Low vaccine rates a symptom of health system failures and incomplete data

Friday, 29 October 2021

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The Government’s decision not to combine population datasets has made it difficult to seek out Māori who are yet to be vaccinated, a Māori health provider says.

Throughout the vaccine roll-out, the Ministry of Health has used the National Health User index to track vaccination rates, but the data lacks integrity, Te Hau Ora o Ngāpuhi chief executive Te Rōpū Poa says.

The dataset only records people who have used the health system in the past year, and with whānau from her rohe in Te Tai Tokerau struggling with accessibility, many have not been counted.

“The DHB data was the most out of date, like the census data, it’s so out of date so there’s no integrity.”

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Te Rōpū Poa, chief executive of Te Hau Ora o Ngāpuhi, said the Government needs to use integrated datasets to capture Māori in the roll-out.

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It’s a problem across the motu, Poa said.

Te Hau Ora o Ngāpuhi ran vaccination clinics over Labour Weekend to try to reach those struggling to access the vaccine.

Due to financial constraints, location, isolation, and a lack of trust in health professionals, some whānau are not registered to a general practice which has left them out of the count towards the overall vaccination rates for Māori, Poa said.

“You can almost guarantee most people wouldn't be in primary healthcare unless they were really unwell.

“My concern is that we’re underestimating the amount of work that needs to be done, and we’re not prioritising where we need vaccinations, testing and engaging with our communities.”

The Ministry of Health has admitted many Māori aren’t registered in the HSU index, but was yet to respond to questions about whether other avenues were being used to find those who weren’t recorded.

A ministry spokesman said Māori hauora providers had been working hard in clinics and mobile outreach services since the vaccine programme started in February, but as the nation works towards a 90 per cent vaccination rate, more support was needed.

Te Hau Ora o Ngāpuhi was on the frontline of the Covid-19 response, but it had struggled to access the data needed to find those who were slipping through the cracks.

Data researcher Dr Rawiri Taonui says the Ministry of Health’s use of data has led to gaps for Māori in the vaccine roll-out.

To combat this, it used its own records as well as data from the district health board, general practices, Whānau Ora and iwi membership to pinpoint where resourcing needed to be allocated.

Poa said they were trying everything from heat mapping, door knocking and mobile vaccination vans to ensure Māori were being included in the race to be vaccinated.

However, resourcing was at the whim of the DHB, Poa said.

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“It’s worrying because we are beholden to a system that is not accountable.”

Indigenous data researcher Dr Rawiri Taonui has been vocal about his concerns Māori were being left behind in the roll-out, which include ignoring unrecorded whānau.

The HSU index undercounts about 4 per cent of the total population, adding up to more than 200,000 people, Taonui said.

Most of those undercounted are Māori and Pasifika, Taonui said, with about 7 per cent of the total Māori population, up to 40,000 people, being missed in the Government’s tracking, a figure he said was conservative.

Adjusting for this undercount, 65 per cent of Māori have had at least one dose of the vaccine and 46.1 per cent were double vaccinated on October 27, Taonui said.

“Māori remain well behind the rest of the population.”

However, the Ministry of Health recorded 70 per cent of Māori had received at least one dose of the vaccine and 50 per cent had received two.

Māori health researcher Dr Donna Cormack says the Government’s roll-out has led to the inequities in Māori vaccination rates today.

Taonui said the consequence of using the HSU index rather than capturing the true number of Māori eligible for the vaccine meant, when the nation reached 90 per cent, Māori in areas of deprivation or struggling to access health care will suffer.

“We will be in two worlds, where Pākehā are using vaccine certificates and Māori living in deprivation and intergenerational homes will be dealing with whānau with Covid.

“This is not our fault. The vaccine roll-out was discriminatory and poorly led by the Ministry of Health and district health boards.

“However, we do now have the facts in front of us, and the clear message is to get vaccinated now, not later.”

Māori health researcher Dr Donna Cormack said the government received advice about the roll-out and building in equity by opening up vaccinations for all Māori, but chose to ignore it.

‘We can’t say everyone had an equal chance from the start because they didn’t.

“We can’t lose sight that there are a whole lot of structural and systemic barriers in place,” Cormack said. “They’ve created this situation.”

She agreed that there were issues with the HSU being used to count ethnicity, and said those who were being missed out were likely to be young, male, Māori and Pasifika.

“Because of the decisions the Ministry of Health has made around ethnicity data, the rates are likely to be underestimated for Māori.”

If there was a move to reopen Auckland into the traffic light system, Māori would be at higher risk if their vaccination rates didn’t exceed Pākehā rates because of the undercount, Cormack said.

“It’s really important that we’re building up vaccinations for all ethnic groups, not just the overall population.”

The Ministry of Health was approached for further comment.