Māori and Pacific communities achieved impressive outcomes with Covid-19 vaccination. Mobilising their great knowledge, expertise, and experience could go a long way to tackling rheumatic fever.

Comment: The Covid-19 pandemic showcased how critical Pacific leaders, health providers, community groups and churches were in ensuring the community was protected and vaccinated, achieving a 90 percent vaccination rate among Pacific people by the end of 2021.

It demonstrated the power of communities in public health, an approach that could and should be used to reduce the high rates of rheumatic fever in Aotearoa New Zealand.  

As Jacinda Ardern has said our rate of rheumatic fever is a “national shame”, a condition that is preventable and not common in developed countries, but profoundly impacts Pacific and Māori children here in New Zealand

Rheumatic fever has been around for centuries. In the early 1920s, it was the leading cause of death for five to 20-year-olds in the US. Over time, with improved living conditions, socioeconomic status and antibiotics, rheumatic fever disappeared from most developed countries.

This is not true, however, for New Zealand. We still have some of the highest incidence rates worldwide with Pacific and Māori children unacceptably bearing the greatest burden.

Research published in 2021 showed that Pacific children were 80 times more likely to develop acute rheumatic fever and Māori 36 times more likely compared to non-Māori non-Pacific children. On top of that, they are also more likely to experience recurrences of rheumatic fever, more likely to develop rheumatic heart disease and more likely to die from it.

The disease starts with a strep infection, often experienced as a sore throat or skin infection. Antibiotics can get rid of the strep bug, but if not treated it can develop into rheumatic fever, when your body’s immune system mistakenly starts to attack its own tissues. This can cause inflammation in the joints and damage heart valves, which in turn can progress into rheumatic heart disease. There is no cure for rheumatic heart disease. Those with severe form of rheumatic heart disease will often need surgery to replace or repair the damaged heart valves.   

We hear examples of this too often within our Pacific communities. One mother I spoke to told me how her son would sometimes complain of a sore body and how they thought it was from playing rugby. By chance, his year level at primary school was selected for a heart screening programme, and he was diagnosed with rheumatic heart disease. Another family bravely shared their ongoing pain from losing a family member – a brother, a son, and a father – to rheumatic heart disease. He was in his 40s.

So why are rates of rheumatic fever so high in Pacific and Māori children?

It is not as simple as “parents should know to take their child to the doctor for a sore throat”, as I often hear.

Colonisation and migrant histories have structurally disadvantaged Māori and Pacific communities in New Zealand, influencing the health inequities we see today. Factors such as socio-economic deprivation, poorer housing quality and overcrowding increase one’s risk for rheumatic fever.

Access to primary health care is a hugely important factor, including cost, accessible open hours and the location of health practices, whether people have positive or negative experiences with health professionals, what treatment is prescribed and whether it is adhered to. We know that timely healthcare is critical for rheumatic fever prevention, but many families also talk about the long wait to see a GP, particularly in Covid-19 times.

Successive governments have sought to reduce rheumatic fever. In 2011, the coalition government established the ‘Rheumatic Fever Prevention Programme’. The programme included mass media campaigns to increase awareness of sore throats, healthy housing strategies and sore throat swabbing initiatives in schools to identify and treat those at risk. Although national rates decreased during the programme, this was not sustained long term and inequities for Pacific and Māori still exist.

Our research group is looking at a different approach – and whether an intervention created by the community for whom it is intended may have a more effective and long-term impact.

This project began after Pacific community groups identified rheumatic fever as a critical issue within South Auckland that needed urgent attention.

Our research team, comprised of Pasifika academics, researchers, and health professionals, aims to work with Pasifika communities in South Auckland to co-design an innovative intervention to help reduce the burden of rheumatic fever. We want to explore with those communities, what they believe would make the most difference in their community.

We only have to look over the past two years and the response to the Covid pandemic to see what Pacific communities can achieve in response to health challenges. Their innovative approaches included specific drive-thru vaccination events led by Pacific health professionals and churches, accompanied by music and dancing, flags flying high and care packages for families. The 90 percent vaccination target was achieved before many other groups.

The power of communities can be great and should be prioritised in public health approaches.

The challenge we are facing with rheumatic fever is no different. It is unacceptable that we continue to see high rates in our developed nation, particularly for Pacific and Māori.

Our hope is that we can mobilise the great knowledge, expertise, and experiences within our communities to address this “national shame” and ensure our children are able to live long and healthy lives.

Dr Siobhan Tu'akoi is a health research fellow, Pacific Health, Faculty of Medical and Health Sciences, University of Auckland.

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