Pandemic Influenza Containment and the Cultural and Social Context of Indigenous Communities

In this Letter to the Editor, Rural and Remote Health, the authors discuss the omission of Australian indigenous people from respectful partnerships in World Health Organization (WHO)-directed, nationally developed comprehensive influenza pandemic plans.

As stated here, "A review of 37 national pandemic plans found that plans, including the Australian plan, inadequately addressed the needs of socially and economically disadvantaged communities in their disease containment policies...Indigenous Australians, particularly in rural and remote areas, experience profound social disparity, including overcrowding, excess co-morbidity, poor access to health care, communication difficulties with health professionals, reduced access to pharmaceuticals, and institutionalized racism. History clearly demonstrates the devastating toll of previous influenza pandemics on Indigenous Australians. During the 1918-1919 pandemic, mortality rates approaching 50% were reported in some Australian Indigenous communities, compared with the national rate of 0.3%. The leprosy control program used in Aboriginal communities in the past included isolation, incarceration and other punitive measures that caused much fear. The fear drove people into hiding and increased the disease risk for families and communities....Although the Australian plan recognizes the increased risk for Indigenous people, it does not acknowledge that Indigenous Australians must inform containment strategies if these are to be appropriate and effective for all Australians." [Footnotes removed by editor.] The authors call for genuine partnership with communities in decisions on appropriate pandemic containment measures, recognising that some cultural practices may amplify or reduce infection risk.

As reported here, "[d]uring a recent focus group discussion with Indigenous people from Aboriginal medical services and Aboriginal health services in a rural area of Australia, concerns were raised about the currently recommended pandemic social distancing and other infection control strategies. Many of these concerns were associated with individual and group memories of intrusive government surveillance and control of Indigenous people in the past. These memories impacted on people’s responses to contemporary government policy. Planned policies to control and contain outbreaks may meet with the same passive and active resistance that past government policies provoked."

The authors recommend that the "basis of genuine and respectful partnerships is captured in the human rights approach, which demands that individuals and communities are adequately involved in the decisions that affect their wellbeing." They warn of consequences if the aspirations for indigenous self-determination are not met with genuine and respectful partnership to define what pandemic containment measures are culturally appropriate and acceptable.