Every time Lindsay Peach, the executive director of Mi’kmaq Health and Wellness, walks into the convention centre of the Membertou First Nation, an Indigenous community near Sydney, Nova Scotia, she has flashbacks to the H1N1 pandemic. 

Back then, the convention centre acted as a makeshift vaccination site for the community of around 1,600. Peach recalls seeing people lined up around the corner during the H1N1 pandemic, waiting for their shots. “I think, in this case, the planning for the COVID vaccine needs to look so different because we can’t have people gathered in large areas like we would for a mass immunization clinic,” she says. “The whole logistics requires a rethink of everything we would have done before.” 

That convention centre may very well be used again as the province of Nova Scotia rolls out its COVID-19 vaccination strategy for its 13 Mi’kmaq First Nations and off-reserve Indigenous people, as well as settler communities. Two vaccines by Pfizer and Moderna have already been approved by Health Canada and priority patients — mainly medical workers — are lining up to receive the first doses. Indigenous communities are on the priority list for the Canadian government’s massive vaccination strategy, along with medical workers, the elderly, and the immunocompromised. 

Much of the news coverage around vaccinating Indigenous communities is about the logistics of supplying doses in the first place. The Pfizer vaccine, in particular, requires ultra-low refrigeration that is simply unavailable in remote or rural communities. But an equitable vaccine strategy for Indigenous communities needs to consider far more than simple logistics. It also has to account for Canada’s long history of medical racism and the hesitancy or reluctance Indigenous people may have towards COVID-19 vaccines. 

The history of medical abuse, unethical experimentation, and biological warfare against Indigenous peoples in North America goes back centuries. Perhaps the most horrific and well-known example comes from 1763, when British Army officers gave blankets infected with smallpox to representatives of the Delaware people during a siege. In the 20th century, so-called “Indian hospitals” in Canada offered substandard care to Indigenous patients, who reported frequent physical and sexual assaults. Medical researchers tested tuberculosis vaccines and nutritional supplements on malnourished Indigenous children in the 1930s and 1940s, respectively, without parental consent. In 2019, a Saskatoon-based law firm filed a class action lawsuit on behalf of Indigenous women in five provinces and two territories who claimed they’d been sterilized without their consent — including a case that allegedly happened in Saskatchewan in 2018. 

Trust in the medical system is one of the most important factors for a public health agency. Understandably, a legacy of medical racism undermines it. British Columbia’s First Nations Health Authority (FNHA), a provincial-level organization responsible for health care delivery to over 200 First Nations, is aware of this legacy. Just last month, the B.C. government released a report documenting the prevalence of systemic racism within the province’s medical system. One of the ways to counter mistrust in this system is through a willingness to answer basic questions about the vaccine. 

Trust in the medical system is one of the most important factors for a public health agency. Understandably, a legacy of medical racism undermines it.

“One of the things that we’ve worked really hard to do is to be available to help people understand what the vaccine is. What’s it based on? What does it contain?” says Dr. Shannon McDonald, acting chief medical officer of the B.C. FNHA. “There are lots of different questions that have come forward and we have made ourselves available.” 

Becky Palmer, the B.C. FNHA’s chief nursing officer, says building relationships with Indigenous communities also involves nurses having one-on-one conversations with people so they can feel comfortable about the vaccine. “We’re ensuring that there is no question that people can’t ask — and they can ask it again if they like,” Palmer says. “We’re here to walk alongside them in this journey.” 

It isn’t clear to Peach whether Nova Scotia First Nations communities are hesitant to receive a COVID-19 vaccine. However, she says Indigenous leaders acknowledge that it is a possibility. “We won’t really know that until we get out there and have some of those conversations and start to actually roll out the vaccine,” she says. 

Another aspect of an equitable vaccine strategy is including Indigenous people at the table. “When vaccine strategies are being discussed at the provincial level, it’s really important for Indigenous communities to see themselves in that rollout,” Peach says. That includes not only having Indigenous leaders meet with provincial and government health authorities, but also having Indigenous representation within organizations responsible for distributing the vaccine. She says her colleagues encouraged provincial health authorities to speak very openly about how First Nations will fit into the broader vaccination strategy. In Nova Scotia, Peach says provincial and Indigenous-led organizations have been working together throughout the COVID-19 pandemic. “There’s a good working relationship between public health and the First Nations community, so they work very closely in collaboration to manage those cases,” Peach says. 

They can also address fundamental issues with the vaccine rollout strategy itself. Here’s one: elderly people are considered to be a priority demographic. Who counts as elderly? In the settler Canadian population, people aged 65 and older usually qualify. However, First Nations communities have much younger populations and lower life expectancies. “The median age for the Mi’kmaq population is 25,” Peach says. “And the median age for the Nova Scotia population is 41.” 

There is also the question of off-reserve or urban Indigenous people. Jocelyn Formsma, executive director of the National Association of Friendship Centres — a network of over 100 social services centres for urban Indigenous people — is worried that the current vaccination strategies will not reach them. As part of a working group with indigenous Services Canada, she says her organization is trying to ensure urban Indigenous people are not left out. “We feel through our engagement, we can provide a more trusted and culturally safe approach to vaccine roll out. We can also play important educational roles,” Formsma wrote in an email to Future of Good. 

Indigenous communities are more vulnerable to the spread of COVID-19 for a host of reasons, including long standing medical racism and the historic lack of proper infrastructure. But First Nations reserves have some advantages. As sovereign nations, they are able to shut down access to their land in times of crisis — a decision made by many First Nations across the country during outbreaks. Peach says that during the first wave of COVID-19 in Nova Scotia, not one person on-reserve tested positive. 

Another issue is whether or not to consider those holding Indigenous cultural knowledge — perhaps those fluent in a traditional language — to be worthy of priority vaccination.

Another issue is whether or not to consider those holding Indigenous cultural knowledge — perhaps those fluent in a traditional language — to be worthy of priority vaccination. According to National Public Radio, the Cherokee Nation in Oklahoma is using its first shipments of COVID-19 vaccine to inoculate Cherokee speakers along with elders and medical workers. Peach says this understanding of the importance of culture and its preservation might not just be about vaccine equity for Indigenous communities — she suspects the settler Canadian public might see it as a valuable idea, too. “I think, in many ways, Indigenous communities are further ahead in thinking about how to protect [culture] because they’ve lost so much,” she says. 

One other way to ensure an equitable vaccination strategy and build Indigenous trust in the public health system is to avoid talking about vaccination as a requirement. That may seem counterintuitive. After all, a COVID-19 vaccination is only as effective as the size of the population that’s willing to be inoculated. However, Dr. MacDonald with B.C.’s FNHA says pushing the idea of mandatory vaccination will not work. “It’s not like communities aren’t aware of the risks, but they have to balance their concerns and their anxieties with the knowledge that we’re giving them,” she says. “And like every other health care provider, Indigenous or not, there’s some hesitancy about having a health system tell them what to do.” 

An October survey conducted by Ipsos on behalf of Global News found that just 54 percent of Canadians were willing to take a vaccine as soon as possible. Researchers have found those numbers are higher in Canada and the U.S. for Black and Indigenous people because of medical racism, despite the fact these groups are far more likely to be infected with the virus. MacDonald says health care providers should be ready to answer the questions of community members about the vaccine, but also be willing to respect the choices of people who refuse to be inoculated.

That’s not to say that Indigenous medical professionals aren’t trying to make a strong case for vaccination. Peach recalls pleading with a young girl to receive the H1N1 vaccine during that pandemic, and suspects similar conversations will need to happen now. The goal for COVID-19 is for 75 percent of eligible people to be vaccinated and achieve herd immunity for the population. “That may not be as simple as just making it available,” she says. “There may be some work to do to actually encourage and convince people to go forward and get immunized.” 

By and large, Peach says Nova Scotia’s Indigenous communities have a very good understanding of what they need to weather the COVID-19 pandemic, even if all the details of a vaccine rollout are not yet public. Indigenous peoples are already thinking about how to reach the most vulnerable people within their communities, she says, such as elders who may be fearful to leave their homes. “When you look at the ability to actually put vaccines into arms, I think there’s a real strength that First Nations communities bring in being able to have a really good understanding of the needs of the community,” Peach says.

Tell us this made you smarter | Contact us | Report error