Holding fast to collectivist values in a health emergency

Aotearoa New Zealand is currently grappling with an outbreak of the Delta variant of Covid-19. Since a recent returnee from Australia tested positive for Delta in mid-August 2021, we have been under public health emergency measures, with Tāmaki Makaurau, our largest city, in Level 3 and 4 lockdowns for 88 days (at 13 November). The Delta outbreak has resulted in 5371 cases so far. There are so many cases now that those of us in Tāmaki (and probably in Waikato and Tai Tokerau) have to assume that there are Covid-19 cases in our neighbourhoods. We scan the vaccination statistics every day to see if we are getting closer to that magic number of 90% of our eligible population double-vaccinated, at which point some restrictions can be lifted.

Over the last 20 odd months social workers have been caught up in the many impacts of this pandemic. Many aspects of our professional lives have been reshaped by the impacts of the Covid-19 pandemic. We learned to respond to a rapidly changing style of communication. And this year as this Delta outbreak has spread its tentacles we have seen at close quarters, or via Zoom, how existing inequalities in Aotearoa New Zealand society have been intensified. “Social work relies on understanding and responding to the social world, and addressing inequities in that world” (Keddell & Beddoe, 2020, p. 41) and we have seen how these inequities are revealed in the lives of the people we work with. The most recent and perhaps the sharpest end of the public health measures is mass vaccination. And in facing this vexed discourse, let’s look at the best evidence, support public health and hold tightly to our collectivist values.

While our profession has continued to practise solidarity across our fields of practice, vaccine mandates have recently exposed tensions. Social workers have generally supported vaccine mandates. A poll conducted by ANZASW last week provides the following snapshot. The survey was available to social workers over 1-5 November 2021 and there were 1240 responses.  The majority (90%) of social workers are vaccinated or intend to be vaccinated. Only 6% indicated they will not be vaccinated and 2.3% are unsure if they will be vaccinated. The results indicated that 72% of social workers were currently required to be vaccinated (59% because of the Covid-19 Public Health Response (Vaccinations) Order and 13% because of employer policies). In response to the question, “Should social workers be vaccinated to work with clients face-to-face?” 74% are in support of a requirement for social workers to be vaccinated (58% strongly agree; 16% agree) while 11% strongly disagree, 7.5% disagree, and 7.6% were neutral, or not sure.

The Aotearoa New Zealand Association of Social Workers (ANZASW) also announced their position statement, “COVID-19 vaccine and your professional responsibility” last week. The preamble makes the association’s position clear: “vaccination is a critical part of the Aotearoa New Zealand public health response to the COVID-19 pandemic. Social workers should help to protect themselves, the people they work with, and the wider community by getting their COVID-19 vaccination, unless medically contra-indicated” (ANZASW, 2021).

Many social workers already know they will be required to vaccinate under a mandate and that numerous other agencies will develop their own policies. These mandates are focused on ensuring safety for the people we work with, ourselves and our whānau.

Mass vaccination and vaccination mandates are rational responses to our current crisis. Human rights are important and there has never been any suggestion that individuals would be forced to have a vaccine, or indeed any other medical treatment. However, vaccine mandates are a response to a public health emergency, not a matter of abstract intellectual debate. Tina Ngata notes that  the sequencing of the vaccine rollout (with adults 65+ vaccinated first and the age cohorts initially) means that Māori  have been exposed to misinformation and disinformation for much longer. I have been alarmed to observe sentiments on social work social media sites that show positions formed on the basis of mis- and dis-information. The following definitions of damaging information are useful (cited in Hannah et al, 2021):

  • Misinformation: false information that people didn’t create with the intent to hurt others
  • Disinformation: “false information created with the intention of harming a person, group, or organization
  • Malinformation: true information used with ill intent

A Spinoff article report that a recent paper on disinformation (the TPM report)  reports more disinformation has been detected over the past three months than during the entirety of the pandemic before the delta outbreak. It’s throughout New Zealand and not focused in any particular region. Much of the increase followed the government’s announcement in late October that it was extending a vaccine mandate to cover nearly 40% of all workers. There has been far too much that falls within the misinformation category and even disinformation, promoted on social media sites that seem designed to undermine the massive efforts of health providers and community workers as they employ every skill and resource to counter the fears that have been stoked, often in the communities with the most at stake. This dissemination of information is designed to disrupt, emerge fear and create conflicts in struggling communities and has real downstream impacts in communities where Māori providers are working all the hours, in the words of Tina Ngata:

[misinformation] means Māori have to work twice as hard, and be twice as visible, to combat the issue. That means Māori who are working to protect their communities from covid, and those who are also combatting misinformation or even basic sovereignty that doesn’t align with the misinformation movement – are being subjected to threats, harassment, abuse, and acts of violence.  Tina Ngata

I have also found the invocation of human rights and social justice to oppose vaccine mandates disturbing. As the ANZASW position statement states: “[we respect] social worker’s rights to have their own opinions, however, there is no place for anti-vaccination messages or sharing misinformation or disinformation in professional practice, nor any promotion of anti-vaccination claims, including on social media and advertising by social workers” (2021). In addition to this, a human-rights-based approach has to be much more nuanced than simply covering individuals’ rights to have, or not have, the vaccine. Social workers need to reflect on their knowledge about second- and third-generation human rights, those rights which recognise our connections, common needs and shared aspirations. “Second or third generation rights focus on collective rights and responsibilities, rather than just individualistic rights. When considering the collective benefit of vaccination that it is likely to enable collective health and wellbeing, the benefits to the community become important” (ANZASW Position Statement, 2021).

Finally, Covid-19, and the vaccine campaign, has exposed just how deeply ingrained health inequalities are in Aotearoa as became painfully apparent as the vaccine rollout was faltering in reaching all communities, with factors of geography, systemic barriers, racism featuring heavily and:

There are still pockets of the country where people have to travel extraordinary distances, past clinics who don’t vaccinate, in order to access these services. There are still services who are struggling to get through the complex vaccine accreditation system in order to be able to do this work, and many DHBs are clunky, ineffective machines for being able to adapt to support these services. Māori messaging about vaccinations (including ours) have made inroads but have also, at a national level, come too late and are uni-directional. Tina Ngata

Concerns about the equity aspects of the vaccine rollout pointed to major challenges ahead for public health (Whitehead et al., 2021).The tail of unvaccinated people will be in the most economically deprived regions and suburbs, and those are, for the most part, regions where Māori and Pasifika people live. The maps available on access to vaccination services reveal inequities of ethnicity and geography (National Institute of Demographic and Economic Analysis, 2021).  The combination of low vaccination rates and higher rates of respiratory and cardiovascular disease, means that Māori and Pasifika families will continue to carry the largest burden of ongoing Covid-19 illness and unfortunately likely deaths, as shown in Table 1, a snapshot of current cases and hospitalisations.

 Table 1.

Current Cases and Hospitalisation by Ethnicity (Ministry of Health,13 November, 2021).

Prioritised ethnicity Total cases Percentage of all cases Cases who have been hospitalised Percentage of all hospitalised cases
Māori 2104 39% 95 29%
Pacific peoples 1646 31% 133 41%

Social workers must resist the ideological confusion that is present in some calls for ‘freedom’, especially the cries of ‘my body my choice’, that represent muddled messages from populist leaders whose ideological base is as slippery as an eel, but fundamentally rooted in right-wing beliefs. Many of those arguing most passionately for bodily autonomy, for example, are on record as opposing abortion and supporting ‘conversion therapy’. What we are seeing right now is right-wing populism, predicated on preserving and strengthening the rights of dominant cultures at the expense of others. Scratch below the surface of the calls for freedom and you will see racism.

The populist leader highlights the deficiencies of contemporary democratic systems and claims that he will fix them in their favour—sometimes by disposing of political processes, limiting human rights, and appealing to specific forms of nativism over universalism and globalism. (Voss et al., 2018, p. 113)

What unites people behind populist leaders is often not something positive they have in common, but that they share a mistrust in the elite and see government as being to blame for current frustrations, or they find solace in attacking a common enemy who is seen to be doing the work of a malign state. Voss et al. (2018, p. 113) argue that, “by tapping into the emotions and frustrations of disenfranchised people, logic and facts seem irrelevant”. Rather, false facts, dubious sources, outright lies, and “unethical, amoral, and aggressive and discriminatory behaviour previously not tolerated” are all employed when the leader speaks to the understandable anxiety and fears of people, even when those fears have themselves have been created by the repetitive promulgation of false explanations.

This has been visible in Aotearoa New Zealand when health professionals and community leaders have been attacked while delivering vaccination programmes. Social workers who deeply understand social justice will do all they can ensure that collectivist solutions to our current Covid-19 crisis are employed. We need to start with our core values, care and integrity.

Start with a set of values and principles about care for our children – the people suffering the most from this harmful environment.

Have a goal to build and maintain a robust and healthy information environment that our children can navigate their way through independently. An information environment that empowers them, buoys their self confidence, and aspirations for themselves and our world. And scaffold that. (Jess Berentson-Shaw, 2021)

We are very fortunate to have a strong public health response, and the last few weeks have shown us, almost too late, what Aotearoa New Zealand can achieve when we properly support and resource Māori and Pasifika community networks. While the 90% rate of vaccination of eligible people is a worthy target, as social workers we need to mindful of the people in the tail. So yes vax, but we probably can’t entirely relax.

Nāku te rourou nāu te rourou ka ora ai te iwi – With your basket and my basket, we will sustain everyone.

 

 References

Aotearoa New Zealand Association of Social Workers. (2021). Position statement. COVID-19 vaccine and your professional responsibility. 5 November, 2021. https://www.anzasw.nz/public/150/files/Resources/Guidance-COVID-19-vaccinev2.pdf

Berentson-Shaw, J. (2021, 10 November). Vaccination conversation heroes need real support. Newsroom.

https://www.newsroom.co.nz/jess-berentson-shaw-vaccination-conversation-heroes-need-real-support?utm_source=Friends+of+the+Newsroom&utm_campaign=c33ef10a59-Daily+Briefing+11.11.2021_COPY_01&utm_medium=email&utm_term=0_71de5c4b35-c33ef10a59-88913523

Giovannetti, J. (2021, November 12) NZ’s disinformation surge, The Spinoff. https://thespinoff.co.nz/the-bulletin/12-11-2021/nzs-disinformation-surge/

Hannah, K., Hattotuwa, S., & Taylor, K. (2021). Working Paper: Mis- and disinformation in Aotearoa New Zealand from 17 August to 5 November 2021. Te Pūnaha Matatini; Department of Physics, University of Auckland; Centre for Science in Society, Te Herenga Waka. Retrieved from Auckland, Aotearoa New Zealand https://www.tepunahamatatini.ac.nz/2021/11/09/mis-and-disinformation/

Keddell, E., & Beddoe, L. (2020). The tyranny of distance: The social effects and practice adaptations resulting from Covid-19 lockdown rules. Aotearoa New Zealand Social Work, 32(2), 41–45. https://doi:10.11157/anzswj-vol32iss2id741

Ministry of Health. (2021). August community cluster demographics. By ethnicity. 5 November, 2021. https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-case-demographics.

National Institute of Demographic and Economic Analysis. (2021).  Access to Vaccination Services – University of Waikato. https://www.waikato.ac.nz/nidea/access-to-vaccination-services

Ngata, Tina (2021). Rangatiratanga in the Age of Misinformation. Blog post on Dismantling Frameworks of Domination, Rematriating Ways of Being.

https://tinangata.com/2021/11/05/rangatiratanga-in-the-age-of-misinformation/

Voss, T., Bailey, J. D., Ife, J., & Köttig, M. (2018). The threatening troika of populism, nationalism, and neoliberalism. Journal of Human Rights and Social Work, 3(3), 109–111. https://doi:10.1007/s41134-018-0072-5

Whitehead, J., Scott, N., Carr, P. A., & Lawrenson, R. (2021). Will access to COVID-19 vaccine in Aotearoa be equitable for priority populations? New Zealand Medical Journal, 134(1535), 25-34. https://journal.nzma.org.nz/journal-articles/will-access-to-covid-19-vaccine-in-aotearoa-be-equitable-for-priority-populations-open-access

Note: parts of this blog appear in an editorial for Aotearoa New Zealand Social Work 33(4) November 2021

Photo by Belinda Fewings on Unsplash

6 thoughts on “Holding fast to collectivist values in a health emergency

  1. it is disingenuous of you to confuse ant-vax sentiments with anti-mandate sentiments. They are two entirely different things.

    1. yes they are different but it wasn’t my intention to debate the nuances of positions. I was supporting the mandate as a collectivist strategy that is in keeping with social work values, and both rational and necessary in an emergency situation.

  2. Kia ora Liz and thanks for putting these thoughts and useful links together.

    I’m personally aware of so many Māori health practitioners and iwi based services that are really working overtime to make sure that their communities are safe – and, as Tina Ngata says, starting from a position of inequity so having to work twice as hard.
    As a social worker, I am committed to challenging inequities. Being vaccinated and supporting others who may be unsure to do make decisions which are consistent with our professional codes is something small I can do to support the collective effort.

    The ANZASW has helped us think though a professional position by linking the pou from the Code of Ethics to help us understand what a professional position is.

    https://www.anzasw.nz/public/150/files/Resources/Guidance-COVID-19-vaccinev2.pdf

    It’s nicely summarised here for me – and echoes the message in your piece closely.

    ‘Given the clients that social workers work with have some level of vulnerability or are in a population group less likely to be
    vaccinated, there is a duty of care for social workers to be vaccinated, along with following other precautionary measures, when working with clients face-to-face. Our Code of Ethics states: “we place the
    needs of others above self-interest when acting in our professional capacity”.

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