The red flag was raised months ago over an inappropriate Covid-19 pamphlet that went out via Bay of Plenty District Health Board, RNZ understands.
Bay of Plenty health staff have apologised and withdrawn the material, which encouraged people to "give Covid-19 the boot" and has been described by the race relations commissioner as "appalling".
The images, which included Bay of Plenty District Health Board branding, first came to Labour MP Tamati Coffey's attention yesterday.
"The Covid virus had a mataora - a full face moko - that concerned me and the fact that he was being held by one of his tentacles and being booted physically by what looked like an old farmer wearing his Red Bands [gumboots] made me think this was really not good.
"The second image had what looked like a giant Covid virus with a full-face moko, then being stood on by somebody who looked like they were in scrubs inserting something into the top of the virus, again just gave me real cause for concern."
The mataora is tapu and Coffey said it should never be used on Covid-19 virus imagery nor kicked or stood on.
"When I saw those images it reminded me of the old practice of beheading Māori chiefs and actually taking those carved heads overseas as kind of conquests - so all of that imagery and all of those stories popped up in my head at the time."
Coffey said he quickly alerted the chair of the district health board, Sharon Shea, who was equally baffled by the images.
She assured him they would be pulled immediately, and today in a statement said the design would not be used again.
Shea said it was created by a Māori artist and had gone through an approval process.
"I saw the design last night. I was offended by it. It was wrong," she said in a statement.
"On this occasion, we have failed our Māori community, and we apologise. It's not good enough."
The statement included an apology from the Bay of Plenty DHB and Te Rūnanga Hauora Māori o Te Moana a Toi for the design.
Te Rūnanga Hauora Māori o Te Moana a Toi chair Linda Steel said she fully backed the DHB chair and chief executive's decision in removing the "totally offensive material" and starting a review.
But RNZ understands the pamphlet was passed months ago to a local Māori Health provider that is involved in the vaccine rollout.
They advised it was inappropriate - and even redesigned the whole pamphlet to remove the mataora from the cartoon image - but somehow it made its way back in.
Coffey said he was also aware red flags were raised.
"I'm not sure what the processes looked like but I do know that there is a rūnanga that is consulted on Māori issues. I do know that one person from Ngāti Awa that was part of that rūnanga flagged concerns - I congratulate them on that, but again it slipped through processes."
He said there was an appalling lack of tact and judgment by whoever made the calls to greenlight the pamphlet and he was interested in seeing what a review of those processes found.
Race Relations Commissioner Meng Foon said those involved in the approval process should have been aware of the sensitivity.
"It's interesting that this time it wasn't just anybody - that it was actually a person of Māori descent that actually did this, so regardless of who it's still a degrading, appalling incident."
In a statement, Te Paati Māori co-leader Rawiri Waititi said the health system had historically failed Māori and putting mataora on a cartoon virus was not only offensive, but could reinforce people's distrust in the health system.
"As a person with a mataora, I think the use of it on a virus is completely inappropriate.
"A mataora is symbolic of life - tikanga, whakapapa, where you come from, and especially your tīpuna. They are about peace, contribution, oranga and the revitalisation of our culture.
"The fact that the sacredness of mataora is being associated with a virus that is killing millions of people is an absolute disgrace."
The DHB was reviewing its processes to ensure it had the appropriate protocols and approval processes in place.