BACKGROUND AND OBJECTIVES:Aboriginal and Torres Strait Islander people can experience inequitable access to health services. This study assessed the effectiveness of a culturally responsive medication management service (referred to as IMeRSe). METHOD:This is a pre-post single-arm study involving Aboriginal and Torres Strait Islander health services and community pharmacies. Participants had a chronic condition, were pregnant or postpartum within 2 years. Pharmacists wrote a collaborative Medicines Plan and made recommendations to clinicians. The primary outcome was serious medication-related problems 6-months post-IMeRSe. Secondary outcomes included medication adherence. RESULTS:For 255 participants, mean serious medication-related problems reduced from 4.11 to 3.85 per 6 months at risk (incidence rate ratio, 0.93; 95% confidence interval, 0.86-1.01), although rates of potentially preventable medication-related hospitalisations remained similar. Significant improvements in medication adherence were observed. General practitioners accepted 709 of 762 pharmacist recommendations. DISCUSSION:A culturally responsive medication management service delivered by community pharmacists can contribute to reduced serious medication-related problems, improved medication adherence and consumer empowerment.

Abstract Indigenous people are disproportionately impacted by influenza viruses and chronic multimorbidity. Yet, the impact of comorbidities on immunity towards influenza vaccination is unknown. We recruited Australian First Nations and non-Indigenous people vaccinated with seasonal inactivated influenza vaccines and assessed their humoral and cellular responses in the context of comorbidities at baseline and after immunisation. Our study highlights prevalence of multimorbidity in First Nations people, associated with elevated baseline cellular activation, pro-inflammatory cytokines and agalactosylated IgG. Following vaccination, all groups had increased antibody titres and haemagglutinin-specific IgD - B-cell frequencies as compared to baseline. However, we reveal increased prevalence of pro-inflammatory atypical B cells within influenza haemagglutinin-specific IgD - B cells and lack of significant circulating T follicular helper type-1 cell activation in individuals with comorbidities, correlating with multimorbidity-associated baseline inflammatory features. Our findings thus reveal that vaccinees with comorbidities, both Australian First Nations and non-Indigenous participants, can mount antibody responses following influenza vaccination, although their cellular immune features, haemagglutinin-specific IgD - B cells and cT FH 1 compartments, display features of perturbed humoral axis functionality linked to multimorbidity-associated inflammation and IgG glycosylation patterns at baseline. Our study supports influenza vaccination for individuals with comorbidities, especially relevant to Indigenous populations with prevalent multimorbidity.

Equity in pandemic planning and response for First Nations peoples in Australia requires a deeper understanding of sociocultural realities to determine appropriate public health actions. First Nations community panels were held in three locations across Australia between September 2020 to December 2020 to make decisions on how government authorities should help First Nations peoples keep safe from COVID-19. Twenty-two First Nations peoples participated in online panels. Panels heard from public health experts, examined the evidence and deliberated on the issues. All panels highlighted that embedding First Nations worldviews into health policy was important. First Nations peoples must be supported and resourced to enable self-determination in preparation for future infectious disease emergencies, otherwise their health could be negatively impacted if they are not intentionally considered or actively engaged.

Genetic variation in host immunity impacts the disproportionate burden of infectious diseases that can be experienced by First Nations peoples. Polymorphic human leukocyte antigen (HLA) class I and killer cell immunoglobulin-like receptors (KIRs) are key regulators of natural killer (NK) cells, which mediate early infection control. How this variation impacts their responses across populations is unclear. We show that HLA-A∗24:02 became the dominant ligand for inhibitory KIR3DL1 in First Nations peoples across Oceania, through positive natural selection. We identify KIR3DL1∗114, widespread across and unique to Oceania, as an allele lineage derived from archaic humans. KIR3DL1∗114+NK cells from First Nations Australian donors are inhibited through binding HLA-A∗24:02. The KIR3DL1∗114 lineage is defined by phenylalanine at residue 166. Structural and binding studies show phenylalanine 166 forms multiple unique contacts with HLA-peptide complexes, increasing both affinity and specificity. Accordingly, assessing immunogenetic variation and the functional implications for immunity are fundamental toward understanding population-based disease associations.

We describe the establishment of a First Nations governed grant program that built on an existing Australian research collaboration during the height of the COVID-19 pandemic in 2020. Following a generous philanthropic donation, a process was initiated to centre and privilege First Nations perspectives and governance in the grant dissemination process. Decision-making was driven by First Nations people, including setting research principles and priorities, eligibility and review criteria, and in overseeing the advertising and grant review. This led to a widely distributed and highly competitive application round and the funding of ten grants from diverse organisations addressing various aspects of the COVID-19 response. The resulting grant outputs were diverse and impactful, including academic publications, articles for general readership, internal reports, social and traditional media, and frameworks. The principles from the grant round have underpinned the more recent formation of the ongoing First Nations Research preparednesS neTwork (FIRST), to further embed the important principles of First Nations self-determination for ongoing and future pandemic research.

Background More than 50 million influenza infections and over 100,000 deaths from influenza occur annually. While Indigenous populations experience an inequitable influenza burden, the magnitude of this inequity has not previously been estimated on a global scale. This study compared rates of influenza-associated hospitalisation and mortality between Indigenous and non-Indigenous populations globally. Methods A systematic review and meta-analysis was conducted including literature published prior to 13 July 2021. Eligible articles either reported a rate ratio (RR) comparing laboratory-confirmed influenza-associated hospitalisation and/or mortality between an Indigenous population and a corresponding benchmark population, or reported sufficient information for this to be calculated using publicly available data. Findings were reported by country/region and pooled by country and period (pandemic/seasonal) when multiple studies were available using a random-effects model. The I2 statistic assessed variability between studies. Results Thirty-six studies (moderate/high quality) were included; all from high or high-middle income countries. The pooled influenza-associated hospitalisation RR (HRR) for indigenous compared to benchmark populations was 5·7 (95% CI: 2·7–12·0) for Canada, 5·2 (2.9–9.3) for New Zealand, and 5.2 (4.2–6.4) for Australia. Of the Australian studies, the pooled HRR for seasonal influenza was 3.1 (2·7–3·5) and for pandemic influenza was 6·2 (5·1–7·5). Heterogeneity was slightly higher among studies of pandemic influenza than seasonal influenza. The pooled mortality RR was 4.1 (3·0–5.7) in Australia and 3·3 (2.7–4.1) in the United States. Conclusions Ethnic inequities in severe influenza persist and must be addressed by reducing disparities in the underlying determinants of health. Influenza surveillance systems worldwide should include Indigenous status to determine the extent of the disease burden among Indigenous populations. Ethnic inequities in pandemic influenza illustrate the need to prioritise Indigenous populations in pandemic response plans.

Indigenous peoples globally are at increased risk of COVID‐19‐associated morbidity and mortality. However, data that describe immune responses to SARS‐CoV‐2 infection in Indigenous populations are lacking. We evaluated immune responses in Australian First Nations peoples hospitalized with COVID‐19. Our work comprehensively mapped out inflammatory, humoral and adaptive immune responses following SARS‐CoV‐2 infection. Patients were recruited early following the lifting of strict public health measures in the Northern Territory, Australia, between November 2021 and May 2022. Australian First Nations peoples recovering from COVID‐19 showed increased levels of MCP‐1 and IL‐8 cytokines, IgG‐antibodies against Delta‐RBD and memory SARS‐CoV‐2‐specific T cell responses prior to hospital discharge in comparison with hospital admission, with resolution of hyperactivated HLA‐DR + CD38 + T cells. SARS‐CoV‐2 infection elicited coordinated ASC, Tfh and CD8 + T cell responses in concert with CD4 + T cell responses. Delta and Omicron RBD‐IgG, as well as Ancestral N‐IgG antibodies, strongly correlated with Ancestral RBD‐IgG antibodies and Spike‐specific memory B cells. We provide evidence of broad and robust immune responses following SARS‐CoV‐2 infection in Indigenous peoples, resembling those of non‐Indigenous COVID‐19 hospitalized patients.

BACKGROUND:Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples.METHODS:We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses.RESULTS:Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples.CONCLUSIONS:First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia.

BACKGROUND:Environmental chemical contamination is a recognised risk factor for psychological distress, but has been seldom studied in the context of per- and polyfluoroalkyl substances (PFAS) contamination. We examined psychological distress in a cross-sectional study of three Australian communities exposed to PFAS from the historical use of aqueous film-forming foam in firefighting activities, and three comparison communities without environmental contamination.METHODS:Participation was voluntary following recruitment from a PFAS blood-testing program (exposed) or random selection (comparison). Participants provided blood samples and completed a survey on their exposure history, sociodemographic characteristics, and four measures of psychological distress (Kessler-6, Distress Questionnaire-5, Patient Health Questionnaire-15, and Generalised Anxiety Disorder-7). We estimated prevalence ratios (PR) of clinically-significant psychological distress scores, and differences in mean scores: (1) between exposed and comparison communities; (2) per doubling in PFAS serum concentrations in exposed communities; (3) for factors that affect the perceived risk of living in a community exposed to PFAS; and (4) in relation to self-reported health concerns.RESULTS:We recruited 881 adults in exposed communities and 801 in comparison communities. We observed higher levels of self-reported psychological distress in exposed communities than in comparison communities (e.g., Katherine compared to Alice Springs, Northern Territory: clinically-significant anxiety scores, adjusted PR = 2.82, 95 % CI 1.16-6.89). We found little evidence to suggest that psychological distress was associated with PFAS serum concentrations (e.g., Katherine, PFOS and anxiety, adjusted PR = 0.85, 95 % CI 0.65-1.10). Psychological distress was higher among exposed participants who were occupationally exposed to firefighting foam, used bore water on their properties, or were concerned about their health.CONCLUSION:Psychological distress was substantially more prevalent in exposed communities than in comparison communities. Our findings suggest that the perception of risks to health, rather than PFAS exposure, contribute to psychological distress in communities with PFAS contamination.

High-risk groups, including Indigenous people, are at risk of severe COVID-19. Here we found that Australian First Nations peoples elicit effective immune responses to COVID-19 BNT162b2 vaccination, including neutralizing antibodies, receptor-binding domain (RBD) antibodies, SARS-CoV-2 spike-specific B cells, and CD4+ and CD8+ T cells. In First Nations participants, RBD IgG antibody titers were correlated with body mass index and negatively correlated with age. Reduced RBD antibodies, spike-specific B cells and follicular helper T cells were found in vaccinated participants with chronic conditions (diabetes, renal disease) and were strongly associated with altered glycosylation of IgG and increased interleukin-18 levels in the plasma. These immune perturbations were also found in non-Indigenous people with comorbidities, indicating that they were related to comorbidities rather than ethnicity. However, our study is of a great importance to First Nations peoples who have disproportionate rates of chronic comorbidities and provides evidence of robust immune responses after COVID-19 vaccination in Indigenous people.

BACKGROUND:Cultural differences between health professionals and Indigenous peoples contribute to health inequalities, and effective cross-cultural communication and person-centred healthcare are critical remedial elements. Community pharmacists can play a significant role by reducing medication-related problems through medication reviews, yet barriers to access include cultural and linguistic challenges. The Indigenous Medication Review Service (IMeRSe) aimed to address these barriers via a culturally responsive intervention. The aim of this paper is to present the cross-cultural training framework developed as a component of this intervention and the feasibility evaluation of the first stage of the training framework.METHODS:A training framework was developed, emphasising pharmacists' skills and confidence in effective cross-cultural communication and relationship-building with Indigenous Australians (Please note that the use of the term 'Indigenous' in this manuscript includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures) across three stages: (1) online and workshop-based, covering Indigenous history and health, cross-cultural communication and a holistic, strengths-based approach to intervention delivery; (2) orientation to local Aboriginal Health Services, community and cultural protocols; and (3) ongoing mentoring. The feasibility evaluation of the first stage included the following: self-reported levels of cultural capability, cultural confidence and skills, motivators and barriers to working with Indigenous Australians, assessed pre- and post-training. Participants completed self-administered questionnaires including a 22-item validated Cultural Capability Measurement Tool. Paired t tests assessed change in mean scores of Likert scale data.RESULTS:Stage 1 development resulted in an 8.5-h standardised cross-cultural training programme tested with 39 pharmacists working across urban and rural/remote Australia. Thirty-six pharmacists completed the feasibility evaluation (75.7% female, all non-Indigenous, 75.7% never attended prior cross-cultural training). Participants reported overall acceptability with training; the majority perceived it added value to their practice. Improved cultural capability post-training was reflected in increased scores for 21/22 items, nine reaching statistical significance. There were significant improvements for all 26 confidence and skills statements, and selected motivational and barrier statements, particularly participants role in improving Indigenous health outcomes and cross-cultural communication.CONCLUSIONS:This study provides preliminary evidence that the training programme was feasible to deliver and prepared pharmacists to deliver a culturally responsive medication review intervention. The online knowledge-based modules and face-to-face workshops provide a standardised framework for larger-scale implementation of the intervention training.TRIAL REGISTRATION:Australia and New Zealand Clinical Trials Registry ACTRN12618000188235 .Prospectively registered 22 January 2018.

Background Communities impacted by environmental contamination may have higher exposure to per- and polyfluoroalkyl substances (PFAS), which has the potential for both immediate and latent impacts on human health. We investigated PFAS exposure in children and adults who had lived or worked in three Australian communities affected by environmental contamination associated with the historic use of Aqueous Film Forming Foams (AFFF) at military bases. Methods From 2016 to 2019, the Australian Government conducted the Voluntary Blood Testing Program for PFAS. We recruited 2,587 participants into the PFAS Health Study, in addition to 702 randomly sampled residents of three comparison communities not known to be affected by environmental contamination. Comparison communities were selected based on area-level sociodemographic characteristics, in accordance with the three exposed communities. We measured concentrations of nine PFAS blood serum samples from each participant using Liquid Chromatography Tandem Mass Spectrometry. Results Geometric means of serum PFAS concentrations across exposed communities ranged from 4.9–6.6 nanograms per millilitre (ng/mL) for perfluorooctane sulfonic acid (PFOS), from 2.9–3.7 ng/mL for perfluorohexane sulfonic acid (PFHxS) and from 1.3–1.8 ng/mL for perfluorooctanoic acid (PFOA). Geometric means of PFAS concentrations were higher in older participants and males. In total, 29–42% of participants from exposed communities had an elevated serum PFOS concentration (above the 95th percentile of the comparison population) and 48–55% had an elevated serum PFHxS concentration. Conclusions Evidence of higher serum PFOS and PFHxS concentrations in these Australian communities is consistent with the nature of the environmental contamination and the main constituents of the AFFF used in the areas. Serum PFAS concentrations across the exposed communities were comparable to those reported for communities in the United States of America affected by environmental PFAS contamination from firefighting foam use on military bases, though lower than in a community in Sweden.

CD8(+) T cells are a pivotal part of the immune response to viruses, playing a key role in disease outcome and providing long-lasting immunity to conserved pathogen epitopes. Understanding CD8(+) T cell immunity in humans is complex due to CD8(+) T cell restriction by highly polymorphic Human Leukocyte Antigen (HLA) proteins, requiring T cell epitopes to be defined for different HLA allotypes across different ethnicities. Here we evaluate strategies that have been developed to facilitate epitope identification and study immunogenic T cell responses. We describe an immunopeptidomics approach to sequence HLA-bound peptides presented on virus-infected cells by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Using antigen presenting cell lines that stably express the HLA alleles characteristic of Indigenous Australians, this approach has been successfully used to comprehensively identify influenza-specific CD8(+) T cell epitopes restricted by HLA allotypes predominant in Indigenous Australians, including HLA-A*24:02 and HLA-A*11:01. This is an essential step in ensuring high vaccine coverage and efficacy in Indigenous populations globally, known to be at high risk from influenza disease and other respiratory infections.

BACKGROUND AND AIM: Per- and polyfluoroalkyl substances (PFAS) have been associated with altered kidney, thyroid, and cardiometabolic function markers, particularly elevated total cholesterol, but the evidence for specific health conditions has been inconclusive. We quantified the single and combined associations of PFAS on 17 biomarkers and 13 related health conditions in Australian communities with PFAS-contaminated water from the historical use of aqueous film-forming foam in firefighting activities. METHODS: This was a cross-sectional study of 881 adults in three exposed communities and 801 adults in three comparison communities. Participants self-reported their health and sociodemographic characteristics, and provided blood samples for measurement of nine PFAS and 17 biomarkers. We estimated differences in mean biomarker concentrations for each PFAS (PFOS, PFOA, and PFHxS) using linear regression and for the PFAS-mixture using Bayesian kernel machine regression. We also estimated prevalence ratios of biomarker concentrations above/below the reference limit and self-reported health conditions using modified Poisson regression. RESULTS: We observed higher mean total cholesterol and uric acid concentrations with higher single and mixture PFAS concentrations in blood serum, with varying certainty across communities and PFAS. PFOA was associated with higher prevalence of self-reported hypercholesterolemia (one community) and gout and kidney disease (two communities), but PFOS and PFHxS were associated with lower prevalence of gout and kidney disease. No clear associations were observed for self-reported cardiovascular disease, and there was less certainty for liver and thyroid function markers and disease due to low prevalence. CONCLUSIONS: Our study is one of few that simultaneously quantifies the associations of a PFAS-mixture on a large number of biomarkers and underlying health conditions in multiple communities. Our findings for total cholesterol and uric acid were consistent with previous studies; however, few associations were consistent across communities and the cross-sectional design limited causal inference. KEYWORDS: perfluoroalkyl substances, lipids, liver, kidney, thyroid

SARS-CoV-2 has led to >270 million infections and >5 million deaths globally. Indigenous people are disproportionately affected by infectious diseases, therefore also more susceptible to the COVID-19 pandemic. There are an estimated 476 million indigenous people globally, including an estimated 798,365 Aboriginal and Torres Strait Islander in Australia. With the high vulnerability to COVID-19, this knowledge is urgently needed to better protect indigenous populations. We evaluated a breadth of immune responses in indigenous (n=57) and non-indigenous (n=49) individuals after COVID-19 vaccination. We tested RBD antibodies, spike/RBD-probe-specific B cells, peptide stimulations with activation-induced marker (AIM) assay and intracellular cytokine staining. We found 22% and 34% seroconversion rates after 1st dose of BNT162b2 vaccine for Indigenous and non-indigenous individuals, respectively, which increased to 100% at 1-mth after 2nd dose for both groups. RBD-specific IgG levels in indigenous individuals at 1-mth after 2nd dose positively correlated with their body mass index. At 1-mth after the 2nd COVID-19 vaccination, CD4+ and CD8+ T cell responses via AIM expression and IFN-γ+TNF+ production was comparable between indigenous and non-indigenous individuals. We are also going to assess the longevity of antibodies and T cells. Therefore, COVID-19 vaccination induced similar immune responses in indigenous and non-indigenous individuals.

INTRODUCTION:First Nations Peoples of Australia have not been included in the development nor prioritised in pre-2009 pandemic plans despite being a priority population in Australian health policy. Marginalised groups experience amplified barriers and systemic disadvantage in emergencies, however, their voices have not been heard in past pandemic responses. Through effective engagement with disadvantaged and oppressed groups, health authorities can gain a deeper understanding of how to design and implement pandemic control strategies. There have been limited studies with First Nations Peoples that has focused on pandemic planning and response strategies. Deliberative inclusive approaches such as citizens juries have been a way to uncover public perceptions.METHODS:Qualitative thematic research methods were used to conduct the study. We convened five First Nations Community Panels in three locations in Australia between 2019 and 2020. We used an Indigenist research approach, community-based Participatory Action Research framework and 'yarning' to understand whether Community Panels were an acceptable and appropriate way of engaging First Nations Peoples. Forty First Nations participants were purposively recruited through local and cultural networks. Panels heard evidence supporting various pandemic response strategies, and cross-questioned public health experts.RESULTS:All 40 participants from the 5 panels verbally indicated strong support of the Community Panels approach as an effective way of engaging First Nations Peoples in making decisions about pandemic planning and response strategies. The main theme of 'respect' centred on the overarching principle that First Nations Peoples are important in the context of continuation of culture and ongoing political resistance.CONCLUSION:First Nations Community Panels are a way of enabling active participation of First Nations peoples, increasing knowledge and understanding, and a way for government and policymakers to respectfully listen to First Nations opinions and values.

HLA-A*11:01 is one of the most prevalent human leukocyte antigens (HLAs), especially in East Asian and Oceanian populations. It is also highly expressed in Indigenous people who are at high risk of severe influenza disease. As CD8 + T cells can provide broadly cross-reactive immunity to distinct influenza strains and subtypes, including influenza A, B and C viruses, understanding CD8 + T cell immunity to influenza viruses across prominent HLA types is needed to rationally design a universal influenza vaccine and generate protective immunity especially for high-risk populations. As only a handful of HLA-A*11:01-restricted CD8 + T cell epitopes have been described for influenza A viruses (IAVs) and epitopes for influenza B viruses (IBVs) were still unknown, we embarked on an epitope discovery study to define a CD8 + T cell landscape for HLA-A*11:01-expressing Indigenous and non-Indigenous Australian people. Using mass-spectrometry, we identified IAV- and IBV-derived peptides presented by HLA-A*11:01 during infection. 79 IAV and 57 IBV peptides were subsequently screened for immunogenicity in vitro with peripheral blood mononuclear cells from HLA-A*11:01-expressing Indigenous and non-Indigenous Australian donors. CD8 + T cell immunogenicity screening revealed two immunogenic IAV epitopes (A11/PB2 320-331 and A11/PB2 323-331 ) and the first HLA-A*11:01-restricted IBV epitopes (A11/M 41-49 , A11/NS1 186-195 and A11/NP 511-520 ). The immunogenic IAV- and IBV-derived peptides were >90% conserved among their respective influenza viruses. Identification of novel immunogenic HLA-A*11:01-restricted CD8 + T cell epitopes has implications for understanding how CD8 + T cell immunity is generated towards IAVs and IBVs. These findings can inform the development of rationally designed, broadly cross-reactive influenza vaccines to ensure protection from severe influenza disease in HLA-A*11:01-expressing individuals.

Background First Nations Peoples of Australia were not included in pre-2009 pandemic plans despite being a priority population in Australian Health policy. Marginalised groups experience amplified barriers and systemic disadvantage in emergencies, however the voices of the peoples most affected in past pandemics were not heard. Through effective engagement with disadvantaged and oppressed groups, government and health authorities can gain a deeper understanding of how to design and implement pandemic control strategies. Deliberative inclusive approaches such as citizens juries have been a way to uncover public perceptions, however, there have been no studies with First Nations Peoples that has focused on pandemic planning and response strategies.Methods We convened five First Nations Community Panels in three locations in Australia between 2019-2020 to privilege First Nations voices in pandemic planning and response strategies. We applied an Indigenist research approach using a community-based Participatory Action Research framework and ‘yarning’ to understand whether Community Panels were an acceptable and appropriate way of engaging First Nations Peoples. Forty First Nations participants were purposively recruited through local and cultural connections and networks. Panels heard evidence and arguments supporting various infectious disease emergency strategies, and cross-questioned public health experts.Findings Participants from all five Panels strongly supported the approach of the First Nations Community Panels as an effective way of engaging First Nations Peoples in making decisions about pandemic planning and response strategies.Interpretation There has been no clear way of how to engage First Nations Peoples in planning and implementation of public health advice and guidance in Australia. First Nations Community Panels are a way of enabling active participation, increase knowledge and understanding, and a way for government and policymakers to respectfully listen to First Nations opinions and values.Funding: Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE). Declaration of Interest: None to declareEthical Approval: Ethics approval for the study was granted from Hunter New England Local Health District (2018/ETH00547), Far North Queensland HREC (HREC/2019/QCH/54524), Western Australia Country Health Service (RGS 33676), NSW Aboriginal Health and Medical Research Council (1543/19), Western Australian Aboriginal HREC (959), Charles Darwin University HREC (H19056), and Wuchopperen Health Service.

BACKGROUND:Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland.METHODS:The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework.RESULTS:Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, "copping it", and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah.DISCUSSION:The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes.CONCLUSIONS:The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.

Morbidity and mortality rates from seasonal and pandemic influ-enza occur disproportionately in high-risk groups, including Indig-enous people globally. Although vaccination against influenza is recommended for those most at risk, studies on immune responses elicited by seasonal vaccines in Indigenous populations are largely missing, with no data available for Indigenous Australians and only one report published on antibody responses in Indigenous Canadians. We recruited 78 Indigenous and 84 non-Indigenous Australians vacci-nated with the quadrivalent influenza vaccine into the Looking into InFluenza T cell immunity -Vaccination cohort study and collected blood to define baseline, early (day 7), and memory (day 28) immune responses. We performed in-depth analyses of T and B cell activation, formation of memory B cells, and antibody profiles and investigated host factors that could contribute to vaccine responses. We found ac-tivation profiles of circulating T follicular helper type-1 cells at the early stage correlated strongly with the total change in antibody titers in-duced by vaccination. Formation of influenza-specific hemagglutinin-binding memory B cells was significantly higher in seroconverters com-pared with nonseroconverters. In-depth antibody characterization revealed a reduction in immunoglobulin G3 before and after vaccina-tion in the Indigenous Australian population, potentially linked to the increased frequency of the G3m21* allotype. Overall, our data provide evidence that Indigenous populations elicit robust, broad, and prototypical immune responses following immuniza-ti on with seasonal inactivated influenza vaccines. Our work strongly supports the recommendation of influenza vaccination to protect Indigenous populations from severe seasonal influ-enza virus infections and their subsequent complications.