Increasing Underrepresentation of Pacific Peoples in Community-Based Respiratory Surveillance in Aotearoa New Zealand, 2018-2024.

Abstract

Pacific peoples experience a disproportionate burden of respiratory infectious diseases in Aotearoa New Zealand, and surveillance sensitivity depends on capturing transmission in high-risk populations. Despite substantial post-COVID investment in respiratory surveillance, representativeness for Pacific peoples has not been systematically evaluated. We analysed de-identified data from two national community-based surveillance systems-FluTracking and sentinel general practitioner (GP) respiratory surveillance-from 2018 to 2024. Observed Pacific participation was compared with population benchmarks and non-Pacific participation, and trends by age, sex, deprivation and health district were examined, including Pacific-dense districts. Pacific peoples, who experience a disproportionate burden of respiratory disease, were persistently underrepresented in FluTracking. After a temporary increase in 2020, representation declined by an average of 0.8% per year to 2024 (p = 0.027). By 2024, less than one-third of the expected sample was achieved annually. Pacific participants were disproportionately from less deprived areas. Sentinel GP surveillance showed the lowest density of participating practices relative to Pacific population size in Pacific-dense districts, particularly Counties Manukau and Waitematā. Underrepresentation creates a mismatch between disease burden and surveillance visibility, weakening early outbreak detection and limiting equitable public health responses. Embedding representational equity as a core design principle is essential for effective surveillance and equitable health outcomes.