Māori health experts say the age-based approach baked inequities into the Covid-19 vaccine rollout and giving Māori and Pasifika vaccination priority could have dampened the Delta outbreak.
A Rotorua district health board member and Whānau Ora representative says the rollout typified a "back of the queue, back of the bus" approach to Māori.
The Ministry of Health says the vaccine sequencing was established to vaccinate those most at risk first and it is working to boost Māori and Pasifika rates.
Massey University Te Pūmanawa Hauora Māori Health and Development Research centre director Professor Chris Cunningham said more than half of the Māori population was under 30, a statistic linked to a lower life expectancy than the general population.
When the vaccine plan prioritised over-30s above younger people, it effectively excluded more than half the Māori population, Cunningham said. The median age for Māori is about 26 years.
"The age distribution in NZ is a result of inequity, then when they use age as the entrance criteria it replicates the inequity … it's crazy."
He said with a median age of 23 at the last Census, the Pasifika population was younger than the general population (median age 37) and was also a medically vulnerable group.
Vaccination access was ramped up for under-30s after the outbreak of Delta in August.
Cunningham said if Māori and Pasifika had been prioritised in Group 1 of the vaccine rollout "we would have made better progress".
"You shouldn't use age as a criterion uncritically."
He said prioritising Māori and Pasifika could have helped prevent the spread of Delta.
In the Assembly of God Church of Samoa cluster, for example, 500 attendees of a service caught Covid-19. He said it "wouldn't have been as bad" if they were all vaccinated.
Te Rōpū Whakakaupapa Urutā the National Māori Pandemic Group co-leader Associate Professor Sue Crengle said she believed putting all Māori and Pasifika in Group 1 or 2 would have been difficult due to vaccine supply, which she did not think was entirely the Government's fault.
Group 1 was limited to managed isolation and border workers. Group 2 was for frontline healthcare workers, people living in care situations and their carers, plus some groups in Counties Manukau.
In Crengle's view, Group 2 should have also included essential workers such as those in supermarkets, factories and supply chains.
She said Māori should have had a lower age criteria due to the younger population and because tangata whenua were more likely to face higher transmission risks at work or home.
Māori were also more at risk of adverse outcomes from Covid-19 due to a higher rate of poorer health including respiratory disease, she said.
She said the vaccine rollout before the Delta outbreak was "clearly inequitable" and not accessible enough – and there was still room for improvement.
"The Government needs to have an increased focus and put more resources into ensuring access to the vaccine for all Māori whānau."
That meant reaching Māori where they were and targeting vaccine information to younger people.
Auckland University Medical School Associate Dean (Pacific) and Associate Professor of Public Health Collin Tukuitonga said he believed Māori and Pasifika should have been in Group 1 and had "lobbied" for it.
He called the Government's resourcing of Māori and Pasifika vaccine providers "half-hearted".
He said the rollout could have better supported Māori and tagata Pasifika to be vaccinated, but the Ministry of Health had been "reluctant to prioritise on ethnicity".
Tukuitonga, who was on the Ministry of Health's Covid-19 technical advisory committee, said there were not enough resources to empower Māori and Pasifika health care providers to deliver the vaccine.
"They know their communities better than anyone else."
Early vaccination for Māori and Pasifika would have "without a doubt" hampered the Delta's spread, he said.
Whānau Ora commissioning agency chairwoman Merepeka Raukawa-Tait agreed Māori and Pasifika should have been in Group 1 and said the Government had not listened to that advice.
"It's just a continuation of what we've always seen, back of the bus, back of the queue," said Raukawa-Tait, who is also a Rotorua councillor and Lakes District Health Board member.
"If the Ministry of Health had listened right from the outset to the Māori Reference Group, Māori vaccination rates would be well ahead of where they are now.
"Māori should have been a priority just as those over 65 years of age were.
"[The Government knows] what they have to do but they're always worried somebody's going to say, 'here we go, prioritising the Māori'."
She said Whānau Ora was working to get Māori vaccinated, particularly in Auckland.
Ministry of Health Covid-19 vaccination and immunisation programme equity group manager Jason Moses said the vaccine sequencing framework was established to vaccinate those most at risk first.
"This included kaumātua, whānau and Pasifika people with underlying health conditions, border and frontline workers."
He said the Ministry had worked hard to boost awareness of the vaccine programme to Māori and Pasifika but there was "still more to do". More younger Māori and Pasifika people had been getting vaccinated as they became eligible.
He said as of Thursday, 53 per cent of eligible Māori had at least one vaccination and a quarter were fully vaccinated. Of the eligible Pasifika population, 68 per cent had one shot and 36 per cent had both.
According to Statistics NZ data, about 23 per cent of Māori and 27 per cent of Pasifika people were under 12 and therefore ineligible for vaccination.
Moses said there was a "thirst" for face-to-face vaccine information. He said hui, particularly in remote and rural areas, were examples of the Ministry meeting that need and collaborating with Māori and Pacific organisations.
Targeted initiatives included pop-up events, an 0800 booking number staffed by Pacific language speakers and sending vaccination buses to areas with low rates and where people had difficulty accessing services.
"Everyone will have the chance to be vaccinated – no one will miss out."
Covid-19 Response Minister Chris Hipkins said vaccination rates were lower for younger Māori, although comparable in over-55s.
He said the Government had a "big job ahead of us" ensuring equity in vaccination rates.
There had been a "whānau-centred" approach for Māori, meaning if one person in a whānau was eligible for vaccination, the whole whānau could be vaccinated at the same time.
"District health boards across the country are using innovative ways to encourage people to get vaccinated through incentives, local and targeted advertising and campaigns using community leaders and influencers, and ensuring Māori have access to good health information."