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Leaked documents show Covid-19 infections among Indigenous people are almost double the national average. By Rick Morton.

Exclusive: Government documents reveal Indigenous infection rates

Brooke Johnson holds her son Christopher while a NSW Health worker takes a Covid-19 swab in Wilcannia.
Credit: Matthew Abbott

Aboriginal and Torres Strait Islander people have been infected with Covid-19 at a rate between almost two and three times higher than that of non-Indigenous Australians, according to confidential briefing papers from the federal government.

The analysis of vaccination and infection rates, provided to the Aboriginal and Torres Strait Islander Advisory Group on Covid-19 this week, is marked “in confidence: not for further distribution” and provides the clearest picture yet about critical failures across multiple levels of government.

Now, as the two most populous states, NSW and Victoria, begin to ease restrictions, the woefully low vaccination rates among First Peoples generally and especially in some communities pose a real threat to the lives and wellbeing of those for whom the priority vaccination effort has been anything but urgent.

“I don’t think it is appreciated how much it is hitting the community already,” Dr Jason Agostino, a medical adviser at the National Aboriginal Community Controlled Health Organisation, tells The Saturday Paper.

“We’ve now got that outbreak blowing up in the [NSW] Hunter/New England area and on top of that, you know, people aren’t talking about the ACT, where Aboriginal and Torres Strait Islander people make up 10 per cent of the cases.”

Nationally, the rate of infections per 100,000 population for Indigenous people since the start of this year is 503 compared with 301 for non-Indigenous Australians. Almost all of that has been due to the outbreak in NSW, which added more than 4000 Indigenous Covid-19 cases to the nation’s tally. The ACT recorded 122 and Victoria 150.

But the rates are worse when considered against age brackets. The confidential briefing paper details shocking statistics about the age breakdown in cases, partly owing to the historically skewed age profile of Aboriginal and Torres Strait Islander people as a consequence of ongoing colonialism. Nationally, the most affected age group in this cohort is 30- to 39-year-olds with 708 cases per 100,000 population, almost double the rate for everybody else.

In NSW, however, this age bracket has an infection rate of more than 2155 cases per 100,000, more than three times the rate for non-Indigenous people of the same age.

In children aged 11 and under, the rates are more than double non-Indigenous Australians.

About 80 per cent of all Indigenous infections are in people aged 39 and under, with the largest single group being children from birth to age nine, closely followed by preteens and teenagers.

Among these childhood groups, 62 were hospitalised and four ended up in intensive care. For young adults, 174 were hospitalised with 10 in ICU. Put another way, 6 per cent of Indigenous children aged under five who contracted Covid-19 were admitted to hospital. Eight per cent of 16- to 17-year-olds and 12 per cent of those aged between 18 and 29 were hospitalised.

For Indigenous people in their 30s, 14 per cent of those infected were admitted to hospital. For those in their 40s, 18 per cent were hospitalised.

The proportion of Aboriginal and Torres Strait Islander people with Covid-19 aged in their 40s who died was 1 per cent, higher than the “less than 1 per cent” recorded for the whole age group in NSW. For those in their 50s, Indigenous people died at twice the rate as their peers – at 2 per cent. Looking nationally, the death rates are even worse.

“So, when you do comparisons by age groups you see that for that 40-to-60 age group where vaccinations are lower and Aboriginal and Torres Strait Islander people have that early onset of chronic diseases, the rate of death is around three times that of non-Indigenous people,” Agostino says.

He says there are new treatments available such as sotrovimab, which can be administered to people with even very mild cases of Covid-19 that are likely to progress to severe illnesses, but it must be done within five days of infection. The Australian government purchased an initial 7700 doses of the novel monoclonal antibody and access is available, although it requires an intravenous infusion.

“Really, getting tested early is particularly important now,” Agostino says. “Delta has infected Aboriginal and Torres Strait Islander people at almost twice the rate of non-Indigenous people during lockdown and so it is really worrying to think what is going to happen with lower vaccination rates and [when] we’re not in lockdown.”

The briefing paper, circulated on Wednesday, provides a glimpse into the ongoing struggle to lift vaccination rates ahead of likely further outbreaks.

“Acceleration of the vaccine rollout for Aboriginal and Torres Strait Islander people continues,” the paper says.

“The National COVID Vaccine Taskforce is working with stakeholders across 5 jurisdictions to initially prioritise action in 30 LGA’s (local government areas) and communities (20 urban and 10 remote) in order to reach 80 per cent vaccination coverage by the end of October.”

That 80 per cent figure references first doses only.

Across the country, the worst regions for Indigenous vaccination are almost all in Western Australia and Queensland. In the East and West Pilbara, for example, just 22 per cent of the 7200 Indigenous people have had a single dose of a Covid-19 vaccine. In Queensland’s Kuranda (East) and Tablelands region, first dose coverage is below 27 per cent.

These results are partly because both states have avoided widespread Covid-19 outbreaks which, experts agree, has contributed to lower vaccination rates across the entire population. But even within the states where there are higher vaccination rates there is wide variation.

NSW is due to hit the milestone 80 per cent double dose vaccination as early as this weekend. In areas such as the Richmond Valley, Inverell-Tenterfield, Kempsey-Nambucca Heads, the Clarence Valley and Moree-Narrabri, Indigenous first dose vaccination rates are still between 50 and 65 per cent. The regional vaccination breakdowns in the data do not include double dose values, which will necessarily be even lower.

In Victoria, from the Latrobe Valley, Shepparton and Mildura to Gippsland (East) and the Grampians, between 48 and 68 per cent of Indigenous people have had one dose of a vaccine.

Covid-19 vaccination taskforce commander Lieutenant-General John Frewen told a senate committee hearing on Thursday morning that the “vaccination of Aboriginal and Torres Strait Islander people” was his “No. 1 priority”.

“Progress will be incremental,” he said, “but we remain committed to working community by community to get this done.”

Committee chair Katy Gallagher asked Frewen why, 18 months into the pandemic, “specific interventions around accelerating vaccine seems to have occurred in the last six to eight weeks?”

The military commander conceded that urgency in the vaccine strategy has been “driven by the outbreaks in western NSW” and only in the past three days have rays of hope been visible in the program.

“So for the over-16 cohort nationally we are now at a first dose rate of 73.6 per cent and the fully vaccinated rate is 65.4 per cent,” Frewen told the hearing.

“Overall, in Indigenous communities we are at first dose rate of 57.5 per cent and 42.3 per cent double dose. So it’s a pretty, pretty wide gap at the moment. One positive for the last three days is that first dose vaccination rates for Indigenous people have exceeded the national average. That’s the first time we’ve experienced that.”

Federal Health Department secretary Brendan Murphy praised the “success of the Wilcannia outbreak” in far north-western NSW as proof that the Commonwealth and state governments can manage outbreaks.

In that town, which has been Covid free for two weeks after a significant outbreak, about 20 per cent of all residents were infected.

“And that has been an extraordinary story with door-to-door vaccination and local leadership,” Professor Murphy said.

In response, Senator Gallagher said: “I have heard a different version of Wilcannia other than a success story.”

Noongar woman and chief executive of the South West Aboriginal Medical Service Lesley Nelson told the senate hearing on Thursday morning that in Western Australia the accelerated vaccine response “has originated because it has been a crisis”.

“There is hesitancy, and this is not something that is new to Aboriginal communities,” she said. “So unpacking that and understanding how better to equip and build the capacity of trusted organisations to do this work is key.”

The deputy chief executive of the National Indigenous Australians Agency, Letitia Hope, a Bundjalung and Torres Strait Islander woman, told senators there was a range of concerns and fears in some communities.

“So some of it is around general health concern because of comorbidities, some of it is around deep cultural belief, sometimes around a history of practice with governments, and some of it is around really radical thinking in terms of, if you have a Covid shot it reduces your indigeneity as well as other conspiracy theories,” she said. “This is a really important social process as well as a logistical process.”

While all of these are recognised issues within communities, Department of Health first assistant secretary Dr Lucas de Toca told the senate that the first gaps in vaccination rates emerged because of changing medical advice surrounding the AstraZeneca vaccine and also the storage requirements for Pfizer.

“There is a very clear moment when in which that [gap] commences in mid-to-late April,” de Toca said on Thursday morning.

“So throughout the commencement of the primary-care rollout in early March up until late April, vaccination [of Indigenous people] was occurring at an equivalent rate.”

Most Aboriginal and Torres Strait Islander people were suddenly thrust into a situation where the most accessible vaccine was no longer the preferred one. Thawed Pfizer vaccine, at that point in time, could only last for five days and de Toca says managing a wide distribution of this shot “through primary-care channels wasn’t feasible”.

While governments and regulators worked on a solution – the thawed storage advice was changed – there was a month-long gap where it was impossible to access Pfizer in GP clinics and other primary-care settings. Pfizer hubs, according to Dr Agostino, just did not work for Indigenous people.

Everything else since late May has been a game of catch-up. The results in NSW are now a matter of grim history.

When asked what plans the Commonwealth has specifically for Indigenous people in NSW as the state reopens, the chief medical officer, Paul Kelly, said there has been Doherty Institute modelling done on these populations.

“Your specific question was about the change in parameters for the public health and social measures in NSW and of course we are watching those very closely and carefully, particularly in relation to places where vaccination rollouts may have been less than other parts of the community,” he said.

“And that is where those local measures [lockdowns, restrictions] may need to be modified to take account of that.”

De Toca said part of the government’s Indigenous media communication strategy, contracts for which were reported by The Saturday Paper in early October, is to work with the “Aboriginal advisory group and our comms area to capture in a very clear way some of the very sad stories from what has been happening in NSW to date.

“Sadly, to date, we have had several deaths in First Nations communities,” he said.

“And we need to make sure that we are equipping these [Aboriginal] services with the clear ability to explain that actually this is a very severe disease.

“This could have devastating consequences in those communities. This could have an incredible impact on cultural preservation and the transmission of culture from elders.”

This article was first published in the print edition of The Saturday Paper on Oct 16, 2021 as "Exclusive: Government documents reveal Indigenous infection rates".

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Rick Morton is The Saturday Paper’s senior reporter.