000 and 1400 cases a week — even if vaccination rates get to 90 percent, according to modelling carried out by the Counties Manukau District Health Board (DHB).
Under the modelling prepared for the DHB, if strong border controls and public health measures remained in place and the vaccination rate reached 90 percent, the Counties Manukau region would see only 40 cases and one hospitalisation per week.
This number jumps to 200 cases per week if vaccination rates reach only 80 percent.
The scenario gets grimmer for South Aucklanders if border and public health restrictions are lifted.
The DHB’s modelling shows there will be at least 1000 cases and 30 hospitalisations per week with a 90 percent vaccination rate, or 1400 cases and 45 hospitalisations if vaccination rates reach only 80 percent.
Given rates remain well below 80 percent in much of South Auckland, University of Auckland public health associate professor Dr Collin Tukuitonga said the modelling was too conservative.
“I think the vaccination rates are too ambitious and I think we will probably get more cases than 1000 a week,” Dr Tukuitonga said.
“And as a result, it will have a greater impact on Māori and Pacific people. This could get totally out of control – in terms of what we’ve experienced in New Zealand up to now.”
Pressure already immense
The pressure on Middlemore Hospital was already immense given “Māori and Pacific are most affected by the inequities in our society”, Dr Tukuitonga said.
Dr Collin Tukuitonga … “The problem for Middlemore is that they are already stretched to their full capacity, even without covid.” Image: SPC
“If the government loosens public health measures, there will be more cases, and that’s the risk people need to be aware of.
“The problem for Middlemore is that they are already stretched to their full capacity, even without covid, as they are underpowered to serve the population size that exists within Counties Manukau.”
At the opening of a mobile vaccination bus last month, Counties Manukau Health Chief Executive Margie Apa said the hospital had already been working hard to increase its capacity for covid-19 patients.
“We have done quite a lot of preparatory work to increase our ICU [intensive care unit] and high-dependency units,” she said.
“But what that does do is take bed stock out of being able to look after the rest of our non-covid patients.”
According to a DHB spokesperson, the hospital has 18 intensive care unit (ICU) beds, seven high dependency unit (HDU) beds and a special respiratory ward for covid-19 patients.
Planning capacity increase
It is also planning ways to increase “hospital capacity to care for all patients in a safe way”, the spokesperson said.
“Middlemore Hospital has been the epicentre of the covid-19 Delta outbreak with more than 1000 cases since the pandemic began in the Counties Manukau region.
The team’s experience is now being applied to how services and patient care will be provided in the future.”
A medical specialist familiar with Middlemore Hospital and its intensive care unit said given what the modelling shows and the hospital’s capacity, the implications for South Aucklanders with pre-existing conditions were “very serious”.
“When a person goes into intensive care with covid, they can spend up to 16 hours a day lying on their stomachs and are spending between four to six weeks in there.
“If every week you get just a tenth of hospitalisations going into ICU, you’re still going to get pretty overwhelmed pretty quickly.”
Lot of people suffering
An increase in covid-19-related deaths was “a reasonable assumption to make, and there will also be a lot of people just suffering, as they are unable to get the relief they were hoping to get from other interventions that had been planned but will be delayed,” he said.
Opening the vaccination rollout to all Māori and Pacific people from the start, and having it led by South Auckland providers, was the only way for the current scenario to have been avoided, he said.
“The people of South Auckland have borne the brunt of so much for so long, and you have to think they have been let down.
“They should have been listening to people on the ground but it seems they never learn.”
Local Democracy Reporting is a public interest news service supported by RNZ, the News Publishers’ Association and NZ On Air. This article is published by Asia Pacific Report in partnership with LDR.
Papua New Guinea is unsure of what message the government is trying to convey over the latest covid-19 pandemic surge — effectively creating a state of confusion.
In the midst of a dire healthcare crisis in the Eastern Highland’s capital Goroka, Prime Minister James Marape recently travelled to neighbouring Morobe Province’s remote Menyamya district to launch projects related to health care among other things.
This would have been truly uplifting given the times, if not for the apparent disregard for recently reemphasised covid-19 measures that were displayed during this visit.
Photos from the event showed hundreds of mask-less people gathered to welcome the arrival of Marape and government MPs namely Minister for Education Jimmy Uguro, Menyamya MP Benjamin Phillip and Morobe Governor Ginson Saonu, making it seem like there was no surge in covid-19 cases affecting the country.
At face value, the project launching and visit by the PM was a typical political event with the big song and dance. But, given the context of the country’s surge in covid-19 cases stressing major hospitals, the event reeked of bad taste.
This comes just as Morobe’s capital Lae has begun clamping down on non-mask wearing persons in the hopes of steering clear of a possible Goroka kind of surge.
The Morobe provincial administration, in a recent joint statement with the Morobe Provincial Health Authority and Northern Command of the Royal PNG Constabulary, instructed that there would be a no mask, no entry requirement for business houses and government facilities.
Conflicting policies
The confusion arises when on one side, Pandemic Controller David Manning, has issued measures banning gatherings of more than 20 people, but on the other side — and as if fully indifferent to the covid-19 orders — the PM is traveling around the country attracting large crowds in excess of 20 people.
In fact, many members of parliament have not slowed down on grand openings and ground breakings since the start of the pandemic, which arguably is acting as a catalyst for spreading covid-19.
Given the context of Papua New Guinea’s surge in covid-19 cases stressing major hospitals, the Menyamya event reeked of bad taste. Image: @LepaniThierry
In April, this masthead raised the same issue regarding the PM’s official visit to Kikori district in Gulf province.
Six months later it seems not much has changed other than an increase of gatherings from 10 to 20 people.
At the time the Post-Courier reported: “In the official statement from the PM’s office, it stated ‘Thousands of people arrived to welcome Prime Minister Marape and his delegation’.”
But this goes against measure nine – business and social where measure two states: “An immediate ban is placed on gatherings of over 10 people.”
“While the government continues to push the adherence of nuipelapasin, it seems they have failed to implement the nuipelapasin for launchings of projects.”
Criticism on social media
Marape’s recent visit has received criticism on social media, with one person saying:
“This is infuriating to see.
“No wonder people don’t follow niupelapasin if the people making the mandates about it keep hosting events like this!”
Another comment described it as “100 percent irresponsible behaviour”.
On Sunday, the country officially lodged a “request for assistance” with the Emergency Medical Teams (EMT) Secretariat in the World Health Organisation.
The request called on any international EMT capable of assisting to help PNG with the surge in covid-19 cases, another indication of the bad state of the health system.
The request stated: “From September 20-26, there were 600 newly confirmed cases in PNG, including 17 deaths.
Cases, deaths underreported
“New cases and deaths are significantly underreported in PNG due to the very limited testing across the country and inconsistent reporting from several provinces”.
It also stated that PNG has the lowest vaccine coverage in the Western Pacific with less than 1 percent of the population fully vaccinated.
As Parliament resumes yesterday, it was certain that many MPs would also be returning from their districts after launching and attending similar events over the break.
While it may be an important display of their leadership duties, such events are potentially thwarting the efforts of the tired, exhausted and under-resourced doctors and nurses of the country – making the problem worse.
Published by the PNG Post-Courier on its front page today.
Eighty-three covid-19 cases have been reported during the Indonesian National Games (PON-XX) being held in Papua as of yesterday afternoon, says Health Minister Budi Gunadi Sadikin.
He said evaluation of the Games would improve public health protocols in future.
“The 83 cases are concentrated among the participants competing in several sports — judo, archery, roller skating, cricket and motocross — as well as originating from a number of provinces (Jakarta, East Java, Central Java and Bali)” Sadikin told an online media conference on community activity restrictions (PPKM).
According to the ministry’s observation, virus transmission occurred in the lodging as each room was occupied by four people and the PON participants often ate together, the minister said.
“It will be our evaluation to improve the implementation of health protocols in future events,” he said.
The implementation of the health protocols could still be improved by giving greater authority to the regional covid-19 handling task forces, he added.
Furthermore, he said that his ministry had noticed that seven infected athletes had returned to their provinces before the end of their five-day quarantine period.
One athlete returned to Tarakan City, North Kalimantan Province, two returned to Jambi Province, three to Sidoarjo District, East Java Province, and one to the Special Region of Yogyakarta Province, he said.
“The President [Joko Widodo] has urged the athletes to be quarantined at their hometowns,” Sadikin said.
Several standards had been set regarding the implementation of health protocols at the XX PON, including giving adequate authority to the task forces and maintaining distancing among participants at the hotels and hostels both while resting and eating, the minister said.
Other standards included conducting routine covid-19 PCR tests to identify infected participants faster and keeping isolation centers ready to quarantine patients immediately, he added.
Asia Pacific Report notes that the Games were controversial because of repeated calls to postpone them given the public health risks from the covid-19 pandemic.
Desi Purnamawati and Uyu Limanare reporters with Antara News.
Some in New Zealand’s health industry fear that the ICU system will not cope if the delta outbreak escalates, but Health Minister Andrew Little says anyone with covid-19 will be cared for.
Little told RNZ Morning Report there was pressure on hospitals and headway was being made to bring in more nurses to deal with covid-19 patients in intensive care units.
“That’s why last year we started the programme of providing that additional training for more nurses, now nearly 1400, to work in an ICU environment,” he said.
“Even if they’re not fully qualified ICU nurses, they can work in an ICU environment.”
Little said that plan had worked in Britain.
He said nationally ICU capacity use hovered around 65-70 percent, and total hospital use sat around 80-85 percent.
“So there is some spare capacity.”
He said in the coming months, people with covid-19 could be assured that they would be cared for.
100 ICU beds available
There were about 100 ICU beds available at the moment, he said.
“We can surge up to 550 ICU or HDU level care beds.
“That will put planned care at risk, so people will lose planned care operations and stuff.”
He said the ministry would be working with DHBs to help clear the backlog.
Since the pandemic began, about 100 more ICU beds were added nationally, Little said.
Specialists have said nurses were already stretched and there was pressure to keep up with the treatment of non-Covid-19 patients.
Little said there was surge capacity to fill crucial nursing gaps on short notice.
Nurses shortage
“We know there is a shortage at the moment, but like other health care professionals, they are facing vulnerable people and vulnerable populations.
“This is about keeping people safe, they need to get vaccinated.”
He said the Health Ministry would be in conversation with midwives if mandatory vaccinations led to shortages in an already labour-short sector.
“For those who are hesitant, there’s an opportunity to get more and better information and with the professional organisations they are part of and health authorities.
“I’m confident that we will get through this.”
He said the emphasis was on getting vaccination numbers up “because it won’t be safe to reduce restrictions until we get those vaccinations level right up, beyond the 85 percent that we can get to up to 90 percent and hopefully beyond”.
National on mandatory vaccines The opposition National Party supports the government’s vaccine mandate for teachers but is not too keen to see it go any further.
School staff dealing with children will have to be fully vaccinated by January 1, and high-risk health and disability sector workers have to be fully vaccinated by December 1.
National’s covid-19 spokesperson Chris Bishop told Morning Report that there were unvaccinated health workers attending to covid-19 patients until now, “most people would think that’s a bit nuts”.
“Aged care is also a real area of concern because you’re dealing with vulnerable populations, elderly people, so that’s obvious,” he said.
“Teachers is more tricky. The starting point that I come from … bodily autonomy is important, freedom of choice.
“The state is not normally in the business of imposing medical procedures on people, like vaccinations.”
Bishop said taking the mandate any further would be hard to justify under the Bill of Rights.
But he said the party supported it for teachers because of the risk to children, with those under 12 currently unable to get vaccinated.
“You’re dealing with kids who can’t currently be vaccinated. The evidence is that teachers can really spread covid to young people.
“We support the teacher mandate. It’s a tricky issue and I think the government acknowledges that, but on balance it is the right to do.”
Bishop said he would not completely rule out support for vaccine mandates for other sectors.
This article is republished under a community partnership agreement with RNZ.
The government will be doing two things this week to drive vaccination rates up.
“The first is Super Saturday where, across the country, we’ll be pulling out the stops to increase vaccination rates. It is also an opportunity to get your second vaccine if you’re three weeks since your first,” she said.
“Getting fully vaccinated as soon as possible means we can be in a stronger position to ease restrictions.”
The second thing the government will be doing is to strengthen its response by making vaccination mandatory for large numbers of the health and education workforces.
“The reason we are stepping up our vaccination requirements is because delta is a different and more difficult opponent. We have seen all around the world that is the case,” Ardern said.
“No one yet has eliminated a delta outbreak.”
Ardern said restrictions were extremely important in controlling the virus while we get the population vaccinated.
Measures to make all the difference
“These measures, when followed, make all the difference.”
She said the r-value had crept up, meaning that cases were likely to grow in the coming days.
“If followed, our alert level restrictions can help control that spread.”
Ardern said people wanted more certainty than the government could provide at the moment.
“Our goal remains the same, even if the approach to achieving it changes. We have a pathway forward, we remain in a very strong position to make the transition from lockdown restrictions to the individual armour of vaccines while maintaining our world leading position on case numbers, hospitalisations and deaths as well as delivering a strong economy and low unemployment.”
Covid-19 Reponse Minister Chris Hipkins said the government was expecting a busy week ahead for vaccinations
“Vaccination remains our strongest and most effective to protect against infection and disease and we need as many people as possible to be vaccinated to allow all of our sectors to respond to the pandemic whilst continuing to deliver everyday services with as little disruption as possible.”
He said that making vaccination mandatory for some workers was not an easy decision, “but we need to have the people who work with vulnerable communities, who haven’t been vaccinated, to now take this extra step”.
Auckland schools to remain closed Ardern said the advice about schools being able to reopen for term 4 was initial advice which has now changed.
“Today, the public health team have advised us that the state of the outbreak in Auckland has highlighted the need for robust safety measures to be in place before schools reopen.”
School and early learning staff and support people who have contact with children and students will need to be fully vaccinated by 1 January, 2022.
If parents are involved in their child’s school any more than “pick ups and drop offs” they would also need to be fully vaccinated, the prime minister said.
Masks were required at secondary schools around the country.
Northland testing Ardern said the government was relying on high community rates of testing to give them confidence there was no covid-19 in Northland.
“This is an incredibly frustrating situation, the likes of which we’ve seen very rarely in our covid response before. Given how extraordinary it is, I have asked Health to consider all of the options available to them as they and the police work with the individuals involved.
“The two most important things Northlanders can do in the meantime is to please get tested and also get vaccinated. We need the confidence provided by testing to reduce restrictions,” she said.
Director of Health Dr Ashley Bloomfield said police were confident that the woman they could not locate in Northland was not travelling around at the moment.
Ardern said that if the person was watching, “the absolute easiest option for you right now is to come forward, allow a test to be undertaken so that we can ensure that we are protecting those that have been around you — and that may include your family and friends.
“That is by far the simplest path forward from here.”
This article is republished under a community partnership agreement with RNZ.
This content originally appeared on Asia Pacific Report and was authored by APR editor.
Covid-19 modeller professor Shaun Hendy of the University of Auckland said that as cases trended upwards, the outbreak was at a critical point.
“It is possible that we could end up in the triple digits so that’s something that the government should be considering and it should be developing a plan for what happens … because that will put real strain on the health system in Auckland,” he said.
Numbers like that could require a dip back to alert level 4 as a circuit breaker, he said.
And there was another worrying number emerging – there were still about 400 case contacts health authorities had yet to get in touch with, to check that they know to isolate and get a test.
Contact tracers don’t keep up
The switch to alert level 3 meant contact tracers could not keep up with cases as quickly as they needed to, and this was illustrated by the cases with no known links turning up to hospitals or because of surveillance testing, Dr Hendy said.
Professor Shaun Hendy … Auckland may have to return to level 4 if numbers reach triple digits. Image: RNZ
Some of those mystery cases had surfaced in the Bay of Plenty, Waikato and Northland.
Epidemiologist Professor Nick Wilson and his team were calling on the government to tighten the border around Auckland.
Only those doing the most essential jobs should be allowed out and they should have to stop for 15 minutes at the border for a rapid antigen test, he said.
“It does seem that some people are getting across that border for pretty flimsy reasons and documentation,” he said.
In the meantime, authorities could keep the level 3 parts of the country walled off from the rest – literally – using concrete blocks and containers on some roads, perhaps at the Central Plateau, he said.
Keeping covid out of the rest of the country could also help Auckland, by creating backup if the city’s health resources became overwhelmed.
Tasmania an example
New Zealand should look to Australia where cases were raging in two states but well controlled in others, especially Tasmania.
Covid-19 Response Minister Chris Hipkins said New Zealand already had some of the toughest restrictions in the world and would continue to work hard to stop the spread.
“The number of cases serves as a reminder of how tricky delta is,” he said.
Cabinet will today decide what to do with restrictions.
Hipkins said they would take into account the most up to date case numbers, as well as unlinked cases. There were 19 yesterday.
Critically, it would also decide whether Auckland schools could reopen.
Opening schools too soon
Professor Hendy said it was too soon.
While it was possible to open them safely if the right precautions were taken, now was not the time, with the outbreak finely balanced, he said.
Eighty-six percent of Aucklanders have now had at least one dose of the vaccine while 61 percent are fully vaccinated.
More than 10,000 crucial first doses were administered on Friday and Saturday, and more than 50,000 second doses.
GP Siro Fuata’i helped at a weekend event aimed at Samoans in Manurewa which reached 1300 people.
A lot of those getting vaccinated were young and he was seeing momentum grow as many saw their friends and family getting vaccinated.
“The whole process has picked up quite quickly and I think next week we’ll probably see a lot more of this. I’m looking forward to see that the the numbers go further north, and everybody getting vaccinated would be great,” he said.
Professor Hendy said the impact of the vaccinations should be seen in the case numbers by the end of the month, because the vaccine took time to take effect.
This article is republished under a community partnership agreement with RNZ.
New Zealand’s Ministry of Health today announced 60 new community cases of covid-19, the most in nearly six weeks, while Northland and the Bay of Plenty continued to deal with positive cases visiting their regions.
The ministry said there were 29 infected people in hospital, including seven in intensive care.
The ministry also reported that a person receiving treatment at North Shore Hospital dialysis unit yesterday tested positive for the coronavirus.
The unit closed yesterday afternoon for a deep clean.
There were 20,421 tests carried out in New Zealand yesterday, including 7071 in Auckland.
There have now been 1587 cases in the current delta outbreak, and 4265 covid-19 cases in total in New Zealand.
Positive case region visits Outside of Auckland, officials continued to follow up details of a positive case who visited Northland and the other case revealed in the Bay of Plenty last night.
It is not known if this second woman has covid-19.
The woman who tested positive remains in an Auckland quarantine facility, the ministry said in a media statement.
That woman had not been “forthcoming” in providing information to contact tracers, Prime Minister Jacinda Ardern said, complicating efforts to track down any possible cases.
The infected person was tested in Auckland, but was moving to the Bay and was in the region when the result arrived.
Western Bay of Plenty mayor Garry Webber said Katikati was hoping to prevent further infection. He said the result was a weak positive.
“But regardless of what it is, it is here in one shape or form and we just have to get into preventative mode.”
A steady climb in cases since the drop down from alert level 4 to 3 on September 22. Image: TVNZ screenshot APR
Vaccination push continues Nearly 82,000 doses of the vaccine were administered yesterday.
This includes 18,000 people receiving their first shot, and 65,000 people completing their course of both vaccines.
Prime Minister Ardern continued her visit to East Coast communities to encourage vaccination with a trip to Gisborne this morning.
Turanga Health’s clinic was in high demand, with many people in cars lining up to be vaccinated.
Parts of the city have some of the lowest vaccination rates in the country.
This was the last stop on the Prime Minister’s four-day tour of East coast communities, and she returned to Wellington today. She visited Rotorua, Murupara, Hastings, Wairoa, Gisborne and Ruatōrea.
Ardern said she was trying to support people.
“There’s not too much that’s useful I can do at a vaccination centre, other than distract people when they get injected, or provide a coffee.”
In the last seven days 115,000 people have received their first shot.
Another 9700 Māori were vaccinated, after yesterday’s record of just over 10,000.
Auckland now has 86 percent of people with at least one dose.
This article is republished under a community partnership agreement with RNZ.
Hipkins said the move was necessary following new information on the risk presented by a positive case initially tested in Whangārei earlier this week and confirmed in Auckland yesterday. The woman was now in an Auckland managed isolation quarantine facility.
“Updated information provided by the police today shows the case moved extensively around Northland after travelling there on October 2,” Hipkins said.
He said it was believed she did not travel alone and travelled with another woman, who was not yet in MIQ.
“We believe this new information warrants an alert level change decision to keep Northland people safe,” he said.
“It has also been taken because the individual has not been cooperative with contact tracing efforts.”
He said the woman had not supplied the reason for being in Northland.
Watch the news briefing
Video: RNZ News
“It has been very difficult to get information about this particular case,” Hipkins said.
“The first test result we had was what you could describe as an indeterminate test result, so it was quite difficult to locate the person.
“The information that they supplied when they were tested the first time did not provide sufficent information to be able to contact them with the test result and get them back to be tested.
“It took some time to track them down, the police ultimately were able to assist there and did help to track the person down.”
Hipkins said he understood the woman obtained a document by providing false information to leave Auckland but this was yet to be verified. When it was discovered and revoked they were already in Auckland.
They include BP Connect Wylies petrol station and the Z Kensington service station in Whangārei.
Northland vaccination rates low
Hipkins said another factor taken into account was that vaccination rates in Northland were low compared to the national average.
“Without placing restrictions on movement there is a possibility that the virus could spread quite rapidly within the community.”
It is one of the least-vaccinated regions – just two thirds of residents have had their first Pfizer dose.
“Cases spreading at alert level 2 are a risk we cannot take, but it’s also further reason why we need to really focus on vaccinations,” said Hipkins. “Without high vaccination rates we will need to continue to use restrictions to stop the virus spreading.
“I have two things to ask of Northlanders. First, if you have any cold and flu like symptoms please come forward and get a test as soon as possible.”
“The second request that I have and I can’t stress this enough, is please get vaccinated. These cases do highlight the risk of Covid-19 to the unvaccinated anywhere in the country.
“Now is the time to be vaccinated.”
Northlanders ‘stay in bubble’
Hipkins reminded Northlanders that alert level 3 meant they had to stay in their bubble and stay at home.
“Don’t go and visit family, friends and neighbours, this is a virus that can spread quite quickly and that is part of the way it spreads.”
Speaking to RNZ Checkpoint after the announcement, Whangārei Mayor Sheryl Mai said she was “actually quite grumpy”.
“We’ve got a person who really has done everything that they should not do. And they’ve impacted on all of Northland as a result.
“I was giving the person the benefit of the doubt earlier today. Now I’m just ropeable.”
View: RNZ Checkpoint
‘Very confused messages’
Epidemiologist Michael Baker said without full cooperation with contact tracers, public health staff are reliant on swabbing and wastewater results to track the virus’ spread.
Professor Baker said the Te Tai Tokerau situation was “really concerning” and the lockdown “had to be done”.
With Northland entering level 3, Auckland in a level 3 with benefits, and Waikato in level 3 restrictions, he told Checkpoint there needed to be clarity on what strategy New Zealand was pursuing against covid-19.
“We’ve actually had very confused messages this week about a number of things, including what comes after elimination, which we seem to be transitioning out of. That hasn’t been made clear,” he said.
“Also how are we going to use the alert level system? Because Auckland is using a stepped approach, they’re stepping up. The rest of the country’s got alert levels and is stepping down. There’s also a version of a traffic light system that’s been proposed circulating at the moment.
“So I think this week has really been quite poor for clarity of communication and coherence.
“The government really has to sort out where we’re going. And one of the approaches I think we should look at would actually be a regional approach.”
Professor Baker said suppression could be pursued in Auckland while an elimination strategy could work in the South Island.
Twenty three complaints regarding New Zealand doctors spreading anti-vaccination misinformation have been made to the Medical Council as the group says it has “zero tolerance” for anti-vax positions.
Medical Council chairperson Dr Curtis Walker told RNZ Morning Report today: “I can’t speak about individual cases or individual notifications, but what I can say is that we very much exist on behalf of the public to ensure that doctors are practising safely at all times and our first concern to protect public safety.”
The council had “zero tolerance for anti vaccination messages”, he said.
“We will consider all concerns and notifications that are made to council.”
There was no New Zealand media briefing today. In a statement, the ministry said 12 of the new cases were yet to be linked to earlier cases. There were now 26 cases unlinked from the past 14 days.
Director of Public Health Dr Caroline McElnay said the higher number of new cases today was not unexpected “because there have been a number of contacts of new cases and we can expect to get fluctuations from day-to-day”.
The three new cases in Waikato are all linked and contacts of existing cases.
Yesterday, there were 29 new cases in the community. Five of those were in Waikato.
There are 25 people in hospital, including five in intensive care.
There have now been 25 cases in Waikato and 1450 in Auckland in the current outbreak. There has been a total of 1492 cases.
Complaints considered
About complaints to the Medical Council, Dr Walker said: “We will examine the circumstances of what a doctor has said or done, carefully consider their responses, for example, if they’re not going to do it again, or not going to post anymore videos or promulgate any further misinformation.
“If that’s the kind of response we sort of take a satisfied or an educative type approach, and a ‘don’t do it again’ approach,” he said.
“If people are going to persist and in disseminating this information, then we will look at taking further action.”
Dr Walker said the council had “received the number of notifications around doctors, including the Northland people”.
The council expected doctors to act in accordance with the expected standards at all times, Walker said.
“Our standard around this is that any advice provided around vaccination has to be evidence based and expert informed and the medical evidence is that the vaccination is safe, effective and overwhelmingly supported by the healthy evidence, and certainly the best way to predict our whānau and communities from this pandemic.
“So that is the evidence-based advice that we expect doctors to give.”
‘Small part’ of medical advice
Dr Walker said doctors spreading anti-vax misinformation were a “very small part of the medical profession”.
The council had received notifications about 23 individual doctors.
“I’m pleased to say that despite the noise and distraction and harm that a few doctors can do, it is a very small part of the medical profession – we’ve just received very small number of notifications, in contrast to the many thousands of doctors and health care workers at the frontline vaccinating, delivering health care and leading New Zealand’s public health response,” Dr Walker said.
“Also I note the thousands of doctors who recently stood up publicly to encourage and support vaccination.”
The complaint review process involved reviews called professional conduct committees.
Walker said the council aimed to “get those up running and sorted in around six months – a decision in six months and that decision can involve a charge with the health practitioner practitioners at a disciplinary tribunal”.
When asked if that time frame was too long, Dr Walker said “what I will say is that at all stages the public is protected. So if we see that there’s harm being done by a doctor’s conduct or practice or misinformation, in these cases we will institute measures such as requesting or requiring the doctor to cease doing what it is that they’re doing.
“And that can include suspending a doctor while the investigations take place so that the public is protected as we work our way through the cases.”
This article is republished under a community partnership agreement with RNZ.
This content originally appeared on Asia Pacific Report and was authored by APR editor.
It explains the topics prone to misinformation, and seeks to inform rather than inflame. It does not advocate for policy positions, apart from transparency and accuracy in public debate.
On this page, and across a range of social media and print publications, “The Whole Truth” about the covid-19 vaccine is published through a series of videos, graphics and words.
The project received funding from the Google News Initiative. This money is used to pay animators, presenters, and an expert advisory panel.
The announcement this week that New Zealand will introduce a vaccination certificate by November is welcome news. Whether by “carrot” or “stick”, vaccination rates must keep climbing, as it is now likely case numbers will climb under alert level 3 conditions in Auckland.
We’ve seen a growing number of mystery cases over the past couple of weeks – people testing positive after going to hospital for non-covid reasons, or from essential worker surveillance testing.
These cases suggest there is a significant amount of undetected community transmission, and that makes it much harder to stamp out.
To some extent this is a semantic argument. Elimination has been defined as “zero tolerance” for community transmission, as opposed to zero cases. The fact that New Zealand was able to get to zero cases for much of the past 18 months has inevitably come to define what elimination has meant in practice.
Before vaccines were widely available, having zero cases was crucial in allowing us to enjoy level 1 freedoms.
But New Zealand is now transitioning into a new phase of the pandemic, and this was always going to happen. Borders can’t remain closed forever and the virus was always going to arrive sooner or later.
Return to tougher restrictions still a possibility In an ideal world, our border defences would have kept delta out and New Zealand would have been able to stay at alert level 1 until the vaccine rollout was complete.
But the delta outbreak has forced our hand to some extent.
Whether another week or two at level 4 would have been enough to eliminate this outbreak is impossible to know. Given the outbreak is spreading in very difficult-to-reach communities, stamping out every chain of transmission is extremely challenging.
As we shift from an elimination to a suppression strategy, the country will have to tread a very narrow path to avoid overwhelming our hospitals and throwing our at-risk populations under the bus.
We are now relying on a combination of restrictions and immunity through vaccination to prevent cases growing too rapidly. As vaccination rates increase, restrictions can be progressively eased.
But if we relax too much, there is a risk the number of hospitalisations could start to spiral out of control. When the R number is above 1, cases will continue to grow relentlessly until either more immunity or tougher restrictions bring it back under 1.
Getting vaccination rates up is crucial but will take time, so the government may yet be forced to tighten restrictions to protect our healthcare systems.
The vaccination advantage New Zealand was always going to have to grapple with these really tough decisions, though delta has forced us to do this earlier than we would have liked.
But our elimination strategy has given us has an important advantage – almost 70 percent of the total population has had at least one dose of the vaccine before experiencing any large-scale community transmission.
We still have a lot of work ahead, but having access to the vaccine before being exposed to the virus is a luxury people in most countries didn’t have.
Those ICU beds are normally full with patients with conditions other than covid-19.
The implications for the healthcare system are obvious. If New Zealand goes the way of Melbourne, harsher restrictions will probably be inevitable.
Not a white flag The more optimistic scenario is that a combination of restrictions, vaccination and contact tracing is just enough to keep a lid on the case numbers. It’s almost inevitable cases will increase. But if it isn’t too rapid and hospitals can meet the demand, it could tide us over until we have the high vaccine coverage we need.
And while vaccination rates are not yet high enough, they are still helping a lot, cutting the R number to around half what it would be with no vaccine.
The country is in a far better position now than it would have been if the Auckland outbreak had happened in May or June.
Everyone can do their bit by doing two things: help and encourage those around you to get vaccinated, and stick to the rules.
We have to keep community transmission rates low to keep pressure off our hospitals and help us get to the next step of the road map. Moving away from a literal interpretation of elimination does not mean waving a white flag.
It appears we are a nation of selfish malcontents for whom enough is never enough.
That is one of the conclusions I’ve been forced to draw after seven weeks of covid lockdown in Auckland. And, because my isolation has been broken only by a few medical appointments that are valid reasons for leaving my security-guarded community, I gain my impressions through our media and a diet containing a surfeit of opinion, some of it in the guise of news.
I am confronted daily by examples of peevish bleating, whining, and complaining. I hear demands for certainty where there can be none.
I hear commentators crying out for an end to level 4 then level 3 lockdown. They range from predictable nay-saying radio hosts like Mike Hosking, Heather du Plessis-Allan and Kerre McIvor to the unscientific Sir John Key, whose syndicated comments were the product of some yet-to-be-revealed stratagem by the former prime minister.
I see New Zealanders demanding that their right to return to this country be met NOW when it is obvious that the number of intending returnees far exceeds the country’s capacity to safely manage them.
I read of business demanding the ability to trade, and parents demanding to take their children to far-flung spots for the school holidays, when doing so risks undoing the constraint that has been put on the spread of the delta variant.
I am told the government is incompetent or that it has gone too hard, and that the police haven’t gone hard enough on gangs and followers of Brian Tamaki.
Nation of whingers?
What else could I conclude but that we are a nation of whingers?
But I have also concluded that some of our news media are exhibiting signs of split personality: While devoting an extraordinary amount of time and space to the malcontents, they are also pursuing positive campaigns to get the eligible population vaccinated.
They also – thank goodness – show a willingness to accommodate the views of members of the medical and scientific community, whose opinions we so desperately need to hear.
The two positions are not, of course, mutually exclusive. Media have a duty to report dissent as well as the positives. However, while front page lead stories supporting efforts to contain the delta variant have far outweighed those that argue against them, I have a sense that this Winter Of Our Discontent emphasis is compromising the vax campaign by legitimising self-entitlement.
In my lockdown musings I have, however, reached one further conclusion that both saddens and frustrates me. It is the realisation that many of those who need to get the message to get vaccinated are beyond the reach of news media.
These are people who do not read newspapers, watch television news programmes, listen to radio news bulletins or access the online services that each provides. They have no idea what a “1pm stand-up” means.
They do not engage with news on any other basis than word-of-mouth or social media and the results are fragmented, selective, and often-as-not wrong. In other words, the commendable media campaigns to raise vaccination levels never reach them.
Getting to the marginalised
Ways need to be found to get to this marginalised part of our community. Perhaps the answer is for the media to go on the road. A media roadshow visiting suburbs with which they seldom positively identify might have benefits beyond helping us to get closer to that magic 90 per cent vaccination target.
I was about to say I had reached another conclusion but that’s too strong a word for it. I have a suspicion that the Winter Of Our Discontent is not a reflection of widespread public opinion. I am led to that suspicion by two polls.
These suggest to me a greater level of resilience (and common sense) than negative media stories might indicate. It’s also manifested in the (admittedly limited) interactions I have with people these days.
That also might be reflected in a letter I read in The New Zealand Herald last week. It was in response to a story about a man who feared he would not be allowed to witness his wife giving birth to triplets in Auckland if he returned to Rotorua to work.
M.A. Hume of Mt Roskill, who admitted to being “old enough to remember the Second World War”, recalled a friend whose husband died at El Alamein without ever seeing his daughter and others who had not seen their families for four years and had no certainty of returning to them. “In those days,” the letter writer said, “huge sacrifices were commonplace.”
I would like to think that, today, most of us can muster that same sense of self-sacrifice and resolve. Given the announcements last weekend of rising cases in Auckland and a spread to the Waikato, we’ll need it.
Dr Gavin Ellis holds a PhD in political studies. He is a media consultant and researcher. A former editor-in-chief of The New Zealand Herald, he has a background in journalism and communications – covering both editorial and management roles – that spans more than half a century. Dr Ellis publishes a blog called Knightly Views where this commentary was first published and it is republished by Asia Pacific Report with permission.
Black women and their newborn babies are trapped in a public health crisis that is rooted in enslavement and perpetuated by systemic racism. Centuries of marginalization, exposure to environmental toxins, use of Black women’s bodies for scientific and pseudo-scientific experimentation, poor housing, substandard education, and the food apartheid that denies Black people self-determination in nutritional health have conspired over centuries to produce alarming health disparities and literally kill Black women and infants. These deaths are preventable, yet the numbers of the dead have risen. Looking forward, experts fear that the COVID-19 pandemic will only exacerbate racial disparities in maternal and infant health.
Across racial lines, the United States has the highest rates of maternal mortality than any other developed country in the world, with 17.4 deaths per 100,000 live births in 2018. According to the American Medical Association (AMA), this rate of maternal death was more than double the rates of maternal mortality in countries of comparable wealth. The following year, in 2019, the Centers for Disease Control and Prevention (CDC) found that the U.S. maternal mortality rate rose to 20.1 deaths per 100,000 live births.
Black maternal mortality ranks even worse. Maternal mortality rates for non-Hispanic African American women rose from 37.3 deaths per 100,000 live births in 2018 to 44.0 deaths per 100,000 live births in 2019. Black women’s maternal mortality exceeds that of other BIPOC women, including Latinx women, whose rates of maternal mortality (11.8 in 2018 and 12.6 in 2019) are lower than white women (17.4 in 2018 and 17.9 in 2019).
The CDC 2018 statistics on maternal mortality do not include data on Indigenous women, even though statistics on racial disparities were included in the report. (Indigenous women’s exclusion from the 2018 CDC report is consistent with their experience of marginalization in U.S. politics and policies, as well as silencing in the public discourse.) The CDC does have rates of maternal mortality for Indian and Alaska Native women for 2014-2017: 28.3 per 100,000 live births compared to 41.7 per 100,000 live births for African American women during that same period. During that period, white women and Asian and Pacific Islander women were statistically tied, at 13.4 per 100,000 live births and 13.8 per 100,000 live births respectively, while Latinx women had the lowest rates of maternal mortality, at 11.6 per 100,000 live births.
A History of Medical Apartheid
In a stunning 2018 New York Times article, Linda Villarosa, journalist-in-residence at the Craig Newmark Graduate School of Journalism at CUNY, identified the stress related to Black life in the U.S. as one cause of the racial disparities in Black maternal health. The impact of racism on maternal health has specific expressions on women of African descent when compared to other BIPOC women, including Latinx, Asian and Pacific Islander, and Indigenous women.
“The racial disparity in maternal and infant mortality between Black and white women is stark — but Black women have the worst outcomes in America because we have been the targets of harm for so long,” Villarosa told Truthout. “Institutional and structural racism have affected our communities for centuries, beginning with slavery and continuing with Jim Crow, segregation in housing and education, redlining and the poisoning of our neighborhoods with pollution. Our bodies have also been studied closely, at first because of the commodification tied to enslavement, later as test subjects.”
Black babies are also locked in this death grip. According to the CDC, in 2018, the infant mortality rate in this country was 5.7 deaths per 1,000 live births. However, the rate of Black infant mortality was, alarmingly, double that, at 10.8 deaths per 1,000 live births.
“What is interesting about this question regarding the impact of poor maternal health on Black communities is that, despite education, income and employment, we are still dying,” Simone Toomer, a certified birth and postpartum doula, childbirth educator and international board-certified lactation consultant, says. “This shows it is beyond us and our efforts, although being informed and advocating for ourselves does make a difference.” Toomer adds that these disparities, despite wealth and education, impact Black families in ways maternal and infant mortality rates do not quantify when mother and baby survive but do not thrive. “Poor maternal health care trickles down into poor breastfeeding rates amongst our infants, higher percentage of Black mothers being readmitted to the hospital after delivery and higher rates of PMADs [perinatal or postpartum mood and anxiety disorder].” These health outcomes have reverberating impacts on Black communities across income levels and through U.S. society more broadly.
Villarosa, who is author of the forthcoming book on race and public health titled, Under the Skin: Racism, Inequality and the Health of a Nation, does have numbers to place poor maternal and infant care in perspective: “Racial disparity in maternal and infant mortality has led to tens of thousands of lost lives. For every woman that dies as a result of pregnancy, childbirth and the months after a birth, nearly 100 women almost die. This is traumatizing for individuals and families.”
The reasons for these racial disparities and the overwhelming trauma they cause across income and education levels are vast and complex, according to Chi Chi Okwu, executive director of EverThrive Illinois, a social services agency dedicated to achieving health equity. “What we do know is that the combination and crushing weight of racism and sexism has a profound impact on the health of BIPOC women,” Okwu says. “This is a complex issue that requires us to look at the entire health ecosystem in addition to dismantling the racist and sexist institutions in our society.” In a state where, according to a 2016-2017 report from the Illinois Department of Public Health, Black women are three times likely to die from pregnancy-related medical conditions as white women, Okwu and her colleagues at EverThrive are focused on changing policy to improve birth outcomes. At the state level, these policies include expanding Medicaid to provide doula, lactation consulting and home-visiting services.
Black Women Are Doing the Work
To produce healthier outcomes, African American women are working to disrupt the policies, systems and the inherent bias among health care workers that harm vulnerable Black mothers and their babies. Policymakers in the Biden administration seeking to improve Black maternal and infant health should listen to these women.
In addition to policy, EverThrive Illinois also supports initiatives developed through strategic partnerships that center women and babies most impacted by racial and economic inequalities in health. The Family Connects Chicago program is one initiative Okwu’s organization supports to promote positive health outcomes for Black women and their newborns. In a city where Black unemployment far outpaced other racial groups well before COVID, Family Connects provides a visiting nurse for parents who are having difficulty getting to doctor’s appointments. Okwu says a home visitation nurse can work with the parents to identify the barriers to care and obtain the support they need to overcome them.
To afford a baby nurse that comes into the home to support mother and child, wealthy families in the Chicago area must pay salaries averaging in the high-five to low-six figures. The median baby nurse salary in Chicago is nearly $80,000. Through Family Connects, parents who can’t afford to pay more than they make themselves receive the same privilege of in-home care. “Home visiting provides an opportunity for parents to conveniently receive additional support in their own home. This is not a substitute to going to their OB-GYN or pediatrician,” Okwu explains. “Parents need all the support they can get after giving birth, and home visiting is just one part of the support network to ensure both the parent and child are getting all of the help they need in the postpartum period.”
Improving the relationship between health care systems and African American homes requires shifts in both policy and the public conversation in order to address racism in medical settings. The AMA and The American College of Obstetrics and Gynecologists (ACOG) have identified racism as a public health crisis. To dismantle racism in health care and improve outcomes in Black maternal and infant health, professionals must focus on policies and systems that directly impact Black families. “Dismantling racism in health care will take a multi-pronged systemic and localized approach. We need to ensure that all people have access to high-quality, comprehensive health care,” Okwu says. “We also need to ensure that the care being provided is culturally competent and patient-centered.”
Reducing racial health disparities requires such significant change, but Black women like Okwu are already producing outcomes that health care professionals in ACOG and the AMA, as well as policymakers in Biden administration, should consider. In Okwu’s state, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program had declined, reducing the opportunities for Black women and babies to benefit from the breastfeeding support and healthy food WIC provides. In response, EverThrive Illinois convened a group of partners — those who run WIC sites and WIC program participants — to form the Making WIC Work Coalition and, in 2019, published a landmark Making WIC Work Report. In response to the coalition’s advocacy, the State of Illinois has made significant improvements to the way it runs WIC, including eliminating a discriminatory coupon system which has limited access to food for mostly Black and Brown families in Chicago for more than 20 years; offering more choices so people shopping with WIC can redeem their benefits for a wider variety of foods; providing updated guidance so that all WIC sites provide consistent services and implement streamlined application procedures; and adapting quickly to provide flexibility in WIC enrollment and redemption of benefits so families can care for themselves during the COVID-19 pandemic.
Though the data is not yet available, certainly the global pandemic has exacerbated racial disparities in health outcomes for Black women and babies. The California Health Care Foundation has documented these complications, but the problems of Black women’s access to quality maternal and infant care through the pandemic are national in scope.
Black-led organizations lead the efforts to fill COVID-related gaps. The Social Science Research Council (SSRC) is studying the work done in Cleveland, Ohio, by Birthing Beautiful Communities (BBC), a Black-owned and run perinatal support agency. By studying service shifts caused by the COVID pandemic, including the use of technology in infant mortality prevention programming, SSRC expects “the findings to have implications for healthcare service delivery for Black women and their families.”
Black Women and Doulas
One successful program initiative at BBC is the community-based doula program, which provides overnight postpartum care. Doulas can fill wide gaps created by racism in health care. According to Toomer, “The data is limited on how doulas reduce the Black maternal and infant mortality; however, across the board, we know continuous doula support increases positive outcomes for both the birthing person and infant through emotional and physical support, advocacy and preparation.”
Toomer, who works at New York Presbyterian Methodist Hospital in Brooklyn as a doula and lactation consultant providing prenatal education and support in the clinic and on the Mother Baby Unit, and who also has a thriving private practice, explains that doulas provide multiple beams of support for families. Depending on their training, birth doulas support families through pregnancy, with some trained to support people as they undergo the assisted reproductive technology known as in vitro fertilization (IVF), in which eggs and sperm are combined in a laboratory. Toomer explains that “Doulas provide resources, educate and empower families around their birth options before the baby is here and in the laboring room. We assist within that first hour with latching baby and ensuring a smooth transition once home.” Consistent with the efforts of organizations like EverThrive Illinois and the BBC, doulas also provide critical care to support mothers and give infants a better chance at surviving the first year after birth. Toomer says, “Postpartum doulas come into the home to support newborn feeding, assessing for PMADS, the need for sleep and food, newborn education and ensuring everyone continues to transition smoothly.”
Toomer says that doulas fill gaps that are the standard in maternal care throughout in the medical community. “All parents have to bring their infant to the pediatrician in the first 24-28 hours after discharge; however, oftentimes, no one is checking in on the parents. Many things can happen in those six weeks but unfortunately that is the next time most birthing people are seeing their care providers after delivery.”
Toomer worked with the Healthy Start Brooklyn’s By My Side Support Program for four years. She says that, as a doula, “at every monthly meeting we would hear how our support prenatally, through delivery and postpartum, affirmed families, empowered them and provided that continuity of care that is lacking from the American health care system.”
Systemic Change Is Needed
From her vantage point on the front lines of the Black maternal and infant mortality crisis, Toomer hears “in many stories regarding Black maternal death, accountability is lacking. Accountability of these providers.” She insists that the work she does will never be enough to save Black women and their babies, and that this country’s health care system needs significant institutional change. “It is nice to be on the radar; however, it is beyond providing a doula for every Black mom. We are a small piece in the big puzzle.”
Change needs to start at the top with establishments such as hospitals, Toomer asserts. “Anti-racism health professionals need to continue training in cultural humility. Black women need to be heard and listened to. Biases need to be erased. We need to be looked at as human and respected as such.”
Villarosa says California is providing a template to address the needs that Black women like she and Toomer have identified. “Our country should follow the lead of California, which made implicit bias training mandatory for all health care providers who work with pregnant and birthing people,” Villarosa says. “During the pandemic, the state became the first to make implicit bias training mandatory for all providers, which will go in effect in January. The U.S. should do the same.”
The California Health Care Foundation says that exposing people to their unconscious bias and providing “a historical context for modern-day inequities in maternal health” can help professionals produce healthier outcomes as they “begin to understand how even well-meaning routine responses to patients can inadvertently cause harm and even death.”
Despite this promising commitment to dismantling racism in health care, Villarosa says that, in researching her book, the most surprising thing she discovered “is how well discrimination in our medical system has been documented — yet, there’s still a call for more ‘proof.’” This is more than unnerving as Black women and their babies continue to die at disproportionate rates, and experience poor health outcomes even when Black mothers survive the birthing process and Black babies survive the first year of life. These poor maternal and infant outcomes are the shame of a system that, as Toomer says, “is a broken system never meant to help us.”
Villarosa testifies to a consistent national truth: “Racial health disparities have been part of the American story since the founding of our country. Black mothers and babies should not be dying for reasons that are largely preventable. This isn’t how a just society treats a segment of its population.” The U.S. has the most advanced, expensive health care system in the world, she points out, “so why are we the only wealthy country where the overall rates of women dying or almost dying related to pregnancy are rising? And why do we have the highest rate of infant mortality of all the wealthy countries? These poor health outcomes are shameful, driven by the disproportionate death rates of Black mothers and babies, and are revealing that nation’s inequality.”
The 2014 coup d’état against the elected Yingluck Shinawatra’s government, staged by a military group calling themselves the National Council for Peace and Order (NCPO), can be viewed as a continuation of the 2006 coup d’état that deposed Yingluck’s elder brother, Thaksin Shinawatra. In each case, a central goal was to disrupt the system of electoral politics that was based on the provisions of the 1997 constitution. This system was viewed as a major threat, as it had empowered politicians and political parties at the expense of the bureaucracy. The 2014 coup also led to major disruption at the subnational level, as it interrupted the mechanisms of local democracy that had arisen from innovations incorporated into the 1997 constitution. These provisions not only challenged the historical territorial dominance of the Ministry of Interior (MOI), but had more generally become an important foundation for Thailand’s democratic consolidation. In sum, the 2014 coup undercut the spirit of the 1997 reform.
Click on the cover image below to download the full policy brief.
My report, available to download by clicking on the image above, examines changes in central-local relations under the NCPO military regime. While many observers of Southeast Asian politics would be familiar with how the 2014 coup undermined national-level democratic institutions—from the constitution to elections to representative structures—it is also important to understand how the regime suspended local elections and tried to assert control over the mechanisms of local democracy that had emerged since 1997 (as part of what as known as the system of Local Administration, centred around what are called Local Administrative Organisations, or LAOs). This report examines changes in the power relations at three distinct levels: between the central bureaucracy and the Local Administration, between bureaucrats and politicians, and between politicians and people. In order to understand these processes of political change, I argue, analysis needs to consider dynamics not only within formal institutions but also across the informal networks that extend from NCPO rulers at the top of the system through intermediary levels (politicians, bureaucrats, and local leaders) and downward to the people at the grassroots.
The analysis is divided into four parts. The first section demonstrates how the NCPO centralised its power after 2014, leading to discontinuity in the processes of local democracy. Second, I trace the mechanisms of control deployed by the NCPO at the subnational level, from the promulgation of the 2017 constitution up to the general election held in March 2019, as they manipulated political networks at various levels to support of their electoral victory. Thirdly, the Royal Project is discussed as an illustration of how a project prioritised by the central bureaucracy could introduce new imperatives into the chain of command linking the bureaucracy to the democratically elected LAOs. The article closes on a more hopeful note, exploring the important role of LAOs in responding to the crisis of the COVID-19 pandemic.
An urban election rally in 2019. Image supplied by the author.
From day one, the NCPO exerted its power through the Provincial Administration, the traditional territorial structures of the MOI, a central bureaucracy through which any command from Bangkok can be communicated all the way down to the village level. Through the extensive reach of the Provincial Administration into subnational levels, the NCPO was able to keep track of the resistance, track down opponents, and enforce its commands at the local level. Moreover, the NCPO interrupted local democracy by ordering the indefinite suspension of all local elections.
To tighten its power, the NCPO also took advantage of a rarely used organisation under the control of the Ministry of Interior: the Damrong Darma Centres. These centres can receive complaints from any source, and ultilise their powers to mediate and to summon relevant people for the purpose of investigation. These tools have been used by the NCPO to suppress their political opponents, especially the community leaders and politicians who were associated with the Thaksin and Yingluck Shinawatra governments. Second, as part of an effort to gain control over the LAOs, the State Audit Office investigates the budgets of various projects carried out by the local authorities. Third, the NCPO also has utilised the power of the National Anti-Corruption Commission to investigate local politicians who were allegedly involved in corruption. These mechanisms forced local politicians to yield to the power of NCPO, switch political allegiances, or at least to refrain from conducting political activities.
An election rally organized at a community forest. Image supplied by the author.
Also as part of its efforts to consolidate power, the NCPO dipped deep into the national budget to fund government projects under the umbrella of the Pracharath (people-state) scheme. Launched in September 2015, the scheme was promoted as an economic stimulus with the goal of eliminating poverty. Judging by how the project was structured, the goals were not only to build popularity for the NCPO government but also to establish mutual benefit with business enterprises. The first tangible project was called Thongfa Pracharath (thongfa – blue flag), which issued indigent cards for low-income people. The cardholders could use the credit to buy goods at the designated blue-flag shops selling products from Pracharath’s partner companies.
Another project was Pracharath Rak Samakkee (Pracharath Loves Unity), aimed at establishing local enterprises in every province by obtaining know-how from national business conglomerates. While some local enterprises were successfully established, the overall pace of project roll-out has been delayed by the pandemic. Even so, this project allows the bureaucracy to connect with the business enterprises and gives ample opportunities for the enterprises to deepen their linkages at the subnational level.
In September 2018, the NCPO established its own political party, Palang Pracharath Party (PPRP), meaning “the Power of Pracharath”. Not coincidentally, people in rural areas had, by that point, seen “Pracharath” signs in every community at the Thongfa Pracharath shops.
Apart from its institutional manipulation, the NCPO also tried to consolidate its power by utilising and altering existing networks, beginning with people’s networks that had the potential to resist the regime. Bonds between leaders and their supporters were undermined by the use of some unjust laws, including lèse-majesté, to accuse and prosecute activists, local leaders, and politicians. In addition, the NCPO prosecuted various politicians who sided with Thaksin in order to pressure them to stop their political actions and switch to the NCPO side. All of these actions exacerbated the climate of fear felt throughout the country.
During the actual election campaign, the PPRP used many techniques to obstruct the campaigns of its opponents. For example, it restricted their access to public areas such as government facilities, schools, and universities. Furthermore, officials closely monitored the campaigns of opposition candidates, seeking to spot behavior that could be construed as a violation of the electoral law. Mechanisms intended to curb vote-buying were enforced very selectively against one side but not the other.
Through these various manoevres, the overall trend has been toward a marked re-centralisation of power. In effect, the NCPO has relied heavily on the central bureaucracy, and the central bureaucracy has in turn increased its control over the Local Administration. As the power of the bureaucracy has been enhanced, it has also needed to develop a new means to mobilise citizens—a task that it could not legitimately perform by itself. This has led to reliance on political brokers who are highly proficient in the art of mobilisation. This inevitably heightens the power of the brokers as they act as the intermediaries between the bureaucrats and the people. In the process, we see the reemergence of local powerbrokers—the phu mi itthiphon—who were especially important in Thai politics in the period before 1997. Their informal political networks are now more evident once again, albeit now working alongside the new players that have been introduced through the Pracharath scheme. This includes, most notably, some of the country’s leading business conglomerates. In effect, there is a new form of government patronage that puts people at the mercy of the state and wealthy capitalists.
A municipal mayor gives a speech to open a group exercise project organized by the municipality and senior citizen network. Image supplied by the author.
Lastly, this report examines the valuable role played by municipalities in mounting an effective response to COVID-19 within their respective jurisdictions—using their strong political networks to disseminate health expertise. Among the measure introduced are those mandating home quarantine, temperature assessment in crowded areas, handing out face masks and alcohol gel, and teaching the public how to make personal protective equipment. Even with the suspension of local elections by the NCPO, local politicians commonly persisted in trying to perform their duties as best as possible—hoping, of course, to enhance their political prospects once elections resume (as they finally were: for the provincial-level LAOs in late 2020 and at the municipal level in April 2021). The creative health measures put in place at the local level represented a major contrast with the central government, which generally did not respond effectively to the pandemic as they centralised the decision-making process and used emergency decrees to control information.
This strong health response at the local level, responding to the immediate needs of the people, helped to keep alive the strong linkages between the LAOs and the people. For those wanting to see the restoration of democracy in Thailand, the recent local elections represent a potential source of light at the end of the tunnel.
New Zealanders need to pitch in for a final push to get as many people vaccinated as possible, says the Covid-19 Response Minister Chris Hipkins, who has announced a new “national day of action” for vaccinations.
Hipkins and Director of Public Health Dr Caroline McElnay gave today’s update on the fight against covid-19.
Half of eligible Kiwis have been vaccinated and at least 85 percent of Aucklanders have received at least one dose.
But Hipkins said everyone had a role to to play in getting vaccination rates up, and he wanted those already vaccinated to help those who had not been to get a dose.
“This will culminate in a national day for vaccination on Saturday 16 October — Super Saturday.
“On that day, we will have vaccine clinics open all through Aotearoa all day and into the evening and a bit like election day, we will be asking all our civic and political leaders to contribute to a big effort to turn people out.”
Tomorrow, maps showing suburbs with lowest vaccination rates will be published.
Watch the briefing
Video: RNZ News
“This will be helping local iwi, who have been pushing for this, our local communities, and our local MPs to work together to mobilise their communities.”
A website will be going live later today with information about the Saturday event.
“My request to everybody is this: Pitch in and get this done.”
Hipkins said the new cases outside the Auckland border were “stark reminder of how tricky the virus can be”.
“Our strategy to date of keeping covid-19 out has served us well, but we can’t keep doing that forever,” he said.
“As the prime minister said on Monday, getting back to zero cases of covid-19 in the community is unlikely. We need to prepare for a gradual transition to the next phase of our covid-19 response.”
South Seas chief executive Silao Vaisola-Sefo said it was successful because it was community-driven.
He said they wanted to take people on a journey through the process of getting vaccinated and to create a festival atmosphere.
Minister of Pacific Peoples Aupito William Sio said the numbers were impressive.
“A huge congratulations, absolutely proud of the leadership of the Bubble Gum group in leading that,” he said.
“Their efforts alongside other young people who are leading the charge are probably responsible for the huge uptake in the covid-19 vaccine for that age group.”
More than 5000 food parcels, petrol vouchers, 2000 kids packs, and NZ$100,000 worth of incentives were distributed to those attending.
This article is republished under a community partnership agreement with RNZ.
This content originally appeared on Asia Pacific Report and was authored by APR editor.
More details will be shared in coming weeks, but for now the certificates will be used as a tool in high-risk settings including large events and the government is consulting on their use in places like hospitality.
It will not be used for places like supermarkets or essential health services. It will be available either in digital form on smartphones or can be downloaded and printed out.
They are likely to start being used in November.
Ardern said: “Please get vaccinated now, summer is close. And so to be fully vaccinated and fully protected and do the things you love, you need to be vaccinated this month, not in December”.
The best Christmas present to families this year would be to get vaccinated, Ardern said.
Ministry of Health officials Shayne Hunter (Deputy Director-General Data and Digital) and Michael Dreyer (General Manager, National Digital Services) said they would be making access to vaccination records available “soon”.
Watch the announcement
Video: RNZ News
Within a few weeks of that — late this month — test results should be available via the My Covid Record, and after that the downloadable certificates will be accessible around November.
People wanting to access their record will be able to access it using a My Health account or RealMe. They will be able to create an account if they do not already have one.
The record will show details including batch number, site, and which arm was used. Second vaccinations can also be booked through the system.
Watch: How My Covid Record will work
Video: RNZ News
There will be an app available for verification, and it should be able to be used either on a mobile device, on a website or using printouts.
They say it will be reachable from the current Covid app, but it is not part of the app because of privacy settings that are required.
They intend to keep the paper form available to people who don’t have access to digital technology.
Ardern says they are also looking at ways that people can visit a health professional and have a certificate printed out for them.
Large scale events are likely to make the use of the certificates mandatory, and while they may not be mandated in smaller settings those venues may consider using it themselves. The government is still considering its options about whether the certificates will be mandatory in some of those gatherings.
“That is an area where we are going to be very cautious and also learn from overseas,” Ardern said.
Technology on trial
The technology was being trialled and it was being widely used by some individuals, she said.
The government is also still considering when the certificate will take effect for individuals who have been vaccinated. People are considered fully vaccinated after a second dose but they are not considered fully immunised until two weeks after they have had their second dose.
Ardern said clear advice would be supplied about where the certificates cannot and should not be used.
“The best way to guarantee your entry into a summer festival is to be vaccinated,” she said.
The system could in future be adapted to take account of vaccinations administered overseas, and certification offered by other countries.
24 new covid-19 community cases
Twenty four new covid-19 cases in the community today — 18 of them in Auckland — were reported in New Zealand today, the Ministry of Health reports.
The other six are in the Waikato. Three of the Waikato cases were made public yesterday but are included in today’s numbers.
There are two cases in recent returnees in managed isolation and quarantine.
Of today’s 24 cases, seven are yet to be linked. Of yesterday’s 29 cases, eight cases remain unlinked. All the Waikato cases are linked.
There remain 12 active subclusters where there have been recent cases.
Based on already notified cases and their contacts, an additional 48 cases are expected.
There were 14,905 tests were processed nationwide yesterday with 12,595 of those in Auckland. More than 85,000 swabs have been taken across Auckland in the past seven days.
This article is republished under a community partnership agreement with RNZ.
The New Zealand government has set out a three-stage roadmap that gradually eases covid-19 restrictions in Auckland.
Prime Minister Jacinda Ardern said the government would take a careful, methodical approach to the changes.
From midnight tomorrow, Tāmaki Makaurau will remain in alert level 3 but Aucklanders will be able to connect with people outside their bubble outdoors, with no more than two households and 10 people mingling at a time.
Early childhood education will return as normal and people can move around Auckland for recreation, like visiting the beach or hunting.
At the second stage, retail shops can open with face masks and social distancing, public facilities such as pools and zoos will open and the number of people who can meet outdoors will increase to 25.
Hospitality venues will open at the third stage, seating people at a distance with a maximum capacity of 50 people.
Public health advice at this stage also indicates schools will be able to return after the school holidays on the October 18 – with a final decision to be made closer to the time, the prime minister said.
Outdoors makes the difference
Ardern said that being outdoors and the ventilation that provides makes all the difference.
“Don’t for a moment be tempted to suddenly, if the weather turns bad, switch to being in your home,” she said.
In a statement, the Ministry of Health said there were also two new cases at the border.
It said 28 of the new cases were in Auckland and one was in Waikato.
Of the new cases, 21 were epidemiologically linked and eight were being investigated.
That brings the total number of community cases in the current outbreak to 1357. There have been 4025 cases since the pandemic began.
Lot of work done on step-wise process
Director-General of Health Dr Ashley Bloomfield said a lot of work had been done to evaluate the step-wise process.
“I think this is the important feature of this next four to eight weeks, being methodical and stepwise and doing it safely. As our vaccination rate goes up, that helps and it’s already helping.”
He said public health officials also looked carefully at the things in each step that would not increase the risk much at all, and it’s on the basis of reviewing the status each week that the decision has been made.
“Cabinet will review each step weekly to ensure it’s safe to move before confirming the next step. The wage subsidy will continue to be available,” Ardern said.
“In total, this phasing amounts to a careful and methodical transition plan for Auckland.
“At the end of these steps, we will then move to a national framework that reflects a more highly vaccinated population, allowing us the ability to deal with riskier settings such as large-scale events with the use of vaccine certificates.”
Still covid ‘zero-tolerance’
Covid-19 Response and Education Minister Chris Hipkins told RNZ Checkpoint preparations had been underway for some time for the three-step transition.
“If we look internationally, it’s countries that have stepped down well have stepped down slowly and consistently. Those countries that have moved faster tend to have ended up cycling backwards and forwards with their restrictions so that is something that we would like to try and avoid here if we can.”
He said the government was continuing to have a “zero tolerance approach towards covid-19. But the way we approach this will be a little different.”
Hipkins did not say if vaccination for school teachers would be mandatory, but signalled tougher rules for unvaccinated teachers would be introduced.
“It may be that those who are not vaccinated need to be tested more frequently, for example, there might be requirements for unvaccinated people working in schools and working with young people who can’t be vaccinated to be frequently tested.
“We’ll work our way through those we will talk to the sector about the practical realities of all of those other things.”
Opposition slams roadmap National leader Judith Collins said the government’s “incompetence” had meant New Zealand was stuck in a “lockdown limbo” with no answers and no way out.
She said the situation was clearly out of control and worsening every day.
ACT leader David Seymour said the government should give the public a “proper plan” and let Aucklanders know when the finish line was in sight.
The Green Party said the government’s roadmap for Auckland risked the safety of vulnerable communities and children.
Co-leader Marama Davidson said now ws not the time to change the approach.
This article is republished under a community partnership agreement with RNZ.
Students have had a range of experiences with remote learning over the past 18 months, with some students thriving at home, others completely disappearing from the school system, and most falling at various points in between. Since last spring, when it seemed that vaccines could end the COVID pandemic in the United States, families and educators have eagerly awaited the start of a new “normal” this fall.
But the latest COVID spike, which in September led to over 2,000 daily deaths and critical shortages of ICU beds across much of the country, has once again turned school reopenings into a source of anxiety and argument — especially because children under 12 are ineligible for the vaccine (although that may change soon). But while some districts, including Los Angeles, are offering a choice of in-person or remote learning this year, many others are forcing almost all students to attend in person.
This decision is especially controversial in New York City, where the failure to promptly shut down schools in March 2020 was a major factor in allowing the deadly disease to spread. Throughout the following school year, Mayor Bill de Blasio — eager to get students back in school and parents back to work — promoted the safety and educational benefits of in-person learning, but the vast majority of families chose to remain remote, with Black and Asian students avoiding school buildings in especially overwhelming numbers.
This year, de Blasio is giving students no choice. But many parents remain concerned about the safety of in-person learning, especially because while cities like Chicago and Los Angeles plan weekly COVID tests for each student, New York’s plan is to test far fewer students — and only to test those who fill out a consent form. These fears have been borne out by the first weeks of school, which generated numerous social media images of overcrowded hallways, almost 3,000 positive COVID tests and the closure of over 1,000 classes. One week into the school year, the Department of Education (DOE) abruptly changed policy and announced that unvaccinated students in a class with a student who tests positive will no longer have to quarantine at home — doubling down on its plan to keep all students in school no matter what.
For months, a small coalition of parents and educators has sounded the alarm about the city’s reopening plan. Tajh Sutton, the president of the Community Education Council for District 14 in Brooklyn and the program manager for Teens Take Charge, a youth activist group that organizes against school segregation, has been one of the lead organizers of the #RestoreRemote campaign. In this interview, which was conducted before the DOE policy change on quarantining, Sutton says the refusal to create a remote option is a connected to the ongoing struggle to make the New York City school system democratically responsive to its majority of Black, Brown, Asian, working-class and poor constituents, who have expressed high levels of concern about the safety of in-person learning throughout the pandemic.
Danny Katch: Why should the New York City public school system offer a remote learning option for all students?
Tajh Sutton: Everywhere needs to offer remote learning because the pandemic is not over. In fact, we’re at higher risk because these variants are coming out that are even more contagious and deadly than their predecessors. So the idea that we would limit the possibility for safety by not providing virtual schooling and work options is counter to public health.
This is an issue everywhere, as you say, but New York City’s plan seems particularly negligent around testing. Can you speak about that?
There’s an intentional negligence taking place with safety precautions. As of now in New York City public schools, only 10 percent of the school population at any given time is being tested. Last year when there were only 30-40 percent of New York City public school students in the building, testing was mandatory for everyone. This year it’s not, and that is a direct result of affluent white families who want schools open at all costs, who are advocating that all of the health mitigation measures in place be eradicated so that there are no more quarantines and no more school closures, health be damned.
The irony is that a lot of the arguments for mandatory in-person schooling argue that it’s especially necessary for students of color.
Yes, don’t you love it when we’re tokenized? If we need something, don’t you think we’d tell you? And we have been. Black and Latino and Asian families and educators, since the schools closed, have been attempting to provide the mayor and the chancellor — both old and new — with demands and recommendations about what a safe and equitable reopening would look like. And all of that has been discarded so that we can reopen the system at all costs — so that we can reopen the city.
I understand that there are students — particularly students of color, particularly students who live in temporary housing or have disabilities or are multilingual learners — who need to be in person. What I don’t understand is why the entire system needed to be reopened to do that, when one of the things we were fighting for first and foremost was prioritized reopenings. Because we wanted those kids back in school as soon as possible, but if those children are in a school that is overcrowded, what quality education and services are they even providing?
As a longtime organizer against school segregation, particularly the racially biased admissions screening in New York City schools, do you see continuity in terms of things being done in the name of Black and Latino families who in fact are being ignored?
Oh, absolutely 100 percent! It’s the same individuals who were slandering Teens Take Charge when we were trying to get rid of admissions screens, who are fighting to keep schools open, who are fighting to eliminate things like quarantines and mask mandates, which is how you know that the safety and care of our children aren’t what’s actually their focus. Wanting kids in school is something I can understand, but not wanting to know if there’s an infection in the school? Not wanting to do everything possible to keep children safe — particularly children under 12 who cannot be vaccinated? That’s not something I can understand. None of them care about Black and Latino children, so they really need to keep our names out of their mouths.
Most coverage of people opposing testing and mask mandates is of Trump supporters. In your experience, are these people Trump supporters or do they view themselves as liberal Democrat types?
A lot of individuals in New York City who believe they are progressive are actually one Twitter argument away from agreeing with everything someone in a MAGA hat would say. And that’s a conversation that we really need to have as a city.
In New York City, parents of color — particularly African American parents — have long organized for greater community control against the institutional racism of the school system. Is the #RestoreRemote campaign part of this very long debate about community control?
I do think it’s part of that legacy. There’s an incredible amount of organizing that’s being unnoticed, by the mayor and also by the city at large. Most people don’t even know that this Restore Remote coalition and this organizing even exists, or that we have 7,000 signatures or that we were able to convince over 35 state senators and city council members to come out in support of this — as well as two borough presidents and the public advocate.
But the thing about these systems is that they are designed so that none of that matters. In a system like mayoral control, the mayor’s going to do what he’s going to do. So our next fight, especially with Eric Adams coming in [as the likely next mayor], is really going to be about how we put that power for public education back in the hands of students and educators and families and communities.
The individuals leading the so-called “keep schools open” campaign can make one petition that barely got any signatures and wind up in Vogue magazine. But Black and Latino and Asian mothers like myself, who have been fighting for an equitable reopening for 18 months — and who were fighting before that for public education in general — we don’t get shit.
What’s it been like leading this fight while being the parent of two kids you’ve been keeping out of school?
I would love nothing more than to send my children to school. This is my son’s 8th grade year. I hate that he’s not enjoying it with his friends in his school. But what I would hate more is if my child got sick or worse. Because I’m coming home to an asthmatic husband, an immunocompromised baby brother and a daughter who is too young to be vaccinated. And I wish that we were having more multilayered conversations about that, because you’ll find way more community members who live in a multigenerational home and who are immunocompromised than you will these individuals who just can’t wait to get to get back to work — especially since a lot of those folks have the capability to work from home.
When the pandemic started, I interviewed a teacher who said the city’s delayed closing of schools was due to its failure to listen to teachers and parents. Do you feel like the current failure to offer a remote option is due to the people in charge of schools not being in touch with the needs of most public school families?
Looking at Twitter and listening to the news, you can feel mentally unwell because the gaslighting has been so effective — particularly over the summer in terms of this idea of “get back to normal.” Seeing all these pictures of these beautiful little masked faces walking into school, you really start to feel like maybe you’re just overreacting. But then you see the COVID case numbers, you start hearing about even more variants, start hearing about the disparity in the vaccination rates across communities.
The Department of Education had a moral obligation to have a culturally competent conversation about valid vaccine hesitancy and medical racism, and create the space to change minds and support people in making healthy decisions. That did not happen. Who’s doing that work? Parents like myself, for free. Two days ago, I was at my church in Harlem virtually, talking to my elders and community members about ventilation, masking, hand washing, and how they can get in touch with their superintendent or their principal and advocate for their children. We’ve been doing panels since last year, and for that to all just be ignored because we are not white and moneyed is disgusting but also so unsurprising.
How is the campaign for a remote option going so far, and what do you see as the next steps?
We have a toolkit that tries to draw out different resources together that folks can utilize virtually from the comfort of their home to join this fight. What this looks like around the corner is really applying pressure to our new governor, because the mayor has made it clear he does not care. And I think as cases skyrocket, which they inevitably will, we’re going to see more families opting out of in-person learning, because now they’ve seen it firsthand. It’s different when someone tells you something and you’re holding out hope, and when you actually experience that classroom closure, experience your child sitting next to a child that you find out two days later was positive, and now you have to go get that rapid test. And so we’re going to see a lot more families opting in to this strike for school safety as the weeks go on and the numbers rise.
This interview has been lightly edited for clarity.
Parts of Waikato — including Raglan, Huntly, Ngāruāwahia and Hamilton City — will join Auckland in alert level 3 from midnight tonight, the New Zealand Prime Minister has confirmed.
Prime Minister Jacinda Ardern and Director-General of Health Dr Ashley Bloomfield have given today’s briefing after three recently reported community covid-19 cases outside of Auckland.
Announcing that parts of the district would go into level 3 at 11.59pm tonight, Ardern said there would be spot checks around Hamilton boundary areas, but they would not be as rigorous as the boundary in Auckland as it was too difficult to have a hard boundary around Hamilton.
She said Cabinet intended for level 3 restrictions to apply for the next five days, which would give authorities the opportunity to contact trace and widely test in the coming days. The restrictions would then be assessed.
Ardern said the vast majority of the cases had not been vaccinated.
‘Vaccination makes a difference’
“Vaccination makes a difference, it keeps people safe,” she said.
“If we had a vaccination rate of 90 percent or above in either Hamilton or Raglan it is highly unlikely we would be here today announcing level 3 restrictions.
“Instead we would be able to rely on other tools like contact tracing and much lower level public health measures but while we are vaccinating we have fewer choices in how to react to cases.”
She said none of the three community cases outside of Auckland had been vaccinated.
“We’ve been advised that the household members of the truck driver are vaccinated and have not yet tested positive,” she said.
Watch the briefing live
Video: RNZ News
Ardern said the government was doing everything possible to keep cases confined to Auckland.
Auckland’s alert level will be reviewed tomorrow.
Waikato treatment
Ardern said the level 3 in Waikato would be treated distinctly from what was happening in Auckland.
Last night, the ministry reported an Auckland truck driver who had travelled to Palmerston North had tested positive for covid-19.
Ardern said today that with the Palmerston North case the source was known and Auckland based, but this was not the case for the Waikato cases.
Dr Bloomfield said he was not worried about community spread in Palmerston North, but people with symptoms should still get tested.
Yesterday in its daily update the Ministry of Health reported 27 new community cases of covid-19 in Auckland. One of these cases was a patient who went to Middlemore Hospital seeking treatment for issues unrelated to covid-19, but who then tested positive.
This article is republished under a community partnership agreement with RNZ.
About 2000 people have turned up to a New Zealand anti-lockdown protest in Auckland’s domain arranged by Destiny Church leader Brian Tamaki.
Those attending included gang members and one vehicle had a banner reading: “Let Freedom Reign”.
Police said they recognised people’s lawful right to protest, but under alert level 3 restrictions, the only gatherings allowed were weddings, funerals and tangihanga with no more than 10 people.
A statement was expected later this afternoon, once the event is over.
Protests were also scheduled to take place in Wellington and Christchurch.
27 new community cases
Meanwhile, 27 new community cases were reported in New Zealand today, with five not yet linked to earlier cases.
There was no media conference today. In a statement, the Ministry of Health said 14 of today’s cases were household contacts, eight were known contacts and five were under investigation to determine how they were linked to the current outbreak.
“Due to the highly infectious nature of the delta variant within households, we expect to see fluctuations in case numbers at this stage in the outbreak.”
All the new cases are in Auckland.
There are 10 unlinked cases from the past fortnight.
There have now been 1295 cases in the current community outbreak, with 1068 now considered recovered.
There was also one new case in managed isolation today.
22 people in hospital
There are currently 22 people in hospital with the coronavirus, including three in intensive care.
The ministry said there had also been another exposure event at Middlemore Hospital last night, with a person seeking treatment for issues unrelated to covid-19 subsequently testing positive.
They have been moved to a covid-19 isolation ward at the hospital.
“The patient was wearing a mask at all times in ED. All staff were wearing appropriate PPE and as such no staff members are required to stand down,” the ministry said.
The ministry also said whole genome sequencing had identified a clear epidemiological link between the Naumi MIQ worker who was reported as a positive case earlier this week and another case at the border.
“The worker tested positive on September 29 as part of routine surveillance testing. They are fully vaccinated and have been tested regularly. The hours they worked mean they had limited contact with guests at the hotel. They are now isolating in a quarantine facility.
“An investigation is underway to determine the pathway of the worker’s infection and identify potential contacts.”
The ministry said 22,041 tests were taken yesterday, with more than 13,000 swabs taken in the Auckland region.
“We would like to thank everyone in Tāmaki Makaurau who has come forward to be tested.”
This article is republished under a community partnership agreement with RNZ.
Mental illness has historically dwelt in the shadows of the global health and development agenda and only recently has moved from the margins to become a central priority in research and policy. Mental disorders account for 30% of the worldwide non-fatal disease burden and 10% of the overall disease burden, including death and disability, and the cost to the global economy is estimated to reach as high as USD 6 trillion by 2030. Large middle- and low-income countries like Indonesia struggle with a plethora of challenges in delivering adequate mental health care to its 270.2 million citizens. Centralised funding for Indonesian mental health is only 1% of the national health budget; health expenditure is around 3% of GDP. National health programming such as Indonesia Sehat, the incorporation of mental health into primary care basic standards and voluntary contributions from provincial budgets does provide some additional resources. However, there is a severe shortage of mental health personnel, treatment and care facilities, especially outside the island of Java.
Estimations based on the 2018 Basic Health Survey (RISKESDAS) indicate there are 450 000 families in Indonesia with at least one member diagnosed with schizophrenia; given the high level of stigma against mental illness and psychosocial disabilities, we suggest this number is much larger. Many of these people are subject to human rights abuses, being left to languish in cages, stocks or chains referred to as Pasung. Human Rights Watch estimated that 12,800 people were experiencing Pasung at the end of 2018. Over 26.23 million people, more than the entire population of Australia, suffer from clinically relevant symptoms of anxiety and depression and 16.33 million likely meet the diagnostic criteria for a depressive disorder.
Although there is a shift to community-based outpatient models of care, Indonesia’s 48 mental hospitals and 269 psychiatric wards in general hospitals are still the primary sources of care. There are just over 1000 registered psychiatrists, 2000 clinical psychologists, 7000 community mental health nurses, 1500 mental health trained GPs and 7000 lay mental health workers unevenly distributed across the archipelago, (Ministry of Health Regulation on Pasung Management, 2017; Pols, 2020). Need outstrips supply, with eight provinces without a mental hospital: three of these hospitals without a single psychiatrist. Less than half of all primary care centres and only 56% of government district hospitals are equipped to handle mental health cases. Fortunately, there are many passionate and committed mental health personnel, government officials, academics, consumer group founders and mental health advocates who are working tirelessly to implement the vision embodied by the 2014 Indonesian Mental Health Law. Our webinar for World Mental Health Day is a small sample of these extraordinary individuals, who will share their experiences in Indonesian mental health.
Dr Nova Riyanti Yusuf, a psychiatrist, legislator (member of the DPR from 2009-14 and 2018-19), novelist, scholar, television personality and activist, was one of the driving forces behind the 2014 mental health law. She will talk about the ongoing journey of the mental health law, what its vision is for Indonesian mental health and the current state of implementation at the grass roots level. Professor Hans Pols, a renown psychiatric historian based at University of Sydney and expert on Indonesian mental health will then take us through a brief history of Indonesian Psychiatry and will talk about some of the emerging trends for the future of the profession across the archipelago. Anto Sg,Pasung survivor and current recipient of an Australia Award currently studying a Master of Health Promotion at Deakin University, will share his person experience of Pasung and introduce the survivor or consumer group movement in Indonesia. Dr Erminia Colucci currently based at Department of Psychology, Middlesex University, UK will is working with the Center for Public Mental Health (CPMH), Psychology at the University of Gadjah Mada and Ade Prastyani, GP and scholar on traditional healing approaches to mental health. We will show a short exert of their upcoming film produced by their collaborative Together4MentalHealth. After which, CPMH director, distinguished academic and clinical psychologist Dr Diana Setiyawati will provide us with a current update on community mental health initiatives in the age of Covid19. Aliza Hunt, Centre for Mental Health Research PhD Candidate and Endeavour Scholar at the ANU is chairing the session.
Wear a Mask, Scan QRs, Vaccinate (@marcdaalder) 
