Saliva testing saga continues with 'frustrating' and 'short-sighted' U-turn on MIQ returnees
Friday, 12 November 2021
Critics say the Government has performed yet another policy reversal with a move to not allow any form of saliva testing for people passing through MIQ – even though it is being used regularly on border workers.
The Government had planned to saliva test MIQ returnees on days three, six and nine of their stay by the end of October, part of a trial to see if saliva tests could replace nasal swabs for returnees.
But in answers to written questions, Covid-19 response Minister Chris Hipkins said the Government had abandoned its own saliva testing pilot for MIQ returnees, and now believed saliva testing was not suited to the reduced isolation periods announced in October.
“The Ministry of Health will revisit piloting saliva testing for returnees in the near future.”
**READ MORE:
* Ministry of Health gave saliva testing provider 'the metaphorical finger' during outbreak
* Covid-19: U-turn on saliva testing as fears grow around nasal swab hesitancy
* Covid-19: The issues with saliva tests, and why NZ's rollout has been so slow
**
Saliva testing expert and Yale public health research scientist Anne Wyllie says there is no reason the Government can’t collect both nasal swabs and saliva samples from returnees to inform future decisions around testing, particularly because border workers are already being tested for Covid-19 using saliva.
“This is so incredibly short-sighted. If MIQ staff are already being tested with saliva, they have the materials and processes available to also introduce this.”
National Party Covid-19 Response spokesman Chris Bishop says the ministry is wedded to a single form of Covid-19 testing: the nasal swab, and is unable to properly consider anything else.
Instead of insisting on nasal swabs it should be trying to use different tests to fit a much broader testing strategy, especially with the move to suppression of the virus.
“The evidence is just compelling and overwhelming that saliva testing is just as accurate, has a real role to play,
“Here we are at November 2021, 14 months after the Roche Simpson report said roll it out as a priority, and the ministry says it’s basically too difficult to do saliva testing of returnees.
“This how pathetic the situation is, they can’t even do a trial of returnees, and they’re still insisting on using nasal PCR tests … it’s just hopeless progress, and it’s incredibly frustrating.”
Director-General of Health Ashley Bloomfield, too, has already accepted the science.
“The evidence, and we’ve had a look at this, it’s very important, is saliva testing if it’s validated can be as sensitive as nasopharyngeal [swabs],” he told a select committee in April.
However, in recent months concerns have been raised about the validation of the Ministry of Health’s chosen saliva test.
These concerns increased after an ESR study using the Government’s chosen saliva test was leaked to Stuff.
Objectives attached to the study implied data from it was being used for validation, despite the study itself being populated with errors.
Wyllie says if it was worried about accuracy the ministry could use both nasal swabs and saliva testing to check.
Bishop says the unresolved issues around validation should be examined as part of a wider inquiry into saliva testing.
“I’m not an expert and I don’t claim to be. But there are experts like Anne Wyllie, who have real credibility, quite obviously and manifestly in this area, who have raised real concerns in this area.”
The U-turn on saliva testing for returnees is doubly surprising in light of recent ministry moves to embrace PCR saliva testing as an alternative to nasal swab tests.
In September, the ministry said it was “now confident” PCR saliva testing could identify cases early and stop chains of transmission in their tracks.
A few weeks later the New Zealand Microbiology Network said saliva testing was accurate enough to be used as a substitute for nasal swabs, and that same month accreditation standards changed to allow saliva testing to be used in medical clinics to diagnose people with Covid-19.
The ministry has come under mounting criticism, including from the Auditor-General, over its slow roll-out of saliva testing and the awarding of a $60m saliva testing contract to NZ Superfund-owned Asia Pacific Healthcare Group over saliva testing competitor Rako Science.
A damning letter from Auditor-General John Ryan this week criticised the Ministry of Health’s processes around its saliva testing roll-out, including conflicts of interest and poor procurement management.
Ryan also said people within the ministry’s procurement processes had preconceived ideas on saliva testing.
In its answer to Bishop’s written questions on saliva testing Hipkins said: “PCR nasopharyngeal tests are considered to be the best test for the purpose of diagnosing Covid-19 before returnees leave MIQF [Managed Isolation and Quarantine Facilities] to self-isolate.”
NZ-expat Wyllie has advised US President Joe Biden on saliva testing (she was part of a White House call on the country’s testing strategy), and Biden put her forward for a United Nations-hosted global summit on Covid-19 testing.
She disagrees with what Hipkins asserts, and points to a wealth of academic literature backing up her point of view.
Not only do some of the studies she cites say saliva PCR testing can be just as accurate as nasal swabbing, but they say saliva tests often pick up Covid-19 cases before nasal swabs do.
Bishop says Wyllie’s concerns and advice should be taken seriously by the Government: “We’ve got a world-class Kiwi, who’s essentially an adviser to the President of the United States on saliva testing, who can’t get a gig in New Zealand to explain her concerns around how we’re doing saliva testing.
“When you just reflect on that, that is an extraordinary situation, and it just reiterates our call, which I think others have echoed as well, for an inquiry into what has happened here.”