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As Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) began to spread internationally in early 2020, New Zealand took a series of rapidly escalating approaches to limiting the direct impacts of COVID-19 on its small South Pacific island population. New Zealand implemented a graded series of non-pharmaceutical interventions (NPIs) ranging from increasing border entry restrictions to national lockdown. As evidence emerged from overseas of the ways the new coronavirus could be controlled in the absence of vaccine or effective treatment, New Zealand established a system of Alert Levels with differing levels of NPIs. This focused resources on border measures, increasing surveillance capabilities including testing, supporting intensive case and contact tracing, public communications, and strict physical distancing measures. The Government at the time set a goal of COVID-19 elimination, meaning eliminating chains of transmission in the community and effective containment of any future imported cases from overseas. These measures would aim to reduce the virus to zero or very low incidence in New Zealand on an ongoing basis.

New Zealand is a high-income country with a dual public-private health system which provides free secondary level care and subsidised primary community-level care to a population of approximately 5 million people. This is delivered across 20 District Health Boards which receive national funding and strategic and operational guidance from the Ministry of Health based in the capital city of Wellington. New Zealand has a diverse ethnic structure, and longstanding social and ethnic health inequities whereby people of lower socio-economic status and particular ethnic groups - predominantly New Zealand’s Indigenous Māori, and Pacific peoples - experience persistent infectious and other disease disparities.This is despite specific legal protections for Indigenous Māori provided by the Treaty of Waitangi. In this context, preventing social and ethnic health inequities in the burden of COVID-19 and the public health response to it, was a national priority.

In this chapter, we outline key features of New Zealand’s experience of the initial response to prevent entry, detect and limit the spread of COVID-19 in the country.