Relying on inequitable, status-quo health services meant the Covid-19 vaccine roll-out “failed” Māori and at-risk communities, researchers have found.
A study published in today’s New Zealand Medical Journal found that as at mid-August, of the 447 vaccination services nationally, just 28 – or 6 per cent – appeared to be iwi led or run by Māori or Pacific providers.
Other providers included 212 (47 per cent) GP clinics, 91 (20 per cent) pharmacies, and 50 (11 per cent) DHB-run dedicated vaccination centres.
The geographic distribution of these services also disadvantaged several priority populations.
The study’s lead author Dr Jesse Whitehead, from the University of Waikato, said vaccination services could have been planned to target priority populations, but the research showed authorities relied on health services regardless of their already recognised inequitable distribution and delivery.
“It reinforces the urgent need for an independent Māori Health Authority, with a service-commissioning mandate, to design and deliver effective and equitable services for Māori.”
The study – initially published last year ahead of peer review – showed Māori and Pacific people, over 65-year-olds, and rural residents had the worst access to vaccination services.
Ongoing monitoring suggested that although the availability of services did increase in response to the Delta outbreak, accessibility has not substantially improved in rural areas.
“These findings add to the body of research describing spatial inequities in New Zealand’s health system, across a range of health services.”
Modelling by Te Pūnaha Matatini researchers has indicated Māori were two and a half times more likely to need hospital care for Covid-19 than non-Māori – while the risk for Pacific people was three times higher.
The new study said Māori and Pacific people already report experiencing racism from healthcare providers and are disproportionately affected by cost and transport as barriers to accessing GP services.
“To ensure an equitable and universal vaccine roll-out giving priority populations appropriately higher access to vaccination services and opportunities for vaccination is key,” the study stated.
District health boards providing high levels of access across their region had more equitable vaccination uptake.
Whitehead said an earlier study concluded that if health services and facilities were used without well-designed and supported outreach services, then access to vaccination was likely to be inequitable.
He said his latest study had proven that, and believed the roll-out showed there needs to be a better national strategy.
“If you don’t consciously try to design a pro-equity vaccine roll-out, the consequence is that it will disadvantage our most vulnerable populations,” Whitehead said.
“Individual DHBs are all going to have different strategies and may not have the resources to do the spatial planning.
“That’s why we suggest a Māori Health Authority has the potential to design and deliver effective and equitable health services.”
Whitehead says it would become more important as New Zealand moved to vaccinating 5-11-year-olds and continued with Covid-19 booster shots.
As at yesterday, 87.8 per cent of Māori teens and adults had received two doses of the vaccine, while 59.8 per cent had been boosted.
Respectively, those figures compared with 96.2 and 59.5 per cent for Pacific people, and 95.3 and 72.6 per cent for all ethnicities.
The disparity was also seen in the child vaccine roll-out, with just a third of Māori tamariki having received their first dose, compared with the national average of 52.8 per cent.
Last month, the Government announced it would boost support available to Māori and Pacific communities as they continued to face the Omicron outbreak.
Using the $140 million, 160 Māori and Pacific health providers would together support Māori and Pacific households throughout the country.
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