Famous for the landscapes from the Lord of the Rings, Māori culture and flightless kiwi birds, we head to New Zealand for the latest in our World of Genomics series. Also known by its Māori-language name, Aotearoa, the island country has one of the oldest social security systems in the world and prioritises equity and accessibility in its healthcare. This is particularly important when considering New Zealand’s Māori and Pacific Islander communities. With 6 sheep per person, New Zealand is known for its agricultural economy, but it is seeking to grow its genomic presence on the world stage.
The population of New Zealand
New Zealand is an island country in the southwestern Pacific Ocean. It consists of two main landmasses, the North Island (Te Ika-a-Māui) and the South Island (Te Waipounamu)—and over 700 smaller islands.
Owing to their remoteness, the islands of New Zealand were the last large habitable landmass to be settled by humans. Mitochondrial DNA variability within Māori populations suggests that Eastern Polynesians first settled the New Zealand archipelago between 1250 and 1300.
Dutch explorers came to New Zealand in the 1600s, followed by British and French explorers in the 1800s. In 1841, New Zealand became a colony of the British Empire before gaining full statutory independence in 1947.
Mātauranga is a modern term for the traditional knowledge of the Māori people of New Zealand. Mātauranga Māori has only recently gained recognition in the scientific community for including knowledge consistent with the scientific method as it was previously dismissed by scientific institutions and researchers. Māori traditional knowledge is multi-disciplinary and holistic, and there is considerable overlap between concepts. It includes environmental stewardship and economic development.
New Zealand’s geography includes glaciers, fjords and mountains as well as volcanoes, subtropical forests and sandy beaches. This diverse landscape contains many unique flora and fauna, as well as making it a popular location for filming.
Geographic and demographic information
Summary statistics
- Land area: 268,021 km2
- Gross domestic product (GDP):
- Total: 212.5 billion USD
- Per capita: 41,791.79 USD
Population statistics
- Population size: In 2021, the total population of New Zealand was estimated to be 5,122,600.
- Birth rate: In 2020, the crude birth rate was 11 per 1,000 people.
- Death rate: In 2020, the crude death rate was 6 death per 1,000 people.
- Infant mortality rate: In 2020, the crude infant mortality rate was 4 deaths per 1,000 live births.
- Average life expectancy: In 2020, the average life expectancy was 82 years.
- Ethnicity: According to the 2018 census, the ethnicity breakdown of New Zealand is European descent 70.2%, Māori 16.5%, Asian 15.1%, Pacific people 8.1%, Middle Eastern/ Latin American/ African 1.5% and other 1.2%.
Healthcare system
The 1938 Social Security Act implemented New Zealand’s universal healthcare system. The country has achieved universal health coverage through a mostly publicly funded, regionally administered delivery system. Patients owe co-payments on some services and products, but no deductibles. Approximately one-third of the population has private insurance to help pay for services that aren’t covered and co-payments.
The national government plays a central role in setting the healthcare policy agenda and service requirements and in determining the publicly funded annual health budget. The government sets an annual overall budget and benefit package, based largely on political priorities and health needs.
The ability to access and share accurate clinical information is central to the New Zealand Health Strategy, which provides high-level direction for the country’s health system. Meanwhile, the New Zealand Health Strategy Future Direction emphasises prevention, early intervention and pursuing technological innovation.
In 2021, the Universal Health Coverage of New Zealand was deemed to be 80, in comparison to the global score of 57. Universal Health Coverage is a score measured by the World Health Organisation monitoring to what extent all individuals and communities receive the health services they need without suffering financial hardship. In 2021, New Zealand’s healthcare system was ranked 13th in the world by the Global Health Security Index. In addition, New Zealand has 11.1 nurses and 3.4 physicians per 1,000 people.
Health disparities are a concern in New Zealand. Māori and Pacific Island people have shorter life expectancies than other New Zealanders (by seven and five years, respectively) and experience greater difficulty in gaining access to health services. Reducing disparities is a policy priority.
An aging population is another challenge facing New Zealand. Social and health services need to adapt to support an aging population stay healthy and independent. In addition, New Zealand’s health workforce is aging – 40% of doctors and 45% of nurses are aged over 50 years.
Health priorities
In New Zealand, the most widespread causes of death in 2019 were ischemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer’s disease and lung cancer. Health disparities are seen here, with Māori people more likely to die from lung cancer than non-Māori people.
Furthermore, while 5.6% of Māori people have diabetes compared to 2.8% of non-Māori people, 97% are likely to suffer from renal failure and 31% are likely to suffer lower limb amputation. In comparison, just 17.5% and 9.1% of non-Māori people respectively suffer these diabetes-related complications.
The Ministry of Health released Whakamaua: Māori Health Action Plan 2020-2025 in July 2020. Whakamaua outlines a suite of actions aiming to ensure the health and disability system is fair and sustainable and delivers more equitable outcomes for Māori people.
New Zealand currently has three organised cancer screening programmes, including the BreastScreen Aotearoa, the National Cervical Screening Programme and the National Bowel Screening Programme.
In 2020, New Zealand adopted a set of non-pharmaceutical interventions aiming to bring COVID-19 incidence to zero. The country saw rapid improvements in testing and tracing capacity and case management. People were isolating an average of 2-7 days before illness onset. Therefore, cases were isolated from the community promptly, reducing the risk of onwards local transmission.
As of July 2022, New Zealand had 1,452,748 confirmed COVID-19 cases and 1,674 COVID-19 deaths.
Genomic medicine capabilities
New Zealand was one of the first countries in the world to have a national metabolic screening programme, starting in 1969. New Zealand offers free new-born screening for over 20 conditions. Uptake is high and around 99% of babies in New Zealand are screened for metabolic and genetic conditions.
In addition, New Zealand provides free genetic counselling and genetic diagnostics to residents. The Genetic Health Service NZ is part of New Zealand’s public health system and is publicly funded.
New Zealand also collaborates internationally. For example, the Australia and New Zealand Children’s Haematology/Oncology Group (ANZCHOG) established a combined biobanking network in 2017. The ANZCHOG Biobanking Network consists of nine paediatric and adolescent/young adult cancer biobanks across Australia and New Zealand.
One struggle for New Zealand genomics is that Māori are significantly under-represented. There are multiple efforts and projects underway to increase Māori voices and leadership. In 2018, New Zealand launched and developed the first workshop in the world where all presenters were indigenous practitioners of genetics, titled ‘Ira Rangahau Māori – Genetics-based research by Māori’.
In New Zealand, gene editing is currently considered genetic modification and is subject to approval processes under the Environmental Protection Authority (EPA). Gene therapy is highly regulated. It is permitted for certain diseases, when the cause is a defect in a single pair of genes or in cancers.
An Aotearoa New Zealand Variome project is under development to gather and analyse genomic variation in Aotearoa’s unique and increasingly diverse population. Researchers are currently sequencing the genomes of New Zealanders and identifying the variation inherent in these genomes to better document and understand variations within the population.
New Zealand utilised genomic sequencing effectively in August 2020, during their second wave of COVID-19. They generated genomes from 78% of laboratory-confirmed samples of SARS-CoV-2 from the second outbreak and compared them with the available global genomic data. Genomic sequencing rapidly identified that wave as belonging to a single cluster and restrictive measures were taken. New Zealand were able to eliminate COVID-19 for a second time.
Notable projects
- Genetics Health Service NZ: Part of New Zealand’s public health system, the health service provides free genetic counselling and genetic diagnostics to residents.
- Vision Mātauranga: A policy that ensures guidelines for conducting genomics and biobanking research with Māori are met.
- Te Ira Kāwai – The Auckland Regional Biobank (ARB): A collaboration between the University of Aukland and Aukland district health boards, ARB is a secure facility that hosts a collection of donated patient tissue samples as well as relevant clinical information regarding these samples to support ethically approved research
- Healthier Lives – He Oranga Hauora: A National Science Challenge aligned research project. The epigenomics work focuses on obesity and type-two diabetes and the project also explores effective community intervention.
Notable organisations and companies
- Genomics for Aotearoa New Zealand (GFANZ): Established in 2017, GFANZ is a charitable society that provides resources and co-ordinates collaboration between experts.
- Indigenous Genomics Institute (IG): Initiated in 2019, IGI is a kaupapa Māori multidisciplinary platform, for Māori by Māori, and comprises Māori genetic scientists, kaupapa Māori researchers and community representatives.
- Genomics Aotearoa: A leading-edge and collaborative platform, established to ensure that New Zealand is internationally participating and leading in the rapidly developing fields of genomics and bioinformatics.
- Living Cell Technologies: A regenerative medicine biotech company. They discover, develop and commercialise novel treatments for conditions.
- Real Time Genomics: A bioinformatics company providing deep computational capabilities.
- Capital Genetics Group: A private genetic health service who support the Genetics Health Service NZ with genetic counsellors.
Notable individuals
- Allamanda Faatoese: Faatoese is known for her work exploring the potential of novel biomarkers to stratify cardiovascular risk among Māori. She also represents the University of Otago Division of Health Sciences Pacific Strategic Group to provide support for enhancing Pacific achievement in Health Sciences.
- Diana Hill: Hill is a molecular geneticist whose work led to New Zealand’s first agri-biotechnology project, AgResearch joint Molecular Biology Unit, in 1989. This unit created gene maps for sheep and deer as well as developing sheep as models for human diseases.
- Julia Horsfield: Horsfield is a biochemist and developmental geneticist. She founded the Otago Zebrafish Facility and her work is focused on cancer, stem cell biology and epigenetics.
- David Penny: Penny is an award-winning theoretical and evolutionary biologist. He helped to develop mathematical techniques and computer programmes to analyse DNA sequences and construct evolutionary trees, in addition to providing compelling DNA-based evidence that the Māori migration to New Zealand included between 50 and 100 females.
- Phil Wilcox (Ngāti Rakaipaaka, Rongomaiwahine, Ngāti Kahungunu ki te Wairo): Wilcox is a quantitative geneticist specialising in statistics and known for his teaching on Te Ao Māori, Māori ethical frameworks and the co-design of study with Māori communities.
- Maurice Wilkins: Wilkins was a biophysicist and Nobel laureate who is best known for his work on the structure of DNA with Crick, Watson and Franklin.
The future genomics landscape
GFANZ are creating a Public Bioinformatics Platform in collaboration with Catalyst Cloud, New Zealand’s cloud provider. Whilst still in the production phase, the aim is to produce a transparent, end-to-end automated platform to increase reproducibility in genomic studies.
GFANZ are also developing a language resource project, Te Reo Māori for Genomics. One of the barriers to Māori engagement with science and technology is a lack of transferable language. The project will bring together experts in Te Reo Māori and tikanga, research science and education to explore the language of genomics in a Māori context.
While gene therapies are highly regulated, New Zealand is starting the development of therapeutics. The US Food and Drug Administration have approved a clinical trial using a gene therapy approach for Parkinson’s Disease, run by researchers at the University of Auckland. In addition, researchers at the University of Auckland are currently developing gene therapy approaches for epilepsy.
New Zealand has recently approved a phase 1b trial with Verve Therapeutics for its in vivo gene-editing drug for high cholesterol, designed to permanently switch off the PCSK9 gene with a one-shot treatment. A New Zealand patient has become the first person to receive the dose and it is thought to be the first base editing test in humans.
New Zealand is becoming increasingly active in genomics, having prioritised communication and ethical integration, especially in regards to Māori and Pacific Islander involvement. With strong universal healthcare already in place, and an appetite for equitable accessible medicine, New Zealand has a robust foundation to lead in genomics.
References
- Gauld et al. International Health Care System Profiles: New Zealand. The Commonwealth Fund. 2020.
- Global Gene Editing Regulation Tracker. New Zealand: Therapeutic /Stem Cell. Genetic Literacy Project. 2020.
- Hudson et al. Indigenous perspectives and gene editing in Aotearoa New Zealand. Frontiers in Bioengineering and Biotechnology. 2019.
- National Screening Unit. Newborn Metabolic Screening Programme. Ministry of Health. 2014.
- New Zealand Minister of Health. New Zealand Health Strategy: Roadmap of Actions 2016. Ministry of Health. 2016.
- New Zealand Minister of Health. New Zealand Health Strategy: Future direction. Ministry of Health. 2016.
- O’Hallahan et al. Cancer screening in New Zealand. Journal of Cancer Policy. 2020.
- Robert. Lessons from New Zealand’s COVID-19 outbreak response. The Lancet. 2020.
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Image credit: canva
