Going for CALD on Covid

Feb 14, 2021

Two outbreaks of Covid in Victoria occurred among Greek and Urdu communities – entirely predictable given that diverse communities had long been identified as potentially vulnerable. Despite repeated warnings no one in authority seemed to want to know. That is now being rectified to ensure the message on vaccines is heard loud and clear, with Health Minister Greg Hunt’s announcement that the federal government is to fund a significant communication campaign guided by specialist and community input.

A critical issue was the lack of hard data about the spread of the virus in language communities. Now as the vaccines roll out and there is a clear interest in as many people as possible receiving them, the focus on CALD Australia has intensified and many proposals that were side-lined for more than six months are now being put in place.

In March 2020, with the first  lockdown in place, and reports appearing that the virus was affecting people of colour in the US and UK, I started to look at the research in Australia and the data in the government data collecting agencies about people our bureaucracies label CALDs – Cultural and Linguistic Different/Diverse Australians.

The evidence from our allies proved indicative – meat works, nursing homes, crowded towers of poor people of colour – we had them all. And still as the death toll rose and lockdowns intensified, no one thought it might be helpful to discover how the disease was tracking in cultural communities, and to partner with them to make sure the messages of safety and survival were delivered where they were needed most.

Probably the most abysmal outbreak occurred at St Basil’s Greek Orthodox Nursing Home in Fawkner, in north Melbourne. On July 19, Neos Kosmos reported that the then 32 cases among staff and residents had taken off in a few days. On 12 September, the ABC reported 183 cases and 44 deaths (the home had 150 residents). The independent review of St Basil’s released by the Commonwealth in December 2020 made no mention of the lack of data, its six “key areas” carefully avoiding the issue.

Perhaps it was just that no one thought about the data question, as it was not important or useful.

Well, no. The NHMRC COVID research advisory committee, chaired by Professor Michael Kidd, knew all about it from the outset, as did its politician members – from the ALP and the Liberals, both medicos who had communicated their concerns to their parties.

The committee was anxious to identify the vulnerable groups requiring close attention and support. Migrants and similar CALD people were front of mind, but unlike any other priority groups, they were left un-enumerated and without any sense of scope, dimension or extent. This “don’t mention the war” attitude was the direct result of Government push back, both within the public service hierarchy (when Professor Brendan Murphy was CMO), and in the offices of key ministers. My inbox is full of emails from key players saying “not our problem”. While the Morrison government has been all talk and little action on cultural diversity (“the most successful multicultural society in the world” is nothing of the sort), the Labor opposition has also been missing in action, perhaps part of its small target position on any public policy that might be controversial.

I went through my networks of contacts in the ALP, including those who had recently invited me to contribute to policy development, and made the case that the Opposition should be pushing hard for recognition of cultural groups as dangerously marginalised by the government policy position. I was told the party had no problem with me pushing on the issue, but they would not support the argument.

I went through my network of contacts in the Liberal party in NSW and the national government, having after all just spent three (unexpected) years as a member of the MulticulturalNSW Advisory Board to a rapid sequence of Liberal ministers. I have been brushed off by some of the best over the years, but I came across deeply entrenched resistance to any data collection in NSW from those with policy responsibilities in both the public service and politicians’ offices. I also learnt from Victorian multicultural policy people that communication with state Health had disintegrated, with any attempt by them to advocate for better strategies and data collection not merely ignored, but effectively disregarded.

Then as the debate re-emerged in late 2020, following the shifting of Murphy to Health Secretary, and Kidd to deputy Chief Medical Officer, the mood changed. The pressure from a key lobby group, the Federation of Ethnic Communities Councils of Australia, in a detailed paper on data failures, combined with the realisation in government especially in PM Morrison’s office that tracking infections was different to rolling out vaccines, resulted in a new initiative. FECCA was persuaded Health that there should be a CALD advisory group, as there was for Aboriginal and Torres Strait Islander health, disability issues and sport. In parallel the Commonwealth should move from avoiding initiating and facilitating changes to the National Notifiable Diseases Surveillance System (NNNDSS) , to taking the lead on introducing CALD data into the data collection protocols.

Two important and immediate transformations were implemented. First the very well-personed CALD advisory group – health care, cultural minority, peaks etc – soon started working with Health on communications and the vaccine rollout. Rather than cultural groups being perceived as a threat, danger or marginal, they were moved into partnership roles where their expertise was integrated with the public health skills so evident during the pandemic tracking phase. One immediate benefit, Minister Hunt agreed that the vaccine roll out should include everyone in Australia – an extension from the “living in Australia” coda that had been the original brief. This means, for instance, that the 40-80,000 invisibles (those with lapsed visas and so on) who have been missed in the pandemic testing period, are now eligible for free vaccination. The only danger remains their vulnerability to arrest by Home Affairs if they surface and are detected.

The second initiative has been the decision to include CALD data collection in the NNDSS, using country of birth and language spoken at home, a move I had called for in June 2020. This agreement has to be incorporated into all the jurisdictions in Australia, a somewhat slow but nevertheless relentless process, which saw the first stage of this – data collection in the Commonwealth funded GP respiratory clinics – unfurled about a fortnight ago. The changes once fully implemented will forever change the information base of Australia’s NNDSS, and ensure that cultural diversity will be a core data set in understanding and engaging with pandemics in the future.

But what about Fawkner? In my research I could find only one “guerrilla” data raid anywhere in Australia. An emergency doctor from Royal Melbourne Hospital was charged early on in the Melbourne winter outbreak to establish a pop-up testing clinic in Fawkner. He was a data nerd (we are everywhere), and rapidly developed an app (now widely in use in Melbourne hospitals, which are their own fiefdoms), which asked language, country of birth, and whether the user had access to Covid-19 data in their own language. In the first week they covered more than 30% of the Fawkner area population, 90% of whom used the app, and everyone else had staff support to register. There was no resistance reported to supplying the CALD data. The process package included Redcap data collection, and an integrated health intelligence/demography survey using ABS data definitions. This last was critical as it allowed everyone to be located by ABS census area and produced a profile of which groups were and were not getting information and getting tested.

The report on this project went up the line (in so far as there is one in Victoria Health) and disappeared without trace. Over a third of the respondents were LOTE, who typically obtained their information from social media or the Internet (far more than English speakers). LOTE speakers were massively under-represented in testing, with Greek and Urdu speakers the most under-represented. This data was collected just as people began to die in St Basil’s.

The two big outbreaks around Fawkner occurred among Greek and Urdu communities – and no one saw them coming. Except of course they did but nobody wanted to know. That’s why what has happened in the past month or so to see cultural diversity as a critical dimension of health is  so critical for the wellbeing of multicultural Australia, whatever your skin colour.

Andrew Jakubowicz is a volunteer member of the COVID CALD advisory group.

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