Universal Health – Canada

Indigenous health governance during COVID-19

Sean Hillier and Elias Chaccour

At the start of the pandemic, there was widespread concern within Canada that the spread of COVID-19 would disproportionately impact Indigenous Peoples compared to the broader general public. Since European contact, Indigenous Peoples in Canada and around the world have been disproportionately impacted by pandemics, including smallpox, influenza, TB, HIV, HepC and H1N1.

Greater susceptibility to adverse health outcomes from infectious diseases is the result of an ongoing history of genocidal policies, either promoted or permitted by colonial structures, which actively marginalize Indigenous Peoples from basic rights such as health care infrastructure, clean drinking water and stable non-crowded housing, to name a few.

However, despite concern and predictions of the possible imminent collapse of Indigenous social systems in the face of a significant pandemic, many Indigenous communities in Canada are asserting their authority in managing and containing the virus, including creating their own public health orders, restricting travel through their territory, adapting ceremonies and intensifying Indigenous-specific and relevant public health campaigns. This phenomenon is being recognized as an expression of Indigenous self-governance and a continued assertion of sovereignty and nationhood. Indigenous nations and communities across Canada have implemented, to varying degrees, principles of Indigenous health governance, including nation-to-nation relationship-building and decision-making, self-government, self-determination, reciprocal accountability and meaningful community engagement. As a result, the overall impact on Indigenous communities has been less severe than on the general public in Canada.

Throughout the pandemic, Indigenous communities have established partnerships with national, provincial, territorial, regional and municipal health and social services agencies, and both Indigenous and non-Indigenous health care providers to mount an effective public health response. In addition to deploying Indigenous-specific and responsive testing and contact tracing campaigns, communities have worked to combat vaccine hesitancy by establishing culturally relevant communications strategies and Indigenous-led vaccine clinics that create an environment of safety and trust for their people. Indigenous nations have demonstrated that they are best equipped to respond effectively to their own people’s unique health needs through a community-specific approach: for example, by providing culturally sensitive information in Indigenous languages and respecting cultural practices. 

Indigenous assertion of self-governance led to the effective deployment of vaccines, which caused COVID-19 cases in Indigenous communities to drop by more than 85 per cent between January and April 2021.

As the Canadian government secured millions of doses of COVID-19 vaccines, Indigenous leaders led a nation-to-nation lobbying campaign to apply pressure to the federal government to ensure they would be prioritized for vaccine access. As a result, the government of Canada declared Indigenous adults, including First Nations, Métis and Inuit, as a high-priority group and among the first groups to receive the vaccine. This was a significant development, given the long history of marginalization and sub-standard care afforded Indigenous Peoples in Canada, and was the result of relentless Indigenous advocacy and research on the urgent need to counteract the detrimental effects of colonization on Indigenous Peoples’ health – particularly in the face of a virus that posed severe risks to their communities.

However, while Indigenous leaders fought for access to vaccination, harmful and false tropes circulated throughout the country, fuelling concerns that vaccine hesitancy among Indigenous Peoples would hinder the overall pandemic response. This misconception does not stand up in the face of data suggesting that vaccine hesitancy was not more pronounced within Indigenous communities when compared to non-Indigenous communities. Much of this resulted from the effective health response and information campaigns mounted by Indigenous leaders and systems themselves, a testament to the success of Indigenous health governance in times of crisis.

Indigenous assertion of self-governance led to the effective deployment of vaccines, which caused COVID-19 cases in Indigenous communities to drop by more than 85 per cent between January and April 2021. Indigenous community actions and Indigenous health leadership created an atmosphere of trust that led to increased vaccination uptake among Indigenous Peoples, contributing to the decline in communities’ active cases and protecting them against future outbreaks. In May 2021, as the third wave of the pandemic raged across most of Canada, more than 50 per cent of Indigenous adults living in their communities had received at least one shot of a COVID-19 vaccine, a figure four times higher than that for the Canadian general adult population.

Indigenous communities and health care providers facilitated the successful uptake of vaccination by creating an environment that reflects the people’s cultural needs. For example, community vaccination clinics allow their members to participate in traditional ceremonies and medicines when they come to receive their vaccines, blending both Western and Indigenous perspectives. Community vaccination clinics were integrated within the shared social spaces of communities, where elders could take time to understand the COVID-19 vaccination process and then connect with one another in a safe and socially distanced way after receiving their injections.

Indigenous leadership in vaccination extended beyond their own reservations’ borders to reach their community members living in Canada’s towns and cities. While Indigenous People living in urban areas were similarly placed on government vaccine priority lists, ensuring adequate uptake required different strategies to reach and inoculate this population. For example, in Thunder Bay, Ontario, the Mattawa Indigenous tribal council servicing remote communities began running vaccination clinics aimed at vaccinating people hailing from their communities along with other Indigenous People in the core of the city. These clinics offered culturally safe services in Indigenous languages as well as transportation and childcare for those who required it. In Toronto, where Indigenous Peoples are more dispersed and difficult to reach, Indigenous health organizations, including Anishnawbe Health, have offered pop-up mobile vaccination clinics to reach those who are homeless and are most vulnerable during the pandemic.

All of this is a testament to the success of Indigenous Peoples’ assertion of health governance and sovereignty, and the successful nation-to-nation collaboration and partnerships between Indigenous leaders and governments at all levels. Indigenous nations, through their sovereignty, have clearly demonstrated through their response to the pandemic that they are highly proficient and capable of dealing with major health emergencies. In fact, they have been more effective than most communities in Canada, stemming the pandemic’s advance and promoting immunity among their citizens. This runs counter to widely held notions within Canadian society of Indigenous Peoples being unable to manage and run their own affairs without state oversight and surveillance. Indigenous communities’ success in administering vaccines to their people has even influenced vaccine distribution for non-Indigenous Canadians. Indigenous communities are now playing a vital role in expanding COVID-19 immunity to their neighbours. For example, the Saskatoon Tribal Council and the Prince Albert Grand Council are opening vaccine clinics that will serve Indigenous and non-Indigenous people. These clinics will also provide smudging ceremonies and will have staff who will help people navigate language barriers. These clinics actively dismantle the colonial legacies that led to a health care system rife with racism and barriers to accessing care for all marginalized communities. This assertion of health governance principles is essential for continued efficient health care delivery to Indigenous communities in Canada and for dismantling colonial structures that hamper all other marginalized people’s progress.

Photo: Residents, including Chief Wilfred King, far right, stand at a checkpoint restricting access to their community to slow the spread of coronavirus disease (COVID-19) in their remote First Nations community of Gull Bay, Ontario, Canada April 27, 2020. Picture taken April 27, 2020. Credit: Reuters/David Jackson.