Vaccinating the highest-risk groups first was the plan. But people with disability are being left behind


Shutterstock

Helen Dickinson, UNSW and Anne Kavanagh, The University of MelbourneWith Australia’s COVID vaccination campaign set to open up to over 50s on May 3, many at-risk Australians eligible under phase 1A are still waiting.

Last week we learned only 6.5% of residents in disability care homes had received the vaccine.

Aged care is faring slightly better, with roughly 30% of aged-care facilities having received both vaccine doses. But that’s still some way to go.

Also worrying, an estimated 15% of aged-care workers and only 1% of disability-care workers have so far been vaccinated.

Federal health department officials have conceded the vaccine rollout in the disability sector is progressing more slowly than they would have liked.

But critics like shadow minister for the National Disability Insurance Scheme (NDIS) Bill Shorten have described the situation as reflecting a “pathology of dangerous incompetence” in the government’s treatment of vulnerable Australians.

After failing to address the needs of people with disability at the height of the pandemic last year, the poorly executed rollout in disability care does little to reassure this group the government has their best interests at heart.




Read more:
4 ways Australia’s COVID vaccine rollout has been bungled


A high-risk group

Australians with disability are at heightened risk during the COVID pandemic because many have other health conditions (for example, respiratory problems, heart disease, and diabetes). This makes them more likely to get sicker or die if they become infected.

People with disability are also more likely to be poorer, unemployed and socially isolated, making them more likely to experience poor health outcomes.

Many people with disability, particularly those with complex needs, require personal support, which puts them in close contact with other people. Different workers will come through residential disability-care settings, sometimes moving between multiple homes and services, just as in aged care.

Should there be an outbreak of COVID-19 in residential disability care, there’s high potential for it to spread because some residents may have difficulties with physical distancing, personal hygiene, and other public health recommendations.

In Victoria’s second wave we saw outbreaks linked to at least 50 residential disability settings among workers and residents.

Two people with Down Syndrome cooking in the kitchen.
People with disability are at higher risk during the pandemic.
Shutterstock

In other countries we’ve seen people with disability die from COVID-19 at higher rates than their non-disabled peers. In England, nearly six out of every ten people who died with COVID in 2020 were disabled, and this risk increases with level of disability.

While Australia has not seen these levels of deaths, the longer this group goes without being vaccinated, the longer they’re contending with this risk. Discussions about reopening international borders only serve to heighten fears.

Given the unique risks this group faces, the disability community fought hard to ensure disabled people living in residential care and their support workers were included in phase 1A of the vaccine rollout.




Read more:
People with a disability are more likely to die from coronavirus – but we can reduce this risk


Repeating previous mistakes

Last year the disability royal commission was presented with extensive evidence to show the Australian government had not developed policies addressing the needs of people with disability in their initial emergency response plans.

For example, while others on welfare payments received the COVID supplement, people with disability and their carers were denied this.

Many schools didn’t make appropriate adjustments so children with disability could engage with remote learning. And families with a child with disability struggled to secure the basics.

Advocates did significant work before governments started to consider people with disability in their COVID response plans. But this was often made more challenging because no data were collected about disability in the case numbers, reflecting an endemic problem of lack of recognition of people with disability in the health system.

We’re seeing this again in the vaccine rollout, where daily updates on vaccination numbers group aged and disability care together, rather than breaking these figures down across the sectors.

Without this sort of data, we can’t effectively plan for people with disability.

Meanwhile, the government’s announcement that the Pfizer vaccine is recommended for under 50s because of the very rare but serious side effect of low platelet count (thrombocytopenia) and blood clots (thrombosis) will see further pressure on Australia’s limited Pfizer supplies.

It may be some time before people with disability under 50 living in residential care are vaccinated. Yet the government continues to roll out Pfizer in residential aged care where AstraZeneca could be used, further demonstrating the low priority of the disability sector.

It appears little has been learned from the government’s earlier pandemic response (or lack thereof) concerning people with a disability. This group is being forgotten once again.

Getting back on track

In the Senate’s recent COVID-19 committee we heard confirmation aged-care residents had been prioritised over disability-care residents as they’re perceived to be at higher risk. This has angered many in the disability community who were not told the phase 1a group would be broken into sub-groups.

The government has some way to go in mending its relationship with the disability community. In addition to bungling the vaccine rollout, at the moment there’s significant concern over proposed reforms to the NDIS.

What we need now is a clear plan to roll out vaccinations, not only to people with disability in residential care settings, but also those in the wider community and their support workers. The government needs to set a clear timeframe for vaccinating disability-care residents and staff — and stick to this.

The World Health Organization argues community engagement is key to a successful vaccination rollout. In this light, commonwealth and state governments need to do some substantial work to engage people with disability and the broader sector to turn this situation around.




Read more:
‘Dehumanising’ and ‘a nightmare’: why disability groups want NDIS independent assessments scrapped


The Conversation


Helen Dickinson, Professor, Public Service Research, UNSW and Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Putting homes in high-risk areas is asking too much of firefighters


Mark Maund, University of Newcastle; Kim Maund, University of Newcastle, and Thayaparan Gajendran, University of Newcastle

The impacts of the bushfires that are overwhelming emergency services in New South Wales and Queensland suggest houses are being built in areas where the risks are high. We rely heavily on emergency services to protect people and property, but strategic land-use planning can improve resilience and so help reduce the risk in the first place. This would mean giving more weight to considering bushfire hazards at the earliest stages of planning housing supply.

The outstanding dedication of emergency agencies such as the NSW Rural Fire Service and Queensland Fire and Emergency Service is obvious in their efforts to save lives and properties despite the increasing intensity of fires. However, strategic land-use planning could help reduce the risks by being more responsive to such changes in hazards.




Read more:
Grattan on Friday: When the firies call him out on climate change, Scott Morrison should listen


Comprehensive management of bushfire risk should include a strategic planning focus on reducing the pressures on emergency services and communities. We may have to rethink land-use planning approaches that prove inadequate to deal with the increasing intensity and unpredictability of natural hazards.

Strategic planning policies and practices provide the opportunity to be more attentive to changes in bushfire hazards in particular. Planning decisions that fail to do this may leave communities exposed and heavily reliant on emergency services during a disaster.

Planning to build resilience

The Australian government has identified land-use planning as a key step in managing natural hazards. In 2011, the Council of Australian Governments declared:

Locating new or expanding existing settlements and infrastructure in areas exposed to unreasonable risk is irresponsible.

The increasing intensity of hazards associated with climate change makes strategic planning even more relevant. Land-use planners could help greatly with building resilience by placing natural hazards at the top of their assessment criteria.




Read more:
Drought and climate change were the kindling, and now the east coast is ablaze


Coordinating land-use planning reforms is itself a challenge. Planning in Australia involves many policies, institutions, professions and decision-makers. Policies and processes differ depending on the state or territory.

Furthermore, planners must reconcile the demand for residential land from population growth and the need to protect the environment. Deciding where to locate housing is often fraught with complexity, so the process needs expert early input from relevant scientific communities and emergency services.

Anticipate risk to reduce it

Land-use planning offers an opportunity in the earliest phase of development to manage the combined pressures of population growth, urban expansion, increasing density and risks of natural hazards.

When rezoning land for residential development, many issues have to be considered. These include environmental sustainability, demand for housing and the location of existing buildings and infrastructure, as well as natural hazards. It’s a complex and intricate process, but clearly the strategic planning stage is the first opportunity to minimise exposure to bushfire risk.

Existing policy and processes may defer the detailed review of bushfire risk and other natural hazards to development stages after land has been rezoned. There’s a case for policy to increase the importance attached to bushfire hazards at this early stage.

Ultimately, strategic planners aim to locate settlements away from risk of natural hazards. However, bushfires continue to have disastrous impacts on people and properties. Ongoing demand for housing may add pressure to build in areas exposed to risk.

Settlements are pushing into undeveloped areas that are more likely to be exposed to bushfire risk. The role of strategic land-use planning then becomes even more critical. The devastation we have seen this month shows why this risk must be given the highest priority in land-use planning, particularly when zoning land as residential.




Read more:
Natural hazard risk: is it just going to get worse or can we do something about it?


Key steps to reform planning

The increasing intensity of bushfires points to a need to rethink planning processes and mitigation strategies to reduce exposure to such hazards before they arise. This will help ease the burden on emergency services of managing a disaster when it happens. We can’t ignore the opportunities to minimise the risks at the early stages of land-use planning. Key steps include:The Conversation

  • a policy review to mandate natural hazards, including bushfire risk, as one of the highest priorities in policy, with an objective framework for making land-use decisions
  • mandatory consultation with relevant science disciplines to model natural hazard risks when land is considered for rezoning
  • involve emergency services in the strategic planning phase to help minimise future risk.

Mark Maund, PhD Candidate, School of Architecture and Built Environment, University of Newcastle; Kim Maund, Discipline Head – Construction Management, School of Architecture and Built Environment, University of Newcastle, and Thayaparan Gajendran, Associate Professor, School of Architecture and Built Environment, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.