Grim reality behind Indigenous vaccine fears

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.”

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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.”

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?”

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