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News
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Indigenous
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Health
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Coronavirus

‘A Matter of Trust’: The Grim Reality Behind Indigenous Vaccine Fears

The BC government has prioritized remote First Nations communities. But a record of health-care racism has left many skeptical.

By Amanda Follett Hosgood and Moira Wyton 17 Feb 2021 | TheTyee.ca

Amanda Follett Hosgood is The Tyee’s northern B.C reporter. Twitter: @amandajfollett.
Moira Wyton is The Tyee’s health reporter. Twitter: @moirawyton. This reporting beat is made possible by the Local Journalism Initiative.

Devin Sampare is clear that he’s not an anti-vaxxer.

“My children got all the same vaccines I got as a kid,” he says. “I’m just very conscious about weighing risks, using discernment and making sure what I’m putting in is going to benefit me.”

When it comes to the COVID-19 vaccine, Sampare is one of many Indigenous people who aren’t sure the benefits outweigh the risks. Given Canada’s history of colonization and systemic racism, some researchers say there is a clear reason for hesitancy.

Sampare currently lives in Smithers. But he says growing up in a small Gitxsan community in northern British Columbia taught him to distrust government and advocate for his own health care. So, when the vaccine was first announced, he began researching.

He wasn’t convinced.

“To be honest, I don’t think they’ve rushed it past clinical trials, I think we are the clinical trials, because they’re selling this as a favour to minorities,” he says.

The federal and provincial governments have said they will prioritize Indigenous communities in the vaccine rollout, with B.C. saying in December that it would immunize about 400,000 high-priority people — almost 10 per cent of British Columbians — in the first phase, scheduled to wrap up by the end of March.

Included in Phase 1 are remote and isolated Indigenous communities. Indigenous people over the age of 65 are included in Phase 2, but those between 18 and 59 are not being given priority.

Both vaccines to treat COVID-19 were developed more quickly than normal, but not because any steps were skipped, public health experts say.

Funding was plentiful and people were eager to participate in trials, factors that cause the most delays in other clinical trials.

And while Health Canada approved them for emergency use rather than through its non-emergency process, this mainly meant their review was given priority.

“The COVID vaccines that we have in Canada, that have been approved by Health Canada, we know are safe and effective and save lives,” said provincial health officer Dr. Bonnie Henry.

Both formulas went through the same checks and balances as any other vaccine, says Ranjit Dhari, an assistant nursing professor at the University of British Columbia and vaccine educator with Vancouver Coastal Health. “We’re very lucky in Canada that we have a great system of regulation, and that it goes through many phases of approval.”

Remote Indigenous communities were prioritized because systemic racism in health, housing and education increases the prevalence of chronic underlying conditions which heighten risks for serious illness and death due to COVID-19.

“First Nations have a higher risk, even when compared by age,” said Health Minister Adrian Dix during the vaccine rollout announcement on Jan. 22. “And when they are living in remote and isolated communities and become ill, it is a logistical challenge to ensure that they get to safety.”

In B.C., more than 74,283 people have tested positive for the disease and at least 68,705 have recovered. At least 1,314 people — 1.8 per cent of those infected — have died from COVID-19.

According to the First Nations Health Authority, 4,399 of those infected were First Nations people as of Feb. 7, about six per cent of the total cases. First Nations people make up about 3.3 per cent of B.C.’s population, and all Indigenous people, including First Nations, comprise about 5.9 per cent of the population.

More than 2,000 of the First Nations people infected were living on or near reserves, according to Indigenous Services Canada. Countrywide, the number of reported cases is 40 per cent higher on reserve.

When vaccinations began in 10 remote First Nations communities in December, most of them in northern B.C., the First Nations Health Authority said they were chosen based on their limited access to health care and “high-risk environment if any members become infected with the COVID-19 virus.”

Kevin Boothroyd, media director for First Nations Health Authority, said more than 80 of the province’s 203 First Nations communities have received enough vaccine to immunize the entire population over age 18 with at least one dose, and second doses are on their way.

Despite some delays, the province says it’s on track to meet its target and will begin to open mass vaccination centres early in March.

But in prioritizing Indigenous communities, health officials have neglected to address a long-standing mistrust of government and the health-care system, says Ian Mosby, an assistant professor in Ryerson University’s history department who studies Indigenous health.

Mosby points to research revealing Indigenous children in Saskatchewan were used in trials for a tuberculosis vaccine in 1933 as one example of Canada’s history of systemic racism in health care. Forced sterilization, performed on Indigenous women in Canada as recently as 2018, is another.

“This is not some conspiracy theory,” Mosby says. “This is well-documented fact of Indigenous people’s treatment by the health-care system that is brutally unjust.”

Mosby’s own research includes a study published in 2013 that outlines a decade of nutrition experiments in the 1940s and 1950s on Indigenous communities, including children in residential schools.

Nearly 1,000 children countrywide, including from the Nuxalk Nation in the Bella Coola Valley on the north coast, were subjected to experiments without their knowledge or consent, according to the research. Some died due to malnutrition. The experiments were conducted by prominent researchers and supported by the federal government.

“I’m a firm believer in the safety of the current vaccine and the process, but if I was an Indigenous person, I would definitely have reasons to be wary,” Mosby says. “This is different than the anti-vax movement. It’s people who have been lied to before and whose questions about their experience with the health-care system have not been answered.”

In November, the province released a scathing report that described “widespread and insidious” anti-Indigenous racism in B.C.’s health-care system. The investigation surveyed and interviewed almost 9,000 patients and health-care workers and found that 84 per cent of Indigenous patients had experienced racism in health care and more than 50 per cent of Indigenous health-care workers experienced racism on the job, mostly from colleagues.

In a followup report this month, investigator Mary-Ellen Turpel-Lafond said this racism causes Indigenous people, particularly women, to bear the heaviest burden of diseases, including COVID-19.

“They have a high burden of disease and they need the vaccines, and we must respond in a way that prioritizes the need,” said Turpel-Lafond.

Colleen Varcoe, a professor of nursing at the University of British Columbia, says vaccine hesitancy is a matter of both historical racism in health care and the present-day harms Indigenous people continue to face from health-care professionals.

“The long history of harms done through colonialism through health care are still fresh in people’s minds,” said Varcoe, who studies Indigenous health. “When entire communities have been wiped out through intervention, then it is very understandable that any public health intervention will be mired in mistrust.”

And the ongoing “widespread and insidious” systemic racism documented in B.C.’s health-care system in recent months means Indigenous people have no reason to believe anything has changed.

“It seems like a very minor thing to go and get a vaccine... but when you have had those experiences and you anticipate being judged and stereotyped and treated poorly, it’s really a huge barrier,” said Varcoe.

“Those horrendous stories they hear from their mother, and from their cousin, and the ones that are in the media, they are incredibly powerful.”

582px version of ColleenVarcoeProfile.jpg
UBC nursing professor Colleen Varcoe: ‘The long history of harms done through colonialism through health care are still fresh in people’s minds.’

Varcoe says public health needs to stop placing the onus on Indigenous people to choose to be vaccinated. Instead, officials need to make changes to ensure them culturally safe and competent care if they do opt to do so.

“The more important priority is to make sure that when people do go for vaccination, they’re treated well,” she said. “It seems like a very minor thing to go and get a vaccine... but when one person has a bad experience, it will deter the entire community. My preference would be we start providing that care in the first place.”

And for the more than half of Indigenous people in B.C. who live in urban centres and are not immediately prioritized for a vaccine, Varcoe said it could make that hesitancy increase if they feel the health system is ignoring them again.

“People tend to get dropped between systems,” said Varcoe, because of “a very problematic relationship between Canada and Indigenous people.”

Systemic racism in health care, housing and education places Indigenous people at a higher risk of many chronic conditions that increase their chance of serious COVID-19 illness, whether they live in rural communities or urban centres.

Varcoe is concerned that vaccination concerns among urban Indigenous people will receive even less attention than in traditional communities where health-care professionals are more likely to have relationships within the community and know its cultures.

“We often have good and important attention to people who are living in their communities, but there is as great a need to pay attention to the experiences and safety and well-being of urban Indigenous people,” she said.

Turpel-Lafond agrees.

“Communities are important, the urban context is also important,” she said. “Because we do know who’s deeply at risk and deeply vulnerable and, frankly, it’s First Nations people and, frankly, it’s First Nations women.”

Tania Prince was one of 500 people who received the COVID-19 vaccine when it was available in her community of Nak’adzli Whut’en First Nation, 115 kilometres northwest of Prince George, over a week in January.

She says she has no regrets.

“I respect everybody’s wishes or beliefs. All I can say is that it’s not that bad. It was quick and I share my experience of having a sore arm,” she says. “I’m really glad that my bubble was able to get vaccinated because I miss my grandkids.”

Nak’adzli Whut’en was prioritized for the vaccine after COVID-19 cases surged there in December. Prince says she sees people expressing hesitation about the vaccine on social media and wondering why First Nations have been moved to the front of the line.

“I see a lot of people saying, ‘I don’t know’ and, ‘doesn’t sound safe’ and, personally, I’ve actually felt that,” she says.

UBC’s Dhari said Indigenous people’s concerns need to be respected. “It all comes down to trust around how the vaccine has been developed,” she said.

And that is complicated by mistrust, language barriers and the fact that the vaccines were developed quickly and with new technology.

“I try to work with a patient as a partner and listen to their concerns and honour them,” said Dhari.

The two vaccines approved for use in Canada are made by Pfizer-BioNTech and Moderna.

Because the Pfizer vaccine needs to be stored at extremely low temperatures, - 70 C, it has been deemed inappropriate for use in remote areas without the necessary storage facilities. In addition, it is distributed in trays of 975 doses which can’t be broken down into smaller shipments for small communities.

Prince said some people in remote Indigenous communities are wondering why health officials appear to be pushing the Moderna vaccine on them, while urban areas receive the Pfizer vaccine.

“I think maybe if they explained it or educated people about it.... A lot of people never really understood the difference between Pfizer and Moderna,” she says.

Confusion leads many people to turn to social media or word-of-mouth to better understand vaccines. Particularly in rural areas, Prince points out, internet access may be limited. “They’re just going by what their family or friends are telling them.”

As of Friday, more than 162,980 British Columbians had received their first vaccine injection and more than 17,562 of those had also received their second dose.

More than 15,000 of those were people in First Nations communities and members living outside communities, according to the First Nations Health Authority.

The health authority said it could not comment on what percentage of residents of Indigenous communities were opting to take the vaccine.

In a Jan. 14 media availability, First Nations Health Authority acting chief medical officer Dr. Shannon McDonald addressed the question of vaccine hesitancy in First Nations communities.

“This is a matter of trust. That’s one of the biggest challenges that we have come up against. Communities do not universally have trust in the health-care system for lots of different reasons in history. There is a long-standing issue of misinformation around vaccines and there are some challenges to understanding the technology of the mRNA vaccine versus what we’ve experienced in the past,” she said.

“Our role is communicate, communicate, communicate and provide as much information as possible so people can make informed choices about whether or not they accept the vaccination.”

In order to address that underlying mistrust, Mosby says health officials and governments need to first recognize the history of systemic racism in Canada’s health-care system.

“There’s not really an acknowledgement of this historical trauma,” he says, adding that the Canadian government declined to apologize for the nutritional testing on Indigenous children, maintaining that it was covered under the 2009 apology for residential schools.

“An inquiry into medical experimentation in Indigenous communities is a start. But, in the short term, it means public health authorities, governments, doctors need to acknowledge that the cause of vaccine hesitancy in Indigenous communities has historical origins, and that hesitancy is grounded in very real experiences of being abused by the medical system.”

As for Sampare, he says he’s not entirely opposed to the COVID-19 vaccine, but he’s happy to wait it out until more is known.

In the meantime, he’ll continue researching.

“You know, you put more care into who works on your car than you do what you put in your body,” he says. “If there was this much risk involved in working on my truck, I wouldn’t allow it. So why would I allow my children to take that risk?”  [Tyee]

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