Commentary
Understanding Lessons From the COVID-19 Pandemic in Creating Healthcare Initiatives for Indigenous Populations

Prabhdeep Gill¹, Ishmanjeet Singh, Jobanpreet Dhillon²
Published online: June 2025

¹The Michener Institute of Education at UHN, Toronto, Ontario, Canada
²University of Ottawa, Ottawa, Ontario, Canada
Corresponding Author: Prabhdeep Gill. Email Address: psgill98@gmail.com

DOI: 10.26443/mjm.v22i1.1020

Background

From providing support to affected individuals to regulating public health policy, the resilience of healthcare systems worldwide continues to be tested by the COVID-19 pandemic. As of November 2023, there have been a total of 4.8 million documented coronavirus cases in Canada. (1) However, it is important to consider how different populations in Canada were impacted because the burden of disease was not equally shared. More specifically, COVID-19 cases were 188\% greater for on-reserve First Nation community members compared to the general population in Canada. (2) Moreover, Indigenous peoples presented with significantly higher rates of COVID-19 symptoms compared to those with non-Indigenous status (49.3\% versus 42.9\%, respectively, p = 0.04). (3) This may have occurred due to structural and systemic factors faced by Indigenous peoples such as poverty, crowded housing, and limited access to healthcare, making them more susceptible to contracting COVID-19. (4, 5) Their increased vulnerability justifies the need for additional resources to contain the virus and limit its devastating effects, with efforts from the government and local Indigenous communities. In this perspective article, we highlight some of the initiatives, reflecting on the lessons learned from these positive action responses that can ultimately be implemented in the future.

COVID-19’s Differential Impact

The COVID-19 pandemic appears to have exacerbated existing disparities with regards to providing healthcare to minority groups. Overall, compared to majority ethnocultural groups, ethnic minorities and immigrants in North America reported higher rates of COVID-19 infection, hospitalization and death, and higher levels of distress and mental health issues. (6) Looking beyond Canada, comparisons can be drawn between Indigenous communities across the world. Indigenous peoples in Canada, when compared to Australia, New Zealand, and the United States, were estimated to have the highest percentage of complete vaccinations. (7) Taking this into consideration, it may be argued that Canada’s Indigenous peoples were better equipped to handle the pandemic compared to those in other developed countries. We propose that due to the Canadian government’s response in providing financial resources, along with community-led initiatives, the Indigenous peoples of Canada were able to better mitigate some of the adverse effects of the pandemic.

Government-led Pandemic Response Initiatives

The Canadian government developed a specific supportive response for Indigenous communities during the COVID-19 pandemic. Specifically, the government established an Indigenous Community Support Fund ($290 million) and research grants targeting COVID-19 in Indigenous communities ($3 million). (7) However, such responses were observed in other countries as well, which raises the question of what specifically might have led to Canada’s relatively high vaccination rates among this group. A major factor was the collaborative efforts between Indigenous groups and provincial governments. For example, First Nations organizations such as the First Nations Health and Social Secretariat of Manitoba (FNHSSM), Assembly of Manitoba Chiefs, Southern Chiefs Organization, and Manitoba Keewatinowi Okimakanak Inc. worked together with the province of Manitoba to establish a First Nations Pandemic Response Coordination Team (PRCT). The First Nations PRCT deployed teams of nurses and other health professionals from the FNHSSM to assist First Nation communities with COVID-19 testing and contact tracing. (7) The lack of consistent and reliable data has and continues to be a limiting factor when organizing public health initiatives, but the PRCT’s swift negotiation and enactment to allow access to First Nations surveillance data may have played a pivotal role in addressing the data issue. (7) We believe that the Canadian government’s approach strengthened existing and fostered new relationships that should last beyond the pandemic. These alliances may be used to tackle other healthcare challenges in Indigenous communities, such as healthcare accessibility and youth mental health. Ultimately, we believe that combatting the pandemic using a combination of both public health and Indigenous knowledge appears to have catalyzed Canada’s success in reaching vaccination goals among Indigenous communities. Indeed, though financial resources are important, it would have proved difficult to tackle health-centric issues without cultural consultation, community support, and the integration of Indigenous peoples’ perspectives.

Community-Led Pandemic Response Initiatives

Although government-led initiatives were crucial in achieving vaccination goals, vaccinations only played a partial role in helping limit the spread of coronavirus. In addition to the government-led responses, Indigenous peoples in Canada implemented several successful community-led initiatives. Local groups created culturally-relevant public health measures and campaigns. For example, the Nishnawbe Aski nation produced handwashing posters and instructions in various languages. (2) Several Indigenous communities also asserted community health orders that best aligned with their needs. Fort McKay First Nation and Peerless Trout First Nation implemented curfews and reduced the number of community gatherings, with the goal of protecting vulnerable members. (2) Inuit communities in Manitoba employed similar curfews, but acknowledging their profound impact on community cohesion, they creatively began adapting community events to virtual settings. The Qanuinngitsiarutiksait hosted three virtual events around the holiday season in 2020, which were deemed successful considering the sizable number of attendees. (8) Lastly, communities also formed local task forces to assist in regulating mandates and supporting self-isolation. Uniquely, Curve Lake First Nation used a flag system that allowed families to communicate if their household needed water, food, or had a sick member. (2)

Such strategies were also fueled by a unique motivation among many Indigenous communities to protect their Elders and other older Indigenous community members facing a higher risk of fatality from COVID-19. Their pivotal roles in maintaining Indigenous languages, as well as intergenerational teaching and passing down of meaningful cultural practices, were emphasized by Indigenous scholars and leaders when planning for the pandemic. This may have encouraged Canadians to partake in immunization efforts to reap the benefits of herd immunity and experience less severe symptoms. (9, 10)

Furthermore, Indigenous knowledge of cultural and healing practices and traditional subsistence activities were used to complement the implementation of vaccination efforts, as well as promote mask mandates and curfews during social gatherings. This helped in achieving the vision of whole-being health by prioritizing resilience through emotional, mental, spiritual, and physical support throughout the pandemic. (11) According to Petrov et al., (11) Indigenous peoples’ testimonies further support this as they significantly attributed the regulation of the spread of COVID-19 among their communities to such holistic efforts.

It is also important to acknowledge the improvements made in pandemic planning. In the initial stages of the pandemic, there was insufficient COVID-19-related information and a lack of accurate representation felt by specific Indigenous communities, making it difficult to strategically develop a pandemic response plan. (8) However, with research teams incorporating Indigenous community members and local initiatives collaborating with Indigenous Elders, unique community needs were better voiced, understood, and thus accordingly planned for. For example, the Inuit community in Manitoba achieved better recognition through the pandemic, which partially led to their inclusion in Manitoba’s Legislative Assembly’s land recognition statement. (12) This is crucial when taking into consideration that, according to Nigel et al., Indigenous populations perceived the pandemic to be more of a threat to their culture, compared to other populations who deemed it as more of a health or material threat. This view made it even more important to better understand Indigenous cultures to help them fight the pandemic. Since it is valued deeply by Indigenous peoples, respecting and adapting practices to specific Indigenous cultures is an important lesson that can be extrapolated to projects beyond just pandemic planning.

Therefore, although the government provided funding and vaccines during the pandemic, we strongly believe that these local initiatives supplemented the government’s efforts while also demonstrating the resilience and sovereignty of Indigenous communities in Canada. In the future, we propose that the government should directly attempt to support such initiatives in conjunction with the local groups to facilitate the implementation and improve the efficacy of health-focused programs.

Conclusion

The collaborative efforts between public and Indigenous health organizations took steps in the right direction in addressing healthcare disparities during the COVID-19 pandemic. It seems evident that forming effective healthcare policies requires a complementary balance between government-led programs and proactive action led by local Indigenous communities. Further studies should be conducted to identify key factors and stakeholders that facilitated successful collaborative efforts and assess their applicability in future pandemic and non-pandemic settings.

References

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