Earlier this year, Canada’s chief public health officer, Dr. Theresa Tam, made it clear that race matters when it comes to outcomes related to COVID-19. This was the case even though race-based data is not consistently made available across Canada.
“For example, surveillance data from Toronto and Ottawa indicates that COVID-19 cases are 1.5 to 5 times higher among racialized populations than non-racialized populations in these two cities,” Tam said in her statement, delivered on February 21. “Data from First Nations peoples living on reserve also point to higher rates of infection with SARS-CoV-02 compared to the general population (currently 69% higher).”
Moreover, Tam stated that there are “troubling examples of anti-Black racism that continue to this day” within Canada’s health-care system, “particularly involving racial bias on the part of health professionals and systemic racism within institutional practices”.
“This is compounded by the low proportion of Black health-care practitioners in Canada,” she added. “This continued generational systemic racism and mistreatment within the health system has led to considerable wariness within racialized communities, and a significant lack of trust in these systems and institutions. This lack of trust has contributed to significant COVID-19 vaccine hesitancy among the Black and Indigenous, as well as other racialized communities.”
Now a Vancouver-based Black community group, Hogan’s Alley Society, is leading a research project to delve more deeply into COVID-19 vaccination experiences in Black communities in B.C.
Through a survey on its website, HAS is asking Black people about their intentions with regard to COVID-19 vaccines, as well as their thoughts about immunizations, vaccine hesitancy, and the B.C. Vaccine Card program.
HAS spokesperson Stephanie Allen told the Straight by phone that the survey takes about 10 minutes to complete and it’s available in English and French. It’s being funded by the B.C. immunization committee.
“I think one of the things that was very concerning to us, early days, were the anecdotes—more the qualitative kind of feedback we were getting from community members that were deeply distrustful about vaccination,” Allen said.
She pointed out that this distrust is related to people’s personal and family histories with health-care professionals, as well as the troubled relationship that Black communities have had in the past with public-health agencies.
Socioeconomic marginalization puts communities at higher risk
The most notorious example is the U.S. Public Health Service’s study in 1932 to record the natural history of syphilis. Working with the Alabama-based Tuskagee Institute, the study tracked 600 Black men, including 399 with syphilis. The research subjects were not told about the nature of the study, which meant that they did not offer their informed consent.
The Black men in the study did not receive penicillin to treat their syphilis, leading to a class-action suit, which was settled in 1974 with a $10-million award. In 1997, then president Bill Clinton formally apologized.
When the pandemic struck, Allen said that some people in her community were put on edge very quickly, in part due to this history.
“So we saw this rising discourse as well—among community groups, among families—of fear, of real distrust,” she said. “And yet we had enough evidence to know, especially from Ontario, that Black communities were getting disproportionately impacted by COVID.”
Allen added that the same is true in the U.S.: a significant distrust of vaccines yet a high impact from COVID-19. The dangers were elevated for those working in frontline jobs without adequate sick leave.
“The socioeconomic marginalization that Black communities face has put them in higher risk,” she said.
Allen said that a town-hall meeting was held for the Black community with the Black Physicians of British Columbia to answer people’s questions. The goal was to convey credible information to the community from sources they could trust.
That led HAS to form a partnership with the principal investigator for the study, Dr. Gina Ogilvie, a Black physician and senior public health scientist at the B.C. Centre for Disease Control, as well as a Canada Research Chair in Global Control of HPV at UBC.
Ogilvie is well aware of the Tuskagee study and other health-research projects that have sowed distrust in marginalized communities. She sees the partnership with HAS as a way for the Black community to help gather data that can shape, direct, and guide policies going forward.
“So I think we need to learn from history but I also think we need to take that history and allow it to shape our future,” Ogilvie said. “And so I’m excited about repositioning Black folks—Black health—at the front of the conversation, and maybe in the centre of the conversation. I think that’s what we’re trying to do here.”
She noted that there has been a “massive gap, particularly in Canada” in collecting race-based health data. And this has impaired the ability of policymakers and health leaders to address “co-embedded inequities” within the health-care system.
“I think what’s clear after this pandemic is that everyone now understands this as a critical issue,” Ogilvie said.
Allen said that the existence of disaggregated race-based data makes it possible for community-based organizations to made a case for better policies. But this isn’t as easy to do when this data hasn’t been collected, which is another good reason for HAS to lead this research.
“We’re hopeful that we can use these findings to have very specific and targeted policy conversations at the provincial level, at the regional level, and with health authorities, and really start to see policies change and adapt,” Allen said. “You know, the First Nations Health Authority is a great model for how the needs of Indigenous peoples are being centred and addressed in health care. We’re just hopeful that we can start to build similar capacities for Black communities in B.C.”