Chris Hipkins says he never got the ‘unnecessary risk’ advice on teens and Covid vaccine. This Cabinet paper shows otherwise

Labour’s response to pressure from the Government has leaned on the Royal Commission’s report, which said: “Ministers we interviewed could not recall receiving that advice, nor is there any evidence it was provided to them in the material we obtained from agencies.”

But Hipkins’ Cabinet paper indicates he knew of the advice, which was shared with Cabinet colleagues in a Cabinet Social Wellbeing Committee meeting (Hipkins is not listed in the minutes as being present at that March 2022 meeting).

Hipkins declined a request for an interview, and did not directly address the issue of making the advice public.

“We had to make tough decisions under extraordinary pressure and a rapidly changing environment,” he said in a statement.

“The Royal Commission found that the Government made numerous efforts to communicate safety issues, including the risk of myocarditis and pericarditis.”

At the time, 92% of the 12-17 age group - a population of 350,000 to 400,000 - had had two doses of the vaccine. That translates to about 30,000 young people yet to have a second dose.

“It is an outrageous situation where many tens of thousands of children and teenagers were exposed to the known risks of having two vaccine doses yet the public, and more importantly the parents, were not told,” New Zealand First leader Winston Peters told the Herald.

Health Minister Simeon Brown echoed Peters’ sentiment: “Parents deserve confidence that decisions are evidence-based, that the advice behind them is visible, and that ministers are being open with the public.”

Hipkins had another Cabinet paper considered at the same committee meeting - in March 2022 - about the changing Covid response following the Omicron peak.

Cabinet then agreed to follow the public health advice and end the vaccine passes, as well as the education mandate. This was implemented at the start of April 2022.

Vaccine passes in certain settings, such as cafes, had been applicable to the 12-17 age group, while the education mandate also covered 12- to 17-year-old workers or volunteers, including in home-cased education and care.

Other vaccine mandates continued - at MIQ facilities, the border, the health and disability sector, among others - because they involved vulnerable people, or due to the risk at the border of a new variant from overseas.

While these mandates had no specific age restrictions, they generally did not involve any workers under 18.

Peters described it as “alarming” that the key Cabinet paper did not come up in the Royal Commission’s report, which he said “relied upon Hipkins’ and [former Labour minister Ayesha] Verrall’s denials”.

He repeated his call for a select committee inquiry into the injuries that “the mandated double-dose of the vaccine may have caused”.

Hipkins said he and other Labour ministers acted with the Royal Commission “in good faith” and “to the best of our recollection”.

“While I do not recall all of the advice we were provided over the three years, ministers kept the vaccine mandates under review and continuously sought expert advice on the safety and impact of vaccinations for under-18s,” he said.

A Herald analysis of how the myocarditis risk materialised over time suggests that only a tiny proportion of the 12-17 age group - dozens out of up to 400,000 - were affected.

The Herald looked at the period from the start of 2022, the earliest time that policy changes might have been made, had the right advice gone to the right people at the end of 2021. The period ends at the end of November 2022, the most recent available data in the latest Medsafe Covid-19 vaccine safety report.

For the 10-19 age group (there is no breakdown for the 12-17s), there were 33 cases over this period following a second or third dose of the Covid vaccine: 17 for myocarditis, 16 for pericarditis (inflammation of the sac surrounding the heart).

This paints an indicative picture, not a definitive one. There may be cases that were never reported, and of those that were, there may not be any causal link between the second or third vaccine dose and the myocarditis/pericarditis.

For the 12 to 17 age group, this picture suggests that myocarditis or pericarditis cases following a second or third Covid vaccine dose are “very rare”. Medsafe defines this as fewer than 1 in 10,000 people being affected.

“The protective benefits of vaccination against Covid-19 far outweigh the potential risks of vaccination,” said the safety report, of the Covid vaccine in general.

There has been one reported death in the relevant age group from myocarditis following vaccination, a 13-year-old whose name has not been released. The coroner did not find a causal link between the vaccine and the death, nor could such a link be ruled out.

The death was in October 2021, before the key CV TAG advice, so any policy changes based on the advice would not have made a difference in this case.

There also appears to be no suggestion of a ticking myocarditis time bomb. Symptoms and diagnoses have to be within 30 days for the Centre for Adverse Reactions Monitoring to record an AEFI report for myocarditis.

This means that any myocarditis potentially caused by a second or third shot should have long materialised.

The hospitalisation database, the National Minimum Dataset, shows the number of 12-to-17-year-olds admitted to hospital for myocarditis and pericarditis.

It shows more severe cases, though excludes ED admissions and GP visits, and has no information about vaccination status.

Like the AEFI data, it also doesn’t say anything about causation. The cases in hospital may have come from a Covid-19 infection, which generally presents a greater risk of myocarditis than getting a vaccine dose.

Before the pandemic, there was an annual average of 14.25 hospitalisations for myocarditis or pericarditis. Since 2022, there have been at least 22 cases a year among this age cohort, peaking with 32 cases in 2022 and 2024.

The context for the CV TAG’s concerns starts in October 2021: Delta was spreading, vaccination rates were rising, and, to help contain the spread, Auckland was in the middle of a months-long lockdown.

Cabinet approved the education vaccine mandate to protect children and young people from infection. Education workers and volunteers 12 and older would need to have two vaccine doses by January 1, 2022.

This followed advice from the CV TAG, in August 2021, that those aged 12-15 should be vaccinated; Medsafe had granted provisional approval for that age cohort two months earlier.

In fresh advice in November 2021, the CV TAG told the Health Ministry that “younger age groups are more at risk than older age groups of myocarditis after the second dose”.

One dose was still worth it because it indicated “some protection from Covid-19″, based on early data, and catching Covid-19 presented an even greater risk of myocarditis.

“Consideration should be given to permitting younger people [18 and under] who have had one dose to be permitted to work or undertake other activities covered by the [education] mandate,” the CV TAG recommended.

The group delivered updated advice on vaccine mandates to Sir Ashley Bloomfield, head of the health response at the time, on December 9, 2021. It said the risk of a severe impact from Covid on under 18s was “very low”.

The danger of increased Covid transmission from forgoing a second dose was “insufficient to justify mandating a two-dose schedule of the Pfizer vaccine prior to working in any environment” - a reference to all vaccine mandates, rather than just the education one.

“The two-dose schedule, particularly when administered in the shortest possible clinical timeframe, may add unnecessary risk to increasing the likelihood of myocarditis as an outcome in this population,” the advice said.

The Royal Commission characterised this as “advising against requiring two doses for 12–17-year olds", but this wasn’t the CV TAG’s specific recommendation.

Similar to November, it recommended “that consideration be given to ... those aged <18 years only being required to have received one dose of Pfizer vaccine to meet the vaccine requirements for employment”.

Though the recommendations were similar, the Royal Commission said the substance of the CV TAG’s advice had changed in December 2021, compared to the previous month.

But it was the November advice that was included in a briefing paper, from Bloomfield to Hipkins, on December 22 (despite the director-general himself receiving updated advice 13 days earlier).

“In November 2021, CV TAG has raised concerns about vaccine mandates requiring younger age groups (e.g. those under 18 years) to be fully vaccinated,” the paper said, along with the group’s recommendation to consider changing the requirements to one dose.

Bloomfield made recommendations about vaccine-related matters, but nothing on the issue of whether under 18s should avoid a second vaccine dose.

Verrall, the Associate Health Minister at the time, considered the paper on January 7, 2022 (Hipkins was on leave). She wrote in the margins: “CV TAG’s concerns, at the time, were about insufficient data on safety of second dose.”

The Royal Commission did not find any record of the CV TAG’s December advice going to ministers, who told the commission they had no recollection of receiving it. The failure to deliver this advice was “significant”, the commission said.

Dr Andrew Old, deputy director-general of health at the Ministry of Health’s public health agency, acknowledged this failure.

“We are reflecting carefully on this finding, including reviewing our processes to assure ourselves that our advice is being delivered clearly and consistently.”

The Herald asked Bloomfield whether he recalled the CV TAG’s December advice, and whether he took any responsibility for the failure of this delivery at the time.

He declined to answer. “I’m not doing any interviews in response to the [Royal Commission’s] report,” he said in an email.

It’s not knowable what might have happened if Bloomfield had included the December advice in his paper to Hipkins at the end of 2021.

At the time, 75.6% of the 12-17 age group had already had two doses of the vaccine, according to the Health and Independence Report 2021. This means about 91,000 people in that age cohort were yet to get a second jab, though most of them had had no vaccine doses.

Just over a third of them - about 34,000 12- to 17-year-olds - ended up getting a second jab by the time the vaccine mandates were all lifted, in September 2022, according to the Ministry of Health.

What is known is how Hipkins responded once he was aware of the advice in question - in March 2022, when it was in his Cabinet paper, including how two doses “may add an unnecessary risk of myocarditis in this [12-17] population”.

He followed the public health advice to end the education mandate and vaccine passes, but the advice was not made public.

The Royal Commission noted that the risk of myocarditis for the 12-17 age group was “widely published”.

How many 12-17s were double-vaccinated because of the mandates is unknown, the Royal Commission said.

Nor can it be known how many might have chosen to forgo a second dose, had the advice been made public.

Following the end of the education mandate, the mandates for border workers, prison workers, and Fire and Emergency staff ended in July. The remaining ones - for health, disability and aged care workplaces - ended in September.

The Ministry of Health noted the Royal Commission’s finding that, overall, the decisions taken and methods used during the Covid response were “considered and appropriate”.

Areas where the response could have been better included better monitoring of the use and impacts of vaccination requirements, including job losses.

“In hindsight, some vaccination requirements were introduced too slowly, some lasted too long and some went too far,” the commission’s report said.

While vaccination requirements were “a valid intervention”, they should be used with great care due to the severe consequences for those who choose not to be vaccinated.

“Future requirements should be applied with flexibility, should be monitored systematically and reviewed frequently against clear criteria, and decisions to end mandates should be actioned quickly, given their impact on individual rights.”

2021

June: Medsafe grants provisional approval for the Covid vaccine for those aged 12 and older.

August: The Health Ministry’s Covid-19 Vaccine Technical Advisory Group (CV TAG) recommends those aged 12 and older to be vaccinated.

October: Cabinet introduces the education mandate, requiring education workers and volunteers 12 and older (including those in home-based care) to have two vaccine doses by January 1, 2022.

November 5: CV TAG’s advice to the ministry notes concerns about younger age groups “more at risk than older age groups of myocarditis after the second dose”. Recommends consideration of one dose for those 18 and under for the education mandate.

December 9: CV TAG’s updated advice, sent to Bloomfield, is that two doses for vaccine mandates isn’t justified. Two doses “may add unnecessary risk to increasing the likelihood of myocarditis”. Recommends considering one dose for under 18s for all vaccine mandates.

December 22: Bloomfield sends a paper to Hipkins that includes the CV TAG’s November advice and recommendation, but not the December advice. The Royal Commission describes the failure to deliver the December advice as “significant”.

About 24.4% of the 12-17 age group (or about 91,000 young people) at this time are not double-vaccinated, while 9% (about 34,000 young people) get the second jab between this point and when the vaccine mandates are lifted.

2022

January 7: Ayesha Verrall makes a note in the margins of Bloomfield’s paper to Hipkins, who is on leave. It says: “CV TAG’s concerns, at the time, were about insufficient data on safety of second dose.”

March: A Cabinet paper in Hipkins’ name, sent to the Cabinet Social Wellbeing Committee, includes the CV TAG December advice. It is primarily looking at the 5-11 age group, and does not make any recommendations for the 12-17 age group.

At the time, 92% of 12-17s have had two doses, meaning about 30,000 young people are yet to have a second dose.

The committee also considers a Cabinet paper on the changing Covid response, following the Omicron peak. It recommends ending the education mandate and vaccine passes - which are applicable to 12- 17-year-olds - which Cabinet agrees to, because their public health benefits are now limited.

April 4: The education vaccine mandate and the vaccine passes end.

July: The mandates for border workers, prison workers, and Fire and Emergency staff end.

September: The remaining mandates (for health, disability and aged care workplaces) end.

2026

March: The Royal Commission of Inquiry Phase Two report lands. It finds the decisions taken and methods used during the Covid response were “considered and appropriate”. Areas where the response could have been better included better monitoring of the use and impacts of vaccination requirements, including job losses. Vaccination requirements were “a valid intervention”, but should be used with great care.

Coalition ministers accuse Labour’s Covid ministers of not doing enough, based on what they knew about the CV TAG’s concerns over the two-dose vaccine mandate requirements for 12-17s. Covid ministers point to the Royal Commission’s report, which said they weren’t informed of the CV TAG December 2021 advice.

The Herald finds a Cabinet paper, in Hipkins’ name, that shows him sharing the CV TAG December advice with Cabinet colleagues in March 2022, which led to the education mandate and vaccine passes ending.

Hipkins says he engaged with the Royal Collection in good faith, and to the best of his recollection of what was a rapidly-changing and high-pressure environment. He doesn’t directly answer why the advice wasn’t made public.

Derek Cheng is a senior journalist who started at the Herald in 2004. He has worked several stints in the press gallery team and is a former deputy political editor.

Clarification: This story has been updated to include context that the vaccine mandates - except the education mandate - did not generally involve any workers under 18.