On July 1 st , 2022, the New Zealand government established a new health and disability system, representing the largest overhaul of the current system the country has ever seen.It is expected the new national health system will be simpler and more coordinated, allowing for better and more consistent care, and address equity at all levels.Public health is a particular focus of these reforms with more emphasis on population health and the determinants of health.However, a year on from the establishment of this new health system little has changed with regards to the deep-rooted problems facing public health in New Zealand.The potential to create a public health system that truly delivers on equity can be realized by looking to Māori (Indigenous people of New Zealand) socio-cultural beliefs and practices, which were exemplified by recent localized response to COVID-19.This Viewpoint highlights two important considerations for public health in New Zealand: the lessons from localized Māori responses to COVID-19 and, the creation of a public health framework for New Zealand that is based on a Māori worldview.Looking forward to the future of the public health system in New Zealand, the government must make space for and advocate for Māori ways of public health.

This whakataudki or proverb, from Dr. Whakaari Te Rangitakuku Metekingi (LLD, CBE) of Whanganui and Ngdti Hauiti tribes reminds us that, while we must have a vision to aspire toward, we must also tend to the here and now, to the issues that are up front and close to home. It exhorts us to strengthen what has already been achieved and to find ways of creating benefits for others. This paper presents the collaborative response to COVID19 by Iwi (tribes) within Te Ranga Tupua (TRT), a collective of Iwi from the South Taranaki/Whanganui/Rangiakei/Ruapehu regions of Aotearoa New Zealand. The research employs a mixed methods design, based on a Kaupapa Maori approach. The quantitative section identifies the population served and quantum of support provided, while the qualitative data presents the processes and associated learnings from the perspective of those tasked with the response. TRT's response to the threat of COVID-19 is shown to have been grounded in Maori tikanga (values), whdnau (family) based and holistic, taking into account the mental, emotional, social, cultural, and spiritual elements of safety and wellbeing rather than just the absence or presence of the virus. The extensive relationships and networks that existed between tribes represented in the TRT collective were key to the timely distribution of care and support to Iwi members, to appropriate and relevant information dissemination, and to the overall well-being of the people during the most difficult times of the COVID-19 response.

Throughout the coronavirus disease 2019 (COVID-19) pandemic, the Māori, Indigenous people of New Zealand, public health response has been guided by the collaborative and relationship-centered principles of te ao Māori, the Māori world. This article presents the communications response to COVID-19 by Iwi, tribes, within Te Ranga Tupua (TRT), a collective of Iwi from the South Taranaki/Whanganui/Rangitīkei/Ruapehu regions of Aotearoa, New Zealand. This research uses a qualitative design based on a Kaupapa Māori approach. The research presented here focuses on the intersect between COVID-19-related public health messaging, and the application of Māori knowledge and worldviews to establish equitable protection for Māori. By prioritizing equity, self-determination, and adopting a holistic approach to well-being, TRT have been able to re-frame public health messaging in accordance with our tikanga, customs, and notions of Māori public health. We provide a snapshot of how a unique tribal collective deployed its resource to provide culturally appropriate information and communication responses to the first wave of COVID-19 in 2020, and then built on this knowledge and experience providing a modified and more strategic response to the pandemic in 2021.

The strategy in New Zealand (Aotearoa) to eliminate coronavirus disease requires that international arrivals undergo managed isolation and quarantine and mandatory testing for severe acute respiratory syndrome coronavirus 2. Combining genomic and epidemiologic data, we investigated the origin of an acute case of coronavirus disease identified in the community after the patient had spent 14 days in managed isolation and quarantine and had 2 negative test results. By combining genomic sequence analysis and epidemiologic investigations, we identified a multibranched chain of transmission of this virus, including on international and domestic flights, as well as a probable case of aerosol transmission without direct person-to-person contact. These findings show the power of integrating genomic and epidemiologic data to inform outbreak investigations.

Since the first wave of coronavirus disease in March 2020, citizens and permanent residents returning to New Zealand have been required to undergo managed isolation and quarantine (MIQ) for 14 days and mandatory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of October 20, 2020, of 62,698 arrivals, testing of persons in MIQ had identified 215 cases of SARS-CoV-2 infection. Among 86 passengers on a flight from Dubai, United Arab Emirates, that arrived in New Zealand on September 29, test results were positive for 7 persons in MIQ. These passengers originated from 5 different countries before a layover in Dubai; 5 had negative predeparture SARS-CoV-2 test results. To assess possible points of infection, we analyzed information about their journeys, disease progression, and virus genomic data. All 7 SARS-CoV-2 genomes were genetically identical, except for a single mutation in 1 sample. Despite predeparture testing, multiple instances of in-flight SARS-CoV-2 transmission are likely.

Background: Since the first wave of COVID-19 in March 2020, people returning to New Zealand have been required to undergo managed isolation and quarantine (MIQ) for 14 days with mandatory testing for SARS-CoV-2. As of 20 October, testing in MIQ had identified 215 cases of SARS-CoV-2 from a total of 62,698 arrivals. While the majority of infections were likely obtained in the country of origin prior to departure, there have been possible reports of in-flight transmission. Methods: Seven people who arrived in New Zealand on the same flight on 29 September tested positive during their stay in MIQ (out of 86 passengers). The seven passengers originated from five different countries before travelling on the same flight from Dubai, United Arab Emirates (UAE) to Auckland, New Zealand. Information about their journeys, disease progression and virus genomic data was used to assess possible points of infection. Findings: All seven SARS-CoV-2 genomes were genetically identical, with the exception of a single mutation in one case, and all genomes had five signature mutations seen in only six other genomes from the >155,000 genomes sequenced globally. Four of these six related genome sequences were from Switzerland, the country of origin of the suspected index case. Interpretation: By combining information on disease progression, travel dynamics and genomic analysis, we conclude that at least four in-flight transmission events of SARS-CoV-2 likely took place.