Introduction by Croakey: Western Australian Indigenous Labor Senator Patrick Dodson tweeted this week he was “beyond worried” about the possibility of COVID-19 outbreaks in the Kimberley and Pilbara regions, saying that the outbreaks in western New South Wales were showing how “the consequences for First Nations communities are devastating”.
Aboriginal and Torres Strait Islander health experts are urging the Federal Government to take urgent action on many levels to ensure communities across Australia are safe, particularly when the country begins to open up.
Below are two articles. In the first, Marie McInerney reports on priorities in the days and weeks ahead.
In the second, Central Australian Aboriginal Congress CEO Donna Ah Chee maps out the risks and responses needed for the Aboriginal and Torres Strait Islander community in Central Australia, estimating that “every 30 people vaccinated has the potential to save a life should COVID-19 spread in the Aboriginal community in Alice Springs”.
Marie McInerney writes:
The Australian Indigenous Doctors Association (AIDA) is calling for a 90-95 percent vaccination rate for Aboriginal and Torres Strait Islander people before Australia can ‘live with COVID’, amid growing concerns about the outbreak in regional New South Wales.
AIDA vice president Dr Simone Raye said the association was “deeply saddened” to hear this week about the COVID-19 death of a 50-year-old Aboriginal man in Dubbo, believe to be the first Aboriginal and Torres Strait Islander person to die of COVID in Australia.
“The Aboriginal community-controlled sector has been working extremely hard to avoid this outcome; it was the news we were hoping we would never have to hear,” Raye said in a statement, offering heartfelt condolences to the man’s family and the broader Aboriginal community in western NSW.
Raye and other Aboriginal and Torres Strait Islander health leaders say the “lesson from this sad outcome” is that Aboriginal and Torres Strait Islander people and communities must be prioritised for the vaccine rollout and other health services related to COVID-19.
AIDA said it was “cautious about the idea of ‘living with COVID’ if our communities cannot be fully vaccinated in accordance with the Doherty Institute modelling.”
If the 70-80 percent vaccination rate is made up of people living in larger cities, “that potentially exposes people in rural/remote areas who may not have had opportunity to be vaccinated,” Raye said.
“AIDA is calling for 90-95 percent vaccination rate for Aboriginal and Torres Strait Islander people before we can ‘live with COVID’,” Raye said, urging also for the Aboriginal community-controlled health sector to be able to take the lead in the vaccine rollout in these communities.
Dr Peter Malouf, a Wakka Wakka and Wulli Wulli man and epidemiologist with the NSW Aboriginal Health and Medical Research Council, told ABC RN’s Breakfast program this week that around 700 COVID cases have been reported among Aboriginal and Torres Strait Islander people in NSW since 16 June, with the majority in western and far western communities such as Dubbo and Wilcannia.
On 1 September, the NSW Government announced that 30 motor homes will be set up in Wilcannia from Monday to help the community safely isolate, given overcrowded housing in the town.
However, Aboriginal and Torres Strait Islander organisations like AIDA and Central Australian Aboriginal Congress are calling for urgent and wide-ranging Federal Government action to make sure that outbreaks like those happening in regional NSW and in Sydney do not put communities elsewhere in Australia, and particularly in remote areas, at risk.
Dr Mark Wenitong, Aboriginal Public Health Medical Officer at Apunipima Cape York Health Council, said Aboriginal and Torres Strait Islander health leaders knew the risk for remote communities like Wilcannia and therefore the need for urgent vaccination rollout.
“Unfortunately there wasn’t enough supply or we didn’t get prioritised, but having said that, there is vaccine hesitancy as well, which needs a much larger communications/ media response than we have done previously,” he told Croakey, raising concerns about the risks of opening up.
“An equity issue may be that if Australia gets to 80 percent vaccine rates and opens up before our communities hit that target, we will be disadvantaged. This therefore requires a major ramp up of both vaccine programs and workforce to administer these.”
Wenitong said there is time in most jurisdictions to “really engage with local leadership and max out the vaccine rollout and get it done faster”.
“This is completely do-able. Also given the unfortunate, now documented mortality for our mob that is associated with this virus, this may drive a higher uptake of vaccine via an increase perceived benefit versus risk,” he said.
Donna Ah Chee writes:
Congress is deeply concerned about the spread of the COVID-19 virus into the Aboriginal communities of Western New South Wales and we express our condolences for those Aboriginal families who are suffering, and our support for the community’s efforts to respond to the crisis.
We can’t talk for everywhere – the situation is very diverse for Aboriginal communities across Australia. However, from our perspective in Central Australia, the issues are as follows.
High vaccination rates require three things: a sufficient and reliable source of the vaccine; a community that has the opportunity and willingness to get vaccinated; and services that have the capacity, and particularly the workforce, to carry out the vaccinations.
Speaking for Congress in Central Australia, we have had a good supply of the vaccines (AstraZeneca and Pfizer) for some time. That has not been our primary problem – though, as above, we can’t speak for everywhere.
However, the second two are impacting on our ability to get Aboriginal people vaccinated in Central Australia.
First, there is a lot of hesitancy about vaccination amongst Aboriginal people in Central Australia. However, there are many reasons for this hesitancy.
For some, there is a historical and understandable distrust of the health system. Others have been confused or made fearful by some of the misinformation about vaccinations and COVID-19 being spread on social media.
However, in our experience there are many community members who are not fundamentally opposed to vaccination, but are adopting a ‘wait and see’ approach.
For this group, the thinking is that that COVID-19 is not here yet so they can wait to get vaccinated. Many also believe that even if COVID does come to Central Australia, we will be able to get on top of it by lockdowns and other measures as has been done in the past and in other places.
This ‘wait and see’ approach is understandable and is seen in non-Aboriginal communities as well – many people in Sydney or Melbourne thought the same before the latest outbreaks of the Delta variant overwhelmed conventional public health responses.
To overcome this hesitancy, we need urgent government support across Australia for:
- community-specific, relevant messaging that hits the mark for Aboriginal people, including messaging in language. Congress and other Aboriginal community controlled health services are vital to be able to deliver this, but governments have been too slow in getting this resourced at a local level and developing a umbrella national campaign.
- well-resourced outreach services that reach people in their homes and communities – we can’t wait for the vaccine-hesitant to turn up at our clinics. Congress has already been implementing these since July, with initiative such as:
- a house-to-house outreach program in Alice Springs town camps from July 2021
- a ‘pop up clinic’ and community engagement at Alice Springs shopping centres from August
- a ‘pop up clinic’ and community engagement at community football finals in Alice Springs in August.
- incentives for people to get vaccinated. These can be:
- financial – many Aboriginal community controlled health services in the Northern Territory, including Congress have introduced or are trialling the use of store / shopping vouchers to encourage vaccination, and these seem to be effective in increasing the demand for vaccinations; and
- non-financial – such as vaccine passports for travel, access to restaurants and sporting events for all citizens (not just Aboriginal people).
In addition, government needs to act urgently to address the third requirement for high vaccination rates (service capacity) with immediate action and resources to address workforce shortages.
Congress is currently refocussing and intensifying our vaccine efforts over the next 6 weeks to increase the uptake of the COVID-19 vaccine.
However, a key limiting factor is the availability of workforce to implement both clinic-based and outreach programs, including Aboriginal community engagement staff, administration staff and especially nurses to deliver the vaccinations.
Because of the urgency of the situation, and because no other health care intervention is as effective as saving lives as COVID-19 vaccination at this time1, we have been forced to redeploy a range of staff from non-critical programs within our comprehensive model of primary health care to enable implementation of our Vaccination Intensive Program.
This is common across many services, especially in remote areas where the COVID-19 pandemic has exacerbated the already existing remote nurse workforce shortage which led to the closure or reduced services from several government clinics in recent times.
Congress has recently written to the Australian Government advocating a number of initiatives that could be rolled out in the medium term, including a new nurse registration category; a Graduate Nurse Program in Aboriginal primary health care; financial Incentives; and exemptions for International Recruitment with the proviso that they work in remote areas and are fully vaccinated.
In the meantime, Government needs to act rapidly to ensure a short-term increase in workforce for Aboriginal communities to support intensive vaccination programs.
This could take the form of:
- an immediate short-term salary subsidy for nurses working to service remote and regional areas to ensure that their remuneration matches that available to them in vaccination and quarantine centres
- an immediate targeted international recruitment drive with appropriate exemptions to enter Australia with quarantine at the Centre for National Resilience (Howard Springs)
- an immediate recruitment drive for retired nurses to work as vaccinators in primary health care for remote / regional areas .
We estimate that every 30 people vaccinated has the potential to save a life should COVID-19 spread in the Aboriginal community in Alice Springs.
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