Experts fear a devastating measles outbreak could be imminent with record low vaccination levels and international travel ramping up. Photo / File
Experts fear a devastating measles outbreak could be imminent with record low vaccination levels and international travel ramping up. Photo / File
"It's a recipe for disaster" is how "petrified" health experts have described record low childhood immunisation rates - including for measles - which they fear will fuel deadly new epidemics.
For Māori just 47 per cent of those aged 18 months had full immunisation coverage over the past year - a drop of 26 points since the start of the pandemic, and 22 points below the national rate.
To achieve herd immunity experts say at least 90 per cent must be achieved.
With vaccination coverage lower than at any point on record the health sector especially in Auckland is on tenterhooks as international travel ramps up and so too the risk of imported cases, including from Fiji which is currently experiencing a measles outbreak.
"I think worried is an understatement," said Dr Owen Sinclair (Te Rarawa), a Māori paediatrician at Waitākere Hospital.
"We are petrified. An outbreak would be catastrophic, with many deaths."
The issue is also ramping up politically with National accusing the Government of dropping the ball over workforce shortages after it reallocated stretched resources during the pandemic to the Covid-19 vaccine rollout.
Sinclair and other health experts spoken to meanwhile say the whole immunisation programme is "broken" and needs to be rebuilt from the ground up, with a focus on equity, for the risks in any outbreak will be far from evenly shared.
According to the Ministry of Health's latest data in the 12 months to June, for Māori at 18 months, a key marker for vaccinations such as MMR - measles, mumps and rubella - nationally rates have dropped below 50 per cent for the first time in well over a decade, for the past year, to 47.4 per cent.
In Counties Manukau, the centre of many severe and deadly Covid outbreaks and the measles outbreak several years ago, the rate at 18 months for Māori is just 37 per cent (for Pākehā it is 72 per cent).
Nationally the rate is 69.4 per cent, 76.5 per cent for Pākehā and 59.6 per cent for Pacific.
While all groups have dropped significantly since the start of the pandemic it has been most significant for Māori and Pacific.
Health Minister Andrew Little. Photo / Mark Mitchell
For Māori, the rate has plummeted 26 points from 73.1 per cent in June 2020, and Pacific 25 points from 84.5 per cent.
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.
MMR vaccinations are given at 12 and 15 months (it was previously 15 months and 4 years but changed in October 2020 after the measles outbreak here) meaning 18 months gives an indication of measles coverage.
The Ministry data only records those fully vaccinated, so it is unclear exactly how many have had MMR vaccines, but health experts say from experience it is the most-commonly missed vaccine.
Rates are also alarmingly low at other key age brackets.
According to the Ministry's latest quarterly figures (June 2022), the percentage of children who were immunised at 8 months of age was 87.6 per cent of Pākehā (down from 94.2 per cent in December 2019, the quarter prior to the pandemic); 69.3 per cent of Māori (down from 86.3 per cent); and 83 per cent of Pasifika (down from 93.2 per cent).
Sinclair said there had been problems with vaccination levels but never like this.
Rather than a rise in anti-vaccination sentiment, Sinclair said it had actually been the opposite. "The Covid-19 vaccination rollout has shown that there really is high acceptance."
Instead, it has been a lack of access and outreach programmes, with resources reallocated during the pandemic to the Covid-19 vaccine rollout.
Sinclair, who also works in a range of advisory and governance groups, said other issues were around availability, as in some areas it was only available through a GP.
Other solutions were identifying those at risk at birth and having follow-up programmes in place.
"There is currently no system approach, it is just patched together. We need to start again with a new system, with equity at the heart."
Using accessible Ministry data going back to 2009, rates peaked around 2016 before declining steadily and plummeting through the pandemic.
It is not unique to New Zealand, as last year 25 million children missed out on life-saving vaccinations, according to Unicef. It has been called the "largest sustained drop in childhood immunisation in a generation".
University of Auckland immunisation researcher Dr Anna Howe said everybody in the health sector was "extremely concerned" at the record low rates.
"We know MMR coverage is not great around the world and measles is starting to circulate globally and it is far more infectious than Covid."
She said Auckland, with its extremely low rates and proximity to travel, was like a "tinderbox".
Howe said of most concern was the inequity, which had only grown since the pandemic.
She said many of the lessons learned in the latter stages of the Covid-19 vaccine rollout in working with Māori and Pacific providers, and extra trained vaccinators, should be employed here.
"Systemic change is needed, and that could be possible with the new Māori Health Authority."
National health spokesman Dr Shane Reti. Photo / Mark Mitchell
National Party health spokesman Dr Shane Reti said the low rates had been a worry "for a long time".
"We clearly have not learned our lessons from the 2019 outbreak."
Reti said while he agreed resources needed to be refocused on the Covid-19 vaccine rollout the workforce issues should have been addressed to begin with, along with expanding access to places like pharmacies.
Reti said the rates started to decline after Labour came into government in 2017, and that taking the focus away from targets could have contributed.
Health Minister Andrew Little said while the low rates were "worrying" it was a consequence of reprioritising resources during the pandemic, which meant pausing things like the MMR outreach programme.
"And that pause has now ended so the Ministry is working to build up momentum again behind that and other programmes."
On low Māori rates, Little said the Māori Health Authority would help focus attention and resources.
The wider health reforms would also provide a "reset" of the wider immunisation programme, with more focus on access to primary care and community outreach, he said.
Auckland Regional Public Health Service, which would be responsible for handling any outbreak, declined to comment for this article. The Ministry of Health did not respond by deadline.
