Indigenous people are disproportionately affected by COVID-19, but they were not first in line to get vaccinated when Manitobans started rolling up their sleeves on Wednesday.
“Our elders, we want them to be given priority, and anyone who is immune-compromised, is what we are hoping for,” said Jerry Daniels, grand chief of the Southern Chiefs’ Organization, which represents 34 First Nations and 80,000 people in southern Manitoba — nearly half of whom live off reserve.
“The future will tell us what’s going on here with the way that the province has allocated” the vaccine, he said, and “how it’s going to actually roll out.”
Manitoba administered its first doses of the Pfizer-BioNTech vaccine in Winnipeg on Wednesday. Currently, none of Manitoba’s doses are going to rural or remote communities, including First Nations, because the vaccine needs to be stored at temperatures between –80 C to –60 C.
Isolated communities are expected to have access to the Moderna vaccine once it’s approved by Health Canada. It doesn’t require temperatures as frigid as the Pfizer-BioNTech vaccine, making it a better option to transport further away from main distribution hubs.
It will be sent to remote locations through mobile vaccination teams using ground and air transportation, the province announced Tuesday.
But which communities will get it first? The solution won’t please everyone.
“It is entirely possible that a particular community gets an appropriate number of vaccines all at once, while others do not until we have the next shipment,” Maj.-Gen. Dany Fortin, the military commander in charge of Canada’s vaccine distribution logistics, said at a Wednesday technical briefing in Ottawa.
That’s “because of the practicality of delivering this over a very large country, sparsely populated, in the middle of winter,” he said.
Another sticky question without a clear answer: should the vaccine go first to a communities like Shamattawa in northern Manitoba, which is experiencing a major outbreak, or to communities that have held the virus at bay and could protect people before they get infected?
“It is so important that First Nations … be the lead in those discussions together,” said Dr. Tom Wong, the chief medical health officer for Indigenous Services Canada.
Access for southern First Nations
As more vaccine arrives in the new year, Manitoba plans to establish fixed vaccination sites in Winnipeg, Brandon, Thompson, Steinbach, Gimli, Portage la Prairie and The Pas.
That will make it more convenient for elders to get vaccinated, Grand Chief Daniels said, adding southern communities are looking at transporting a few elders at a time via multiple van trips each day.
But even the definition of “elder” is complicated, said Dr. Evan Adams, Indigenous Services Canada’s deputy chief medical officer.
Manitoba has made health-care workers on the COVID-19 front lines the first priority for vaccination, followed by other high-risk groups — such as adults 80 or over.
Indigenous leaders have asked the province to expand the criteria for eligibility, saying COVID-19 is killing people in their communities who are 15 to 20 years younger than the general population.
“They’re concerned about children who may not be extremely well, about young mothers,” said Adams. “Definitely, there is some discussion that starting with over [age] 80 … why not over 65?”
Manitoba has more than 220,000 Indigenous people, representing 18 per cent of the province’s population, including more than 130,000 First Nations people.
But last week, the province’s chief public health officer said First Nations people made up roughly half of those in Manitoba’s ICU wards with COVID-19, and about a third of daily new cases.
What about urban Indigenous people?
Another big question is how Manitoba’s large urban, off-reserve Indigenous population will receive the vaccine, he said.
Will their vaccination fall under federal jurisdiction, involving home reserves, or will they access vaccines the same way as non-Indigenous Manitobans?
“We have huge, huge concerns about our people who are struggling in the streets, not having a place of residence, huge mental health challenges, addictions,” Daniels said.
“It’s going to take a great deal of continued advocacy and work and resources and people who are… really committed to supporting our people.”
In Winnipeg, Thunderbird House already provides a medical clinic and COVID-19 testing, and the Indigenous cultural hub has been suggested as a location for a vaccination clinic.
The Salvation Army’s Maj. Gordon Taylor says his organization could also help.
It runs flu clinics every year, so it could be another possible location for COVID-19 vaccination.
As well, the Salvation Army already runs transitional housing and a 30-bed emergency shelter in downtown Winnipeg, and half its clients are Indigenous.
“Sometimes when they’re not staying in a place like this, they have limited access to good sanitization and sleeping facilities,” said Taylor, the executive director of the Salvation Army’s Winnipeg Centre of Hope.
“So the sooner they can be vaccinated, the better.”
The fact both the Pfizer-BioNTech and Moderna vaccines require two doses, administered weeks apart, could also present a challenge for people who don’t have a permanent home.
“They’re hard to find maybe three weeks later,” Taylor said.
Some will make sure they get a followup dose, but “we do help a lot of people who are in addictions or have mental health issues, and sometimes they’re just not able to make good choices,” he said.
Everyone at the table
In Manitoba, these discussions are complicated by the fraught relationship between the premier and Indigenous leaders, some of whom say they are not part of the planning and implementation process.
“The challenge here, I think, is that the province really needs to extend some of that … decision making to First Nations,” Daniels said.
Adams, Indigenous Services’ deputy medical chief, said it is in everyone’s best interest to work together.
“Our legacy will be that people are safe and [vaccination is] done very quickly and done very wisely. And I would hate to consider the worst-case scenario, where people don’t get along or agree not to organize.”
However, on Tuesday, Premier Pallister said he wants the federal government to do more to address COVID-19 outbreaks on a growing number of First Nations and in Winnipeg’s inner-city.
“I have advocated for more vaccines for Manitoba First Nations people, whether living on or off reserve, because we know those numbers are exploding, and I’ll continue to advocate for that, regardless of criticism,” he said.