Australia's First Nations' response to the COVID-19 pandemic

Abstract

Kaitlin Curtice and Esther Choo 1 described the well known risks for infectious diseases among First Nations internationally and the serious concerns that COVID-19 poses for them. These risks include their levels of chronic disease, poverty, poor living conditions, and racism in mainstream services with resulting lack of trust using them. They also highlighted the problem of data not being available specifically for First Nations so that authorities are blind to the situation and hence how best to help them. In Australia, we have seen an extraordinarily different outcome. We do have data identifying Aboriginal and Torres Strait Islander populations. 2 Since the beginning of the pandemic here, we have observed only 60 First Nations cases nationwide; this represents only 0·7% of all cases, a considerable underrepresentation, as First Nations make up 3% of our population. If rates for First Nations were the same as non-Indigenous people, we should have seen 215 cases, and the incidence should have been higher given their risk status. Only 13% of First Nations cases needed hospital treatment, none have been in intensive care, and there were no deaths. Most cases were in urban centres, and none in remote or very remote communities. There is much debate every year about the continuing gap in health, education, and other outcomes in Aboriginal and Torres Strait Islander people, yet the gap here seems completely reversed, with our First Nations doing better than everyone else. How did this happen? First Nations health leaders, chief executive officers of the Aboriginal Community Controlled Health Services, and others responded rapidly to the news of the pandemic, having been badly affected by the 2009 H1N1 influenza epidemic. They lobbied governments (federal, state, territory) to close remote communities, to help with personal protective equipment, testing and contact tracing, prepared sophisticated videos for social media about COVID-19 and what people should do (which was better than anything in the non-Indigenous space), trained their staff, organised the homeless in safe accommodation, and focused on the elders and those with serious illnesses. They established partnerships with government departments and relevant non-governmental organisations to ensure services were implemented and culturally appropriate. The result of this First Nations-led response has shown how effective (and extremely cost-effective) giving power and capacity to Indigenous leaders is. This response has avoided major illness and deaths and avoided costly care and anguish. It is nothing short of a triumph as we sadly read about the situation mentioned by Curtice and Choo. 1 There is debate in Australia about the Uluru Statement from the Heart, a document prepared 2 years ago, via a series of national dialogues with First Nations peoples. They have asked for a voice enshrined in the Constitution, discussions about treaty, and acknowledgement of history. The response to the pandemic is surely the best evidence we have for giving our First Nations people such a voice and hastening progression towards authentic Indigenous self-determination.