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Pandemic responses need to better involve Indigenous communities

Jason Staines writes:

Indigenous communities must be genuinely embedded in the response to any future pandemics and other health emergencies, according to submissions to the Federal Government’s COVID-19 Response Inquiry.

The inquiry has received more than 2,000 submissions from individuals and organisations since it was announced by Prime Minister Anthony Albanese in September 2023. Led by a panel of three, it is examining the Commonwealth’s pandemic response and will make recommendations on improving response measures in the event of future pandemics.

Among the matters to be considered are mechanisms to better target future responses to the needs of particular populations, including across genders, age groups, socio-economic status, geographic location, people with a disability, First Nations peoples and communities and people from culturally and linguistically diverse communities.

Responses from a range of Indigenous organisations across the country highlighted several common themes that the inquiry needed to consider, particularly the importance of Aboriginal Community Controlled Health Services (ACCHSs) in responding to the pandemic and the need to have Aboriginal workers embedded in any response in a genuine manner.

Such embedding of Aboriginal and Torres Strait Islander workers from the outset would avoid a number of the issues identified in several of the responses, such as ineffective communication, inappropriate quarantine and travel restrictions and the effective administering of vaccines.

Key role

According to the Central Australian Aboriginal Congress (CAAC), ACCHSs “played a key role in keeping COVID-19 mortality in Aboriginal communities much lower than that experienced by comparable First Nations communities in other parts of the world”.

This was because ACCHSs integrated community engagement and health promotion, which allowed for comprehensive primary healthcare that was culturally responsive. According to Congress, ACCHSs also advocated for healthy public policy as well as directly providing treatment and support for those with COVID-19, and their families.

Other organisations told a similar story in their responses, with the Queensland Aboriginal and Islander Health Council (QAIHC) saying that close and early collaboration with the local ACCHS was essential “to put the community in the best position when facing a pandemic of this nature”.

Again, this was because such organisations — with their local knowledge, networks and earned trust — were best-placed to serve the needs of their communities. Indeed, the Council noted that at times, the services were undermined when their local knowledge and experience was disregarded to make way for “resources from external agencies, rather than using their pre-existing effective strategies around communication, education, and engagement with their own community”.

The Aboriginal Medical Services Alliance of the Northern Territory (AMSANT) also recommended that ACCHSs and local communities be central to any decisions about which services should continue in the wake of the pandemic and how they should continue during a public health emergency.

Services that should be considered a high priority included “allied health and responses to, and management of, mental health, domestic and family violence, alcohol and other drug use, and social and emotional wellbeing”.

Continuing with the theme of Indigenous involvement in pandemic responses, AMSANT said that any decision-making bodies that will have responsibility for directing a public health emergency response for Aboriginal and Torres Strait Islander communities “must be formed early and include leadership from the ACCHS sector”.

The Aboriginal Health Council of Western Australia (AHCWA) made a similar recommendation, saying that Aboriginal and Torres Strait Islander leadership “must be authentically embedded in all government-led emergency health responses”. It added that the ACCHS sector needed to be recognised as an “essential partner in emergency health responses”. What that would look like in practice is formally including the sector in response plans and recognising them as shared decision-makers.

Funding matters

Building ACCHSs into the system will, however, require more than just good intentions, with the services themselves needing ongoing funding to build – and sustain – the capacity that would enable them to not only deliver comprehensive primary healthcare, but allow them to partner with state and territory agencies.

According to the CAAC, funding the necessary infrastructure, recurrent and staffing costs would be a valuable move in terms of communicable disease control since it would assist in dealing with the ongoing effects of COVID-19, and preparations for future pandemics.

Quarantine measures and restrictions on travel were among the more highly visible – and contested – responses to the pandemic. While much media attention focussed on urban lock-downs, including Melbourne’s extended stretch of isolation, remote communities faced their own challenges.

Among those, according to CAAC, was the high number of Aboriginal people unable to safely isolate at home. Dealing with this situation would require the provision of suitable isolation facilities that could be stood-up at short notice. Such facilities, however, would need to be culturally appropriate, according to the AHCWA, pointing to its success in providing such services in Western Australia.

In South Australia, early cases of COVID-19 were managed by evacuating patients to Adelaide. While this worked to protect the community, according to the Aboriginal Health Council of South Australia (AHCSA), it meant patients were isolated from their support networks, who were unable to join them or to bring much-needed supplies.

A further issue was identified by the QAIHC, which pointed out that the requirement to obtain permission to travel was “triggering for many First Nations people as it drew parallels with needing permits to move between locations in the past”.

Food security concerns

In its submission, the National Indigenous Australians Agency (NIAA) noted a particular challenge faced by remote communities during the pandemic was that of food security.

According to the NIAA, remote communities already face unique barriers when it comes to the range, cost and quality of food and other essential groceries that are available. These range from longer and more complex supply chains, a reduced ability to take advantage of bulk purchasing or storage, seasonal isolation and fluctuating community numbers.

Even in the absence of a pandemic these concerns pose significant challenges to remote communities, but were exacerbated amid the pandemic’s restrictions on movement and constrained supply chains. The inquiry needed to consider the implications of these barriers in terms of planning for future crises, according to the agency.

Concerns over information was another issue that was shared across submissions, with concerns over inconsistent messaging worsening vaccine hesitancy and individuals would being left unaware of various forms of government support available to them throughout the pandemic.

Vaccine hesitancy was a particular worry as it had implications that went beyond COVID-19 and crossed into efforts to control other infectious diseases. To overcome continuing hesitancy, the CAAC recommended governments support ACCHSs to “deliver community-specific messaging, including in local languages; well-resourced outreach services; and incentives for people to get vaccinated”.

The AHCWA had similar advice, saying the Commonwealth needed to resource the ACCHS sector so that it could effectively communicate important health information, particularly during an emergency.

The AHCSA noted the changing nature of messaging throughout the pandemic, which could sometimes be opaque. For example, early debates over the efficacy of masks were unhelpful, as was the changing nature of messaging as new variants of COVID-19 emerged.

Such inconsistent messaging may have led to mistrust, according to AHCSA. This mistrust was heightened by the spreading of misinformation through social media channels, which the council suggested could fall within the remit of the Commonwealth to remedy.

To effectively communicate health messaging, the use of local people to disseminate information that was both in English and local languages was seen as crucial.

Financial supports

The QAIHC also noted that there was limited information about financial support services available to patients. It recommended better public messaging and collaboration with primary healthcare services to assist patients in accessing such supports.

Data was seen as crucial to managing the pandemic, and submissions urged the Commonwealth to build its data-gathering capability, particularly within the new Centre for Disease Control.

This data should be granular, according to the CAAC, delving down to a regional and subregional level in order to better inform local public health responses. At a minimum, such data should include the number of COVID-19 deaths, excess mortality, and rates of long COVID.

The AHCWA recommended that methods for vaccination coverage reporting be reviewed, and Indigenous data sovereignty principles be embedded in the collection, analysis and reporting of vaccination data.

Meanwhile, AMSANT said ACCHSs needed to be provided with public health emergency data ­ including mortality and morbidity data ­ specific to Aboriginal communities in a timely manner. It added that “social determinants of health, community infrastructure and financial support must be addressed to ensure community preparedness for future public health emergencies”.

While noting the challenges, many submissions also pointed to the successes of the response, including the introduction of Medicare Benefits Schedule (MBS) items designed to support and encourage the use of telehealth.

The AHCWA saw this as “one of the major systems benefits” to occur as a result of the pandemic, adding that MBS telehealth items “must be here to stay” in order to enable access to primary and specialist care for Aboriginal people throughout the state.

The inquiry’s panel will deliver a final report to the Federal Government, including recommendations on improving Australia’s preparedness for future pandemics, by the end of September 2024.


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