Introduction by Croakey: More new cases of the novel coronavirus were reported outside China than within it for the first time on Thursday, an unwelcome milestone underscoring that the COVID-19 outbreak has entered a new, potentially pandemic phase.
World Health Organization chief Dr Tedros Adhanom Ghebreyesus has declined to declare COVID-19 a pandemic, yet, and repeated assurances that the virus still appeared containable, with nine countries reporting no new cases for two weeks.
Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems.
It may also signal that we can no longer contain the virus, which is not true. We are in a fight that can be won if we do the right things.”
Dr Tedros made the remarks during a briefing to nations on COVID-19, in which he stressed the importance of preparedness, with the virus certainly having pandemic potential. Australia has endorsed and activated a COVID-19 preparedness plan, and we published an excellent piece on important measures and messages earlier this week here.
National responses should focus on three priorities, the director-general said:
- containing the virus in order to protect more vulnerable countries
- prioritising health care workers
- engaging communities to protect populations most at risk of severe disease
“Every country needs to be ready to detect cases early, to isolate patients, trace contacts, provide quality clinical care, prevent hospital outbreaks, and prevent community transmission,” Dr Tedros said.
In this piece for the Public Health Association of Australia’s InTouch newsletter, and republished here with permission, infectious disease and public health specialists Kristy Crooks and Julie Leask say meaningful, respectful engagement with Aboriginal and Torres Strait Islander populations must be the centrepiece of Australia’s pandemic planning and response, drawing on lessons from previous outbreaks to correct past wrongs.
Kristy Crooks and Julie Leask write:
As China grapples with more than 78,000 cases of the novel Coronavirus – COVID-19 (as of February 27), Australia has been fortunate that just 23 individual cases have been notified to date, and still no deaths.
SARS-CoV-2, the virus causing COVID-19 disease, appears increasingly likely to become a pandemic. Australia has activated an emergency response plan for COVID-19. Now is the time to engage with communities.
Public health professionals are working overtime around the nation, in both managing the current phase and considering the next. One thing they should be doing now is engaging and talking with Aboriginal and Torres Strait Islander communities (respectfully hereafter First Nations) – part of effective risk communication.
Risk communication is a central aspect of infectious disease event preparedness and response. CJD, SARS, Influenza H1N109, and Ebola have contributed to our knowledge of how to communicate about health risk.
Developed after the Three Mile Island nuclear accident in 1979, Risk Communication is defined as:
an interactive process of exchange of information and opinion among individuals, groups and institutions. It involves multiple messages about the nature of risk and other messages, not strictly about risk, that express concerns, opinions or reactions to risk messages or to legal and institutional arrangements for risk management.”
Risk Communication originally grew out of challenging environmental hazard issues, with many working in this distinct field, utilising anthropology, sociology and cultural studies, psychology, governance, and global health security.
They draw on epidemiology, toxicology, microbiology and virology and many other technical fields contributing to risk analysis and management, and will often find themselves practising risk communication.
In 1988, Vincent Covello proposed seven cardinal rules of risk communication (see below). Guiding principles like these are useful because each situation is unique in its contextual and technical considerations.
- Accept and involve the public
- Be honest frank and open
- Coordinate and collaborate with other credible sources
- Meet the needs of the media
- Speak clearly and with compassion
- Plan and evaluate efforts.
We add another: Prioritise engagement with key populations.
Time and meaningful engagement
Key populations such as First Nations communities are more likely to be affected by hazards. They will bear a disproportionate burden of the risk, as they do with seasonal and pandemic influenza, but are generally not those making the decisions.
Potential divides between perspectives of decision makers and communities are larger. Decision makers who are overwhelmed with responding are more likely to base decisions on time pressures and assumptions. Just when decision-makers should be more empirical about their decisions, they become less so when it comes to community perspectives.
Time and meaningful engagement as an investment in health should be the focus – getting the process right will produce better outcomes. Importantly, it will enhance trust with key populations – the most crucial resource in managing health emergencies.
In Australia, the Chinese community has been particularly affected – those who have been caught in China, those subject to onshore and offshore quarantine, those affected economically and socially, such as by racism. Governments at all levels should be proactively engaging with these communities to learn about the impact on them and address these, and the questions people might have.
The omission of First Nations people from Australia’s pre-2009 pandemic plan highlights the need for meaningful engagement with First Nations peoples, creating a space where First Nations voices are prioritised and privileged. First Nations communities have already advised us what effective communication, collaboration and culturally acceptable and appropriate infection control strategies could look like. Now is the time for public health professionals with governments to begin engaging with First Nations communities on the COVID-19 threat, if they have not already.
Centre and value culture
One-way communication during an emergency will almost certainly fail to be fully effective because if people feel they are not being heard, or actively engaged, they cannot be expected to listen. For example, recommendations to stay away from others during a period of isolation or quarantine during a pandemic are often unrealistic because of the nature and realities of family structures and ways of living, and family and community obligations are more important than national health policies.
In terms of listening, there is already much known from previous research during the 2009 H1N1 pandemic and after. First Nations public health professionals and academics have recommended that pandemic planning should:
- be developed early with Aboriginal organisations;
- be flexible to meet local priorities;
- include how to reduce risk in families and in community;
- ensure targeted communication strategies are co-developed;
- have flexible models of health care to access vaccinations and other medical interventions; and
- include a stakeholder engagement plan
In terms of infection control, one team of researchers heard from First Nations communities in eastern Australia after H1N109. They learnt about the importance of:
- Working with the local go-to people
- Clear communication
- Accessible and welcoming health care
- Households and funerals – quarantine realism
- Impact on daily events
Involvement could entail having First Nations people as active participants in a governance capacity at district level creating a space that privileges First Nations voices. This inherently means choosing to listen to other voices less; giving up space and sharing power where First Nations people’s knowledge and voices are prioritised and privileged. For example, Chief Executives of health services could engage with representatives of Aboriginal Community Controlled Health Organisations (ACCHOs), creating a space for engagement, investing time to listen, and sharing knowledge, in an ongoing capacity.
An approach such as this could centre and value culture, address First Nations health needs, and strengthen partnerships between services. First Nations people must be actively engaged at the outset of any public health emergency in planning, response and management, whereby First Nations people make a real contribution, having a real say in defining the issues, suggesting the solutions and participating fully in shared decision-making. Public health responses and actions are more likely to be effective if they are done in a way that reflects cultural ways of knowing and doing.
Now is the time to undo the past wrongs and be more proactive in engaging First Nations peoples to develop culturally appropriate health policy, that values culture, family and community ways.
We need to spend less time on the empty rhetoric of closing the gap. What is needed is action. Action that facilitates active and equal participation in the planning, response and management of public health emergencies, that is supportive of community and strengths-based solutions.
If we take the time to engage with and listen to First Nations people, learn from First Nations communities, we can build stronger relationships and partnerships, and together we can make a difference.
Kristy Crooks is a Euahlayi woman and a PhD scholar with APPRISE‘s key populations research section, at the Menzies School of Health Research at Charles Darwin University
Julie Leask is a professor at the Susan Wakil School of Nursing and Midwifery at the University of Sydney, teaching and researching in risk communication. She was named overall winner of the Australian Financial Review’s 100 Women of Influence in 2019 for her work on vaccination
This piece first appeared in the PHAA InTouch newsletter. You can read it here