Covid-19 vaccine data highlights cultural barriers for Indian elderly

While young Indian New Zealanders have participated in the country's 'two shots for summer' vaccination campaign and far exceeded health service user expectations, those in the 50 to 64 and 65-plus age brackets have fallen behind, with the latter currently sitting at the ethnic group's lowest rate of vaccination uptake with 98 percent double jabbed.

With a booster shot now in the picture, the rate of vaccination uptake has lowered even further for elderly Indians, with the 65-plus age bracket sitting at just 83 percent triple vaccinated.

RNZ has recently reported on the high rates of vaccinations by Indian New Zealanders.

At present, the ethnic group boasts 106 percent of its eligible population fully vaccinated. But while a general overview of the figures highlights a keenness to get jabbed, breaking the data down by age demographics paints a slightly different picture.

So what is keeping the elderly Indian population from reaching the milestones their younger counterparts have crossed so easily?

RNZ spoke to those working closely with South Asian elderly who say that for this pocket of the community, there may be a number of cultural and practical barriers holding them back.

Nilima Venkat is the general manager of Shanti Niwas Charitable Trust, an organisation that provides culturally-appropriate support services to senior citizens of Indian and South Asian origin.

It was set up nearly three decades ago, at a time when Indian immigration was picking up. Families brought their elders and started acclimating to a new way of life. But while parents looked for jobs and schools, Venkat says the elderly found themselves feeling a little lost.

"Being from the Asian culture, we like to look after our seniors and bring them along with us. But when this sect of people came here, they didn't know where to go, they didn't have access to any services here. And you know, settling in a new country at an elderly age is also very difficult."

Shanti Niwas was then established so the elderly could meet, greet, and build community.

Over the past 27 years, it has grown to five centres across Auckland seeing about 400 people every week.

The list of services they provide are extensive, and largely run with the help of volunteers. These range from exercise programmes, health and welfare workshops, entertainment and activity sessions, technical classes, and even an 'Indian Meals on Wheels' service providing culturally-compatible meals to its patrons.

Venkat has steered the organisation towards providing social services too, including community-based emergency housing, a caring caller and visitor service, and elder abuse and neglect services, with the help of the Ministry of Social Development (MSD).

She has been working alongside the Indian elderly community for years, and knows their needs. When the pandemic began, it came with a host of challenges - but none the team at Shanti Niwas could not deal with. Venkat says a majority of the seniors that came to them weren't opposed to getting vaccinated at all, which for many other communities would have been the very first obstacle.

This was unsurprising to Venkat - she knows that Indians are generally health conscious, and generally trust authority. But more importantly, she knows they've seen what happened to their families and friends back in India last year.

"Every family in New Zealand has known somebody who has passed away or has been affected very badly by Covid. Even my family, I lost about four or five elderly people, seniors. Gone. It plays a psychological part. This is happening back home, this shouldn't happen to us or our family here. And they know that they're vulnerable because of the age group, and other morbidities that come with age. They know it is not good for them not to be vaccinated. I think one of the main contributors was what happened back there. It's fear.

"Most of them were okay with it. There were a few who were hesitant, but I think it came from the families, not from them."

Nonetheless, in early 2021, Shanti Niwas held Zoom sessions with Director-General of Health Dr Ashley Bloomfield to answer any questions the seniors might have had, and to clear doubts on the safety of the Covid-19 vaccine. And once everyone was on board, they teamed up with Pakuranga Pharmacy to hold a mass vaccination event, "so [the seniors] could have it in a culturally safe manner and with all their peers".

Venkat's team organised transport for about 250 people over the course of a week, with Shanti Niwas staff accompanying the group to and from the vaccination site. They served refreshments and made the elderly feel comfortable and informed, and set up the same mass vaccination event again for the second dose. By the end of July, all their seniors were fully vaccinated.

"It all went very smoothly and they were very happy as well, because it does make a difference. We are seeing how Māori are trying to do it in their marae and how they're trying to increase their people, so it is very important that our own people take that step and do it. So that's what we did."

And with the 65-plus age bracket currently sitting at 83 percent on booster uptakes, the vaccination efforts at Shanti Niwas continue on.

Venkat says the elderly can face a lot of challenges when it comes to getting vaccinated, and feeling like they have autonomy over making their own decisions. Practical barriers like transport, mobility and computer illiteracy are common, but Shanti Niwas helps with the admin of it all. But not all elderly know this kind of support is available to them.

"Initially there was a lot of confusion in the booking system, because it's online and ... people had to go and wait there for one-and-a-half, two hours. They sometimes had to go faraway places like Manukau to get jabbed ... transport was an issue. Then because some seniors can't come out of the house for whatever health and mobility reasons, isolation can become a big problem. People didn't take it seriously before but now we've all faced isolation in lockdown, so everybody knows what isolation is. But because we got this mass vaccination, it made it very easy for them."

During last year's 107-day lockdown in Auckland, Shanti Niwas established a range of initiatives to help keep their elders afloat. Volunteers dropped off groceries and repeat prescriptions directly to their homes, delivered ethnic-specific food parcels through MSD's food secure programme, and supported people in managed isolation however possible.

It's all part of Shanti Niwas' objective to "serve older people's needs and ensure they're being valued and treasured by society". Venkat says in the context of a pandemic, getting them vaccinated is key to honouring this ethos, and honouring their wishes too.

"Just as young people want to protect the elderly, the elderly want to protect the young ones. They want protection for themselves and their families. That is our culture. That is the uniqueness of our culture and our family unit. Everybody cares about everybody, and everybody protects everybody."

Shanti Niwas has been operating diligently through the Delta and Omicron outbreaks, providing practical and moral support for elderly Indians to navigate an uncertain time in their lives. While the organisation has focussed on combating those health and mobility hurdles, another community Covid-19 expert has been using his voice to break down one of the biggest barriers impacting this age group - language.

Dr Hari Talreja is a specialist physician at Counties Manukau Health and an honorary senior lecturer in medicine at the University of Auckland. He's been doing regular programmes on the Hindi radio station Radio Apna throughout the pandemic, offering Covid-19 information and dispelling myths around the vaccine. He says that for this age group, things are generally pretty smooth sailing once the communication barrier is overcome.

"Not everybody in that population understands English that well, but the community comes together to provide that information ... I do a programme where we discuss Covid-19 in the local language. I've done messages for the Ministry of Health trying to explain why vaccinations are important and where you get it. Most of the people, they are not hesitant or reluctant. Once they get the message and understand how things work in their language, they've come forward and raised their hands to get vaccinated."

This is usually the case. But Dr Talreja says there have been the odd instances where his patients have come forward with misinformed views too.

"One patient told me, 'I don't want to get vaccinated because after vaccination, your arm becomes magnetic and you might have different metal things stuck onto you'. This was actually a prank played on YouTube, but people who are kind of naive take it too seriously. Another patient told me, 'I don't want to take the vaccine because I don't want to miss work'. I had to explain to him, any time we have an intervention, a medicine, a daily procedure or a vaccination, we always try and see the benefit and the risk. The risk associated with Covid is much, much higher than the risk associated with a vaccine.

"There's no intervention in the world which is risk-free, most of them will have some risk, but it's the balance. There's a lot of misinformation, mainly from social media which I try and address, and I've realised that once you give them the accurate information, once you give them the reliable source of where to look for this information, then I think they get quite convinced."

The way Dr Talreja explains it, it seems that elderly people trust too easily in disinformation, while younger people tend to fall on the other end of the scale, challenging everything they see - including accurate information. It's this misguidedness that entraps the elderly, rather than any real deliberate alignment with misinformation.

"I think it's the younger group which are more active on social media, they tend to have a lot of misinformation around this, in my limited experience, but for the older people it generally tends to be a lack of information, like, 'Okay, can Covid do this? What about the vaccine? Can I be really sick? Can I be in hospital, what are the chances?' Once you provide them this information, then they kind of are relieved, they're more than willing to take it."

And as the data shows, elderly Indians clearly do come around to vaccinations in large numbers, despite various cultural and practical barriers. Dr Talreja says he is pleased with the progress, and indeed the efforts of New Zealand's entire Indian community, but he believes the ongoing booster rollout will require another big push in messaging. Which means as the pandemic carries on, so too does his work for the community.

"My role in this environment is to keep a steady head on my shoulders. I want to advocate, in my own little way, especially to the Indian community because I can speak the language ... I've done videos to promote this, I'm doing the radio programme, I see the patients in my clinic and I'll try and convince them, so this is my tiny way of giving back to the community.

"They've done a really good job. The numbers speak for themselves, even in the age group of 65-plus, more than 90 percent have been vaccinated with the double dose ... it's an excellent achievement. But the job isn't done yet."