Thursday, December 9

Covid elimination strategy cannot be abandoned while minority vaccination rates are low

By Collin Tukuitonga * from The conversation

The conversation

Analysis Auckland’s move to alert level 3 has also sparked speculation as to whether the national Covid-19 elimination strategy has failed or is even being abandoned. While the government denies it, others clearly believe it is at least a possibility.

People waiting their turn at the self-service vaccination center at The Trusts Arena, Auckland.

People waiting their turn at the self-service vaccination center at The Trusts Arena, Auckland.
Photo: RNZ / Nick Monro

The uncertainty is worrisome. If removal fails or is abandoned, it would suggest that we have not learned the lessons of history, particularly when it comes to our most vulnerable populations.

In 1918, the death rate among Maori from the influenza pandemic was eight times that of Europeans. The preventable introduction of influenza to Samoa from Aotearoa resulted in the death of approximately 22 percent of the population.

Similar observations were seen in subsequent influenza outbreaks in Aotearoa in 1957 and 2009 for both Maori and Pasifika. These trends are well known and documented.

And yet, despite concerns that we could see the same thing happen again, there have been repeated claims that an elimination strategy cannot be successful. Some businessmen, politicians and media commentators have called for a change in approach so that Aotearoa “learns to live with the virus.”

This is premature and will likely expose vulnerable members of our communities to disease. Abandoning the elimination strategy while vaccine coverage rates remain low among the most vulnerable would be reckless and irresponsible. In short, more Maori and Pasifika people would die.

Much better will it be to stick to the original plan that has served the country well, raise vaccination coverage rates more urgently, and revise the strategy when vaccination rates among Maori and Pasifika are as high as possible, not less than 90 percent. .

Fewer worse options

After 18 months of dealing with the pandemic, it is important to remember that Aotearoa’s response has been based on sound science and strong political leadership. The elimination strategy has proven effective at home and has been admired internationally.

Of course, it has come at a price. In particular, the restrictions have had a major impact on small business and personal income, student life and learning, and overall well-being. Many families have needed additional food packages and social support, and there are reports of an increasing incidence of family harm.

The latest Delta outbreak has also had the longest level 4 lockdown in Auckland, with at least two more weeks at level 3, and there is no question that many people are struggling to cope with the restrictions. The “long tail” of infections will test everyone the most.

There is no easy way to protect the most vulnerable people from the life risk of Covid-19 and the potential impact on the public health system if it gets out of control. The alternative, however, is worse.

We know that Maori and Pasifika people are at increased risk of contracting Covid-19 infection, being hospitalized, and dying from the disease. Several studies have confirmed this, but we must also recognize why: entrenched socioeconomic disadvantage, overcrowded housing, and a higher prevalence of underlying health conditions.

More than 50 percent of all new cases in the current outbreak are among the Pasifika people, and the number of new cases among Maori is increasing. When the pandemic ends, the implications of these socioeconomic factors should be part of any review of the pandemic strategy.

Lower vaccination rates, higher risk

Furthermore, the nationwide roll-out of vaccination has once again exposed long-standing inequalities in the health system. While the rollout is finally gaining momentum, with more and better options offered by and for Maori and Pasifika, their comparative vaccination rates have lagged significantly.

Community leaders and health professionals have long called for priority to be given to vaccination against Maori and Pasifika. But the official rhetoric has not been matched by reality, as evidenced by our highest-risk communities that still have the lowest vaccination coverage rates in the country.

Te Rōpū Whakakaupapa Urutā (the National Maori Pandemic Group) and the Pasifika Medical Association have repeatedly called for their communities to be empowered and have the resources to own, lead and deliver vaccination implementations in ways that work for their communities.

Te Rōpū Whakakaupapa Urutā has also said that Auckland should have remained at level 4, with the border extended to include the areas of concern in Waikato.

However, as those closest to these communities have pointed out, their advice has not been systematically heeded. The resulting delays only run the risk of increasing the need for the kinds of closures and restrictions everyone must endure until vaccination rates are higher.

There is a reason we do not hear many voices in the Maori and Pasifika communities calling for an end to the elimination. Left unchecked, Covid-19 disproportionately affects minority communities and the most vulnerable. “Living with the virus” does indeed mean that some people die with it. We know who many of them would be.

*Collin Tukuitonga is Associate Dean of the Pacific and Associate Professor of Public Health at the University of Auckland.

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