Introduction by Croakey: Aboriginal and Torres Strait Islander health experts and leaders are calling for governments to invest in and support an urgent community-led vaccination push into communities across Australia.
Their call comes as governments begin to open up against the advice of Aboriginal and Torres Strait Islander health organisations and leaders, putting many under-vaccinated communities at huge risk.
Marie McInerney writes:
Prime Minister Scott Morrison famously said Australia’s vaccination rollout was “not a race” but now there is a desperate push to get Aboriginal and Torres Strait Islander communities protected from COVID-19 before the lifting of restrictions and borders puts them at grave risk.
Aboriginal and Torres Strait Islander health leaders and experts are urging a huge, community-led, culturally safe “foot soldier army” to go house to house and community to community across Australia.
They say this is necessary to address vaccine access issues, fears, misinformation, and a worrying risk of “out of sight, out of mind” for those communities who have avoided COVID to date, including in many parts of Western Australia where vaccination levels are under 30 per cent.
At Yarrabah, a community just 40 minutes drive from Cairns, where only 25 per cent of the community is fully vaccinated, a big door-knock campaign is underway, led by Dr Jason King, who heads the local Gurriny Yealamucka health service clinical team.
The unvaccinated in his community risk being the “canaries in the mine” as Australia moves to ‘living with COVID’, he said.
“We’re not going to hit 80 percent (fully vaccinated) before February, so that will leave us open for three months to just let it rip,” he said, warning that Australia needs to step up at every level possible to protect Aboriginal and Torres Strait Islander communities.
“Otherwise we are doomed to see what’s happened in places such as America and North America where Native Americans and Aboriginal Canadians have seen high case rates and high death rates in certain tribes over there, which is a tragedy that we want to avoid here in Australia.”
Aboriginal and Torres Strait Islander and non-Indigenous health leaders have been calling on states and territories to open up only after vaccination rates reach 90-95 percent in Aboriginal and Torres Strait Islander communities.
The failure to heed those calls is the latest example of the ‘dying race’ narrative for Associate Professor Lisa Whop, a Torres Strait Islander NHMRC Early Career Research Fellow at Australian National University (ANU) and an epidemiologist.
“I think it speaks to the way in which Australian governments value people’s lives, and I don’t think anyone would deny that they do not value the lives of Aboriginal and Torres Strait Islander people as much as they do others,” she told Croakey.
She said it was “deeply disrespectful” of them to just ‘cherry pick’ the advice they would take from Aboriginal and Torres Strait Islander leaders.
Whop, an award winning researcher on cervical cancer, has just finished 14 days of quarantine in Canberra, after assisting the AUSMAT vaccine rollout in western NSW in response to the devastating outbreak in the region.
In two weeks, via door-to-door knocking, pop up clinics, drive through facilities and a vaccination bus, the teams achieved “just shy of 2,000 vaccines, predominantly to Aboriginal people, and I think most importantly to people who wouldn’t have accessed vaccines (in any other way),” she said.
In one community, by the time her team got to the third house on the street, “everyone was coming out to their fences, basically waiting”, she said.
“People could see their neighbours getting vaccinated, or having that yarn and that created a sense of being vaccinated ‘in my home, my safe space, on my terms’.”
It was resource intensive, spending time with families, talking through their concerns, but it was also “a really culturally safe model”, from the way households were approached and supported through to the clothes the team wore, and to the importance of cultural protocols, for both sets of stakeholders.
History matters
At one Welcome to Country ceremony, a local Elder talked about the community’s history of interactions with governments and health systems and how white government cars used to come to take children from their families.
“We had rocked up in five white Prados,” Whop says. “It helped the team to understand.”
Whop is concerned that the Federal Government is blaming vaccine hesitancy for low rates in Aboriginal and Torres Strait Islander communities, when the real issue she observed was “access to the right information by the right person”.
“They really just want to know: ‘Is this good for me? Is this good for my family?’ Is this good for my community?’
“That shouldn’t be seen as vaccine hesitancy, they’re allowed to ask questions and people are allowed to make an informed consent about why they’re getting a vaccine.”
Targeted misinformation
In many ways the growing emergency for Aboriginal and Torres Strait Islander people is like Groundhog Day for health leaders like Associate Professor James Ward who have been warning since the pandemic first emerged of the devastating risks.
Ward, a Pitjantjatjara and Narungga man who is the Director of the Poche Centre for Indigenous Health at the University of Queensland, is a founding member of the Aboriginal and Torres Strait Islander Advisory Group for the Communicable Diseases Network of Australia (CDNA) and the only Indigenous member of the CDNA.
The Advisory Group is currently meeting weekly with COVID taskforce commander Lieutenant General John Frewen, and a new vaccine drive in more than 200 key communities is showing “promising results” in its first week, Ward says.
Asked if he supports calls for Australia to open up only when we have vaccination rates of 90-95 per cent in Aboriginal and Torres Strait Islander communities, Ward says: “Of course I do, but the reality is that’s probably not going to happen.”
But he says it is “disturbing” that governments are proceeding with opening up when pockets of the Australian population, including Aboriginal and Torres Strait Islander people, “will remain susceptible to COVID outbreaks, COVID hospitalisations and ultimately COVID deaths”.
Ward, an infectious diseases expert, has been shocked at the level of misinformation about COVID and vaccination in Aboriginal and Torres Strait Islander communities.
They have, he says, been targeted by anti-vaccine campaigners in a Trumpian world of disinformation that has played into historical distrust of government and health systems. This is having an “unprecedented” impact on vaccine readiness, which he worries will affect other vaccination programs that Aboriginal and Torres Strait Islander people have previously supported.
“Big stick” messaging about what people will not be able to do if they are not vaccinated has also been a problem for Aboriginal and Torres Strait Islander people, who have been hurt historically by “no jab, no school, no welfare” style policies, he says.
To prevent “terrible and dire consequences” for communities where rates are worryingly low, Ward says governments need to resource “a foot soldier army” – “not the ADF, (an army of) our mob” – to knock on people’s doors, and to properly address misinformation and other concerns with “comprehensive, culturally appropriate messaging across multiple mediums – scaled up, bigtime”.
Valuing expertise
In the first 15 months of the pandemic, there was not a single case of COVID-19 in remote Aboriginal and Torres Strait Islander communities, and not a single Aboriginal and Torres Strait Islander death.
But to date, as outlined by Dr Kalinda Griffiths, a Yawuru woman and epidemiologist at the Centre for Big Data Research in Health at UNSW, the Delta outbreak in New South Wales has led to 3,800 cases among Aboriginal and Torres Strait Islander people, with 450 hospitalised, 50 admitted to intensive care units, and nine deaths, mostly in the west and far western regions.
Those risks are now shifting to other communities, like the Hunter New England region, where every day is bringing a new case for the Awabakal Aboriginal medical service, including “lots of kids with COVID”, says Awabakal CEO Raylene Gordon.
Not being able to vaccinate children under 12 is a big issue for the community. So too is how COVID can spread because of community connectedness and kindship. “So we’re more at risk, just because of who we are and the way we live really,” she says. “It’s really personal for us.”
Gordon does not want to comment on whether the NSW Government has opened up too soon, but she is clear about the risks for her community: “It’s not the right time for us”.
Awabakal, which to date has fully vaccinated close to 40 percent of its 8,000 strong population, has not experienced significant vaccine hesitancy, she said, but the state hub style rollout that has dominated did not support the work that community controlled organisations could and needed to do.
Now, she says the community needs a targeted “family by family” approach, led by community controlled organisations – “we know who is high risk, who is hesitant, who is not”.
But that’s resource intensive and will take “lots of energy” trying to partner with mainstream agencies which are often not culturally safe and bound by bureaucracy, in a system that does not value the expertise of Aboriginal community controlled health services, and where staff are already “burning out”.
She’s confident the Awabakal community can fight off the virus, “but we are going to need some time and some different heads around the table to have a really local response”.
Community leadership
By Friday, Dr Jason King hopes that this week’s vaccination blitz in Yarrabah will have doorknocked all of the community’s 350 households.
There’s a sea breeze, he told Croakey, but it’s still “a huge slog” in 30 degree Celsius temperatures for the teams “rolling up and down every street” in Australia’s largest Aboriginal and Torres Strait Islander community, which is spread over 40 square kilometres, with many remote pockets.
So many factors have played into Yarrabah’s low vaccination numbers, including the “out of sight, out of mind” sense that Queensland has not been at risk like NSW and Victoria.
As well, slow supplies in the early days meant having to rationalise doses for the highest risk in the community.
Then, King said, the changing advice on the AstraZeneca vaccine and how this was announced by the Federal Government “really put us on the backfoot”, leading to a “huge amount of hesitancy” in a community where the average age is 22 years.
He echoes James Ward’s concerns too about misinformation, describing the importance of being able to talk through vaccine decisions with community members.
But that takes time and effort, and needs to be properly resourced, given this “an incredibly fatiguing time” for health workers and that primary health care remains an “incredibly under-appreciated part of the health system”.
With the prospect of interstate and international arrivals to Cairns and the region in the coming months, it is, however, urgent.
“When you’re talking about a community that’s overcrowded, with between eight and 10 people per house, with a high burden of chronic disease, upwards of 60 percent of people, high rates of smoking, obesity…it’s a recipe for disaster,” he says.
Without taking these risks into account with the national opening up strategy, “we’re really putting them to the sword,” he said, urging community, cultural, health, political and other leaders across Australia to “push as strongly as they can to get these rates up as fast as we can, to take this by the scruff of the neck”.
Lisa Whop agrees, urging governments to learn some of the “incredible” lessons that kept COVID-19 out of Aboriginal and Torres Strait Islander communities last year, in terms of quick decision making, resource allocation, and partnerships that people had been trying to form for years.
“We know that COVID will find unvaccinated people,” she said. “So I think that the conversations really now have to be about where are we going, how are we working with local people, and what are our goals. It’s about resourcing, about being adaptable, and it’s about political will.”
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