The bulk of Covid-19 vaccinations will be done through GPs, other primary care settings and community clinics, Dr Ashley Bloomfield has said at a briefing with health officials.
Dr Bloomfield has been explaining New Zealand's Covid-19 vaccine roll-out plan including delivery, the online booking tool, and public sentiment research at a briefing, joined by Counties Manukau District Health Board (DHB) chief executive Fepulea'i Margie Apa, and Ministry of Health deputy director-general for data and digital Shayne Hunter.
He said of 220 economies and countries around the globe, 194 had started vaccinations programmes - over 733 million doses of vaccines have now been administered around the world.
In New Zealand, there would be no fee for receiving the vaccine, and funding would already have been arranged with primary care providers to fund every part of the vaccination visit, he said.
"Our priority continues to remain that our population has access to at least one highly effective safe vaccine, the one we're rolling out now (Pfizer), but we still have the other three in our portfolio and are looking to make sure we have back-up options," Bloomfield said.
"I think the initial envelope that was set aside for the vaccine advance purchases was up to $1 billion, not all of that has been used, but I would imagine that the cost of all the rollout right across the country will be probably half that again."
He said he expected the total cost of the vaccination programme would be between $1bn and $2bn.
He said they continued to be confident about Pfizer, and were also watching for when under-16s would be able to get immunised.
Medsafe has requested additional information from Johnson & Johnson ahead of making a decision about whether to approve the pharmaceutical company's Covid-19 Janssen vaccine.
In the past few days the US, EU, Australia and South Africa have temporarily halted its use, over concerns about a rare type of blood clotting.
New Zealand passes 150,000-dose milestone - Bloomfield
Bloomfield said New Zealand was in the first scale-up, moving from a few thousand doses a day up to between 12,000 to 15,000 a day.
"Last Thursday was when we had 100,000 doses administered - by the end of today it will be 150,000," Dr Bloomfield said.
Scaling up would level off until the end of June, then increase again to 50,000 to 60,000 doses a day as more vaccine supplies arrived.
He said Pfizer's track record on deliveries was very good, and although the level of detail about deliver dates was less clear, Prime Minister Jacinda Ardern had sought assurances from the global head of the company a few weeks ago to ensure New Zealand would have all its doses by the end of 2021.
The Defence Force was half way through second doses of vaccinations with nearly all workers having received the first dose, he said, and strong systems were in place for ongoing monitoring of safety.
More than 200 ministry people were now working on this programme, with people right across the public sector contributing as well as people from the private sector, Bloomfield said.
The bulk of vaccinations would be done through GPs, other primary care settings, the community clinics that were being set up, and some larger events that DHBs may set up to vaccinate up to 10,000 or 20,000 people a day, he said.
When the programme was first set up efforts focused on general practice hubs, but the ministry was now looking at adding in more dispersed general practice, with planning for that under way, Dr Bloomfield said.
They were looking at logistics of distributing vaccine, including training and workforces in general practices to do that - though not all GPs would be able to - and finally making sure the information systems were in place.
Dr Bloomfield said there had been some global delays in vaccine access, but it had not been a problem for New Zealand and there were no indications there would be any problems here.
There were fewer details about vaccine shipments coming from July onwards, he said, but the government did have an agreement with Pfizer to receive all of New Zealand's vaccine orders this year, he said.
Dr Bloomfield said the countries that were further advanced in their vaccination programmes were those with outbreaks. They also started earlier.
New Zealand officials were working closely with Australia's where there was a similar pace of rollout, he said.
The public information rollout will include booklets in letterboxes, TV and radio ads, social media and public figures, Bloomfield said.
Ramping up vaccinations in Auckland
Counties Manukau District Health Board (DHB) chief executive Fepulea'i Margie Apa said the goal was to set up enough points where communities could access vaccinations to make it safe and easy to access.
Apa said the first supervaccination site set up in Highbrook on 1 March employed up to 60 people, drawn on workforces across Auckland and whanau ora, and was scaling up to do 1000 vaccinations a day, currently at 800.
"By the end of April the northern region aims to have at least 22 to 23 sites open to our community, that includes 16 large primary care settings, two super vaccination sites that can do up to 1000 people per day and local vaccination sites that can do between three [hundred] to five hundred."
Manurewa marae had also been able to set up a vaccination site for that community, Apa said.
She said they wanted to be able to offer certainty from July onwards when vaccinations opened up to general population that people would be able to get vaccinations when they booked.
Setting up the vaccination sites was a major logistical exercise, including things like parking, good training, take a lot of care in working with community to set up the right sites, Apa said. Also recruiting, northern region DHB has been recruiting for staff and had 250 applications for vaccinators in last couple of weeks, she said.
A pop-up testing centre remains open in Mt Roskill in central Auckland, an area where some places were visited by an MIQ worker who tested positive at the weekend.
Vaccination bookings system in place end of May
Hunter said a Covid-19 immunisation register had been in place from December last year, with inventory management and logistics support in place since February.
"The Covid immunisation register is really the single most important source of truth of who's been vaccinated, where they've been vaccinated, when they've been vaccinated, what dosage they've had, what batch they've had," Hunter said.
"So if we ever had to do anything like a recall then that's the place when we know all the information about who's been vaccinated."
He said the ministry was working with the Adverse Reactions Monitoring centre in Dunedin but had to scale up their systems in case of significant numbers of adverse reactions to the vaccine.
He said most recently they were focused on a national booking system, which would be in place at the end of May.
Hunter said it was essential for the system to be able to deal with changes to appointments - and it would.
The system should cater for all the different circumstances that may come up he said, and they had talked to counterparts in Israel, UK and the US about their vaccination systems.
Dr Bloomfield said once vaccination centres opened to the general population, there would also be some opportunities for walk-ins - immunisations without a prior appointment.
Unregistered vaccinators
The NZ Nurses Organisation, a nurses union, has expressed concern over the training of non-clinical staff to give Covid-19 vaccinations.
The union said it stemmed from a long-standing failure by the Ministry of Health to recruit more Māori nurses, and was a stop-gap measure that would create further pay inequities for clinical staff.
Bloomfield said regulations needed to be changed to ensure it was lawful for this unregulated workforce to vaccinate under supervision.
He said they would also need some additional background training, a programme was being developed with the aim of having this completed by the end of this month.
He said it was hoped they would be able to start training from the beginning of May.