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A vaccine clinic at Chief Joe Mathias Centre in Squamish, B.C., in June 2021. First Nations health officials are concerned the protection offered by COVID-19 vaccines is fading, just as the more dangerous Delta variant is spreading.Adrian MacNair/Courtesy of First Nations Health Authority

The remote B.C. community of Maaqtusiis, home to the Ahousaht Nation, has been in lockdown for two weeks because of COVID-19. The schools have been closed, non-essential travel to and from the community has been prohibited, and families have been asked not to mingle with other households.

Unlike many Indigenous communities in British Columbia where vaccination rates are below the provincial average, the Ahousaht enthusiastically welcomed a team of public-health nurses who arrived with the Moderna vaccine on Jan. 6. The outbreak adds to growing concerns that the protective benefits of the vaccines may be waning.

The village, which is a half-hour boat ride north of Tofino on the west coast of Vancouver Island, had already experienced a COVID-19 outbreak that prompted a lockdown in November of 2020. Once vaccines were available, both its elected and hereditary leadership showed their support for the rollout.

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Ahousaht Chief Councillor Greg Louie helped set the tone by being first in line to receive his vaccine. He says 92 per cent of eligible community members got their first shot during that January clinic, after public-health officials ran information sessions. Most residents returned for their second shot four weeks later. (The province later increased the recommended interval, based on clinical trials that concluded that getting the second dose six to eight weeks after the first may provide stronger protection.)

Now, eight months on, First Nations health officials are concerned the protection offered by the vaccine is fading, just as the more dangerous Delta variant is spreading. Since Sept. 4, there have been more than 50 cases of COVID-19 in Maaqtusiis, involving five households, with additional cases among Ahousaht members living off-reserve. A breakdown of how many cases required hospitalization was not provided.

“We have seen higher rates of COVID among fully vaccinated individuals – as high as three times the rate among the general B.C. population,” said Dr. Shannon McDonald, acting chief medical officer for the provincial First Nations Health Authority (FNHA).

“First Nations are overrepresented in both active cases and hospitalizations, and a higher proportion of First Nation individuals who contract COVID require hospitalization compared to other residents of B.C.”

According to the FNHA, Indigenous people in British Columbia are significantly more likely to be affected by COVID-19 than the rest of the population. First Nations make up about 3.3 per cent of the population, but they account for almost 18 per cent of the hospitalizations provincially. Factors include overcrowded living conditions and inadequate access to health care, which is why remote and rural First Nations communities were an early priority in the province’s vaccine effort.

Rising COVID-19 cases and low vaccination rates among Indigenous people prompted the Union of British Columbia Indian Chiefs on Thursday to issue what it called “an urgent and critical call” for First Nations to get their full COVID-19 vaccinations immediately.

According to the FNHA, 75 per cent of First Nations people in B.C. who are 12 and older have received at least one dose of a COVID-19 vaccine, compared with 88 per cent for the rest of the province. As with the broader population, the majority of Indigenous individuals who end up in hospital are unvaccinated, but there are still breakthrough cases involving those who are fully vaccinated.

Dr. McDonald says the evidence supports a third round of vaccines for Indigenous communities, but her agency requires approval from both the federal and provincial governments. The province has recognized the need for boosters in some cases, but so far only approved third doses for those in long-term care and assisted living homes, as well as individuals who are immuno-compromised.

“It’s very clear from our provincial surveillance teams covering First Nations that we are able to establish a need for a third dose, especially among some of our elders,” Dr. McDonald said in interview. “But why stop there? Do we have vaccine available? Apparently we do.”

On Oct. 5, Dr. McDonald met with Provincial Health Officer Dr. Bonnie Henry to advocate for access to more vaccine. The same day, the province announced it is returning 300,000 doses of vaccine to the federal government – mostly Moderna, which has been favoured in the smaller, rural clinics in First Nations communities because it is easier to transport than the Pfizer vaccine.

In a written statement, Dr. Henry said she is working with Dr. McDonald to review the data around vaccine efficiency for all ages and populations “to determine if, and when, a booster dose may be needed for First Nations elders, vulnerable individuals and First Nations communities. We will ensure vaccine is available as soon as this decision has been made.”

Some of the reasons for the low vaccine rates among Indigenous peoples in B.C. are deep-rooted, Dr. McDonald said.

“There is a layer of mistrust of government. I get asked, over and over again, ‘Are they just experimenting on us?’ ” she said. Aboriginal children at six residential schools in Canada were the subject of highly unethical nutrition experiments between 1942 and 1952.

In addition, Indigenous people are reluctant to seek health care because of systemic racism, according to a report last November. The report identified widespread, Indigenous-specific stereotyping, racism and discrimination in British Columbia’s health care system.

Add to that the misinformation that is shared through social media, and the result is some communities are ill-protected against the virus. “We have some communities right now who are actively in outbreak, where the vaccination rates are between 40 and 50 per cent for the second dose,” Dr. McDonald said.

But even those with high vaccination rates are at risk, she noted. She would like to see vaccine teams gearing up to return to the province’s 200-plus First Nations communities to offer first, second or third doses as needed, ideally at the same time that the seasonal flu vaccines are delivered.

Mr. Louie said he, too, is looking forward to the return of health care workers with more doses, especially for children aged five to 11, once vaccines are approved for that age group by Health Canada. In the meantime, his community has imposed tough isolation measures, which are wearing hard. “We’re a small, close-knit social community,” he said.

While the band council is helping facilitate grocery deliveries, there is limited selection and most families rely on regular trips to Tofino or Port Alberni for supplies. But the strict rules are producing hopeful results. In the Oct. 3 update, the band council reported just three active cases in the community, with 48 people recovered.

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