The end of COVID-19 lockdowns, the easing of restrictions and the reopening of borders is a cause for relief and joy for many Australians and New Zealanders. But not everyone is celebrating.

Surgeons from the Royal Australasian College of Surgeons (RACS) are concerned about the impact of widespread COVID-19 infections on Indigenous communities once restrictions are lifted.

They warn that without putting in place safeguards against the spread of the virus and increasing vaccination rates, reopening of borders and lifting of restrictions could have devastating consequences for Australia’s Indigenous and Aotearoa’s Māori populations.

Australia’s first Indigenous surgeon and Macquarie University Professor Kelvin Kong says vaccination is a key step to protecting Indigenous communities, but multiple cultural and economic barriers mean vaccination rates remain low.

In September, the ABC reported that the vaccination rate among Indigenous Australians was 20 per cent lower than the national average.

Professor Kong believes a major factor driving lower vaccination rates in these communities is the delivery method of the vaccination program. This is further confounded by a historical wariness of the government resulting from generational disadvantage and prejudice.

“A long, convoluted history of racism and unconscious bias has meant that when the government says you have to do something, you have a wariness of that advice. This is especially the case among older members of the Indigenous community.

“We can only overcome this distrust and fear by communicating effectively—the best chance of success in convincing the mob lies in asking them what their concerns are and dispelling their fears.”

Professor Kong says another driver of the slow uptake of vaccinations is the misinformation widely available and propagated via social media, which has created unnecessary fears pertaining to vaccination, such as supposed adverse effects on fertility and side effects of vaccines.

Compounding this issue is a lack of access to trusted medical information. He says that while ensuring a greater Indigenous presence in the health system would be a positive step in creating a greater sense of trust, it is crucial that services themselves address barriers to access.

“If you own a shoe shop and no one comes and buys your shoes, you’re not going to blame people for not coming to you. You’re going to adjust what you do. If we have 20 per cent of people not attending their appointments and they’re all Indigenous, we need to ask ourselves what we’re doing wrong.

“The public health response to COVID-19 in Australia and Aotearoa New Zealand was fantastic, but it revealed disparities quite starkly. There have been huge differences in vaccination rates between affluent areas compared with disadvantaged communities. It shows we need to be serious about removing the barriers to health care. Surgeons are in a unique position to be able to speak up.”

For orthopedic surgeon John Mutu-Grigg, the issue of protecting Indigenous communities is close to home. He is concerned about the impact of COVID-19 on his tribe living in far north Aotearoa, and other similar rural Māori communities across the country.

He agrees with Professor Kong that lifting vaccination rates is crucial to stopping the spread of the virus among these vulnerable communities.

“For a long time, we were able to hold off COVID-19 in Aotearoa, but now we know that the idea of remaining COVID-free forever is fanciful,” Dr Mutu-Grigg says.
“We now understand that we will all become exposed to the virus and it will become a disease of the unvaccinated.”

In mid-late October, only 48 per cent of young Māori had received their first vaccine, compared with 80 per cent of white New Zealanders. At the time, The Guardian reported that the outbreak had disproportionately affected Indigenous New Zealanders. While Māori make up just 16.5 per cent of the overall population, Māori had made up almost half (46 per cent) of cases over the previous two weeks.

Dr Mutu-Grigg says there are two main reasons why vaccination was low among Māori communities.

“For some people, it is a matter of access. The area where my family lives is a long way from any vaccination clinics, and there are many people who would struggle to access vaccinations. They might not have a car, or petrol to get them to a clinic.

“Then there are those who are slightly hesitant who might be mistrustful of the government, due to the intergenerational disadvantage, but who might be responsive to incentives.”

He says government and administrative errors had also played a role in the low vaccination rates among Māori, with the age brackets for the rollout penalising a community with a shorter life expectancy.

“By rolling out the vaccine to the elderly, the first phase missed Māori almost completely,” Dr Mutu-Grigg says.

“The Māori population is a much younger cohort than the non-Māori, therefore Māori by proportion have only very recently had the opportunity to become vaccinated.”

This failure is particularly damaging for people often living in poor and crowded housing conditions, and which is at increased risk of comorbidities such as diabetes, heart disease and stroke.

In addition, there has been a delay in the distribution of funding allocated by the government to vaccinate rural Māori communities.

Dr Mutu-Grigg is calling on the government to act quickly to enable health workers to access the funding to provide access to information and vaccination to his Maori tribe.

“It’s all about timing and now that the virus has arrived in New Zealand and it’s here to stay, we need to act quickly.

“I’m definitely worried because a lot of people are going to die, and that’s the reality. It’s so avoidable and we’re doing our best to encourage and support Māori to get vaccinated, and if only it wasn’t for the road blocks, it would be that much better.”

Retired paediatric surgeon Alan Woodward says the government also has a role to play in preventing COVID-19 from spreading among Indigenous communities in Australia.

Dr Woodward worked at the Royal Darwin Hospital for 30 years and witnessed the effects of poor and crowded housing on the transmission of infectious disease, resulting in long-term health problems.

He says that poor and crowded housing, where 10 people were living in a house suitable for two or three, were a breeding ground for illness, causing Indigenous children to suffer from streptococcal disease, rheumatic fever, and glomerulonephritis—diseases that have all but disappeared in places with adequate housing.

“These diseases were circulating in cities like Melbourne in the 1950s, but when housing improved, they disappeared. They are still rife in the Indigenous communities. It’s extremely frustrating.”

The housing conditions that allow these diseases to spread will also accelerate the spread of COVID-19 in these areas. Combined with the pre-existing conditions disproportionately suffered by Indigenous Australians, Dr Woodward believes the introduction of COVID-19 into these areas is a recipe for disaster.

“For Indigenous people in the Northern Territory, the opening up of Australia’s borders is a potential nightmare.”

He says that, along with providing culturally-sensitive information about vaccination, housing conditions must improve before the virus starts to circulate in Indigenous communities.

“Housing can make a huge difference in the transmission of infectious diseases like COVID-19. In Wilcannia, the government provided caravans and mobile homes in areas where housing was inadequate, and the number of infections turned around immediately.”

His vision is for RACS to bring together the government, architects, public servants and Indigenous leaders to find a solution to poor housing conditions in these communities.
“While surgeons might not be directly involved with housing, it would not be the first time we have driven change in an area outside our own,” he says.

“When road trauma deaths ran out of control 1960 – 70 the RACS acted as the catalyst to bring together government, car manufacturers and the Australian Road Research Board to enact mandatory seat belt legislation.

“There is a similar opportunity today for RACS to act as a catalyst to bring together the relevant groups to improve Indigenous housing and reduce the spread of infectious disease,” Dr Woodward said.