SYDNEY — From Alaska to the Amazon, Indigenous people are more likely to get sick with or die of covid-19, as the pandemic magnifies deep-rooted health and socioeconomic inequities.
There have been no cases in remote communities, and not a single Aboriginal elder has died. Of the 149 cases involving Indigenous people since the start of the pandemic nationwide, few were serious enough to require hospitalization. By contrast, covid-19 is killing Native Americans at a faster rate than any other group in the United States.
Health experts say Australia’s pandemic experience offers a potential model for Indigenous health care — after a history of discrimination and neglect that typically led to poor health outcomes.
The vaccine rollout is also proceeding more smoothly in many Indigenous communities than elsewhere in Australia, where some clinics are complaining of empty vaccine fridges. Aboriginal people and Torres Strait Islanders are being prioritized for vaccinations because of their higher risk of developing serious illness if infected.
On the first day of the vaccine rollout in Sydney, one Aboriginal clinic booked all of its appointments in an hour, according to Aboriginal health officials. In the remote Australian-controlled islands of the Torres Strait — near Papua New Guinea, which is battling an outbreak — over 80 percent of adults have been vaccinated, officials said.
“This is a most amazing response to the pandemic from a community that is so marginalized,” said Fiona Stanley, an Australian epidemiologist specializing in public health. “This is probably the best evidence we have that if you put Aboriginal people in charge, then you get better outcomes.”
First-nation people globally have a painful legacy of disease and its impact on elders, those most responsible for the survival of Indigenous culture. Europeans introduced smallpox and other diseases to the New World starting from around 1500, wiping out much of the Indigenous population. The 1918 flu pandemic destroyed entire villages.
Australia’s 800,000 Indigenous people are more likely to be hospitalized for chronic illnesses such as pulmonary disease, diabetes and epilepsy than other Australians, according to government data. The life expectancy of an Aboriginal man lags that for the rest of the population by nearly nine years and is lower than that in Bangladesh or Venezuela.
The first case of the coronavirus in Australia, in January 2020 — a man from Wuhan, China, who arrived in Melbourne — was a wake-up call for the country, but especially for Australia’s Indigenous leaders. The new virus was striking older people, particularly those with chronic conditions. And being highly contagious, it was likely to spread like wildfire through remote Indigenous communities where overcrowding is common.
Dawn Casey, who co-chairs a government task force established to develop a virus plan for Indigenous communities, said Aboriginal doctors expressed alarm during weekly meetings at the number of flights arriving from countries where the virus had taken hold. “We could see what was happening overseas,” she said. “If it got into remote communities, it would wipe them out.”
Pat Turner, chief executive of the National Aboriginal Community Controlled Health Organization, wrote to state and federal leaders in March 2020, asking them to use their powers to order the closure of remote communities to stop visitors from entering. Accordingly, the communities were sealed off.
Lawyer Teela Reid kicked off efforts to protect elders in Gilgandra, a rural town 270 miles northwest of Sydney. “I could clearly see how catastrophic it could get in the country, if we got one case in our town of 3,000, because we don’t have the health resources,” Reid said.
The local municipality compiled a list of elders and made sure they did not need to leave their homes for food or medicines. Reid’s grandmother Stella, the town matriarch who presides over traditional ceremonies, went against her natural instincts and padlocked her gate.
“It was hard for us,” Reid said. “Our grandparents are often the people who raise children. But they also hold our story lines. They’re passed down orally. If you lose that, it’s gone.” She added, “The ways in which many communities acted was through the natural instinct to be a survivor and to protect elders.”
Before the pandemic, Aboriginal health organizations had been talking with government officials about plans to address a syphilis outbreak using local Indigenous health services. Australia’s chief medical officer at the time, Brendan Murphy, supported the approach, an endorsement that Casey says helped smooth the way for a community-led approach to the coronavirus.
On Facebook, TikTok and Vimeo, Aboriginal health agencies launched coronavirus messages — including instructions on cough etiquette and hand hygiene — and interviews with trusted health officials, translated into local languages.
One animated video described a scenario in which the virus is passed around a community in the remote Kimberley region by people who share a ride to a grocery store.
“We gotta treat everyone outside la our home like a lumbarra, like a poison cousin,” the cartoon extolled in Aboriginal English. “. . . Only way to look after our mob is to stay la your own house with one mob.”
Humor played a part. Yindjibarndi elder Tootsie Daniel posted a modified version of the Knack’s “My Sharona” on Facebook: “Ooh, I’m making bubbles come, bubbles come. Scrubbing hands is so much fun. Goodbye, corona,” Daniel sang as she rinsed her hands in a basin.
Health experts say the low case numbers among Indigenous Australians are especially remarkable considering 81 percent live in urban areas.
When an outbreak swept public-housing towers in Melbourne in July, community health workers dispensed groceries and prescription drugs to vulnerable residents locked down in their homes. High-risk people were monitored daily. That same month, after an interstate truck driver visited a Sydney pub while infectious, sparking a cluster of 57 cases, health workers scrambled to trace any Indigenous people who had been at the venue at the time. For the first time, Aboriginal health workers were given contact-tracing powers usually reserved for state health authorities.
“I think increasingly the Australian government is looking at the Aboriginal-controlled model and seeing they can be really effective,” said Jason Agostino, an epidemiologist and medical adviser on Aboriginal health.