Consent at heart of Ontario's vaccination plan for remote First Nations communities

Ontario's plan to vaccinate the populations of its most remoteFirst Nations communities against COVID-19 faces many challenges,but Indigenous leaders say that earning the trust of the people mustbe a priority.

Grand Chief Alvin Fiddler of Nishnawbe Aski Nation, a politicalorganization that represents 49 of Ontario's 123 First Nations, saidthat the most obvious hurdle of Operation Remote Immunity isgeography, as those remote communities may not have an airstrip andmust have their winter roads built in time for the vaccine to bedelivered. But he said that even more important than the physicallogistics of delivering the vaccine is ensuring that Indigenous
people are willing to accept it.

"Making sure that communities are aware of the vaccine, thatthey understand the vaccine and why it's important so they canconsent to getting the vaccine is part of the challenge," saidFiddler.

All 31 remote First Nations that are participating in OperationRemote Immunity are part of Nishnawbe Aski Nation, so Fiddler andhis staff have been working with Ontario's vaccine task force as aliaison between the individual communities and the government.

Communication has had to flow both ways before the vaccines startarriving on Feb. 1.

"We're creating material for distribution with our healthauthorities, creating pamphlets and social media, making sureeverything is translated into Ojibway, Ojicree and Cree," saidFiddler. "So our elders can really understand the informationthat's being sent to them.

"Once they do understand it they can give it seriousconsideration before giving their consent."

Fiddler said that making sure everyone understands what's in thevaccine and why it's important to take it is necessary for FirstNations people who are living with the trauma of Canada's colonialhistory.

"It's not just the vaccine itself, it's the whole history of thesad, sometimes tragic past of health care and how it's been delivered in our communities," said Fiddler, adding thathistorically there has been a two-tiered system where Indigenous people received inferior health care.

"That's what we're up against. It's a massive undertaking andit's a challenge we know that we have to address as part of thisrollout."

Ontario Regional Chief RoseAnne Archibald, who is on theprovince's vaccine task force, said she was also aware of somereluctance by First Nations people to take the vaccine. She pointedto a history of medical experiments being performed on Indigenouspeople from the 1930s to the 1970s.

"We do know that in the past vaccines were tested in FirstNations communities," said Archibald, who added there is no mechanism for polling First Nations populations about things likevaccine hesitancy.

"The trauma and experiences from residential schools have leftour communities in a state of hesitancy when it comes to trustingCanada."

A spokesman for Ontario's Ministry of Indigenous Affairs saidthat the administration of vaccines has already begun in Ontario'slarger First Nations communities, starting with long-term care homesin Six Nations of the Grand River, Mohawks of Akwesasne, OneidaNations of the Thames, and Wiikwemkoong Unceded Territory.

Vaccinations have also begun at the Sioux Lookout First NationsHealth Authority and Weeneebayko Area Health Authority, with a focuson hospital and long-term care and chronic care staff and residents.

Spokesman Alex Puddifant said Ornge, the province's air ambulancecorporation, is leading the operations for the 31 fly-in FirstNation communities, transporting the vaccine from hub cities inNorthern Ontario to the reserves. Partner organizations including,Northern School of Ontario Medicine and Queens University, will helpprovide nurses and paramedics to administer the doses.

Fiddler said that NAN is playing a supporting role, ensuring thatcommunities are ready when the vaccines arrive with interpreters,drivers, and a co-ordinator to make sure that all of the residentsin a territory consent to the vaccination and receive their dose.

Dr. Sarita Verma, the dean of the Northern Ontario School ofMedicine, said that she and her team know they'll have to buildtrust with patients who are, or are directly related to, residentialschool survivors.

"Taking a patient-centred approach that's different in NorthernOntario with First Nations communities will be important," saidVerma.

Indigenous Services Canada reported on Tuesday that there were428 active cases of COVID-19 among Ontario's First Nations.