By Te Aniwa Hurihanganui of RNZ
John Rarere's phone won't stop pinging. Over the last three months, it's been flooded with messages from relatives urging him and others to be wary of Covid-19 vaccines.
"They believe the Government is trying to scam everybody," he says. "Some of them think the vaccine will change their DNA or that it contains nanotechnology which will eventually give the Government the ability to control them."
Hamilton-born Rarere, now living across the ditch in Brisbane, has counted more than 40 of his New Zealand-based relatives sharing ideas like these all over social media. He's never seen anything like it before.
A recent post from a cousin falsely claims China is refusing to inoculate any of its citizens for safety reasons. It encourages people to cure themselves of the virus through "heat therapy", by inhaling steam from a boiled kettle, gargling hot water and drinking cups of hot tea four times each a day. On the fifth day, it says, "you are Corona negative".
Rarere laughs - he can't help himself sometimes. But the truth is he's afraid. He knows of two kaumātua who are also sharing misinformation online, and he's deeply worried they won't take the vaccine. He says the thought of them contracting the virus, and suffering, is inconceivable.
"It's really concerning," he says. "If whānau members are refusing to get vaccinated because of this information, that could influence even more at-risk kaumātua to do the same."
Research by Te Pūnaha Matatini shows Māori in their 60s and 70s are twice as likely to die from Covid-19, but the hope is that vaccines will make sure we never see such tragedy play out.
By May, all Māori aged 65 years and older or with comorbidities will have access to the vaccine. But will they take up the opportunity? How do you convince Māori the vaccine is safe when there's a tidal wave of misinformation online telling them otherwise? And why should they trust a health system that continues to perpetuate poorer outcomes for their people?
Eric Teokotai, who works for the Waikato District Health Board, feels helpless watching his own whānau and friends fall down the conspiracy theory rabbit hole, but he sympathises with them too. He says many of them feel displaced and oppressed by the health system, and he doesn't blame them.
"Very close friends say they're not going to get vaccinated and it comes down to the lack of trust in government processes and departments and agencies, and a history of government oppression and colonialism," he says.
"They'll say, 'nah, we don't trust the Government, it's colonial health issues that have caused damage and destruction to our people', and there's an element of truth in there. Māori are still suffering in health. We have the highest rates of cancer, obesity and even loss of hearing. You name it and Māori are right up there. The feeling is, why should Māori trust the Government now?"
Vaccine hesitancy has long been tied to distrust of colonial systems, says historian and researcher Rawiri Taonui.
"In circumstances where there's been marginalisation and experiences of racism, there's been an element of distrust over vaccines," he says. "Early on in the history of vaccination in Aotearoa, where Māori had a good relationship with Pākehā, they tended to take up vaccines. But in areas where the relationship wasn't so good and they were suspicious of the motives of Pākehā, they tended not to."
He says that's partly why there's a higher level of rejection of vaccinations today among Māori generally, including with infant immunisations and flu vaccinations among the elderly.
Some in Teokotai's whānau are vaccine hesitant for different reasons. Some are worried about the potential side effects of the vaccine, or the pace at which it has been developed and distributed across the world. One of them is his wife, who once had a severe allergic reaction to the Polio vaccine and needed to be hospitalised.
A March survey by Horizon Research and University of Auckland's School of Public Health suggests 9.4 per cent of the population will definitely say no to the vaccine. However, the number of Māori likely to say no has dropped from 27 to 18 per cent since surveys began last year, and that gives Teokotai hope.
He says with greater publicity about the vaccine, confidence should continue to grow. While he understands where much of the distrust stems from, he says Covid-19's threat to kaumātua is far too great, and the vaccine is their best shot at protecting them.
"I will keep engaging with whānau," he says. "And sometimes it's not good enough to say, 'go on the Ministry of Health's website'. You literally have to get that information and put it before them for them to decide whether they want to read it or not.
"I'll just say to them, 'look, you've taken the time to read the information you've given me, so how about you take the time to read this information?' Sometimes you'll get, 'oh, well, let me think about it'."
The role of Māori health providers
Teokotai has company. Māori health providers are determined to spread the word that the vaccine is reliable and safe and they're driven by dire statistics.
It's well documented that Māori are more likely to suffer more serious effects of the virus if infected than non-Māori. Researchers from Te Pūnaha Matatini, the University of Otago and Auckland University say Māori are more likely to suffer serious effects of the virus because they are more likely to have the underlying health conditions which make surviving Covid-19 more difficult, including cardiovascular and respiratory conditions.
Of the 18 people in New Zealand who have been admitted to intensive care for Covid-19, half were Māori.
Within the next few weeks, Māori health providers will receive 40,000 vaccine doses for Māori aged 65 years and older or with comorbidities. The Government has already allocated a portion of these doses to some Māori health providers in South Auckland, and made $11 million available for providers to set up the infrastructure needed to carry out the work.
For Tūranga Health chief executive Reweti Ropiha, meeting with Māori communities kanohi ki te kanohi (face to face) is crucial. So he and other members of his 60-strong team at the Gisborne-based clinic are travelling the length of Tūranganui a Kiwa, including to isolated rural communities such as Matawai, Whatatutu and Waituhi, to do just that.
"There's two things we need to consider. One is around the information coming through Facebook and the kōrero which is presenting a lot of anxiety," he says.
"And the second one is, as we engage with whānau, the experience we give them must be pristine. So when they leave the service and speak to their whānau, they provide the insight to give the confidence for their whānau to participate as well."
Ropiha says if there's a long waiting time, for example, that could potentially put people off.
"So you've got misinformation, yes, but we also need to give people a good experience."
Dr Mataroria Lyndon from Te Tai Tokerau has been attending community hui in his own rohe to provide a clinical perspective to the conversation. One common concern whānau raise is about the potential side effects vaccines could have, including the possibility of death.
"If anything, the vaccine actually prevents death. And that's the purpose of the vaccine, to protect us from Covid-19, both by reducing the risk of acquiring Covid, but also around preventing serious illness that leads to hospitalisation and death," he says.
"Some of the side effects are common with existing vaccines, like pain at the injection site, fatigue, you might get a headache or a minor fever. But that's the vast majority of the side effects. Now in terms of anaphylaxis, which is a major side effect or risk, that's very rare. In fact, Ministry of Health data shows only five out of one million people have a serious allergic reaction to the vaccine."
Lyndon says ensuring as many Māori as possible have this information ahead of the vaccine roll out is vital, and he is pleased the Government has set aside $24.5 million for a vaccine support service, which will make access to information and vaccines easier for Māori living rurally.
Whanganui-based iwi health provider Te Oranganui has re-established the communication team it pulled together during last year's lockdown to get the message out to its community that the vaccine is coming.
Its chief executive, Wheturangi Walsh-Tapiata, says the provider is very aware of the influence misinformation is having on Māori, so Te Oranganui's strategy is to ensure they're approaching everyone's beliefs with aroha. Staff have been encouraged to let whānau know they are welcome through its doors at any stage of the vaccine process.
"It's important to have what I call 'a rolling door', that they may say no right now, but that as a consequence of ongoing conversations and as the vaccine continues to roll out throughout the country, that they still have opportunities to come back to us at a later date."
'Keeping the communication lines open'
Despite the heightened risk Covid-19 poses to vulnerable tangata whenua, some Māori MPs have been reluctant to tell Māori they should be vaccinated. The Māori Party's Rawiri Waititi and Labour's Willie Jackson have said it's about mana motuhake and whānau have the right to choose.
But on a grey March day at a community hui at Terenga Paraoa Marae in Whangārei, surrounded by local Māori health workers, kaumātua, parents and children, deputy director-general of Māori Health John Whaanga takes a bolder approach. Standing at the front of the meeting house with his head up and eyes scanning the room, he doesn't hold back.
"I will be encouraging anyone I know and anyone I'm related to take the vaccination," he says loudly.
Whaanga has accompanied the Associate Minister of Health Peeni Henare to the town as part of a nationwide "marae roadshow" to inform Māori communities about the vaccine and alleviate any concerns whānau have. He is the first speaker of the day to say outright that Māori should be vaccinated, and he does so with confidence.
"I grew up with a grandfather who lost three siblings to the Spanish Flu epidemic," he says. "And I grew up with elders who told me what it was like to live through polio and whooping cough. They were horrible. I have no doubt that if we look at the history of Māori health development, we can clearly show that vaccination has helped improve Māori health."
Some sitting around the wharenui look agitated, as though they could stand at any moment to interrupt. When Whaanga sits down, a few take up the opportunity to respond: Why are people losing their jobs because they don't want to get the vaccine? Are there enough vaccines to cover all kaumātua? Will I be able to get vaccinated even though I'm only 64?
Henare says they're all valid and important questions. He assures the community no one has or will lose their job because they don't want a vaccine, and the 40,000 doses currently being supplied to Māori health providers will be topped up when required. He says Māori health providers know their communities best, and he doubts kaumātua who aren't quite 65 will ever be turned away.
"If you're 65 and over, ka pai. But if you've come all the way from a place like Te Kao to get vaccinated and you're 62, I expect that in the way we look after and manaaki our whānau, our Māori health providers will be able to do that."
Henare says many of his own whānau are reluctant to take the vaccine because of the discrimination they've faced by the health system in the past, and he understands. All he can do, he says, is continue to be open and keep encouraging them to engage in the clinical advice.
For Teokotai, engaging with whānau has never been more important. He says lives are on the line.
"I'm keeping the communication lines open, keeping the aroha open and keeping the connection open. It's a matter of going, 'e hoa, whānau, cuz, how about this one here? Have you read this information?'".