Dr Rawiri Taonui Covid Maori | Maori Vaccination Authority needed to combat low vaccination, new variants and increasing outbreak risk

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New Zealand needs a Māori Vaccination Authority to reverse the low rate of Māori vaccination and counter the emerging risk of an outbreak stemming from high numbers of Red Zone and Green Zone arrivals into the country.

World Update

The world total passed the threshold of 160 million cases this week. The last 20 million cases came in a record 25 days. The 4th Wave continues to push numbers up on the Indian sub-continent. India has several times reported over 400,000 new cases per day making up 50% of all cases reported worldwide.

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There is a reduction in cases in other parts of Europe and the Americas. However, the overall seven-day trend at 750,000 is still higher than the 740,000 January peak of the 3rd Wave.

Vaccine inequality continues to give Covid the opportunity for new variants to appear. Vaccinating all countries together and at the same rate is the only solution to defeating Covid. Until the world achieves vaccine equality, Covid-19 will continue to circle and surge around the globe.

General New Zealand Update

The 18 active cases in MIQ is the lowest since the middle of last year.

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Māori and Pacific Peoples have the lowest ratio of total cases to population. Māori are still the highest proportion to population of cases in ICU and deaths. Pacific Peoples have the highest ratio of hospitalisations and ICU admissions.

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Variants in New Zealand

The B117 (Britain), B1351 (South Africa) and P1 (Brazil) variants spread across the globe during the 3rd Wave because widespread fraud undermined the pre-departure test requirement most countries had introduced to combat the global surge.

The three variants are the primary drivers of the current 4th Wave. Experts consider B117 the most infectious of the three. Vaccines are less effective against these mutations, particularly B1351 and P1, although inoculation still affords a degree of protection against severe disease.

Scientists believe we will need top-up vaccines for the three variants. Pharma giants like Pfizer-BioNTech and Moderna are already working toward this.

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B117, B1351 and a new variant B1617.2 (India) are 83% of all cases genomically sequenced in New Zealand to 3 May. The arrival of B1617.2 on 30 March in New Zealand is a concern. The original version of the mutation (B1617.3) arose in India in October last year before evolving into three sub-types. The B1617.2 sub-type appeared in December and is now outpacing B117 across large tracts of India.

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The mutation has since spread to 44 countries. B1617 is increasing as fast or faster than B117, B1351 and P1 in Britain, Europe, and the United States, where it is causing significant alarm because countries like Britain and the United States have higher rates of vaccination than the rest of the world and anti-Covid protocols are stronger than when B117, B1351 and P1 first arose. Three days ago, the World Health Organisation and Public Health England classified B1617.2 (India) as a variant of worldwide concern.

The Vaccination Rollout

Māori continue to be the lowest vaccinated group compared to population.

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The Ministry of Health sets vaccination policy and administers the $39 million Māori vaccination fund. The Ministry’s approach is systemically racist. The Ministry consults the Ministry of Māori Development on the fund but not the Whānau Ora Commissioning Agency, which has the widest scope over Māori health.

Ministry policy has also not followed the best professional advice that Māori aged 50 have the same risk from Covid-19 as Europeans aged 65. A rigid age-based monocultural one size fits all cultures rollout plan prioritises European over 65-year-olds and lacks the dexterity to effectively vaccinate lower socio-economic and remote Māori communities.

The Ministry has District Health Boards (DHBs) distribute the Pfizer-BioNTech vaccines. The previously inability of the DHBs to test Māori last April/May and the bungled communications during the Papatoetoe Cluster show that they are cross-culturally incompetent.

Historical Amnesia

The Ministry has failed to follow best overseas practices. For example, Australia included remote indigenous Aboriginal and Torres Strait Islander communities, the equivalent of our Northland, East Coast and Urewera regions, alongside frontline border and health workers as the first group to get vaccinated.

In Canada, British Columbia also prioritised remote First Nations and Inuit communities alongside frontline workers. Thereafter, they applied an age-adjusted protocol to vaccinate 1) over 80-year-old non-indigenous and over 64-year-old indigenous people together, 2) over 64-year-old non-indigenous and over 50-year-old indigenous adults, and 3) over 50-year-old non-indigenous and over 18-year-old indigenous adults.

In the United States, rather than disperse vaccinations through bodies like our DHBs, the federal government distributes vaccines directly to Indian Health Service providers who prioritise their communities as they perceive. In the main, this has involved gathering communities together and vaccinating everyone aged over 18. The outcome, indigenous Native Americans have the highest rate of vaccination of any indigenous peoples in the world.

The difference with New Zealand? Australia, Canada, and the United States apply their indigenous strategies through the lens of the differential impact on indigenous peoples of earlier pandemics like the 1918 Spanish Flu and 2009/2010 Swine Flu Epidemic. New Zealand health officials do not because collectively they suffer selective cultural-historical amnesia.

Māori need a Māori-led, by-Māori for-Māori vaccination authority to disperse vaccinations by need, not age, and a community approach bringing together Māori communities and vaccinating everyone over 18-years-old.

Red Zone Weekly Arrivals

The chart below shows all Red Zone arrivals (from countries with higher Covid-19 cases than New Zealand and Australia), border/MIQ failures/breaches into the community and the arrival of hypervirulent variants in New Zealand.

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Entries declined steadily from late February to early May, helped by restricting entries from a new category of ‘Very High-Risk Countries’ where there have been more than 50 cases of Covid per 1,000 arrivals during 2021. This includes India, Brazil, Pakistan, and Papua New Guinea. A proper adjustment would aggregate arrivals by region. For instance, there have been a sizeable number of positive cases arrive from the European West, South America, and the Middle East.

Red Zone entries cases rose sharply to 2,285 last week. Red Zone entries must stay below 1,400 per week. If they do not, we will see another variant-driven outbreak. There were breaches in two of the last eight weeks representing a 25% chance of a new outbreak each week.

Green Zone Trans-Tasman Arrivals

The chart below shows daily arrivals from Green Zone arrivals, including from Australia, Niue, and Rarotonga, and risk events.

There have been 12 risk events over the first 22 days of Green Zone travel, giving a 55% chance of another risk event occurring every day. This includes an airport worker infected (red arrow), three suspensions of travel (red), three traveller breaches of the travel rules (purple) two of which were deliberate, and five locations of interest notifications after community cases in Australia.

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Arrivals from Green Zone countries present less risk than Red Zone countries. Australia has robust Covid systems, Niue and Rarotonga are Covid free.

However, the absence of control over numbers travelling, the complicated management of multiple bubbles between Australian states and New Zealand, passengers reporting few health checks as they pass through airports, the number of incidents, the large-scale tracking of passengers when events happen (more than 7,000 in New Zealand so far), the uncertainty that all those associated with Locations of Interest notifications come forward, the absence of a guarantee that arrivals are using our Covid-19 app or that travel details like addresses in New Zealand are accurate, increase the likelihood of an outbreak.

With over 63,000 entries in 22 days at an average of 2,900 per day and 12 risk incidents and vaccination in New Zealand still at a low 7.6%, the sheer numbers amplify the generally minimal Green Zone travel risk making an outbreak inevitable unless numbers are reduced. The government should reduce numbers back to 200 per day until vaccination reaches 50% in New Zealand.

Active Cases in MIQ

Twelve of the 16 border/MIQ failures/breaches occurred when active cases in MIQ were above 30 per day. Eight variants have arrived in New Zealand when active cases were above 30 in MIQ.

The government has done well over the last two weeks to reduce the number of active cases in MIQ below 30. They must stay at this level if we are to avoid an outbreak. With eight variant arrivals, and this year 12 incidents in the Trans-Tasman Bubble and six breaches into the community, Green Zone travel and Red Zone arrivals must stay below 1400 per week each.

Noho haumaru – stay safe and self-sovereign.

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