March 23, 2021
Dr Rawiri Taonui Covid Maori | Up to 200,000 vaccines needed by Maori and Pacific Providers
Last week, the Labour government unveiled a revised Vaccine Roll-out Plan and the Māori Vaccine Strategy.
Responding to the advocacy of the National Iwi Pandemic Response Group, Te Rōpū Whakakaupapa Urutā, the National Hauora Coalition and providers up and down the country, such as Te Turuki in South Auckland and Waipareira Trust in West Auckland, the strategy pulled together by the Māori Caucus of the Labour Government is an advance on earlier Māori Covid-19 initiatives.
However, there are shortcomings, particularly on funding for iwi, and an ignoring of the risk to Māori between the ages of 50 and 60 years old with comorbidities that discriminates in favour of Pākehā. The 40,000 vaccine to Māori and Pacific providers is both tokenistic and unrealistic.
Māori are a Priority Group
Māori have suffered disproportionately in every pandemic-epidemic event to awash our shores. By the early 1800s, the absence of immunity to Western diseases had halved the Māori population, something Pākehā academics have minimised by lessening estimates of the at-contact Māori population and exaggerating the impact of the Musket Wars.
During the 60 years after the signing of Te Tiriti o Waitangi, Māori mortality switched from being immunity-absent to immunocompromised as a colonial government methodically stole their land and natural resources compressing impoverished and malnourished Māori communities onto diminishing parcels of increasingly marginal land. Many Māori communities lived in a state of continuous epidemic. On central North Island community, lost 50% of all those aged under 30 years over two decades.
This vulnerability has continued until the present day. During the 1918 Influenza Pandemic, the Māori death rate was eight times higher than Pākehā and in the 1957 Flu Pandemic, six times higher. During the 2009 Swine Flu Pandemic, the rate of infection for Māori was twice that of Pākehā, Māori were three times more likely to be hospitalised and 2.6 times more likely to die. Māori were 39% of cases in the 2019/2020 Measles Epidemic.
Māori are vulnerable to Covid-19. More Māori live-in poverty, more housing is substandard and overcrowded. The increased risk of Covid-19 infection reflects the prevalence of pre-existing comorbidities such as heart disease, diabetes, respiratory ailments, and hypertension.
Māori are 16.5% of the total New Zealand population. While overall cases during Covid-19 have so far been lower than demographic at 8.2%, Māori have been 38.9% of those admitted to intensive care, 19.2% of deaths and were 25.7% of cases in the largest-post first wave Auckland Outbreak.
Racism is as damaging as the pathogen during a pandemic event. During the late-1800s, Pākehā presumed that Māori suffered worst during contagion because they were genetically inferior, lacked character and were dirty.
The reality was quite different. Racism cost lives. Vaccines were withheld from Māori communities, Māori given lower supplies or lower-grade serums. Māori were banned from delivering inoculations. During the 1918 pandemic, many of the sick in remote Māori communities died from starvation because no effort was made to help them.
Last year, the Ministry of Health (the Ministry) released a Māori Covid-19 Strategy that lacked consultation with Māori. Few if any Māori sit on the main Ministry and government Covid-19 advisory groups. Preliminary Covid-19 testing of Māori was significantly lower than for Pākehā because the Ministry and District Health Boards (DHBs) failed to engage culturally equipped Māori health providers. More Māori and Pacific people were declined tests, and, in a century-old echo, some DHBs resisted registered Māori provider medical staff administering tests.
The Ministry and DHBs regularly obfuscated Māori testing data. In early April, the Ministry listed meaningless micro-percentages of total tests rather than raw numbers of Māori tested. DHBs released self-flattering regional testing data rather than less flattering DHB-specific data. The testing of Māori only improved when Māori providers pushed their way into the testing effort.
New Zealand health officials continually reference ‘discussions with iwi and Māori advocates about health inequities’. Inequity is a polite word for racism employed to retain Pākehā control of health. ‘Talking equity’ recycles conversations that avoid asking why white people monopolise all the decisions. The answer, to avoid empowering Māori decision-makers to achieve equality in health outcomes for Māori.
The Māori Vaccine Strategy
The Māori Vaccine Strategy is an improvement over previous Māori support efforts. Recognising that Māori Health providers are better qualified than mainstream providers to engage Māori communities, the package provides $11 million to Māori Health Providers to engage and prepare communities for vaccination, $24.5 million to community groups and $2 million to iwi to support that work and $1.5 million for workforce development.
The Vaccine Rollout Plan
The Māori Vaccine Strategy overlaps with the government’s wider four-group Vaccine Rollout Plan.
- Group 1: This covers 4,000 border and 11,000 Managed Isolation and Quarantine (MIQ) workers, including, customs and border officials, airline staff, MIQ hotel workers, security staff, nurses who conduct health checks, cleaners, and maintenance staff. The group also includes 40,000 family members and household contacts. Together this covers a sizeable number of South Auckland Māori border and MIQ workers and whānau.
- Group 2: This has three sub-groups. Sub-group 2a includes 57,000 frontline non-border healthcare workers who could be exposed to Covid-19 while providing care. 2b covers 183,000 frontline healthcare workers who may expose vulnerable people to Covid-19. This includes doctors, nurses, pharmacists, those conducting community testing and healthcare workers protecting the vulnerable. This group includes Māori providers and frontline health workers. At the time of writing, 38,000 people in groups 1, 2a and 2b had received vaccinations.
Sub-group 2c covers 234,000 at-risk people with an elevated risk of transmission or exposure to Covid-19, including those living in the Counties-Manukau DHB district who are 65 years and older or have an underlying health condition.
The emphasis on the Counties-Manukau region is a long-overdue recognition of the contribution of South Auckland to the Covid-19 effort and the particular risk confronting the region.
South Aucklanders formed a substantial number of the essential workers during the first wave of Covid-19 and the current border and MIQ workforce.
The region faces specific risk because of the proximity of Auckland Airport the main gateway into New Zealand, five isolation hotels and the Jet Park quarantine facility. South Auckland also has a lower socio-economic profile with a greater proportion of people living in poverty and poor often over-crowded housing. The region is also home to a large Māori and Pacific Peoples population with concomitant higher rates of comorbidities.
The Covid-19 response has often let South Auckland down. There was no mitigation strategy addressing the location of the airport and MIQ. An absence of random testing in the area during July last year was a factor in the 179-person August Auckland Cluster of which Māori and Pacific people formed 83.2% of cases.
The Director-General of Health Dr Ashley Bloomfield also scuttled a clear 23 June directive from then Minister of Health David Clark for ‘regular and required testing whether symptomatic or not’, of all border, customs, biosecurity, immigration, airport and MIQ staff. By the first week of August, it was clear that 63% of 7,000 MIQ staff had never been tested. It is now known that around 21 July, the Ministry released a seriously misjudged internal directive saying, ‘regular and required testing was not viable’ because ‘the Ministry felt there were adequate protections in place’ and in an astonishing contradiction to a raft of research that ‘asymptomatic infection had not been proven’.
The Ministry and Auckland Regional Public Health Services also let the region down during the February Papatoetoe event with a bundle of befuddled communications between 14-19 February. Later, an uninformed Prime Minister Jacinda Ardern and Minister of the Covid-19 Response Chris Hipkins, and the Director-General of Health, the person responsible for communications, unfairly lambasted members of the community for supposed non-compliance leading to a significant sometimes racist social media backlash against the community.
- Group 3: Beginning in May, the vaccination of this group will focus on 739,000 people aged over 65 and an estimated another 730,000 people with underlying health conditions or disabilities that make them vulnerable if sick with Covid-19.
This group should include a sizeable number of Māori with comorbidities, contingent upon their registration with doctors and their conditions known. This is not guaranteed. The New Zealand Health Survey 2019/2020 shows that 20.5% of Māori adults had not visited a doctor over the past year because of cost.
- Group 4: The remainder of the general population â€“ approximately 2 million people.
The Māori Vaccine Strategy has limitations. The $2 million funding spread across over 70 iwi organisations is low. Many iwi-based health providers will receive funding through the Māori strategy, nevertheless, central iwi organisations also require support. Iwi have a proven record in emergencies. Ngāi Tahu mounted widely admired community-wide support during the Christchurch Earthquakes. Mataatua were to the fore after the Whakaari Eruption. Last year, iwi protected Māori and Pākehā communities through checkpoints.
Covid-19 funding to iwi has fallen short before. The $56 million Covid-19 Māori Support financial package aided a massive wave of support during the first outbreak. Aimed primarily at Whānau Ora and other Māori providers, it left many hapū and iwi self-funding support to at-risk whānau. A paltry $470,000, provided through Te Ara Whiti – the Ministry of Crown Māori Relations, to help the development of iwi Covid-19 strategic plans, emphasised pre-Treaty settlement iwi entities leaving a considerable number of established tribes to finance themselves.
The Age – Comorbidity Disconnect
The Māori Vaccine Strategy falls well short of bridging the priorities of age and comorbidities in Māori-indigenous health. The Unite Against Covid-19 website now has an app by which New Zealanders can determine which vaccination group they are part of. This makes no allowance for Māori aged under 65-years-old who have comorbidities. In this regard, the $39 million Māori Vaccine Strategy falls short of the reality of Māori health.
Prioritising over 65-years-olds continues the pre-Māori Vaccine Strategy approach. Over 65-year-olds prioritises Pākehā who make up 18.3% or 630,300 of the European population. By comparison, Māori aged over 65 are just 6.1% or 59,000 of the indigenous demographic.
Māori contract illnesses like diabetes at 45 years of age, ten years earlier than Pākehā. The Covid-19 risk to Māori therefore occurs ten years or earlier. A 50-year-old Māori faces the same risk as a 65-year-old Pākehā.
Born from 2000s Clarkist Labour government Pākehā paranoid about favouritism to Māori, the reluctance of the government to be explicit in this regard jeopardises Māori falling between the gaps.
Reserved Vaccines Reserved for Māori and Pacific Providers
With the government lacking cross-cultural fortitude, bridging the age â€“ comorbidity disconnect will take an unprecedented effort from Māori health providers.
The Māori Vaccine Strategy reserves a first tranche of 40,000 vaccines for Māori and Pacific providers. Associate Minister of Health Peeni Henare explained that the ‘By Māori for Māori’ 40,000 courses will enable ‘Māori and Pacific health providers to ‘target’ ‘kuia and koroua’ and the ‘whānau members who live with them’. Nationwide, Māori and Pacific persons over 50-years-old number over 210,000. If they live with one, two or more whānau or aiga the numbers extrapolate significantly higher. 40,000 doses will simply not be enough.
Mainstream providers engaging the South Auckland Group 2 cohort targeting over 65-year-olds and those with health conditions will capture a sizeable number. However, with over 450,000 Māori and Pacific Peoples living in Auckland, and, as shown during testing last April and May, Māori and Pacific communities prefer Māori and Pacific providers, 40,000 doses will not be enough to cover anything beyond the Bombay hills and Auckland Harbour Bridge.
Another issue arises with the Pfizer-BioNTech vaccine requiring hyper-deep-freezing. When removed, it is stable for about 48 hours. This creates a major challenge between delivery to Pacific peoples, the majority of whom live in Auckland and other urban centres, and Māori the majority of whom live outside Auckland and many in remote regions like Northland, the central Bay of Plenty and the East Coast.
Even bearing in mind that this is the first tranche and more will become available, the allocation is fraught because it raises tensions between supply and demand, choosing between elders and how many whānau/aiga to vaccinate, age and comorbidities, distribution between Māori and Pasifika providers and coverage between Māori/Pacific and mainstream providers, and delivery across urban, regional, and remote/rural communities.
This raises the spectre of the 2013 Smallpox Epidemic. The bulk of 760,000 vaccines produced for that event went to Pākehā cities. Communities like Taupiri in the Waikato, which had a significant outbreak, received only enough lymph to vaccinate 80 of 300 Māori. Hokianga Māori received no vaccines.
The better first allocation to Māori and Pacific providers should be between 150,000 to 200,000 doses, a third of which should go to Pacific Communities.
There is a need for a specific Pacific Vaccine Strategy. About 20% of the emerging youth demographic are of Māori-Pacific descent. Pacific Peoples also confront disadvantage and discrimination in the New Zealand health system.
New Zealand authorities were responsible for the death of 22% of the population in Samoa during the 1918 Influenza Pandemic. During the 1957 Flu Pandemic, the Pacific death rate was nearly six times higher than that for other New Zealanders.
In late 2019, Samoa had a measles outbreak reaching over 5,700 cases by January 2020. The death toll was 83 deaths, 87% of which were in children under the age of five. The epidemic likely originated in New Zealand being transferred to Samoa through flights from Auckland because the Ministry and Auckland Health authorities failed to declare a health emergency.
Pacific peoples were 57.5% of all cases in the August Auckland Outbreak. Pacific people have a higher risk of Covid-19 hospitalisation than Māori.
The history speaks for itself.
Noho haumaru – stay safe and self-sovereign.
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