A rush of government tenders to outsource Covid-19 responses shows who is most at risk as lockdowns end. The 20 per cent who will not be fully vaccinated when states begin to open are not anti-vaxxers but rather the most vulnerable. By Rick Morton.

Exclusive: Australia's most vulnerable ignored in plan to open up

On Thursday, September 16, days after the third Aboriginal person died in the western New South Wales Covid-19 outbreak, the federal government entered into an emergency contract for $275,000 to help boost Indigenous vaccination rates.

The virus had already infected more than 1000 people across the state’s west and north-west population centres – including one-in-six people in Wilcannia – when the federal Department of Health began a four-month partnership under limited tender.

It was granted in a rush, the department said, due to “extreme urgency or events unforeseen”.

For those representing the most at risk in Australian communities – the aged, disabled and Indigenous – this is a particularly galling characterisation.

“I don’t buy that argument that this was unforeseen,” says Damian Griffis, chief executive of the First Peoples Disability Network. “We have been flagging this from the outset. We understand the devastation of pandemics in the history of First Nations people. Australian history tells the story of introduced diseases that led to so much devastation in our communities.”

On almost every measure, Griffis’ remarks are backed by a time line of events that began the same month the novel coronavirus was announced to the world.

Community leaders, such as those from Apunipima Cape York Health Council, were quick to understand the implications of this new pathogen, moving in January last year to make plans for a possible outbreak. In February, Northern Territory Land Councils produced messages in first languages about the virus.

When the harsh reality of the pandemic reached Australian shores in March 2020, Aboriginal and Torres Strait Islander people were identified by the Commonwealth as an at-risk group in the “health sector emergency response plan for novel coronavirus” published the same month.

Less than a year later, Scott Morrison released the nation’s vaccination rollout plan, which included First Peoples in phase 1b, the second most urgent category, and 2a, a category that placed all Indigenous adults in the same cohort of non-Indigenous Australians over the age of 50.

By September this year, with Indigenous vaccination rates still behind the rest of the country, there was a flurry of activity from the Commonwealth in response to apparent “events unforeseen”.

On September 6, the Department of Health entered a nine-month, $770,000 contract with Carbon Creative, led by Birri Gubba man Wayne Denning, for “public relations on Covid-19 vaccine communication targeting Aboriginal and Torres Strait Islanders”. Ten days later it took out another tender with First Nations Media Australia.

Driving these tenders is the realisation that the very people who were to be the highest priority in Australia’s vaccination strategy are the same ones most at risk as the nation begins to reopen.

The University of Sydney’s Professor Julie Leask, an immunisation expert in the school of nursing and midwifery, tells The Saturday Paper there will be two core groups among the unvaccinated: objectors and a complex array of others who may face multiple barriers.

“Even though it is very hard for a lot of us to imagine ongoing access to vaccination being a problem, it will be a problem for certain groups,” she says. “I am really concerned about those inequalities in coverage when we open up at 70 and then 80 per cent in NSW and Victoria.

“We have really failed some of these groups where they were on the priority list to begin with. Disabled people have much lower coverage and that is a failure.”

This week, the Australian government added another $21 million to a contract for Aspen Medical – almost doubling the initial contract value – for its work in running outsourced vaccine clinics for disabled people and aged-care residents.

Eight months after the priority rollout began that work is far from finished. Even as government agencies scramble to complete a job that was meant to be finished months ago, Treasurer Josh Frydenberg revealed this week the Coalition will terminate billions of dollars in ongoing “disaster payment” support two weeks after any state or territory hits the 80 per cent vaccination target for the adult population.

Frydenberg and Morrison’s manoeuvre on income support is designed to force state and territory governments to obey the transition stages in the national plan or risk having to pay for support costs themselves.

Many have argued that the removal of these payments – and below living standard welfare more broadly – is in itself a public health threat.

Antipoverty Centre spokesperson Jay Coonan points out that modelling by the Doherty Institute, which gave life to the national transition plan, does not predict an end to lockdowns even after 80 per cent vaccination targets are met.

“The disaster payments have lived up to their name from the very beginning. Inadequate, confusing and unavailable to millions who needed help, the human cost has been incalculable,” he said in a statement.

“All that happened is those in the poorest communities suffered, ending in more Covid cases, more hospitalisation and avoidable deaths.”

On Monday, the disability royal commission released a blistering interim report about a series of catastrophic and ongoing failures in the administration of the vaccination program for disabled people. Central among them was the decision to deprioritise the vaccination of people with disabilities. The report said the department of health’s “lack of transparency in decision-making in effect denied people with disability the information they were entitled to receive”.

In the NSW outbreak, it is impossible to know how many disabled people who ought to have been in the now-abandoned priority group ultimately wound up seriously injured or dead. The data is not presented in a way that allows proper analysis.

But a senate committee was told on Wednesday that only two-thirds of National Disability Insurance Scheme participants in shared accommodation – one of the key indicators of risk – were fully vaccinated. This figure does not capture every person eligible for the highest priority inoculations.

The discrepancy is worse for Indigenous people. Covid Shield commander Lieutenant-General John Frewen told the hearing that just 29.1 per cent of Aboriginal and Torres Strait Islander people have had a second dose. There is significant crossover between these two communities. Damian Griffis says using the NDIS as a proxy for the number of disabled people needing vaccinations, especially for Indigenous people in remote Australia, is “totally inaccurate and unreliable”. He says: “The NDIS rollout has been an abject failure for our people.”

This week, health authorities told the ABC that increasing case numbers in the Illawarra–Shoalhaven region south of Sydney were mainly a result of the virus spreading through “cluster-style” homes and supported accommodation. These types of so-called “group homes” are almost exclusively used for disabled people with complex and high-care needs.

Federal Health secretary Dr Brendan Murphy, who has overseen the nation’s handling of the pandemic as chief medical officer and now as the top bureaucrat in the portfolio, confirmed to the senate on Tuesday what was reported by this newspaper in May: disabled residents had been left behind so the government could focus on aged care. This is despite both groups being equal priorities under phase 1a of the vaccine strategy.

“There was a shift in the focus to residential aged care and that did increase the pace of residential aged-care vaccinations,” he said. “Certainly, the rate of residential disability vaccinations were significantly slower at that time because of the clear need to get the residential aged-care population vaccinated to save the lives that we have done. But we don’t accept it was a de-prioritisation.”

In the past month, Murphy’s department has published a host of contracts that were finally issued to aged-care providers so they could vaccinate their own staff. The agreements included $700,000 paid to private provider Opal HealthCare and $606,000 to Bupa Aged Care, one of the largest multinationals operating in Australia. Bupa was subject to sustained scrutiny throughout the aged-care royal commission.

About 99 per cent of aged-care staff have now had their first vaccine dose and 86 per cent of residents are double-dosed, according to Frewen. This is six months after the phase 1a rollout was due to be completed.

Now the Commonwealth is boosting its Covid vaccination communication strategies. At the start of September it awarded a $466,000 for “concept testing research” on a Covid-19 vaccination campaign to Sydney-based firm Fiftyfive5. It paid another $770,000 to public relations agency Cox Inall Change for “support vaccine communication work”. The firm, led by Justine Sywak, a former principal media adviser to former Coalition minister Mitch Fifield, now has a contract worth a total of $3.7 million.

As the nation’s two largest states begin to slowly ease restrictions, employers are struggling to navigate a world where some staff will not be vaccinated even after they have had the opportunity to do so.

The Saturday Paper has obtained a presentation from Services NSW, the biggest customer-facing department in the state government, which shows managers grappling with how to proceed.

In this presentation, the Department of Customer Service said “risk assessments” had shown that front-line staff should be subject to mandatory vaccinations by December 1. For other staff, considerations are ongoing about whether the shots will be required.

An employee, who asked not to be named, told The Saturday Paper the leadership briefing on the document made no argument or case for why vaccinations are important.

“Where people don’t want to be vaccinated, or if they cannot be vaccinated, they will just be moved into other roles,” the staff member says. “They kept emphasising that people on staff who are choosing not to be vaccinated are making a ‘very personal choice’ that should be respected.”

In the presentation for leaders, staff were shown a slide with some common issues. One diagram highlights that vaccines are reliable, but this is bookended with the statement: “The information is changing so regularly, it is hard to know who to believe.”

From October 11 in NSW, life will look different, especially for vaccinated people. Victoria is following a similar path with restrictions easing at certain milestones. Other states, such as Tasmania, have indicated they will wait for 90 per cent vaccination coverage before opening to the rest of the country.

Whatever happens, restrictions will be lifted while a substantial part of the population remains unvaccinated.

“I feel very uncomfortable about the way we view some of the most vulnerable people in our society,” Damian Griffis says. “It really reflects badly on us that this is still not fixed and we need to address it now, and urgently, before we reopen. The people at grave risk are the disadvantaged anywhere and I find it difficult to think of any group more outside of public consciousness than disabled Aboriginal and Torres Strait Islander people.”

As Griffis says, it is the oldest, the poorest, the sickest and most disabled who are most at risk from the virus – even after they have received both doses of a vaccine. It is also this group who may not have had access to the vaccine in the first place.

This article was first published in the print edition of The Saturday Paper on October 2, 2021 as "The forgotten number".

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