Why has Northland had three local outbreaks of different strains of meningococcal disease, two more than any other region in New Zealand? Poverty and inequity.

The Northland DHB has not been secretive about meningococcal W in our community.

Why would we be? We have a history of being very open and transparent with our staff and the public.

However, the only effective public health response to a disease that can mimic a very wide range of conditions, including arthritis, pneumonia, cellulitis, throat infections and gastrointestinal illnesses, that strikes rapidly and randomly, and has a high fatality rate, is a vaccination campaign.

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There is no concise public health message to warn Northlanders, and the only answer is to ensure our high-risk population is immune and protected.

We cannot go out to the public and tell them to go and get their children vaccinated when the cost is over $100 per child, and those that are at highest risk cannot afford it. It has to be free.

Advice from one of our most respected senior doctors to his colleagues, who can afford the vaccine and are pro-vaccination, is very different from being able to go out to the public with that message.

It would be unfair and wrong for a public health organisation to do that until we were allowed to provide a free mass vaccination campaign.

We have been working closely with the Ministry of Health for over six months to be prepared for when we reached outbreak status to allow us to commence this campaign.

Because of international evidence and our own Northland history and parochialism, we wanted to commence the vaccination campaign straight after we had our first two adult cases of meningococcal W.

However, we were very aware that, as with other countries, the Ministry of Health needed to track the disease and wait until it reached outbreak status to justify both local and possibly national vaccination campaigns.

This was also the case before we commenced our meningococcal C campaign in 2011. There was also the consideration of a global shortage of vaccine.

Why has Northland had three local outbreaks of different strains of meningococcal disease, two more than any other region in New Zealand? Poverty and inequity.

The intense media interest regarding Northland's meningococcal outbreak and the planned vaccination campaign highlights the huge challenges of poverty and that the resultant health inequities can affect everyone and put all Northlanders at risk.

It challenges the system and whether it is meeting the needs of those who most need it. It must not put the whole burden of Maori health and other inequities on the health system.

There is no doubt that we can and must do better, and in Northland we are redesigning large parts of the health system to do that. We have made mistakes, learnt from them, changed and improved significantly. However, addressing poverty and employment, housing, education, drug and alcohol abuse, roading and infrastructure require whole-of-system responses and targeted government policies. It's not just down to the health system.

What I can't abide is when our hard-working health workers are criticised or there is an implication that the individual care of our patients, whether in the hospital or in general practice and the community, was less than excellent. Our over 3000 staff and more than a thousand health workers in the community come to work every day to do their best to help people. That's why they chose health as a career.

I'm not aware of any concerns about the care of the seven patients who have contracted meningococcal W disease in Northland.

I genuinely believe that the vast majority of healthcare provided every day throughout Northland is excellent.

So, challenge policy that doesn't reduce poverty and inequality. Criticise the system and the need to continually improve, but please acknowledge the values, intent and skill of the incredibly dedicated and hard-working people who work in health.

DR NICK CHAMBERLAIN
Chief executive
Northland DHB