Removing ‘structural racism’ first step in fighting vaccine hesitancy


COMMENT: Dr Nadia Chaves is an infectious diseases and general specialist who has worked with people from diverse backgrounds in Australian public hospitals and in community health for over 20 years. She believes that reports of COVID-19 vaccine hesitancy and misinformation amongst people from cultural and linguistically diverse backgrounds provide an opportunity to re-examine and address inequity in the Australian healthcare system.

Watch 'Battle For The Vaccine Hesitant' on SBS On Demand

In Australia, although we have a fantastic universal health system, there is an increasing disparity between the haves and the have-nots.

We pride ourselves on giving people a 'fair go' and treating everyone the same way, however, treating everyone the same is part of the problem.

We need to understand and address peoples’ unique needs, values and preferences otherwise health disparities will grow.

Although the COVID-19 pandemic affected us all, in Melbourne, it disproportionately affected people who are older, with chronic illnesses, but also those who live with disadvantages such as housing insecurity, poverty, low literacy and insecure work. Geographic areas where there are high rates of these risk factors are also areas of our greatest cultural diversity.  

The clinic where I work as an infectious diseases specialist is close to several public housing estates. Although the residents of these estates feel grateful for the enormous effort required to contain the pandemic in Melbourne, there is a constant fear that a hard lockdown will occur again.  

Many of my clients in the towers which were put into hard lockdown last year had fled police brutality in their countries and came to Australia as refugees. We in community health all knew those towers were more susceptible to COVID-19 and we felt worried well before the outbreaks occurred. The public housing high-rise environment sees people living in close quarters, with many shared spaces such as elevators, entries, and exits. The flats often accommodate large, multi-generational families, and due to the shortage of adequately sized housing, people may be sharing bedrooms. This high-density environment led to the high-rises being dubbed ‘vertical cruise ships’.  

Many people from culturally diverse backgrounds work in casual jobs in high-risk occupations such as aged care or hospital cleaners but did not have sick leave. Those in casual work such as Uber or taxi drivers found that work quickly dried up altogether. There were no COVID-19 testing sites within walking distance. Even access to mental health support required a degree of technological literacy and English language proficiency.   

Structural racism is the presence of policies, practices and people which perpetuate racial group inequity. We have seen this occurring in other parts of the world as COVID-19 infections disproportionately affect certain communities.  

Dr Nadia Chaves is an infectious diseases expert.
Dr Nadia Chaves is an infectious diseases expert.

There is currently a lot of discussion around vaccine hesitancy and misinformation in people from culturally and linguistically diverse backgrounds. What’s important to understand is that there is vaccine hesitancy across all parts of our community – to suggest it is simply a problem amongst ‘migrant communities’ is wrong, and simply reinforces so much of the demonization that these community groups have already experienced. Improving vaccine hesitancy and reducing misinformation for people from culturally and linguistically diverse backgrounds requires identifying and breaking down the structural barriers to care and building trust. 

We do, of course, need translated materials on COVID-19 vaccination. But a translated brochure alone is not enough. Overcoming vaccine hesitancy and misinformation requires implementing changes to address inequity. 

At the community health centre I work for – cohealth - we are employing and educating residents to lead vaccination sessions for their communities. We help identify those who are most at risk and support them to make informed choices about vaccination regardless of their preferred language. Vaccine clinics and testing sites should be present in local neighbourhoods and be accessible regardless of technological or health literacy.  

Whilst advocating for vaccinations is important, we also need to advocate for safer housing, secure employment and more relevant mental health and wellbeing services. Unless support for healthcare is wrap-around, trust will not be established or maintained.  

As we look across the world at the devastation wreaked by the COVID-19 pandemic, I’m acutely aware that we need everyone here to be vaccinated. If we do not, when we open our borders, our hospitals will become overwhelmed and people will die, starting with those who are most at risk.  

As I write this, my husband’s uncle has been admitted to an Indian hospital with COVID-19. He could only access one of the two COVID vaccine doses required for protection despite having diabetes.  

We are so lucky our Australian health system provides COVID-19 vaccinations for everyone. However, we must work together to ensure equitable access. We can do this by co-creating targeted strategies that address marginalisation and structural racism, create belonging and promote safer healthcare for all. 

For more information about the COVID-19 vaccine in more than 60 languages go to