Dr Rawiri Taonui | Auckland border risk threatens Māori over holiday

By Contributor

Researcher Dr Rawiri Taonui says Aotearoa should watch out for several pocket-sized Covid-19 outbreaks in holiday spots before the New Year, and Maori will be over 50% of cases by mid-January. He also argues Māori are sitting at the back of the room, “pieces of silver in well-intended inept catch-up budgets”.

Māori are 8.1 times more likely to get infected with Delta, 6.5 times more likely to be hospitalised and 5.3 times more likely to die than non-Māori non-Pasifika. Māori are 45.8% of all cases, 42.3% of active cases, 38.9% of hospitalisations, and 47.8% of deaths.

These are the highest numbers for Māori during a pandemic-epidemic event since the 1930s typhoid, tuberculosis, and measles epidemics. The opening of the Auckland border threatens to exploit lower Māori vaccination rates in a multi-location outbreak over the holiday period that could precipitate something significantly larger.

Traffic light system

On  October 22, Prime Minister Jacinda Ardern announced the introduction of the new Covid-19 Protection Framework. Better known as the Traffic light system, the new system would replace the Alert Level Framework and allow fully vaccinated people and businesses to continue their day-to-day activities at green, orange and red levels with limitations on numbers at events, gatherings, and businesses depending on the size and breadth of outbreaks and their impact on the health system.

The new system came into effect on December 3. Northland, Auckland, Taupō and Rotorua Lakes Districts, Kawerau, Whakatane, Ōpōtiki, Gisborne, Wairoa, Rangitikei, Whanganui and Ruapehu Districts began at Red. The rest of the North Island and the South Island started at Orange.

Auckland border

On November 17, the Prime Minister announced the Auckland border would re-open between December 15 and January 17. Travellers would require a vaccine pass showing they were fully vaccinated, or evidence of a negative Covid-19 test taken within 72-hours before departing the city.

Current situation

The government will be confident it has successfully managed the transition to the Traffic Light System and opening of the Auckland border. The Ministry of Health Service User index (HSU) says Aotearoa reached 90% full vaccination the day after the border opened. New cases have steadily declined over the last four weeks.

The government has prepared for an emergency by investing $1 billion to boost testing, contact tracing and case investigation; $300 million buying new therapeutic medicines; $204 million to support social services delivery and locally led initiatives supporting those isolating at home; $644 million to strengthen health and ICU delivery, $120 million in two tranches to support Māori vaccination efforts and Māori and iwi-led community protection initiatives.

Travel risks

Government measures appear comprehensive but may not be enough. The vaccine pass and negative test travel protocols by air travel, train, bus, and crossing Cook Strait are robust. Travellers must produce their passes or negative tests before booking or boarding.

However, apart from the light border into Northland, “random checks” by Police of road travel and light $1,000 fines for breaches are distinct weaknesses. Fake vaccine passes are now widely available on the dark web.

Unvaccinated children

Exempt from the Vaccine Pass and negative test requirements, and not eligible for the vaccination until 17 January, children under 12-years-old, who account for 24% of all Delta cases, present a significant risk of carrying the virus into low vaccinated regions.

A scenario emerges whereby adults who willingly comply with the travel requirements unwittingly arrive at holiday destinations with kids who spread the virus. Professor Michael Baker from Otago University has previously called for under 12-year-olds to undergo rapid antigen testing before leaving Auckland. Because this fell on deaf ears in government, this might have grave consequences.

Whole-of-population approach

The Ministry of Health and government are ebullient when each DHB passes the 90% full vaccination threshold. Doing so creates a false sense of security.

The last hard barrier under the old Alert Level system, the Auckland border, is gone (at least to January 17). We need now shift our thinking from ‘eligible vaccination percentages’ to a ‘whole of population vaccination approach’ if we want to accurately assess the risk between vaccination protection and unvaccinated vulnerability.

As of midday, December 22, 3.98 million New Zealanders or 94.6% of the HSU eligible population of 4.21 million people had received at least one vaccination. While impressive, that number equates to a significantly lower 77.6% of the current New Zealand population of 5.13 million.

This means there are 1.15 million New Zealanders or 22.4% of the population, including unvaccinated over-12yr-olds and vaccine ineligible under-11yr-olds who are at immediate risk of carrying and transmitting the virus. If we factor in that the partially vaccinated are 19.7% of Delta cases and fully vaccinated 16.9%, then the pool of people potentially able to carry Delta rises anywhere over 1.3 million.

Risk to Māori

Delta cases have surged in Māori communities whenever the government prematurely eases restrictions for the convenience of Pākehā voters.

Māori cases surged after Auckland went to Level 3 on September 22. From the lowest percentage of all ethnicities on September 1, by the end of the month, Māori had passed the combined total of Pākehā, Asian and MELAA (Middle Eastern, Latin American, and African people).

After Auckland went to Alert Level 3 Step 2 and the Waikato moved to Alert Level 2 in early November, Māori cases jumped to an average of more than 100 per day for 15 days.

And despite currently declining daily Māori numbers, the resulting high number of active Māori cases has seen Māori become 49.6% of all new hospitalisations since November 1, and 54.5% of deaths since November 20, several of whom are among the six youngest deaths since Covid-19 first arrived in New Zealand.

Opening the Auckland border for mum and dad Pākehā holidaymakers is the next major risk to Māori.

Māori vaccinations

Māori are vulnerable because our one dose and full vaccination numbers are respectively 10.7% and 15.1% behind the national total.

Recent effort has closed the gap by a large margin. Providers have vaccinated more than 90,000 Māori since 1 November; the 22.6% increase higher than all other ethnicities combined. This includes a massive 36.6% increase among the previously lagging 12-to-34-years cohort. Nevertheless, the gap will not close in time should there be a major event during the holidays. Here is why.

The Waitangi Tribunal Haumaru Report found that the government vaccination rollout disadvantaged Māori by failing to take expert medical advice that equated the risk of 45-year old Māori with 70-year- old Pākehā. The age-staged rollout privileged 600,000 Pākehā aged over 65yrs while pushing the younger but more at-risk Māori population to the back of the queue.

The Ministry of Health refusal to release key vaccination data to Māori on facile reasoning rather than evidence-based facts, such as Māori might not reach the 90% target, therefore, withholding the data that will assist them to do so, sabotaged Māori health providers. Consciously or unconsciously, the deliberate intent was to maintain ministry control of Māori health.

These factors created a void into which white supremacists, tithe-enriched self-anointed prophets, and an array of weird conspiracists poured misinformation exploiting Māori mistrust of the government that further weakened the vaccination effort.

To its credit, the government has provided substantial funding to support the Māori vaccination effort. However, what the tribunal missed is that a government default preference for catch-up funding does not bridge poor strategy in an emergency.

Māori DHB vulnerability

Much has been made of a potential Māori vaccination undercount. The 2020 Ministry of Health vaccination HSU index counts 570,000 Māori aged 12 years and older. The December 2020 12 year-plus Māori population is 644,000. This gives a potential maximum undercount of 74,000.

The ministry tried to convince the Waitangi Tribunal that many Māori might be counted under other ethnicities. Some might, because census type data allows multiple cultural identities while the health system only allows just one. However, that number will not be significant because, in the case of multiple cultural identifications, the Health system defaults to prioritising the Māori identity.

Moreover, figures from the departments of Physics and Statistics at the University of Auckland show that the HSU total for Māori across all ages is over 88,000 short of the actual Māori population and more than 106,000 lower than the total 2020 New Zealand population. A wider assessment of the HSU index shows that there are also undercounts for the Pacific and Asian communities. In the case of the latter, the HSU eligible Asian population is 598,000 but over 628,000 are vaccinated. And, if we apply the current 2021 NZ Statistics calculation of the Māori population, the potential Māori undercount increases to 110,000. A Māori undercount is clear and apparent.

Applying even a conservative Māori undercount of about 45,000, shows that no DHB has reached the 90% vaccination threshold for Māori. Thirteen DHBs have passed 80% for first vaccinations and just three (Capital Coast, Auckland, and Canterbury) have passed 80% full Māori vaccination.

Seven DHBs remain below 80% for single-dose vaccination, including three under 70% for full vaccination. These include our four largest Māori DHBs, the poorest and more rural DHBs with weak health infrastructure, including Waikato, Manukau, Northland, Bay of Plenty, the Lakes, Te Tai Rāwhiti and Whanganui. Given the popularity of Northland, the Coromandel and the Bay of Plenty for Auckland holidaymakers, this is where the risk lies.

Omicron

Managed isolation and quarantine has seen 28 cases of the new Omicron variant. The research has yet to catch up with the spread of this variant. What we do know is Omicron is more infectious than Delta with cases in many parts of the world doubling every two days. There is also emerging evidence Omicron can evade antibodies in those who have recovered from previous bouts of Covid-19, some monoclonal anti-body treatments appear less effective, and that single dose and double dose Pfizer vaccinations are less effective.

There are signs that Omicron might cause less severe sickness and sickness is shorter. The current evidence does not show whether Omicron causes higher fatalities. The risk remains that even at a lower rate of fatality, Omicron by sheer numbers could overwhelm vulnerable communities and health systems.

Some researchers believe Omicron is a recombinant of an early Alpha strain and Delta. There are fears Omicron and Delta could recombine into a new variant of significant lethality.

Last year, National called on the government to construct a dedicated isolation and quarantine facility. Professor Nick Wilson from Otago University made the same call earlier this year, citing successful examples in Victoria and Queensland. The continued reliance on permeable hotel facilities rather than implementing this recommendation in a world with ever more dangerous Covid-19 variants is a significant failure. This is the dark cloud on the horizon of the New Year.

The holiday period

The probability is high that we will see several pocket-sized outbreaks in holiday spots between Christmas Day and the New Year. Our relatively high vaccination rates and restrictions on inside gatherings will initially limit the spread but, if Delta reaches under-vaccinated local Māori communities, the probability is also high that Māori will be over 50%-plus of total cases, active cases, hospitalisations, and deaths by mid-January.

Prime Minister Jacinda Ardern is talking less often about the “Team of Five Million.” This is because Māori are not prioritised by need and vulnerability. We sit at the back of the room, pieces of silver in well-intended inept catch-up budgets.

This is not entirely the government’s fault. The last two years have shown that Covid-19 and Māori vulnerabilities are little more than a political football for the opposition parties of Act and National. This is not who we should be in a pandemic emergency.

Kia noho haumaru, stay safe.

Dr Rawiri Taonui