Urgent and widespread changes to New Zealand's childhood immunisation system are needed to protect Māori children from fatal infectious diseases, according to an official report obtained by the Herald.
The report, prepared by experts at Auckland, Waitematā, Counties Manukau and Northland DHBs in July, blamed a host of problems — including an overburdened workforce and racial bias — for "plummeting" vaccine rates and "chronic inequities" in immunisation coverage.
The report provides a stark assessment of the potential for another public health crisis when New Zealand's borders reopen if childhood immunisation rates are not lifted to levels required to achieve herd immunity against infectious diseases.
"Business as usual is not enough to remedy or impact the current situation," it said. "Immediate and intentional disruption of the current childhood immunisation programme is required to have any impact on tamariki wellbeing."
In New Zealand, children are immunised for a range of diseases, including pertussis (whooping cough), pneumococcal disease and measles, between 6 weeks and 4 years old, with further immunisations at 11 or 12 years.
National vaccination rates have fallen in the past few years, with the declines particularly sharp among Māori and Pacific children.
In July, Ministry of Health officials warned Health Minister Andrew Little in a confidential briefing that immunisation rates for Māori children in most district health boards were below the level of 85 per cent required to achieve "herd immunity".
According to the Ministry of Health's latest quarterly figures, the percentage of children who were immunised at 8 months of age — a key milestone — was 89.7 per cent of New Zealand Europeans (down from 93.9 per cent in the same quarter in 2016); 74.7 per cent of Māori (down from 90.3 per cent); and 84.8 per cent of Pasifika (down from 95.8 per cent).
The report by the northern DHBs underscores the health authorities' growing concerns about the immunisation gaps and blamed the breakdown in coverage on years of systemic failures.
The report said low immunisation rates presented a significant risk.
"The current border closures are keeping most VPD [vaccine-preventable diseases] out of the population. However, experience tells us that without a population health strategy we will be faced with future VPD lethal outbreaks within clusters. This will invariably inequitably impact Māori and Pacific children and their communities."
The northern DHBs were so concerned about the regions' plummeting rates and "growing inequities" that they brought together a working group to develop an urgent report that assessed the region's childhood immunisation systems.
The report focused on Māori children, assessing the family journey through the immmunisation system from pregnancy to the child's 4-year shots.
"The national immunisation system was last reviewed in 2016," the report said. "Since that time health teams have continued to work hard to lift immunisation rates and connection with services for Māori. Despite intent, and occasional instances of achieving equity for Māori, rates of immunisation for Māori continue to drop.
"There is a long-standing history of a system that underperforms and continues to fail Māori."
The report said some Māori whānau faced "racist, discriminating and unfriendly" language and behaviour in the early phases of enrolling their newborn in medical care.
The report recommended better training for staff to overcome any prejudices.
Many families also faced financial barriers, such as a requirement for a birth certificate to enrol in health serivces at a cost of $33, which some couldn't afford.
Deprivation had an enormous impact on timely immunisations when experienced during the first year of a child's life, the report said, and Māori were overrepresented in areas of high social deprivation.
Waitematā DHB paediatrician Dr Owen Sinclair, who was a member of the report working group, said in a separate review that the reason for low uptake in primary care among Māori was barriers to access connected to economic deprivation – not Māori attitudes to vaccines.
"Although immunisations are free, there are costs to getting to a primary care practice and real barriers for lower socioeconomic people with respects to transport and time off employment," Sinclair wrote.
"It is glaringly obvious that the immunisation system in New Zealand, particularly in primary care, is not fit for purpose and has never got close to achieving on-time immunisation herd immunity for children in New Zealand," Sinclair said.
The northern DHBs' report said childhood immunisation rates had been affected since March last year by the Covid-19 pandemic and changes to the childhood immunisation schedule.
Staff were being moved to Covid-19 swabbing, increasing the daily work demands on remaining staff. In Counties Manukau, there were 20 per cent fewer immunisation episodes for up-to 4-year-old children for the year to March 2021 because of Covid-19 disruptions.
Meanwhile, in October 2020, an immunisation event was moved forward in the schedule, meaning the number of vaccines children need by age 4 increased from five to six, adding pressure to an already stretched workforce and pushing work demand to outstrip workforce capacity.
"With no increase in staffing or funding to achieve the required vaccinations, some report that everyday business is not achievable. Services are in a seemingly impossible 'catch-up' phase to complete the overdue immunisations."
In addition, staff were grappling with the "dysfunctional" computer system that held children's immunisation data. Significant amounts of staff time was used ensuring the data in the system was accurate.
Auckland and Waitematā DHBs estimated the data was incorrect for more than 8000 children, meaning the wrong health care provider could be contacted for overdue immunisations, potentially slowing the follow-up process.
Vaccinologist Helen Petousis-Harris told the Herald the immunisation system in New Zealand was grossly underresourced, "old, broken and no longer fit for purpose", resulting in children "falling through the cracks" and missing scheduled vaccinations.
"This isn't going to fix itself. This is going to continue on that trajectory downward unless there is some significant interventions put in place."
Several strategies were recommended by the working group to address the falling rates – but the most important factor requiring change was how services were delivered.
The report emphasised the importance of a regional approach, sharing resources across the region as well as a whānau-centric service model, which was holistic, welcoming and empowering for families, and understood the needs of Māori and placed value on building trust and relationships.