What’s in the COVID19 disability vaccine rollout debacle report?

This blog was originally posted on Our Royal Commission Website.

On Monday, the Disability Royal Commission released a draft report about the evidence from Public hearing 12: The experiences of people with disability, in the context of the Australian Government’s approach to the COVID 19 vaccine rollout.

The report has a lot to say about how this rollout has failed those of us who needed help the most. It also emphasises how important it is to catch up now and finish vaccinating people with disability (and our support workers) before easing the lockdown restrictions that are keeping the virus partially contained at the moment. Find out how you can join our campaign to raise awareness about the need to #SpeedUpVaxForPWD at the main PWDA website.

Meanwhile, here are some highlights (or possibly lowlights) from the Royal Commission draft report.

Finding 3: The Australian Government Department of Health had sufficient information available to draft the COVID-19 Vaccine Roll-out Strategy with an appreciation of the significant challenges it would face in rolling out the vaccine to the Priority Disability Group. The Department has not adequately explained the apparent failure to take that information into account.

The Australian Government, both during the hearing and in their submissions afterward, swing between two somewhat contradictory excuses. On the one hand, they say that they never planned to vaccinate everyone who lives and works in disability group homes before moving on to the rest of the population and they certainly didn’t knowingly give us all the impression they would do so. And on the other hand they imply that it just mysteriously turned out to be too hard and there was nothing they could have done.

The Royal Commission dismisses both of these claims. They go through the information and resources the government had available in 2020 and show that the Department of Health (DOH) did not even try to seriously listen to people with disability or our organisations about disability-specific parts of the rollout.

They had a Disability Advisory Committee and a Disability Support Services Committee ready and willing to give expert advice on the risks we face in this pandemic and the challenges of getting vaccines to disability group homes, as well as all the evidence from August 2020’s Public hearing 5: Experiences of people with disability during the ongoing COVID-19 Pandemic. But it turns out all this was lip-service, and when it came to planning the vaccine rollout they preferred to work with assumptions and approximations.

The Australian Technical Advisory Group on Immunisation (ATAGI) Preliminary Advice featured the most glaring omission:

“There are only two mentions of disability in the ATAGI Preliminary Advice and both relate to ‘disability care’ workers as a potential priority population group. These workers were deemed to be ‘at high risk of COVID-19 due to frequent exposure to persons and settings that could transmit SARS-CoV-2’. People with disability were not recognised as a priority population group warranting protection. In effect, they were identified essentially as a hazard to the health of their disability support workers.”

The Royal Commission asked their government witness, Ms Edwards, what changed after that to put some people with disability into Phase 1a of the rollout strategy. She said ATAGI provided some extra advice about it, but after the hearing the government refused to show the Royal Commission that document on the basis of “public interest immunity,” an interesting phrase we have now added to our Jargon Buster.

Could this document be politically inconvenient? Such as by conclusively proving what the Royal Commission’s evidence can only “suggest” so far:

“Contrary to what appeared in the Strategy, DOH considered disability residential settings should be prioritised equally with aged care residential settings only to the extent that they closely resembled aged care residential settings. The evidence suggests that DOH gave no independent thought to the risks posed by COVID-19 to people in disability residential settings. DOH assumed that the settings would be very similar to aged care residential accommodation and vaccines could be administered in similar ways.”

Operating on an outdated imagining of disability residential services as giant institutions, they tacked us on to aged care as an afterthought. (This is not the place to get into aspects of the group home system that are still very much institutional in a bad way.)

Then they realised, weeks into the rollout, that “in-reach” teams would have to visit about 6,000 different homes to vaccinate 26,000 people with disability (compared to the aged care strategy’s plan to visit 240 aged care facilities housing 184,000 people, although these numbers also turned out to be significantly lower than reality). That was when they decided to “pivot” and put all their resources into the aged care population. The Royal Commission acknowledges that people in aged care were at very high risk, and that the rollout to them and their support workers needed more resources than they were getting, but refutes the government’s implication that this justifies totally abandoning the disability in-reach efforts. They point out that we don’t know if a smaller-scale or differently-resourced disability program could have at least vaccinated the disabled people who needed it the most, because the government didn’t even try.

“At no stage did the Australian Government Department of Health consider identifying people within the Priority Disability Group most at risk of serious consequences from contracting COVID-19 or formulating a plan to reach these people and offer the vaccines.”

The Commission also dismissed the government’s nonsensical claim that prioritising or focusing on aged care residents was somehow different from deprioritising people with disability. They also emphasised the lack of transparency involved in that decision.

In the first week of March 2021, Ms Edwards as the officer in charge of the rollout decided to prioritise aged care residents over people with disability living in residential settings in Phase 1a of the vaccine rollout. Ms Edwards explained that ‘it could have been the second week of March by the time we moved all the resources across’ to rolling out the vaccine to aged care. There is no contemporaneous record of Ms Edwards’ decision. The Australian Government did not produce to the Royal Commission any record of the advice relied on or the reasons for the decision. The effect of the decision was that the in-reach vaccination teams that were supposed to be deployed to disability residential settings during the rollout were instead re-deployed to aged care. In other words, from the second week of March 2021, DOH diverted resources from people with disability included in Phase 1a to people in aged care who were also included in Phase 1a.

Prioritising means putting one task ahead of another task. Generally, this means the second task is now behind the first one. If two things were meant to be equal priorities and then you decide to prioritise one of them, this necessarily deprioritises the other. The Government tries to claim that they never said everyone in Phase 1a would be equally prioritised. The Royal Commission very firmly points out that no reasonable person would interpret the actual words used in the Strategy in that way.

The report is very clear that, whatever word you use for it, in-reach teams that were working to vaccinate people with disability in group homes got reassigned to aged care, leaving disability residents and staff hanging with no information about their place in the queue. By the end of April, “a total of 1,936 doses had been delivered via in-reach to the disability residential sector. This amounted to 0.85 per cent of the total 226,934 doses administered to 29 April 2021 via the in-reach program.” And nobody knew.

“…the decision to deprioritise the vaccination of people in residential disability accommodation should have been publicly disclosed. It was a decision that directly affected the health and wellbeing of people with disability. They were entitled to know.”

We were entitled to know. We were also entitled to a greater-than-token effort to solve the logistical problems and, to whatever degree it was possible, keep us safe. But at the very least, we were entitled to know.