Outcomes Reported for Australian First Nation Populations for the Influenza A(H1N1) 2009 Pandemic and Lessons for Future Infectious Disease Emergencies: a Systematic Review

Abstract

Aims: Enhanced data collection during infectious disease emergencies, such as the COVID-19 pandemic, must inform the clinical and public health responses appropriate for Australian First Nations populations. To inform the design of such data collection protocols, we systematically reviewed the reported outcomes for the First Nations population related to A(H1N1) 2009 pandemic influenza infection. Methods: We searched PubMed and Google using the search terms: pandemic AND Australia AND 2009 AND (Indigenous OR Aboriginal OR "Torres Strait"). Data extracted included: location; study design; data source(s), number of study participants and the number and percentage that were First Nations; completeness of First Nations status; and reported outcomes (stratified by First Nations status). Each study was also reviewed for documentation of engagement or consultation with First Nation individuals, communities or health services regarding the study design, data collection, analysis, interpretation and reporting. Results: Our search identified 53 citations, with 13 deemed eligible for inclusion. Most studies were case-series (n=6) and used primary data (n=8) and/or secondary data (n=10). The number of First Nations participants ranged from 13 to 3,966. The proportion of First Nations participants per study varied from 1.8% to 100%. Completeness of reporting First Nations status ranged from 62% to 100%. Reported outcomes stratified by First Nations status included notification rate (n=3), comorbidities/risk factors (n=4), severity of disease (hospital admission (n=8), intensive care unit admission (n=8), death (n=5)) and interventions (anti-viral use (n=2) and vaccination (n=4)). There were no studies that described engagement/consultation with First Nations individuals, communities or health services regarding any aspect of the study process. Conclusion: Studies identified in this review mostly used secondary data and reported on outcomes relating to severity, and comorbidities and other risk factors. Studies specifically designed for First Nations populations are required to fully understand the contributing factors for the frequency and severity of disease in an infectious disease emergency and inform appropriate responses. First Nations communities and health services need to be adequately engaged and participate in the design, implementation, analysis and reporting of such enhanced data collection studies.

Self‐reported wellbeing and health‐related quality of life of Aboriginal and Torres Strait Islander people pre and post the first wave of the COVID‐19 2020 pandemic

“…Australians during pandemics due to social and cultural determinants of health and the lack of political influence. 14,24 The results of the current study suggest that Aboriginal and Torres Strait Islander people aged 18-54 years, with less financial stability and presence of comorbidity (particularly, very high levels of comorbidity and any mental health comorbidity) may have lower baseline levels of wellbeing and/ or HRQoL than other Aboriginal and Torres Strait Islander people. This suggests that these groups were at higher risk of negative impacts on wellbeing and HRQoL due to the lockdowns associated with Australia's first COVID-19 wave in 2020.…”

“…24 For others living in community, the restrictions on movement may have reduced their accessibility to healthcare and affordable and traditional food. 14 Previously, Aboriginal and Torres Strait Islander people have fared worse than non-Indigenous…”

“…Previous pandemics have had a greater toll on Aboriginal and Torres Strait Islander people and communities than other Australians. For example, the type A H1N1 virus (swine flu) pandemic in 2009 resulted in higher relative rates of infection, hospitalisation and death for Aboriginal and Torres Strait Islander people 14 . This has been attributed to the higher prevalence of risk factors and comorbidities within this population, 15 however, due to the lack of outcome data reported during previous pandemics, these underlying causes are likely more complex, potentially embedded in social and health services structures 14 .…”

“…For example, the type A H1N1 virus (swine flu) pandemic in 2009 resulted in higher relative rates of infection, hospitalisation and death for Aboriginal and Torres Strait Islander people 14 . This has been attributed to the higher prevalence of risk factors and comorbidities within this population, 15 however, due to the lack of outcome data reported during previous pandemics, these underlying causes are likely more complex, potentially embedded in social and health services structures 14 . During the current pandemic, the success of Indigenous‐led strategies to prevent spread of COVID‐19 among Aboriginal and Torres Strait Islander people and communities in Australia, and Government's support of these, has been recognised 16 .…”

A discourse analysis of the Aboriginal and Torres Strait Islander COVID‐19 policy response

“…44 Aboriginal and Torres Strait Islander people accounted for 11% of H1N1 cases, 20% of hospitalisations and 13% of deaths despite making up only 3% of Australia's population. 45 This genealogy helps to explain the formation of the COVID‐19 response for Aboriginal and Torres Strait Islander people.…”