COVID-19 open the borders: Aotearoa (New Zealand)¹

1.Introduction

COVID-19, the Delta and now the Omicron variant, has had a devasting effect globally. However, Aotearoa (New Zealand), with strict Government controls and national, regional and local collaborations, has managed to stay relatively safe compared to most countries. The combination of the elimination strategy, vaccine rollout, traffic light system, booster shots and inclusion of the paediatric vaccine consistently provides statistical evidence that assistance is obtainable and making a positive impact. The community narratives described through Māori the Indigenous population of Aotearoa (New Zealand) case studies offer practical examples of the breadth and depth of support processes utilised in the Waikato District Health Board (DHB) region [2] to combat and protect them in a COVID-19 stricken environment.

2.Background

In early 2020 the COVID-19 Pandemic came to our shores in Aotearoa (New Zealand). It was introduced by worldwide travellers and returning nationals within a reasonably mobile and affluent population. The move by our Government to put in place a COVID-19 elimination strategy, immediate border controls and unprecedented alert lockdown strategies was decisive with the positive messaging Go early, Go hard, Keep to your bubble, and We are a team of 5 million [3]. These sentiments and regulations stressed the new containment in Managed Isolation Quarantine (MIQ) facilities for travellers on arrival to Aotearoa, staying home for non-essential workers, vigilance with coding check-in, wearing facial masking, continued use of hand sanitisers, and social distancing when in public places, e.g. supermarkets. This expected behaviour became the new norm [3]. These implicit restrictions meant Aotearoa (New Zealand) did not succumb to the devastating impacts of the COVID-19 Delta variant, the significant loss of life and medical trauma occurring daily and globally at the time.

Māori, the Indigenous population of Aotearoa, although not a highlighted population during COVID-19 2020, raised their concerns and produced their solutions often within their limited budgets. The content within Ko Tōku Ara Rā Aotearoa COVID-19 2020 [4] is a broad snapshot of the Māori leadership shown between March – June 2020. A history of pandemics, reliant on past experiences, the forward-looking narratives offered by Māori ensured whakapapa (bloodlines) continued and were nurtured in times of renewed threat.

Ko tōku ara rā Aotearoa COVID-19 2020 [4] profiles the breadth and depth of the spread of contributions made by several rohe (regions) of the Ao Māori (Māori world), Aotearoa (New Zealand). It acknowledges the range of responses utilised by Iwi (tribes), Hauora Māori (Māori Health Services), Community-based and Non-Governmental Organisations (NGOs) and DHB.s [1]. What is clear is that all the approaches by Māori were anchored by a sense of intergenerational manaaki (care) and the protection and continuation of whakapapa (bloodlines). Unique Māori Indigenous COVID-19 responses were their norm. The distribution in Ko tōku ara rā, Aotearoa COVID-19 2020 [4] of participating rohe (regions) and relevant services occurred across Aotearoa (New Zealand). Raukura Hauora O Tainui [5] and Te Tauihu o Te Waka [6] have shared whakapapa (bloodlines), and their contributions maintain the dedication to a shared legacy of resilience. In addition, Tai Tokerau [7] and Te Pūtahitanga o Te Waipounamu [8] acknowledge the connection and generosity during the COVID-19 2020 period of Waikato Tainui Iwi (tribe), where the Hauora service of ‘Raukura Hauora O Tainui [5] is located. Ngāti Porou Hauora [9] continued to commit to tino rangatiratanga (self-autonomy) in setting up a COVID-19 response. Ngai Tahu [10] affiliated researchers and Hauora authorities expressed a similar pandemic past to other rohe (regions) and acknowledged the reliance on their priorities, solutions, and resource committed response in the COVID-19 environment. The Ngāti Hauiti [11] narrative valued building evidence and developing Iwi (tribal) and Research capability and capacity in the COVID-19 environment. A national lived experience voice, Te Kete Pounamu [12], provided the leadership needed to focus on who we are here to serve and how that needs to be. Like other Māori responses, these approaches were centred on manaaki (care) and nurturing whakapapa (bloodlines) [4].

By the end of 2020, it was evident that the COVID-19 elimination strategy had been a success. But this success must also consider the Māori contributions to Ko tōku ara rā, Aotearoa COVID-19 2020 [4] and other initiatives known across Aotearoa (New Zealand). These celebrate Māori agility, commitment, resilience and the resolve to manaaki (care) and protect whakapapa (bloodlines). Without these developments, the situation would have been very different for Māori and Aotearoa.

3.Beyond 2020

Late 2020 saw a reasonable return to normality for Aotearoa. Unfortunately, stability did not last, and early 2021 brought evidence that a COVID-19 case had penetrated border controls and was in the Tamaki (Auckland) community, one of the largest urban metropolises in Aotearoa [3]. The virus spread amongst the Pasifika population in Tamaki, where their largest population base is located, rapidly throughout the Tamaki region. The Government wasted no time, and the COVID-19 elimination strategy was immediately reinstated, shutting down borders and protecting within and outside the Tamaki region [3].

However, despite the rules and restrictions, COVID-19 case numbers kept escalating within Tamaki, including hospitalisation entries. Fortunately, by this time, a different strategy was presented, the availability of the mRNA vaccine produced by Pfizer [3]. The Government urgently structured a vaccination rollout. The population 65 years and over was prioritised for receiving the vaccination and then scheduled staggering until the younger age groups with eligibility to 12 year olds were reached. As Aotearoa purchased more vaccine dosages, the wait time between the 1st dose and 2nd dose lessened from 6 months to 3 months. The COVID-19 Protection Framework ousted the Alert levels and lockdown, much to the local, regional and national Business and Economic advocates and Aotearoa’s pleasure [3]. The success of the later phase primarily relied on vaccination rates reaching 90 % of eligible populations.

Although viewed as a success, the vaccine rollout did not prioritise ethnicity or the commitment to Tiriti o Waitangi [13] and equity responses. Unfortunately, this lack of attention meant for the Māori population being treated no differently from their non-Māori counterparts. This decision ignored Māori known poor health status due to inadequate access to health services, as well as Māori appropriate health responses and Māori population configuration [14]. The Māori population is configured differently from non-Māori, with the most significant proportion in the under forty age group. The added difference is that Māori is whānau (family, families) orientated and find comfort when seeking help to present as whānau [4].

A 2020 COVIID-19 study surveyed 3116 Māori as part of a Māori Identity and Financial Attitudes research during the first stages of the COVID pandemic [15]. One of the questions asked was about How the COVID-19 pandemic had impacted them and their whānau. Nearly 66% of the participants answered this question, and 25% reported that the pandemic and the associated lockdown and travel bans harmed their broader relationships somehow. Issues also included being separated from whānau (family) and loved ones as painful and causing stress and sadness. Deterioration in their mental well-being due to stress related to relationships, work, finances and a decline in living standards are also identified [15].

The COVID-19 study viewed that the primary concern of many participants was to secure the safety of their people. The long term implications of the economic damage caused by COVID-19 were too early to ascertain. However, the study noted that International evidence had reported that those living at a disadvantage before and during COVID-19 would experience further challenges [15].

Another COVID-19 Aotearoa publication reported Māori to be vaccine-hesitant and did not trust a system that had been traditionally hard to access or provided insufficient information [14]. It suggested that discrimination and racism existed toward Māori, who were blamed for their poor response [14].

Some Māori Hauora providers, in not having their concerns met about the low COVID vaccine rates and uptake, appealed to the Waitangi Tribunal to ensure the Ministry of Health provided all COVID-19 data to assist Māori themselves address the pandemic [16]. A second concern was Government Tiriti obligations in a pandemic environment.

The Waitangi Tribunal ruled in favour of Māori: the Crown did not consistently engage with Māori to the fullest extent practicable in its pandemic response, a breach of the principle of partnership. It recommended better ethnicity data collection, better resourcing and support for Māori providers and communities, and a more equitable rollout for booster shots and paediatric vaccines [16].

Ko tōku ara rā, Aotearoa COVID-19 2020 [4] stated that the Ministry of Health and DHBs were slow to disaggregate the COVID-19 data, identifying Māori disadvantages. By 2021 the insistence by influential Māori Hauora practitioners for data disaggregation improved to display location, ethnicity, and age. The Ministry of Health released the vaccination data that proves Māori vaccine uptake was lower and slower to achieve than their non-Māori counterparts, disadvantaging Māori [17, 18].

In 2022 this inequity remains, with Māori being the last population to reach the 90% Government determined vaccination level. Booster shots and paediatric vaccines are on the radar. The Booster shot is expected to protect against the Delta and the newly arrived Omicron variant. Paediatric vaccines are expected to safeguard all school-aged tamariki (children). The Waitangi Tribal has responded [16]. The Government has listened and is applying action to prepare Aotearoa to act and respond during these current COVID-19 times [3].

4.Waikato region narratives

Māori are the most likely to be impacted and experience poorer outcomes if the desire for impact on their health is not considered part of the Government work plan [14]. An appropriate response must be guided by Te Tiriti o Waitangi and Māori Tikanga (protocols) based on manaakitanga (care) to identify and implement a proactive hauora (health) response to COVID-19 [16]. A respectful relationship at all levels is a meaningful partnership with the Iwi (tribal) Māori community and ensures Te Tiriti o Waitangi is honoured [19].

The Waikato region boasts the highest Māori population in Aotearoa (New Zealand), at 24.03% of the total Māori population [2, 20].

Data is based on population projections [20] for two reasons, the first being the 2013 census data are dated, and the second, the most recent census data was delayed because it was electronic and the enumeration of Māori was poor.

Waikato also has some of the most significant deprivation challenges in Aotearoa (New Zealand). There is considerable variation in socio-economic deprivation within the Waikato DHB [2] region with poverty having different impacts on rural populations than their urban counterparts [2]. The Waikato region comprises contrasting communities, with 25% living in the most deprived areas of Aotearoa (decile 10)22 [21].

The COVID-19 2021 narratives within this section of the article focus on some responses within the Waikato DHB region [2, 19], stretching from the Bombay Hills in the North to the remote rural areas in the South and the coastal border West. It consists of nine Territorial Authorities (TA) [19], the region across Aotearoa with the most TA’s [22].

This table provides the ethnic breakdown of the population within the 4 participating TA’s, then the total combined with the other 5 [19, p. 9]. The narratives document the responsiveness of Hauora (Health) Māori providers and collaborations in 4 out of 9 TA’s. These profiles include developments in 2 urban TA’s, Waikato District, Hamilton City and 2 rural areas, South Waikato and Waitomo.

5.Conclusion

The fight against COVID-19 in Aotearoa is dependent on receiving timely and exact data. However, data and the subsequent promotion and delivery of service must also reach those who can effect change and, more importantly, positively impact the health and wellbeing of its population.

Māori has shown a history of resilience and innovation against extreme adversity as prey of colonisation in Aotearoa. The COVID-19 threat is no different as Māori look to protect their whakapapa (bloodlines) through a collective response. Our remote rural and urban communities continue to rely on each other within and regionally. They are agile in collecting and analysing their own data and embrace the new learning to move into new roles and routines to enhance health and wellbeing.

Forever, we will draw from Kingii Tuheitias’ [22] tongikura (proverb): Amohia ake te ora o te iwi, ka puta ki te wheiao. To protect the wellbeing of our people is paramount.