We’ve all grown tired of lockdowns, border closures and other restrictions. So the promise of a freer life, when 70 per cent, and then 80 per cent, of Australians aged 16 and older are vaccinated, feels like a beacon on the horizon.
Prime Minister Scott Morrison, some premiers, and leading public servants have promised us that at 80 per cent we can live ‘safely’ with COVID-19, or come out of our “caves” in the PM’s parlance.
The narrative is one of ‘Team Australia’ and we are ‘all in this together’.
But are we really?
Risks of COVID-19 infection, serious disease and death are not equitably distributed. They disproportionally cluster among the most disadvantaged.
Vaccine access and uptake is also lower in many disadvantaged groups.
Opening the country at 80 per cent without ensuring these groups have met or exceeded those targets will result in substantial avoidable illness and death.
Who is most vulnerable to serious disease?
The risk of serious COVID-19 complications and death is related to ‘clinical vulnerability’, such as whether the person has underlying health conditions like diabetes or respiratory disease.
First Nations Australians, disabled Australians, prisoners and people living in rural and remote Australia have much higher levels of chronic conditions, which have their roots in social and economic disadvantage.
On top of their clinical vulnerability, these groups face multiple barriers to accessing quality health care, including intensive care.
These barriers might include lack of physical access, discrimination, an inability to access culturally competent care, and/or geographical distance.
What have we learnt from other countries?
Across the world, COVID-19 infection rates have occurred at higher rates in aged-care facilities, disability group homes and institutions and jails.
Besides aged-care residents, Australia hasn’t yet seen the high death rates in clinically vulnerable groups that other countries have witnessed.
COVID-19 infections are more common in disadvantaged areas, both in Australia and internationally.
Residents in disadvantaged communities are more mobile, live and work in close proximity to other people, and are more likely to be essential workers who can’t work from home.
These areas also tend to have high populations of ethnic minorities and migrant communities.
Victoria’s second wave included outbreaks among residents and workers in aged-care facilities, along with outbreaks in health care, meatworks, and disability group homes.
In NSW’s current wave, outbreaks are spreading rapidly in First Nations communities in western NSW and in prisons.
Who is getting vaccinated? Australia’s vaccine rollout strategy prioritised people at most risk of serious disease and death from COVID-19.
Phase 1A included aged-care and disability group home residents and the workers who support them.
In Phase 1B, First Nations Australians over 55 years and people with disability and/or with chronic health conditions were eligible.
People prioritised in these phases were meant to be vaccinated by April.
More recently, all participants in the National Disability Insurance Scheme and Indigenous Australians 12 years and older became eligible.
Prisoners are not explicitly included as a priority population.
But the strategy came without an implementation plan, and vaccination levels are appallingly low in many groups. Vaccination rates are substantially lower among Indigenous Australians than the rest of the population in every state and territory, except Victoria.
In western NSW, where COVID-19 is rapidly spreading through First Nations communities, 11.6 per cent of Indigenous Australians are fully vaccinated compared with 28.9 per cent of non-Indigenous Australians.
Information about vaccination rates among disabled people and workers are not routinely shared, and tend to be leaked to the media.
On August 22, for example, the Sunday Age revealed just 27 per cent of NDIS participants were fully vaccinated, lagging behind the national average.
No targets yet for vaccinating vulnerable groups
Until now, we have relied on public health measures to contain the spread of COVID-19. If we relax these and move quickly to rely mainly on vaccination, without ensuring equitable delivery, those most at risk will face a disproportionately greater burden of serious illness and death.
♦ First published in www.theconversation.com. Authored by Professor Anne Kavanagh (University of Melbourne), Professor Helen Dickinson (UNSW) and Professor Nancy Baxter (University of Melbourne).