Tamariki Māori should be prioritised in the Covid-19 vaccination roll-out for children, health experts say in a New Zealand Medical Journal editorial published on Friday.
Otherwise, the government risks repeating the "multiple mistakes" already made in a Covid-19 response which has disadvantaged Māori, the editorial says.
"We must not repeat the failures that led to the existing vaccination inequities for Māori, inequities that are not a matter of chance but the result of structural racism and inequity by design," say Dr Owen Sinclair (Te Rarawa), Dr Jin Russell, Dr Danny de Lore (Ngāti Tuwharetoa), Dr Erik Andersen (Ngāti Raukawa), Teuila Percival and Siouxsie Wiles, co-authors of the editorial.
"The paediatric roll-out is an opportunity to learn from previous errors and protect Māori." In planning this programme, the editorial says "Consultation with Māori as an afterthought is unacceptable."
"Because evidence suggests that Māori children are at a higher risk of all harms, we argue that Māori children should be prioritised in any paediatric vaccination programme," the experts say.
Planning for an equitable paediatric vaccine roll-out is a "matter of urgency," they say, and "a rapid school-based roll-out in partnership with iwi and Māori providers should be pursued to protect as many children as possible" - starting at low-decile schools.
"Because the majority of tamariki Māori are clustered in low-decile schools, a simple and obvious solution is to begin the rollout at schools below, say, decile 4. This approach was used successfully to provide school lunches to underfed children."
The tamariki roll-out should also include primary healthcare vaccine sites in partnership with Māori authorities, the experts say.
"Providing paediatric vaccines at school sites, and then at primary healthcare sites, would ensure the most equitable access."
There are early signs that MidCentral District Health Board, for one, intends teaming up with Māori partners.
"We also anticipate being able to vaccinate 5-11-year-olds next year, pending final approval from Cabinet. The DHB will continue to partner with Iwi and Māori providers with these vaccinations to ensure Māori communities are protected against Covid-19," Adele Small, the board's Iwi and Māori engagement lead, is reported as saying.
The experts warn in their editorial that "substantial increases in funding and resources" should be urgently allocated to Māori health providers and providers in low-decile communities "well in advance" to allow for recruitment of new staff and efficient planning.
"Due to the existing health and socio-economic inequities, tamariki Māori and their whānau deserve a greater share of resources to attain the same level of health enjoyed by non-Māori.
"We write this editorial knowing that there has never been a national rollout of any health intervention designed and targeted to benefit Māori," the experts say in their concluding remarks.
"The adult Covid-19 vaccination programme, which resulted in stark inequities for Māori, is an example of the norm for health programmes in Aotearoa. Programmes that disregard the structural racism and disadvantages faced by Māori result in differential outcomes and harm.
"We ask those in charge of designing the paediatric vaccine roll-out to consider the principles of equity, Te Tiriti o Waitangi and social justice and to take this historic opportunity to change the direction of the last 250 years. Our tamariki deserve this."