Vaccine Equity – Who calls the shots? 

Dr Marco Giuseppin, Chair AMA Council of Rural Doctors   

As we enter 2021, there are few things on the minds of medicos other than the ongoing COVID-19 pandemic. With each news cycle we are treated to new fears and hopes;  vaccines, new outbreaks, and the harrowing situation in countries like the United States and the United Kingdom. 

There is a misconception by many, that COVID 19 is predominantly a disease of cities - due to concentrated populations where transmissibility is increased in close quarters.  

Nothing could be further from the truth. The impacts of the pandemic on rural Australia have been profound.  

Members of our community are unable to travel to and from major centres out of fear of bringing the virus home to a community unable to cope.  

The scourge of geographic narcissism has devalued rural practice to the point where our rural hospitals and infrastructure (both humans and buildings) are stretched thin. Our communities face the twin challenges of COVID 19 and bushfires in the summer. Rural Doctors are unable to access locum relief in a timely and effective manner, and the training of our next generation of rural doctors and health professionals has gone through profound change. 

The vaccine offers hope. In the near future, it is likely that vaccines produced by Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca will receive approval from the Therapeutic Goods Administration (TGA).  

The first two vaccine options are likely to be the first to receive approval. This sets the road out of this pandemic – a return to a world where we no longer have to live in fear. 

Unfortunately, the delivery plans for this vaccine are ultimately controlled by a small number of senior people (clinical and non clinical) in our major cities.  

Already we have heard musings that some states have decided that delivery of the Pfizer and Moderna vaccine candidates to rural areas will be “too hard” owing to storage and transport requirements as well as ageing infrastructure in rural areas.  

This creates a “two tier” system where vulnerable populations in major cities will likely have access to a vaccine candidate far earlier than those in rural areas. Many hard-working rural doctors have identified these concerns but have been brushed off by their metrocentric leadership – as we know, if you are based in the city, you clearly know best. 

COVID 19 is a disease that knows no boundaries and no borders. It affects us all in profound and unique ways, even if we never actually have the misfortune of contracting it. Travel and work restrictions alone have caused significant suffering particularly amongst our rural and remote communities. Rural families have been displaced from their city relatives. Students and prospective rural workforce are afraid to take the leap into rewarding rural careers for fear of not being allowed back home. Isolation worsens mental health outcomes that have already been magnified by the pandemic. Rural Australia has very significant pockets of vulnerable populations including the elderly, those with chronic conditions, and indigenous populations. 

It is not all doom and gloom however. In the US, resourceful clinicians are working to develop logistics and supply chain infrastructure to allow the delivery of all vaccine candidates to the most remote corners of the country. It is by no means a perfect system.  The US has long abandoned primary care and this is reflected by the significant access barriers faced by rural Americans.  

If you approach the problem from a less metrocentric attitude i.e., how do we deliver a -70-degree vaccine to the most remote community in Australia safely; It makes the rest of the rollout plan – including to cities - incredibly straightforward. 

Rural Australia is an equal participant in our society. Rural Australians deserve equitable access to all prospective COVID 19 vaccine candidates.  

The time is ripe for our state and federal governments to listen to this call. They must ensure our vaccine rollout plans are equitable and encompassing of our entire population.