Māori aged 50-64 are getting vaccinated by health providers, even though the Government rejected expert advice for them to be prioritised.
Cabinet was advised by the immunisation advisory group to give higher vaccine priority to Māori and Pacific peoples aged 50-64, and to those in residential care, including the imprisoned, the homeless and the addicted.
But this was rejected, and Māori and Pacific peoples up to the age of 64 were instead part of the general rollout, while those aged 65 and over having the same priority as the others in that age group - even though they are much more likely to catch Covid-19 and have more severe outcomes.
Instead, Cabinet agreed to give 40,000 vaccine doses to Māori and Pacific health providers for group 2 for older Māori and Pasifika cared for by whānau - though Cabinet was advised to do this as well as prioritise those aged 50-64.
The general rollout, known as group 4, was supposed to begin at the end of July, but many health providers have already begun vaccinating people deemed vulnerable in those groups.
Dr Chris Tooley, chief executive of Te Puna Ora o Mataatua in Whakatāne, said they were taking a "local interpretation" to the guidelines.
Guidelines for group 2 included "older Māori or Pacific person being cared for by whānau" and those who live with or care for an older Māori or Pacific person, among other criteria.
Tooley said they started vaccinating those in group 2, they used the term "kaumatua" rather than any specific age, and would vaccinate everyone in their household no matter their age.
Now they have opened up to all Māori aged over 50, but Tooley said they would assess anybody who requested a vaccine to determine their vulnerability.
"It is a whānau ora approach," said Tooley, who was part of the Ministry of Health Māori Covid19 Experts Group.
"The ministry has given guidelines, and it is up to providers like us to make sure we convert that into real numbers on the ground. We have taken an equity lens.
"In our township we also know the whānau, their health history, so quite aware of the vulnerabilities.
"It is not just Māori but rural community deprivation. Our goal is to get everyone vaccinated who chooses to be vaccinated, and the reality is we need to be more responsive to meet that goal."
There was no point in vaccinating only one person in a household, and then having them have to come back in at a later date, Tooley said.
"For many in our community it is a long way into town, so when they come in they need to make the most of it."
Tooley said they were working alongside the Bay of Plenty District Health Board and Ministry of Health and had not had anybody raise issues with their rollout.
In fact Te Puna Ora o Mataatua had just been awarded the Ministry of Health Equity Award in May.
It was a similar story in Northland, with vaccinations for Northlanders aged over 50 and other vulnerable groups brought forward at the end of April to reduce waste and increase the availability of the vaccine.
Health providers in the Far North were also taking a similar approach, Whakawhiti Ora Pai general manager Errol Murray said.
From last week people over the age of 16 living between Kaimaumau and Te Rerenga Wairua (Cape Rēinga) could get a vaccine at certain marae and community halls - well ahead of the national rollout.
Their approach was about realising the practical difficulties many whānau faced travelling long distances to clinics, and close living situations.
"When people visit and if we just said we're only doing nana today, they might not come back. So we do everyone."
The Cabinet paper containing the expert recommendations said the higher proportion of cases among Māori and Pacific peoples linked to the August 2020 cluster demonstrated "the significant risk of infection and transmission in these communities".
"The rate of infection during the second wave was six people per 100,000 for Māori (47 cases) and 32.3 people per 100,000 for Pacific peoples (104 cases), compared to rates of 1.3 for European/other and 2.2 for Asian per 100,000.
"Officials recommend that in the roll-out of Tier 3 to older people, a risk-adjusted age
factor of 15 years (younger) is to be explicitly applied to Māori and Pacific peoples."
But this advice was rejected, and Dr Rawiri Jansen even quit the Government's expert immunisation advisory group over the issue.
Covid-19 Response Minister Chris Hipkins told the Herald despite not officially accepting the advice, the Government expected DHBs and regional health providers to tailor the vaccine rollout to fit the specific needs of their communities.
"This isn't a one-size-fits-all programme," he said.
"South Island DHBs, for instance, are vaccinating everyone in hard to reach towns at the same time, to be practical."
Asked if there were concerns about vaccine supplies and planned priority groups missing out, Hipkins said the initiatives were "within the planned allocation of available doses".
Over $40 million had been allocated for communities facing significant barriers in their rollout, including $24.5m for community-based vaccine support services to support Māori health providers, and 40,000 courses of the vaccine as a starting point.
"I'm consistently seeing hauora providers like Te Puna Ora o Mataatua doing all they can to ensure the roll-out is successful," Hipkins said.
A Ministry of Health spokesman said they expected each DHB to take an approach that worked for their communities within the overall framework.
"The sequencing framework specifies older Māori or Pacific people being cared for by whānau are eligible for the vaccine as part of group 2.
"We also anticipate that hauora providers such as Te Puna Ora o Mataatua will consider making the vaccine available to wider groups of whānau Māori as part of the rollout of group 3 to ensure equity is achieved."
The spokesman said iwi and Māori partnerships were critical to the programme's success, and to upholding Te Tiriti o Waitangi principles.
"This is fundamental to the programme's success and protecting the unique whakapapa of New Zealand Aotearoa."