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Mana motuhake hesitancy: a threat to the COVID-19 vaccine roll out

Updated: Jun 4, 2021

Aotearoa New Zealand has done a remarkable job so far in keeping COVID-19 at bay. However, we can’t keep the borders of our island-haven closed forever, so getting the nation vaccinated is our next big challenge.

A Ministry of Health insight report on vaccination found 20 percent of respondents are unlikely to have a COVID-19 vaccine if offered. Of high concern is the large proportion of these groups who are Māori. Failure to reach Māori in the COVID-19 vaccination programme would risk further exacerbating historical and existing inequities and failings in our health system.

Distrust has been identified globally as one of the key reasons for vaccine hesitancy. Given the devastating effects of colonisation and the persistent evidence of institutional racism in our health system, it makes sense that some Māori would be vaccine hesitant. However, to amplify a narrative that Māori are vaccine-hesitant in a widespread way assumes that the capability doesn’t exist within the community to reach vaccination goals. This is wrong. Trust is a two-way street, and the government need to start trusting Māori.

Reports from Minister Peeni Henare’s hui with Māori communities across the country contrast with the ‘vaccine hesitant’ narrative, finding that communities are less concerned with the legitimacy of the vaccine and more concerned to know when they can get it, where they can get it and whether it will be delivered by the people they trust. This sentiment is further reflected by multiple Māori health leaders and Māori owned health services who are calling for greater access to the vaccine. In fact, if we look at the COVID-19 response more broadly, we have seen outstanding efforts from Māori to do their part to keep communities safe from the virus. We have seen iwi and Māori provider-led mobilisation of people and resources to distribute food and enable whānau to follow lock-down rules. We even saw the establishment of iwi border controls, a clear example of mana motuhake in action to protect people. These efforts have been completely under-recognised when celebrating the nation’s success so far. Why?

Public Health has been learning about vaccine hesitancy for over 200 years. What we know is that people hesitant about vaccines, especially people from under-served communities, are more likely to trust information from friends and family than they are any other source. If sound pandemic policy is to be evidence-informed, then research and experience tells us that community empowerment is what works.

It makes sense when you think about it. People are driven by values, and mistrust happens when those values don’t align. The government’s statements talk of prioritisation of Māori, the pursuit of equity and promoting Māori leadership in the health sector, but their actions continue to demonstrate the opposite. Recently we saw respected Māori health leader Dr Rawiri Jansen resign from his position advising the government on the COVID-19 vaccination roll out. Dr Jansen asked that Māori under 65 years of age be included in the vaccine priority groups, given the poor health outcomes experienced by Māori at an earlier age than Pākehā. The government said no. This one decision signalled that despite rhetoric around honouring Te Tiriti o Waitangi, Māori will not be supported to make important decisions and the government is not willing to live up to its commitment to health equity for Māori.

So, here is a values-based message to the Ministry of Health: Do your bit for the team of five million, get over your mana motuhake hesitancy, and listen to the science.If there is a disproportionate number of Māori hesitant about the vaccination, an evidence-based approach would be to authentically enable a Māori-led campaign and delivery programme.

About the author

Kate is a Pākehā New Zealander. She spent her childhood in Te Tairāwhiti where she was nurtured and educated by the people of Ngāti Porou. Kate now lives in Te Tai Tokerau and works in the areas of public health and environmental sustainability. She is completing a Masters in Public Health with University of Auckland and is particularly interested in “peace, justice and equity as prerequisites to health” as stated in the WHO Ottawa Charter for Health Promotion.


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