Communicating COVID-19

It was overwhelming, say immunologist Dr Chris Puli’uvea and virologist Dr Natalie Netzler. 

The New Zealand Association of Scientists (NZAS) had called to say the pair had won New Zealand’s most coveted science communication prize, the 2023 Cranwell Medal, for their community engagement during the COVID-19 pandemic. 

“It was such a privilege and an honour,” Netzler says. 

We all remember the dark days of the COVID-19 pandemic — the fear and the lockdowns, the loneliness, and perhaps the losses of those we loved. The quiet cities. The variants and the vaccinations. Working from home, the toilet paper wars.

Those days are still raw, and of course, COVID-19 is still with us.  

Puli’uvea, who is Tongan, was then a PhD candidate at the University of Auckland. Netzler is Māori and Samoan and a senior lecturer also at the University of Auckland. Neither set out to win the prize, they were simply responding to the Māori and Pasifika communities’ need for unambiguous, factual information on the disease, and on the vaccinations under development. Pasifika communities are people of Pacific ethnic origin living in New Zealand.

By the end of June 2021, both researchers had been fielding COVID-related questions from family and friends in their Pasifika and Māori communities for months. “What’s this new vaccine?”, “Why get vaccinated” “Is it safe?”, “What do we do?”

New Zealand’s often-cursed ‘tyranny of distance’ and government policy were working in the country’s favour — by then, there were just 2741 cases, and 31 people had succumbed to the disease. Globally, the picture was dire, with about 180 million cases and almost 4 million deaths. The US Food and Drug Administration’s approval of the first COVID-19 vaccine — Pfizer BioNTech, on 23 August — was then still almost two months away. 

Then Puli’uvea and Netzler received invitations to talk at the Inaugural Pacific People’s Fono (meeting), held In Auckland in June 2021. The conference, hosted by Māori and Pacific Island researchers from the Universities of Auckland and Otago, discussed research into issues affecting Pacific peoples.  

Subjects ranged from antimicrobial resistance to drug development, traditional medicines, and COVID-19, with Netzler covering vaccines and PuIi’uvea, the immune response. Researchers also focussed on correcting misinformation and disinformation, says Puli’uvea. The hall was packed with a broad cross-section of Auckland’s Māori and Pacific communities, including community organisations, nurses, midwives, clinicians and doctors.

Puli’uvea and Netzler were flooded with questions. Netzler says that the response showed the community’s appetite for answers — “they were really struggling to find a touch-point that was relatable, where they could get the answers that they needed,” she says.

Multiple invitations followed, and more talks were given, at community groups and organisations in Auckland, and online — more than 60 events: videos, webinars, Tik Tok and Facebook ‘Lives’, reaching into Māori and Pasifika communities in New Zealand, Australia and throughout the Pacific, says Netzler.

The videos, on how vaccines work and getting vaccinated, were created because the pair couldn’t keep up with demand, says Puli’uvea. Many of the face-to-face and online events were set up by Youth Horizon’s (Kia Puāwai) Pasifika Principal Advisor, Synthia Dash, with the first aimed at Kia Puāwai’s Pasifika and Māori frontline staff, 90% of whom were averse to vaccination.

Dash knew that Netzler and Puli’uvea had the necessary cultural competency and humility to sensitively frame the information without stepping on the cultural and religious beliefs holding staff back from vaccination. Proportions reversed after 6 months of work, with 90% taking the needle. “What we wanted was to answer specific questions and make sure that people felt like it was a two-way dialogue, so they were empowered,” says Netzler. At one of those meetings, she continues, a guy got up and said: “I’ve never seen a scientist that looks like us, before.” 

It’s what you say

Science is full of jargon — converting the language of COVID-19 into understandable English was, and is, a challenge in itself. Translation into meaningful Māori, Tongan, Samoan, Niuean and Tuvaluan, adds further complexity, particularly as there are often no equivalents for the terms needed.  

The researchers’ presentations were translated into these languages through a range of organisations. A partnership with the Moko Foundation delivered the English-Māori translation, and Puli’uvea did the Tongan translations. He would often ‘Tonganise’ a word to make it flow within a sentence in that language. ‘Antibody’ would become ‘antipoti’, ‘lockdown’ would become ‘lokatauni’’, so that the Tongan community could relate it to the English word when they came across it, he says. “Immune system became ‘sisitemi malu’i’. ‘Malu’i’ means ‘to protect’”.      

At one of those meetings, a guy got up and said: ‘I’ve never seen a scientist that looks like us, before.’

Dr Natalie Netzler

Puli’uvea and Netzler also made extensive use of analogies. One of Netzler’s favourites involved going to war with the virus, and comparing the vaccination to a fire drill. Antibodies are the weapons, she’d say, and the vaccine is like a fire drill, teaching your body how to fight off the virus before it brings the house down. Viruses, like fires, can get away on you, she’d continue, and become uncontrollable. “If you’ve had a vaccination, your immune response has been trained and can quickly ‘quench’ a real infection before it brings the house down”.

In addition, Puli’uvea says Māori and Pasifika communities are showing a lot of interest in the publication of a dictionary of medical terms in their languages. “We don’t need to wait for a pandemic for this to happen”, he adds. “We need medical terms and their Māori and Pasifika translations, to improve communication between communities and local medical professionals.”

Some lists do exist already — April 2020 saw the release of a list of Māori terms for COVID. 

Community drivers 

It’s not merely the need to understand concepts which drives these communities. 

Data are hard to come by, but the New Zealand Medical Journal  reported that Māori are 2.5 times, and Pasifika 1.8 times, more likely to die of a COVID-19 infection than European New Zealanders.  

A variety of issues contribute, including multigenerational living which tends to overcrowding because of the lack of suitable housing, and poverty, which exacerbates access to health care.

We need medical terms and their Māori and Pasifika translations, to improve communication between communities and local medical professionals.

Dr Chris Puli’uvea

And there may be genetic reasons. The gene, LZTFL1, has been associated with a two-fold increase in respiratory failure in COVID patients. A variant of this gene causes shorter villi in the upper respiratory tract in some Southeast Asian populations, which means that the virus spreads more easily into the body, resulting in severe disease, says Puli’uvea. 

That gene is slightly different in Māori and Pacific people, and Puli’uvea is currently exploring linkages with disease. “If the variant is associated with severe illness, we can prioritise carriers for vaccination”, he says. “We detected more than 2000 unique genetic variants in Māori and Pasifika people, that were virtually absent in other populations. Some of these unique variants occurred in up to 30% of the people sampled”, he adds. 

Puli’uvea and Netzler continue to drive health literacy and empower Māori and Pasifika communities. As Netzler said, “Chris and I were really honoured with this medal, but there was such a group effort, involving a lot of partnering with a lot of people, including churches, charities, schools, and other organisations.”