First Nations peoples leading the way in<scp>COVID</scp>‐19 pandemic planning, response and management

Abstract

Engaging First Nations peoples in public health emergencies is critical to reducing health inequities Aboriginal and Torres Strait Islander (respectfully hereafter First Nations) peoples of Australia have experienced poorer health outcomes than the rest of the Australian population during recent pandemics.1, 2 In 2009, during the H1N1 influenza pandemic, diagnosis rates, hospitalisations and intensive care unit admissions occurred at five, eight and three times, respectively, the rates recorded among non-Indigenous people.1-3 The vulnerability of First Nations peoples to coronavirus disease 2019 (COVID-19) is well understood by community leaders and non-Aboriginal policy makers and clinicians alike. The risks for First Nations peoples from COVID-19 taking hold are immense — the oldest continuous culture on the planet is at risk. This is because of all of the following interrelated factors: an already high burden of chronic diseases; longstanding inequity related to service provision and access to health care, especially because 20% of First Nations peoples live in remote and very remote areas; and pervasive social and economic disadvantage in areas such as housing, education and employment. Moreover, many of the interventions put in place to curb the spread of COVID-19 are counter cultural or difficult to implement because of crowded housing and extended family groups living together. This means interruption of cultural life in order to be consistent with new social isolation concepts. Using lessons learnt from the 2009 H1N1 influenza pandemic, First Nations clinicians, public health practitioners and researchers are strategically leading the way in public health planning, response and management for COVID-19 alongside our non-Indigenous dedicated allies. The omission of First Nations peoples from the 2009 National Action Plan for Human Influenza Pandemic4, 5 not only disadvantaged those who most needed protection but failed to identify First Nations peoples as being a high risk population group. Research following the 2009 pandemic found that a one-size-fits-all approach to infectious disease emergencies is unlikely to work — partnerships between communities and government agencies for the management of public health emergencies could be improved,6, 7 and future pandemics should ensure that First Nations peoples are appropriately engaged as active and equal participants in pandemic preparedness, response, recovery and evaluation.6, 8 During the early days of the COVID-19 pandemic, we as a community have proactively proceeded to ensure that this occurs. Recognising that public health measures, containment strategies and risk communication often do not consider the socio-economic, historical or cultural context of First Nations peoples, it is appropriate that First Nations peoples lead the way in pandemic planning. Pandemic plans developed and implemented with First Nations peoples leading will likely mitigate risks and avoid the oversights of the 2009 response. On 6 March 2020, the Australian Government Department of Health convened the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 to provide advice on preparedness, response and recovery planning. The Advisory Group works on principles of shared decision making, power sharing, two-way communication, self-determination, leadership and empowerment. The Advisory Group is co-chaired by the National Aboriginal Community Controlled Health Organisation with the Department of Health and includes membership from the Aboriginal Community Controlled Organisation sector, state and territory government representatives, and First Nations communicable disease experts.9 The Advisory Group links to the Communicable Diseases Network Australia and reports to the Australian Health Protection Principal Committee. The brief is to ensure that all stages of the pandemic are considered with an equity lens and are proportional to the risk of disease in communities; to discuss and work through logistic issues related to the pandemic, especially in planning phases; and to ensure that these actions are locally led, holistic and culturally safe for communities. The group initially met three times per week and currently meets twice weekly via video or teleconference. The Advisory Group has provided strategic input into the development of the national management and operational plans for Aboriginal and Torres Strait Islander populations,10 and has significantly contributed to the series of national COVID-19 guidelines.11 To prepare communities for COVID-19, Advisory Group actions and advocacy have included: Pandemics are a serious public health risk for First Nations communities here and globally. Measures to reduce COVID-19 risk have been addressed swiftly, based on lessons learnt from the 2009 H1N1 influenza pandemic response. The involvement of communities has been fundamental to early change and action. Making space for First Nations peoples to define the issues, determine the priorities and suggest solutions for culturally informed strategies that address local community needs may reduce health inequities and has the potential to influence system changes. Privileging First Nations voices, within a culturally appropriate governance structure, to develop and implement planning, response and management protocols, can make a real difference. The model has the potential to be replicated where public health agencies and First Nations practitioners and researchers have developed shared understanding. Only time will tell now how we will fare over the coming months. We acknowledge the traditional custodians of the land and waters on which we live and work as the First Peoples of Australia. We are members of the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 and we acknowledge and thank all members of the Advisory Group for their continued work and commitment in advocating for cultural inclusion and providing space for First Nations peoples to have a voice in pandemic planning, response and management. No relevant disclosures. Not commissioned; externally peer reviewed.

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