Since the pandemic began, we've spent late nights and early mornings with a list of worries familiar to people the world over: which of our colleagues will end up in an ICU with COVID-19? Whose patient's or family member's or friend's life will be cut short by this pandemic? Whose grandparent will suffer neglect in long-term care?
How many barriers will Indigenous and racialized Canadians face in attempting to access care? How many doctors and nurses and personal support workers and teachers will burn out? How will essential workers who don't have the privilege to work from home and isolate get through this pandemic safely?
Will people with disabilities and seniors in the community be forgotten because they aren't in institutional settings? How will people in rural and remote areas, people who live in poverty, migrant workers and new immigrants access care? What will happen to people in jails and people who are homeless?
Aware that there are many voices not invited to decision-making tables, Dr. Nili Kaplan-Myrth brought together a group of health-care experts and community representatives -- family doctors, nurses, infectious disease experts, inner-city health and addictions specialists, essential caregivers, patient advocates and disability activists -- to talk about geographic, racial, socioeconomic and other disparities in access to COVID-19 vaccine across Canada.
Although health is a provincial-territorial mandate, we were shaking our heads about the ad hoc, uneven, uninformed strategies from one region to another (even within a province or territory). Having already spoken with MPPs and MPs, Dr. Kaplan-Myrth pitched a conversation directly to Prime Minister Justin Trudeau. To our amazement, he and Health Minister Patty Hajdu agreed to speak with us about these issues. Amie Varley, an RN, was invited by Dr. Kaplan-Myrth to co-host as an important mark of the partnership between family doctors and nurse colleagues. Dr. Alika Lafontaine was invited to give a land acknowledgement. The 14 panelists represented geographic, professional, and racial diversity. Our panel discussion was broken down into three segments.
1. Strategic challenges and the need for local understanding and national standards
The panelists in the first segment were Dr. Lynora Saxinger, an infectious diseases specialist from Alberta; Dr. Amy Tan, a palliative-care specialist and anti-racism activist from British Columbia; Dr. Elizabeth Muggah, a family doctor and president of the Ontario College of Family Physicians; Nancy Mike, an Inuit nurse in remote Nunavut; Dr. Courtney Howard, an emergency doctor in the Northwest Territories; and Dr. Robyn MacQuarrie, an obstetrician in Nova Scotia.
- We need a pan-Canadian vaccine registry.
- COVID-19 vaccine rollout is a perfect test case for network building and development of a federal coordinating table to improve cohesion, transparency, and public communication. We must address data and information fragmentation and break down professional silos to build a stronger health-care system for our post-pandemic future.
- Discrepancies in vaccination strategies should be addressed through national "best practice" guidelines.
- An explicitly anti-racist framework is required to address systemic inequalities in access to COVID-19 vaccine.
- Primary care delivered by family physicians and nurse practitioners is based on relationships of trust with populations. It should have been central to pandemic task forces rather than peripheral to vaccine rollout. Looking to the future, we need to "build back better," to invest in primary care, to ensure quality health care for all Canadians.
- Issues of access to vaccines in remote communities must be understood within the context of systemic inequalities in access to local, culturally safe health care. Inuit women flown south from Nunavut to give birth, contracting COVID-19 in Winnipeg and dying, is a poignant example of the dire need for health-care policy reform.
- Domestic production of medications -- including vaccines -- is required to address supply chain issues, especially to the rural and remote areas.
- We must address the exclusion of women (which results in the dearth of vaccine guidelines around pregnancy and lactation) in all clinical trials. As Prime Minister Trudeau responded, if men were the ones who became pregnant, we would include them in studies.
2. Patient and caregiver advocacy and issues of equity for marginalized populations in vaccination rollout
The panelists for this segment were Dr. Jillian Horton, an addictions specialist in Manitoba; Maggie Keresteci, a community caregiver advocate in Ontario; Amy Ma, a patient advocate and disability rights expert in Quebec; Dr. Vivian Stamatopoulos, a professor of health policy and leading advocate in Ontario for long-term care residents and their families; and Dr. Naheed Dosani, a palliative-care physician who works with homeless populations in Ontario.
- The populations marginalized and made vulnerable by society must be prioritized for vaccine access.
- Populations that face systemic discrimination in our health-care system include (but are not limited to): people who are homeless, who struggle with addictions, Canadians in prisons, people who live with disabilities (in community and congregate settings), seniors (in community and congregate settings), essential caregivers, new immigrants and refugees, LGBTQ2+ Canadians, Indigenous people, and racialized Canadians. A national equity framework is required to guarantee the inclusion of otherwise marginalized voices, and/or the voices of the health-care workers who are their advocates, on COVID-19 vaccine task forces.
3. Collaboration with interdisciplinary health-care partners
This final segment was represented by Kristin Watt, a pharmacist in Ontario; Abiola Tijani, a personal support worker in Ontario; and Lehe Spiegelman, a midwife in British Columbia.
- We must leverage all interdisciplinary professionals who work in health care on planning and roll-out of the vaccine. Pharmacists are prepared to participate in COVID-19 vaccination strategies, as a component of mass vaccination in the community.
- Personal support workers (PSWs) have been heralded as health-care heroes but their safety and precarious employment situations have been largely overlooked by provincial and territorial governments. It is necessary not only to prioritize PSWs for vaccination, but also to address their working conditions and understand issues of vaccine hesitancy in the context of systemic racism and discrimination.
- Midwives in rural and remote communities have relationships of trust and play a central role in outreach to pregnant and lactating people and their families.
After each segment, Prime Minister Trudeau and Minister Hajdu responded to the issues raised. Their responses were thoughtful, validated what each speaker said, and acknowledged the work required to address the issues highlighted. In particular, they reiterated that systemic racism, discrimination, and geographic as well as socioeconomic barriers to accessing health care in Canada are ongoing significant concerns, exacerbated by the pandemic. They acknowledged that further conversations are required at a national level and acknowledged the need to collaborate across professions.
Where do we go from here?
People across Canada have been struggling through this pandemic for one year, although the ways in which we suffer and the privileges and resources we have -- our safety nets -- are influenced by Canadian geography, by systemic racism, by many institutionalized inequalities.
After our panel was broadcast, we received many positive responses. Speaking with Prime Minister Trudeau and Minister Hajdu felt like a balm against the burnout that so many health-care and other front-line workers are struggling with right now. We need a dose of optimism to get through the hard days, weeks and months ahead of us. This panel was an example of the diverse voices that should be at every decision-making table. It is only the beginning of the collaborative conversation that we hope will continue.
In his final remarks, Prime Minister Trudeau said to us, "I demand that you continue to advocate." Dr. Kaplan-Myrth ended by thanking the prime minister, the health minister, the panelists, and all the people across Canada who listened to the conversation. To Prime Minister Trudeau she responded: "I accept your demand." We must continue in our advocacy, for our patients, our colleagues, our friends, our community, and our country.
Watch the video of the virtual roundtable with health-care professionals and advocates here.
Dr. Nili Kaplan-Myrth, MD, CCFP, PhD, is a family doctor and anthropologist. She writes about health policy and politics and co-hosts RxAdvocacy.ca. Follow her on Twitter @nilikm
Dr. Amy Tan, MD MSc CCFP(PC) FCFP is a palliative-care and family physician, and an ethics and health communications researcher. She advocates and writes about health equity and anti-racism. Follow her on Twitter @AmyTanMD
Image courtesy of authors
Editor's note, February 25, 2021: A previous version of this article omitted the names of two people who took part in the panel. It has been updated to include Amie Varley and Dr. Alika Lafontaine among the panel participants.
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