Counties-Manukau DHB has now joined Auckland and Waitematā DHBs in getting 90 per cent of its residents fully vaccinated. Adam Pearse talks to those who helped drive the city's vaccine rollout and what needs to happen in 2022.
More than 2.5 million vaccines across 416 vaccination sites.
That's what it took to get each of Auckland's three district health boards to vaccinate 90 per cent of their people after Covid-19 struck New Zealand in March, 2020.
Today, Counties-Manukau DHB joins Auckland and Waitematā DHBs in achieving double vaccination in 90 per cent of its eligible residents, just days before the country is expected to hit the 90 per cent milestone.
It's a big moment for those in South Auckland. More than 4600 positive cases were seeded in that community, which is more than a third of all cases New Zealand has registered.
However, there is more work to be done. On Friday, more than 140,000 Aucklanders weren't vaccinated.
In Counties-Manukau DHB, there were roughly 10,000 Māori and 15,000 Pasifika still to reach.
Now, vaccination of 5- to 11-year-olds is on the horizon. So, what worked in 2021, what didn't, and what needs to be learned next year?
'Kanohi ki te kanohi'
In April, Manurewa Marae was among the first to operate a fully fledged vaccination centre.
Since then, the small but dedicated team has administered 45,000 vaccinations at the Finlayson Ave site, using the authority of kaumātua and kuia to engage whānau - many of whom were connected to staff on site.
Marae chief executive Takutai Moana Natasha Kemp said the familiarity whānau had with vaccination staff was invaluable in attracting those who were put off by traditional vaccination sites.
From the early days of vaccination in February, the system relied on walk-in appointments for essential workers who were prioritised.
By April, as more people became eligible and vaccination sites became overwhelmed, DHBs shifted to a booking model.
That was later confirmed on a national level in June when the Government introduced the national booking system, Book My Vaccine, and established a timeline of when different age-groups would be able to make an appointment.
Kemp identified this as a key failure of the rollout, particularly for Māori who didn't have access to the necessary technology or those who preferred in-person interactions.
"We're a people who like to turn up and [have] face to face, kanohi ki te kanohi, engagement so the booking system never worked for us."
Most of the marae's 45,000 vaccinations were for non-Māori, which Kemp said signalled how the reliance on booking was flawed.
However, the system soon changed in the marae's favour in August. With the threat of Delta overpowering the country and vaccination supplies at an all-time high, vaccines became available to nearly all age groups and capacity for walk-ins was extended.
In the drive to vaccinate 90 per cent of Kiwis, DHBs soon realised a more mobile approach was necessary.
Manurewa Marae was among the first to set up such a service, creating the Shot Cuzz bus - one of many mobile vaccination units used across Auckland.
That's since evolved to an even more local approach for the unvaccinated as marae vaccination staff now go door to door, talking with whānau who might need further support.
Criticism has been levelled at health officials for not adopting such an approach earlier, which Kemp agreed with.
"We should have been doing mobile earlier because that's how our people engage."
Kemp referenced the struggle of the Whānau Ora Commissioning Agency in accessing personal data of unvaccinated Māori from the Ministry of Health as a critical barrier to mobile vaccination.
"If we had access to the data right at the beginning, we could have had a more targeted approach to mobile outreach, but we didn't."
Nationally, 94 per cent of eligible Kiwis have had one dose while 89 per cent are double dosed. For eligible Māori, 86 per cent have had one dose and 75 per cent are fully vaccinated.
Asked whether she believed the rollout was equitable, Kemp said not enough resource had been put towards Māori vaccination.
"We always need more resource for Māori health and I don't believe we were prioritised for the rollout of Covid vaccinations or Covid in general."
Kemp said it was a valuable lesson for public health officials to learn before the vaccination of 5 to 11-year-olds, particular when it came to supporting local initiatives.
"I don't believe national campaigns work for local level work, they need to talk to local communities because they have their own local solutions."
"It's about relationships"
South Seas Healthcare in Ōtara has been a pivotal vaccination provider for Auckland's Pasifika population.
Since opening in early April, the outfit has administered more than 93,000 vaccinations - 45 per cent Pasifika - at its site in Ōtara as well as various drive-through events.
Pasifika communities were the focal point in the initial days of the Delta outbreak - largely through widespread transmission caused by an Assemblies of God (AOG) Church of Samoa meeting, where hundreds were infected and it quickly became the outbreak's biggest cluster.
South Seas chief executive Lemalu Silao Vaisola-Sefo said his staff's ability to connect with the community prompted an essential shift in the rollout, in which more trust was placed in local providers.
"We were able to have a special arrangement with health officials for us to be able to look after [the AOG cluster] how we wanted," he said.
"[The health system] could have done a lot better at the start, but what I'm really proud of in the last few months is we were given the opportunity to do things in the way that we think would work and it did work."
Full vaccination levels among Pasifika nationally have reached 87 per cent with 93 per cent partially vaccinated. Across all three Auckland DHBs, Pasifika are 90 per cent partially vaccinated.
Vaisola-Sefo said trust was crucial when dealing with gangs, citing a local Mongrel Mob chapter that was willing to engage with more familiar faces.
"They trusted that we were the same colour as them, we could speak the same language."
It was that trust which Vaisola-Sefo deemed the most important lesson to take from the rollout.
"My hope is we don't default back to the old system where everything has been centralised in Wellington but really empowering local communities to do what we've been doing in the last 20 months.
"To me, in terms of the whole health system, we can do it when we want to, there's no barriers, it's about relationships."
'We just need to keep striving'
Those who organised Auckland's vaccine rollout are equal parts proud of the programme and accepting of where improvements can be made.
Programme director Matt Hannant professes the logistical nightmare of the rollout presented in early March was extraordinary, a sentiment echoed by Auckland DHB chief executive Ailsa Claire.
"You went through a bloody fright which was 'My God, look what we're going to have to do', and then all of a sudden it was happening," she said.
Through the exemplary efforts of health staff, Auckland's rollout progressed - as expected - to become the biggest in the country, administering 30,000 vaccines per day at times.
Initial targets for overall vaccination levels were modest. Hannant quoted Ministry of Health research that indicated once 65-70 per cent of citizens had been vaccinated, rates would stall.
Now, with Auckland expected to reach at least 95 per cent fully vaccinated, Claire credited Māori and Pasifika providers as the key to community engagement.
However, many factors inhibited the resourcing of local providers to administer vaccines initially.
Conditions for handling and preservation of the vaccine were much more strict than they are now, while negotiations between GPs and Primary Health Organisations (PHOs) stalled the rollout to primary care.
"If we could have, we would have gone faster on a lot of things but actually, there was a limit to the capacity and how we could do things," Claire said.
Dr Anthony Jordan was one of many clinicians brought onto the programme to enable a more nuanced approach that would suit communities yet to be engaged.
He was open to criticism from providers over the rollout, saying it was necessary to achieve more equitable outcomes.
"Everyone has their opinion on the speed and the ability to deliver on time and we just have to keep trying to meet those expectations.
"The worst thing we could do is get defensive about what we did and try to defend it; we just need to keep striving."
For 5- to 11-year-old vaccinations, Hannant said local GPs and schools would be integral to that rollout in Auckland, with an emphasis on those in less-resourced areas.
Jordan said the key would be parents and whether previous vaccination efforts had resonated with them.
"People will step forward with their children if they feel like we've been safe and kind with them. If we haven't, it makes it harder."
Nevertheless, Hannant, Claire and Jordan agreed New Zealand's Covid journey was a watershed moment for healthcare provision, stating it was enough to change a traditionally racist system for the better.
"You can't unlearn all the things you've learned," Claire said.
"There has been very public and very clear statement that if we had done things in the way we had always done them, it would have failed and I think it has been a really clear demonstration of what has to happen in the future."