Tuberculosis (TB) has many known risk factors that allow persistence in many countries, particularly developing countries in the Pacific. Aotearoa New Zealand as a high-income country by World Bank standards is fortunate to have low incidence rate of 6.3 per 100,000. However, TB incidence is more common in particular ethnic groups of the population. The Pasifika population in New Zealand exhibit unique set of vulnerabilities that increase susceptibility to the disease due to two main factors. The first is the fluid movement to neighbouring Pacific Island countries that have higher TB prevalence, which can increase exposure to TB. This can result in Latent TB infection (LTBI) or active TB. The second factor that contributes to Pasifika vulnerability is the high prevalence of both communicable and non-communicable diseases in the communities (and social determinants of health that influence these disease rates, such as, housing and access to appropriate health care) that increases the risk of LTBI activation to active TB.
There is one licensed vaccine widely used to prevent TB called the Bacillus Calmette–Guérin BCG. The World Health Organisation recommends BCG inclusion in neonatal vaccination schedules, depending on the TB epidemiology of the country. Many high prevalence countries in the Pacific have been recommended to administer one dose to all neonates. However, low prevalence countries, such as New Zealand, can focus vaccination on high risk groups only, through recommendation by healthcare professionals to parents. Recommendation is based on specific eligibility criteria, meaning that Pasifika children born in New Zealand are not necessarily entitled to BCG vaccination. Considering their unique set of vulnerabilities, this is a disadvantage for the Pasifika population. Therefore, this study aims to inform improvements to the BCG vaccination programme in New Zealand, and to TB prevention efforts in general, to reduce TB disease burden among the Pasifika population for more equitable outcomes. This will be achieved through a mixed methods study involving a quantitative observational study and a qualitative interpretive descriptive study. The overall study will draw from a Pasifika research worldview, utilizing Te Kora as a framework.
