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A syringe containing a test H1N1 vaccine at the University Hospital of Antwerp, Belgian. (FRANCOIS LENOIR/Reuters)
A syringe containing a test H1N1 vaccine at the University Hospital of Antwerp, Belgian. (FRANCOIS LENOIR/Reuters)

Influenza has a cure: affluence Add to ...

The last Haida left the village of K'uuna Llnagaay, or Skedans, off the north coast of British Columbia, almost a century ago - long enough even for cedar to crumble back into soil.

The house timbers were all gone years ago; the frontal and mortuary poles are all that remain of human handiwork - but even these lie at increasingly acute angles. Soon the forest will take them back. The stylized orca and thunderbird representations gazing out at the sea are bearded with moss. The poles themselves have been reduced to a crust of grey carved cedar around a core of disintegrating rot.

K'uuna Llnagaay was 26 houses, about 500 people, until the smallpox epidemics began in 1862. After these reduced the Haida by more than 95 per cent throughout the Haida Gwaii archipelago (now also called the Queen Charlotte Islands), the remnant population of just 558 gradually abandoned the coastal villages. The northern villages coalesced mostly into Masset, the southern ones into Skidegate, both on Graham Island.

This is where most of the Haida lived when the next viral cataclysm struck them - the influenza of 1918, which laid waste to their settlements and left many islands permanently uninhabited. The effect of the Spanish flu on the indigenous peoples of the planet is one of the underappreciated details of its cruelty. No one who witnessed the devastation wrought upon the Haida then would have been surprised this year, when the first ripples of the current influenza pandemic showed up in Canada, that native communities were hit first and hardest.

Now, the whole country is bracing for autumn, colder weather and the re-opening of schools. The portents seem clear: The average death toll of influenza, about 4,000 Canadians annually, will be exceeded significantly. In hospitals, Tamiflu is locked up with the narcotics, to remove any temptation. This year's influenza vaccine is the most anticipated ever, as the Canadian Medical Association showed this week by calling for a speed-up in the review process to get it to high-risk populations.

In 1918, the tolls were worst in remote regions; among American Indians, 8.5 per cent died - but in Nome, Alaska, 55 per cent of the Inuit were killed. It was comparable among the Alaskan Haida and Tinglit: In fishing village Micknick, 42 of the 50 residents were killed. The Canadian Haida died similarly.

On the same latitude, but 3,000 miles to the east, in Hebron, Labrador, 150 out of 220 Innu were killed. This against a world-wide case-fatality rate of 2.5 per cent.

That year's influenza was extraordinary in several ways beyond its lethality: It affected the young and the healthy disproportionately; it also spread readily beyond the lungs to injure the brain, the kidneys and the heart.

But in its appetite for indigenous peoples, the Great Flu was drearily typical. Tuberculosis, HIV, measles, E. coli - all the important pathogens claim Inuit and first-nations people at rates many multiples of what is seen in cities. This was the case at the outset, with initial exposure to European infections, and it remains so half-a-millennium later - the T.B. infection rate on reserves in 2004 was 20.9 per 100,000; the national rate was 1.6.

When the discipline of public health first arose, and directed its attention to the death rates on the reserves, much was made of indigenous peoples' innate vulnerability to introduced infections such as influenza, presumably on a genetic basis, presumably as a consequence of different - the subtext here is apparent - evolutionary pressures.

In the popular discourse this susceptibility continues to be emphasized. Given the calamitous 500-year history of infections and aboriginals, it is easy to understand how such an idea might gain traction, but the truth is more complex and difficult.

There are differences in immunity between various racial groups - the Inuit, for instance, may suffer more middle-ear infections than other populations, partly because of differences in inflammatory responses; African Americans seem to suffer fewer, for reasons less well-explained.

But the main reason native people die of infections, at rates that would be inconceivable and entirely unacceptable to other Canadians, is because they are poor. The poor die of everything - heart attacks, diabetes, suicides, homicides, drowning, house fires - at rates that would not be permitted along the various Bridle Paths of the nation.

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