As vaccines are rolled out in Quebec, urban indigenous populations are left behind.
While we continue to battle COVID-19, at risk populations remain the ones that should be most protected.
By Josh Swain
Urbanization is not unique to Canada, globally our cities are growing at an astronomical pace, and it is projected that by the year 2050, close to 60% of the world’s population will reside in urban areas. This is a trend reflected in Canadian Indigenous populations as well, and it is estimated that around 55% of the First Nations population of Quebec lives in major urban areas such as Montreal and Quebec City. First Nations, Inuit and Metis people relocate to urban areas for many reasons including education, employment, and housing among others, and Montreal itself is home to an estimated 34,000 urban Indigenous residents, many of them separated geographically by vast distances from their home communities. And yet, throughout the COVID-19 pandemic, Quebec has failed to implement targeted strategies to ensure the safety and support of already vulnerable people who are disproportionately at risk of more severe health outcomes. Most disappointingly, urban Indigenous people in Quebec have been left out in the cold so to speak, when it comes to vaccine accessibility.
Indigenous populations are not only at a heightened risk of being affected by public health emergencies in general, but also experience higher rates of underlying health conditions like diabetes and respiratory illnesses, due to structural inequities and systemic racism. As we know, existing underlying health conditions are one of the main contributors to severe outcomes like hospitalization and death in people that develop COVID-19. It is for this reason that other provinces such as Manitoba, Ontario and B.C. have opted to prioritize Indigenous communities in their vaccine rollout strategies. This allowed Indigenous people to register at general vaccine sites earlier than the general population, alongside other groups at risk of severe outcomes. They also helped create urban Indigenous vaccine sites. These vaccine sites have not only greatly increased uptake of vaccines in urban Indigenous populations, but have also offered a safe, culturally appropriate space for people to receive accurate and reliable information about the vaccine and their health. Additionally, as these sites operated continuously throughout the pandemic, they allowed time for those possibly hesitant to make an informed decision. For many Indigenous people, there remains a mistrust of the healthcare system that stems from both historically unethical practices as well as ongoing mistreatment and racism from medical practitioners and institutions. Quebec has failed to recognize this, and so has failed to develop specific strategies for the urban Indigenous community.
Throughout 2020, vaccines were continuously promised to be the single most effective tool in fighting the COVID-19 pandemic. Now with nearly 80% of eligible Canadians fully vaccinated, data shows they have saved countless lives, with the vast majority of those hospitalized in ICU with COVID-19 being unvaccinated individuals. First Nations, Inuit and Metis communities worked to vaccinate their citizens and strategize to overcome vaccine hesitancy, often with the support of regional health authorities or provincial governments. For those living in urban centres away from their home communities, urban vaccine sites offered the chance to be protected, aligning with the federal prioritization of Indigenous people in the vaccine rollout strategy. But in Quebec, no such plan was developed by the provincial government, leaving community organizations to take charge to support and protect their members. The only sites that operated in Montreal were on a temporary basis and were supported by the city’s public health department. These sites operated out of the Montreal Native Friendship Centre, CÉDA, and Douglas Mental Health University Institute, many of which do receive support and funding from city and provincial governments, but the initiatives were largely coordinated by the organizations themselves in collaboration with the city’s public health department. This puts additional strain on an already taxed limited network of spaces that offer services to urban Indigenous residents.
Quebec has the resources to provide strategic services and a responsibility to build trust in the healthcare system, a major step towards reconciliation. Other provinces have placed high priority on providing vaccine access to Indigenous people residing outside their home communities, keeping in line with priority recommendations from Canada's National Advisory Committee on Immunization. However, Quebec failed to follow these recommendations, putting already vulnerable urban residents at risk. This is a learning opportunity for Quebec. We have understood repeatedly throughout this pandemic that our strongest course of action in battling COVID-19 is protecting those most likely to be affected. We must demand this of our government. This includes understanding the unique needs of not only First Nations, Inuit, and Metis people in their home communities, but also those living in urban centres.
Acknowledgments:
We thank Dr. Ananya Tina Banerjee for encouraging her students to write and sharing this opinion article with us.
About the Author:
Josh Swain is a first-year MScPH student at McGill University and a McCall MacBain Scholar. His public health interests lie in access to health, specifically mental health and substance addiction resources for northern remote Indigenous communities. Josh is a citizen of the Red River Métis Nation of Manitoba, and really enjoy life in a rural/rural adjacent community. He graduated from the University of Winnipeg with my BSc in Biology. He tweets at @JoshuaBSwain1.