By Natalie Netzler
Covid-19 is hitting our Māori and Pacific communities disproportionately hard. So how can we improve clear, targeted messaging on vaccination?
The Covid-19 pandemic continues to create global chaos and devastation. At the time of writing there have been 216 million cases reported and 4.5 million deaths worldwide, increasing every day.
Here in New Zealand, the disease continues to hit hard in our Māori and indigenous Pacific populations, both among the ethnic groups suffering disproportionately higher rates of infection, severe outcomes and death compared to other ethnicities. In previous Covid-19 outbreaks in Aotearoa, Māori and Pacific peoples were up to three times more likely to require hospitalisation compared to other ethnic groups after adjustment for age and pre-existing conditions.
It was also recently reported that if pre-existing conditions or age are dominant factors determining Covid-19 fatality, then Māori are at least 50 percent more likely to die from the disease. Pacific peoples also carry double the risk, compared to New Zealand Europeans. Given these reports were before the highly contagious Delta variant arrived on our shores, these disparities are likely to increase.
Similarly, in the US where Covid-19 cases were widespread, infection rates were reported to be five times higher in Pacific populations compared to other ethnic groups. In some states it was reported that Pacific peoples were between four to five times more likely to die from the disease. These tragic inequities are not unique; during the 1918 influenza pandemic in Aotearoa, the death toll in Māori was around seven times that of non-Māori.
So, why are Māori and indigenous Pacific populations more susceptible to infection and severe outcomes? There are multiple factors which include increased exposure from high proportions of frontline health and border workers; easy transmission within high occupancy, multigenerational housing, and disproportionately high levels of underlying co-morbidities (existing illness or disease) including diabetes and cardiovascular disease. In addition, the influence of genetic factors on infection rates was recently confirmed with a study that identified genetic links to increased Covid-19 susceptibility in Oceanic populations.
Given these well-documented risks, Pacific and Māori populations should have been prioritised within Group 1 for vaccination and clear, targeted messaging should have started sooner.
Tragically, despite the increased risk of Covid-19, vaccination rates in Māori and Pacific populations in Aotearoa remain much lower than other ethnic groups. Rates of fully vaccinated individuals reported on August 1, 2021 indicated Māori rates were less than 60 percent of New Zealand European rates, while Pacific communities were less than 80 percent in comparison.
These lower rates of protection reflect multiple barriers. For example, poorer access to vaccination sites for isolated rural Māori communities, language barriers for some Pacific communities, lack of trust in the European-centric healthcare system, systemic inequities and socio-economic disadvantages which are well-evidenced to impact on healthcare choices and opportunities.
A huge amount of vaccine-related misinformation and disinformation currently circulates, making it hard for the general public to discern what is true and what is not. The increased risk of Covid-19 to Māori and Pacific communities is amplified here; we are more vulnerable, less protected and less informed.
On a personal level, my father is Samoan, and I have Māori tūpuna from my mother’s side, so I fear for my whānau along both family lines. Professionally, as a virologist, I feel a personal responsibility to improve messaging and engagement of Māori and Pacific here in Aotearoa and across Pacific diaspora, to increase understanding, awareness and help protect my peoples.
Significantly lower vaccination rates are evidence that communications to engage Māori and Pacific populations have been insufficient. Our cultures are built on strong oral traditions and kanohi ki te kanohi communications, where we can hear, see and smell the trust of the relationship. Vaccine communication platforms such as a Government website link or a pamphlet in English are not going to have the same impact as delivering these messages clearly, in appropriate languages and ideally face-to-face when safe and possible to do so.
In some communities, lack of trust following decades of systemic inequities means the message needs to come from those within these populations to ensure the engagement is both appropriate and accepted.
There have been some significant success stories in this regard, such as Māori health provider Whakawhiti Ora Pai in Te Tai Tokerau, which has achieved great engagement with Māori in the Far North. Other significant impacts within these at-risk communities are being achieved by social change agency The Cause Collective, and also by Alliance Health Plus in Auckland which has Pacific clinicians and translators engaging with Pacific communities and church groups to address concerns and raise awareness about the importance of vaccination. More positive examples like these are needed nationwide.
To try and ensure as many of our Pacific and Māori whānau are protected, I am working as part of a team within the University of Auckland and the Maurice Wilkins Centre of Research Excellence that is collaborating directly with several Pacific and Māori communities, churches and groups to produce communications to raise awareness with maximum impact. This team includes a Tongan immunologist, Chris Puli’uvea, Dr Ofa Dewes and Professor Peter Shepherd (University of Auckland, Maurice Wilkins Centre), Siufofoga Matagi and Denise Tahuri (Immunisation Advisory Centre) and many others. Together we are working to produce several platforms for communication ranging from Zoom sessions to answer questions through to videos in te reo Māori and several Pacific languages to explain, in layman’s terms, what the vaccine is, how it works and why it is so important we protect ourselves and our whānau.
Before the Level 4 lockdown we were going throughout the communities and holding face-to-face hui and fono to raise awareness. Since lockdown these have moved online and are occurring almost daily.
These efforts and others need to be widespread to ensure our at-risk populations have the right information in the right format to ensure we can all make informed decisions with respect to our health. Only then can we start to combat these disparities and increase vaccination rates to avoid the tragedies and disproportionate losses of the past.
This article was originally published on Newsroom and was republished with permission. For the original, click here.
Natalie Netzler is a Research Fellow in Molecular Medicine and Pathology at the University of Auckland.
For more information on COVID-19, head to the Ministry of Health website.
Disclaimer: The ideas expressed in this article reflect the author’s views and not necessarily the views of The Big Q.
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