Consent will be important as COVID-19 vaccine delivery to remote First Nations picks up in Ontario

As the rollout of the COVID-19 vaccine to remote First Nations in northern Ontario picks up steam, the week promises a lot of phone calls for Nishnawbe Aski Nation Grand Chief Alvin Fiddler.

A schedule detailing when each of the 31 First Nations can expect to receive their doses of the Moderna vaccinehas been drafted, and Fiddler, along with the president and CEO of Ornge Homer Tien, plan on calling the leadership from each community to confirm delivery dates and arrange necessary logistical details to prepare for the vaccinations.

But a week earlier, the Grand Chief had another important, more personal phone call. It was with his mother Eunice and his sister Margaret, who both live in Sioux Lookout, Ont.

"I called [Margaret] because I wanted her to have this conversation with our mom about the vaccine and that my mom needed to give her consent in order to receive the vaccine.

"I think my mom recognized the importance of this and why it's important that when a vaccine became available, that she was willing to receive it just thinking about her own family and her own grandkids and her children. She wants to see them and she wants to live and be free of this virus," Fiddler said.

And a monumental step towardmaking that a reality happened on January 7 when Eunice Fiddler, 85, became the first person to receive the vaccine at the William A. George Extended Care Facility at the Sioux Lookout Meno Ya Win Health Centre.

According to NAN's count, 44 of the 47 elders that live at the extended care facility "gave their consent to get the vaccine."

Preparations ramping up for vaccinations of NAN communities

The stage is being prepared for fly-in First Nations to receive vaccinations, as health care workers that will be deployed north to administer the vaccines have already begun receiving their own in Thunder Bay, Sioux Lookout and some communities along the James Bay coast.

But before either the workers or the vaccines will be deployed, significant logistical hurdles remain.

Grand Chief Fiddler said his team is encouraging First Nation leadership to "start looking for someone in the community who can play this critical role" of vaccine coordinator to address barriers of access and facilitate vaccine deployment plans.

He added that before any vaccinations teams will be sent north, communities need to be prepared to receive the vaccine.

"And that means making sure there's facilities, that there's local transportation available, that there's interpreters from the community and to communicate all this information at the local radio station and social media."

Dr. John Guilfoyle, a public health physician with the Sioux Lookout First Nations Health Authority, added that the priority list of remote First Nations is determined by a range of factors.

"The communities that are more remote, that have less access to medical care, that have less organized medical care services and for whom an outbreak of COVID would be most problematic those are going to be some of the ways in which one community will be put ahead of another.

"One of the concerns is, you know, there are some communities on the east side of our region which are more prone to flooding in the spring. So efforts would be done to make those communities a higher priority because we would like to get the vaccinations done before there might be evacuations."

Vaccine hesitancy a concern given mistrust of health care system

Dr. Guilfoyle also suggested he would like to see a target of immunizing 80 per cent of the population in each First Nation, and said he expects new data will indicate that it is safe to use the vaccine for pregnant women and children under the age of 18.

But Anna Banerji, the Dalla Lana School of Public Health faculty lead in Indigenous and refugee health, says she's concerned about levels of vaccine hesitancy given the legacy of mistrust that many Indigenous people have when it comes to the health care system.

She says that legacy has been created by things like the nutritional experiments run by the Canadian health department in the 1940s and 50s on First Nations children in residential schools, "where they intentionally starved children of certain nutrients to see what deficiencies would result, and they would use that knowledge to make baby formula."

Banerji said, "with that history, people are nervous. They don't want to be used as a guinea pig."

NAN launches comprehensive public education plan

Fiddler agreed that it's a complicated task for NAN to design and deliver the public education program.

"There's such a painful history to all this with the health care [system] that historically has been a two-tiered system."

The Grand Chief added, "It's so critical to give this information to everyone in the language that they can understand it, whether it's in Ojibway or English or Oji-Cree, both spoken and written. We need to make sure that we arm all our citizens with information and we plan to do it in different ways.

"For example, I was on Wawatay radio an hour ago or [through] social media or pamphlets or local radio station we're committed to doing this."

Fiddler said he hopes the first community-wide vaccinations will begin in early February, with the last of the 31 First Nations to be vaccinated in April.