BackgroundThe Aotearoa/New Zealand Government is aiming to end the tobacco epidemic and markedly reduce Māori:non-Māori health inequalities by legislating: (1) denicotinisation of retail tobacco, (2) 95% reduction in retail outlets and (c) a tobacco free-generation whereby people born after 2005 are unable to legally purchase tobacco. This paper estimates future smoking prevalence, mortality inequality and health-adjusted life year (HALY) impacts of these strategies.MethodsWe used a Markov model to estimate future yearly smoking and vaping prevalence, linked to a proportional multistate life table model to estimate future mortality and HALYs.ResultsThe combined package of strategies (plus media promotion) reduced adult smoking prevalence from 31.8% in 2022 to 7.3% in 2025 for Māori, and 11.8% to 2.7% for non-Māori. The 5% smoking prevalence target was forecast to be achieved in 2026 and 2027 for Māori males and females, respectively.The HALY gains for the combined package over the population’s remaining lifespan were estimated to be 594 000 (95% uncertainty interval (UI): 443 000 to 738 000; 3% discount rate). Denicotinisation alone achieved 97% of these HALYs, the retail strategy 19% and tobacco-free generation 12%.By 2040, the combined package was forcat to reduce the gap in Māori:non-Māori all-cause mortality rates for people 45+ years old by 22.9% (95% UI: 19.9% to 26.2%) for females and 9.6% (8.4% to 11.0%) for males.ConclusionA tobacco endgame strategy, especially denicotinisation, could deliver large health benefits and dramatically reduce health inequities between Māori and non-Māori in Aotearoa/New Zealand.

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Background Identifying optimal COVID-19 policies is challenging. For Victoria, Australia (6.6 million people), we ranked 44 policy packages (two levels of stringency of public health and social measures [PHSMs]; providing respirators during infection surges; 11 vaccination schedules of current and next-generation vaccines) in the context of 64 future SARS-CoV-2 variants (combinations of transmissibility, virulence, immune escape, and incursion date). Methods We used an agent-based model to estimate morbidity, mortality, and costs over 18 months from 1 April 2022 for each scenario. Policies were ranked on cost-effectiveness (health system only and health system plus GDP perspectives), deaths and days exceeding hospital occupancy thresholds. Findings The median number of infections across the 44 policies was 6.2 million (range 5.4 to 7.1 million). Higher stringency PHSMs ranked better from a health system perspective, but not a health system plus GDP perspective. The provision of respirators to replace surgical/cloth masks had minimal impact. Vaccinating all ages was superior to nil further vaccination and targeted vaccination of individuals aged ≥60 years. Averaging over 64 future SARS-CoV-2 variant scenarios the optimal policy was a multivalent vaccine for all age groups with higher stringency PHSMs and no respirator provision. For the SARS-CoV-2 variant scenario approximating recent BA.4/5, Omicron-targeted vaccines were more likely optimal even with a three-month delay compared to boosting with current-generation vaccines. Interpretation Modelling that accommodates future scenarios with uncertainty, and that can be rapidly updated as new data arises, can provide a framework for pandemic decision making.

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