Pushing for Indigenous inclusion in rollout
Vulnerable urban population left out of vaccine plans, leaders say
Indigenous people have been largely left out of Toronto’s COVID-19 vaccine rollout plans, according to several prominent Indigenous health leaders.
“We’re ready as Indigenous organizations and Indigenous providers,” said Dr. Lisa Richardson, a clinician who is also the University of Toronto medical school’s strategic adviser on Indigenous Health. “We really want to mobilize.”
But Richardson, who spoke to the Star by phone from an acute-care hospital ward where she cares for COVID patients, said she and others working in Indigenous health care have not received the strategic planning or other support they need to get vaccines to the highly vulnerable urban Indigenous population.
Toronto is home to the largest population of Indigenous people in the province — an estimated 70,000 people. Yet Dr. Janet Smylie, a Métis physician and Canada Research Chair in Indigenous Health based at St. Michael’s Hospital, says she is drafting plans for vaccinating the city’s Indigenous population “on the side of my desk” in the absence of a clear strategy from the government.
“The federal government, the provinces and the territories and local public health units did this kind of planning for every other population that I’m aware of,” she said. “But they seem to think that you don’t need to do that for the Indigenous population in Toronto.”
The vast majority of Indigenous people in the city — 90 per cent, according to a 2016 study — live at or below the poverty line. One in four is homeless. And Toronto is a “red zone” for infection, Smylie said.
Indigenous people living in Toronto face a “disproportionate burden” of health challenges and barriers to accessing health services, according to Toronto’s first Indigenous health strategy, published in 2016. Higher rates of poverty, unemployment and food insecurity all contribute to poorer health and lower life expectancy, the report notes.
First Nations, Métis and Inuit adults living in cities are included among the high-risk populations the province plans to vaccinate in Phase 1 of their vaccine distribution plan, alongside people living on-reserve in First Nations’ communities.
But Richardson and Smylie say the province has been focused on the on-reserve populations, with scant attention paid to the complexities of vaccinating the much larger urban Indigenous populations.
“I would never, ever suggest that remote communities, flyin communities, should not be prioritized,” Richardson said. “I care for patients who have COVID and I see how quickly you can deteriorate” — that puts Indigenous people who live far from medical facilities at heightened risk.
But that doesn’t mean urban Indigenous people should be considered “second tier,” she said.
And they shouldn’t be competing against those on-reserve for vaccines, Smylie said.
The only Indigenous representative on Ontario’s Vaccine Distribution Task Force is RoseAnne Archibald, the Ontario Regional Chief for the Assembly of First Nations. Archibald initially agreed to an interview for this story, but her office later declined, saying she was only responsible for First Nations people living on-reserve.
A provincial spokesperson told the Star in an email an “Urban Indigenous COVID-19 Vaccination Sub-Table” has been established under the vaccine distribution task force to “support the vaccine rollout for urban Indigenous communities.”
Flavia Mussio, spokesperson for Ontario’s Ministry of Indigenous Affairs, said the province is working with the sub-table to “understand the challenges and concerns of vaccinating this population and appropriate strategies for mitigating these challenges.”
At the moment, they are considering using mobile vaccination clinics in Toronto, she said, and “exploring” potential partnerships with Indigenous health service providers who may be able to host their own vaccine clinics. Nothing is finalized, however.
Smylie said she was asked last week to help figure out urban needs and numbers, information she says she provided the federal government back in December. “To achieve the commitment that has been made to prioritize adults in Indigenous communities, including urban communities, there need to be existing dedicated in-house supports who have the prerequisite community relationships and knowledge,” she said. “You can’t just pull someone in at the side of the desk.”
While there are major challenges in terms of resources and logistics in remote communities, vaccinating urban Indigenous people is, if anything, a more complex task, Richardson said. The population is heterogeneous and geographically dispersed.
Richardson said the lack of advocacy for urban Indigenous people may be related to the fact there isn’t the same kind of formal governance as there is for the on-reserve population.
“It’s not a surprise,” Smylie said. “Both the federal government and the provinces and territories have made a colonial habit of ignoring Indigenous people in cities.”
Joe Hester, the executive director of Anishnawbe Health Toronto, which provides primary health care to Indigenous people in the city, is not concerned about the urban vaccine rollout. He said he’s still waiting to hear from the province on when his organization will receive an allotment of vaccine, but when it does, his staff will be able to distribute it quickly via their Mobile Healing Unit, a repurposed recreational vehicle currently administering COVID-19 tests and flu vaccines.
Richardson worked with Anishnawbe Health to vaccinate 30 First Nations elders at a senior’s residence called Wigwamen Terrace on Jan. 14, the only targeted urban Indigenous vaccination to have taken place so far.
“Right now of course the vaccine availability has been impacted with the reduction from Pfizer,” Hester said.
Given the size of Toronto’s Indigenous population, Hester said it poses a “formidable task to reach everybody,” but Indigenous providers are best positioned to lead the effort, given the distrust that exists within Indigenous communities for government health care.
“Our community generally has accepted our service delivery as opposed to, say, going down to the local emergency room.” Smylie said one draft of the vaccination plan included a model for urban Indigenous people to be vaccinated through hospitals, an idea she says ignores the experience many have with structural racism in institutional settings. “After Joyce Echaquan, who’s going to go to the special clinic at the hospital?” she said, referring to an Indigenous woman who livestreamed a video showing nurses insulting her before her death at a Quebec hospital last September.
Richardson said the innovative mobile health unit would be essential, but pointed to other logistical issues that should have been anticipated — such as how public health officials will track those who get a first vaccine when they belong to a highly transient population and may not have phones, internet access or fixed addresses, to ensure they receive a second dose.
The National Advisory Committee on Immunization’s guidelines for prioritizing initial doses of vaccine recommends that adults in Indigenous communities “where infection can have disproportionate consequences” should be prioritized. But it also states that racialized and marginalized populations have been disproportionately affected by COVID-19 and “systemic barriers” to accessing care also exist in urban settings due to poverty, systemic racism and homelessness.
The Indigenous housing organization Na-Me-Res is running a testing centre and director Steve Teekens is eager to add vaccination to the services they offer to clients without the risk of exposing them to the racism he says many routinely experience in hospitals and other conventional health care settings.
“We are trying to be at the vaccine planning table, so we could roll out vaccines from our testing centre,” he said. “You’re doing a disservice if you’re only looking at vaccinating on reserves.”
Brad Ross, spokesperson for the City of Toronto, said once the city is provided with an allotment of vaccine, it will undertake a targeted outreach campaign to specific groups. “The Indigenous community in Toronto is a key focus of our outreach efforts,” he said.
“We’re ready as Indigenous organizations and Indigenous providers. We really want to mobilize.”
DR. LISA RICHARDSON CLINICIAN/ U OF T MEDICAL SCHOOL’S STRATEGIC ADVISER ON INDIGENOUS HEALTH
“(Government, provinces and territories) have made a colonial habit of ignoring Indigenous people in cities.”
DR. JANET SMYLIE
MÉTIS PHYSICIAN/ CANADA RESEARCH CHAIR IN INDIGENOUS HEALTH