Kaupare Atu I Prevention: Te Niwha Priority Research Area
Kaupare Atu I Prevention Research Projects
Reducing barriers, improving lives: A new approach to rheumatic fever treatment
Whakarāpopoto Rangahau I Summary of Research
“Hurts less, lasts longer”, is a quote from a young participant who was part of our world-first subcutaneous injection of penicillin (SCIP) trial.
Before SCIP, rheumatic fever patients would need to receive painful monthly injections of penicillin for a minimum of 10 years to prevent the development of rheumatic heart disease. This inconvenient, painful regimen has remained the same for the last 70 years.
An estimated 60% of rheumatic fever cases progress to carditis and permanent heart value damage, known as rheumatic heart disease which can cause death.
This program builds on a body of work which has shown striking results. Our early trials demonstrated that by delivering penicillin as an “implant” via SCIP, patients retain the desired penicillin concentrations for at least 3 months. This project will expand the trial into other regions of New Zealand. In addition, will utilise a previously developed rangatahi Māori and Pacific patient and whānau centered model of care to implement the delivery of SCIP. The model’s effectiveness and responsiveness to rangatahi Māori and Pacific patients, whānau and health care workers involved in the delivery of SCIP will be evaluated.This project will expand the trial into other regions of New Zealand. In addition, will utilise a previously developed rangatahi Māori and Pacific patient and whānau centered model of care to implement the delivery of SCIP.
The model’s effectiveness and responsiveness to rangatahi Māori and Pacific patients, whānau and health care workers involved in the delivery of SCIP will be evaluated.
Te Hiranga a Rangahau I Research Impact
By providing an acceptable model of care that delivers sustained penicillin concentrations, which last at least 3 months this approach fulfils the ideal product characteristics for the next generation of long-acting penicillin. Implementing SCIP successfully could be life-changing for those living with rheumatic fever and rheumatic heart disease locally and globally.
Impact Case Study
Principal investigators: Dr Julie Bennett (University of Otago) and Dr Anneka Anderson (University of Auckland)
Māngai Wai Māori: Ngāi Tahu drinking water programme
Whakarāpopoto Rangahau I Summary of Research
It has been estimated that between 18,000 and 34,000 people in Aotearoa develop acute gastrointestinal disease (AGI) each year from contamination of drinking water supplies. However, this estimate was completed in 2006 and has a number of limitations.
Taumata Arowai, the new water services regulator, is introducing new rules that will require registration for marae and other small water providers.
Te Kura Taka Pini (TKTP), the freshwater entity of Ngāi Tahu, has highlighted that some marae within the Ngāi Tahu Takiwā where unaware of potential issues with their water supplies, prompting the development of a Māori-led testing and monitoring system to track water quality over time and intervene and provide support when necessary.
This project aims to establish a Māori-led audit and surveillance programme for drinking water systems on marae in the Ngāi Tahu takiwā; estimate the burden of AGI attributable to community drinking water supplies in Aotearoa that assesses differences by ethnicity and deprivation; assist Taumata Arowai to estimate the potential health and equity benefits of improvements to community drinking water infrastructure.
Te Hiranga a Rangahau I Research Impact
We will estimate the current burden of AGI attributable to community drinking water supplies in Aotearoa. The methodological approach is based on that utilised to estimate AGI attributable to contaminated drinking water in Canadian and US community water supplies. In brief, the approach involves two main steps: assessing AGI risks for each water distribution zone (WDZ) from source water to tap, using data on source water contamination, treatment methods and efficacy, and reticulation system quality; and assessing international epidemiological evidence for AGI risks in relation to the quality of drinking water system components (source, treatment, reticulation).
In partnership with Te Kura Taka Pini, researchers at the University of Otago support the expansion of a testing programme for nitrate in drinking water and formalise the training of people within each Rūnanga to take ownership of and become champions for drinking water quality. We will extend the current testing to quarterly testing for pathogens (e.g. E. coli) and establish a monitoring programme so that drinking water quality can be tracked over time.
The training will include provision of information on how to collect, store and transport samples for testing, how to interpret the results of any tests, how to store and analyse water quality data and potential interventions when water quality is degrading.
We will carry out an audit of drinking water systems at each marae and estimate the potential AGI risk, based on results of pathogen surveillance (see below). This audit will include supporting marae to make any improvements needed to either meet compliance obligations under the Water Services Act 2021; to meet their own community aspirations, mana motuhake, for drinking water quality.
The results of this project will help better understand the public health burden of contaminated drinking water in Aotearoa New Zealand. It will help identify aspects of our water infrastructure are most likely contributing to this burden, what areas are most affected and who is most affected. The new information will provide insights into where is best to intervene to ensure all New Zealanders have access to clean drinking water.
Impact Case Study
Principal Investigators: Dr Tim Chambers and Connor Redmile University of Otago and Te Kura Taka Pini, University of Canterbury
Preventing recurrent admissions for preschool wheeze respiratory infections – ARROW
Whakarāpopoto Rangahau I Summary of Research
We aim to find out if an oral medicine, with an excellent safety profile, prevents wheezy illness hospitalisations in preschool-aged children with recurrent wheeze. The medicine is called OM-85. This trial will determine the efficacy of OM-85 for preventing hospitalisations in preschool-aged children with recurrent wheeze. If we show that OM-85 prevents preschool wheeze hospitalisations, we will request PHARMAC funding so it can be prescribed to children to prevent wheezy illness hospital admissions.
Preschool wheeze causes more preschool-aged children in New Zealand to be hospitalised than any other illness. Of children hospitalised with preschool wheeze, one-in-five will have a hospital readmission for preschool wheeze within the next year.
Medicines currently used for preschool wheeze are those used for asthma. These are not as effective for treating preschool wheeze, and may cause children to be shorter and fatter, to have weaker bones, and impaired stress responses.
Most of these medicines are delivered via metered-dose inhalers. The propellants in these inhalers have global warming effects much greater than carbon dioxide.
We aim to find out if an oral medicine, with an excellent safety profile, prevents wheezy illness hospitalisations in preschool-aged children with recurrent wheeze. This medicine is called OM-85. We are enrolling children admitted with preschool wheeze to five New Zealand hospitals and, in Waikato and Auckland, enrolling through primary healthcare, Kōhanga Reo, Pharmacies, and other Māori and Pacific providers. More than 1,000 children will be enrolled from 2022-2025. Each child is in the study for 12 months.
This trial will determine the efficacy of OM-85 for preventing hospitalisations in preschool-aged children with recurrent wheeze. If we show that OM-85 prevents preschool wheeze hospitalisations, we will request PHARMAC funding so it can be prescribed to children to prevent wheezy illness hospital admissions.
Te Hiranga ā Rangahau I Research Impact
This project has the potential to prevent preschool aged children from having recurrent hospital admissions due to wheezy acute respiratory infections, the most common cause of acute hospital admission in this age group. This project also has the potential to prevent the development of chronic lung disease, such as bronchiectasis, a lifelong disabling condition that leads to premature death. Prevention of preschool wheeze leads to decreased direct costs to the health system and indirect costs to whānau.
The community engagement and relationships created through this project will enable the role-out of preventive interventions not only in hospitals, but also in primary care and in the community. Many other initiatives that seek to improve the health of our tamariki and Aotearoa New Zealand's pandemic preparedness,i.e. immunisations and alternative ways of healthcare delivery, may also be facilitated through the two-way knowledge exchange platform created through this project.
Impact Case Study
Principal Investigator: Professor Cameron Grant, University of Auckland.
COVID-19 needle length study
Whakarāpopoto Rangahau I Summary of Research
COVID-19 mRNA vaccines are registered for intramuscular (IM) injection; however, the standard 25mm needle length is insufficient to ensure deltoid muscle delivery in up to 45% of adults with obesity. The current vaccination guidelines provide non-specific advice for needle length selection, and only 2% of COVID-19 vaccine doses in Aotearoa New Zealand are actually administered with a needle longer 25 mm.
It is currently unknown whether regulatory-mandated IM delivery of COVID-19 vaccines is essential to achieve full therapeutic effects and whether inadvertent subcutaneous (SC) delivery could lead to increased reactogenicity and local adverse events following vaccination.
This study is a randomised controlled trial of 486 adults conducted at community pharmacies across A/NZ. Study participants will be randomised to receive a booster dose of Pfizer bi-valent COVID-19 vaccine by IM or SC injection. This study will compare immunogenicity and reactogenicity following vaccination by IM or SC route.
Te Hiranga ā Rangahau I Research Impact
If differences between reactogenicity and immunogenicity are identified between SC and IM delivery of vaccination, these findings would directly influence public health practice in A/NZ and globally. Vaccination guidelines which ensure IM delivery could reduce side effects following vaccination, potentially reducing vaccine hesitancy and in turn reducing the burden of disease that disproportionately affects Māori, Pacific, and other disadvantaged groups.
As concern regarding adverse events following immunisations is known to result in vaccine hesitancy and refusal, highlighted during New Zealand's Immunisation Programme, therefore identifying differences in reactogenicity will have direct relevance to vaccine uptake. If results show that SC and IM administration gives comparable immunogenicity, this provides reassurance for clinicians and for people with obesity, who may have previously received inadvertent “off-label” SC delivery, that they are likely to be adequately protected.
This project will validate the capacity in New Zealand to undertake embedded research within community pharmacy vaccination clinics and will would further develop pharmacist research capacity. This will ensure the network of embedded community pharmacy research hubs across New Zealand are able to rapidly and efficiently respond when a new infectious
Impact Case Study
Principal Investigator: Medical Research Institute of New Zealand
Likely future pandemic agents and scenarios
Whakarāpopoto Rangahau I Summary of Research
Most countries, including NZ, had pandemic plans pre-COVID-19 that focused on an Influenza Pandemic – but they were largely silent on non-Influenza virus pandemics. Future pandemic preparedness needs to more explicitly consider a range of possible pandemic agents or pandemic scenarios.
The purpose of this project was to:
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Identify and characterise agents that are most likely to cause future pandemics/Public Health Emergencies of International Concern (PHEICs) and possible scenarios resulting from such events.
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Capture the key features that need to be considered during the interpandemic period (i.e. preparedness) and the multiple phases of an extant pandemic/PHEIC (i.e. response).
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Provide a framework and essential material for the preparation of a pandemic plan that is fit-for-purpose now and into the future.
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Identify capabilities that are needed to aid rapid decision making in the event of a new pandemic/PHEIC.
Te Hiranga a Rangahau I Research Impact
Most countries, including NZ, had pandemic plans pre-COVID-19 that focused on an Influenza Pandemic – but they were largely silent on non-Influenza virus pandemics. Future pandemic preparedness needs to more explicitly consider a range of possible pandemic agents or pandemic scenarios.
Full Report
Executive Summary
Spreadsheet
Principal Investigator: Distinguished Professor Nigel French, Massey University.Uncovering the risk of a dengue virus incursion from the Pacific: determining the mosquito epidemiological landscape of Aotearoa
Whakarāpopoto Rangahau I Summary of Research
Mosquito-borne diseases, once confined to the tropics, are now appearing in places like Europe, North America, and Australia. With climate change, urbanisation, and extreme weather helping mosquitoes spread, the risk of new mosquito-borne diseases entering Aotearoa New Zealand is increasing. Already, mosquito-related illnesses are on the rise here, yet we know very little about the viruses carried by our local mosquitoes or what animals they feed on.
Aotearoa has 16 mosquito species (waeroa in te reo Māori), most of which are native and likely to feed on birds. However, female mosquitoes also feed on many other animals, including humans, which can allow viruses to jump between species. While the transmission of well-known viruses like dengue is understood elsewhere, the viruses present in New Zealand mosquitoes remain almost completely unstudied.
This project will use cutting-edge genomic tools to examine individual mosquitoes from across the country, revealing what species they are, which animals they have fed on, and what microbes and viruses they carry. By mapping this viral diversity nationwide, we can identify hotspots where harmful viruses might emerge, assess the risks of new outbreaks, and better prepare for future mosquito-borne disease threats in Aotearoa.
Te Hiranga a Rangahau I Research Impact
This project will deliver the first nationwide map of viruses and microbes carried by mosquitoes in Aotearoa New Zealand, providing critical insights into potential risks of mosquito-borne disease. The immediate impact will be improved understanding of which mosquito species are most likely to act as vectors, what animals they feed on, and where viral diversity is concentrated. Expected outcomes include the discovery of novel viruses, identification of hotspots for incursion or emergence of pathogens, and a clearer picture of how mosquito ecology may influence transmission. Success will be evaluated through the generation of high-quality genomic datasets, peer-reviewed publications, and the translation of findings into risk assessments for public health and biosecurity agencies.
The significance for Aotearoa lies in strengthening preparedness for future outbreaks by providing an evidence base for surveillance, conservation, and health policy. To ensure relevance, the project will use a two-way knowledge exchange approach, engaging with iwi, community groups, health agencies, and conservation managers to include their priorities and perspectives. Findings will be shared through multiple channels, including open-access scientific papers, public reports, hui with stakeholders, media engagement, and presentations at national and international forums, ensuring knowledge is both accessible and impactful.
Principal Investigator: Professor Jemma Geoghegan, University of Otago
Using models to understand and respond to the uneven impact of infectious diseases and future pandemic threats
Whakarāpopoto Rangahau I Summary of Research
New Zealand’s high-quality national-level data and recent disease outbreak experiences provide the ideal environment for creating and testing innovative epidemic modelling approaches. This project will increase the predictive power of epidemiological modelling and its ability to support pandemic preparedness and equitable public health decision making and policy advice.
The Covid-19 pandemic demonstrated the value of mathematical models for informing policy decisions and the public health response to infectious disease threats. However, a major flaw in many models is that they either overlook or poorly characterise differences in disease burden between population subgroups. In New Zealand, Māori and Pacific populations have disproportionately worse health outcomes from infectious diseases and pandemics, but current cutting-edge models cannot account for the disparity in infectious disease vulnerability in these populations.
Our project will create new modelling methods that account for the diversity of vulnerability within and between populations. We have two research aims:
Aim 1. Develop new mathematical models that can capture differential dynamics of disease transmission within and between population subgroups, such as ethnicity groups or deprivation index. This will enhance understanding of epidemic dynamics by using stratified models to simulate the behaviour of future epidemic events.
Aim 2. Apply and validate these models using recent case studies on differences between ethnicity groups in Aotearoa New Zealand. We will parameterise and validate our models using anonymised age- and ethnicity-specific data, as well as linked health, Census and administrative data from Stats NZ, the Ministry of Health and Te Whatu Ora.
Te Hiranga a Rangahau I Research Impact
New Zealand’s high-quality national-level data and recent disease outbreak experiences provide the ideal environment for creating and testing innovative epidemic modelling approaches. This project will increase the predictive power of epidemiological modelling and its ability to support pandemic preparedness and equitable public health decision making and policy advice. This will create the ability for robust modelling of specific subpopulations by ethnicity, provide new capability to identify equity impacts from existing and emergent infectious disease threats, and deliver strategic quantitative tools for pandemic preparedness.
Impact Case Study
Principal Investigators: Dr Samik Datta (NIWA) | Prof Michael Plank (University of Canterbury) | Andrew Sporle (iNZight Analytics Ltd)
Mana-enhancing research strategy for Māori living with HIV
Whakarāpopoto Rangahau I Summary of Research
This project aims to develop a research strategy for Toitū Te Ao with a kaupapa Māori framework for research involving Māori living with HIV. The mahi also involves building a trusted network of community and research partners.
This project aims to develop a research strategy for Toitū Te Ao with a kaupapa Māori framework for research involving Māori living with HIV. The mahi also involves building a trusted network of community and research partners.
Māori continue to bear a disproportionate burden of HIV, increasing the risk of poor long-term health outcomes. As the only Māori-led HIV organisation in Aotearoa, Toitū Te Ao provides holistic care for Māori living with HIV (and whānau) through education, research, and advocacy. With an increase in HIV monitoring and surveillance, Toitū te Ao aims to address gaps in meaningful research for Māori and this means Māori are engaged in all aspects of the research decision-making, including the design, methodology, how the information will be presented and how the data will be used to benefit Māori living with HIV - E kore mātou, e kore tātou Nothing about us, without us.
Te Hiranga ā Rangahau I Research Impact
This work will ensure Māori living with HIV have control and ownership over research that impacts Māori, and it will help contribute to better health outcomes for Māori living with HIV. This mahi will challenge the use of current research engagement approaches and provide a framework of meaningful, mana-enhancing research for Māori living with HIV.
Impact Case Study
Principal Investigators: Milly Stewart ( Toitū te Ao), Abby Leota (Leota Consulting)
A kaupapa Māori infectious diseases surveillance framework
Whakarāpopoto Rangahau I Summary of Research
This research seeks to address the critical data needs for an Indigenous-led framework that enhances infectious disease preparedness and response in Aotearoa, New Zealand, particularly for Māori communities.
By integrating biomedical and public health principles with mātauranga Māori (Māori knowledge), we aim to create a multifaceted approach that reflects the unique health, social, economic, and cultural needs of whānau. Our study emphasises the importance of aligning data collection and usage with community priorities, ensuring surveillance systems are responsive to the specific contexts of Māori communities. We adopt the Whānau Ora approach to develop a holistic framework that recognises not only medical factors but also the social determinants of health that influence infectious disease management.
The project will intersect with a wider surveillance system review that is being undertaken by researchers within the Department of Public Health at the University of Otago, Wellington, led by Professor Michael Baker. This collaboration will contribute to the development of a culturally-appropriate shared vocabulary and concepts for describing disease surveillance and the processes involved.
A kaupapa Māori methodology will underpin this research, emphasising the importance of community engagement throughout the study. Researchers will work collaboratively with whānau and other relevant stakeholders to develop an approach that addresses holistic health needs. The methodology will also incorporate data sovereignty principles, ensuring that stakeholder perspectives are central to the collection, analysis, and application of surveillance data.
Te Hiranga a Rangahau I Research Impact
Our findings will bridge biomedical and public health paradigms with mātauranga Māori, fostering a reciprocal exchange that strengthens health frameworks. By ensuring Māori voices are central in the research process, we ensure cultural integrity and relevance, allowing the research to authentically reflect the values and perspectives of Māori communities, while contributing to broader public health strategies. This synthesis of Māori voice, cultural knowledge and scientific inquiry is expected to yield innovative solutions for infectious disease preparedness that are not only effective but also culturally appropriate and empowering for Māori communities.
The dissemination of this research is designed to be inclusive, respectful, and actionable, ensuring that the findings are not only shared but also utilised to make meaningful improvements in the health outcomes of Māori communities.
By engaging with diverse stakeholders, including iwi leaders, health professionals, and community members, and employing various dissemination methods, this research aims to make a significant contribution towards improving the health and wellbeing of Māori communities, particularly in the face of pandemics.
Impact Case Study
Principal investigator: Hector Kaiwai, Te Whānau O Waipareria Trust
Pacific youth, infectious disease risk, and social media in Aotearoa
Whakarāpopoto Rangahau I Summary of Research
This project will contribute to the reduction of preventable infectious diseases among Pacific youth through the development of culturally relevant public health information disseminated via social media network sites. The focus is Rheumatic Fever, Acute Respiratory Distress Syndrome, COVID-19, sexually transmitted infections and sexually transmitted diseases.
Public health messages are an important component of health promotion. To this end, researchers will work with Pacific networks of stakeholders and communities of young people to generate an in-depth understanding of how young people perceive preventable infectious diseases. They will then co-create a series of messages, assess how these messages are received, and how they penetrate within and across social networks. Working with Pacific Youth will allow the researchers – and ultimately policymakers and public health agencies – to better understand how to use social media platforms to shift social norms around infectious disease prevention.
Anecdotally, the Pacific Islands diaspora communities seem to be heavily reliant on social media to connect. This research will be one of the first to develop and explore use of existing social media networks to disseminate messages within a small island setting with a close connection to family networks in a neighbouring country of residence (New Zealand). If as effective as a mechanism for reliable, cost-effective health communications, this approach could be applied to many other priority issues such as immunisation.
The project consists of three phases:
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Phase 1 (quantitative) cross-sectional research with up to 800 Pacific youth in the Auckland region using a structured, standardised questionnaire. This includes exploration of social media and social networks for the Pacific youth.
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Phase 2 (qualitative) with up to 20 focus groups (of up to 10 youth in each) and fono. The focus groups will explore in-depth issues that emerge from the survey, literature, and advisory group and identify the barriers and enablers to access services, as well as effective information and communications.
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Phase 3 will develop implementable recommendations, in co-design with Pacific youth, for policy and practice with respect to the surveillance, prevention and control of the focus infectious diseases and others. These will be translated into Cook Islands, Tonga, and Niue languages. The developed messages will be selected based on the priorities from the focus groups, and situational gap analysis / literature review whereby paucities of resources and messaging for Pacific youth will be made clear.
Te Hiranga a Rangahau I Research Impact
The NZ Ministry of Health’s COVID-19 Health and Disability System Response Plan identified Pacific peoples as a priority population, requiring targeted support. A Pacific Health Response Plan identified as priorities in the response for Pacific communities: clear, consistent, and accessible communication of national measures with respect to both language and cultural barriers; and engaging Pacific community leaders, youth groups, and clinicians to enhance Pacific communities’ faith and trust in the health system to foster compliance with government instructions and measures. An approach has been developed to ensure that knowledge, information, and key messages would travel both ‘top down’ to facilitate a national response, and ‘ground up’ to feed back about the specific needs of Pacific youth and communities.
Conducting research on Pacific youth and infectious diseases strengthens New Zealand's research capability by expanding expertise in the generation of Pacific knowledges around infectious disease risk factors and prevention strategies that utilise cultural relevant modes of communication. We will be using methods designed to collaborate with existing community networks, with the aid of digital tools, to ensure that there is effective reach and receptivity of infectious disease communications. The use of methods such as social network mapping and diffusion of innovation theory, will build team skills and capabilities that can be applied to other infectious disease threats. This approach ensures that the research project contributes to the overall capacity to respond effectively to emerging health challenges.
This research will:
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Produce greater understanding of how diverse Pacific youth groups manage the risk of infectious diseases (including COVID-19) and access and use health promotion, prevention and clinical services.
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Explore in depth the barriers and enablers to health services and better understand Pacific youth perceptions of infectious diseases as it pertains to their social networks and social media.
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Develop implementable recommendations that will improve health policy for infectious diseases surveillance, prevention and control, and service delivery.
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Make a significant contribution to Pacific health methodological research literature in combining rigorous methods for policy making and health services research and partnering with Pacific stakeholders and end users.
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Work alongside international partners in the region to transfer and share learnings as appropriate, and scalable, to inform their health praxis and preparedness for pandemics.
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Build the capacity and capability of Pacific researchers from early career upwards and provide opportunities for Pacific youth to enter into these spaces with equitable resource, and access to Pacific leaders in the space to provide mentorship, professional and personal development.
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An amalgam of impacts will lead to better health outcomes for Pacific people who are disproportionately impacted by infectious diseases.
Impact Case Study
Principal Investigator: Sir Collin Tukuitonga, Te Poutoko Ora a Kiwa - Centre for Pacific and Global Health (University of Auckland)
COVID-19 Equity response synthesis (for proactive evaluation and gap analysis)
Whakarāpopoto Rangahau I Summary of Research
This strategic project will produce an understanding of the capacity and capability of infectious diseases research in Aotearoa New Zealand including a detailed database of those involved and their specialities and gaps to be filled to ensure the country is best prepared for future pandemics or infectious disease outbreaks. The project will produce a Burden of Disease Index for 25 key diseases, including their cost to the country. The research team will also identify all infectious diseases funding, both from Crown and other sources.
Engagement during development of the Te Niwha research platform indicated a gap of understanding in the landscape of infectious diseases research actors, funding and critical issues that need to be addressed to ensure a successful (and sufficiently informed) grounding. The result of this is a ‘Landscape Mapping project’ (link to this project) which provides a database of research contributors to identify critical mass on capability and capacity as well as gaps. It also summarises infectious diseases research investment and provides a “Burden of Disease Index that shows the real impact of 25 infectious disease, such financial and social costs.
The Covid-19 Equity Response Synthesis project is part of this wider mahi to understand Aotearoa New Zealand preparedness and to pull together learning from the recent pandemic. It focuses on gathering and consolidating documented pandemic plans and responses from iwi Māori, Māori health providers, Pacific communities, and Pacific health providers.
The mahi focuses on understanding their readiness and capacity in preventing, controlling, and managing COVID-19 and other infectious diseases. It acknowledges and includes existing reports and ongoing documentation efforts by communities and organizations, aiming to gain insights into the effectiveness of the documented plans and responses, with a focus on Māori and Pacific health providers and communities.
The research is guided by cultural frameworks and methodologies to ensure it is integral to the communities involved and that it aims to serve, including:
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A kaupapa Māori approach will be integrated into the research design, ensuring methodologies and processes are culturally appropriate and aligned with Māori values and principles. Similarly, the Pacific Kakala Framework will be adopted to guide the research design, ensuring methodologies and processes for the Pacific are appropriate and aligned with Pacific values and principles. In addition, the Braided Rivers approach is a research methodology that integrates Western scientific concepts with Indigenous knowledge systems. It recognises the interconnectedness and complexity of social, cultural, and environmental factors, resembling the braided channels of a river. This approach emphasises collaboration, inclusivity, and the co-creation of knowledge between different stakeholders, including Indigenous communities.
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Strong partnerships with Māori researchers and clinicians will be established to offer valuable insights and perspectives.
Te Hiranga a Rangahau I Research Impact
This project has produced one report and three publications that together strengthen understanding of Māori and Pacific infectious disease preparedness and research equity in Aotearoa New Zealand.
The project delivered the first national synthesis of iwi pandemic plans and Pacific community COVID-19 responses. The findings highlight the central role of cultural infrastructures—marae, churches, kin networks, and trusted leaders—in effective community mobilisation. Enablers included open dialogue, culturally grounded communication, and rapid service adaptation. Barriers included exclusion from early decision-making, inconsistent engagement with Māori and Pacific providers, chronic underinvestment, and reliance on unpaid labour. The synthesis outlines capability baselines and structural requirements for more equitable future pandemic responses.
Appling rigorous data methods, manual coding, and indigenous-informed analysis, this project provided Te Niwha with a strengthened evidence base to guide equitable investment, policy direction, and system-level planning for Māori and Pacific infectious disease resilience.
Principal Investigator: Dr Amio Matenga Ikihele, Moana Connect
Tāngata whaikaha Māori probabilistic panel survey research
Whakarāpopoto Rangahau I Summary of Research
The COVID-19 pandemic exposed health-system barriers for those with disabilities. Disabled people and tāngata whaikaha Māori have since identified factors such as access to primary care and emergency services and delay seeking healthcare due to fear of contracting COVID-19 in health contexts.
This research project will transform the research team’s successful descriptive study of a nationally representative sample of Tāngata Whaikaha Māori into an ongoing panel survey exploring the determinants of infectious disease resilience and pandemic preparedness for Tāngata Whaikaha Māori.
The 2013 New Zealand Disability Survey estimated 24% of the total population were disabled, with those aged 65 or more years more likely to be disabled (59%) than adults under 65 years (21%) or children under 15 years (11%). (Statistics New Zealand, 2014) The survey also found that Māori and Pacific peoples had higher than average disability rates, after adjusting for age differences.
During 2022 the Ministry of Health and Whaikaha compiled data from the Disability Support Services (DSS) database. Their report showed that DSS recipients aged less than 70 years had four times the risk of hospitalisation due to COVID-19 compared with the rest of the population. This group of people were 13 times more likely to die of or with COVID-19. People receiving DSS in residential services required the highest level of support need compared to the overall New Zealand population. For example, this specific group were 19% more likely to be COVID-19 positive, 8 times more likely to be admitted to hospital with COVID-19, and 47 times more likely to die of or with COVID-19.
Due to lack of disaggregated data by ethnicity and other data constraints, there is limited evidence available regarding the direct impacts of COVID-19 on tāngata whaikaha Māori in Aotearoa, such as infection rates, hospitalisation, mortality, and long COVID.
There is also evidence of disproportionate multi-dimensional social impacts from COVID-19 on disabled people and tāngata whaikaha Māori. These groups were more likely to have felt lonely and further concerns around access to appropriate support services, lack of emotional support, financial strain, unemployment, and a lack of adequate and timely communication to vulnerable groups.
Te Hiranga a Rangahau I Research Impact
This project will do an in-depth analysis of COVID-19 resilience and pandemic preparedness specifically tailored for the Māori population and specifically tāngata whaikaha Māori. Data will also act as a baseline of pandemic-related health needs and preparedness and enable comparison between pandemic outbreaks – either for COVID-19 or future pandemics caused by other infectious diseases.
Principal Investigator: Tristram Ingham, University of Otago.
He Tūāpapa Hauora: Housing-Related Health Outcomes in Te Tai Tokerau – A mixed methods study: “A foundation for health”
Whakarāpopoto Rangahau I Summary of Research
Te Tai Tokerau has one of the highest proportions of Māori in Aotearoa, with around 48% of residents identifying as Māori compared to 17% nationally. Many communities face lower household incomes and poorer housing quality, with cold, damp, and overcrowded homes that often do not meet Healthy Homes Standards. These conditions are known social determinants of health and contribute to persistent inequities for Māori whānau and tamariki.
This research seeks to better understand how housing conditions affect infectious disease outcomes across Te Tai Tokerau. By analysing anonymised health data from 2020–2025, the study will identify which communities experience the greatest burden of respiratory, skin, and gastrointestinal infections, and how these patterns compare nationally.
Guided by kaupapa Māori principles and aligned with Te Niwha’s mission to prevent infectious diseases and advance equity, the project places Māori governance and data sovereignty at its centre. Through a Te Tiriti o Waitangi partnership approach, it supports collective action between housing, health, and social sectors to inform policy, direct investment, and improve wellbeing for whānau across Te Tai Tokerau.
Te Hiranga a Rangahau I Research Impact
This project will deepen understanding of how housing conditions influence infectious disease patterns in Te Tai Tokerau, identifying where inequities are most pronounced and why. The evidence generated will help decision-makers across housing, health, and social sectors to target resources and design interventions that deliver measurable impact.
The study will create a regional baseline on the burden of housing-related infections, showing how outcomes differ by age, gender, ethnicity, and levels of deprivation. These insights will guide policies that improve housing quality, reduce preventable illnesses, and enhance community wellbeing.
The evidence base produced will also strengthen cross-sector collaboration between health, housing, and social agencies, helping build resilience to future infectious disease threats. Ultimately, it supports transformative, data-driven decision-making that can reduce hospitalisations, improve quality of life, and advance long-term health equity for Māori and all communities across Te Tai Tokerau.
Impact Case Study
Principal Investigator: Tia Ashby, Te Hau Ora O Ngāpuhi.