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A third of caregivers are still either not keen or unsure about their children aged 5 to 11 getting a Covid-19 vaccine, with just over a month before the rollout is planned to begin.
And the rate is even lower for Māori, with just 57 per cent either willing or likely to have their children under 12 vaccinated.
That's according to the latest Government-commissioned vaccine surveys by Horizon Research, which show major challenges lying ahead in the next step in combating Covid-19.
MedSafe is still considering advice on approving Pfizer's paediatric vaccine for 5 to 11-year-olds, but is expected to do so by January.
While children are less likely to experience severe illness from Covid-19, in the current outbreak 20 per cent, 1838 cases, are aged under 9, and 35 have ended up in hospital - including babies, one just 6 weeks old.
Children are also often more likely to be in crowded environments, like schools, and thus help spread the virus.
The new variant Omicron is also disproportionately impacting children currently.
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* 7.10am: NZ Medical Association chairman Alistair Humphrey
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* 7.37am: Covid-19 Response Minister Chris Hipkins
Covid-19 Response Minister Chris Hipkins says we still have some further challenges and hurdles ahead of us in regards to the pandemic.
Hipkins said he wanted to make clear that the official advice government officials received was for Auckland only to move into the traffic light system once the three main district health boards - Auckland City, Waitematā and Counties Manukau - all reached 90 per cent in full vaccination coverage.
Counties Manukau DHB, however, is still yet to achieve that goal - although, Hipkins said it looks as if it will reach that milestone in the next day or two.
"So Auckland would still be waiting to move to the traffic light framework," he told TVNZ's Breakfast show.
The advice also went on to recommend that the city would not move into the traffic light system until two weeks after that 90 per cent coverage target was reached.
And then the hard border around Auckland would also be removed.
"We made the decision to bring forward moving to the traffic light framework whilst leaving that boundary in place - so decoupling those two decisions."
The result is that Aucklanders have experienced "much greater freedoms" than if we had been waiting for the last DHB to reach 90 per cent full vaccination coverage.
Health Minister Andrew Little said the Government knew that the health system was under pressure even before the current Covid-19 outbreak.
But we have had outbreaks and part of the preparation last year, in case of another outbreak, was to ensure that nurses were better trained to care for Covid patients, he told Breakfast.
However, he reiterated that that extra module of training did not mean they were qualified to give critical care for people in intensive care units.
Little was responding to concerns from the Nurses Health Organisation about capacity issues and pressure on nurses.
"We've been doing a lot to deal with the pressure points in our health system."
He wanted to reassure people, that when members of the public need hospital care and turn up to hospital, they will get the care they need.
They say this time around Māori children needs to be prioritised.
But the survey on Māori attitudes, which included 799 respondents between October 14 and 20, showed the scale of the challenge ahead.
Of those with children in their care aged under 12, just 57 per cent said they were either willing or likely to have them vaccinated.
Respondents reported a lower level of trust in the Government and lower rating on the overall response than the general population. They also reported noticing a higher amount of misinformation - 46 per cent - compared to in July - 29 per cent.
Those unwilling (27 per cent) were more likely to say the didn't trust the vaccine, while those unsure (16 per cent) were mostly concerned about safety.
The survey also however reported a total potential Māori uptake in the eligible population of 74.5 per cent, which is well below the current 85 per cent first dose rate thanks to a major recent campaign, boost in funding and huge effort largely from Māori health providers. Currently 72.3 per cent are fully vaccinated.
For the overall population, the latest survey, which included 2447 respondents between October 28 and November 9, found 68 per cent overall of caregivers of 5 to 11-year-olds would allow their child or children to get a Covid-19 vaccine. This included 11 per cent who were unsure.
This overall rate was up from 63 per cent in the September survey.
Covid-19 Response Minister Chris Hipkins says the survey rates are concerning but he is confident those numbers will increase once MedSafe gives its approval, which is expected by January next year.
Indeed the first Government-commissioned surveys from September and December last year showed just 69 per cent of adults would receive a "well tested and approved" Covid-19 vaccine.
As of Wednesday, 93.5 per cent of the population aged over 12 had received at least one dose, and 88.1 per cent were fully vaccinated.
"I expect there might be a higher degree of hesitancy initially around paediatric doses given we haven't made decisions on that yet, and we haven't communicated the advice we've received," Hipkins said.
"We've been wanting to make sure that we get really good robust advice before rolling out a paediatric vaccine."
Paediatric doses of the Pfizer Covid-19 vaccine are approximately a third of the adult dose.
Pfizer confirmed in September its vaccine was safe and effective for the 5 to 11 age group, and is already being rolled out to children in the United States, and is approved for use in many countries, including Canada.
Australia plans to start vaccinating 5 to 11-year-olds with it from January 10.
Older age groups had been approved first as Covid-19 had been shown to be more severe based on age.
On prioritising Māori and other vulnerable groups disadvantaged by the first rollouts, Hipkins said this time around there would not be supply constraints.
"We'll be able to really zoom in on those areas where vaccination rates are lower, and we know it's going to take longer.
"And that won't be to the detriment of everyone else, because we'll be able to make it available right the way through the vaccine network."
Hipkins said MedSafe was still considering its advice, and this was expected to be delivered to the Cabinet by mid-January, although it could even occur before the end of the year.
If the approval came in January before the next Cabinet meeting Hipkins said they were able to delegate a smaller group of ministers to make a decision.
They'd had assurance from Pfizer vaccine stocks could arrive in time for a rollout from mid-January.
"All the feedback I've had so far is that they're on track to take those milestones."
Hipkins said they were aiming to start the rollout around mid-January as most people would have finished their holidays and there was still some time before the school year began.
They'd use same vaccine network already set up for the rollout but also look into outreach in schools, he said.
University of Otago immunologist Dr Dianne Sika-Paotonu said vaccinating children was a crucial step given Delta's continuing spread, and the threat of Omicron.
The latest variant is currently disproportionately affecting children in South Africa, including hospitalisations, where children under 12 are unable to get vaccinated.
The survey results showed the importance of prioritising vulnerable groups, including Māori, she said.
"It will be critical to ensure an equity focus for ongoing and future vaccination efforts that results in appropriate and targeted approaches for these children and their families and aiga, that reduces barriers and builds trust, to ensure help and assistance gets out to those who need it most."
Given the younger age distribution for Māori and Pasifika and known more severe health risks, Sika-Paotonu said the rollout should be aiming for "at least 90 to 95 per cent" among those populations.
University of Auckland developmental paediatrician Dr Jin Russell has previously said the paediatric rollout was a "second shot" at achieving equity.
"A school-based rollout, alongside existing vaccine clinics, would be the most equitable in terms of access.
"Reaching children with certain pre-existing conditions, children with vulnerable household members, and Māori children should be prioritised for the paediatric vaccine rollout."