Para hopuhopu: Co-designing tikanga for wastewater testing

Abstract

Wastewater-based epidemiology, the testing of sewage to detect disease and monitor community health, has become a key public health tool in many countries around the world, especially since the COVID-19 pandemic. However, wastewater testing raises ethical and cultural concerns. In Aotearoa New Zealand, these concerns are particularly relevant for Māori communities. During the COVID-19 pandemic, an absence of consultation with Māori and exclusion of tikanga in public health policies was exposed. Tikanga is defined as a customary system of values and practices that have developed over time and which are deeply embedded in the social context. Kaumātua (elders) are responsible for determining tikanga and adapting it to various situations. In this article we share a research collaboration and describe the building of relationships and dialogue between science institutions and a Māori community with respect to wastewater-based epidemiology. This collaboration between the New Zealand Institute for Public Health and Forensic Science, Waikato-Tainui College for Research and Development, The University of Auckland and kaumātua from Te Kei o Te Waka o Tainui aimed to produce a framework for future wastewater testing activities in Aotearoa New Zealand rooted in Māori values and aspirations. Over the course of three wānanga (discussion sessions), ongoing hui (meetings) and participatory co-design activities, professional and community researchers explored the implications of wastewater collection, testing and data use. Qualitative analysis of wānanga discussions and interviews informed the development of a new tikanga (Māori protocols) framework for wastewater-based epidemiology. Five interconnected priorities form the basis of this framework: (i) building trust and fostering ongoing relationships, (ii) establishing tangata whenua (autochthonous people of the land)–led tikanga, (iii) acknowledging and accommodating the practicalities of tangata whenua involvement, (iv) collaboratively planning for data ownership and sharing, and (v) recognising the capabilities of Māori as healthcare communicators and providers. This framework demonstrates how Indigenous ethical principles and governance can reshape the design and implementation of wastewater-based epidemiology to better support community wellbeing and equity.