On the sidelines of a women's rugby game at Tauranga domain, two healthcare workers huddle in blue ponchos under a white tent. It is pelting with rain, and freezing cold. But the staff from Poutiri Wellness Centre are on a mission: to prevent a looming healthcare crisis.

This time around, it's not Covid-19, but the spectre of the childhood diseases of measles and whooping cough that's driving kaupapa Māori health services across Aotearoa to take their clinics into communities, working wherever they can.

In the Bay of Plenty this month nurses have been on marae, in bowling alleys, even on the ferry to Matakana Island.

In Tauranga South last month, a vaccination hub named Rangiora - funded by a partnership between government and iwi – opened in a mall.

'We're not here by default. We've chosen to be at a location of a mall site so that we can be a part of everybody's day to day, says Ngāti Ranginui chief executive office Mel Tata at its opening. 'The Warehouse, Countdown, Rangiora.”

Even before the pandemic hit, New Zealand's childhood immunisation rates were dire.

In some areas, they're now the lowest they've been in 10 years. The ministry has a childhood vaccination target of 95 per cent, the coverage needed to ensure herd immunity.

But the national immunisation rate for six-month babies is around 75 per cent. And for Māori babies that rate is only 55 per cent.

Take-up rates are worst in remote areas like the Western Bay of Plenty, where poverty, historic mistrust of the health system among Māori, and rampant misinformation have combined to create a huge challenge for clinicians.

'For us it's almost a perfect storm,” says Te Puke's Poutiri Wellness Centre CEO Kirsty Maxwell-Crawford.

'In the last two years, parents have struggled to access primary care, people are swamped by Covid, they have immunisation fatigue… and in the middle of that they're trying to put food on the table and keep the power on.”

Babies are supposed to get whooping cough jabs at six weeks, three months and five months, while the two MMR doses for measles, mumps and rubella are given at 12 months and 15 months.

But Maxwell-Crawford says when people are so busy, or don't have secure housing, or access to a car, those targets have little meaning to people's lives.

'We realise that when families are stretched, keeping to a vaccination schedule is not a priority.”

Vaccine hesitancy is also rife in remote communities, and has become noticeably worse since vaccine mandates were introduced amid the Covid-19 outbreak.

Each week, Maxwell-Crawford and her team visit schools, to talk to leaders about what Poutiri can offer, ranging from clinical support, to social services.

Previously, this health check-ups would have included a vaccine check for students.

'But it's got to the point where some communities don't even want us to ask families if they want immunisations,” she says.

'Schools impress, over and over again, that families are over it, they don't want to hear about it, they don't want to be told they're overdue.”

When families expressed such views, health workers had to take note and be guided by them, says Maxwell-Crawford.

'If you're push, push, pushing an agenda, families just stop engaging. They will walk away.

'Instead we have to listen, build a relationship, and then we hope families will become more open to a conversation.”

'Yes we need MMR and whooping cough vaccinations, but the way we are going about it is putting people off,” she said. 'For us, it's about hearing and responding to families' priorities.”

Immunisation Advisory Centre director Nikki Turner says she's deeply concerned about a potential measles epidemic, particularly with the border opening, and about whooping cough because New Zealand was 'due” an outbreak.

Whooping cough, which was particularly dangerous for youngsters, with more than half of babies under one needing hospital treatment, reared its head about every 4-6 years, she said.

Turner says to get immunisation rates up, building trust is extremely important, as are flexible, practical outreach services – rather than relying on the traditional model of running clinics 9-5.

'You need families engaging with the right providers.

'But outreach services have always been underfunded. That needs building back up again.”

Bay of Plenty health district's Brent Gilbert-De Rios says it has learned lessons from the Covid vaccination roll-out that it is now applying to a broader vaccination push.

Part of that is funding providers like Poutiri to do what they did best.

'We believe in supporting providers who have long-standing relationships with whānau and communities to help people overcome mistrust of immunisation,” he says.

Maxwell-Crawford says while the challenge ahead of the health practitioners is daunting, it's not insurmountable.

'We will chip away and focus on families. Some of this is unpicking six generations of growing mistrust,” she says.

'In some ways, it's exciting. For the first time the government is allowing us to be innovative – we've never been able to get on a pahi and ask the community what they want, and go and deliver it to them. That is exciting for us.”

-Stuff/Kirsty Johnston.