Cook Islands study flags access gaps in shift to digital vaccine consent

By Ron Rocky Coloma

A paper form sent home through school can seem simple enough. But in the Cook Islands, health workers say those slips can also go missing, come back late or never return at all, leaving some children without routine vaccinations.

That challenge is behind new Cook Islands research, which found many parents and guardians are open to digital consent for school vaccinations, as long as the system stays simple, secure and flexible enough to include families who still rely on paper.

The study, supported by UNICEF, surveyed community members' views in August and September 2025, following working mothers' earlier that year raising the issue during a human-centered design workshop in the Cook Islands.

“School-based vaccination programs rely on parental consent before any vaccine can be administered,” said Tereapii Nimerota, presenting the results of a survey. The current system in schools is paper-based. Sometimes paper forms can be lost, delayed or not returned.”

That matters because immunization remains a public health priority in the Cook Islands, where missed consent can mean missed protection against vaccine-preventable diseases.

About 70 percent of respondents were female, which Nimerota said likely reflected mothers’ strong involvement in children’s health matters. Most respondents identified as Cook Islands Maori, and the majority were aged 36 or older, suggesting many were parents or guardians.

The findings showed broad support for adding digital options, but not at the expense of paper.

“When asked about community preferences, email was the most preferred method, followed by traditional paper forms,” Nimerota said. “Messaging was seen as helpful, especially for reminders and notifications.”

That points to a hybrid approach rather than a fully digital shift. For Cook Islands families, the appeal of online consent is convenience. For health officials, it could mean fewer lost forms and faster turnaround. But the study also found clear barriers that could slow adoption if those concerns are not addressed.

Nimerota said participants raised issues including unreliable internet, privacy and data protection concerns, limited confidence using digital tools and the cost of data. She noted that 16 percent highlighted an access gap.

“These concerns are important to remind us that not all households have access or confidence with digital tools,” she said.

She added that the digital divide is likely greater in the pa enua, making it even more important that any new system not leave outer island families behind.

That is where the Cook Islands story takes on a wider Pacific angle.

Across the region, island health systems are trying to modernize while working within the realities of geography, smaller populations and uneven digital access. A solution that works in an urban center does not always translate neatly to more remote communities. In that sense, the Cook Islands findings echo a broader Pacific challenge: how to use digital tools without creating new barriers for the very families public health systems need to reach.

The study also found that public confidence in vaccines remains high.

“Most respondents agree that vaccines are important for children’s health and community well-being,” Nimerota said. “There is also strong confidence in the safety of school-based immunization programs.”

She said most participants also felt well-informed about making vaccination decisions, though a smaller group remained neutral or disagreed, indicating there is still room for continued education and awareness.

Trust was another important finding. Respondents identified health services and schools as their most trusted sources of immunization information.

“This reinforces the importance of coordinated communication and shared responsibility between education and health,” Nimerota said.

ADVERTISEMENT

That level of trust could be crucial if the Cook Islands moves ahead with digital consent. Community comments showed that people want any online option to be secure, confidential, flexible and accessible, with both paper and electronic choices available.

Based on the results, the study recommends a staged rollout starting with a pilot, then expanding gradually. It also calls for a hybrid system, strong safeguards around privacy, and platforms that are easy to use for busy families and people who are less comfortable with technology.

Nimerota said digital consent could bring several benefits if rolled out carefully.

“It can enable faster delivery of vaccines, reducing delays by moving away from paper-based systems,” she said. “There are fewer lost forms, ensuring more children are reached. The process becomes easier for parents, saving time and effort.”

In the end, the research does not suggest replacing the old system overnight. Instead, it argues for meeting families where they are.

Subscribe to

our digital

monthly issue