A world-class 2021 Covid response, undone by inequity

As 2021 passes into history, our response to the Covid-19 pandemic has continued to be exemplary by global terms.

The elimination strategy was based on science with strong political leadership and impressive community adherence which resulted in low per capita case numbers and death rates. The Government is to be commended for its leadership and for prioritising protection of public health over economic objectives.

The response was widely recognised globally despite the constant criticisms of some stakeholders here at home. Our response remains one of the best in the world even with a restless and tired public, especially in Auckland.

Since then, our national response has become somewhat disjointed and fractured, and has exposed our most vulnerable members to Covid-19 more than necessary. Several studies have shown that Māori and Pacific people are most at risk of infection, hospitalisation and death from Covid-19. Thankfully, deaths from Covid-19 remain low in Aotearoa New Zealand (with due acknowledgement to whānau who have lost a family member).

Business and political pressure on our political leaders has resulted in a precipitate, premature and ill-considered move away from the elimination strategy. The end of year focus on suppression in Auckland and elimination elsewhere has resulted in more than 90 percent of new cases being reported among Māori and Pacific people.

We had encouraged our leaders to maintain the elimination strategy until vaccination rates among these communities were high enough to reduce the risk of continuing spread in these communities. Several submissions were made to prioritise Maori and Pacific people for vaccination, but policy rhetoric was not matched by actual delivery of the vaccine. Racists had a field day blaming the victims and criticised Māori and Pacific whanau for putting everyone at risk. Māori continued to have the lowest vaccination rates in the country.

It is one of our most significant and avoidable policy failures. This is unfortunate because we have many experiences that would have informed our national response such as the successful Meningococcal B vaccination programme.

Slow uptake of the Covid-19 vaccine was also partly due to a centralised rollout plan that relied heavily on conventional delivery arrangements with little involvement by Māori and Pacific leaders and health care providers. Challenges with the supply of vaccine was also partly responsible.

Vaccination rates for Māori and Pacific people have since improved with better engagement, leadership and involvement by community leaders and health care providers. Had these communities and their health providers been trusted, fully engaged, empowered and resourced early in the rollout, we would have been in a different situation at this time.

Our national response is somewhat predictable where those most at risk receive the least level of service. The response highlights yet again the underlying socioeconomic inequities in our nation where Māori and Pacific people reside predominantly in neighbourhoods with the most severe socioeconomic disadvantage. Socioeconomic disadvantage and substandard housing are important determinants of Covid-19 risk of infection compounded by higher prevalence of co-morbidities such as obesity and diabetes.

There are many lessons to be learnt from our response to the Covid-19 pandemic. Many of the lessons are not new but we failed to learn from them. A key lesson is the need to seriously address socioeconomic inequities especially income distribution and housing in our nation. It is also clear that conventional health services (including vaccination programmes) have severe limitations and innovative models are needed.

Active engagement of Māori and Pacific leaders and providers is a critical part of that approach. Reform of our health and disability system is a golden opportunity to revise our design and delivery of health services.