[I] Controlling the scope - the cascading effects

The absence of discussion around potential therapies and their demonstrated efficacy creates five major domino-like problems. Firstly, it is difficult to identify a local media environment that is open to discussion concerning a broad suite of publicly discussed and deliberated upon therapeutics. There are therapeutics that reduce risk in COVID-19 patients, but with a media silent on the issue, vulnerable patients that are vulnerable because of the limitations of current vaccines as standalone treatments – and unaware of a suite of options, have every right to feel terrified.

Secondly, keeping nutritional therapies off the policy options list results in a two-tier system of access to key nutrients as wealthier groups can walk into a shop and purchase these nutrients. For example, Vitamin D cannot be sourced dietarily, and Māori have the lowest levels in New Zealand. This issue could be addressed through the Māori Health Action Plan which aims to improve health disparities and improve equity.

Thirdly, the combinatory effect of likely ongoing infectiveness, and the lack of deliberation over nutritional intervention prevents a feedback loop back to the Ministry of Health and Pharmac. This prevents medical practices and hospitals from directly responding to the personal immunological and nutritional profiles of disadvantaged patients.

Fourthly, the preoccupied focus on cases, and the public health response to vaccination disproportionately results in the targeting of disadvantaged populations and promotes knowledge gaps that more accurately predict risk. This risks a ‘blame game’ over behaviour, rather than a nuanced discussion over disadvantage. The risk for being symptomatic is directly connected to the quality of diet, and the stress, or absence of in your home life. The Ministry of Health reports have for years documented the poorer immune and metabolic health of Māori and Pasifika.In many if not most cases, it is structural issues, access to housing, employment opportunities, and wage levels that lead to adverse outcomes in Covid-19.

Finally, narrow messaging prevents the development of democratically accountable policy that promote meaningful discussion to address New Zealand’s chronic disease epidemic, and improve health equity.

From evading discussion on nutrient deficiency in parenthood, to policy that could Governments have been disinclined[ii] to identify, regulate and tax ultraprocessed foods that drive disease including mental illness, metabolic syndrome, cancer and adverse COVID-19 outcome.[iii] [iv] [v]

Greater policy levers are required to protect health, particularly in pandemics. Bad outcomes from infection are commonly associated with age, chronic illnesses and obesity.

In the Ministry of Health’s response to Covid-19, natural immunity appears to have been downplayed.[vi] This contradicts a century of scientific understanding. An emerging suite of pandemic studies point to the development of strong immune memory after infection, and this appears preventative against unknown future variants.[vii] [viii] [ix] Immunity from vaccination appears to confer much narrower immunity as the current vaccines confer focused immunity that target a single viral spike protein. In contrast, naturally acquired immunity targets multiple components of the Sars-Cov-2 virus.[x] [xi] The public can be informed on the potential role of natural immunity for low-risk individuals who can also access treatments, should they become infected with Covid-19.

NEXT: [J] The Principle of Informed Consent

REFERENCES

[i] MoH. (2018). Health and Independence Report 2017. The Director-General of Health's Annual Report on the State of Public Health. Ministry of Health.

[ii] Warhurst L. Jacinda Ardern 'rules out' introduction of sugar tax despite rising numbers of diabetes. Stuff October 9, 2019. https://www.newshub.co.nz/home/lifestyle/2019/10/jacinda-ardern-rules-out-introduction-of-sugar-tax-despite-rising-numbers-of-diabetes.html

[iii] Lustig 2021. Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation. Nutrients 12, 3401; doi:10.3390/nu12113401

[iv] Baker et al 2020. Ultra-processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers. Obesity Reviews. 2020;1–22.

[v] Kaplan B. & Rucklidge J. The Better Brain. Mariner Books 2021

[vi] Makary, M. Natural Immunity to covid is powerful. Policymakers seem afraid to say so. Washington Post. September 15, 2021 https://www.washingtonpost.com/outlook/2021/09/15/natural-immunity-vaccine-mandate/

[vii] Gallais et al 2021. Evolution of antibody responses up to 13 months after SARS-CoV-2 infection and risk of reinfection. EBioMedicine 71:103561

[viii] Gazit et al 2021. Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections. MedRxiv. doi: https://doi.org/10.1101/2021.08.24.21262415

[ix] Cohen et al 2021. Longitudinal analysis shows durable and broad immune memory after SARS-CoV-2 infection with

persisting antibody responses and memory B and T cells. Cell Reports Medicine 2:100354

[x] Brouqui et al 2021. COVID-19 re-infection. Eur J Clin Invest. 2021;51:e13537.

[xi] Bridle B. 5 factors that could dictate the success or failure of the COVID-19 vaccine rollout. The Conversation. February 11, 2021. https://theconversation.com/5-factors-that-could-dictate-the-success-or-failure-of-the-covid-19-vaccine-rollout-152856

[I] Controlling the scope - the cascading effects

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