Why do some priority groups have the worst access to COVID vaccines?

New Zealand’s rollout of the COVID-19 vaccine failed Māori and Pasifika communities, as well as the elderly, according to a new studyThe study found that because the rollout relied on pre-existing health services, which were already inequitable, they did not adequately prioritise more at-risk groups.

The research was originally published in MedRxiv in August 2021, and an updated version has now been published in the New Zealand Medical Journal. 

The researchers found that on 18 August 2021, of the 447 vaccination services nationally, just 28 (6%) of them appeared to be iwi (Māori people, or nation) led or run by Māori or Pacific providers. Other providers included 212 (47%) GP clinics, 91 (20%) pharmacies, and 50 (11%) District Health Board-run dedicated vaccination centres. The geographic distribution of these services also disadvantaged several priority populations.

According to lead author Jesse Whitehead, from the University of Waikato, vaccination services could have been planned to target priority populations in appropriate ways, but instead providers relied on the usual healthcare pathways, despite their well-known lack of equity.

“It underlines that the COVID-19 vaccination roll out has failed to protect Māori and reinforces the urgent need for an independent Māori Health Authority, with a service commissioning mandate, to design and deliver effective and equitable services for Māori,” says Whitehead.

It’s particularly important because these priority groups face a higher risk should they contract the disease.

And the problem isn’t isolated to New Zealand: Australia’s vaccine rollout faced harsh criticism for its failure to vaccinate priority groups, including Indigenous communities and people with disabilities.

The study found that the people with the worst access to vaccination services in New Zealand included Māori and Pasifika, those older than 65 years, and people living in rural areas.

“These findings add to the body of research describing spatial inequities in New Zealand’s health system, across a range of health services,” says Whitehead.

The study finds that Māori and Pasifika people report racism in healthcare contexts, as well as being disproportionately affected by transport costs.

“If you don’t consciously try to design a pro-equity vaccine rollout, the consequence is that it will disadvantage our most vulnerable populations,” says Whitehead.

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