A top level taskforce has made 54 recommendations to try to turn around the country's "dire" and unfair childhood immunisation rates.
The Immunisation Taskforce was convened last year after the rates for children five and under hit record lows.
Its first report, released today, comes after three deaths from whooping cough this year.
The report highlighted the worst rate in the country - just 34 percent of Māori children in South Auckland were fully vaccinated.
The country's "haphazard" immunisation system was failing them - and other children in vulnerable communities, the report said.
Part of the problem was vaccinators were diverted to the Covid response.
"This caused childhood immunisation rates to plummet. These rates are now the lowest they have ever been and ethnic disparities have further expanded," it said.
But there were large and longstanding ethnic disparities, that existed long before the current decline.
"[The system] meets the personal health needs of individuals with the resources to access care, with little consideration for equity of population needs."
Lower rates among Māori and Pacific children meant their communities were more vulnerable to serious health problems in any disease outbreak.
The large number of recommendations in today's report were aimed at bringing more structure to the system to try to reach every child, no matter who they were.
Some of the suggestions were:
- Training and employing more vaccinators
- Improving rates for pregnant women to protect vulnerable newborns
- Going out to vaccinate children rather than waiting for them to turn up to clinics
- Listening to and using grassroots health providers more
- A national, centrally coordinated system to catch up on current low rates
- A website that parents can access to see when their tamariki are due for vaccination
While it was common to have outreach programmes to vaccinate children who were late for their vaccinations, it would be better to do that to make sure they were vaccinated on time, the report said.
It also wanted to review the role of the Immunisation Advisory Centre.
The centre was the sole funded supplier of vaccinator training and that could be a barrier to making sure there were enough vaccinators, particularly from diverse backgrounds.
"IMAC's role as a sole provider has been associated with low immunisations rates at critical time points and a persistent and increasing ethnic disparity," it said.
The taskforce was convened by Te Whatu Ora but was independent