Opening up when 80% of eligible adults are vaccinated won’t be ‘safe’ for all Australians


Anne Kavanagh, The University of Melbourne; Helen Dickinson, UNSW, and Nancy Baxter, The University of MelbourneWe’ve all grown tired of lockdowns, border closures and other restrictions. So the promise of a freer life, when 70% and then 80% of Australians aged 16 and older are vaccinated, feels like a beacon on the horizon.

Prime Minister Scott Morrison, some premiers, and leading public servants have promised us at 80% we can live “safely” with COVID-19, or come out of our “caves” in the PM’s parlance.

The narrative is one of Team Australia and we are “all in this together”. But are we really?

Risks of COVID-19 infection, serious disease and death are not equitably distributed. They disproportionally cluster among the most disadvantaged. Vaccine access and uptake is also lower in many disadvantaged groups.

Opening the country at 80% without ensuring these groups have met or exceeded those targets will result in substantial avoidable illness and death.

Who is most vulnerable to serious disease?

The risk of serious COVID-19 and death is related to “clinical vulnerability”, such as whether the person has underlying health conditions like diabetes or respiratory disease.

First Nations Australians, disabled Australians, prisoners and people living in rural and remote Australia have much higher levels of chronic conditions, which have their roots in social and economic disadvantage.




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On top of their clinical vulnerability, these groups face multiple barriers to accessing quality health care, including intensive care. These barriers might include lack of physical access, discrimination, an inability to access culturally competent care, and/or geographical distance.

What have we learnt from other countries?

Across the world, COVID-19 infection rates have occurred at higher rates in aged-care facilities, disability group homes and institutions and jails.

Besides aged-care residents, Australia hasn’t yet seen the high death rates in clinically vulnerable groups that other countries have witnessed.

In the United States, Indigenous Americans have had the highest rate of COVID-19 deaths – dying at three times the rate of white Americans (when adjusting for the fact that Indigenous Americans are younger than non-Indigenous Americans).

High rates of death have also been seen among:

  • Black and Hispanic Americans
  • those in rural areas
  • prisoners, who were three times as likely than the rest of the population to die of COVID-19 (after taking into account the differences in age and sex between the prison and general populations).
Hospital equipment sits in front of clinicians in scrubs.
The death rate among clinically vulnerable groups has been up to three times higher in the US.
Stacey Plaisance/AP

In the United Kingdom, people with intellectual disability were eight times more likely than the rest of the population to die of COVID and disabled people made up 60% of the deaths.

Intellectual disability was second only to age as a risk factor for death from COVID-19 in the US.

What’s happening in Australia?

COVID-19 infections are more common in disadvantaged areas, both in Australia and internationally.

Residents in disadvantaged communities are more mobile, live and work in close proximity to other people, and are more likely to be essential workers who can’t work from home. These areas also tend to have high concentrations of ethnic minority and migrant communities.

Victoria’s second wave included outbreaks among residents and workers in aged-care facilities, along with outbreaks in health care, meatworks, and disability group homes.

In NSW’s current wave, outbreaks are spreading rapidly in First Nations communities in western NSW and in prisons.

Who is getting vaccinated?

Australia’s vaccine rollout strategy prioritised people at most risk of serious disease and death from COVID-19.

Phase 1A included aged-care and disability group home residents and the workers who support them.

In Phase 1B, First Nations Australians over 55 years and people with disability with chronic conditions were eligible.

People prioritised in these phases were meant to be vaccinated by April.




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More recently, all participants in the National Disability Insurance Scheme and Indigenous Australians 12 years and older became eligible.

Prisoners are not explicitly included as a priority population.

But the strategy came without an implementation plan and vaccination levels are appallingly low in many groups.

Vaccination rates are substantially lower among Indigenous Australians than the population rates in every state and territory, except Victoria where Indigenous vaccination rates are much higher.

In western NSW, where COVID-19 is rapidly spreading through First Nations communities, 11.6% if Indigenous Australians are fully vaccinated compared with 28.9% of non-Indigenous Australians.

Information about vaccination rates among disabled people and workers are not routinely shared and tend to be leaked to the media. On August 22, for example, the Sunday Age revealed just 27% of NDIS participants were fully vaccinated, lagging behind the national rate.

Vaccination of prisoners and prison staff has also been slow. Many states only started their prison vaccination rollout in the last couple of months and data on vaccination coverage in correctional services have not been released (or perhaps even collected).

No targets yet for vaccinating vulnerable groups

The Doherty-led COVID-19 vaccination modelling is cited as justifying the federal government’s 80% target. The modelling report acknowledges:

particular attention should be paid to groups in whom socioeconomic, cultural and other determinants are anticipated to result in higher transmission and/or disease outcomes.

The Doherty Institute’s director, Professor Sharon Lewin, emphasised that we need to achieve 80% targets for all Australians including our most disadvantaged citizens.




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However, the model itself did not specifically evaluate the potential impact on high-risk groups. Nor does the Commonwealth National Transition Plan focus on equity.

Disadvantaged Australians face triple jeopardy – low vaccination rates, greater likelihood of being infected with COVID-19, and higher risks of serious disease and death from COVID-19.

These risk factors are significant individually. But some individuals face intersectional disadvantage. Indigenous people, for example, experience disability at a higher level than the general population. And people with mental health issues are over-represented in prisons.

Until now, we have relied on public health measures to contain the spread of COVID-19. If we relax these and move quickly to rely mainly on vaccination without ensuring equitable delivery, those most at risk will face a disproportionately greater burden of serious illness and death.

What can be done?

Thankfully, vaccine supply is improving. Australians are being vaccinated at unprecedented levels, particularly in NSW.

However, unless we explicitly move to an equity-based strategy for vaccination, “at risk” populations will be left even further behind.

Man in a mask shops for dip.
All Australians should have an opportunity to be vaccinated before the nation opens up.
Atoms/Unsplash

Equitable allocation of vaccines requires:

  1. defining priority groups and geographical areas
  2. allocating an increased share of vaccines or vaccination appointments
  3. tailoring outreach and communication
  4. offering vaccinations close to or in workplaces and places where people live including private homes, aged-care facilities, and prisons
  5. monitoring vaccination uptake
  6. inclusion of vaccine targets for priority groups in the national plan.

Continuing our current strategy will mean that when we decide the time is right to “live with COVID”, many people who should have been the highest priority for vaccination could die.

We demand a rethink of our vaccine strategy to have an explicit focus on equitable vaccine allocation. Otherwise, it’s simply not “safe” for many Australians to come out of Morrison’s proverbial cave.The Conversation

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

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

Could Britain be sued for reopening and putting the world at risk from new COVID variants?


GettyImages

Kris Gledhill, Auckland University of TechnologyWith most COVID-19 restrictions now lifted in England, the world is watching to see what this so-called “freedom day” will bring.

Some scepticism is warranted, given Britain’s approach throughout the pandemic has hardly been a success. By July 19, there had been 128,985 deaths from COVID-19, and the death rate per million of population was just under 1,900.

True, there are countries with worse rates, including Hungary, Italy and the Czech Republic in Europe. But countries that have taken a different approach have vastly better figures: for example, 35.8 deaths per million of population in Australia, and 5.39 in New Zealand.

No doubt Boris Johnson’s government took its emphatic 2019 election victory and relatively successful vaccination program as a mandate for opening up.

But the current situation doesn’t support such optimism. Infection rates are now the worst in Europe and the death rate is climbing. By contrast, Australia has much lower death and infection rates but state authorities have responded with lockdowns.

Furthermore, many scientists have condemned the opening-up policy. The authors of the John Snow Memorandum stress the risks to the 17 million people in the UK who have not been vaccinated, and state:

[This approach] provides fertile ground for the emergence of vaccine-resistant variants. This would place all at risk, including those already vaccinated, within the UK and globally.

Taking the UK to court

Is it enough to hope Boris de Pfeffel Johnson will not just dismiss these concerns as piffle? Perhaps there is an alternative — taking the UK to court. Specifically, to the international courts that deal with matters of human rights.

For countries in the Council of Europe, this would be the European Court of Human Rights. Globally, there is the option of the Human Rights Committee of the United Nations.

How would this work? A court claim requires what lawyers call a “cause of action” — in this case, a breach of human rights, including the right to life and the right not to be subject to inhuman and degrading treatment.




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In the main international human rights treaty, the International Covenant on Civil and Political Rights (ICCPR), article 6 requires that the right to life, which belongs to everyone, must be protected. Article 2 of the European Convention on Human Rights (ECHR) says the same.

In 2019, the UN Human Rights Committee noted this right to life amounts to an “entitlement […] to be free from acts and omissions that are intended or may be expected to cause their unnatural or premature death”.

It also noted the obligation on states to take steps to counter life-threatening diseases.

A duty to protect

European Court of Human Rights case law establishes that the duty to protect life includes a requirement on states to take reasonable steps if they know (or ought to know) there is a real and immediate risk to life.

This has usually involved the criminal actions of dangerous people, but there is no reason it should not cover government policy that rests on an acceptance that people will die.

After all, the entire human rights framework was put in place to limit states from breaching rights.




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This duty to protect applies not just to deaths. Both the ICCPR and the ECHR have absolute prohibitions on inhuman and degrading treatment. For many people, the severity of COVID-19, including the consequences of long COVID, meet this standard.

If government policy can mitigate such consequences, human rights standards mandate that it should.

In short, this is not just a matter of the right to health. Because the UK will likely allow the virus to spread from its shores, the rest of the world is at risk and therefore has an interest here. So can other countries take action?

A political calculation

Human rights conventions are treaties — promises by states to each other as to how they will act. Article 33 of the ECHR is very clear: states can ask the European Court of Human Rights to adjudicate whether another state is breaching rights. There are many instances of this happening.

Importantly, the court can issue “interim measures” under its procedural rules to preserve the status quo while it hears a case.




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The UN Human Rights Committee may also consider state-to-state complaints under article 41 of the ICCPR if a state has agreed to this — and the UK has made the relevant declaration.

Of course, any decision by a state to take another to court is political. But this pandemic is not just a health issue, it is also a matter of life and death. Protecting life should be a political priority precisely because it is such a fundamental right.

Politicians willing to stand up for human rights should use the tools that exist to achieve that aim.The Conversation

Kris Gledhill, Professor of Law, Auckland University of Technology

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

Grattan on Friday: What does “reopening” Christmas Island actually mean and why do it?


Michelle Grattan, University of Canberra

The Morrison government, politically-speaking, is trying to do a
loaves-and-fishes exercise with the medevac legislation, over which the parliament defied the executive this week.

It is attempting to inflate Labor’s support for a modest measure to facilitate medical transfers from Manus and Nauru into a mini “Tampa” crisis.

Will this succeed? The short answer is surely “no”; the longer one is that this issue could take a deal of skin off Labor. The point is no one is yet sure how it will play out – both sides are operating on gut feelings until the polls and focus groups speak.

The Liberals think anything to do with “boats” is lethal for Labor; the ALP believes community attitudes have changed but is very apprehensive about how the debate would go if boats showed up.

No question, this is rocky for Bill Shorten. The government attack is ferocious, full of exaggeration and scaremongering.

But the Coalition’s tactics are also risky in a policy sense. Scott Morrison is running two lines. He claims that by supporting the medevac legislation Shorten has undermined offshore processing – sending a signal the borders are porous.

He goes on to say that the government, and he in particular, are ready to protect Australia against the danger of a new wave. Whatever the intelligence advisers want done will be done. The borders will stay strong.

Morrison rejects the argument that the detail of the legislation
limits the incentive to people smugglers, insisting they don’t bother with “nuance”.

Indeed. So which un-nuanced Morrison message will the smugglers hear? That the policy has been trashed – or that the borders are being fortified?

There is also the danger, which some critics have highlighted, that in its rhetoric about numerous alleged criminals on Nauru and Manus, the government could make the US more reluctant to take people (it has only accepted 456 so far – the deal was up to 1,250).




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What the government is actually doing is hard to pin down. Take the reopening of the Christmas Island detention facility – or to be more precise “a series of compounds” there – which attracted big headlines, and attention overseas.

What does “reopening” mean? Going in with the vacuum cleaners and the mops so that the centre could function if required? Or setting up some of it immediately on a serious day-to-day operating basis?

And how convincing is the rationale for this reopening, which Morrison described as for dealing “with the prospect of transfers”?

The government says that with the closing of many detention centres, space is somewhat tight. But if people are transferred because they are sick, Christmas Island is hardly the best place for access to medical practitioners.

Maybe some people currently in detention elsewhere would be moved to Christmas Island to make room for newcomers. But wouldn’t it be a lot cheaper and easier – if less dramatic and headline-grabbing – just to lease some more accommodation near currently-operating facilities?

Anyway, while some of the transferees would be kept in detention,
what’s happened previously suggests a lot could be let into the
community.

It’s true that the advice from the Home Affairs department envisaged a scenario “likely necessitating the stand-up of the Christmas Island facility”, but it had the flavour of a worst-case one. (With an election and the prospect of a change of government raising questions about the future of Home Affairs secretary Mike Pezzullo, one wonders what he thinks about the department’s advice being used publicly by the government as a battering ram against Labor.)

If the government really intends to “reopen” Christmas Island in any major way, it could find itself spending a lot of money there on few if any people. If it is a faux reopening, it’s just a bit of spin that should be called out.




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The medevac bill was passed despite the best efforts of the minority government to stop it, including a Senate filibuster on the final sitting day of last year, to delay the bill reaching the lower house then.

On Thursday a rather panicked government did a rerun of that December day.

This time, the Senate had passed a motion – opposed by the Coalition – calling for a royal commission “into violence, abuse and neglect of people with disability.” Labor, expecting the motion to reach the House on Thursday afternoon, prepared to push it through with crossbench support.

The government says it knew the message from the Senate hadn’t arrived as question time was nearing its normal end. But it was spooked by the opposition’s tactics, and fearful of what Labor might be up to. So it just kept question time running for some 150 minutes, a record.

Earlier in the day, it had to pull its legislation for applying a “big stick” to errant energy companies, because the House appeared set to amend it to prevent the government underwriting coal projects.

The government says it will take the “big stick” plan to the election. But its inability to have it bedded down before then is another failure in a long line in the energy area.

The vote on the disability motion will happen on Monday and the
Coalition will not oppose it – despite its stand in the Senate. The government says it will then consider what action it should take.

Abuse of disabled people is surely as important an issue as the
ill-treatment of the elderly. With the public increasingly demanding the facts and culprits be revealed where there is evidence of misconduct, a royal commission in parallel with the aged care one would have merit, in both policy and political terms.

The parliamentary week has been rugged for both sides – the government hasn’t been in control of the House but Labor hasn’t been in control of the debate, which it wanted to be all about banks not boats.

Then again, nothing could match One Nation’s tribulation, with its
leader Pauline Hanson accused of sexual harassment by a bitter
ex-colleague, senator Brian Burston, and her right-hand man, James
Ashby, publicly scuffling with her accuser. This is a party beyond
embarrassment.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

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

Chinese pastor, wife slain at church served by Lottie Moon


A Chinese pastor and his wife were slain Aug. 31 at Penglai Christian Church, where Lottie Moon, an icon of Southern Baptist mission work, served in the early 1900s in Penglai, China, reports Baptist Press.

Pastor Qin Jia Ye and his wife Hong En He, both in their 80s, were killed in the church’s office on Wednesday.

The suspect — a 40-year-old former church member — was arrested within an hour of the early morning incident.

The couple’s violent death is a shock to many, both in China and the United States. The church was closed for 49 years after communists came to power at the end of World War II, reopening in 1988 with only 20 people.

Qin reported 300 baptisms several years in a row. Today, there are 3,600 members.

Chinese newspaper accounts state that the suspect entered the church office carrying an axe and struck the pastor and his wife, killing them both.

The church eventually outgrew Moon’s original structure and built a modern 1,500-seat sanctuary next to it with the help of Johnson Ferry Baptist Church in Marietta, Ga.

"From the moment I met Pastor Qin, I could sense a Christ-like spirit," said Bryant Wright, Johnson Ferry senior pastor and current Southern Baptist Convention president. "We are incredibly saddened by this tragic event, but we know one of the Lord’s faithful servants is with Him forever in Heaven."

Qin graciously acted as tour guide for a large number of Southern Baptist leaders passing through Penglai who wanted to connect with the community where Moon served.

Wanda S. Lee, executive director-treasurer of Woman’s Missionary Union, visited the church during a 1997 China tour. In spite of numerous church responsibilities, Qin and his wife welcomed the group warmly, Lee said, and it was obvious they were well-loved and respected.

"We are deeply grieved at the news of [the] death" of Qin and his wife, Lee said. "It is a great loss to the Christian community."

Candace McIntosh, executive director of Alabama WMU, took seven college students to China in 2008 to experience firsthand the history and work of Southern Baptists. Penglai Christian Church was a stop on the tour.

McIntosh remembers admiring Qin’s humble and quiet strength as he prepared for worship, as well as his ability to state the message clearly for all to understand. After the service, Qin spent a great deal of time talking with the team of young women about Moon’s legacy.

"He was so encouraged that younger women were there, learning about the history of Lottie Moon and the Chinese church," McIntosh recalled. "I know the legacy of Lottie Moon will live on, but one of its greatest communicators is no longer with us. I know Qin’s legacy will live on, too."

Report from the Christian Telegraph