Failing to prioritise Māori children in a vaccine rollout for those aged 5 to 11 could have deadly consequences, the Waitangi Tribunal has heard, especially in light of emerging information about Omicron's severe health effects in children.
The tribunal is hearing a claim from Māori leaders including the NZ Māori Council about whether the Government's Covid response has honoured the principles of Te Tiriti o Waitangi.
The tribunal's panel members heard from several submitters today about how Māori providers felt their consultation with the Crown was nothing more than lip-service, how it was statistically inarguable that a rollout based on age was biased against Māori, and how Government funding for "by Māori for Māori" vaccine programmes was too little, too late.
Submitters also warned that Māori children and their families would disproportionately bear the burden if the vaccine rollout for children aged 5 to 11 – if approved - mirrored the adult rollout.
"If the Crown's response to the Covid-19 pandemic does not take into account the specific needs of Māori children, the burden of health inequity they already bear will be exacerbated," Māori paediatrician Dr Danny de Lore told the tribunal.
He said Māori children suffered higher rates of acute and chronic lung conditions or disabilities.
"The direct health risk of Covid-19 infection is higher than for non-Māori children, and because Māori children have a higher burden of pre-existing condition, they will experience a greater burden of hospitalisation and severe illness as Covid-19 spreads."
Medsafe is still considering whether to grant approval for the paediatric vaccine, though it has been granted by Australia's Medsafe equivalent.
Covid-19 Response Minister Chris Hipkins has said he is optimistic the rollout for 5 to 11s could start before the end of January – and he is looking into how it should be targeted.
Microbiologist Dr Siouxsie Wiles said the early signs about the Omicron variant was that it was mild for adults who caught it, but worse for children than other variants of concern.
"Cases are rising very, very fast, especially in South Africa, where it's doubling every three days at the moment," she told the panel.
"The very, very concerning thing for us is that hospitalisation rates now in South Africa are already beginning to rise, and they're disproportionately rising in children under 5.
"With previous variants, hospital rates have been much higher in older age groups, but with Omicron we're seeing quite a lot of children, especially under 5, now being hospitalised."
She said if Omicron became dominant around the world, "it will arrive in New Zealand".
Developmental paediatrician Dr Jin Russell said a rollout in schools would ensure that almost no child was more than 30 minutes away from access to a dose.
"What we have seen from the adult vaccine rollout is that a priority group of people who have a pre-existing condition actually doesn't lead to sufficient equity," she said.
"We would need to go much further than that and actually prioritise reaching Māori children early in the vaccine rollout, not just because they have a higher number of pre-existing conditions at higher frequency, but also because they are likely to have a higher proportion of undiagnosed pre-existing conditions."
Getting the rollout wrong, de Lore said, could mean children would die.
"If we have poor uptake of vaccination and high vulnerability amongst children, there's the potential for education facilities to become reservoirs of this virus, where they become points where it just keeps circulating around the community," he said.
"The mortality rate per 100,000 infections has been reported in the UK and the USA as between five and 10 children.
"We have half a million children between 5 and 11 (a quarter are Māori). Some children will die from Covid-19 if we have high transmissibility and low vaccination rates."
The tribunal also heard from researcher Charles Waldegrave about how Māori are about twice as likely to live in overcrowded, mouldy homes, and from statistician Len Cook, who said that any age-based policy would be inherently biased against Māori because a higher proportion of them are younger.
National Hauora Coalition clinical director Dr Rawiri Jansen said many providers were already supporting Māori to isolate in overcrowded homes.
"That is very difficult, almost impossible, to manage isolation in that setting. It means that many of those families are directly in harm's way, and 100 per cent of those who are not vaccinated are likely to end up Covid positive, and a smaller number - perhaps 10 or 15 per cent - who are vaccinated are still going to end up Covid positive," he said.
"That means the isolation will be extended in its duration, certainly through the Christmas New Year period. That's a significant hardship on a significant part of our community."
He said many whānau in Auckland were living in difficult circumstances that a pro-equity Government response, in partnership with Māori health providers, would have tried to address a long time ago.
"We are working with whānau who are living in cabins without showers and toilets, whānau with 13 or 15 people in a three-bedroom home, whānau who are dependent on the cash economy and do not get any Covid funding from the Crown, whānau who have no resources to manage living in isolation."
He said it was disgraceful to see whānau placed in MIQ, and then be returned to transitional housing after they've finished their isolation period.
"We should never put them back in harm's way. That's a national disgrace. If we had an independent Māori Health Authority, none of those things would be happening."
The hearing also discussed ongoing talks between the Māori Council and the Crown, including ministers, that had been happening in recent days about how to move forward to achieve the best outcome that all parties want.
Panel presiding chair Judge Damian Stone quizzed lawyers from both sides about how the hearing, which was granted under urgency, should proceed if the main claimant's gripes were suddenly resolved.
The hearing continues.