Māori vaccination rates are still lagging behind those of other ethnic groups and the gap is only widening as younger people become eligible, Marc Daalder reports
Analysis: Even as New Zealand’s vaccine rollout surges, the gap between Māori and Pasifika vaccination rates and those of the general population continues to widen.
Just 19 percent of eligible Māori were vaccinated by the end of Tuesday, compared to 30.4 percent of eligible people in the “European or other” category. A quarter of Pasifika over the age of 12 have received two doses of Pfizer vaccine.
Māori health experts warned about this inequity when the rollout was first being planned. Dr Rawiri Jansen, a co-chair of Te Rōpū Whakakaupapa Urutā, resigned from the Government's Immunisation Implementation Advisory Group in April, describing the lack of prioritisation for Māori under the age of 65 as an "overwhelming failure".
Rhys Jones, a public health physician and a senior lecturer at the University of Auckland, said the warnings of Māori and Pasifika health experts had come to fruition.
"We shouldn’t be surprised by these outcomes. They were predictable right from the beginning," he said.
"And in fact, lots of Māori health experts were saying at the time that the rollout was being designed and decisions were being made that this was going to create inequities. Unfortunately, that’s exactly how things have come to pass."
The Government still insists the rollout is working well and has dismissed most criticism of inequity.
When presented with the starkly different vaccination rates between Māori and the rest of the country, Covid-19 Response Minister Chris Hipkins has repeatedly blamed the different age structure of the Māori community.
It certainly is true that Māori and Pasifika tend to skew younger than the general population, while white New Zealanders tend to be older.
More than a quarter of Māori and 22 percent of Pasifika are under the age of 12, while a fifth of European New Zealanders are 65 or older.
Hipkins says this means you can't make judgments based on the percent of each population which has been vaccinated, but have to break it down by age bands.
The criticism particularly rankled in the early stages of the rollout, when Māori and Pasifika over the age of 60 were being immunised at greater rates than other ethnic groups.
By merely looking at the whole population, like the below chart does, you don't get the full story, Hipkins said.
That's a comment that has been echoed by other ministers and officials too, including Director-General of Health Ashley Bloomfield and Prime Minister Jacinda Ardern.
However, now that the rollout is open to everyone aged 12 and up, breaking vaccination rates down by age band doesn't tell the same rosy story.
"Even when you look within the age bands, there are still inequities in terms of vaccine coverage. What’s even more concerning is that appears to be particularly so at younger ages," Jones said.
"In the age groups that are under 40 in particular, it seems as though there’s still quite significant inequities, with Māori having lower coverage than other ethnic groups in those age groups. That’s concerning partly because a large proportion of the Māori population are actually in those age groups."
The different age structures for each population also raise another issue: larger amounts of the Māori and Pasifika populations are not eligible to be vaccinated than the general population.
"Particularly with the younger age structure of the Māori population, as with the Pasifika population, with the under 12s currently unable to receive the vaccine, that does mean that we should be doing everything we can to make sure that people in the age groups that are eligible are receiving it for the Māori and Pasifika communities," Jones said.
Even if 90 percent of the eligible population of each community is vaccinated, a third of Māori and 30 percent of Pasifika would still be unvaccinated, compared to just 21 percent of white New Zealanders.
"To some extent, there is not much that can be done about that until such time as children are eligible for the vaccine, under 12," Jones said.
"Although, the one thing that can be done, obviously, is just making sure every effort is made to prioritise vaccinating Māori and Pasifika populations. Even the younger age groups."
There's one other big issue that Māori health experts have with the vaccine rollout: that it isn't based on risk.
A study released in July by Te Pūnaha Matatini found that, even after accounting for the greater prevalence of underlying health conditions among Māori and Pasifika communities, the average Māori person has the same risk of hospitalisation from Covid-19 as a white person 20 years older. For Pasifika, the gap was 25 years.
"They show that the risk for an 80-year-old European person is roughly equivalent to a Māori or Pasifika person in their 50s, all other things being equal. Looking at Māori and Pacific compared with Pākehā in a certain age group is kind of like comparing apples with oranges," Jones said.
"We really, really need to be thinking about prioritising Māori at much younger ages. The vaccine rollout really should have reflected that risk difference."
So, while Māori in older age groups may be more vaccinated than their white peers, Māori and Pasifika are considerably under-vaccinated if you take a risk-based view.
The Ministry of Health doesn't release a comprehensive breakdown of vaccination rates for people over the age of 65, lumping them all together.
But for those age groups for which data is available, Europeans are twice as likely to be fully vaccinated as Māori, on a risk-based lens. In almost every age group, white New Zealanders are also 50 percent more likely to be vaccinated than Pasifika.
The Government has defended its age-based rollout by saying this would ensure those who are most likely to suffer severe outcomes from Covid-19 are protected first.
But a 65-year-old white New Zealander has been able to get a vaccine since the start of May, despite having a lower hospitalisation risk than a 50-year-old Māori or Pasifika person who will only have been eligible since August 13.
"The decision of the Government not to prioritise by ethnicity has led to inequity basically being designed into the vaccine rollout," Jones said.
"Because with that one-size-fits-all age criteria, they’re effectively ignoring the huge differences in risk for Māori and Pasifika compared with Pākehā at a given age."
The key now was to focus on vaccinating Māori and Pasifika and particularly to increase youth vaccination rates. Associate Health Minister Peeni Henare told Newsroom last week he supported incentives for young Māori to get vaccinated, a proposal backed by National Party leader Judith Collins.
But Jones also said this could have been avoided if the Government had listened to experts like Jansen.
"Really it’s just another signal that the Government needs to listen to Māori health experts, Māori communities, and to allow Māori communities to be leading in developing interventions and programmes to enable their own communities to achieve good coverage."
