TORONTO — When the Cree Nation of Mistissini, a small town in the province of Quebec, started vaccinating its members against COVID-19 in January, a former Assembly of First Nations national chief expressed his dismay. “The Cree Leadership seems to think they know what is best for us,” Matthew Coon Come wrote on social media. “Mistissini is now the experimental rats of this experimental vaccine.”

As Canada‘s vaccine rollout progresses in fits and starts this year, some Indigenous leaders and others are expressing concern about vaccine hesitancy in their communities. They attribute the reluctance to deep-rooted mistrust of public health-care facilities and providers — a problem that reflects decades of troubled relations between Indigenous peoples and Canadian institutions.

“We look at our history and there’s been a lot of hurt that’s been inflicted on our people,” says Kathy Bird, an Indigenous woman and retired nurse. “That might put us on guard and make us suspicious.”

At least one scholar has dismissed claims of vaccine hesitancy in Indigenous communities as sensationalist reporting but a recent government study seems to validate concerns expressed by Bird and several Indigenous leaders. (The study didn’t include Indigenous people on reserves or in four Inuit regions.)

When Canada’s vaccine rollout started, the National Advisory Committee on Immunization recommended prioritizing adults in groups disproportionately affected by COVID-19. In addition to people who live and work in long-term care homes, seniors 80 years and older and front-line health-care workers, the list included the Indigenous population. It comprises First Nations, Inuit and Metis. (The Metis are of mixed Indigenous and European ancestry.)

Across Canada, the pandemic has hit the Indigenous population especially hard. Overall, the rate of reported cases of COVID-19 among First Nations people living on reserves is 187% higher than in the general population. In the province of Manitoba, for example, First Nations people represent 10% of the population but constitute 71% of active cases and 50% of patients in intensive care. The median age of death from the virus for First Nations people in the province is 66, which is 17 years younger than the provincial average.

Many factors contribute to Indigenous people’s heightened vulnerability to COVID-19. Compared to the general population, they have less access to adequate health care, nutritious food and clean water. They also contend with higher levels of overcrowded housing, homelessness and incarceration. Diabetes, asthma and other illnesses considered comorbidities with COVID-19 are more prevalent among Indigenous people, which puts them at higher risk of suffering severe outcomes from the disease.

That reality has prompted some Indigenous people to get the vaccines, but others are still reluctant to do so.

Like Matthew Coon Come, some Indigenous people are suspicious of the government’s motivation for sending early COVID-19 vaccine shipments to their communities. They are skeptical of the government’s claim that it wants to safeguard their health given that it hasn’t yet delivered on its promise to end boil-water advisories in remote Indigenous communities. They worry they are being used as test subjects, to verify the safety and efficacy of the vaccines — and that wouldn’t be unprecedented in Canada.

Mistrust of Public Health Care

“A big part of vaccine hesitancy among Indigenous peoples is this history of racist treatment by medical institutions,” says Ian Mosby, a history professor at Ryerson University in Toronto, who recently wrote an article on the topic. “I work with communities where experiments have been done and people are traumatized. They have turned away from the health-care system entirely.”

Troubling incidents continue to this day.

In 2008, an Indigenous man named Brian Sinclair waited more than 30 hours to get medical attention at a Winnipeg hospital. The double amputee died in the waiting room and had developed rigor mortis by the time medical staff attended to him. An inquest later found medical staff had assumed he was intoxicated — he had a history of substance abuse — or had been discharged but had nowhere to go because he was homeless. An autopsy revealed that he had a treatable bladder infection. In 2017, a group of doctors claimed racism had been a factor in Sinclair’s death.

Less than a year ago, an Indigenous woman suffered a similar fate in Joliette, Quebec. Joyce Echaquan checked herself into a hospital with stomach pain but never received the help she needed. Instead, nurses taunted her as she writhed in agony, calling her “stupid as hell” and telling her she was “good at having sex more than anything else.” Echaquan, a mother of seven, live-streamed her experience on Facebook. She died that day because she was allergic to morphine, which she had been given while restrained.

The gut-wrenching video sent shockwaves across the country. “Discrimination against First Nations people remains prevalent in the health-care system and this needs to stop,” Assembly of First Nations national chief Perry Bellegarde said at the time. Cabinet minister Miller also weighed in, describing the incident as “the worst face of racism.”

Also last year, British Columbia launched an investigation into allegations that health-care staff in emergency rooms were playing a game that involved guessing the blood-alcohol level of Indigenous patients. The province’s Hospital Employees’ Union issued a statement that said racism is deeply ingrained in the health-care system.

“Health care facilities are not viewed as places of sanctuary by Indigenous people,” says Joe Hester, executive director of Anishnawbe Health Toronto, an Indigenous health-care group that is now holding vaccination clinics. “Our experience in them has too often been of a negative nature. Our people carry that with them.”

“There is definitely some hesitancy, but members of Indigenous communities are more receptive when their leaders encourage them to get the vaccine,” says Hester. “At our clinics, we have our own music and smudging ceremonies. It is a positive experience and that goes a long way toward building trust. Inroads are being made.”

Adds Dr. Lisa Richardson, strategic adviser of Indigenous health at the University of Toronto: “The idea of actually being able to receive a vaccine from a trusted, known Indigenous health-care provider in a safe place … is a way to facilitate uptake in this vaccination strategy.”

Looking to the future, professor Mosby says “Canada needs to answer for systemic racism at the heart of the health-care system. This country needs to put real resources into that.”