The race to vaccinate the last 17 percent against Covid-19 is now on. There’s a few things the Government can do to give us all the best chance of success, says Asher Wilson-Goldman.
The vaccination programme to date has been uneven around the country, but the biggest disparity has been for Māori and Pacific communities.
There’s been plenty of good advice not taken by the Government, particularly from Te Rōpū Whakakaupapa Urutā, and that’s landed us in a place where the final 17 percent yet to receive their first dose are statistically much more likely to be Māori than the 83 percent who are currently vaccinated or booked.
A missed opportunity
We had an opportunity with the vaccination programme to change the way our healthcare system interacted with people it has historically ignored or mistreated. Ahead of next year’s launch of the Māori Health Authority, this could have been an opportunity to deliver a nationally equity-focused health campaign and to demonstrate what the new healthcare system will offer.
The Covid-19 vaccination programme will, by the time it’s finished, interact with more New Zealanders than any other health programme we’ve ever had. Many of us have had negative experiences with healthcare professionals, whether due to colonisation, racism, sexism, the impact of underfunding or other reasons.
If we’d done this right, the impact would have gone well beyond equitable vaccination rates. We could have created a situation where in five years time, when someone feels a lump in their breast, or has a kid due for childhood immunisations, they could have thought back to their last interaction with the public health system.
Imagine if they remembered their Covid-19 vaccination as a great experience – where they were invited by someone from their community to come to a place they felt safe (their marae, their church, their kid’s school), greeted in their preferred language by a friendly face they knew, had their questions answered by a medical professional from their own community, and then went home feeling safe and confident – and well fed with home-cooked food they had been smelling the entire time, waiting to taste.
If that was their memory of the health system, they might well make the call sooner rather than later to get that lump checked, or to proactively book their child’s immunisation. If their memory was of a health system that met them where they are, treated them with respect, and looked, sounded and smelled like a place they felt safe and welcome.
In some parts of the country, for some people, this has been the case in the past few months. Unfortunately, it hasn’t been for most, due to the comparative ease for the system of delivering the status quo, and the lack of desire from many political leaders to do anything different.
We are where we are. We can’t go back at this point and magically make the system less colonising, less racist. The immediate question before us is a simple one: what steps can we take to make sure that as many of the last 18 percent are vaccinated, as soon as possible.
Reinforcing Māori and Pacific providers
Health providers run by and for Māori and Pacific people have been doing critical work to date. Key examples include the sterling efforts of Te Whānau O Waipareira Trust in Auckland over the weeks of this most recent outbreak, or the work of Te Whānau-ā-Apanui to vaccinate their people in the villages and rural areas around Te Kaha.
In Porirua, the vast majority of vaccinations to date have been by Māori and Pacific providers: Ora Toa have run the community vaccination centres and drive throughs since March, Maraeroa Marae opened their doors for vaccinations in June, and the Pacific-run Pacific Health Plus and Porirua Union & Community Health Services have collaborated on a vaccination centre since July. All four organisations have also run pop-up events in churches and community centres, particularly focused on the large Pacific communities living in their city.
They need help however – not just money, of which there’s been some (though never enough), but people. Running a Covid-19 vaccination centre takes a lot of people. Not just vaccinators, and nurses to observe afterwards, but receptionists to check people in, administrators to enter the data in the Covid-19 Immunisation Register, and kaiāwhina to welcome people into the space.
We should temporarily second staff from DHBs and primary care to Māori and Pacific providers, to be under their control. Māori and Pacific providers will then be able to deploy them as they see fit - in administration and vaccination roles. This will free up the providers’ own people to do outreach, to support whānau and help them to feel comfortable and confident to vaccinate. They will also be able to vaccinate in more places at once - to truly lead the programme in their cities, towns and regions.
Get GPs on the phones
Every GP in this country is able to see which of their enrolled patients has already received a vaccine. We should be paying them to prioritise phoning every single patient who hasn’t, and offering to have a conversation with them and answer any questions they may have.
When they’re ready, the GP can book them over the phone, or tell them where their nearest walk-in vaccination centre is. Don’t invite them to go online and book themselves – just do it with and for them over the phone.
Some studies suggest that if you start by booking someone an appointment, tell them when and where it is, and then offer to answer any questions, then that has a higher chance of success than doing questions first, bookings second.
Don’t forget about second doses
While to date the vast majority of people who have their first doses are going on to have their second (well above 95%), we need to be prepared that this may not hold for some of the more hesitant people who we are working hard to get over their line just for one dose.
Hopefully, a positive, warm and friendly experience at dose 1 will make it easier, but we need to ensure that we’re ready to follow up with people missing their second doses. Automated text messages inviting people to rebook aren’t enough. Phone calls should be a first option, but we also need to resource in-person teams who can knock on doors where necessary (preferably with vaccine ready to go).
We can do this
Social media has been full of stories in recent weeks of people who have managed, through hard work and aroha, to get hesitant friends and whānau over the line and agreeing to vaccinate. We’re at the point in the programme where every individual is going to be a bit tricky, but every person who agrees to step up makes us all safer.
If you’ve got a vaccine hesitant loved one, know that it likely won’t be just one magic conversation. It’ll be hard, and it will take time. But if you can find the shared points of interest, if you can engage genuinely, then more often than not, you will get there together.
We’ve missed a lot of opportunities in this programme, but we’ve also done a lot of things right. We’ve strengthened Māori and Pacific providers for the future. The various parts of the health system have got a bit better at working together. And, above all, we’ve saved lives. This final push for 2021 is now the only way we’ll be able to have a summer without mass hospitalisations. Let’s get it done.