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COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort
Nathan C Nickel1, Wanda Phillips-Beck2, Jennifer E Enns1
1Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Insights
Prioritizing First Nations for COVID-19 vaccines in Manitoba led to faster vaccine uptake compared to other Manitobans. This collaborative approach ensured equitable access and may inform future public health strategies.
Area of Science:
- Public Health
- Epidemiology
- Health Equity
Background:
- First Nations in Canada face disproportionately higher illness and mortality burdens.
- The COVID-19 pandemic highlighted the need for equitable healthcare access for First Nations.
- Partnerships between First Nations organizations, public health, and government aimed to ensure timely and culturally safe COVID-19 response.
Purpose of the Study:
- To examine if prioritizing First Nations for COVID-19 vaccination was associated with faster vaccine uptake compared to other Manitobans.
- To analyze COVID-19 diagnostic testing, infection, and vaccination rates in First Nations and All Other Manitobans (AOM).
Main Methods:
- Retrospective cohort study using linked, whole-population administrative data from Manitoba (February 2020 - December 2021).
- Adjusted restricted mean survival time (RMST) models were used to compare vaccine dose timing between First Nations and AOM.
- Cohort included 114,816 First Nations and 1,262,760 AOM, with analysis adjusted for age, sex, income, region, mental health, and comorbidities.
Main Results:
- First Nations experienced higher crude infection and diagnostic testing rates compared to AOM.
- Despite younger age and lower income, First Nations had a similar burden of comorbidities and mental health disorders as AOM.
- Prioritization resulted in First Nations receiving their first vaccine dose an average of 15.5 days sooner and their second dose 13.9 days sooner than AOM.
Conclusions:
- The partnered COVID-19 response, prioritizing First Nations for vaccines, was linked to rapid vaccine acceptance and uptake.
- This collaborative policy approach can serve as a model for future public health initiatives in Manitoba and beyond.
- Equitable access and culturally safe strategies are crucial for addressing health disparities.
Background:
Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM).
Methods And Findings:
In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms.
Conclusion:
In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada.
