While the government denies it, others clearly believe it is at least a possibility.

The uncertainty is troubling. If elimination fails or is abandoned, it would suggest we have not learnt the lessons of history, particularly when it comes to our more vulnerable populations.

In 1918, the mortality rate among Maori from the influenza pandemic was eight times that of Europeans.

The avoidable introduction of influenza to Samoa from Aotearoa resulted in the deaths of about 22% of the population.

Similar observations were seen in subsequent influenza outbreaks in Aotearoa in 1957 and 2009 for both Maori and Pasifika people. These trends are well known and documented.

And yet, despite concerns we could see the same thing happen again, there have been repeated claims that an elimination strategy cannot succeed.

Some business owners, politicians and media commentators have called for a change in approach that would see Aotearoa "learn to live with the virus".

This is premature and likely to expose vulnerable members of our communities to the disease.

Abandoning the elimination strategy while vaccine coverage rates remain low among the most vulnerable people would be reckless and irresponsible. In short, more Maori and Pasifika people would die.

Far better will be to stick to the original plan that has served the country well, lift vaccination coverage rates with more urgency, and revise the strategy when vaccination rates among Maori and Pasifika people are as high as possible - no less than 90%.

Least worst options

After 18 months of dealing with the pandemic, it's important to remember that Aotearoa's response has been based on sound science and strong political leadership.

The elimination strategy has proved effective at home and been admired internationally.

Of course, it has come with a price.

In particular, the restrictions have had a major impact on small businesses and personal incomes, student life and learning, and well-being in general.

Many families have needed additional food parcels and social support, and there are reports of an increasing incidence of family harm.

The latest Delta outbreak has also seen the longest level 4 lockdown in Auckland, with at least two further weeks at level 3, and there is no doubt many people are struggling to cope with the restrictions.

The "long tail" of infections will test everyone further.

There is no easy way to protect the most vulnerable people from the life-threatening risk of Covid-19, and the likely impact on the public health system if it were to get out of control. The alternative, however, is worse.

We know Maori and Pasifika people are most at risk of infection from Covid-19, of being hospitalised and of dying from the disease. Various studies have confirmed this, but we also must acknowledge why - entrenched socioeconomic disadvantage, overcrowded housing and higher prevalence of underlying health conditions.

More than 50% of all new cases in the current outbreak are among Pasifika people and the number of new cases among Maori is increasing. If and when the pandemic is over, the implications of these socioeconomic factors must be part of any review of the pandemic strategy.

Lowest vaccination rates, highest risk

Furthermore, the national vaccination rollout has again shown up the chronic entrenched inequities in the health system.

While the rollout is finally gaining momentum, with more and better options offered by and for Maori and Pasifika people, their comparative vaccination rates have lagged significantly.

Community leaders and health professionals have long called for Maori and Pasifika vaccination to be prioritised.

But the official rhetoric has not been matched by the reality, as evidenced by our most at-risk communities still having the lowest vaccination coverage rates in the country.

Te Ropu Whakakaupapa Uruta (the National Maori Pandemic Group) and the Pasifika Medical Association have repeatedly called for their communities to be empowered and resourced to own, lead and deliver vaccination rollouts in ways that work for their communities.

Te Ropu Whakakaupapa Uruta have also said Auckland should have remained at level 4, with the border extended to include the areas of concern in the Waikato.

As has been pointed out by those closest to those communities, however, their advice has consistently not been heeded.

The resulting delays only risk increasing the need for the kinds of lockdowns and restrictions everyone must endure until vaccination rates are higher.

There is a reason we do not hear many voices in Maori and Pasifika communities asking for an end to elimination.

Left unchecked, COVID-19 disproportionately affects minority communities and the most vulnerable.

"Living with the virus" effectively means some people dying with it.

We know who many of them would be.

• Collin Tukuitonga Associate Dean Pacific and Associate Professor of Public Health, University of Auckland.
• First published in The Conversation. Republished with permission.

Although they are making inroads into the poor COVID-19 vaccination rates, health statistics show the low uptake is part of a difficult yet familiar reality.

At present, for every one non-Maori or Pacific person who has received their first dose of the vaccine in New Zealand, just 0.6 Maori have received theirs.

The problem is the healthcare system delivering the vaccine rollout is racist. That's the opinion of Maori health professionals working in the system and the Associate Minister of Health.

Systemic change and mobilisation is needed urgently, they say.

One issue is that Maori have different health needs from Pakeha, with last September's New Zealand Medical Journal noting Maori are 50 percent more likely to die from Covid-19.

Dr Rawiri Jansen - who quit the Government's immunisation advisory group over concerns his voice was not being heard - says there is evidence that Maori aged 40 have similar health risks as Pakeha aged 65.

For equity to be achieved in the roll-out, he wants Maori and Pacific communities to be given access to the vaccine at a younger age.

"I'm disappointed in the Ministry of Health and their inability to achieve what they promised in the beginning which was equity in the vaccination programme.

"It is consistent with a health system which consistently, persistently, under-serves Maori. And we know that racism is a feature of that system."

A big problem is contacting Maori which has been more difficult than with Pakeha, Jansen says.

"Maori and Pacific people have found it much harder to engage with text messages to tell them to go to a booking app, so that hasn't worked well for us."

Henare says the low COVID-19 vaccination uptake among Maori is not for lack of trying.

"I traveled the country to continue to promote the vaccine amongst our people," he says.

"For whatever reason, our people didn't come forward to get the vaccine."

Jansen says he agrees comments made by Prof Papaarangi Reid last week that the unfolding situation is a breach of the Treaty.

His sentiments are echoed by Mr John Mutu-Grigg, chair of the Royal Australasian College of Surgeons' Maori health advisory group.

Jansen, Mutu-Grigg and Henare's concerns come at the same time as three Maori women are reporting improved health outcomes for Maori due to Maori-focused hard work.

Mata Cherrington, who leads Southland's Awarua Whanau Services, an iwi health provider says at a recent three-day clinic, she and her team of three vaccinators helped 900 people get immunised - double the number the Southern DHB predicted.

While appreciative of the of the health board and Ministry of Health's support, Cherrington says they're far removed from the reality of what is actually happening on the front lines.

Also pushing Southland Maori to take up the immunisation challenge is Tracey Wright-Tawha - chief executive of Southland-based Nga Kete Matauranga Pounamu Charitable Trust. She is setting up clinics in remote areas to ensure vaccines are available to as much of the southern rural community as possible.

In Northland, another Maori woman, Dr Maxine Ronald, is making progress with vaccination uptake. However, systematic change from the top is needed to improve Maori health outcomes, she says.

Source

• Stuff
• Otago Daily Times
• Image: Stuff