Introduction by Croakey: The Federal Government’s decision to introduce a ban until 15 May on all flights from India and to enforce it with threatened fines of up to $66,000 and five years’ prison for Australians living or visiting in India has alarmed public health and human rights experts.
Croakey has asked a broad selection of public health experts this week for their responses to the unprecedented move, and what Australia should be doing to ensure its citizens can return home safely.
While some have sympathy for travel bans as a short-term measure to allow the hotel quarantine system to be strengthened, most echo concerns raised by the Public Health Association of Australia (PHAA) in this earlier story at Croakey.
The PHAA said the move placed Australians in India in greater danger, adds to the stresses on India’s devastated healthcare services, and raised serious questions of human rights violations and whether discrimination is a factor.
Health professionals with family ties to India have shared concerns about India being singled out for harsh treatment, compared to Australia’s responses to big COVID-19 outbreaks in the United States and United Kingdom.
“(Australians in India) have every right to expect the government of their country to help them, not criminalise them,” said Melbourne obstetrician Dr Nisha Khot, who wrote last week for Croakey about the COVID-19 catastrophe unfolding in India.
In an article headed ‘Australia tells its citizens in India amid Covid crisis: Don’t come home’, the New York Times reported that the UK, Germany and the US, while restricting travel from India, have exempted citizens and permanent residents, many of whom are rushing home.
Around 9,000 Australians stuck in India are reported to have registered with Australian authorities to say they wish to return home. Australia’s High Commissioner to India Barry O’Farrell has told the ABC there has been a sharp increase over the past week in the number who are suffering financial distress or health problems, from 600 to 900.
In his formal advice on a travel ban, Chief Medical Officer Professor Paul Kelly had reportedly noted potential consequences for Australian citizens and permanent residents as a result of the “pause on flights”.
“These include the risk of serious illness without access to healthcare, the potential for Australians to be stranded in a transit country, and in a worst-case scenario, deaths,” he said.
1. What is your response to the Federal Government’s decision to jail or fine Australians seeking to return home from India? What issues does this decision raise?
Professor Raina MacIntyre, Head of the Biosecurity Research Program at the Kirby Institute
The Government stated this was based on medical advice, but we have heard the Chief Medical Officer has denied this.
We evacuated citizens from Wuhan. We did leave many people stranded in the UK and US, who are still unable to get back, but none of them face threat of imprisonment. The pandemic was severe in all these settings at those times.
There is no logical explanation for selectively imprisoning Indian Australians. There is a human rights issue here, that citizens should be enabled to come home safely and that we should not have different classes of citizens. We can manage this situation by providing evacuation flights and safe quarantine.
Dr Omar Khorshid, Australian Medical Association President
The AMA has called on the Federal Government to immediately reverse the order to fine or jail Australians returning home from India, and to urgently develop and put in place a plan to ensure the safe return home of Australians from India.
We have written to Prime Minister Scott Morrison and Health Minister Greg Hunt, calling on them to commit to the repatriation of vulnerable Australians in India at the end of the current travel ban.
The pause in flights from India to Australia was warranted to manage the risk associated with large numbers of infectious people entering our fragile hotel quarantine system. However, given the exponential growth in infections in India, expatriate Australians there now face a health risk that requires an Australian Government health response.
Rapid escalation of community transmission of COVID-19 in India is exposing Australians to a risk of avoidable illness and death, because of poor access to vaccination, poor or no access to healthcare, and the ban on travel to Australia.
The order to imprison or fine those who might breach the current ban is seen by the medical profession as mean-spirited at a time when Australia should in fact be aiding India by bringing Australians home in order to avoid further burden on their collapsing health system.
The order also sets a precedent in terms of the Government’s willingness to protect Australians overseas that sits poorly with a great number of Australians, including AMA members.
We must be able to uplift vulnerable Australians from India when the current pause in flights is lifted.
Australians stranded in India need our support and the threat of fines and jail should not be hanging over their heads for wanting to come home.
The order to fine or jail Australians travelling to their home country is unprecedented and should be revoked today.
Adjunct Professor Kylie Ward, CEO Australian College of Nursing
The Australian College of Nursing believes health is a human right and all Australians seeking to return home from India should be supported with appropriate aircraft and quarantining in place upon arrival.
This decision raises concerns of inequity and access. Australians seeking to return from other nations like Europe, UK and USA have been able to do so under protocols and guidelines and this shouldn’t differ in this instance.
The Australian College of Nursing is concerned about discrimination, whether actual or perceived, and what this means for our culturally diverse population.
We are concerned about Australians in India as well as for the people of India and their welfare and wellbeing.
Professor Nathan Grills, Public Health Physician and NHMRC Post Doctoral Fellow, Nossal Institute for Global Health, University of Melbourne; Senior Research Advisor, Australia India Institute
It’s probably wise to limit flights from India and my permission was revoked! Many countries are doing the same and Australia was actually slow to invoke such a ban.
But jailing people who return is not needed from a public health point of view. The numbers who would be able to get around the current flight ban are minimal. Our hotel quarantine can cope with those small numbers.
Threatening jail is excessive and may lack compassion on our own citizens who are currently stuck in India. It is also unwise for our bilateral relationship as it could be misinterpreted negatively. Right now India needs positive messages.
(See his recent article on the Indian COVID-19 crisis: https://pursuit.unimelb.edu.au/articles/hope-in-the-darkness)
Dr Nisha Khot, Melbourne obstetrician
India does not offer dual citizenship. Australian citizens travelling to India have to either apply for a special permit or a visa.
Once their visa expires, they are essentially ‘illegal’ immigrants, stateless in one of the most dangerous places on earth right now.
They have done nothing wrong, they have followed the rules, applied for and been granted permission to travel.
Now they want to return to the safety of home. They have every right to expect the government of their country to help them, not criminalise them.
(Read her story published last week at Croakey: https://www.croakey.org/jai-ho-may-victory-prevail-on-covid-19-for-india-with-love-and-compassion/)
Associate Professor Vinay Lakra, Incoming president, Royal Australian and New Zealand College of Psychiatrists
One of the big aspects of the pandemic has been to acknowledge and recognise that this is a global crisis that affects different countries or groups at different times.
There are many people in Australia with connections to the United Kingdom, so when things were bad there, we were thinking about them. Now it is the turn of those of us with family and friends in India.
We don’t know whose turn it will be next, so we need to be kind, towards ourselves and to others.
I have seen reports about the legality of the Indian flights ban, and that a similar one was not put in place for the UK and United States during their worst periods. That’s an important question for the Federal Government to consider, whether it is engaging in practices which are discriminatory.
We all know from our experience that the pandemic can get out of hand very quickly and there is some concern from the government regarding the potential for stressing the current quarantine system.
We should focus on how we are able to strengthen the quarantine system in Australia so that, if people arrive in those flights who are positive with COVID, they can be appropriately screened, appropriately supported, and if some of them become unwell, receive appropriate treatment as well.
It is unfortunate that we have gone into the territory of harsh fines and jail penalties.
As we also saw during the Victorian lockdown, as a country we appear sometimes to be obsessed with the whole issue of fines, rather than focusing on providing health messaging.
I would have preferred a focus from the Federal Government on India’s crisis being an important problem at our doorstep, that as a global citizen we need to offer support, and also to consider what we should do as a responsibility to our citizens, such as strengthening our quarantine program.
From my professional perspective, such decisions as this by the Federal Government will add despair and distress to those who are waiting to return to Australia.
It adds to their psychological distress and mental ill health for them, and also too of course for people living in Australia who have families there. We are distressed and worried.
(See this story from the Australian Financial Review: https://www.afr.com/policy/health-and-education/every-time-the-phone-rings-my-heart-sinks-indians-abroad-despair-20210503-p57ohg)
Danny Vadasz, Health Issues Centre executive director
Every Australian who ever intends to leave these shores now faces the prospect that should they be caught up in an international crisis, they may be refused a homecoming under threat of internment.
From the government that infamously brought you “we will decide who comes to this country” comes the chilling caveat that this now includes its own citizens.
Professor Stephen Duckett, Health and Aged Care Program Director at the Grattan Institute
No comment (this is a constitutional law question).
Professor Fran Baum, Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University.
The issue concerning India is a tricky one – governments have to balance individual rights versus what’s good for the community as a whole.
The pandemic in India is really bad and while we didn’t do this in regard to the US, this may reflect the fact that the government has learnt more about pandemic handling.
I can imagine if they hadn’t introduced the ban and the quarantine system was overrun to the extent that there was an outbreak in the community then they would have been criticised even more than they are in terms of the human rights arguments being made about the rights of individuals. This would result in more lockdowns.
It is a fact of good public health practice that sometime the rights of individuals do have to be infringed in order to ensure community safety. We have seen that in the case of mandatory face masks.
In this case the government also has a duty of care to all the individuals in hotel quarantine. If they became infected because the system couldn’t handle people returning from India then the rights of those people would be infringed.
The case does raise the fact that we need more quarantine facilities like the Howard Springs one, which is much better at preventing aerosol transmission and also enables those in quarantine to go outside, which will be good for their physical and mental health.
The bottom line is that the ban is for a limited period. When the Indian wave starts to show signs of declining then Australians will be able to return home.
[The decision to jail or fine transgressions] seems over the top – public health is best done with nudges rather than coercion and those fines/prisons have become the focus of the debate rather than the need to implement public health measures.
Associate Professor John Allan, RANZCP President
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has called on the Federal Government to consider all options to help Australians stranded in India and in desperate need of help.
There needs to be a humanitarian and compassionate lens placed on this disaster by this government, with urgent action on facilitating assistance to these Australians and bringing them home.
We urge the government to consider new quarantine models to provide for rapid consideration and expansion, ensuring sufficient quarantine capacity in this humanitarian effort.
We need the government to be talking and acting in a way that is constructive and helpful, instead of being punitive and negative, talking fines and jail.
Our fellow Australians are caught in the middle of a disaster. Not only is their health at risk, but the mental health impact of enduring this is going to have long-term repercussions.
We also call on the government to consider what they can do to continue to support the Indian Government and its people during this time of tragedy with whatever resources available, including materials and personnel.
2.What does the Federal Government need to do to ensure Australians can return home safely?
Professor Raina MacIntyre, Head of the Biosecurity Research Program at the Kirby Institute
If we arranged evacuation of our citizens, we can provide quarantine in safe facilities. These should have adequate ventilation and staff working in these facilities should be fully vaccinated with a high efficacy vaccine and provided N95 respirators.
Return travellers should be tested before departing their last port and after arrival and during and after quarantine, and infected people should be removed from the quarantine facility and housed elsewhere with proper infection control.
The quarantine system as a whole has been an important part of our success, but has been subject to leaks because our national guidelines do not accept that the main mode of transmission of SARS CoV 2 is airborne.
While airborne denialism continues, we cannot fix the things that are not acknowledged – ventilation and high grade respiratory protection.
The World Health Organization (WHO) has just updated their guidelines on April 30 to finally accept airborne transmission, so Australia is an outlier in the world today in terms of guidelines.
Safe quarantine facilities can be stand-alone, purpose built, or can be existing facilities, including hotels, which are tested for adequacy of ventilation and have any areas of poor ventilation fixed. This can include portable air cleaners in rooms, open windows, negative pressure rooms and placement of staff in areas that are not at risk of stagnant air.
The virus spreads through inhalation of accumulated aerosols. But our guidelines do not accept this or address this. Ventilation is hardly mentioned, when it is the single most important mitigation measure for transmission.
Dr Omar Khorshid, Australian Medical Association President
The Australian Government should take all necessary steps to get the most vulnerable home, including chartering commercial aircraft or using defence force capability as needed, and commercial flights should resume at the end of the current pause to allow others safe passage home.
Before the pause is lifted, hotel quarantine arrangements must be improved to ensure minimal risk of breaches, particularly following yesterday’s WHO confirmation that the virus is spread through air, rendering some current hotel quarantine arrangements inadequate.
Planning for alternatives to hotel quarantine also must be commenced now, so that Australia is not continuing to rely on imperfect hotel quarantine as the pandemic enters its third year.
Adjunct Professor Kylie Ward, CEO Australian College of Nursing
The punitive approach is not the only approach that the government could consider. The Federal Government needs to do what they have done for Australians returning from other countries, including chartering planes with only these return travellers on board and providing adequate quarantining upon arrival and with all health and humanitarian needs being considered.
This should already be well established.
Professor Nathan Grills, Public Health Physician and NHMRC Post Doctoral Fellow, Nossal Institute for Global Health, University of Melbourne; Senior Research Advisor, Australia India Institute
See our article: https://www.afr.com/policy/health-and-education/how-to-get-australia-s-borders-open-again-20210503-p57oh8
“Australia should be considering a country-specific quarantine regimen ranging from supervised 14-day isolation in purpose-built Howard Springs-type facilities for arrivals from countries with high infection rates, through to short home isolation or even no quarantine for near-zero risk arrivals from low-prevalence countries, such as students from China.”
Dr Nisha Khot, Melbourne obstetrician
The Federal Government should charter flights and bring every citizen who wants to return back to Australia now. We are a vast country, we have more resources available to us than India does, we have had more than a year to prepare.
Increase quarantine facilities, provide quarantine staff with appropriate protection and vaccinate them, and bring stranded Aussies home. They belong here.
Associate Professor Vinay Lakra, incoming president, Royal Australian and New Zealand College of Psychiatrists
Hindsight is a wonderful thing and we could all say that we could and should have brought more flights from India before the second wave started.
But it’s more helpful to try to address the problem at hand, trying to work out ways how we can enhance the quarantine program and how we can safely bring back people because we know they are at risk of adverse outcomes amid already very stretched resources in India.
Danny Vadasz, Health Issues Centre executive director
Our quarantine system must be robust enough to contain infection and our hospital system must be well enough equipped to deal with infection spikes whether the source is domestic or international.
Professor Stephen Duckett, Health and Aged Care Program Director at the Grattan Institute
The Commonwealth Government has clear responsibility for Australians stranded overseas and unable to return because of arrival caps.
The Commonwealth should partner with states to establish specialised quarantine centres, like Howard Springs, to enable a significant increase in arrival caps.
The Commonwealth should offer to share costs 50:50 with the states, with states committing to increase spaces for returning Australians, but also able to allocate places to other target groups, for example, seasonal workers and international students.
Professor Fran Baum, Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University.
The lesson is we seem to need more quarantine facilities and perhaps purpose built ones is better than relying on hotels. But incoming people who are likely to be COVID positive also need to be somewhere where they can easily be transported to acute care if needs be.
This case also underpins the need for stepping up vaccines across the world and ensuring that all countries have access to affordable vaccines.
Australia could support this by supporting the waiving of IP in the World Trade Organisation. Hundreds of Australian health professionals and researchers have signed a letter organised by Médecins Sans Frontières andhttps://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted PHAA supporting this.
See previous Croakey articles on hotel quarantine issues.
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