10.2 Response Implemented

Early international surveillance information suggested that Indigenous Australian populations were more likely than the general Australian population to experience severe outcomes from infection with pandemic (H1N1) 2009 influenza, and that people with underlying chronic health conditions were also at greater risk. This led Australian health authorities to consider and anticipate that the pandemic (H1N1) 2009 influenza virus might pose a high risk to Indigenous Australians.³⁵

Early Australian data indicated that approximately 20 per cent of confirmed cases of pandemic (H1N1) 2009 were identified as Indigenous Australian patients, and that these patients were hospitalised at eight times the rate of non-Indigenous Australians. While there was no evidence of widespread pandemic influenza in Indigenous communities, there were some cases in many Indigenous communities across Australia. All Indigenous Australians were included as an at-risk vulnerable group for management purposes.

The Australian Government, state and territory health departments and the Indigenous health sector worked closely to ensure timely and appropriate support for case management. The Australian Health Protection Committee (AHPC) agreed that ACCHSs were to be included in the jurisdictional delivery and pre-positioning of personal protective equipment (PPE) and antiviral medications from the National Medical Stockpile (NMS). A number of ACCHSs had commenced or completed work on their own pandemic response plans, and in some jurisdictions ACCHSs and NACCHO Affiliates were included in jurisdictional-level planning processes. State and territory health departments worked with various ACCHSs to coordinate specific local responses, including supplies for case management in remote communities.

The Indigenous Flu Network (IFN) was established during the response. The IFN provided a regular communication channel to share information and discuss solutions to acute and emerging issues relating to surveillance and epidemiological trends, communication and community engagement, workforce shift and surge capacity, and access to and prepositioning of antiviral medications and PPE from the NMS. This meant that a more comprehensive response for Indigenous Australians could be implemented. The IFN comprised experienced clinicians and public health physicians, including members of the Public Health Medical Officers network, from across Australia. It included representatives of peak bodies such as NACCHO and its Affiliates and the Australian Indigenous Doctors Association, as well as the National Indigenous Immunisation Coordinator from the National Centre for Immunisation Research and Surveillance. This positioned the IFN well to optimise ACCHS preparedness and response systems. The IFN also advocated for inclusion of the Indigenous primary healthcare workforce in the training facilitated by the Royal Australian College of General Practitioners (RACGP) and the Australian General Practice Network (AGPN).

Under the PROTECT phase, Indigenous Australians were identified as one of the highest priority groups. To meet the challenges of the 2009 pandemic, an appendix to the PROTECT Annex specifically focusing on Indigenous Australians (Guidance for Primary Health Care Workers Providing Care to Aboriginal and Torres Strait Islander People) was developed in conjunction with the Indigenous health sector. It provided practical advice for primary healthcare workers, outlining issues specific to Indigenous Australians including those with underlying medical conditions and/or living in remote communities. Advice was consistent with national guidelines for measures such as infection control and case definitions, with context-specific advice for populations residing in remote community settings.

The appendix took practical and cultural factors in Indigenous communities into consideration for implementing public health measures such as isolation, cough etiquette and hand washing. It identified that early and rapid clinical support was important, particularly for remote communities. This included identifying sources of clinical support, planning for emergency evacuations by liaising with retrieval services and early anticipation of clinical deterioration to allow timely transfer. In recognition that testing and treatment of pandemic influenza cases may be different for Indigenous Australians living in remote communities, with limited laboratory testing capacity in some areas and less than timely results, wider use of antiviral medication provided a means of protecting communities that were not yet affected by the virus. Antiviral medication could also be used to protect the limited number of healthcare workers available in remote Indigenous communities.

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A national communication strategy was developed to support the response activities outlined in the PROTECT phase, in particular its strong emphasis on recognising contacts who may be vulnerable because of their underlying health conditions, within the context of protecting family or community members. The main objectives were to increase awareness of pandemic (H1N1) 2009 influenza, its symptoms and the health risks it presented for Indigenous Australians; to promote preventative actions to minimise the risk of infection or spread; and to encourage individuals to seek medical attention early.

Communication products based on standard pandemic influenza messages had been pre-prepared for Indigenous communities. Some adaptation was required to ensure relevancy to pandemic (H1N1) 2009. Communication products are likely to require adaption for each pandemic.

Indigenous Australians were identified as a priority group in the Pandemic (H1N1) Vaccination Program. The IFN also assisted in the planning and delivery of the vaccination program, identifying and advising on issues relating to deployment, quality, safety, service provider arrangements, indemnity and Medicare rebates. The IFN assisted in ensuring timely access to the vaccination program, particularly for remote communities. The IFN communicated with jurisdictional immunisation providers so that various models of service delivery for Indigenous Australians were supported and incorporated into the vaccination communication strategy.

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³⁵ Indigenous Australians have higher rates of underlying chronic disease, some of which is undiagnosed, than the general Australian population. Indigenous Australians also have a higher prevalence of risk factors for chronic disease and a higher likelihood of having at least one risk factor for chronic disease. Chronic disease also develops at a younger age in Indigenous Australians than in the general Australian population.