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

In this post, we speak to the authors of a recent PLOS Global Public Health article, Māori and Pacific People’s perspectives on Group A Streptococcus vaccine development and delivery in Aotearoa, New Zealand, about the story behind the research. The paper was written by Anneka Anderson, Shivani Fox-Lewis, Cresta-Jane Afoa-Stone, Monleigh Muliaumasealii, Tanya Heremaia, Annie Borland, Stacy-Roa Te Kurapa King, Rachel Webb, Nicole J Moreland and Julie Bennett.

What led you to decide on this research question?

Aotearoa New Zealand is a high-income country. Yet stark and persistent ethnic inequities in Group A Streptococcal (Strep A) disease remain. While much of the global burden falls on low- and middle-income countries, New Zealand has enough resources to investigate these inequities and the responsibility to act on what we learn.

Our multidisciplinary research team is acutely aware of the impact of Strep A disease on Māori and Pacific peoples in New Zealand. These inequities were the starting point for this work and sit within the wider Rapua te mea ngaro ka tau (“Rapua”) programme.

Rapua is a comprehensive initiative focused on strengthening Strep A vaccine development, enhancing laboratory and clinical infrastructure, and centring Māori and Pacific community perspectives in research and prevention strategies (http://www.strepainsights.org.nz).

It was important to us that this piece of research was led and informed by Indigenous people, to ensure that the findings and any future interventions are meaningful and culturally responsive. These values, alongside guidance from Rapua’s Māori and Pacific Governance Groups, helped us to develop and define the community perceptions research questions.

Could you talk us through how you designed your study? What was important for your team as you created the study team?

The study design was an iterative process. The Rapua team brings experience in qualitative and Indigenous research methodologies within Strep A and rheumatic fever contexts, which informed the initial study plan. This draft plan was then presented to the Rapua Māori and Pacific Governance Groups (that include people with lived experience of rheumatic fever) and our Science Advisory Board for feedback and guidance. The plan was then refined to reflect the valuable feedback from these groups, such as ensuring rangatahi (young people) were included explicitly in the research and ensuring representation of Pacific communities, who are most affected by rheumatic fever.

We then piloted the data collection process with community members. This provided insights to the team about how we approached challenging and sensitive topics about vaccination using neutral, non-judgemental language and emphasising that all perspectives were important and valued.

The values that informed our study were centred on creating a culturally responsive research design that prioritised Indigenous paradigms, practices and knowledge.

Rapua’s qualitative research team

What challenges did you encounter during your study?

As with many vaccination-related topics, we were aware that there are a wide range of perspectives around vaccinations within communities. A key challenge was ensuring we could recruit participants to represent a range of diverse views and importantly earn and maintain their trust. Initially, we did encounter some mistrust and suspicion of the research. Grounding the study in Kaupapa Māori research principles that prioritise whanaungatanga (creating and maintaining relationships) was critical. We also drew on our own community networks engaging people who knew us, and to whom we were accountable. This relational approach enabled us to establish trust and integrity and to include a diversity of voices in the study.

Another challenge for us was ensuring representation of different Pacific ethnic groups. At the same time, we followed an equal explanatory sampling strategy to ensure that at least half of the participants were Māori, as the mana whenua (Indigenous people) of Aotearoa New Zealand. Pacific peoples in Aotearoa represent different ethnicities, each with distinct cultures and languages, which made inclusive representation both important and complex.

With help from Rapua’s Pacific Governance Group and the Pacific researchers, we were able to include participants from four different Pacific ethnic groups (Rarotonga, Samoa, Tonga and Niue). However, there were only small numbers of people from each of these groups and other communities were not represented. We acknowledge these challenges created a notable limitation of the study and we hope that further research is undertaken to strengthen representation of Pacific people in this area.

Rapua’s Pacific Governance Group having a tour of the laboratory

What did you find most striking about your results? How will this research be used?

What surprised us most about the results was the collective support of all the participants for developing a Strep A vaccine. Given the diversity of participants’ perceptions of vaccines, we anticipated that there would be people who would not be supportive of this initiative. The research illustrated for us that vaccines themselves were not the concern of participants, for them what was more important was having the choice about receiving vaccines or not. Also important for them was ensuring that the process of vaccine development was done by trusted people and included culturally responsive, ethical, and clinically robust processes. We plan to use these findings to develop culturally responsive, Indigenous led processes for vaccine development and ultimately, vaccine delivery.

The Rapua Team with the Science Advisory Board and members of the Māori Governance Group

What further research questions need to be addressed in this area?

To the best of our knowledge, there is no research that has explored community perceptions of taking part in clinical trials in our setting. We believe this is a gap that needs to be addressed to review and ultimately improve the trial process. Our team is currently exploring this area for communities in Aotearoa New Zealand.

Why did you choose PLOS Global Public Health as a venue for your article?

Strep A diseases are a global health problem that do not recognise national boundaries. Conditions like rheumatic heart disease disproportionately affect Indigenous populations around the world and have become a health priority for the World Health Organization. Our team strongly believes that collaborative approaches are critical to addressing these inequities. Publishing in PLOS Global Public Health allows us to share our research and findings with a broad, international audience, contributing to the global conversation on equitable prevention and care.

Associate Professor Anneka Anderson presenting study results at the Lancefield International Symposium on Streptococci and Streptococcal Diseases, Brisbane, Australia June 2025

The post Behind the paper: Māori and Pacific People’s perspectives on Group A Streptococcus vaccine development and delivery in Aotearoa, New Zealand appeared first on Speaking of Medicine and Health.