We know how to boost vaccine rates, just give us the resources, Māori health providers say

Tuesday, 14 September 2021

The Government has been heavily criticised for low vaccination rates among Māori, a group considered vulnerable to the health impacts of Covid-19. Prior to the current outbreak, Māori health experts and providers warned the Government to prioritise Māori but were ignored. Pou Tiaki reporter Maxine Jacobs investigates.

Before the Government decided it was time to use buses in Auckland to help get more people vaccinated, Māori health experts, providers and community leaders were already doing mobile vaccinations.

They have been working hard, using a whānau centric approach, to get Covid-19 vaccines to tangata whenua across the country; from repurposing vans, setting up community clinics in urban and remote rural areas, to managing free-call hotlines for advice and information.

Sick of waiting for support from district health boards holding the purse strings, they had to act to protect their people, coming up with a range of out-of-the-box ways to vaccinate Māori.

Despite their best efforts, it is not enough. Their plans have been hamstrung by resource constraints, a lack of funding, and an ineffective national vaccine campaign creating more inequitable health outcomes for Māori.

**READ MORE:

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* Covid-19: First marae drive-through vaccination centre opens in Auckland's Papakura

* Associate Health Minister disappointed with vaccine uptake among Māori, admits system is racist

**

In Te Tai Tokerau, they have an ”act first, ask permission later” approach to help their hapū and iwi get vaccinated. If they had followed the roll-out’s age brackets it would have been a disaster, Errol Murray said.

Murray, the general manager of Whakawhiti Ora Pai, and other health leaders in Northland are working together to understand the barriers for their people and to try to work around them.

“As soon as we knew we could get the doses, we did not wait for the green light.”

Under Whakawhiti Ora Pai, Māori have received about 70 per cent of all vaccines, Murray said.

What worked for his community was setting up vaccination clinics at marae and community halls, picking up whānau and driving them to vaccination centres, calling families and providing advice, and incentivising communities with prizes.

He knew the booking system would be also be an issue for whānau.

Technology and financial constraints discourage people from booking their jab online, so an 0800 booking number was a necessity.

“That certainly worked for us. We realised our whānau have mobile phones but they work off data cards and they can be very precious.”

Ngā Puhi iwi was looking at travelling from door-to-door, offering the vaccine to anyone who was yet to get their jabs, rather than waiting for them to come to the clinics, said Murray.

National efforts are working among the most vulnerable age group – 65 plus – with high vaccination rates for all ethnic groups including Māori. But vaccination rates for Māori under 50 starts to drop away dramatically from the rest of the population and it is problematic for a number of reasons.

The median age for Māori males is 25.1 years and 27.1 years for females, compared with the national median of 36.4 and 38.5 years respectively. If Māori generally have a younger population, and culturally socialise in inter-generational groups, it puts more people at risk if every age group is not being vaccinated.

Add in lower socioeconomic factors, and higher health co-morbidities in younger age groups in the Māori population, and the risks of death or serious illness are higher for Māori than other ethnicities.

Sadly, up to September 12, there have been 27 Covid-19 related deaths in Aotearoa. Despite having lower infection rates than European and Pacific people, Māori have the second highest number of deaths.

Before and during the initial roll-out of the Pfizer vaccines, Māori health experts begged the Government to target all Māori age groups but they were ignored.

The Government has defended its actions, insisting it is doing all it can for Māori by including them in the general roll-out plan.

In March, the Government allocated $39 million to a Māori vaccination programme. Last week, a further $23m boosted Whānau Ora’s Covid-19 efforts in Auckland. Te Puni Kōkiri, the Māori Development Ministry, diverted $5m to the Covid-19 Whānau Recovery Fund focused on Tāmaki Makaurau, Te Tai Tokerau, and northern Waikato.

The national Covid-19 vaccination roll-out was pre-budgeted at $1.4 billion in May, spanning two years. Targeted funding to Māori health providers and Whānau Ora initiatives make up 4 per cent of the national funding allocation.

Associate Professor Andrew Sporle, an expert in indigenous statistics, said health officials had not got it right for Māori. Last year, Sporle’s team created an model predicting outcomes for Māori if elimination strategies were not successful. It paints a dire picture.

Of Ngāti Apa, Rangitāne and Te Rarawa descent, Sporle said that under current vaccination conditions there was no achievable level of vaccination that will prevent deaths from the Delta variant.

“We predicted the inequity,” Sporle said, “and then we demonstrated that it happened with the second outbreak. This current one is going to be much worse if elimination is not possible.”

With 25.5 per cent of the Māori population below 12, Sporle said it was imperative work being undertaken by Pfizer to develop vaccinations for children was successful. Medsafe is yet to approve it in Aotearoa.

Tamariki would be the carriers of the virus that would spread through communities if they were not vaccinated, he said. If in the future the pandemic ran its course without lockdowns, it would still be disastrous for Māori.

“The vaccination is not perfect. Even if we get to 80 per cent and we open the border, in about two years we would see at least 2000 deaths of Māori.”

Sporle is critical of the Ministry of Health for not publishing multidimensional, cross-section datasets, showing ethnicity, age and gender.

The Scottish Government released datasets to provide an in-depth picture of the severity of Covid-19 to ensure resources were allocated to the areas of the highest vulnerability and the lowest vaccination rates, Sporle said.

These datasets were needed in Aotearoa to shape the Covid-19 response and help communities understand the severity of the virus, he said. “People are clamouring for it and it is not available.”

As of September 14, Māori had received 269,506 first doses and 129,609 of the second dose, lagging behind all other ethnic groups.

In an all-of-government statement to Stuff, a spokeswoman for Associate Health Minister Peeni Henare said that nationally Māori aged 50 and above were being vaccinated at a similar rate to non-Māori and non-Pasifika people but younger generations needed more work to achieve equity.

“Delivering vaccination through models such as marae-based clinics, community vaccination centres, mobile units travelling to rural locations, festival events and workplace programmes are all designed to support Māori to access vaccination.

“This is supported through dedicated funding and plans for communications campaigns, provider development, and roles such as facilitators and champions.”

Henare told Newsroom last week the Government was doing all it could to meet demands from Māori health providers, now it was up to individuals to get their vaccinations. Māori Development Minister Willie Jackson doubled down, telling Te Ao Māori News, “we can't let our people off the hook”. Both ministers admit the Government could have done better initially.

Dr Rāwiri Jansen said that if the Covid-19 response team in charge of the vaccination roll-out had listened to the advice of Māori health experts, who explained the barriers and their solutions before the vaccine became available, uptake would have been much higher and Auckland would have been saved from an extended lockdown.

The efforts of iwi and Māori providers would have become streamlined with more financial backing, and there would be an understanding of the diverse needs of Māori, he said.

A South Auckland GP and the co-chair of Te Rōpu Whakakaupapa Urutā, Jansen resigned from his position with the Covid-19 Immunisation Implementation Advisory Board in April after his concerns for health equity fell on deaf ears.

He wanted Māori to be prioritised from day one, with increased resources given to iwi, hapū, and healthcare providers to ensure whānau were comfortable, able to book vaccines in a variety of formats, had access to transport, and were given multiple chances to have their questions answered about the vaccine.

Jansen was confident eligible Māori would reach at least a 95 per cent vaccination rate for their first dose but it would have been achieved earlier had the Government listened to him, other experts and the science, he said.

There were issues of struggling with childcare, lack of transport, lack of technology, not having a general practice doctor, an inability to sign up to a Māori provider, and being from an isolated community.

The one-size-fits-all approach works for mainstream New Zealanders because Pākehā are highly motivated to take the vaccine. A targeted roll-out to Māori would still have given others access to those vaccinations.

Vaccinations could improve with culturally aware approaches, including conversations with whānau, building relationships with patients, targeted advertising, and increasing cultural competency of providers.

Jansen argued more resourcing needed to be afforded to Māori health providers which held an understanding of tikanga to seek out Māori and send them text messages, call them about helping them book vaccinations, answering their questions, and inviting them to bring the whānau along to vaccination sites.

“That kind of approach would resonate warmly with the Māori population.

Ōtaki Medical Centre chief executive Kiwa Raureti wants to set up mobile vaccination clinics and street by street walk-through sites to bring the vaccine to those who need it the most.

That was the easiest solution to increasing vaccination rates among whānau, he said.

Raureti envisioned parking in areas of high Māori populations and high deprivation to remove access issues for those with bigger problems than when they can book in for a jab.

However, with no resources to fund the scheme, the clinic had been hosting drive-through vaccination at Ōtaki Racecourse.

Those with vehicles, including a higher number of Pākehā, were taking up the chance to get their jabs but many Māori in his community did not have vehicles or had to share within whānau, forcing them to miss out on the opportunity or work to find alternative transport.

For some, this meant taking the waewae express (walking), he said.

One family walked 5 kilometres from Ōtaki Beach to the racecourse to take the jab but they were an outlier. Many would rather focus on day-to-day pressures of family life than go out of their way.

A mobile clinic was a no-brainer, Raureti said. Why ask people to find a way to come to you, when you can easily get to them?

“Māori have always been hard to get to. They don’t really have an opinion on it. It is creating the chance that it is right there, so why not just get it done.”

The wrong people were responsible for the roll-out, Raureti said. District health boards were trying to capture 500 people a day but many Māori would not be attending those drives because they were not targets, the clinics were not in their space, and Pākehā had easier access to the booking system.

“No-one has an answer for equity. The only way that we do it is by resourcing a number of vaccines for people who are suffering an inequitable system.

“We need to be more proactive and go to their space, not get them to come to ours.”

Papakura Marae chief executive Tony Kake has an inclusive philosophy based on the kaupapa of the marae. Any arm that came on to the South Auckland marae looking for a vaccine was getting a shot.

Their vaccination roll-out targeted Māori but if Pākehā arms were in the mix that was not an issue, he said. “You would be welcome with open arms. It is important to get the 5 million done.”

It is one of the issues facing Māori health providers. The funding and vaccines they do receive to target Māori are benefiting non-Māori too because no-one is being turned away. Non-Māori are showing up, Māori are not.

Kake and his kaimahi (staff) have taken a similar approach to Te Tai Tokerau, waiting for no-one and taking the vaccine to all. Like Murray, he planned to do away with the online booking system in favour of walk-through clinics once alert level 4 was lifted.

“You have got to be flexible and you have got to be diverse.

“The key part for us is protecting our whakapapa (genealogy), our mokopuna, our future generations and being around to pass on that knowledge.”