‘Disconnect’ between health and disability behind slow vaccine rollout

Matt Woodley

19/05/2021 4:59:19 PM

GPs have reportedly been underutilised in attempts to carry out perhaps the most complicated part of the national COVID vaccination program.

Person pushing a wheelchair.
Fewer than 1000 disability residents nationwide have been vaccinated against COVID-19

Earlier this week, the disability royal commission revealed that fewer than 1000 disability residents nationwide have been vaccinated against COVID-19, leading senior counsel assisting Kate Eastman SC to describe the rollout so far as an ‘abject failure’.
In a parliamentary committee hearing last month, Department of Health Associate Secretary Caroline Edwards said the Federal Government had decided to focus on completing vaccinations for aged care residents first, after a slow start to the program.
But a number of GPs with an interest in disability have told newsGP general practice could have been relied on to help more, particularly since the beginning of phase 1b.
Associate Professor Bob Davis, Chair of RACGP Specific Interests Disability, believes the main issues are a lack of urgency and cooperation.
‘The problems highlighted the fact that there’s a disconnect between disability and health,’ he told newsGP.
‘There needs to be a much more proactive approach to the health issues of people with disability and the problems are magnified when you have a crisis like this.’
The result of the slow rollout, according to GP Dr Lara Roeske, is that health authorities have ‘failed’ to protect a group that is at a higher risk but in many cases cannot arrange to receive the vaccinations themselves.
‘I think it’s fair to say outright that it is very disappointing, and it is concerning as well,’ she told newsGP.
‘In many cases [these people are] living with cognitive disability and there are extraordinary barriers to accessing the vaccine.
‘Some of the challenges are particularly unique to this group, and that really emphasises the need for us to look at the way we’re doing this and really reprioritise.’
Dr Roeske said people with a disability living in residential and group homes should be a particular emphasis, and that GPs need to be supported to help reach these people due to their unique access issues.
‘For example, there will often be an inability to independently book an appointment – either online or via phone – or an inability to actually take public transport to a vaccine hub, or a community clinic or a hospital,’ she said.
‘Even more importantly, often people cannot understand consent, nor the risks or benefits of vaccination.
‘They rely on the disability support workers, staff, and family carers to really interpret information as best as possible, and some will still simply not be able to understand the information or the risks or benefits for themselves.
‘GPs do have a very important role.’
According to Ms Edwards, it was initially anticipated that the Government would commission an ‘in-reach’ program to vaccinate disability residents in the same manner as aged care, based on the assumption that they were housed in similar numbers and facilities.
However, Dr James Best, a GP with a special interest in disability, told newsGP general practice should have been relied upon to play a larger role in this process.
‘Really, it’s primary care that can deliver that role … [but] we have been hamstrung in our ability to respond, both through supply and also policy,’ he said.
‘Individual GPs are the ones who know their patients, including the people in this sector, and so we should be able to have more opportunity to deliver what we want to deliver.
‘There are a couple of constancies here. One is the underestimation of the ability of general practice to contribute – so the under-utilisation of our resources.
‘And I also think there’s been a really clumsy and disjointed delivery of information related to vaccine risk and vaccine hesitancy, which apparently is quite high at the moment among carers and workers in disability.’
Dr Best said the process needs to be nuanced and coordinated, but ‘unfortunately, it hasn’t been’. He also said GPs need more support in order to rapidly increase the number of vulnerable people who have been protected against COVID.
‘These people are at high risk and I just find it very disappointing that such terrible numbers still persist in terms of vaccination rates,’ he said.
‘If it’s someone who may not understand the vaccine process, and may not tolerate getting vaccinated, it’s not necessarily an easy thing for the GP to do, but it’s something that we are capable of.
‘We’re the ones on the ground and often we are the only contact in the health system … [but] we should be appropriately compensated to do that work, which can sometimes be very challenging.’
Associate Professor Davis suggests there is a potential need to compensate GPs with a call out fee, as well as an increased patient rebate to reflect the time it sometimes takes to provide the injection.
‘One issue [for patients with a cognitive disability] is identifying who is a person that can make the decision for them? Often, they’re not living with that person and you have to contact them separately.
‘Secondly, there are situations where a person with an intellectual disability is very resistant to having a vaccination. Sometimes you can do that with them in the room, but sometimes, depending on the situation, you might even have to sedate them.
‘Then there’s the issue of determining the risk–benefit in this situation, so making that decision takes time.’
Regardless of the challenges, all of the doctors newsGP spoke with agreed there is a need for more urgency and that general practice should be relied upon to help.
‘There has been a lack of coordination between general practices and disability support services, and perhaps consideration around how GPs can be facilitators in this Commonwealth program,’ Dr Roeske said.
‘There is a capacity and capability for GPs to add a lot of value in this space.’
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Dr Aline Suan Lin Smith   20/05/2021 6:33:35 AM

Agreed 100% with the comments from Bob and James.
At our practice we are starting to vaccinate our patients in Boarding homes, another group of vulnerable people forgotten by the system. They are perhaps one of the most vulnerable including the one is even thinking about them or if they are they are not talking to GPs who look after these people.
Our practice put in an EOI and demonstrated our ability to give these people the vaccines but we were only given 50 initially not enough to vaccinate the 1500 people in group 1a and b. we proposed to NSW health , PHN etc but no word and no help, so we are doing it now that our vaccine supply has increased to 300. A call out fee for each patient in supported accommodation should be implemented by the government at the very least. Many of these patients will not come to a vaccination hub or even to the practice. Many also will not accept injections from other unknown vaccinators but their usual GP....

Dr Bradley Graydon Gray   20/05/2021 7:27:50 AM

In Victoria no under 50 with disability could book the Pfizer vaccine until this week. They were rolling out to health professionals and aged care workers only. So no wonder disability has not been vaccinated.