Māori and Pacific People’s perspectives on Group A Streptococcus vaccine development and delivery in Aotearoa, New Zealand

Aotearoa New Zealand experiences a disproportionately high incidence of Group A Streptococcus (Strep A) disease, particularly acute rheumatic fever (ARF), with Pacific children 80 times and Indigenous Māori children 36 times more likely to develop ARF than children of other ethnicities. This qualitative study explored Māori and Pacific Peoples' perspectives on Strep A vaccine development. Guided by Kaupapa Māori and Pacific-centred research approaches, semi-structured interviews were conducted with 29 participants, including 20 whānau (family) members and nine healthcare stakeholders. Interviews were recorded, transcribed verbatim, and analysed using a general inductive thematic approach. Three interconnected themes emerged: Perceptions of ARF, vaccine development, and vaccine delivery. These themes were grounded in cultural values such as hauora (wellbeing), whanaungatanga (relationships), kotahitanga (collective action), and tino rangatiratanga (sovereignty and self-determination). Participants' perspectives were shaped by lived experiences of colonisation and the recent Covid-19 vaccine rollout. Māori and Pacific-led approaches rooted in cultural knowledge systems were consistently highlighted. Participants emphasised that the current healthcare system is not fit-for-purpose for Māori and Pacific health and wellbeing and must be realigned to better reflect varying worldviews. Vaccine delivery models must be holistic and flexible, incorporating a whānau ora (family-centred) approach. While recognising the importance of a Strep A vaccine, participants stressed that addressing social determinants of health, such as housing, poverty, and access to health care is essential to reducing disease burden. These findings demonstrate that culturally responsive approaches are essential for successful vaccination programmes. In Aotearoa New Zealand, this requires embedding Māori and Pacific leadership, perspectives and participation from design to delivery, together with strengthened Māori and Pacific health workforces.