Childhood vaccination levels were already worryingly low, and then Covid hit. Kirsty Johnson speaks to healthcare workers facing an uphill battle to get children immunised.

This story was first published on Stuff.

On the sidelines of a women’s rugby game at Tauranga domain, two healthcare workers huddle in blue ponchos under a white tent. It is pelting with rain, and freezing cold. But the staff from Poutiri Wellness Centre are on a mission: to prevent a looming healthcare crisis.

This time around, it’s not Covid-19, but the spectre of the childhood diseases of measles and whooping cough that’s driving kaupapa Māori health services across Aotearoa to take their clinics into communities, working wherever they can.

In the Bay of Plenty this month nurses have been on marae, in bowling alleys, even on the ferry to Matakana Island. In Tauranga South last month, a vaccination hub named Rangiora – funded by a partnership between government and iwi – opened in a mall.

“We’re not here by default. We’ve chosen to be at a location of a mall site so that we can be a part of everybody’s day to day, said Ngāti Ranginui chief executive office Mel Tata at its opening. “The Warehouse, Countdown, Rangiora.”

Even before the pandemic hit, New Zealand’s childhood immunisation rates were dire. In some areas, they’re now the lowest they’ve been in 10 years. The ministry has a childhood vaccination target of 95%, the coverage needed to ensure herd immunity. But the national immunisation rate for six-month babies is around 75%. And for Māori babies that rate is only 55%.

Take-up rates are worst in remote areas like the western Bay of Plenty, where poverty, historic mistrust of the health system among Māori, and rampant misinformation have combined to create a huge challenge for clinicians.

“For us it’s almost a perfect storm,” said Te Puke’s Poutiri Wellness Centre CEO Kirsty Maxwell-Crawford.

“In the last two years, parents have struggled to access primary care, people are swamped by Covid, they have immunisation fatigue… and in the middle of that they’re trying to put food on the table and keep the power on.”

Babies are supposed to get whooping cough jabs at six weeks, three months and five months, while the two MMR doses for measles, mumps and rubella are given at 12 months and 15 months.

But Maxwell-Crawford said when people are so busy, or don’t have secure housing, or access to a car, those targets have little meaning to people’s lives.

“We realise that when families are stretched, keeping to a vaccination schedule is not a priority.”

Vaccine hesitancy was also rife in remote communities, and had become noticeably worse since vaccine mandates were introduced amid the Covid-19 outbreak.

Each week, Maxwell-Crawford and her team visit schools, to talk to leaders about what Poutiri can offer, ranging from clinical support, to social services.

Previously, this health check-ups would have included a vaccine check for students.

“But it’s got to the point where some communities don’t even want us to ask families if they want immunisations,” she said.

“Schools impress, over and over again, that families are over it, they don’t want to hear about it, they don’t want to be told they’re overdue.”

When families expressed such views, health workers had to take note and be guided by them, Maxwell-Crawford said.

“If you’re push, push, pushing an agenda, families just stop engaging. They will walk away,” she said. “Instead we have to listen, build a relationship, and then we hope families will become more open to a conversation.”

“Yes we need MMR and whooping cough vaccinations, but the way we are going about it is putting people off,” she said. “For us, it’s about hearing and responding to families’ priorities.”

Immunisation Advisory Centre director Nikki Turner said she was deeply concerned about a potential measles epidemic, particularly with the border opening, and about whooping cough because New Zealand was “due” an outbreak.

Whooping cough, which was particularly dangerous for youngsters, with more than half of babies under one needing hospital treatment, reared its head about every 4-6 years, she said.

Turner said to get immunisation rates up, building trust was extremely important, as were flexible, practical outreach services – rather than relying on the traditional model of running clinics 9-5.

“You need families engaging with the right providers,” she said. “But outreach services have always been underfunded. That needs building back up again.”

Bay of Plenty health district’s Brent Gilbert-De Rios said it had learned lessons from the Covid vaccination roll-out that it was now applying to a broader vaccination push.

Part of that was funding providers like Poutiri to do what they did best.

“We believe in supporting providers who have long-standing relationships with whānau and communities to help people overcome mistrust of immunisation,” he said.

Maxwell-Crawford said while the challenge ahead of the health practitioners was daunting, it was not insurmountable.

“We will chip away and focus on families. Some of this is unpicking six generations of growing mistrust,” she said.

“In some ways, it’s exciting. For the first time the government is allowing us to be innovative – we’ve never been able to get on a pahi and ask the community what they want, and go and deliver it to them. That is exciting for us.”