Indigenous patients and COVID-19 vaccine distrust

Cultural safety for Indigenous patients is critical to COVID-19 vaccination success

Ensuring that your patients feel understood and respected when interacting with you will encourage them to seek care when needed. This will support increased confidence in the COVID-19 vaccine, leading to higher uptake and improved health outcomes for patients and communities.

What is cultural safety

Cultural safety is achieved when people of diverse cultural and ethnic backgrounds feel respected and safe from discrimination.

Cultural safety:

  • Is defined by those who receive care, not by those who provide it.
  • Acknowledges power imbalances in the health-care system, including structural and interpersonal power imbalances
  • Considers how social and historical contexts, as well as power imbalances shape a person’s health and health-care experiences
  • Is a framework that integrates awareness, sensitivity, competency and humility

Providers and organizations that practice cultural safety are self-reflective and self-aware about their position of power and the impact this role has on Indigenous clients.

This webpage has been developed in partnership with the Indigenous Primary Health Care Council (IPHCC).

Indigenous populations in Ontario

The following online dashboard includes demographic data with the number of Indigenous people in each postal code area. These numbers are under-representative, and the true numbers are estimated to be approximately three times those listed. Many Indigenous people do not self-identify due to fear of discrimination and inequities in the health-care system that have led to unsafe care.

View the online dashboard

Fostering cultural safety for Indigenous patients

Small steps can lead to big impacts. You can foster cultural safety for Indigenous patients in your practice in multiple ways. Choose to start with one area and build in more steps over time.  

Steps you can take

a) Understand why Indigenous communities and people were prioritized to receive the COVID-19 vaccine in the early phases of the vaccine rollout

A lack of understanding of the reasoning behind this decision has resulted in Indigenous populations being the targets of racism. Individuals who self-identify as First Nations, Inuit or Métis were prioritized based on a statement from the National Advisory Committee on Immunization, which identified them as high risk due to the following factors:

  • Those living in remote or isolated areas may have limited access to health care, which increases their risk for severe outcomes, including death
  • Indigenous individuals are more likely to have at least one underlying medical condition associated with severe COVID-19
  • The risk of transmission is high in settings where physical distancing and other infection prevention and control measures are challenging
  • Immunization of Indigenous individuals has the potential to mitigate the impacts of social inequities, such as racism, poverty and homelessness

b) Recognize the history of medical experimentation on Indigenous people in Canada

Concerns and fears related to these experiences contribute to vaccine hesitancy among Indigenous people. Become more aware and increase understanding of vaccine hesitancy in Indigenous populations.

To learn more about this read the article Medical experimentation and the roots of COVID-19 vaccine hesitancy among Indigenous Peoples in Canada.

a) Learn about key strategies for fostering culturally safe environments for Indigenous patients

The following resource can help you learn about culturally safe environments:

Ne-iikaanigaana toolkit External link icon

A toolkit to support creating safer environments for Indigenous people.  

Indigenous Primary Health Care Council

b) Ask patients to self-identify as First Nations, Inuit or Métis to become aware of the Indigenous patients in your practice and educate yourself on their history

If you are not already using a self-identifier question, consider adding one to your intake forms. Here is an example of a self-identifier question that is culturally appropriate and safe.

a) Learn strategies for engaging with Indigenous communities

Use the following resources to successfully engage with Indigenous communities:

Gashkiwidoon toolkit External link icon

A toolkit to support Indigenous organizations with community-level COVID-19 vaccination clinics. 

Strategies to support Indigenous participation in Ontario’s COVID-19 response External link icon

A short online course hosted on the IPHCC learning portal.

To sign up for an account to access the portal, fill in the registration form. To sign up multiple people from your organization, choose a point person from your organization to be the main contact with the IPHCC and fill out the form with their information and the names of all individuals who would like access to the portal. Email your completed registration form to ics@iphcc.ca.

Indigenous Primary Health Care Council

b) Form relationships with Indigenous organizations in your community

You can reach out to organizations and introduce yourself as a way of building trust. Examples of community organizations or resources to locate these organizations:

c) Engage with local Indigenous-led organizations regarding COVID-19 vaccination to help bridge the trust and transparency gap between Indigenous people and the mainstream health-care system

Indigenous-led organizations have already established trusting relationships with the local Indigenous population. Take steps to become informed and aware of Indigenous Peoples’ history and their worldviews to better equip yourself for meaningful engagement.

  • Take the lead from communities in shaping their health-care outcomes
  • Reframe yourself as a “partner”
  • Express that you are there and willing to assist when needed

d) Learn about general Indigenous health resources that could be helpful to Indigenous patients

  • Call Auntie Clinic: A Toronto-based organization that connects individuals to Indigenous care. They offer supports around pregnancy and postpartum, STIs, harm reduction, food, traditional medicines, or brainstorming difficult family or community situations
  • Talk 4 Healing: A culturally grounded, fully confidential helpline for Indigenous women available in 14 languages across Ontario
  • Toronto Council Fire Native Cultural Centre: An Indigenous agency serving the community in the downtown core of Toronto
  • Za-geh-do-win Information Clearinghouse: A collection of resources on health, healing and family violence

a) Watch the IPHCC’s Wise Practices webinar

A webinar with wise practices for COVID-19 vaccinators. The session discusses colonial history and power dynamics within the health-care system.

b) Develop an engagement strategy to support Indigenous patients around addressing vaccine distrust and boosting vaccine confidence

Examples of how to engage with Indigenous communities:

Indigenous wellbeing in times of COVID-19 External link icon

Includes a poster of the four directions virtual support hub focusing on health of body, spirit, heart and mind, and an interactive grandmother wisdom guide.

Maad’ookiing Mshkiki: Sharing medicine External link icon

Resources to empower informed consent and decision-making of First Nations, Inuit and Métis peoples related to COVID-19 vaccines.

Women’s College Hospital

a) Learn about Indigenous colonial history in Canada

Access the following resources to learn more:

IPHCC learning portal External link icon

A learning portal that includes courses on Indigenous cultural safety, contact tracing, and strategies to support Indigenous participation in Ontario COVID-19 response.

To sign up for an account to access the portal, fill in the registration form. Sign up multiple people from your organization by choosing a point person from your organization to be the main contact with the IPHCC and fill out the form with their information and the names of all individuals who would like access to the portal. Email your completed registration form to ics@iphcc.ca.

Indigenous Primary Health Care Council

Books

  • Indigenous Healing, Rupert Ross
  • Seven Fallen Feathers, Tanya Talaga
  • Five Little Indians, Michelle Good

b) Contact the IPHCC to learn more about Indigenous culture and history