Thread by @AmyTanMD, #COVID19 has sadly been a masterclass in longstanding, entrenched systemic injustices and [...]

#COVID19 has sadly been a masterclass in longstanding, entrenched systemic injustices and inequities, & how they harm pop'ns that these systems continue to make vulnerable.
How do we engage those who have reasons to distrust the system that has been shown to work against them?

https://twitter.com/VoiceOfFranky/status/1342684808124768257

https://twitter.com/VoiceOfFranky/status/1342684808124768257

To try to work on solutions, we must acknowledge & understand the underlying issues.
This gives a thoughtful look at issues the US, many of which can be applied in Canada for context: /2 https://www.nbcnews.com/news/us-news/racial-disparities-create-obstacles-covid-19-vaccine-rollout-n1249627

Racial disparities create obstacles for Covid-19 vaccine rollout

“Without considering racial equity, we deepen the cracks that systemic racism has already created in our health care system," a health advocate said.

https://www.nbcnews.com/news/us-news/racial-disparities-create-obstacles-covid-19-vaccine-rollout-n1249627

There have been too many examples this year alone in Canada showing the persistent racism that Indigenous people face in accessing healthcare:
#systemicracism

https://thetyee.ca/News/2020/07/09/Indigenous-People-Accessing-Health-Care-Not-Safe/ @TheTyee

https://globalnews.ca/news/4398976/indigenous-patients-still-waiting-for-equity-in-health-care-canadian-doctor/
@AlikaMD

Indigenous People Don’t Feel Safe Accessing Health Care. Here’s What Has to Change | The Tyee

It will require big systemic shifts, but also smaller things like signage, say experts.

https://thetyee.ca/News/2020/07/09/Indigenous-People-Accessing-Health-Care-Not-Safe/

And now add in the fact that racialized Canadians are disproportionately affected by #COVID19 illness in Canada.

https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00079-eng.htm

Here is a deeper dive into Ottawa's data: https://globalnews.ca/news/7482070/ottawa-coronavirus-impact-racialized-black-residents/

COVID-19 disproportionately affects Ottawa’s Black residents, according to new data

Black residents represent 37 per cent of COVID-19 cases in Ottawa, while making up just seven per cent of the overall population.

https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00079-eng.htm

In addition to illness from #COVID19, the same ppl & communities are more affected by the negative social impacts from the pandemic.

These experiences of discrimination decrease trust in institutions & governments in Canada.
#DismantleInequities
#COVID19
https://www150.statcan.gc.ca/n1/daily-quotidien/200917/dq200917a-eng.htm

So to get back to the original Q:
How do we engage w those who have reason to be hesitant re vaccines due to systemic inequities?
Given the complex factors & persistent history, it is difficult but imperative to work with communities to earn trust: https://www.nejm.org/doi/full/10.1056/NEJMp2030033#.X-bV26VWklo.twitter

Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community | NEJM

Perspective from The New England Journal of Medicine — Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community

https://www.nejm.org/doi/full/10.1056/NEJMp2030033#.X-bV26VWklo.twitter

"Public health agencies will have considerable discretion in rationing scarce COVID-19 vaccines. They could become agents of change toward improving social and racial justice."

Is this possible? Necessary? If so, how?
#COVID19 https://jamanetwork.com/journals/jama/fullarticle/2771874

Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?

This Viewpoint considers how COVID-19 vaccines can be distributed strategically, ethically, and legally given conflicts between consensus public health recommendations to prioritize allocation to...

https://jamanetwork.com/journals/jama/fullarticle/2771874

Here are the key populations that have been identified by Canada for early immunizations. Indigenous populations have been rightly prioritized.

Would like to know where other adversely impacted racialized groups fit in the prioritization too. https://www.cmaj.ca/content/192/48/E1620

Key populations for early COVID-19 immunization: preliminary guidance for policy

KEY POINTS Alarming levels of spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the World Health Organization (WHO) to declare novel coronavirus disease 2019 (COVID-19)...

https://www.cmaj.ca/content/192/48/E1620

This is the Equity Matrix that is ref'd in the

#COVID19 vaccine roll-out recommendations.

I hope all provinces can directly articulate how each province's roll-out measures against this matrix that considers intersectional risks & inequities because

https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-key-populations-early-covid-19-immunization.html#a14

I have seen firsthand & heard from colleagues that these recommendations are up to individual public health interpretation & discretion.

We must ensure interpretation doesn't lead to intentionally or unintentionally upholding inequities that could further vaccine hesitation...

Transparency re vaccine allocation decisions, open public communication, & sincere engagement w grps affected by inequities will help build trust.

Explaining why/how complex decisions made, acknowledging competing tensions, directly/openly addresses Q's+concerns./fin
#COVID19

Transparency re vaccine allocation decisions, open public communication, & sincere engagement w grps affected by inequities will help build trust.Explaining why/how complex decisions made, acknowledging competing tensions, directly/openly addresses Q's+concerns./fin #COVID19

@FionaMattatall @pamelamroach @doreen_rabi @DocMCohen @Monika_Dutt @RitikaGoelTO @AlikaMD @MaryFernando_ @SharkawyMD
Please consider amplifying. Decisions are being made now and we need community members AT THE TABLE NOW! Thank you!

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