Lessons From a Not-so Distant Pandemic: The H1N1 Pandemic and Indigenous Disparities

Indigenous pharmacist Dr. Jaris Swidrovich preparing to administer vaccines at the Saskatoon Tribal Council’s clinic.

Curtis Fraser

Over 80% of Indigenous adults have now received their first vaccination against COVID-19, compared to 57% of the Canadian population as a whole. Active COVID-19 cases among Indigenous peoples peaked in January of 2021, but have since dropped by 85%, thanks to the successes of the vaccination campaign. While the number of cases among Indigenous people is likely undercounted, as Courtney Skye showed in a Yellowhead Institute report, Indigenous activism is resulting in improved health outcomes for Indigenous peoples, although much work remains to be done. Canada’s health care system continues to struggle with systematic racism as we have seen recently in the case of Joyce Echaquan, the forced sterilization of Indigenous women in Saskatoon, and widespread discriminatory practices within British Columbian health care against Indigenous patients.

The most recent epidemic was that of H1N1. For Canada as a whole, the history of H1N1 is seen as a success story – the epidemic was not nearly as severe as was initially feared. There were fewer hospitalizations and fewer deaths in many regions from H1N1 than during a regular flu season. But this was not the case for Indigenous peoples. In 2009, Indigenous peoples made up roughly 4% of the Canadian population, but they accounted for 25.6% of those who became critically ill.

The H1N1 deaths in Indigenous communities cannot be blamed on the virus.  The Federal government badly mismanaged the epidemic.

The first of the two waves of H1N1 arrived in Canada during the spring of 2009. Health officials in the early days of the pandemic were optimistic after researchers found that H1N1 had a relatively low virulence in comparison to previous novel flu strains, such as the 1918 influenza strain. Low case counts in May and June 2009 provided public health officials with a false sense of security, while the virus stealthily moved into communities in northern Manitoba and Ontario.

There is a persistent lack of Indigenous-centered processes for data collection, which allowed the virus to spread to remote communities with minimal detection. Media reports on the severity of H1N1 often outpaced institutional data reporting on case counts, mortalities and hospitalizations. In St. Theresa Point First Nation, a community with a population of only 3,200 people had 30 individuals who had to be airlifted to hospital to treat H1N1 infections.

The virus continued to spread to several communities, which prompted the Assembly of Manitoba Chiefs to declare a state of emergency on June 24, 2009. First Nations leaders pursued talks with Health Canada, emphasizing that many communities had been waiting over a month for the delivery of gloves, masks, and hand sanitizers.

Health Canada’s delayed action was not accidental. As communities waited for shipments of personal protective equipment, public health officials spent several weeks debating whether or not to send hand sanitizers over concerns that alcohol content might be abused by individuals. This incident illustrated the disdain health officials had for the Indigenous people they were supposed to be serving.

After waiting nearly a month for the delivery of personal protective equipment, First Nations leaders were shocked to find dozens of body-bags crammed into shipments of PPE from Health Canada. Many shipments did not contain the protective measures that were promised, such as hand sanitizers and antiviral treatments.

When Health Canada announced vaccine rollout guidelines in the Fall of 2009, Indigenous peoples were initially excluded from receiving priority access. This did not sit well with many First Nations leaders who emphasized that Indigenous peoples had been disproportionately impacted by the H1N1 virus.

In Manitoba, First Nations and Métis organizations served on a tri-partite table alongside the federal and provincial government. Indigenous representatives regularly liaised with provincial and federal governments to improve access to health care for First Nations communities. The tri-partite table was also instrumental in developing a national pandemic response plan.

The tri-partite table was not able to achieve their goal of providing all Indigenous adults with primary access to the H1N1 vaccine, but Health Canada eventually revised their guidelines for vaccine rollout in October, which included remote and isolated First Nations communities. The vaccination campaign that began in the Fall of 2009 reached approximately 60% of the Indigenous population in Manitoba, compared to a vaccination rate of 37% in the province overall. Vaccines reduced the severity of H1N1 during the second wave, which saw fewer hospitalizations than the first.

Since the H1N1 pandemic First Nations leaders have worked closely with Indigenous Services Canada to better prepare for future pandemics. Such collaboration can be seen in the National Advisory Committee on Immunization’s decision to prioritize all Indigenous adults in the first two phases of COVID-19 vaccine rollout.

The improved collaboration between First Nations leaders and public health officials have led to more positive health outcomes in Indigenous communities during COVID-19. Despite these successes, political and media figures continue to fan the flames of resentment.

The aftermath of NACI’s announcement to prioritize Indigenous adults for the COVID-19 vaccine triggered a wave of anti-Indigenous sentiments, accusing the Trudeau government of engaging in “reverse racism”. Many Indigenous peoples have been subjected to harassment, including Indigenous MPP Sol Mamakwa, who was accused by Ontario Premier Doug Ford of “jumping the line” to receive his COVID-19 vaccine. Manitoban Premier Brian Pallister also stirred up controversy earlier in the pandemic by expressing his disdain for prioritizing First Nations people in the COVID-19 vaccine rollout. Other Indigenous people have reported being questioned by public health officials about whether or not they were really eligible for a vaccine as well as being subjected to racist abuse on-line for the fact that they were prioritized in this vaccine roll-out.

As Mr. Ford and Mr. Pallister continue to struggle to control COVID-19 outbreaks in the Northern regions of their provinces, Indigenous communities in northern Saskatchewan have seen a dramatic decrease in cases. Faced with a lack of support from the provincial government, First Nations leaders in Saskatchewan instead turned to the federal government for support. Working directly with Indigenous Services Canada improved efficiency, and ensured vaccine distribution to Indigenous communities who need it the most.

While lessons have been learned from H1N1, much remains to be done in terms of improving the delivery of health care to Indigenous peoples. Improved collaboration between First Nations leaders and public health officials during H1N1 and COVID-19 led to positive health outcomes for Indigenous populations. The same approach must be adopted by the wider health care system in Canada.

Curtis Fraser is an MA candidate in the Department of History at the University of Guelph. Email him at cfrase10@uoguelph.ca