Good morning.  

Thank you for inviting me to open the National Health Emergency Forum. The theme for the day is "sharing the lessons" of the national response to Swine Flu - pandemic influenza H1N1 09.

May I start by saying this opening is significant to me personally.  It's been a privilege to work alongside a group of dedicated health professionals as we faced the first significant pandemic event to affect New Zealand and the world for 40 years.

On ANZAC Day, 25 April, swine flu landed in New Zealand - literally - aboard Air New Zealand flight NZ 1.  The virus had infected some members of a group of secondary school students returning from a school trip to Mexico.   

Thanks to a couple of alert Auckland GPs, public health officials identified the significant potential threat quickly and within 48 hours we had activated our National Pandemic Plan and set up the National Health Coordination Centre - we were the first country in the world to report importation of swine flu.

Today is day 130 of the national response.  Most New Zealanders would say it was prompt and effective in containing and delaying the spread of swine flu.

There are encouraging signs that the basic public health messages such as staying home when sick, covering coughs and sneezes and regular hand-washing, have helped lessen the pandemic's impact.

These interventions were practical and sensible, but were also based on careful planning, both within the health system and with other sectors.

Let us not forget however, that this pandemic has taken its toll - people have been severely affected and some have died.

It is therefore the right time - during this post peak ebb in activity - to record and share the lessons we've learned and undertake the critical task of planning for the next wave or the next pandemic.

The efforts of everyone in this room should be acknowledged. Equally the efforts of your colleagues and fellow health professionals who aren't here today but also gave up days, nights, weeks and weekends, month after month, mobilising to meet this threat head on. 

We should also recognise people in the wider health sector and those in the border agencies and education who worked alongside us to first 'keep it out' and then contain the swine flu pandemic.

The Ministry of Health led and managed the national emergency response involving the entire health and government sectors.  Many organisations and individuals needed to collaborate to achieve the response goals.

With that said, I want to specifically point out the efforts and leadership of the National Co-ordinator - Steve Brazier - and his team in the NHCC. Over these last four months Steve and his team have been at the epicentre of managing both the response and my office's need for the best possible intelligence on the course of the pandemic and the adequacy of our response.

Counting cases and hospitalisations is important to monitoring the pandemic.   But intelligence about regional spread, infection rates and modes, and ICU capacity is vital to understanding the pandemic and to adapting the response.

Many clinicians and managers at District Health Boards provided a lot of that information as well as dealing with the extra pressure of the pandemic on their hospitals and clinics.             

While this is an opportunity to look back and learn, we must remain vigilant in the knowledge that viruses by their very nature can and do change, and influenza pandemics often re-emerge with greater severity.

The last four global influenza pandemics all had multiple waves, with the first wave being relatively mild and the following ones more serious.

Let's use this forum and this time to analyse the experience and better prepare our plans, our people and our sector for what may lie ahead.

The WHO and the rest of the world have shown particular interest in the way we have responded to the pandemic.  They see that they have much to learn from New Zealand's experience.  

While some regions experienced significantly more pressures than others, overall we were fortunate that the virus has so far been relatively mild - although sadly, in a few cases it was tragic.    This pandemic has given a clear indication of our capacity and capability, and areas where there are opportunities to improve.

Thanks to those of you at the front line who lasted through the pressures of having to manage rapid logistical and operational challenges such as border health team staffing and contact tracing in the "Keep it Out" & "Containment" phases.

While it was difficult to add the surge requirements of swine flu to business-as-usual workloads, it's clear that all of this pressure and disruption equated to a better result - as we delayed community transmission, allowing time to learn about the virus, further prepare and communicate effectively with the community on steps everyone could take.

All of this ultimately lowered the impact of the virus on New Zealanders and at that time it was not known that the virus - in this wave at least - was less virulent than the 1918 flu.

We don't know how many New Zealanders caught the virus in the first wave.   Because it was mostly mild, many people cared for themselves at home while others may have been infected but had no obvious symptoms.  Officials estimate between ten and 25 percent of New Zealanders have been ill with swine flu.  They advise at least fifty per cent  of a population needs to be infected to provide sufficient community immunity. 

So there is likely to be a significant proportion of the population that have not been exposed to the current strain of swine flu and will still be susceptible to swine flu in the future , including a possible second wave.

With that in mind, we are considering a serological prevalence survey - a series of targeted blood tests - to help us understand more about the spread and levels of exposure and susceptibility in the population.

This information will greatly aid our ability to plan for our future responses including vaccination strategies.

None of us should forget that it is possible, or according to the Director of Public Health, probable cases will increase again and that a future second wave of the pandemic may well prove to be more severe.

You'll no doubt be looking at your local and regional operational responses to ensure you can meet these future challenges.

I challenge you to look particularly at times when your resources were more than fully stretched. The question we all need to consider is this; what would our Plan B have been if the virus had been as virulent as in 1918?

You will all know the strengths, weaknesses and gaps that exist in your own plans and responses.  Use this session to discuss these and share them so that if and when we're called on to respond again, we can do so with an even better response.

It is the government's intention to use this swine flu experience to update the National Pandemic Plan.

I am pleased to see on the agenda that there are case study experiences being shared about different aspects of our response.  The Flu Clinics or Community Based Assessment Centres in Canterbury were a great example of an intervention that was implemented extremely well and had demonstrable benefits in managing the volumes of people seeking assessment and treatment in the region.

There are other examples of our response strategy that have been highly effective. These include things such as:

• The DHB and Intensive Care Unit groups that were formed rapidly to share information and daily intelligence


• Healthline and the co-ordination and effectiveness of the public information campaigns around hygiene and social distancing.


• The border response and interagency management, and


• Our surveillance and data collection that supported daily decision making

These are just a few examples of the items you will get a chance to share and discuss in this forum.

It is important to recognise that the lessons you have learned will be applicable with some modification to other types of pandemic. Indeed, emergency management in New Zealand should find the lessons useful in planning for other types of emergency altogether.

Finally, today as we review and reflect on the last four months, I am sure you too will realise that this national pandemic response is a unique period in your careers as health and emergency management professionals, one where your decisions, and your actions really counted in mitigating what might have been, and what still may be, one of the few major threats to our well-being as a nation.

Thank-you again, and I look forward to seeing the outputs of the forum incorporated into our forward planning and policies to better equip us for what may lie ahead.