By Rhiannon Hoyle
SYDNEY — To reach indigenous clans in northern Australia, vaccinators must navigate monsoon rains that can ground aircraft and waterways infested with crocodiles. Once they reach communities, they face another tough challenge in convincing those groups to accept the shots.
First Nations people like those in East Arnhem Land — more than 600 miles by road from the closest city of Darwin and a bastion of traditional Aboriginal culture — are next in line in Australia’s vaccination program that began last month and has focused on giving priority to health and other workers on the front lines of keeping Covid-19 out of the country.
In many ways, the vaccination program is a litmus test for nations with large indigenous groups that feel marginalized and distrustful of government policy. Almost 150,000 indigenous Australians lived in remote areas in 2016, according to the most recent government data available. In East Arnhem Land, life expectancy is around 50 years and half of Aboriginal children develop a severe hearing, lung or other health problem by age 4.
“What we’re hearing now is probably 50-75% will say no,” said Eddie Mulholland, chief executive of Miwatj Health Aboriginal Corp., an indigenous-controlled primary health service for roughly 8,000 people across East Arnhem Land.
Concerns have increased among indigenous Australians after reported cases of rare blood clotting in people in Europe who had received the Covid-19 shot developed by AstraZeneca PLC and the University of Oxford, though regulators found no link between the clots and the vaccine and recommended its continued use.
Australian regulators also analyzed reported cases of suspected anaphylaxis but concluded that the risk of a severe allergic reaction was no higher than with any other vaccine. Australia has ordered 53.8 million doses of the AstraZeneca vaccine.
Mr. Mulholland, an indigenous Torres Strait Islander born on Thursday Island, said the troubles facing AstraZeneca had been widely shared on social media.
Local indigenous groups already don’t believe in Western medicine, said Mr. Mulholland, who had earlier hoped for a 75% vaccination rate among adult indigenous Australians in East Arnhem Land, to help safeguard against infection risks when travel restrictions are eased.
Australia aims to have its adult population receive at least a first vaccine shot by the end of October and complete the program before the year ends. It will happen in five phases, with most adults in later stages and children last in line, should the vaccines be authorized for them.
Australia has no plans to stop using the AstraZeneca vaccine, Prime Minister Scott Morrison said.
Given entrenched health problems in remote Australia, some doctors have advocated for indigenous groups to get priority access to the Pfizer Inc.-BioNTech SE vaccine, which has been shown to be 97% effective against symptomatic Covid-19 cases in Israel when two doses were administered.
Australia has ordered 20 million doses of the Pfizer-BioNTech vaccine. However, authorities face a daunting distribution challenge because it requires cold-chain logistics that don’t exist in the hot and sparsely populated areas where many Aboriginal Australians live.
The Pfizer-BioNTech vaccine has to be kept at temperatures around minus 94 degrees Fahrenheit, although Australia’s regulator recently decided it can be stored at standard freezing temperatures for up to two weeks.
Still, many indigenous groups move among communities across an area almost as large as the contiguous U.S., raising concerns about whether all would receive the second vaccine dose.
No Aboriginal or Torres Strait Islander people in remote settlements have caught the virus, but authorities and health experts worry it could be introduced by people traveling from cities.
In places where the virus has spread uncontrollably, such as the U.S., indigenous people have been overrepresented in the number of hospitalizations and deaths.
“This is a highly vulnerable group of people,” said Dr. Michelle Ananda-Rajah, a Melbourne-based physician in general medicine and infectious diseases. “This is the very group that should be getting the most efficacious vaccine.”
According to an analysis in medical journal the Lancet, rates of chronic disease, including diabetes and hypertension, are higher among indigenous Australians than other Australians. Indigenous Australians are twice as likely to have three or more chronic conditions, it found.
Paired with higher rates of smoking, overcrowding in multigenerational houses, and poor access to water and sanitation, that puts indigenous people more at risk of dying from the coronavirus.
Hugh Heggie, chief health officer of Australia’s Northern Territory, which includes East Arnhem Land, said the federal government had agreed that remote Australia shouldn’t use the Pfizer-BioNTech vaccine.
“I have confidence we have that plan in place,” Dr. Heggie said, referring to the overall inoculation plan. “It’s a bit like, though, flying the plane while you’re building it.”
Getting enough vaccinators who can travel to remote communities is another worry, said John Paterson, chief executive of Aboriginal Medical Services Alliance Northern Territory. The territory relies on clinicians from other states or New Zealand, a system that was strained by state and international border closures to contain outbreaks.
While most remote communities have rough airstrips, outstations — where families or small groups live on traditional lands — can be several more hours’ drive on dirt tracks.
“Some of those remote communities can only be accessed by aircraft at this time” as the Northern Territory is enduring an especially bad wet season, Mr. Paterson said. “Roads are cut off. Some of them can just be little islands until the water recedes.”
Last year, Australia’s leaders restricted intrastate travel to stop the virus from reaching remote communities. The Northern Territory, where Aboriginal and Torres Strait Islander people make up roughly 30% of the population, banned nonessential travel to and from remote communities. Those who needed to travel there had to isolate for 14 days.
Australia’s experience will offer lessons to Pacific nations, where border closures mostly prevented outbreaks. Governments there face challenges including remote populations on islands and in highlands, a scarcity of vaccinators and a mistrust of vaccines.
“Everyone is sharing information about how this is done,” Prime Minister Morrison said.
For Miwatj Health’s Mr. Mulholland, getting the rollout right is crucial.
He expects vaccines in only roughly 150-dose parcels from the government, which has been facing supply-chain bottlenecks. That would require him to either stockpile vials or make many trips by plane to give shots to the communities his service treats, the largest of which is home to more than 2,000 residents.
While a botched rollout would hurt the reputation of regional health services among indigenous communities, low vaccination rates could be catastrophic.
“If they don’t do it, and someone comes in, they could wipe the whole place out,” he said, referring to someone introducing infection.
Write to Rhiannon Hoyle at [email protected]
(END) Dow Jones Newswires