A Northland emergency doctor has issued a confronting warning to the people of Northland - Aucklanders are coming with Covid and it might not be pretty.

Concerned Northland emergency medicine specialist Dr Gary Payinda is pleading with people to get vaccinated now before its too late and says the political decision to lift Auckland's border in mid-December will come at a cost to people's health and lives.

"To my Whangārei and Northland patients, especially tangata whenua: Dec 15 is when Auckland will empty out into Te Tai Tokerau. Bringing Covid," his Tweet read.

"By mid-January, it is highly likely people will be dying who didn't need to. Mask up indoors. And get vaccinated with that first shot by 1 Dec at the latest so you have at least some protection. Protect your whanau."

Payinda, who works at Whangārei Hospital as an emergency doctor and is the medical director for Surf Lifesaving New Zealand, told the Herald he posted the Tweet because he was worried especially with Northland's vaccination rates being low and dangerously so when it came to Māori.

With only 83 per cent of the eligible population having its first dose and 73 per cent fully vaccinated, Northland has the lowest vaccination rate in the country.

He blamed poverty, misinformation and a lack of access to the vaccine for creating a "perfect storm" that had resulted in the incredibly low vaccination rates in the region.

And despite the protections the Government said it was putting in place to safeguard more vulnerable communities such as Northland, Payinda believed presenting a negative test or being double jabbed wouldn't be enough to stop extensive community spread when Auckland's border lifts on December 15.

"We should have required it to be double vaccination and a negative test if we were serous about protecting, rural, remote, deprived and under-vaccinated communities."

He said the decision to open Auckland up by Christmas was political and there would be a cost paid in terms of hospital illness and death for that decision.

"It's getting to crunch time and Covid is going to spread quite quickly through all of our communities up here especially the less vaccinated ones, the more remote ones, the ones with less access to care."

His message to anyone sitting on the fence right now waiting to see how it goes, was they had more than a year to do that and they had to understand that New Zealand was no different to any other country that faced Covid and it would affect a number of people.

Payinda said the vaccine was a "no brainer" as it reduced the need for hospitalisation and the chance of dying by 90 per cent. It also significantly reduced transmission.

His own DHB's predictions for January "weren't pretty" and while he didn't release it on its behalf, he expected the national figures to be "multiple times" more than the daily 200 or so cases they were now.

Northland DHB's capacity was already stretched some days and was facing "chronic and entrenched issues" so adding Covid into the mix was not going to be a situation that anyone wanted, he said.

Northland needed more vaccination centres run by locals and the vaccine needed to be compulsory.

"We've missed an opportunity for people to understand that vaccinations are not only about you, they are about the entire community, they are about protecting all of us," he said.

"The reason we have all of these protests right now is because people have not seen the reality of how bad Covid was and how extensive Covid deaths can be when you leave it up to people to decide whether they want to take public health measures or not.

"Your personal decision not to do something is wonderful as long as that decision doesn't go on to hurt or kill and hospitalise others."