How to lift COVID-19 vaccination rates in Aboriginal populations

Where Aboriginal people went to get information, to get tested for COVID-19 and get vaccinated mattered. Aboriginal people preferred to access COVID-19 vaccination through their local Aboriginal medical service or a GP they had an existing and trusting relationship with. It was clear Aboriginal people in our study felt a cultural connection to their local Aboriginal medical service; as well as feeling safe and they trusted the service.

AS of 29 September 2022 an estimated 10.3 million of COVID-19 have been reported in Australia. Unfortunately, 14 963 deaths have occurred — 0.13% of people infected with COVID-19 have died. Since the start of the Omicron wave in December 2021, there have been 265 978 cases of COVID-19 among Aboriginal and Torres Strait Islander peoples, which represents 3.2% of all Omicron cases (here, here).

One way to decrease the risk of severe illness has been vaccination.

Aboriginal and Torres Strait Islander people in Australia have higher rates of chronic health conditions, have less access to primary health care services and face broader social issues that impact their access to health services such as racism. These health and social factors increase their risk of poor health outcomes if Aboriginal and Torres Strait Islander people are infected with COVID-19.

Achieving high rates of COVID-19 vaccination is possible among Aboriginal and Torres Strait Islander people as high rates of childhood vaccinations have been achieved among Aboriginal and Torres Strait Islander children. The key question is how.

In our study, published recently in BMJ Global Health, local Aboriginal people conducted interviews with 35 Aboriginal people aged 15 to 80 years living in Western Sydney between February and March 2021. At this time COVID-19 vaccines were only available to people aged 60 years or older, people who had conditions that compromised their immunity, nurses and doctors in hospitals, health care workers in aged care, and border security staff at airports.

Participants valued vaccinations as they reduced the chances of serious illness, and many said they regularly received vaccinations to prevent serious illness from other diseases such as influenza. However, with COVID-19 vaccines, participants were cautious, and a handful had negative views. This suggests that the right messaging from GPs and state, territory and federal governments is needed to not only provide accurate evidence-based information, but also clear information that built confidence in the COVID-19 vaccines, so that people could make decisions that best suited their needs.

Some of the reasons why Aboriginal people want to be vaccinated for COVID-19 included:

1. to protect themselves from severe illness, from needing hospitalisation or from dying;
2. to protect others in their community, especially older people and Elders; and
3. to return to “normal life”, including the ability to travel again and to return to pre-COVID work arrangements

Concerns that participants had about COVID-19 vaccines included:

1. That the vaccine involves injecting a fragment of the virus which could make people sick;
2. That the vaccine could develop into COVID-19 disease, and that older people could be particularly vulnerable if this happened;
3. That vaccinations could be just as damaging to people’s health as COVID-19 itself; and
4. That vaccines could be costly and unaffordable for many Aboriginal people, indicating that some people were unaware that COVID-19 vaccinations are free in Australia

Other reasons why some Aboriginal people were hesitant about being vaccinated included:

1. negative stories on social media; and
2. distrust in Australian governments and medical institutions

There was a difference between what motivated young Aboriginal people to be vaccinated (to protect others/their family/their Elders) versus what motivated older Aboriginal people (to avoid getting really sick, avoid needing a hospital, not to die).

Where Aboriginal people went to get information, to get tested for COVID-19 and get vaccinated mattered. Aboriginal people preferred to access COVID-19 vaccination through their local Aboriginal medical service or a GP they had an existing and trusting relationship with. It was clear Aboriginal people in our study felt a cultural connection to their local Aboriginal medical service; as well as feeling safe and they trusted the service.

Overall, Aboriginal people valued the benefits of COVID-19 vaccines but they raised concerns about how COVID-19 information, testing and vaccinations were delivered.

As of 21  September 2022 81.8% of Aboriginal and Torres Strait Islander peoples  over the age of 16 years  have received at least two doses and 56.0% have received three doses of a COVID-19 vaccine. Increasing the  percentage of those who have received their third or fourth doses is the challenge now, especially with decreasing case numbers of COVID-19.

All participants mentioned Aboriginal Medical Services as the trusted and preferred way to access COVID-19 information, testing and vaccination.

As of 29 September 2022, rates of COVID-19 cases and deaths in Australia are beginning to decrease after another wave of COVID-19. Although this is promising and will ease the strain on Australian hospitals, another wave of COVID-19 could occur in the future. This highlights more than ever that preparedness is important. This includes the important role of Aboriginal Medical Services. GPs and pharmacists play a role in delivering COVID-19 boosters, testing, providing accurate information, and treatments.

Simon Graham is a Narrunga man from South Australia and a National Health & Medical Research Council fellow with the Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, the University of Melbourne.

More information regarding this project can be found here. This article was written on behalf of the research team Joanne Bryant, Mitch Beadman, Kristy Gardner, Megan Blaxland, Reuben Bolt, Kacey Martin, Michael Doyle, Karen Beeston, Dean Murphy, Stephen Bell, Christy E Newman, Jessica Wilms. This research was funded by NSW Health COVID-19 Research Grants Round 1 and is an extension of Australian Research Council Linkage grant (grant number: LP170100190). National Health & Medical Research Council Investigator grants supported the salaries of Simon Graham (grant number: 2009727) and Michael Doyle (grant number: 1193618). The project is a partnership between UNSW Sydney, the Nepean Blue Mountains Local Health District, the South Western Sydney Local Health District. The authors acknowledge the important contributions of Kaysan Penning, Tamika Briggs and all the peer interviewers.  We would like to acknowledge the Aboriginal and Torres Strait Islander members and authors on the team and their communities, Jessica Wilms (Wiradjuri), Kristy Gardner (Kamilaroi), Mitchell Beadman (Gadigal), Karen Beetson (Mandandaji), Reuben Bolt (Yuin/Wandandian and Ngarigo), Michael Doyle (Bardi) and Simon Graham (Narrunga). We would also like to acknowledge the participants in the study who identified with a range of Aboriginal communities, most commonly Kamilaroi, Wiradjuri, and Dunghutti.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.

If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.