Leading medical bodies and local councils are concerned that rates of vaccination among smaller rural communities are lagging behind metropolitan centres – as New South Wales prepares to open up after it reaches a 70% double vaccination rate.
Dr Chris Moy, the vice president of the Australian Medical Association (AMA), said doctors were concerned by data on the vaccination rollout, which showed that while numbers were up in inner-city suburbs, the lower socioeconomic and rural areas were being left behind.
Peta Rutherford, the chief executive of the Rural Doctors Association of Australia (RDAA), said official data from the federal health department showed a number of smaller rural communities were sitting below 60% first dose vaccination. Rutherford gave the example of Edward River where, according to the latest data, only 47% of people have had their first dose and 30% both.
Norm Brennan, the mayor of the Edward River Council, said the low vaccination rates were concerning, especially “when we do open up it puts another dynamic into the equation”.
In its “roadmap to freedom”, the NSW government has said regional areas will be accessible for travel to the fully vaccinated, once the state reaches the 70% fully vaccinated mark.
Dr Charles Evill, the president of RDAA NSW, highlighted that “it is far easier to meet the 70% state-wide target if you make sure a large percentage of the metro populations are vaccinated”.
However, the RDAA said this week that in order for rural communities to be safe they too need to hit the 70% vaccination level before they opened up for travel.
About 100 mayors from across the Hunter Valley held a virtual meeting with the NSW deputy premier, John Barilaro, on Friday. Most were concerned about low vaccination rates and warned about lifting restrictions in Sydney before regional communities caught up on vaccinations.
Lake Macquarie mayor Kay Fraser said her constituency was 15% behind the average in Sydney and that access to the vaccine had been “a real issue”.
Fraser’s council area was one of those which saw their designated Pfizer vaccine doses rerouted for Sydney HSC students. She said as well as Lake Maquaries’s HSC students, a lot of vulnerable communities in regional NSW such as those from low socio-economic backgrounds and Aboriginal communities had not had access to vaccines.
Fraser said the situation for many was exacerbated by a lack of access to public transport and the internet in order to be able to book appointments.
Rutherford said while “some of these towns have high rates, we are concerned some have very low rates and if 70% is made up of major cities, it leaves the rest of the country vulnerable”.
NSW Health told Guardian Australia “the finer details of the roadmap are currently being worked through by the NSW government, but there will be requirements in place to ensure only those who have received both doses of the Covid-19 vaccine can take advantage of the freedoms”.
Moy said that while medically-based guides about opening up were important “the constraining factor is the need to consider your most vulnerable link which is rural Australia”.
He said the Doherty Institute modelling was based on Delta infectivity and vaccination rates indicating how many people were going to get sick – but “in rural environments that equation doesn’t add up” because “the burden shifts to the hospitals” and any modelling needs to be worked out backwards from the health service capacity.
Absolutely agree with AMA spokesman who is saying that the absolute constraint re any opening up scenario is to keep our hospitals functioning so they can handle both COVID and emergency needs. That's challenging enough in the cities, but even more problematic for small towns.
— Prof. Peter Doherty (@ProfPCDoherty) September 2, 2021
Peter Wark, the conjoint professor for the centre for health lungs at the University of Newcastle, said there were significant challenges when it came to rural health, starting with the fact that on almost every significant health outcome, rural and regional Australians did worse than their metropolitan counterparts.
Wark said Covid-19 posed a greater threat for rural and regional populations because of the high prevalence of chronic disease..
Hospitals in regional and rural locations “have relatively limited resources and limited ability to escalate care to more high levels of therapy, particularly intensive care,” he said.
Wark said that “really only regional centres can offer intensive care support, which often means transporting from remote locations to a regional centre and even regional centres have limitations in terms of finite bed capacity and resources for high-end therapy, which means they have to transfer more complex patients out of their intensive care”.
“When the patient can’t be managed on a standard respirator, extracorporeal membrane oxygenation (ECMO) therapy they would have to be transferred to a metropolitan hospital.”
In dealing with the outbreak which began in Shepparton, in Victoria, the Goulburn Valley Health chief executive, Matt Sharp, said that a number of cases had required transfer to Melbourne for a higher level of care than was able to be provided by the local health district.
Scott McLachlan, the chief executive of Western NSW Local Health District, also acknowledged that in Dubbo as more cases required hospitalisation, even with the extra support of practitioners that had travelled from Sydney and out of retirement, they needed additional staff to meet demand.
Wark highlighted that even interventions regarded as standard in treating Covid 19-could potentially be challenging for smaller regional centres because of limited staff numbers.
Wark gave the example of “proning” – ventilating the patient while they’re on their stomach – a therapy which is time consuming so “even just one or two patients can be very burdensome for staff.”
Moy also highlighted the vulnerability of the medical services to the disease themselves – especially in situations where “only one or two doctors are providing medical services to a town, if that doctor becomes infected the entire medical care is down.”
While Wark said the measures in place in western NSW looked to be very effective, the situation with health resources in regional and rural Australia remained a potential threat.
“Covid-19 has the potential to lead to those very high levels of acute and complex care. Unfortunately, the other side to that is that they can appear in high numbers. Those two factors combined, health services can get overwhelmed, but rural and remote areas are that much more at risk, and essentially don’t have the same degree of depth as metropolitan services,” he said.
