“You cannot send children aged under seven to Manus Island because of the issues of inoculation - you can’t do it.” - Opposition immigration spokesman Scott Morrison, press conference, 21 July.
Scott Morrison has led the criticism of the lack of practical detail in the two-page asylum seeker agreement between Australia and Papua New Guinea, questioning how the Rudd government plans to safely process potentially thousands of people, including children, on Manus Island and other yet-to-be determined sites.
Morrison has repeatedly raised concerns about protecting young children’s health, asking on ABC Radio if the Rudd government was “going to ignore the medical advice that says you can’t send children to a place under age seven who need to be inoculated against tropical diseases”.
Election FactCheck contacted Morrison’s office about the source for the claim. “This was information conveyed to Mr Morrison by officials during his visit to Manus Island earlier this year,” a spokesman said.
Health checks for asylum seekers
Asylum seekers are vaccinated under the Australian schedule before being sent to offshore processing centres. The Immigration Department told Election FactCheck that all asylum seekers receive a physical and mental check-up and a chest x-ray. A blood sample is also collected, but which tests were done was not specified.
Asylum seekers receive the following vaccinations, and further boosters once on Manus Island if necessary: Hepatitis B; Diptheria; Tetanus; Pertussis (whooping cough); Polio; Meningococcal C; Measles; Mumps; Rubella and Influenza. If an X-ray detects tuberculosis, it is treated in Australia.
Asylum seekers also receive Malarone, a tablet treatment to prevent malaria, a mosquito-borne infectious disease which is prevalent in parts of Papua New Guinea, including Manus Island.
Without more information from Morrison’s office, it is difficult to say exactly what he means by his statement, but he may be referring to the practice of the Immigration Department under the Labor government not to send children under seven to Manus Island due to concerns about malaria, for which there is no vaccine.
The national communications manager for the Department of Immigration and Citizenship, Sandi Logan, told Election FactCheck that until now, the government has sent no children under seven to Manus Island because of a “conservative” approach to malaria health risks.
The World Health Organisation recommends that no child weighing less than five kilograms should receive Malorone. Babies generally weigh less than five kilograms and a seven-year-old child is normally around twenty kilograms. But Labor’s conservative approach has meant that no babies and no child under seven have been sent.
WHO also recommends that pregnant women should not receive Malorone until the second trimester of pregnancy, but it is understood that, so far, no pregnant woman has been sent to Manus Island.
Unless there are exemptions - and the government to date has said that all asylum seekers who arrive by boat would be sent to PNG and had “no chance” of settlement in Australia - it will mean a significant shift in policy, with children under seven being sent to Manus Island for the first time.
Children over seven were sent prior to the PNG deal being announced on July 19, but recently have been removed to Christmas Island, and the government has indicated that family groups won’t be sent until a suitable facility has been built.
Morrison is correct in raising health risks in children as a concern, but may have confused the issue by using the word “inoculation” - which is generally understood to mean vaccination. Treatment for malaria is not through inoculation.
It is possible to successfully vaccinate and otherwise protect young children against common tropical diseases with relatively modest resources. Despite the enormous challenges of vaccine delivery in a country where nearly 90% of the population live in rural and remote areas, the country has achieved high vaccine coverage rates.
There is no reason to believe that in a controlled environment of a refugee camp there would be anything other than total vaccination coverage. Other effective preventative measures which should be provided include insecticide-treated bed-nets, protective clothing, and mosquito control measures around camps.
Malaria is not the only health risk throughout PNG, particularly in low-lying regions.
Tuberculosis rates in Papua New Guinea are high. Effective diagnosis, treatment and contact tracing is a pre-requisite to control the spread of this disease.
A young child sent to a crowded detention centre is at risk of contracting TB, unless housed amongst adults who have been fully screened and treated. If the PNG Solution goes ahead, many refugees and their families may be resettled in communities in PNG, and they will then be exposed to a population where TB rates are high. BCG vaccination prevents some of the complications of TB and is part of the PNG vaccine schedule. It should be given before they go to PNG.
A child sent to Papua New Guinea faces greater risks of disease than in Australia. However, it is possible to successfully vaccinate and otherwise protect young children against common tropical diseases with relatively modest resources, especially in the controlled environment of a refugee camp.
The government has indicated that prior to the PNG deal, no child under seven was sent to Manus Island for health reasons and the public should be assured that camps are safe before this happens. This does not only include vaccination programs (which should be achievable and do not represent an impediment to the policy) but more comprehensive public health measures to prevent the spread of diseases against which there are no vaccinations. We should not forget that there are around a million children in this age group who already live in PNG.
Scott Morrison’s concerns are well founded, but not for the reasons of “issues of inoculation”.
PNG has among the highest rates of morbidity and mortality from malaria outside the African continent. Despite considerable reductions in malaria prevalence in the last decade in PNG, mostly through the use of insecticide-treated bed nets, malaria is still in the top three causes of hospital admission amongst children.
Young children are particularly susceptible to malaria; infants are more prone to severe complications of malaria, including severe anaemia, seizures, coma and death. The risk is highest among children who have no immunity to malaria, particularly those who come from countries where malaria is not endemic.
Although as the author notes, it is possible to successfully vaccinate or otherwise protect young children against some common tropical diseases with relatively modest resources, refugee children detained in PNG will be at risk of other diseases for which there are no effective or widely available vaccinations, and for which illness among young children can be severe or fatal, such as malaria.
Morrison’s statement that children under seven could not be sent to Manus Island due to “issues of inoculation” is partly correct if one interprets this as meaning not all diseases that children may be exposed to in Manus Island are prevented by vaccines.
Potential health risks for children in Manus Island for which no vaccines are widely available or effective include malaria, dengue fever, dysentery and, in some parts of PNG, cholera. These are health risks faced to a greater or lesser extent by PNG’s children in many area of the country. Most of these infections are preventable by good public health measures, vaccines, adequate nutrition, insecticide-treated bed-nets, and having a healthy environment for children to grow up in.
I would also note that the health risks for refugee children are broader than infectious diseases and include serious psychological problems, impaired development, or physical or sexual abuse if the environment of a detention centre is volatile, violent or lacking hope.
The policy of the Immigration Department not to send children under seven on Manus Island is a good, cautious policy, because babies and young children who come from an area where there is low prevelance of malaria are particularly susceptible to a severe case of the disease if it is contracted early in life. It is a cavalier attitude to change this policy on many levels, not just for malaria. It is potentially putting a child’s health at risk. - Trevor Duke