ANALYSIS: It's a common misconception to think that Māori have had the same access to the vaccine as everyone else. Derek Cheng explains why this isn't the case, and why, even if it was, the rollout would still not be equitable.
The Delta outbreak has hit Māori hard.
They make up 17 per cent of the population, but about 45 per cent of the cases, 39 per cent of the fatalities, and 36 per cent of the hospitalisations.
The growth in the outbreak started from a church super-spreader event which saw the majority of cases among Pasifika people, but Māori became increasingly caught in the outbreak as the virus hunted the unvaccinated.
This scenario was long-predicted, and Māori leaders have been warning the Government all year about its likelihood in an effort to see a more targeted vaccine rollout.
Today the Waitangi Tribunal begins a week-long hearing brought by Māori leaders who do not want to see history repeating.
The hearing will consider whether Te Tiriti o Waitangi principles of equity and active protection were and are honoured in the vaccine rollout, in moving the country to the traffic light system, and in loosening of the Auckland boundary on December 15.
Equal and equitable access
Equal access essentially means that everyone has the same chance to get the vaccine.
This is impossible to achieve literally, given that not everyone lives the same distance from a vaccine clinic, nor does everyone have the same amount of available time or resources, such as transport, to attend one.
Both of these factors will mean, in general, that if you live in an area of higher deprivation, it will be harder for you to get a jab.
But even if everyone had equal access, not everyone has equitable access, which would mean that people at greater risk should be higher priority.
Part of why Māori (and Pasifika) are at greater risk is because they are more likely to suffer severe impacts from catching Covid-19.
A study published in the NZ Medical Journal, looking at the initial outbreak in New Zealand and the August-September outbreak in Auckland last year, found that a 44-year-old Māori person had the same hospitalisation risk as a 40-year-old Pacific person and a 65-year-old New Zealand European person.
Similar research results overseas saw Canada and Australia age-adjust the vaccine rollout for their indigenous populations.
Despite this, the Government rejected expert advice to roll out the vaccine for Māori and Pasifika aged 50 and up at the same time as for non-Māori and non-Pasifika aged 65 and up.
This meant that 112,050 Māori and 46,780 Pacific people aged between 50 and 64 years were not prioritised according to the expert science and health advice.
So what did the Government do?
In March, $39 million was set aside for Māori health providers to vaccinate Māori, while 40,000 doses were set aside for both Māori and Pacific Providers to vaccinate older people being cared for by their whanau. The whole whanau were also invited to be vaccinated.
The Herald asked the Ministry of Health three months ago how these doses were split between Māori and Pasifika providers, but has still not received an answer.
The next direct Government support for the Māori vaccination rollout was on September 21. By then, 5.8 million doses of the vaccine had arrived in New Zealand, and the Delta outbreak was already starting to spread more rapidly among Māori communities.
This $38m package was sent through the DHBs, but this led to a lack of funding filtering through to Māori health providers in several areas including Taranaki, Tairāwhiti, Northland and Bay of Plenty.
"We did put the second lot of funding through the DHBs, and that has proven problematic," Associate Health Minister Peeni Henare said during an October 19 press conference.
Asked why the DHBs weren't side-stepped like they were in the first tranche of funding, he said: "The second tranche was to go to the DHB to be able to facilitate the equity plan with those Māori health providers, and we had all agreed on that."
He said it was speculative for the Whanau Ora Commissioning Agency to claim that more than 90 per cent of eligible Māori would have been vaccinated by now if the Government hadn't rejected its plan for a targeted rollout in February.
"Māori health providers were clear for the first half of this year that they didn't have the infrastructure to be able to deliver on the kind of scale that we required them to," he added.
A further complication was that the vaccine, at the time, had to be stored at ultra-low temperatures, which the Government was better placed to do.
By the time the next direct funding was announced, on October 22, Māori made up the majority of new cases and the outbreak had already spread all over Auckland.
Half of this $120m funding - which side-stepped DHBs - was for supercharging the vaccine rollout for Māori, and half was for iwi-led initiatives to proactively protect their own communities under the traffic light system.
Prime Minister Jacinda Ardern has also staunchly defended the rollout.
"In the beginning of the year, we had limited supply, and so we targeted that supply to those people most at risk of being hospitalised or losing their life - and I absolutely stand by that," she told the Herald on October 22.
"That's why we went to those who had comorbidities no matter the age. That's why we went to older New Zealanders. We also took a whanau approach so if we were enrolling isolated communities and we were vaccinating older members of their community, we would vaccinate the rest of the family at the same time."
How did the targeting change when supply was not an issue?
By the third week in July, when 350,000 doses arrived, and from mid-July until the end of August, 2.3 million doses arrived.
A few weeks after supply was no longer an issue, the Government brought forward all the age groups in group 4. Last cab off the rank was the 16 to 29 age group, who could get vaccinated from September 1.
This treated all ethnicities the same, but a greater proportion of Māori are in younger age brackets than other ethnicities.
Just over a quarter (25.5 per cent) of Māori are under 12 and are still ineligible, more than twice the proportion of "European or other" (12 per cent) in the same age group.
A further 31 per cent of Māori are aged 12 to 29, meaning they weren't eligible until after September 1, compared with 21 per cent of "European or other".
This also meant a greater share of Māori were exposed to the sustained and increasingly fervent misinformation and disinformation campaigns that have flooded social media, especially since the start of the outbreak.
This is what led some health experts to call the rollout implicitly inequitable.
Where we are today
The vaccination gap between Māori and non-Māori has shrunk in recent months, but remains significant; coverage of the eligible population is 93 per cent for one dose and 87 per cent for two doses, while for Māori it's 84 and 71 per cent respectively.
Māori coverage is particularly low in certain regions - including Northland, Bay of Plenty and Tairāwhiti - where Māori leaders have asked Aucklanders not to visit once the boundary softens from December 15.
Actual coverage among Māori could be even lower because the Ministry of Health bases its figures on its own database, which doesn't include those who don't use health services. This undercounts Māori aged 12 by up to 70,000 people compared to Census projections.
Taking this into account, Māori health analyst Dr Rawiri Taonui says double-dose coverage is as low as 30 per cent for 12- to 29-year-old Māori in the suburbs of Waimana, Ruatāhuna, Ruātoki and Waikaremoana.
Unvaccinated places also tend to correlate to further distances away from a local or metropolitan hospital, which has been mapped by health geographer Dr Jesse Whitehead; access to health services is a factor in how the Government applies the traffic light system.
This is largely due to the incredible efforts of Māori health providers in recent months, as well as successful court action against the Health Ministry to gain access to contact details of the unvaccinated.
Since the vaccine rollout opened up to all eligible age groups on September 1, Māori vaccinations have increased faster than any other ethnicity. First doses have increased at double the rate of Pākehā.
But what will happen following more movement within Auckland, and then in and out of Auckland, remains to be seen.
In deciding these freedoms, Ardern has had to balance protecting the unvaccinated with rewarding those who got vaccinated but who remained stuck in Auckland's lockdown.
The tribunal hearing is in part an effort to prompt the Government to do more to protect Māori.
"There's the failure to give effect to the treaty, including the principle of Tino Rangatiratanga, giving Māori communities authority and resources to protect themselves," National Māori Pandemic Group co-leader Rawiri Jansen told the Herald.
"There's a failure of active protection: we see that in terms of the failure of the vaccination sequencing. There are some remediation attempts now - I don't want to say the Government's done nothing - but the crescendo of additional funding is in response to the failure.
"As we step into the next phase, Māori communities are more at risk because we're less protected in terms of vaccination, and in terms of resources and infrastructure and health services. We are facing an increasingly complex, increasingly urgent and increasingly unsafe period."