One of the country's top epidemiologists and community agencies are calling for a refreshed Covid-19 strategy that better supports marginalised communities in Auckland, where the Delta outbreak is continuing to linger.
It has been revealed this week that emerging positive cases – the long tail of the community outbreak – have been linked to transitional housing tenants and gang-associated communities.
On Wednesday 45 new cases emerged in the city, and among the 18 cases yesterday are transitional housing tenants.
The majority of yesterday's cases were connected to two newly identified sub-clusters of households in southeast and west Auckland, director general of health Dr Ashley Bloomfield said, and none were "specific gang households".
Epidemiologist Michael Baker is urging the Government to refresh its Covid-19 response in order to support marginalised communities.
Organisations such as the Drug Foundation and Community Housing Aotearoa are supporting the call.
The strategy should include engaging with community leaders, having a more cohesive response from Government agencies such as the Ministry of Social Development and police, and continuing door-to-door and mass testing in the community, he told the Herald.
"Given how important it is to get the last remaining strands of this outbreak brought under control, I think it would be very useful for the Government to convene a suitable online hui with key players to refresh the strategy."
The Auckland Regional Public Health Service (ARPHS) was already "talking regularly" with gang leaders to help stamp out cases, Baker said.
"Police and Corrections and Health all need to be on the same page with critical need to work with marginalised groups, Māori and Pasifika leaders, gang leaders, all those leaders."
He said work was already underway on this, but was "clearly not enough" to curb daily positive cases.
There had been a lot of engagement with gang leadership after infections had been revealed in three separate households, Bloomfield said on Wednesday. However, they weren't seeing many new cases in those households.
Baker said police enforcement activities could be "fine-tuned" to make room for a harm minimisation health approach.
Community Housing Aotearoa chief executive Vic Crockford said there should be a "trauma-influenced" approach to the vaccine rollout and surveillance testing for transitional housing tenants.
One solution was to build people's trust, who might not have had good experiences with state health, by working with housing providers, she said.
An example of this could be for health providers to give social workers a "heads-up" when they are going to carry out surveillance testing so tenants are not alarmed when people turn up in PPE gear, she said.
To get more people in that community vaccinated, Crockford said some incentive intiatives were working, such as one used by Lifewise which was giving phone credit to rangitahi when they got the jab.
"Some of the communities might be harder to reach with information and that might because of barriers like the digital divide, so not having access to devices or being able to afford phone or internet bills...or it could be rumours, conspiracy theories, all the reasons why other people in our comunities mistrust the vaccine.
"You need to put yourself in the shoes of people who have experienced uncertainty in their day-to-day lives. If you're in an insecure housing situation, that overrrides a lot, including tuning into the pandemic news cycle."
Crockford said any lessons learned from the approach in Auckland could be built into the framework around the country.
New Zealand Drug Foundation Director Sarah Helm said people might be nervous to disclose information that might put them at risk of criminal charges, or they might be in fear of being moved into isolation, or they might be experiencing extreme poverty that meant they need to leave their home for food, money or resources.
She said those people needed to be supported by organisations they trust, such as community housing providers or emergency food and shelter providers.
"One of the most upsetting things to hear is that our people in transitional housing ... are among the new Covid infections, is firstly they probably have underlying health conditions and therefore their lives are much more at risk than other people.
"Secondly, we know that vaccine rates are low in some populations and so playing catch-up with vaccinations is incredibly important, and maybe we have come in too late."
She said the health sector is "probably exhausted and working their guts out" but bringing in additional expertise will bring "new energy".
Te Rōpū Whakakaupapa Urutā, National Māori Pandemic Group, co-chair Rawiri Jansen said he raised the idea of a gang-specific Covid-19 strategy last year.
Jansen said there should be a specific Covid strategy for gangs, just like there should be for the disabled community and other marginalised groups.
"I wouldn't privilege the korero just about gangs," he told the Herald.
"Many of the suburbs of interest have large numbers of people who have been made vulnerable or marginalised, so specific efforts are required...to do a good job of managing it in those communities.
"I would like to see that we resource that effort by bringing Māori expertise to it."
Jansen said the challenges some families face include distrust in the health system, overcrowding and difficulty self isolating, or drug and alcohol abuse.
Jansen said the Covid elimination strategy needed to address the welfare needs of those families and to "build a relationship with Covid-positive family members".
Black Power life member Denis O'Reilly said most members of gang-intense communities were very similar to the mainstream population.
"Generally they are pro-social and want to comply with the Government's Covid-19 response to the current Delta community outbreak.
"There are those that have had bad experiences with the authorities and do feel alienated, those who have addictions, and those who duck and dive because of outstanding warrants or that they're living with someone they shouldn't be living with....these peripheral sorts of things."
He said he has had feedback from some gang leaders about people who had adverse affects from inoculation, but yet are prepared to "go ahead" with DHB-driven information sharing about the vaccine.
O'Reilly said during last year's lockdown, weekly teleconferences would take place between former deputy police commissioner Wally Haumaha and pro social gang leaders.
"This hasn't happened this time around. I wondered whether that was because of the moral panic in the recent politicisation of the gang issue.
"That's a shame, because I thought we'd come across a formula that is useful."
A person might be resistant to receiving the Covid-19 vaccine not just because they were connected to a gang, but because they were living in a prohibitive domestic relationship, or they might have non-association clauses, or there might be "benefit trickery going on", O'Reilly said.
"At a time of the pandemic where you do need extra levels of co-operation in a community, the consequences of demonising some sections of the community for political purposes are counterproductive."
He said one health provider did not want people showing up to get vaccinated wearing a gang patch, and he said this could discourage some people.
The Ministry of Health Pacific health director Gerardine Clifford-Lidstone told MPs on Wednesday, during a Health Select Committee briefing, the virus was "seated" among marginalised communities.
"If we think about the current outbreak, how it seems to have seated itself in a gang environment and the homeless, these are people that are less likely to be trusting of the health system," she said.
"Finding people within these communities that can promote the vaccine will be very important. These are things we've started to work on."
ARPHS and other health agencies continue to work with iwi and Pacific social service providers to reach communities, and there was a good level of engagement and co-operation, the Ministry of Health said in a statement to the Herald.
"Anyone who has tested positive for Covid-19 who may have possible reservations about sharing information due to illegal activity, is assured that information given to contact tracers cannot be used for law enforcement purposes.
"We're prioritising getting as many people vaccinated as soon as possible, and overcoming any obstacles they may be encountering.
"For instance, the director-general acknowledged a new free taxi service beginning in Auckland to help more people get vaccinated if transport is what's holding them back."
Police have been approached for comment.
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