Going CALD on COVID….

Last week about 50 community leaders from across a wide range of ethnic groups and agencies, were invited to a Zoom consultation with the federal Department of Health team charged with the vaccines rollout for COVID19. Eight months ago an NHMRC advisory group had just identified these groups as potentially vulnerable, and requiring accurate information and communication support as the virus spread. A critical issue was the lack of hard data about the spread of the virus in language communities. Now finally 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 sidelined for over half a year are now being put in place.

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

Then all the evidence from the worst of our allies proved indicative – meat works, nursing homes, crowded towers of poor people of colour – we had them all. And still as the death tolls rose, borders were frozen and lockdowns were intensified, no one thought it might be helpful to discover how the disease was tracking in different cultural communities, and what partnering with those communities might be advisable to make sure the messages of safety and survival were accurately 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. As early as July 19, Neos Kosmos reported that the then 32 cases among staff and residents had taken off in a few days.  As of 12 September 2020 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 advisory committee, chaired by Prof 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 back to their parties. The committee was anxious to identify the vulnerable groups that would require close attention and support. Migrants and similar CALD people were at 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 Prof 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. There was slightly more than a brush-off – 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. Quite simply 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 complete new initiative. FECCA was successful in convincing Health that there should be a CALD advisory group, as there was already 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. Firstly 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 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 (visa lapses, boat jumpers, etc) who have been missed in the pandemic testing period, are now eligible for vaccine for free. 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 that 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 (really snazzy all on its own and 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 COVID19 data in their own language. In the first week they covered over 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 got 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 just so critical for the future well-being of multicultural Australia, be you White Folks or coloured Folks.

Andrew Jakubowicz is emeritus professor of sociology at the University of Technology Sydney, and a volunteer member of the COVID CALD advisory group mentioned in this article.


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