Introduction

In Australia, Indigenous peoples are referred to as Aboriginal and/or Torres Strait Islander people. In Western Australia (WA), Australia’s largest state by land size, there are many distinct geographical areas comprised of the land, waterways and skies (described as “Country”), with distinct customs, culture and language practiced by the traditional owners of Country. For example, in the south-west region of WA (referred to as Noongar Boodja), there are 14 different language groups that correlate with 14 different geographic areas (South West Aboriginal Land and Sea Council, 2024). Stories, skills and knowledge have been passed on from generation to generation by Aboriginal and/or Torres Strait Islander people in WA for at least 45,000 years(South West Aboriginal Land and Sea Council, 2024). Before the arrival of and colonisation by the Europeans in the 18th Century, Aboriginal and/or Torres Strait Islander people lived in a mainly infectious disease-free environment (Dowling, 1997); since then, there has been a disproprotionate infectious disease burden on Aboriginal and/or Torres Strait Islander people (Enkel et al. 2024).

Globally, Indigenous populations have also been disproportionately impacted by pandemics (Alves et al. 2022; Goggin et al. 2011; Rudge and Massey, 2010). Within Australia, many consider the increased burden of the 2009 H1N1 influenza pandemic among Aboriginal and/or Torres Strait Islander people being due, in part, to the omission of their voices in pandemic responses (Crooks et al. 2022; Stanley et al. 2021). Institutional racism, discrimination and the transgenerational effects of colonisation continue to impact the equitable access to good quality and timely health care among Aboriginal and/or Torres Strait Islander people (Clark et al. 2023; Thurber et al. 2022) resulting in high rates of chronic disease. In 2018/19, 57.1% of Aboriginal and/or Torres Strait Islander adults in Australia had ≥1 chronic conditions (e.g., hypertension, diabetes) that would eventually place them at risk for severe respiratory infection from pathogens including SARS-COV-2 (Thurber et al. 2021).

Given the disproportionate health burden, Indigenous leaders such as those working within Aboriginal Community Controlled Health Organisations (ACCHOs) made great efforts, particularly through self-governance (Clark et al. 2023), to ensure Aboriginal and/or Torres Strait Islander people did not bear the burden of the Coronavirus Disease 2019 (COVID-19) pandemic. Their success was reflected in the national infection rates, with COVID-19 infections being 5.9 more frequent for non-Indigenous Australians than for Aboriginal and/or Torres Strait Islander people in the first year of the pandemic (and pre-circulation of the Omicron strain) (Stanley et al. 2021).

Australia’s pandemic response was a collaborative effort between Commonwealth and State governments, as well as non-government organisations. In Western Australia (WA), responses included international, interstate, and intrastate travel bans, lockdowns and school closures, capacity limits on gatherings (including funerals), mandated mask-wearing, restrictions on visitors to hospitals and residential aged care facilities, and—once there was ample vaccine supply—mandatory COVID-19 vaccination covering most adults via workplace and public space vaccine mandates. These measures were implemented prior to COVID-19 becoming endemic in the state and kept the state largely free of COVID-19 while the rest of the world battled the pandemic. WA residents often proclaimed thankfulness for the semblance of normality in the state vis a vis the rest of the world (Attwell et al. 2024). However, as we demonstrate in this article, COVID-19 and the measures associated with it had a particularly negative impact on culture, connectivity and community for many Aboriginal and/or Torres Strait Islander people in WA and would go on to affect their health disproportionally, too.

COVID-19 vaccines were first rolled out in Australia in February 2021, and Aboriginal and/or Torres Strait Islander people were among the priority groups for vaccination based on the aforementioned prevalence of health conditions and, thus, the likelihood of severe COVID-19 infection. By the second half of 2021, Australia had one of the highest COVID-19 vaccination rates in the world. However, despite Aboriginal and/or Torres Strait Islander people being a priority group and ample vaccine supply, coverage in this cohort languished compared to the non-Indigenous population (Australian Institute of Health and Welfare, 2022). By January 2022, ~12 months into Australia’s COVID-19 vaccine rollout, a 30% gap in COVID-19 vaccine coverage was reported between Aboriginal and/or Torres Strait Islander adults and non-Aboriginal adults in WA (Woodly, 2022). This suboptimal vaccine coverage likely contributed to the higher rates (1.4×) of severe COVID-19 observed among Aboriginal and/or Torres Strait Islander people once the Omicron strain was circulating in Australia from December 2021 (Australian Institute of Health and Welfare, 2022).

Given the increased risk of severe COVID-19 infection and lower COVID-19 vaccine uptake, it was imperative to understand the stories of Aboriginal people in WA and their personal experience of the COVID-19 pandemic and COVID-19 vaccine rollout. It is anticipated that stories shared and lessons learned will be useful for future pandemic and vaccine rollout planning.

Methods

Research methods

This project involved both Aboriginal and non-Aboriginal researchers with professional experience in qualitative methods, Aboriginal health, infection prevention, vaccine social science, and public policy. It was part of the larger interdisciplinary mixed-methods project “Coronavax: Preparing Community and Government”, which sought to provide research useful to governments in designing a pandemic vaccine rollout that would reflect community attitudes and needs in terms of information and access (Attwell et al. 2021). The present research involved yarning workshops (Bessarab and Ng’Andu, 2010) co-facilitated by both Aboriginal and non-Aboriginal researchers, all of who identify as female. All involved in facilitation had received training in Western qualitative research methods either at university or through mentorship provided by the more experienced qualitative researchers on the project.

Participant eligibility and recruitment

Participants were eligible to participate if they identified as Aboriginal and/or Torres Strait Islander, resided in Western Australia (with a focus on the Perth metropolitan region of Noongar Whadjuk Boodja—Country of the Whadjuk People), and were aged over 18 years. Participants were recruited through personal and professional networks of the research team, and thus at times, there were pre-established relationships between the Aboriginal researchers and some participants and/or partnering organisations. This helped to create a safe space to discuss difficult experiences. Participants were recruited through a combination of face-to-face or email invitations, depending on the organisation or personal network they were recruited through. Data was collected face-to-face through yarning workshops held at community centres, the researchers’ workplace, or the participants’ workplace between September 2022 and October 2023.

Interview guide

The interview guide built on the pre-existing “Coronavax” semi-structured interview questionnaire developed by the interdisciplinary team for the broader project; this was then refined through co-design with Aboriginal and/or Torres Strait Islander community members using 1-on-1 meetings and presentations at forums, as well as feedback provided by Aboriginal Community Controlled Organisations within Perth. After being encouraged to yarn about where they currently live, where their family is from, and any connections among participants, participants were broadly asked about:

  1. 1.

    Their COVID-19 experience (prompted by both positive and negative experiences)

  2. 2.

    Knowledge of and attitudes about COVID-19 infections

  3. 3.

    Knowledge of and attitudes about COVID-19 vaccines and booster doses

  4. 4.

    Whether or not they had received a COVID-19 vaccine, and reasons for this, and their experience of being vaccinated

  5. 5.

    Trusted sources of information and medical provision

  6. 6.

    Knowledge of government or community COVID-19 vaccination programmes for Aboriginal and/or Torres Strait Islander people

Data analysis

Yarns ran for approximately 1-hour and were audio-recorded. Recruitment occurred until data saturation was achieved. Data was thematically analysed in an inductive manner on NVivo by SJC (non-Aboriginal researcher) following the Braun and Clarke method (Braun and Clarke, 2006). A cultural lens was applied to SJC’s analysis through a series of meetings between SJC and VS (senior Aboriginal researcher and healthcare professional). Quotes have been used throughout to illustrate themes, with pseudonyms attached. Preliminary findings were shared at a Data Interpretation Forum with community members in April 2024 to enable further input from attendees (with attendees given the opportunity to be co-author or acknowledged in the article, should they choose). After the local Elder and her grandson provided a traditional Welcome to Country and encouraged all those in the room to have courageous conversations, SJC shared each theme from the yarn with the corresponding quotes. Each theme was discussed in detail as to whether it resonated with attendees, and whether the data had been interpreted and represented in a culturally appropriate manner. Forum attendees were provided with lunch and parking vouchers, and offered transport assistance if needed. It is important to note that community members at both the Data Interpretation Forum and in the research data itself represented their own personal stories, reflections, and opinions rather than that of the entire Aboriginal and/or Torres Strait Islander Community in WA.

Results

Participants

Thirty-eight participants shared their stories and experiences across the 5 yarning workshops. Twenty-one (55%) were aged 18–34 years, 87% identified as female and 32% self-reported that they had health conditions that increased the risk of a severe COVID-19 infection. Nearly all participants (92%) had received at least 1 COVID-19 vaccine dose, and 47% believed that they were eligible for a COVID-19 vaccine booster. For those who were parents/carers, 41% (7/17) self-reported that their eligible children had been vaccinated against COVID-19. Further demographic details are provided in Table 1.

Table 1 Participant demographics.
Full size table

Themes

Pandemic experience

When participants were asked about their pandemic experience, the majority immediately referenced its negative impact on their ability to connect with their community and to practice traditional culture.

It scared a lot of communities…they [government] closed…down [remote communities] and were very strict…We [normally] go fishing but we couldn’t even go to our fishing spot. [The government said] “nope.” We said, “we’re going fishing, we’re not going [into the community].” But still they wouldn’t let us in. So, it did damage a lot of people – Leanne (Yarning Workshop 4, October 2023)

Participants shared stories on the difficulties of navigating important family events and culture within the limits of the pandemic policies, such as capacity limits at funerals. They shared stories on how important cultural practices such as Sorry Business (a period of mourning that involves responsibilities such as attending funerals) are to their connectivity and spirituality and how important it is to say goodbye to loved ones who had passed. This had negative ramifications on the family members having to decide on who could attend the funeral within the capacity limits.

Well black fella funerals are usually really big…My Pop, he passed away during COVID…they live streamed the ceremony…that’s pretty hard to watch that because you don’t have the support from everyone…I lived on my own so…I couldn’t be around my family during that time—Isabella (Yarning Workshop 4, October 2023)

I lost a nephew and…just going through making all these arrangements to go out to his funeral, and then we were only allowed so many people in a room, and because you come from big families it was very difficult…You couldn’t touch your family members and… at the cemetery you had to stand this 1.5 metres away—Barbara (Yarning Workshop 1, September 2022)

Many described the strain COVID-19 caused on families. Some took in family members due to lack of housing availability, some spoke of the difficulties of the intrastate border closures resulting in fewer opportunities to see family members living in regional WA, and some spoke of the difficulties of managing working from home while their children had to undertake remote learning during lockdown periods:

I struggled with lockdowns because I had my three nieces and nephews living with me and my partner and they had behavioural issues, so it was a real struggle to be stuck at home. I couldn’t… take them anywhere …I was, like, pulling my hair out all the time and they wouldn’t do the schoolwork. I just thought that was a bit of a joke, to expect us to do the schoolwork with them while I was still working, my partner was working, and we couldn’t juggle it. Especially when they’re kids from trauma and stuff, and then they’re stuck in a house and it wasn’t working. That was my worst part—Hannah (Yarning Workshop 4, October 2023)

The impact of the disconnection from community and culture, and the strain on families, had enormous negative impact on the mental health of many of our participants and their loved ones:

I reckon in COVID… put more on mental health… suicide and all that. Isolating, that caused a lot of damage towards communication between community…That caused a lot of mental health issues. And not just through domestic violence and all that stuff. It’s more like not understanding, confusion, and then all those other stuff came into it. Now we’re all trying to fix ourselves and the community, but it’s like hitting brick walls anyway. So that caused a lot mental health issues…—Debra (Yarning Workshop 2, March 2023)

Some described positives from the pandemic, including being able to spend more time with family, the perception of reduced pollution due to stay-at-home measures, and new work and study opportunities becoming available. A minority highlighted the community camaraderie:

I think the positive for me was how we were all kept safe, I suppose, and how we got through it, and everybody working together to ensure the health and wellbeing of everybody going through this—Peter (Yarning Workshop 5, October 2023)

Influence of trust in government authorities and processes on vaccination

Very few participants trusted the state and commonwealth governments due to both historical and contemporary factors. Some reflected on pivotal moments of mistreatment of Aboriginal and/or Torres Strait Islander people throughout Australia’s colonial history, such as stolen generations (forcible removal of young children from their families), slavery, severe underpayment for services, and cruelty inflicted by government policies such as unjust incarceration in inhumane living conditions. Some spoke of more contemporary factors layered upon historical injustices to further erode trust, such as recent deaths in custody, lack of genuine community consultation, defunding Indigenous companies, the perception that governments control the health messages that ACCHO’s disseminate, and—during the pandemic—frequently changing the messaging.

… I was, like, working with community for ages, and a concern was the fact that like back in the day the government lied to Aboriginal people about [injections] and other stuff, and so there’s still a generation that is out there that was exposed—or their parents were a part of that. So they were struggling to then just switch on and believe that, like, “COVID is real, it is this bad and you need to be vaccinated, the vaccination is going to help you.”—Hannah (Yarning Workshop 4, October 2023)

Hannah articulated how Aboriginal and/or Torres Strait Islander people’s distrust derived from historical abuses and meant that the government could not simply assume that they would be on board to receive and act upon messaging about protection and prevention. This was exacerbated because governments had not invested enough resources to help people recover from historical and contemporary traumas—and the latter continued unabated.

I don’t think there was enough support to even educate—or not educate, but just support those people in their former traumas, or their current traumas still, what they dealt with or their family dealt with, but the government just expects Aboriginal people just to believe them and trust them when there are so many issues to this day with the government and how Aboriginal people are treated—Hannah (Yarning Workshop 4, October 2023)

This mistreatment of Aboriginal and/or Torres Strait Islander people by the Australian government led some of the participants to be extremely wary of the fact that they were prioritised for COVID-19 vaccination at the beginning of the rollout in 2021. When Grace and Lachlan (Yarning Workshop 3, October 2023) were asked how they felt about the prioritisation, the following conversation ensued:

Grace: Well, that’s like another thing that caused so much, like, conversation and controversy within my family because it was, like—a lot of people were, like, “Oh, they’re trying to like put something in us, they’re trying to like make us sick.”

Lachlan: Kill us off, again.

Grace: Because they didn’t really explain it. [The government] didn’t explain anything with that, they were just, like, “You have to.” And we get it, about closing the gap and everything and making sure we’re safe. But they didn’t explain that. They just put out an untested…vaccine that nobody else was getting, [and] you’re telling us to go first?!

Lachlan: The government has let Aboriginal and/or Torres Strait Islander people down many times before, why would we trust them again with this vaccine?

Grace: Exactly, and it’s, like, a lot of people had things to say about it and did not want to get it. Some purely for the fact that’s how they started rolling it out, being, like, “You need to get it first.” And it felt like, kind of, just being like test subjects, guinea pigs at some point.

In another yarning session, Matthew raised significant concerns about his observation that there had been an increase in deaths among his community during the pandemic, coinciding with COVID-19 vaccine prioritisation for Aboriginal and/or Torres Strait Islander people:

Why is everyone still dying? There’s an incredible amount of Aboriginal people dying…There was never this many funerals…[The government] made the communities, everyone, get needles. Push, push, push….This is an unseen amount of deaths, unseen in my lifetime…this is the same government that says “Take the needle, take the needle, take the needle, Aboriginal people need the needle first”—Matthew (Yarning Workshop 2, March 2023)

Matthew went on to share a perspective that indicated he did not see the vaccines as preventing or reducing illness, suffering, or death in his community: “I think we’d still be okay if we didn’t get the needle. The community would still be okay if no one ever had the COVID needles. I think everyone would still be the same.”

A minority of participants held the opposing view, supporting the prioritisation due to feeling particularly vulnerable to COVID-19. These participants trusted that the government was acting in its citizen’s best interests with the information they had at the time.

I’m grateful we had it, because I look[ed] at other countries and [could] see lots of people dying…People had to make a decision…[The government did] the best they could [with their decision making]….When it first happened and other people were getting vaccinated, I was sitting there going, “Where the hell is ours?…I want my kids to have it, I want all of them to be safe…how do I protect my family, my communities, my people?”…I think [the government did what] it had to do. It was a pandemic…people were dying everywhere and it was horrible, so [the government had to] make a decision—Annie (Yarning Workshop 1, September 2022)

Given the lack of trust in the government by most other participants, however, there was very little support for the COVID-19 vaccine employment mandates that were enforced upon most of the WA adult community in 2021/2022. This opposition was frequently articulated in a way that was distinct when compared to the other community cohorts we studied (Attwell, Rizzi, McKenzie et al. 2022; Attwell et al. 2024). Participants emphasised that for Aboriginal and/or Torres Strait Islander people, mandates removed their hard-fought ability to exercise self-determination.

I was really frustrated that it became compulsory to be vaccinated in order to keep your job…Then it’s at the point where they’ve got control over our money and our income… I feel like the only thing we really do choose is where we work and what work we choose to go into, and then for the government to take control of that, what voice do we have?—Caitlin (Yarning Workshop 4, October 2023)

Despite opposing the mandates, most participants nevertheless took the vaccines to keep their jobs. Participant’s body language and expressions communicated to the research team how grudgingly most participants had taken the vaccine. One participant who held out from this was Susan (Yarning Workshop 1, September 2022), whose strong religious beliefs were, in her view, a contraindication to vaccination as “the Lord…He does not give out mandates”. Susan’s refusal impacted her personally, disrupting an exciting new career path, as well as denying her broader community the benefits of her work:

I did the Aboriginal Health Practitioner course…I was really looking forward to actually going up into the community….and then it all came crashing down because with my faith I didn’t want to get the needles, and you’ve got to get the needles to work in that area…It really touches my heart because I can’t go and do what my goal was to do, to take care of our Indigenous peoples.

Susan also disclosed in her yarning group she knew two people who had taken their own lives over the vaccine mandates, facing an “impossible choice” and “they didn’t want to have it.” Other participants described less traumatic but still troubling effects, such as working in a healthcare setting and having to ask people’s vaccination status (“kind of like a privacy invasion”) and refuse family members access to dying relatives if they were not fully vaccinated.

However, Grace’s reflection on the mandates was more positive (Yarning Workshop 3, October 2023). When she was 16 and working in hospitality in Perth during the pandemic, the WA government implemented the requirement for hospitality workers to be vaccinated. Grace’s mother was “against the vaccines” but Grace wanted to be vaccinated to keep her job and was able to obtain her mother’s consent to be vaccinated on that basis. Grace was working at a restaurant whose “owners were very anti-vax” and she described the establishment as flagrantly flouting COVID-19 vaccine requirements on social media. Despite the complexities of navigating vaccination when there was a lack of enthusiastic parental support (despite providing consent), Grace had quit her job because non-enforcement put her at risk as an employee: “everyone would have been liable for that, not just the owners.” She also reflected that the owners and patrons were “all the most privileged people” who had “never experienced discrimination in their lives” but were now complaining about “discrimination” and “oppression” on the basis of vaccine status, which was galling to Grace. “Now who wants to be the victim,” participant Ella reflected of this cohort in the same yarning group.

Views on COVID-19 disease

Participants reflected higher levels of concern about COVID-19 at the beginning of the pandemic compared to the time of the yarning groups, where they demonstrated little concern about the disease. They invoked memories of the “scary” footage in the media at the beginning of the pandemic, referring to coverage of outbreaks in other countries as a “war zone.” It seemed many participants were fearful of the disease at the beginning of the pandemic, but as stated by Lachlan (Yarning Workshop 3, October 2023), by 2023, it was “no longer the trend anymore to worry about COVID.” Participants shared with us how they initially reacted to COVID and would laugh when reflecting on their behaviour.

To think I used to go to the shop when it first come out, I’d have like [disinfectant spray] in the car, gloves, a mask, hand sanitiser. When I look back, I just think it’s so silly now—Melissa (Yarning Workshop 4, October 2023)

Participants discussed and debated the origins of COVID-19, querying the country it came from and the potential animal it evolved in (or, for some, the laboratory it was created in). Some had a misperception about the way in which the virus and disease had been named:

With a name like COVID-19…people saying it’s…the 19th strand…what about all the previous strands? How come they weren’t as bad as this one?…Why do we now have to get vaccinated against just COVID-19 and not all the others…previous to it?—Georgia (Yarning Workshop 4, October 2023)

Views on and reasons for COVID-19 vaccination

Workplace COVID-19 vaccine mandates were the primary reason most participants were vaccinated. However, other reasons included to protect family members deemed at risk of a severe COVID-19 infection and to protect themselves, demonstrating trust in vaccine efficacy. Others were vaccinated to be role models to others or because their own role models took the vaccines, or because a healthcare provider recommended it. One participant described how reflecting on the history of epidemics and vaccinations helped her decision:

I really went back and looked at history in the past of how they overcome all these epidemics in the past, so that’s what influenced me to have it…This is just another [outbreak] that we’re going through. I then [thought], “Well, I need to [get vaccinated]!” …So that’s what I did—Barbara (Yarning Workshop 1, September 2022)

Despite high levels of vaccine uptake, most participants were nevertheless deeply concerned about the COVID-19 vaccine. Several referenced the speed at which the vaccines were developed and the fear of what this may mean in the long term, such as the potential impact on fertility. Others were concerned about vaccine ingredients, such as the supposed inclusion of “monkey foetus.” These concerns often stemmed from a lack of trust in government:

I believe there’s things in those vaccines that they’re not being upfront with us about, or they are being upfront with us about it, they’ve put it in a way that it’s not actually saying what it’s supposed to say—Peter (Yarning Workshop 5, October 2023)

Others also shared with us the concerns that their friends and family members held, but were considered by participants to be nonsensical, such as COVID-19 vaccines containing HIV and microchips, developing dementia from the vaccine, and how the vaccines were being used as a global tool to control overpopulation. Tanya (Yarning Workshop 5, October 2023) said:

I’ve…got an aunt…her information that she was giving to a lot of her family members was that if we had one of the jabs we would not live until two years later. It’s been more than two years now since I’ve had all the jabs…

However, many also shared stories with us about the negative impact COVID-19 vaccines had on their loved ones and community, such as the perceived onset of heart disease or unexplained deaths. Given participants were witnessing this within their own community, this caused significant concern about their own receipt of the vaccines.

My wife does not drink, does not smoke… I do believe wholeheartedly that the vaccines played a part in contributing to the downfall of her health and wellbeing. Prior to the vaccines she’d never been to the doctors, ever. Now it’s constantly to the doctors, it’s constantly different medications and injections….you could…put it down to these are women’s issues…you could put it down to age…she’s only 50 something…But when there’s a multitude of things that are all happening at once that is not happening within her immediate family, that’s very concerning for me—Peter (Yarning Workshop 5, October 2023)

Some participants also viewed the vaccines as “pointless” and “unnecessary”, reasoning that vaccinated people could still be infected with COVID-19. Moreover, some described more severe responses to the vaccines than their eventual experience of COVID infection.

I was really, really sick when I got vaccinated and then I got COVID like a few months later…I was sick but…surviving and then I had COVID again a few months after that, and then I had to get vaccinated again…I would rather just get COVID [than experience the vaccine side effects]—Hannah (Yarning Workshop 4, October 2023)

Trusted sources of information

Participants spoke about how little they trust media and government media campaigns, and instead turned to their friends, family, and trusted health professionals. Some, particularly Elders, were acutely aware of how important it was to have the correct information if it was them that their community was turning to:

I wanted to know as much as I could about COVID so that I could help my family understand what it was about and let them make the decision, and it was their choice whether they took that step—Barbara (Yarning Workshop 1, September 2022)

Barbara went on to say:

My information would come from people that are researching and understanding about it….We had a doctor from [an Aboriginal Medical Service come to our community centre] and one of his other colleagues that were working with the COVID…come and address us….I know that the information…they got is to be true and that so I could trust them because they were actually doing their research into it, and getting that information out into us in the community.

Regarding Aboriginal Medical Services (AMS), though some participants were appreciative of outreach services and trusted the information they provided, others were wary of the information these organisations shared and had access to:

I think it’s hard because [Aboriginal Medical Services] have to follow what the government is putting out there, so we can’t just turn around and be like “Oh [Aboriginal Medical Services], they’re black fellas.”…I don’t even go to [Aboriginal Medical Services] because personally I think your information isn’t private if you have certain people working there, so…I’m not going to…sit there and be like “oh, they’re telling us to trust this.” I don’t even trust [who’s] working behind the [receptionist] bench—Hannah (Yarning Workshop 4, October 2023)

I don’t trust [Aboriginal Medical Services]..because I feel above our Indigenous organisations there are still non-Indigenous people that sit above that…[they] only just want to tick boxes for Indigenous people. We’ve all been through it, it’s all about ticking boxes for us instead of actually learning about community—Caitlin (Yarning Workshop 4, October 2023)

Knowledge of vaccination programmes

Participants described receiving their COVID-19 vaccines at their workplace, AMS, pharmacy, general practice (GP) clinic, or at their place of education. One participant shared information on community-run clinics they organised:

…We come up with a concept for rolling out the immunisations and having opportunities for people to come into a safe space. So it was a cultural day, we had a BBQ, we had food, we done weaving, we done bush medicine stuff, we done workshops with painting…One side was a [vaccine] clinic, [on the other] side was workshops. People could come in, get the education, sit around, have their needle….Lots of ladies kept coming back, they’d come to about four sessions and then they went and had their immunisations with a doctor [at a GP clinic] because they decided that was when they were ready…We did also end up doing vouchers [financial incentives for vaccination], because we ended up getting funding—Annie (Yarning Workshop 1, September 2022)

Discussing such incentives, although some participants were grateful for the financial assistance, several saw them as bribes, rather than a genuine way to promote vaccine uptake:

There were some incentives from—some of the [Indigenous-led] organisations…to get people to come into the health centre and get vaccinated…a lot of black fellas just wouldn’t have a bar of [the COVID-19 vaccine]. They would’ve had to have been bribed for sure—Peter (Yarning Workshop 5, October 2023)

Discussion

Our yarns identified high levels of COVID-19 vaccine hesitancy amongst Perth-based Aboriginal and/or Torres Strait Islander people. Many of the concerns were those held by other population cohorts in Australia and globally (Carlson et al. 2023, 2022; Graham et al. 2022; Kafadar et al. 2023; Karras et al. 2024; Kaufman et al. 2022; Roberts et al. 2023), but some were more specific to the history and lived experience of Aboriginal and/or Torres Strait Islander people and a deep lack of trust in government and some medical institutions. This distrust was, in part, stemming from past and contemporary injustices and mistreatment, which was also identified among Aboriginal and/or Torres Strait Islander people living in Sydney, New South Wales (Graham et al. 2022). We also heard about the disruption COVID-19 caused to culture and community. This impact, including the inability to attend funerals in a culturally appropriate way, the difficulties in juggling work commitments and remote learning, and the exacerbation of mental health issues, was also felt by Aboriginal and/or Torres Strait Islander people living in other Australian states (Kennedy et al. 2022). Our findings demonstrate that there were many unintended consequences of COVID-19 policies on Aboriginal and/or Torres Strait Islander people and culture. Future pandemic policies and their application to Aboriginal people need to be truly Indigenous-led, consider Aboriginal families and extended families, and involve meaningful co-design between government and Aboriginal communities.

Regarding policies, some of our participants were not in favour of being prioritised for COVID-19 vaccination. However, Community Panels conducted with Aboriginal people (respectfully referred to as ‘First Nations’ by the study authors) in 2019 identified that First Nations peoples believe they should be prioritised for (hypothetical) pandemic influenza vaccine access (Crooks et al. 2023). Though there were some concerns raised in the Community Panels about being “guinea pigs”, as our cohort also had concerns about, the consensus was still to prioritise First Nations peoples. The strong support in the Community Panels for prioritisation of pandemic vaccines is likely due to the detailed, evidence-based information the group received on infectious diseases and vaccines from public health experts before making such a decision. This demonstrates that when the next pandemic vaccine is rolled out, detailed information about the risks (of the disease and the vaccine) and the expected benefits (of the vaccine) must be explained with as much information that is known at the time, with clear explanations of why particular cohorts are prioritised over others.

This also has repercussions for other vaccinations in the childhood and adult setting that are also made freely available for people based on Aboriginality. Infectious disease and public health specialists (who are often non-Indigenous) advising the government to construct risk categories and recommend or facilitate the funding of vaccinations to limit the outbreaks of diseases in cohorts deemed to be at higher risk to infection or to severe illness upon infection. However, what it means to belong to a high-risk group can be interpreted very differently by people belonging to those categories, especially if—as our participants expressed—the basis behind prioritisation is not clearly expressed or explained by authorities. Moreover, prioritisation based on risk factors can be stigmatising and carry the risk of victim-blaming, when so many comorbidity risk factors result from colonialism (Gracey and King, 2009; Paradies, 2016).

It is also important to consider that participants’ experiences of milder COVID-19 infections following vaccination could, in fact, have been influenced by their prior vaccine doses. While some participants expressed a preference for natural infection over-vaccination due to the perceived severity of side effects, prior research suggests that vaccination can reduce the risk of severe COVID-19 outcomes. However, immunity from vaccination has been shown to wane over time (Liu et al. 2023), which may lead to varied experiences with subsequent infections and contribute to mixed perceptions of the vaccine’s protective value.

Our findings add to the growing data worldwide about how general and specific population groups have responded to COVID-19 vaccine mandates (Attwell et al. 2022). Our participants’ vaccination status and stated reasons for vaccination demonstrate that many were what Roberts et al. termed “coerced acceptors” (Roberts et al. 2023). While it appears that coercive vaccination policies help governments reach vaccine coverage targets, our findings demonstrate that such policies may contribute to greater levels of distrust among the very communities that governments and health authorities should be working most closely with to build trust. Conversely, for a minority of our participants, the mandates allowed them the opportunity to finally be vaccinated, as was the case for Grace needing to be vaccinated to continue working in hospitality, despite her mother’s stance on COVID-19 vaccines. Future scholarship might consider what to do with the differential impacts of mandates on different population groups and what measures could be built in to try and mitigate harms versus potential benefits (other than high vaccine uptake).

As of March 2024, adults in Australia are eligible to receive a booster every 6–12 months (dependent upon age group and immunocompromise status) (Australian Government Department of Health and Aged Care, 2024). However, <3% of Aboriginal and/or Torres Strait Islander adults in WA had received a COVID-19 vaccine in the preceding 6 months (Department of Health and Aged Care, 2024). Strategies to improve uptake include advocacy by community leaders, equipping Aboriginal Health Workers/Practitioners with knowledge about COVID-19 disease and vaccination (enabling them to share evidence-based information with their community), collaboration with Aboriginal and/or Torres Strait Islander social media influencers, and incentives such as the provision of a free and healthy meal with vaccination (Poirier et al. 2023).

Our findings do not represent all Aboriginal and/or Torres Strait Islander communities across Australia; rather, they are the stories, knowledge and opinions of just those with who we were fortunate to yarn with. It is, therefore possible that other Aboriginal and/or Torres Strait Islander individuals and communities had different COVID-19 pandemic and vaccination experiences to what we have described in this article. Majority of our participants were female (87%); this gender imbalance may mean that some perspectives, particularly those of Aboriginal and/or Torres Strait Islander men, are underrepresented in our results. Further, though not a limitation, it is worth noting that three of the five yarns were conducted in the fortnight leading into the 2023 Australian Indigenous Voice to Parliament referendum, which may have influenced many of the discussions surrounding trust in government and the ability to exercise the right to self-determination. Our study received invaluable guidance from many members of the Aboriginal and/or Torres Strait Islander community in Perth, helping to ensure the most appropriate methods were used and that there was an indigenous lens applied across the data interpretation and recommendations made.

Conclusion

Our yarns identified the significant impact of the COVID-19 pandemic on Aboriginal and/or Torres Strait Islander people with many unintended consequences of COVID-19 policies on Aboriginal and/or Torres Strait Islander people and culture. Our findings also demonstrate high levels of COVID-19 vaccine hesitancy and circulation of misinformation amongst Perth-based Aboriginal and/or Torres Strait Islander people. Future pandemic policies and vaccine rollouts must consider the impact on not only the health of Aboriginal and/or Torres Strait Islander people but also the impact on community and culture. Ensuring an Indigenous voice in pandemic preparedness, policy development and response is required to ensure optimal outcomes for Aboriginal and/or Torres Strait Islander people.