The study examines whether Pacific peoples are adequately represented in Aotearoa New Zealand's two main community-based respiratory surveillance systems: FluTracking and sentinel general practitioner (GP) respiratory surveillance. These systems play a critical role in monitoring respiratory viruses, detecting outbreaks early, and informing public health responses. 

What the research found 

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• Persistent underrepresentation: Pacific peoples were consistently underrepresented in FluTracking between 2018 and 2024.  

• Widening inequity: Following a temporary increase in participation during 2020, Pacific representation declined by an average of 0.8% per year. By 2024, less than one-third of the expected Pacific sample was achieved.  

• Socioeconomic and geographic gaps: Pacific participants were disproportionately from less deprived areas, while Pacific peoples living in the most deprived communities were underrepresented.  

• Lowest coverage where need was greatest: Sentinel GP surveillance had the lowest density of participating practices relative to the Pacific population in Counties Manukau and Waitematā, districts with some of New Zealand's largest Pacific populations.  

• A mismatch between disease burden and surveillance visibility: Communities experiencing the highest burden of respiratory infectious disease were the least visible within community-based surveillance systems.  

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Why this matters 

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Respiratory surveillance depends on representative sampling. If communities experiencing the greatest disease burden are underrepresented, outbreaks may be detected later and public health responses may be less effective where they are needed most. Representational equity is therefore not only an equity issue but also a fundamental determinant of surveillance performance and pandemic preparedness. 

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The study highlights the need to embed representational equity as a core design principle of respiratory surveillance. This includes risk-based recruitment of sentinel practices, stronger engagement with Pacific communities, routine monitoring of representativeness, and dedicated resourcing to support surveillance in high-burden communities.