NSW communities left ‘high and dry’ in vaccine rollout

Until recently, Aboriginal and Torres Strait Islander communities had been, for the most part, protected from COVID-19.
 
But now a ‘nightmare’ scenario is being realised in regional and rural parts of New South Wales.
 
On 30 August, a Dubbo man in his 50s became the first Aboriginal Australian to die from COVID-19 since the pandemic began. On the same day, Western NSW recorded 51 new cases, before adding a new record of 54 cases the following day – the highest daily caseload in the area to date.
 
Walgett, Wilcannia, Goodooga, Bourke, Orange and Dubbo have all been hit with outbreaks, and more than 700 Aboriginal people have contracted the virus since June, leading epidemiologists to predict it could reach 1000 this week.
 
Dubbo, one of the epicentres of the regional NSW outbreak, has recorded nearly 400 cases and local GP Dr Ai-Vee Chua says the COVID situation in Aboriginal communities is ‘very, very worrying’.
 
‘All the health inequities that we’ve lived and worked with for a long time have been exaggerated during this outbreak in our region, and our vulnerable communities are very much at risk,’ she told newsGP.
 
‘Difficulties with access to culturally appropriate health services, a level of mistrust in the health system, and a myriad of other complex factors contribute to health outcomes for our First Nations people that are so much worse than non-Indigenous health outcomes, and all those factors are absolutely at play in the current COVID outbreak,’ she said.
 
‘We have one in 100 people in Dubbo currently infected with COVID. Just about everybody I know has been identified as a close or casual contact at some point in the last three weeks.’
 
The spread of COVID-19 to these vulnerable communities further highlights the disparities in vaccine supply to areas outside major cities, and to Aboriginal and Torres Strait Islander people.
 
The latest figures show a looming gap between vaccination rates of Aboriginal and Torres Strait Islander people and non-Indigenous Australians across all NSW regions, with Western NSW among the worst.

Dr Jason Agostino, a GP and Medical Advisor for the National Aboriginal Community Controlled Health Organisation (NACCHO), told newsGP the growing number of cases is concerning.
 
‘We’ve always worried about COVID getting down into any Aboriginal and Torres Strait Islander community, but particularly in the more remote areas,’ Dr Agostino said.
 
‘That’s where we have even higher rates of chronic diseases like diabetes and kidney disease … overcrowded housing and hospitals that are less equipped to deal with the consequences.
 
‘We are concerned … and we’re seeing a significant increase.’

With cases rising at a worrying rate in Dubbo, Dr Chua said the impact on general practice has been huge.
 
‘[For example] we’ve had staffing concerns … because every single one of our supermarkets has been identified as a venue of concern multiple times over in the last three weeks, as have several of our schools and day care centres,’ she said.
 
‘So we’ve had to work with reduced staff numbers while they have been in isolation and awaiting test results. We’ve managed to navigate this by rapidly enabling systems to ensure all members of our team are able to work from home. It has been extremely challenging.’
 
Dr Ai-Vee Chua said her Dubbo practice is struggling with the current outbreak.

Dubbo Family Doctors, where Dr Chua works, only received its first allocation of Pfizer doses the week the local outbreak began. While they were initially only supposed to receive an average of 150 doses per week, they have since received additional supplies, including 1200 doses last week.
 
‘It’s been a blessing that we’ve had additional doses of Pfizer supplies provided to us, but it also means we’ve had to work really hard to find staffing to get those jabs into arms,’ Dr Chua said.
 
‘The vaccination rollout had commenced in Sydney hospitals in February, and our [regional NSW’s] very first supply in both the hospital system and general practice arrived for the week of 22 March, so we were behind the eight ball already.’
 
According to Dr Chua, the decision to divert Pfizer doses from the local hospital hub to vaccinate Year 12 students in Sydney was also ‘significant’.
 
‘It meant that many people’s appointments could not go ahead, and they would be contacted at a later date with further information,’ she said.
 
‘These included a whole lot of healthcare workers and people with complex chronic conditions who were left high and dry. And that was not very long before the outbreak hit town, so the supply side of things has been very challenging.’
 
As of 29 August, around 12.5% of NSW’s estimated 265,700 Aboriginal and Torres Strait Islander people had been fully vaccinated, compared to around 30% of the non-Indigenous Australian population.
 
In comparison to NSW, Victoria had already reached a successful milestone in this area last month, with more than 50% of Victoria’s eligible Aboriginal and Torres Strait Islander population having received a first dose, and around 30% fully vaccinated.
 
But despite a slow start to vaccination in Western NSW, the vaccine rollout is starting to pick up speed. The latest figures show a huge week-on-week increase (13.8%) of first doses being received – the highest in the country – in the Far West and Orana area, which includes Dubbo, in the week leading up to Sunday 29 August.
 
Dr Agostino said there has also been a positive response to the expansion of the Pfizer program to Aboriginal and Torres Strait Islander children aged 12−15 years – particularly given the growing number of cases among children.

‘Across Australia around 1000 children aged 12−15 got vaccinated during the first week that they were eligible, so that was a good sign,’ he said.
 
‘The CEO of NACCHO, Pat Turner, sent a message to all GPs reminding them [of the eligibility criteria] and also to highlight the really large gap in vaccination coverage that we have across the country.’
 
A number of public health measures are being implemented to address the growing outbreak in Dr Chua’s area, but the vaccine supply and rollout strategy remains the biggest challenge.
 
‘The local health districts and Primary Health Networks have pulled together with general practice to work on increasing access to testing and vaccinations,’ she said.
 
‘In Dubbo right now we’ve got our showground drive-thru testing site and two different private pathology providers who are stationed there and getting the volumes of testing done each day.
 
‘The local health districts have also created mobile testing units so that they can go to people’s houses to provide testing for some of our most vulnerable people who otherwise might not be able to get themselves to a testing location.
 
‘They have gone above and beyond to try to close up all the gaps that may be there in terms of access to testing.’
 
The state’s first drive-thru vaccination clinic also opened in Dubbo this week, and Dr Agostino said vaccine supply and access to healthcare will be crucial to addressing the current outbreak.
 
‘It’s about meeting the demand, mainly with issues around staffing and access to health services,’ he said. ‘Really the way out of this is for primary care to help with getting those numbers up for Aboriginal and Torres Strait Islander people.
 
‘GPs obviously have a have a key role in communicating that, as well as delivering the vaccines.
 
‘We [the Aboriginal community-controlled health services] are getting out as much vaccine as possible. And the difficulty is having sufficient staff to deliver those vaccines, as well as run a normal clinic.
 
‘We’ve increased point-of-care testing machines in a number of communities, such as Walgett and Broken Hill, and we’re looking to get them into additional communities like Dubbo. 
 
‘We don’t want to have long delays in testing, so we’re trying to make sure that, particularly close contacts and clinic staff, can get a result the same day that they get the test.’
 
For Dr Chua, the current situation serves as a reminder for regional, rural and remote areas about the importance of properly preparing for a local outbreak.
 
‘For rural general practices, and especially with vulnerable communities, think ahead as to what changes might need to be implemented,’ she said.
 
‘This includes having adequate PPE supplies, having systems to enable both non-clinical and clinical staff to work from home, pulling forward second dose vaccinations, rapidly standing up additional vaccine clinics, and ensuring good communication within the team, as well as with patients.
 
‘Communication is key. As GPs we hold roles as leaders in our community and our communities look to us for solutions in times of need.
 
‘The outbreak has also highlighted the importance of really working well together across our health sectors to make sure that we can provide the care for our community that’s most needed.’
 
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Aboriginal and Torres Strait Islander COVID-19 New South Wales regional communities vaccine rollout