If ever we needed evidence of Australian inequality, consider this: people living in the lowest socioeconomic group compared with the highest have experienced almost four times as many COVID-19 deaths. And people born overseas in non-English-speaking countries have also had a much higher age-standardised mortality rate than Australian-born individuals.
The vaccine rollout has struggled with inequities from the start. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability called the rollout strategy "seriously deficient". Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organisation, gave damning testimony to the Senate Committee on COVID-19 on the heartbreaking and utterly predictable death and hardship caused by the spread of the Delta variant in regional First Nations communities. The latest modelling from the Doherty Institute acknowledges the ongoing risk posed to First Nations people, particularly those in remote locations. We've also seen the virus surge through the Park Hotel facility in Carlton, Melbourne, where asylum seekers are detained in atrocious conditions.
The most effective way to promote the safety and protection of all people is by ensuring that, at the very least, 85 to 90 per cent of the population over 12 years old is fully vaccinated. We should be aiming for full coverage. Meeting and ideally exceeding this target means improving access to the vaccine for everyone, including those hardest to reach. We've gained enough experience from the early stages of the rollout to know what to do next.
Firstly, we must ramp up home vaccination visits to those unable to travel to clinics and hubs to get jabbed. For those with significant physical and intellectual disabilities, compromised immune systems or severe mobility issues, we must bring the doses to them. Whilst Medicare incentives exist for doctors to make home and on-site visits, they can be much better utilised to improve vaccination coverage.
Secondly, we must invest more in grassroots health initiatives that enable local community leaders to increase access to the vaccine for everyone. From the beginning of the pandemic, ACOSS and others have urged governments to take a community-led approach to our health response, including the vaccination strategy.
Together the AFAO (Australian Federation of Aids Organisations) and ACOSS recommended governments learn from our successful HIV pandemic response, which showed the power of shifting resources to trusted community leaders and networks who are best placed to support their communities to be safe. A community-led response includes resourcing programs that allow staff to go door-to-door to reach people unsure about being jabbed. Misinformation has been rife in some communities, and for others, the initial government messaging on vaccine eligibility caused confusion. The Sydney suburb of Blacktown, one of the country's most culturally and linguistically diverse areas, was previously a COVID-19 hotspot, but now has one of the highest vaccination rates in the country. This is due in no small part to trusted local leaders and medical staff explaining the vaccine benefits to their communities and encouraging them to get jabbed.
In some of the southern border towns in Queensland, local government works closely with medical services to emphasise the importance of vaccination, while also removing barriers to access. Given the lagging rates in some regional areas, and the fact just over half the country's First Nations population is fully vaccinated, community-led efforts are crucial to cutting through misinformation and saving lives.
Thirdly, we need more holistic and regular updates on the vaccination rates of at-risk groups and communities. We have no clear picture of the rates for people with disability in the community, people without a Medicare card, and migrants on temporary visas, to name some important groups. Reaching a 90 or 95 per cent vaccination threshold requires targeting at-risk individuals through a tailored and personalised approach.
The latest modelling from the Doherty Institute examines how Australia can handle COVID-19 outbreaks, including the disproportionate impact health measures will have on communities with higher rates of disadvantage in the event of increased transmissions. Experts have cautioned us for a while now that when Australia completely reopens, unvaccinated people are most vulnerable. Unless at-risk people and communities are fully protected, not only do they face major health risks upon reopening, but they also face the prospect of needing to isolate to keep safe, preventing them enjoying the same economic and social participation as others. As children remain one of the largest unvaccinated cohorts, this potentially jeopardises their experiences of a new school year in 2022.
Due in large part to the extraordinary efforts of community leaders working in partnership with health professionals, our vaccine rollout is finally gathering pace. We must finish the rollout properly, and keep everyone safe and protected. Otherwise, the consequences for those most disadvantaged amongst us will be devastating. As NSW's Chief Health Officer, Kerry Chant, said in September: "We are only as good as the vaccination levels in our vulnerable communities."
- Dr Cassandra Goldie is chief executive of the Australian Council of Social Service (ACOSS).