Exclusive footage of inside Auckland City Hospital’s Covid ward. Video / Supplied
In the race to vaccinate Kiwis, health officials are sharpening the focus on communities they've yet to reach with the jab.
While 71 per cent of eligible Kiwis have been fully vaccinated through largely consistent outreach methods, the necessity to achieve 90 per cent across all 20 district health boards will require a more innovative and customised approach.
This is particularly relevant for populations with low vaccination levels, often caused by factors including limited access to vaccination centres or vaccine hesitancy.
The NZ Herald has highlighted four populations for whom vaccination rates can be lifted and explores how that might be achieved.
Vaccination levels in Māori have persistently trailed the national average but there is particular concern regarding levels among younger Māori.
As of Friday, only a tick over half of Māori aged 20-29 had received their first dose - a definitive outlier considering nearly all age, ethnic and gender demographics have achieved 70 per cent or higher.
It's important to consider the rollout's priority scheme meant young people were among the last to receive the vaccine. Māori, along with Pasifika, are known to have larger populations of young people than Pākehā as well.
However, two South Auckland rangatahi - Katarina Mahutoto and Jennifer Lewis - believe more engagement with younger generations is required to boost vaccination across the country.
Rangatahi Jennifer Lewis and Katarina Mahutoto believe engagement with youth is the key to boost vaccination. Photo / Dean Purcell
The 20-year-olds, both members of the Manurewa Youth Council but expressing their personal views, have had distinctly different vaccination journeys.
Lewis (Ngāpuhi, Ngāti Whātua) was fully vaccinated in June, alongside her grandmother, in an effort to protect her whānau - much of whom were immunocompromised.
"I wasn't so worried about catching Covid myself, my biggest fear was becoming a carrier and possibly bringing it home to them."
Mahutoto (Tainui, Te Rarawa) received her first dose four weeks ago and has chosen to observe the six-week gap formerly advised by the Government between jabs before it was shortened to the original three-week gap.
Mahutoto hasn't had a pleasant history with vaccinations - her reactions hadn't hospitalised her but they certainly contributed to her reluctance in getting the Pfizer vaccine.
Nevertheless, she braved the needle when she considered the safety of her whānau and her desire to travel to see friends.
"I wasn't quite worried until my Mum told me, 'What about your nephew, what about me?'."
Twenty-year-old Manurewa Youth Council members Jennifer Lewis (left) and Katarina Mahutoto are passionate about advocating for young people. Photo / Dean Purcell
The pair have heard mixed reports from friends - some eager to get the vaccine and enjoy the fruits of youth, others resistant against what's perceived as mandated vaccination.
Both Lewis and Mahutoto agree ongoing kōrero with young Māori and involving them in the process will engage those yet to get the jab.
"A lot of young people and especially a lot of young Māori people are left out of discussions, which will affect them most of all," Lewis said.
"The best thing we can do is to talk to young people."
Mahutoto highlighted the importance of tikanga during vaccination, employing karakia and pōwhiri to create a comfortable and recognisable environment for Māori.
Above all, the pair encouraged any unvaccinated young Māori to seek counsel from a trusted source and choose their vaccination site wisely.
"Whether it's a kuia, kaumātua, brother, sister, friend, elder, [talk to] somebody that you feel comfortable with and feel safe voicing your concerns," Lewis said.
"Shop around for a place that feels comfortable for you, whether that's a marae or a community vaccination clinic because it's about making the experience as comfortable as possible."
A Ministry of Health spokesperson agreed rangatahi must be empowered if vaccination levels were to increase.
"We need to allow young Māori to design and build a campaign that works for them and their peers."
Last week, it was confirmed $120 million had been allocated to boosting Māori vaccination rates, through supporting iwi-led initiatives.
For more on the Manurewa Youth Council, visit its Facebook via the same name and Instagram at @Manurewayouthcouncil.
Isolated and rural communities
A study released last month attests structural inequities within the healthcare system has led to poorer access to vaccination clinics for New Zealand's rural communities.
Considering some rural populations are among the most at-risk to the virus, the importance of vaccinating these communities at an even rate with urban dwellers couldn't be understated.
However, as University of Auckland associate dean of rural health Dr Kyle Eggleton references, access was an issue for rural communities early in the rollout.
Dr Kyle Eggleton (left) assesses Pataua South resident Ashley Wihongi. Photo / Tania Whyte
"The rollout has been constrained because of the inability initially for providers to get out into the community and deliver vaccines close to where [people live]," he said.
"Historically, vaccination clinics have been run at times and locations that don't suit a large part of the rural workforce."
Fortunately, this approach was changing following pressure from rural providers.
"Many rural providers and rural communities are starting to take matters into their own hands and this probably should have been something that was considered very early on."
Eggleton, who has treated some of the country's most rural populations through his former GP work with Northland provider Ki A Ora Ngātiwai, said innovative methods carried out by providers were essential to boost engagement.
Mobile vaccination clinics, like the Shot Cuzz bus in Auckland, are a key tool in the vaccination effort. Photo / Sylvie Whinray
In Taranaki - where the local DHB has copped flak for its lack of engagement with community providers - rural vaccination clinics had been timed to suit the end of calving and did not require a booking, allowing local farmers to attend when convenient.
The Ministry of Health spokesperson said work was under way to analyse vaccination levels across rural and urban areas, which will inform how equity of access can be established.
People experiencing homelessness
Like many communities in Auckland, Covid-19 has hit those sleeping on the streets and in community housing hard.
While fears of a mass outbreak among these populations were commonplace earlier this month, the virus still posed a significant risk to those often battling other hardships in life.
Community Housing Aotearoa chief executive Vic Crockford said lack of trust was a constant barrier in vaccinating people experiencing homelessness - something not helped by "uneven" access to services across the country.
"In some cases, bureaucracy has been a blocker," Crockford says.
"Vaccinations are fundamentally about trust and people tend to trust community organisations more because they know who they're dealing with."
Community Housing Aotearoa chief executive Vic Crockford with her vaccination card. Photo / Supplied
Fortunately, some areas serviced the homeless and those in community housing well, enabling providers like Emerge Aotearoa to run multiple vaccination events, introducing whānau to the concept before they consent to the jab during return visits.
It was through this kaupapa that providers had had the most success.
"Keep coming back and making people feel safe," Crockford said.
"It's not one and done, it is an ongoing conversation to build trust."
Auckland City Missioner Helen Robinson said that trust had been essential in administering some 800 vaccines since August.
Staff from South Seas Healthcare working at the vaccination Centre in Ōtara. Photo / Dean Purcell
Mobile vaccination had also become a critical tool in offering vaccination to people experiencing homelessness, indicating various means of access were necessary.
"There is a pretty good baseline understanding that health services is not a one-size fits all."
In Auckland, the Northern Region Health Coordination Centre had been working with Rough Sleepers Steering Group to design a vaccination programme for people experiencing homelessness.
The programme covers clients who are homeless without shelter or in emergency, transitional and social housing. About 60-80 percent of people homeless or living in "vulnerable housing" are Māori or Pasifika.
Vaccine-hesitant
According to regular surveys published by the Ministry of Health, overall vaccination uptake was estimated to reach 86 per cent as at August, up from 79 per cent in July.
A persistent 10 per cent still claim they are "definitely not" getting the vaccine, in addition to those sitting on the fence.
With an aim to hit 90 per cent across the country, University of Auckland research fellow Kate Hannah - who analyses Covid-19 disinformation - said it wasn't impossible but will require patience with those yet to make a decision.
"That pool of people who are strongly vaccine resistant is actually quite small, but they are very loudly shouting at the other people."
The Disinformation Project Lead and University of Auckland research fellow Kate Hannah. Photo / Supplied
Hannah accepts she was once vaccine-hesitant during the birth of her children, and noted it was quite common - especially for minority populations.
"I know that for me that came from a feeling that many women and other groups have around hesitancy inside a health system that doesn't always feel like your whole person is looked after.
"It's quite confronting to be told, 'You just have to do it', so the advice for engagement with that group is to really remember where they're coming form, they're coming from the same values you have, they're just expressing it in a different way."
Ensuring access to vaccination centres across the country has been a complicated task. Photo / Alex Burton
As vaccination would soon become the key to unlocking normal life, Hannah said it was important to create an environment to enable especially young people to change their position on the vaccine.
"We need to make it easy for people to go, 'Actually I've changed my mind', and that change might be because they want to go to Rhythm and Vines or whatever."
The Ministry spokesperson said concerns about the vaccine were normal and encouraged people to seek out advice from trusted medical professionals.
"It's okay to want to know more about the vaccine and we know that Māori providers in particular are doing a great job of talking to those who are hesitant and pointing whānau to where they can access reliable sources of information."
