Indigenous populations around the world have historically experienced - and continue to experience - both social and economic marginalization. As a result, they are at disproportionate risk during public health emergencies which has led to significant inequities during the COVID-19 pandemic. Unfortunately, measures taken in response to the pandemic have in some instances also created or exacerbated inequities experienced by Indigenous populations. This webinar will explore ethical challenges experienced by Indigenous populations during the COVID-19 pandemic, how explicit and implicit 'vulnerabilities' are portrayed and experienced in this context, and the role that traditional knowledge and practices have played as a source of resiliency.
Dr Caesar Atuire, Senior Lecturer, Department of Philosophy and Classics, University of Ghana, Accra, Ghana
Dr Nicole Blackman, Provincial Director, Indigenous Primary Health Care Council, Toronto, Canada
Ms Nora Parore, Pharmacist/Māori health research fellow, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
Dr Lindsey MacDonald, Research Fellow, Ngāi Tahu Research Centre; Senior Lecturer, Department of Political Science and International Relations, University of Canterbury, Christchurch, New Zealand
Joziléia Daniza Jagso, Counselor, State Council of Indigenous Peoples - CEPIN/SC; Doctoral student in Social Anthropology - Federal University of Santa Catarina – UFSC, Florianópolis, Brazil
The panel discussion began with a presentation from New Zealand’s National Ethics Advisory Committee (NEAC) members Ms Nora Parore and Dr Lindsey MacDonald. Highlighting the country’s bi-cultural history, Ms Parore and Dr Macdonald noted that New Zealand’s indigenous community, known as Maori, actually represent 17% of the national population. They also have a uniquely young population with a median age of 25-27 years old. This is 11 years younger than the national average. Unique to Maori is the concept of Te Tiriti o Waitangi, the founding agreement between native and non-native New Zealanders, and one which guarantees health equity for Maori and asserts the rights of Maori to receive services and resources in accordance with their needs. However, despite the agreement, inequities continue to exist. In fact, experts have concluded that the national government’s response to COVID-19 has left Maori uniquely vulnerable. The systems, governing, legislating and funding primary health care systems, are simply not meeting the needs of New Zealand’s indigenous population. Therefore, addressing these challenges must be a priority. Ms Parore and Dr Macdonald also commented on the fact that COVID-19 struck in the middle of the Waitangi Tribunal; a permanent commission of enquiry established under the 1975 Treaty of Waitangi, to look at Maori health outcomes during the long history of colonisation. It’s now known that the Maori death rate for pandemics is higher than non-Maori. This is true of the 1918 flu pandemic, the H1N1 epidemic and COVID-19. The Waitangi Tribunal, established that the Crown does not have capacity to deliver equitable outcomes to rural and otherwise marginalised people; and this was particularly evident during the COVID-19 vaccination drive which was lacking in capacity, infrastructure, and follow-up data. Ms Parore and Dr Macdonald ended on a more positive note commented that after the pandemic - and perhaps as a result of it - Maori now have their own designated health authority designed to deliver equitable health outcomes to their population. Furthermore, this authority is using Maori models of healthcare such as Te Whare Tapa Wha (or the four dimensions of wellbeing) to ensure the needs of indigenous communities are met. They argued that indigenous communities can be the driving force of equitable outcomes. In the case of Maori using traditional knowledge and practises such Matauranga, which includes the values of Tika (good) Kotahitanga (solidarity) and Manaakitanga (caring for others); Maori were able to forge community relationships, setup vaccination centres, and provide accessible treatment to all. They thereby demonstrated that resiliency within the community is founded upon those traditional values, which they seek to uphold.
Dr Joziléia Daniza Jagso’s presentation focused on the impact of COVID-19 on Brazil’s 900,000 indigenous people. She noted that at the beginning of the outbreak the Brazilian government - including the Special Secretariat of Indigenous Health (SESAI), which operates within the Ministry of Health - began broad discussions of how to manage the virus. These discussions were particularly relevant to the 305 indigenous communities in Brazil, some of which were very isolated. However, it soon became clear, that Brazil’s indigenous population was let down. Dr Jagso commented that within affected settings, there was both a lack of information and an overabundance of misinformation. She argued the Brazilian government, and the various ministries and branches, were institutionally racist, and propagating doubt, particularly in regard to the efficacy of medicines. As a result, when this was combined with widespread shortages of PPE, tests, vaccinations and low-levels of trust toward government within indigenous communities, it meant these same communities were unable to protect themselves. It’s estimated that 27,000 individuals from Brazil’s indigenous communities were infected with the coronavirus, a disproportionate number of whom died. While the Special Secretariat of Indigenous Health should be assisting with promoting and delivering primary healthcare among indigenous communities, in reality it fell to the indigenous communities themselves to organise a frontline of defence. This included the production and translation of communicable information, the introduction of democratic forums of debate, live expert webinars, and a grassroots vaccination campaign. These initiatives acted as a counter-narrative to ignorance, and served as a way to alert the population to wider violations taking place in indigenous territories. Dr Jagso argued the Brazilian government neglected indigenous communities, and so it was up to the communities themselves to organise and fight back. This included federal court action in order to uphold rights.
Dr Nicole Blackman finished the seminar with a discussion on Canada’s indigenous population. She noted that official figures indicate indigenous people make up around 6% of Canada’s general population. However, fragmentary record-keeping, and government-led data collection tools, which instil a sense of distrust and disengagement among indigenous people, means this figure might not be accurate. In any event, it is now well-established that Canada’s First Nation people including Inuit and Métis, are vulnerable. Throughout history, they have been subject to various healthcare inequities, particularly evident during pandemics. Dr Black highlighted the disproportionate impact of the 17th century Smallpox epidemic, which killed off 90% of the indigenous population, the 1918 Spanish Flu epidemic which had a mortality rate of 9 per 1000 among indigenous communities, (as opposed to 6.2 per 1000 in non-indigenous communities), and the more recent H1N1 epidemic of 2009-10, which led to indigenous people accounting for 28% of all hospital admissions. Dr Blackman commented, that in this instance, government authorities sent indigenous communities body bags and toe-tags as opposed to hand sanitiser for fear they might drink it. As a result, when COVID-19 emerged in early 2020, it did so on a backdrop of historical inequities and discrimination. Unsurprisingly indigenous communities also experienced a higher rate of disease burden; but why is this? Dr Blackman stated that it in is the result of a higher rate of underlying health conditions among indigenous people, institutional racism, and finally healthcare inaccessibility. Like in Brazil and New Zealand low levels of trust within Canada’s indigenous population is also an issue. Nevertheless, efforts have been made on the part of both the Canadian government and indigenous communities to counteract this. The co-development of tailored primary healthcare strategies has allowed for the implementation of testing, assessment and vaccination drives within local communities that are often hard to reach. It has also increased community participation; furthermore, front-line responders, including contact-tracers and vaccinators, are now undergoing cultural safety-training in order to foster good community relations. Finally, indigenous-led information campaigns, including the production and dissemination of expert webinars, are providing factual information to galvanise local communities and increase agency and empowerment.
At this point Dr Caesar Atuire closed the panel discussion. What became clear in this seminar, is that despite the diversity and disparity of indigenous populations, most, if not all, are vulnerable. Subject to both historical and present day inequities, institutional racism, and marginalization they have been disproportionately impacted by the COVID-19 pandemic, and antecedent pandemics as well. It appears that national governments have been unable, or unwilling to integrate indigenous communities into primary healthcare strategies, which is itself a product of low levels of trust on the part of indigenous people, and discrimination or disinterest on the part of governments. More simply there is often a lack of capacity or misunderstanding. All speakers indicated that the way forward can be through better partnerships at both state and local level. However, it was also evident that it is the ingenuity of the indigenous communities themselves that has led to more equitable outcomes. This is not to argue, indigenous communities should be left to their own devices, rather that, traditional knowledge and practise should be incorporated into wider public health initiatives to build resiliency in these vulnerable populations.