The 90% Project: How an iwi-led Covid-19 vaccination programme has achieved some of the country's highest rates

Māori are now getting vaccinated at rates faster than any other ethnicity in the country. Michael Neilson talks to those at the forefront of the rollout about why it has taken so long, given the known inequities in the system, and how fast it can ramp up.

An eastern Bay of Plenty iwi is racing towards having 90 per cent of its population fully vaccinated.

It's a success story for the small, mostly-Māori community, given nationally 40 per cent of Māori eligible have had two doses and 62 per cent at least one - well behind the overall rate of 59 and 83 per cent respectively.

It's memories of the 1918 influenza epidemic sealed in graves at the nearby urupā that serve as a constant motivation for Te Whānau-ā-Apanui to get vaccinated, Te Kaha Medical Centre GP and iwi member Dr Rachel Thomson said.

Influenza tore through Aotearoa, proving particularly devastating for Māori communities who died at a rate seven times higher than Pākehā, largely due to living in more isolated areas distant from adequate healthcare.

Fast forward 100 years and as the country races to vaccinate against the spread of Delta, 87.7 per cent of the community have had their first vaccination, and more than 80 per cent fully vaccinated since they began in May.

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The vaccination drive followed iwi-led checkpoints last year as a first line of defence to keep out Covid-19.

"We were very concerned when the virus first arrived, looking at how vulnerable our community is and being reminded with those mass graves from 1918," Thomson said.

"The checkpoints were our only defence initially. Now with the vaccine we have another line of defence."

The area Thomson and her team were responsible for covered the iwi boundaries from Pōtaka to Hawai on the East Coast, including 1432 eligible people.

It had not been easy though, and they had to fight for the right to even vaccinate, Thomson said.

As soon as border workers began getting vaccinated in Tauranga, some of the local nurses went along so they could start the process of becoming certified to give vaccinations.

The clinic, which operates under the Bay of Plenty District Health Board, worked with iwi representatives, St John's volunteers, local social services Te Rūnanga o Te Whānau, and the DHB to design and develop their own rollout, even acquiring a specialist coolstore for the vaccines.

They made a list of everyone in their area, and ran marae-based clinics, sometimes with up to 200 people a day.

As numbers dwindled they innovated, including even giving jabs at tangihanga, on farms, and down by the river while people were whitebaiting.

"In general people were on board but having their doctor there they knew, and being able to ask questions, and have community champions along with us, really helped with trust."

Questions ranged from how the vaccine could interact with medications, to conspiracy theories.

"We just talked it through. Some did not want to change and we accepted that, it is really important not to split the community," Thomson said.

"But I think it is that connection to the community that has seen most get on board."

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Their rollout also ignored official advice to vaccinate people by age groups, as has also been ignored by other Māori-led programmes. This didn't work for a lot of people, including for cultural reasons, but also practicalities.

"Often it was just better to vaccinate the whole whānau than having to wait and come back again," Thomson said.

Te Whānau ā Apanui iwi leader Louis Rapihana pictured at a roadblock set during the first wave of Covid-19. Photo / Alan Gibson

The lower rates for Māori across the country were largely due to access issues, along with mistrust of the Government and medical system, she said.

"When at every level there are these unequal statistics it is unsurprising some Māori are not accepting and trusting of what is being said.

"But generally those concerns are due to a lack of targeted information.

"I think if Māori had been more involved from the beginning we would be in a much different situation as a country."

"Disappointing" approach not more widespread

Health research analyst Dr Rawiri Taonui said the model at Te Whānau ā Apanui should have been replicated across the country.

"One of the keys to vaccinating Māori is to do so irrespective of age bands. We do things as a whānau.

"And taking it to the people rather than at vaccination centres is important, as often marginalised communities don't trust the mainstream system."

Taonui said similar whānau-centric approaches had been adopted for indigenous populations in colonised countries around the world with much success.

In the United States during the pandemic's first wave Native Americans were being infected at about four times the national rate.

As vaccines were dispersed they went directly to the Indian Health Service, and they had now the highest vaccination rates in the country.

Taonui said it was disappointing such approaches were not more widespread here.

He also called for more Māori role models to target younger age groups, and Māori MPs and ministers to front the 1pm updates.

Prior to the rollout beginning in February, the Government decided against expert advice to strictly prioritise Māori from younger ages, given the younger age profile, known health inequities and access issues.

Māori on average die seven years younger than non-Māori, and about 25 per cent of the population is aged under 12, compared to 16 per cent of the general population.

It also followed years of public debate about how Māori are underserved by the health system, including a Waitangi Tribunal report in 2019 that found the Crown had breached the Treaty of Waitangi.

Associate Minister of Health (Māori) Peeni Henare (right) with Yvonne Rogers at the Rotorua Covid-19 Immunisation Hub. Photo / Andrew Warner

Despite this the rollout implicitly prioritised European/Other and Asian ethnicity with a focus on older age groups, and essential workers.

Consequently top Māori GP Dr Rawiri McKree Jansen quit a Government advisory group, stating he considered it an "overwhelming failure" on his part and the Government's that the vaccine rollout did not prioritise Māori below 65.

National health spokesman Dr Shane Reti, also a practising GP, has also been critical of the rollout for not including GPs more.

Trusted information coming from health people such as GPs and nurses was crucial to help persuade people to get vaccinated, said Reti, who is currently in Northland assisting to help deliver vaccinations with his iwi Ngātiwai.

Rates for Māori beginning to ramp up

Associate Health Minister Peeni Henare is in the middle of a tour of DHBs and health providers across the country, seeking answers in areas with particularly low Māori vaccination rates.

He said he rejected any assertion Māori had not been prioritised in the rollout, nor that any of it was political.

The rollout had looked much different in the beginning to now, he said, with some of the more remote locations lacking essential infrastructure, like coolstores.

Vaccination programmes had been led locally, and the guidance for DHBs was to prioritise kuia and kaumatua and for "whānau-centric" approaches regardless of ages.

Some of the low uptake was due to poor co-ordination between DHBs, health providers and iwi; poor data keeping, and some of that crucial messaging getting lost - all of which Henare said a future Māori Health Authority could address.

"All of the ingredients, the resources, were there."

Indeed things are starting to ramp up, and over the past month the number of Māori vaccinations have increased 23 per cent, compared to 14 per cent for Pākehā/Other.

A couple of months ago Māori first-dose rates were about 50 per cent behind the overall rate. This week it was 30 per cent behind, and climbing.

The Government has boosted funding for Māori-led vaccination drives, outreach buses, and groups like Te Whānau Waipareira Trust in Tāmaki Makaurau have vaccinated tens of thousands of people.

The challenge going forward looked to be in the 12 to 34 age band, which still remained about 50 per cent behind the rate for non-Māori.

"It is fantastic to see those numbers start to rise, and it is recognition of the hard work of all of those on the ground.

"But as we come to the remainder, we are now in a space where big national campaigns won't catch many of them, it will take conversations with those they trust, and providers have the resources to help that happen."