Chapter 2Views of affected stakeholders
2.1During its inquiry, the committee received evidence from a range of stakeholders affected by the response to the COVID-19 pandemic. Those stakeholders came from a wide range of backgrounds, industries, and community groups. They included people with disability, frontline workers, representatives of business, and individuals who had adverse reactions to COVID-19 vaccines.
2.2The Australian Human Rights Commission (AHRC) indicated there is no universal experience of the COVID-19 pandemic and that a carefully designed royal commission would provide an opportunity for these experiences to be heard by the Australian public:
…it was often already marginalised and disadvantaged communities who were required to bear a disproportionate burden. It has also been widely recognised that the COVID-19 pandemic created specific risks and concerns with respect to different sections of the Australian community, including (but not limited to) children, culturally and linguistically diverse (CALD) communities, older Australians, Indigenous Australians, people with disabilities, and people in detention. To ensure that these human impacts are fully understood, it will be critical for a Royal Commission to give all of these voices an opportunity to be heard.
2.3This chapter outlines the experiences of some of the stakeholders affected by the COVID‑19 pandemic who shared their stories with the committee. This has informed the formulation of the committee’s views with respect to the content of appropriate terms of reference.
Healthcare
2.4The committee received evidence from a range of organisations engaged in public healthcare, mental health, and aged care. Except for Catholic Health Australia, those organisations supported a COVID-19 royal commission and noted that it would be an opportunity to learn from the pandemic to better prepare for future health emergencies.
2.5The Australian Nursing and Midwifery Federation (Federal Office) (ANMF) saw a COVID-19 royal commission as:
…an important step towards understanding and reflecting on the Australian experience of the pandemic and vital for ensuring that planning and preparations are put in place for improving the health, safety, and wellbeing of the Australian community now and into the future.
2.6In its view, that royal commission should not delve into laying blame or imposing consequences on the action or inaction of any person or body. It should, instead, examine ‘both successes and failures to underpin a clearer pathway forward to improving our country and community’s ability to plan, prepare, respond, and recover from crises’.
Health system
2.7Inquiry participants raised concerns with the implications that the COVID-19 pandemic had, and continues to have, on the Australian health system.
2.8Catholic Health Australia (CHA) reported on the significant strain experienced by the health system broadly:
Our hospital members were subject to various measures, including a ban on elective surgeries, visitation restrictions, mandatory mask-wearing, increased testing and mandatory vaccination for healthcare workers. Facing extraordinary inflation pressures, with the cost of Personal Protective Equipment (PPE), for example, rising 600 per cent, many of our hospitals were pushed to the brink financially and just made it through.
2.9The Consumer Health Forum of Australia (CHF) outlined some of the issues that are continuing to place strain on the health system. It reminded the committee:
SARS-CoV-2 is still a novel virus that has been circulating in human populations for a limited amount of time. As such, it must not be thought of as a thing of the past. As of 2022, COVID-19 is Australia’s third leading cause of death.
2.10The Nurses Professional Association of Queensland (NPAQ) informed the committee that:
We are in the midst of a critical healthcare staffing crisis. We are seeing ambulances ramped up and patients dying in them, widespread short‑staffing resulting in bed block, and increased surgery wait-times. Nurses are burning out and leaving in droves. We are facing an imminent retirement cliff, yet thousands of nurses and midwives are currently unemployed. Things have worsened in recent years and it is imperative that the government’s response to COVID-19 be considered as an exacerbation of these serious problems.
2.11Mr John Larter, a former paramedic, reflected on the toll the pandemic took on staffing arrangements in part of regional New South Wales:
Ambulances are not responding in a timely manner because the staff are not there. The night shift at Tumut ambulance station the other night were sent from Tumut to Cooma to transfer a patient from Cooma to Canberra. It’s 2½ hours just to get to Cooma. There was no ambulance in Tumut, covering thousands of people.
Tumut nightshift is being sent to Wagga to cover 70,000 people, because they haven’t got enough staff there to man the ambulances. The day shift in Sydney take out the ambulance, but when the afternoon shift turns up there are not enough ambulances. We are in absolute crisis. It is a whole-of-health situation.
2.12The Queensland Nurses and Midwives’ Union (QNMU) drew attention to the unknowns associated with long COVID:
The full impact of long COVID on an individuals’ health and mental health, their work capacity, and the healthcare system as a whole, are yet to be seen. To ensure an adequate response to long COVID, patients’ experiences should be included in the Royal Commission hearings as well as the knowledge and experience from health practitioners and researchers.
2.13Long COVID also presents ongoing challenges for the Australian health system. The CHF reported five to ten per cent of COVID-19 cases report long COVID symptoms and that the specialist care those cases require ‘is currently underfunded’. Health consumers living with what were previously considered rare heart conditions have reported to the CHF that ‘specialist clinics are now facing skyrocketing demand due to long COVID increasing the prevalence of rare heart conditions’. That situation has resulted in ‘strain and dangerous delays in care’ for those with rare heart conditions.
2.14The CHF reported the pandemic delayed health consumers from receiving the care they required in 2020.
2.15The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) also drew attention to the continued effects of COVID-19 infection and ‘long COVID’. In its view, a royal commission should investigate the ongoing effects of delayed access to healthcare caused by the pandemic response measures.
2.16VACCHO suggested a royal commission would ideally provide an opportunity:
…to look at how services can be provided support to do further work in prevention, screening and early intervention as quickly as possible while also acknowledging greater support is required for a higher burden of disease due to the missed opportunities during the pandemic years.
2.17The ANMF suggested there were deficiencies in the Australian healthcare system prior to the COVID-19 pandemic and that:
…the experience of COVID-19 was an X-ray of our entire health and aged‑care system. What it did was show all the fractures, reveal all the breaks and even the time cracks. We know those things were there, but it just brought them into sharp relief through COVID, most particularly in the aged-care system. We’d known about the failures there for years and years, more than two decades.
2.18According to the CHF, it is important to get an indication of how the Australian health system coped with the COVID-19 pandemic and how prepared it is for future pandemics:
We do want to understand how the health of Australia has been impacted by the COVID pandemic…There are many reasons why it is very important that we understand the impact that COVID has had and continues to have on the health of our society, so that our health system can appropriately support Australians and keep them as well and healthy as possible.
2.19The Royal Australian College of General Practitioners similarly opined that a royal commission is necessary:
…to see what the opportunities are to learn from what happened, but also apply that in the future. I think key to making any future response to health emergencies is the way that different levels of government respond and communicate together. We're very aware that hospital responses are often at a state level or a regional level, whereas primary care general practice is often managed at a federal level, and that discrepancy between the two levels of government creates problems but also opportunities.
Aged care
2.20In the view of the QNMU, the aged care sector was not appropriately prepared for a health emergency on the scale of the COVID-19 pandemic:
The pandemic exposed deep-seated problems in the aged care sector as the industry was ill-prepared for a pandemic. Inadequate staffing levels and surge staff, a lack of access to PPE and a lack of infection control training, predated the pandemic. This neglect of the aged care sector was long standing before the pandemic however with the arrival of COVID-19 the insufficient preparedness left those who lived and worked in aged care facilities very vulnerable, and the outcomes were catastrophic and led to hundreds of deaths.
2.21Anglicare Australia (Anglicare) similarly agreed that the aged care sector is not adequately resourced to respond to a future health emergency:
The aged care workforce was widely acknowledged to be in crisis throughout the pandemic, while other frontline service areas such as disability were on the precipice. Put simply, the current care workforce cannot withstand another crisis on the scale of the COVID-19 pandemic.
2.22It also indicated there was a lack of clarity around the role of the Commonwealth government and the state and territory governments during the COVID-19 pandemic, not only in the aged care sector but in multiple areas. In its view:
There were many instances where the relationship between the Australian Government and the state and territories was unclear, mismanaged, or absent. This hindered effective planning and responsiveness and led to poorer outcomes for the community. It should be a priority for a Royal Commission to explore the impacts of this lack clarity [sic], and find ways to avoid it in future.
2.23Anglicare called for a COVID-19 royal commission to examine how the ‘Government could have engaged more effectively with the sector in the early stages of its response, and how it could mobilise the sector quickly for any future crisis’.
Mental health
2.24There is a range of evidence outlining the increase in psychological distress during the pandemic period.
2.25The CHF observed that while rates of psychological distress peaked in 2020, they continued to be ‘well above pre-COVID levels in 2022’. According to the QNMU, the full effect of the COVID-19 pandemic on mental health ‘is yet to be fully realised’.
2.26According to Dr Monique O’Connor, a consultant psychiatrist:
…the deterioration in mental health of Australians is undeniable since the onset of the pandemic, and an issue of pressing national importance. A Royal Commission is required to examine in detail the mental health harms arising from the pandemic measures.
2.27Dr O’Connor referred to research conducted by the Australian Institute for Health and Welfare (AIHW) which, in her analysis, ‘demonstrate[d] worsening mental health, evidenced by increased demand for mental health services, crisis and support organisation usage, psychological distress, loneliness, suicide, and ambulance attendances for suicidal ideation’. According to her analysis of the research:
Rates of severe psychological distress (i.e., those with ‘probably serious mental illness’) peaked between August and October 2021, when an increase from 10.1% to 12.5% was observed. A change of 1 percentage point in this statistic represents approximately 200,000 people.
2.28Associate Professor Peter Parry reported the mental health implications of COVID-19 measures differed according to the financial security and family dynamics of those affected:
Families with good income security and likely home garden spaces, for example in public servant jobs, and parents able to work from home, who also had good warm family dynamics – actually appeared to fare better than normal from a mental health perspective.
This contrasted markedly with families of low income or uncertain income such as small businesses under lockdowns, and particularly if there were problematic family dynamics. Mental health problems led to new referrals, or children and young people we saw were more adversely affected by the school closures. There appears to have been an increase in school refusal (social anxiety leading to avoiding school attendance) which persisted post‑school closures.
2.29VACCHO submitted that its members ‘reported a significant increase in demand for social and emotional wellbeing support, alcohol and other drugs services, family counselling and acute mental health crisis support’. It indicated that this increased demand for mental health services reflects the sentiment that it has heard from its members and communities, that they ‘are struggling to regroup and heal in the wake of several fractious years’.
2.30The CHF suggested the terms of reference for a COVID-19 royal commission should prioritise mental health with a particular focus on the barriers preventing mental health services from ‘appropriately meet[ing] demand]. Failing to address those shortcomings and returning to the pre-pandemic status quo would, in the view of QNMU, ‘be a significant error and simply set up service provision to fail when a future pandemic event occurs’.
Incidence of suicide and suicidal ideation
2.31Suicide Prevention Australia (SPA) shared statistics which indicated that ‘there was a significant rise in the use of mental health and crisis services during the COVID‑19 pandemic’. Compared to pre-pandemic levels, there was a marked increase in ‘the average level of psychological distress...in Australia in 2020 and 2021’. Over the course of the pandemic, suicide attempts also increased.
2.32VACCHO reminded the committee that Indigenous suicide rates ‘have been significantly higher that [sic] non-Indigenous Australians for as long as these statistics have been reported on’. The discrepancy between Indigenous and non-Indigenous suicide rates increased in 2020 and ‘reached a devastating new peak’ in 2022.
2.33While psychological distress and suicide attempts increased over the course of the pandemic, according to SPA the number of ‘deaths by suicide did not rise during the COVID-19 pandemic’. There is research to indicate that the increased provision of ‘social supports to combat risk factors for suicide’ during disasters protects against an increase in the suicide rate while those supports are provided. An increase in the suicide rate in the years after the disaster could be attributable to the end of those social supports.
2.34SPA informed the committee that the pandemic affected the suicide rate in a complicated way:
Suicide risk is heightened by factors like social isolation, employment uncertainty, financial distress and a range of other things that are increased by pandemics and the necessary health responses to them. The evidence is that there’s a time lag in those impacts of around two to three years, so we’re really only now starting to see what the effects of the COVID pandemic are on suicide.
2.35SPA called for a royal commission to investigate the measures that made a difference and those that could have made a difference. That investigation could ‘inform actions in future pandemics and other large-scale disasters, but also inform government policy on suicide prevention more generally. The opportunity to better understand how we can prevent suicide should not be lost’.
Frontline workers
2.36The committee received evidence from frontline workers and organisations that represent them.
2.37The ANMF spoke about the kind of abuse its members experienced on the frontline of the COVID-19 pandemic:
…our members got abused—they got spat on; they got physically abused; they got verbally abused—while they were in the middle of trying to do the best to protect everybody in the community. A lot of that was fuelled by social media, even though nurses and midwives are the holders of and understand the evidence behind what they’re doing. How we deal with that…is a real factor for how we deal with these things in the future.
2.38The Police Federation of Australia raised similar concerns about the occupational health and safety of ‘police, nurses and other first responders…during the pandemic’. Its main concerns related to the provision of PPE, the testing of frontline workers for COVID-19, the issue of people deliberately spitting or coughing on frontline workers, and difficulties maintaining social distancing in certain workplaces.
2.39The ANMF stated that the number of nurses who had their employment terminated for refusing to be vaccinated ‘were in the hundreds’. It acknowledged that some of its members ‘for a range of reasons did not want to take the vaccine and did not want to adhere to the mandate’. On the whole, most ANMF ‘members were very strongly in favour of vaccination mandates at the time as necessary and needed, and as an effective measure in dealing with the consequences of COVID-19’.
2.40The ANMF remarked that vaccine mandates are not novel in the healthcare industry:
Vaccination mandates across the health sector and for our members, nurses and midwives working in all sorts of areas are not new. They’re not a new thing. We have dealt with them for decades, knowing that’s the best protection against many of the communicable diseases we can offer to nurses and midwives themselves and obviously to the people they care for.
2.41According to the Australian Medical Network (AMN), the mandates continue to prevent ‘highly skilled and competent medical practitioners from practicing’. It argued during the pandemic:
…there was no opportunity given for health professionals to seek an alternative way of managing their career, maintaining their career, their credentials, their safety and patient care. There was no opportunity to explore any other options except for vaccinations…There could have been other ways. If you are proven to be ill, as a healthcare worker, you could do what you’ve always done, which is to stay home; isolate yourself from anyone who is vulnerable, your patients, and come back to work when you’re feeling good.
2.42The committee received evidence from NPAQ, mainly in relation to the Queensland government’s response to the COVID-19 pandemic. In its view, the measures implemented by the Queensland government ‘seemed extreme considering the huge, negative impacts that they were having on so many Queenslanders’. It reported that during the pandemic:
Many of our hospitals were almost empty with elective surgeries cancelled and many members of the public too frightened to present to hospital, yet we were hailed as heroes and offered huge amounts of support from the community. While this is not the case for all nurses as some worked very hard during this time, there were many who were sent home on annual leave or worked with manageable patient loads as there were hugely decreased numbers of patients in and accessing our hospitals.
2.43When there were large numbers of COVID-19 cases in Queensland it was difficult to adequately staff hospitals ‘with so many nurses off due to COVID infections, being a close contact or taking sick leave due to burn out (among other things)’. During that time nurses ‘picked up extra shifts, we stayed back late and did whatever we could to support each other and our patients’. It was at this point of significant strain that Queensland Health (QLD Health) ‘gave very little notice and issued all of QLD Health with [Health Employment Directive 12/21 Employee COVID-19 Vaccination Requirements] (HED12/21) to receive the first dose of an approved COVID vaccine by September 30 and a second dose by October 31st’.
2.44While it was possible to apply for an exemption to that directive, it was very difficult to obtain one. The NPAQ reported that some:
…QLD health employees who had submitted medical exemptions from their specialists were subjected to independent medical examinations by their employer and many went on to receive show cause and termination letters despite matching the very limited criteria for exemption applications.
2.45The NPAQ submitted it was confused by the inconsistent approach QLD Health took to disciplining its employees. While many of the employees who received termination letters grieved the ‘loss of a career that was stripped from them through no fault of their own’, others received more lenient treatment.
2.46On 25 September 2023, HED12/21 was repealed. According to the NPAQ, QLD Health continued to send termination letters to employees who refused to comply with the vaccination directive. The most recent letter of which it was aware was dated 9 January 2024, more than two years after the first termination letters were issued. The NPAQ raised concerns that QLD Health continued to terminate nurses, some of whom have decades of experience, during a period of significant staff shortages across the Queensland health system.
People who experienced adverse vaccine reactions
2.47The committee received evidence from COVERSE, which described itself as ‘a national science-led charity set up for Australians who have been harmed by or lost a loved one to the COVID vaccines’.
2.48According to COVERSE, there were many reports of adverse reactions to the COVID-19 vaccines. It claimed that ‘adverse events reports for the COVID vaccines constitute almost a quarter of all drug reaction reports published by the TGA since 1971’.
2.49The People’s Terms of Reference told the committee that the number of adverse event reports increased after the introduction of the COVID-19 vaccines:
Adverse events reports in this country, including serious side effects and deaths, have significantly increased since the introduction of the vaccines. Currently, there have been over 139,000 adverse event reports made to the TGA’s passive surveillance system, the database of adverse event notifications, including 1,010 deaths. Importantly, the TGA makes clear that report doesn’t necessarily mean that there has been a causal link, but it is important for people to understand that all causality events start with correlation.
2.50It further noted that adverse events have been underreported and that this is ’widely recognised in the medical literature’.
2.51COVERSE stated that a large number of people affected by adverse vaccination reactions have been ‘burdened with long-term disabilities, acute grief, and a lack of financial means to support themselves and their families’.
2.52Dr Rado Faletic, Director of COVERSE, described his experience of being injured by the Pfizer COVID-19 vaccine:
I got my first Pfizer shot in October 2021.
My very first symptom, within hours, was intense pain in the lymph nodes on my left side.
When I woke on the second day, my entire body went completely numb. That scared the heck out of me. From there my symptoms grew. Many waned over the following weeks, but a few persisted.
I saw my doctor. Apparently, a lot of people had “extended” reactions. My doctor wasn’t concerned about mine though, and said it was safe to get my second shot.
2.53Dr Faletic said the second shot of the Pfizer vaccine led to worse symptoms:
Within hours of my second Pfizer shot in November ’21, all of my existing symptoms got much worse. In particular, I started developing sharp pains in my chest. Like I was being poked by needles. From the inside.
And…the brain fog became oppressive.
…
Over the following months I experienced many disabling and painful neurological, cardiac and systemic symptoms affecting my capacity to work and even just to get through the day.
I could not walk for more than a few metres without feeling like my body was about to shut down. I was constantly bumping into things on my left‑hand side.
I couldn’t recall words. I could not engage in conversations for longer than two minutes before my brain could no longer process what was being said to me.
My emotions became unstable, fluctuating from the inability to feel any emotion, to extreme emotions like suicidal ideation and intense rage.
2.54COVERSE suggested that the compensation scheme for people who experienced adverse reactions to COVID-19 vaccines, which was introduced by the Australian government in 2021, ‘was designed so narrowly that hardly any of us qualify for it…This comes back to the royal commission and why questions need to be asked about that in particular’.
2.55According to COVERSE, the compensation scheme ‘is only for some vaccines but not others’. The list of conditions covered by scheme includes: ‘myocarditis and pericarditis, various blood clot issues, GBS—Guillain-Barre syndrome—capillary leak syndrome, shoulder injury from the needle, anaphylaxis and a particular skin condition’. COVERSE pointed out there are many ‘conditions that are not covered in the compensation scheme, but feature heavily in our groups, and in medical literature, which is constantly emerging’.
2.56COVERSE called for a royal commission to investigate the rationale for the decisions made in relation to the design of the COVID-19 Vaccine Claims Scheme.
2.57The People’s Terms of Reference similarly noted issues with the Australian vaccination program. It argued that ‘the very high levels of vaccination injuries and deaths, and in particular the vaccine induced deaths of Australian children—[are] all powerful reasons for a broad based royal commission’.
Business
2.58Representatives of business and industry highlighted how the response to the COVID-19 pandemic affected supply chains, business operations, employment, and the mental health of business owners.
2.59Ai Group contended that the approximately one million Australian businesses it represents ‘were forced to contend with the most challenging operational environment in living memory, managing both the impacts of the pandemic and the public health measures put in place to contain it’.
2.60During the acute phase of the pandemic, which was:
…a time of extreme social and economic stress, business played a critical role in keeping Australian supply chains open, ensuring continuity of essential services and infrastructure and protecting the jobs of the 11 million Australians employed in the private sector.
2.61Ai Group reported ‘the mixed messaging and the lack of consistent and clear communication made a challenging situation almost impossible to bear’ for businesses. It informed the committee that its role during the pandemic was to collate the disparate government responses into an accessible form for businesses that operate nationally to understand.
2.62Ai Group indicated there are five lessons that should be learned from the COVID‑19 pandemic response:
‘the importance of a nationally consistent approach to communication’;
consideration of ‘business continuity and policy’ during emergencies with opportunities for business to shape government responses;
international and interstate border closures should be used as a last resort and should be imposed only for as long as necessary;
the importance of providing financial support to businesses to maintain operations during periods of ‘societal disruption’; and
consideration should be given to diversifying international supply chains.
2.63The Council of Small Business Organisation Australia (COSBOA) reported that pandemic response measures including border closures, lockdowns, and other restrictions on business operations ‘heavily affected’ small businesses. It cited evidence from the Reserve Bank of Australia to show that while ‘sales at smaller retailers declined in early 2020 and picked up towards the end of the year as conditions improved, sales at larger retailers remained resilient throughout the pandemic’.
2.64COSBOA explained the response to the COVID-19 pandemic ‘significantly impacted the mental health of small business owners across the country’. It noted that while small businesses were provided with a ‘series of financial support measures…financial distress remained a key concern during this period’.
2.65Ai Group agreed that a royal commission into the COVID-19 crisis ‘should give health and the economy equal footing’.
2.66Some representatives raised concerns about the inconsistency of national, state, and territory responses particularly in relation to interstate border closures and inconsistent definitions of COVID-19 contacts in contact tracing regimes.
2.67The Institute of Public Affairs (IPA) reported that its research:
…showed that from March to November 2020 jobs in the private sector dropped by 300,000 while jobs in the public sector rose by 25,000. Jobs for young Australians, over that same period, aged 15 to 34 dropped by 158,000 and rose for those aged over 34 by 20,000. From 20 August 2019 to 2020 over half a million jobs were lost for those in the bottom 20 per cent of income earners, while 195,000 jobs were added for those in the top 20 per cent of income earners.
2.68The Independent Education Union argued:
The Covid-19 pandemic exposed clear divisions in Australia’s labour market, welfare programs and health and safety systems. It disproportionately impacted the millions of workers in insecure circumstances. These included casuals such as relief teachers (many of whom were excluded from the JobKeeper program) as well as workers on minimum award wages, fixed term contracts or other forms of insecure work.
2.69From the perspective of the business community, it is important to learn the lessons from the COVID-19 pandemic. The Ai Group suggested the most important lessons relate to the measures that ‘governments can [implement to] support business to flexibly maintain operations and preserve employment relationships during a period of abnormal and unexpected societal disruptions’.
2.70Ultimately, it ‘hope[d] that a royal commission would provide a framework to give us confidence that there would be a nationally consistent approach for any future pandemic’.
At-risk populations
2.71The committee received evidence from organisations that represent populations at increased risk of COVID-19 or that experienced considerable disruption because of the response to the COVID-19 pandemic.
2.72Those populations included:
children, young people, and women;
people with disability; and
culturally and linguistically diverse (CALD) people.
Children, young people, and women
2.73The Murdoch Children’s Research Institute (MCRI) submitted ‘[t]he direct and indirect impact of COVID-19 on infants, children and adolescents are inherently different to the adult population’. One difference is in relation to the difference in severity of COVID-19 between younger people and adults:
It became apparent early in the pandemic that COVID-19 was largely a mild or asymptomatic illness in most children. Some children did require hospitalisation, but these were relatively few, and in most cases could be treated using hospital-in-the-home. It is important to highlight that it is highly unusual for a respiratory viral pathogen to minimally affect children compared to adults; the opposite is almost always true.
2.74According to MCRI, the unique needs of children and adolescents were mostly ignored during the pandemic. The views of paediatricians, other children’s health professionals, and advocates ‘were not prioritised by policy makers’.
2.75The Wesfarmers Centre of Vaccines and Infectious Diseases ‘emphasise[d] that children need to be prioritised in decision making for their unique needs, risks and impacts during a pandemic’. It ‘recommend[ed] that the Terms of Reference examine the extent to which the needs of children were prioritised and the extent to which the pandemic impacted children and families’.
2.76The MCRI argued children were affected most by ‘the indirect impact related to the public health policies set in place to minimise the spread of the SARS-COV-19 virus’. It acknowledged that ‘[w]hile these [measures] were thought necessary at the time…the closure of schools and disruption to educational systems led to immediate effects on academic, emotional, and physical development, and mental health’. The effect of this disruption is not yet fully understood, ‘however emerging evidence suggests there are longer term and inequitable impacts across mental and physical health, as well as academic outcomes’.
2.77The MCRI stated that a COVID-19 royal commission should:
…examine the importance of schools beyond academic learning, where the social, emotional, and physical health of children and young people can also be supported, along with monitoring child and adolescent mental health and development within schools and health systems.
2.78Organisations representing the education sector noted that the COVID-19 pandemic presented severe challenges and significant disruption for early childhood education centres, schools, and higher education providers.
2.79While Independent Higher Education Australia (IHEA) saw social distancing and lockdowns as a necessary health and safety measure, they ‘significantly impacted providers and students’. The COVID-19 pandemic brought attention to:
…shortfalls in planning and decisiveness, especially in the context of a plethora of changing directives. For higher education providers, some were able to transition to online learning smoothly, while others faced challenges in terms of technology, pedagogy, and student engagement.
2.80In relation to international students, IHEA argued that as international education is Australia’s ‘fourth largest export and largest non-resources export…it is critical that we maintain a welcoming place for international students and that the value of our educational experience is communicated globally’. None of the support packages provided by the government ‘contained provisions specific to international education and international students’.
2.81The committee heard about the financial costs borne by tertiary students due to the COVID-19 pandemic measures:
I am in contact with students who are still unable to complete the degrees they started pre 2019–20 because mandates are preventing them. Their personal choice to take a medical treatment or not is essentially becoming a punishment. They have invested, in some cases, years. In my case, I had invested between five and six years…in my education, to get into the master’s of physiotherapy program. Other students would be within that high time frame. We have invested thousands of dollars. I had invested $42,000 in only one year of my master’s degree, let alone all of the undergraduate study I had done.
2.82The People’s Terms of Reference argued lockdown policies ‘inflicted profound damage on the psychosocial and neurological development of infants and children by overlooking the paramount importance of early-life social and emotional interactions’.
2.83It submitted that social distancing and mask mandates ‘paved the way for enduring developmental impairments’ in infants. Those policies left mothers and young children ‘without the customary support of the community, severely impeding the establishment of secure attachments between parent and child – attachments that are crucial for a child’s future emotional regulation and social competencies’. In its view, this situation has created ‘an impending mental health crisis among the youngest members of our society’.
2.84MCRI linked the closure of schools and the move to online learning as a factor that exacerbated a deterioration in young people’s mental health during the pandemic:
The closure of schools during the pandemic disrupted the traditional learning environment, hindering children’s ability to grow and reach developmental milestones through crucial interactions with peers and educators. The impact is particularly pronounced in adolescents, whose brain development is highly sensitive to environmental stimuli and experiences.
The closure of schools had substantial consequences on the mental health of Australian children. Isolation resulting from lockdowns and social distancing measures has led to an increase in mental health issues such as depression, anxiety, and social withdrawal. Paediatricians in Australia are reporting waiting lists of over 18 months for developmental and mental health assessments and many have closed their books to new patients.
2.85In addition to children and young people, the Council of Single Mothers and their Children (CSMC) and WESNET drew attention to the effect of the pandemic response on women.
2.86The CSMC indicated the pandemic response measures had greater adverse effects on single mothers ‘more than any other family type of worker’. Their children, who were ‘already in many cases disadvantaged and more vulnerable than children in couple families, experienced many adverse effects’.
2.87WESNET reported that because of the pandemic, ‘services supporting victim‑survivors of gender-based violence [were] overwhelmed by demand’.
2.88The Independent Education Union also highlighted that women are ‘more likely to be insecurely employed which, in combination with inequitable and dangerous conditions in the home, made women and their children among the groups worst impacted by the pandemic’.
2.89WESNET suggested the terms of reference for a royal commission into COVID-19 must allow for an ‘examination of the particular impact of the pandemic on women’. The royal commission should consider the effectiveness of the pandemic response in relation to ‘gendered impacts’ to inform strategies for future health emergencies.
People with disability
2.90The broad experience of the pandemic for people with disability was one of anxiety, confusion, and abandonment:
The experiences of people with disability during the COVID-19 pandemic include anxiety over constantly changing messages, feeling confused and abandoned by governments, increased levels of violence and abuse, and feeling unsafe and forgotten as COVID-19 infection control measures reduced.
2.91It was noted ‘that people with disability…will experience much more complicated health implications if they contract COVID’.
2.92People with Disability Australia (PWDA) explained that while steps were taken to protect people with disability during the pandemic, there were still transgressions upon those people’s rights:
While Australia took many positive measures to keep us safe during the pandemic, people with disability experienced many infringements of their rights. For example, people with disability experienced challenges in accessing the supports they need and rely on for daily life. They experienced barriers in the managing of health services.
2.93Those barriers included the use of Auslan interpretation services in communicating changes to public health orders and the use of support workers throughout the pandemic.
2.94PWDA had raised issues with the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability in relation to the COVID-19 pandemic response. It stated that people with disability had:
…reduced or no access to vital health, mental health, rehabilitation services and medications including COVID-19 related screening, masks, personal protective equipment, hand sanitizer, vaccination and treatment, as well as lifesaving treatment due to unconscious bias.
2.95Due to a fear of contracting COVID-19, ‘about 25 per cent of people with disability felt that they had to avoid health services’. Those people also avoided socialising with family and friends for the same reason and felt ‘a sense of self‑imposed isolation’ during the pandemic. An outcome of that social isolation was a loss of ‘the natural safeguard of having people who could check in’.
2.96A member of PWDA recounted their experience of visiting a hospital emergency room (ER):
I went home from the ER and took my chances when I had a near fatal case of cellulitis, as the alternative was waiting for an estimated six to 14 hours in a badly ventilated, crowded hospital ER with a group of anti-vaxxers, anti-maskers and no seating, except right beside them. Hospital staff and security were also ignoring the COVID-19 protocols and ignored me when I begged for somewhere else to sit.
2.97Another PWDA member shared their lived experience and making invidious decisions about accessing health care:
Not even being able to access health care safely is outrageous. We should not have to decide if the risk of attending health care or a hospital is worth it. The real risk of infection that will make your health worse versus delayed care which can equally make your health worse. Safe health care is a health care right, but it’s not really happening.
2.98Redfern Legal Centre shared accounts of some of its clients, who approached it to make sense of the rapidly evolving public health orders:
Many of my clients were in tears trying to keep up with and understand rapidly changing public health orders…These clients ranged from a mother whose son with a diagnosed intellectual disability was issued with three separate COVID fines worth $1000 each, and an elderly couple, one partner with dementia, fined for being at the supermarket together because one partner could not stay at home by herself.
2.99The committee heard evidence from Professor Katy Barnett, a Melbourne‑based law professor living with a disability. As part of her treatment, Professor Barnett is encouraged ‘to walk for at least one kilometre per day’. During the stage 4 lockdown in Victoria, she was not permitted to travel further than five kilometres from her home or spend more than one hour away from her house.
2.100In September 2020, Professor Barnett decided to walk to a nearby coffee shop with her mother. They purchased coffees and sat outside, remaining the appropriate distance apart from each other and other people.
2.101While drinking their coffees and complying with the public health orders, they were asked to move on by police officers. Professor Barnett noticed one of the police officers ‘seemed to be quite tense’. Her ‘mother was extremely anxious’ during the interaction and very concerned about the threat of receiving a fine.
2.102Both women decided to comply with the police officers’ direction and continue moving. Professor Barnett remarked that while both she and her mother ‘got home safely’, the experience left them ‘shaking’.
2.103In her evidence to the committee, Professor Barnett explained how she felt during this interaction with the Victorian police:
During the Victorian lockdown I did come to the attention of police and I did have a very unpleasant interaction with them. However, I feel a bit like Clark Kent with a Superman suit underneath; they didn’t know that the limping woman with the walking stick was actually a law professor. Had they decided to make an issue of my supposed contravention of the law, I would have been able to fight them legally…What I’m distinctly aware of is the fact that many other vulnerable people in our community do not have the same capacity as me.
2.104PWDA recommended that a COVID-19 royal commission examine the implications of the pandemic response measures for people with disability and put forward recommendations for how their needs could be better addressed during future health emergencies.
Culturally and linguistically diverse communities and First Nations peoples
2.105Representatives of CALD communities and First Nations peoples shared the unique experiences of their communities. For the most part, those organisations were concerned about the communication of health information to the people they represent.
2.106According to the Federation of Ethnic Communities’ Councils of Australia and the Australian Multicultural Health Collaborative (FECCA and the Collaborative), the negative effects of the pandemic were disproportionately felt by people from multicultural backgrounds. They provided evidence from the Australian Bureau of Statistics which showed:
70% of people in Australia who died during the COVID-19 delta wave were overseas born.
Overall, during the pandemic, overseas born people died at twice the rate than the Australia born.
Middle East-born Australians died at seven times the rate of the Australia-born.
2.107These disparities can be explained by the kind of industries CALD people predominantly work in and their access to public information. As FECCA and the Collaborative suggested:
…many [members] of those communities work in essential services, so they were more exposed to COVID-19, due to the type of work that they were doing, than others. Another point is that the communication strategy and the translated material, on the quality and quantitative side of it, lacked timing. They were not being timely enough, and this led to creating a vacuum of information. Individuals were seeking information in their own language. On Facebook, there was general information, which led to misinformation, which meant that there was lack of trust in the health system. The last part to it is the level of health literacy, and accessing and navigating the health system. These are the components that I believe contributed to this high mortality rate.
2.108The QNMU also referred to research from previous pandemics which ‘showed that First Nations peoples are more likely to become infected with respiratory viruses and the subsequent morbidity and mortality that accompanies these diseases’. First Nations peoples are more vulnerable than the general population for several reasons ‘including a high burden of chronic conditions, inequity issues related to health services provision and social and economic disadvantage in areas such as housing, education and employment’.
2.109The Redfern Legal Centre explained the New South Wales public health orders were often ‘only published in English, which left many in the community vulnerable both in terms of their health and their ability to comply with the law’.
2.110Similarly, VACCHO raised concerns about the ‘little specific information, action or supports provided to [Aboriginal Community Controlled Organisations] for the delivery of lifesaving service delivery throughout the lockdowns and the pandemic’.
2.111VACCHO shared feedback from its members about the effectiveness of communication from state and Commonwealth governments during the pandemic:
While the daily press conferences aired across mainstream networks were well received by some, many Community members did not have access to a television or streaming device. For those who did, much of the information available on free news sites, television and hard copy papers oscillated between fact and fiction, with misinformation rife and very little accountability for news providers to ensure accuracy. This was even more voracious on social media sites, where there is very little to enforce accuracy in opinion pieces, headlines or comment sections.
2.112It submitted there ‘seemed that there was an assumption that all Australian would be able to understand, seek out and interpret the complex and rapidly changing health information and lockdown orders’. In its experience that assumption was incorrect:
…for vulnerable and diverse communities, both Aboriginal and Torres Strait Islander and otherwise, leaving many to navigate confusing and muddied information by themselves.
2.113Those people did not have ‘clear understandings of lockdown orders and public health advice’. That left them in a position where they ‘were left with significantly increased stress and mental health concerns, fines for public health order breaches and higher likelihoods of COVID-19 infections’.
2.114The Special Broadcasting Service (SBS) reported:
During the COVID-19 crisis, SBS’s cross-platform provision of vital public health information was essential to saving lives and ensuring all Australians had access to up-to-date information on measures to stay safe, restrictions, and vaccines.
2.115It outlined the role it played ‘during the acute phases of the pandemic’ and the rapidness of its actions:
The response included SBS Multilingual coronavirus portal in 63 languages, built within only four days in March 2020, and live interpreting of the daily NSW and Victorian Government press conferences in a range of languages.
2.116A range of organisations supported the establishment of a COVID-19 royal commission that includes terms of reference in relation to engagement with:
CALD communities;
First Nations peoples; and
people living in remote and regional areas.
2.117In the view of these organisations, a COVID-19 royal commission should refer to the lived experience and expertise of these communities to ensure that their views are considered in planning for future crises.
Conclusion
2.118The committee heard from a wide range of stakeholders who were either directly affected by the response to the COVID-19 pandemic or are acting on behalf of communities that were affected by it.
2.119The stories and experiences shared by those affected stakeholders are indicative of the need for a royal commission into the Australian response to the COVID‑19 pandemic.