Picture of Mitchell Crozier, Sarah Giles and Jason McVicarMitchell Crozier is a fourth-year medical student at the University of Ottawa.

Sarah Giles is a family & emergency physician in Kenora, Ontario, and an assistant clinical professor at NOSM.

Jason McVicar is an anesthesiologist at The Ottawa Hospital and an Assistant Professor at the University of Ottawa.

Canada has had unequal success in managing the COVID-19 pandemic amongst different groups of people. The pandemic response has been far from equity-driven. which has worsened inequities and widened outcome gaps for people experiencing marginalization. It has worsened the impacts of discrimination and fuelled discussions of racial inferiority.

First Nations, Inuit, and Métis Peoples, LGBTQ2+ people, members of racialized communities, incarcerated individuals, people experiencing mental illness, poverty, homelessness or addiction, immigrants, women and children facing domestic violence, older persons, and foreign-temporary workers are amongst those at highest risk of developing COVID-19 infections and having to cope with the indirect social consequences of the pandemic. These groups, often called “vulnerable populations,” are not inherently vulnerable: they are made vulnerable due to widespread inequities, all of which contribute to poor health outcomes.

As of Sept. 13, 2021, the rate of reported active cases of COVID-19 in First Nations people living on-reserve was 292 per 100,000 people, 3.5 times the respective rate in the general Canadian population. Further, racialized people have been overrepresented in COVID-19 infection rates across Canada; for example, in Manitoba from March 31st to June 7th 2021, the COVID-19 infection rate for Southeast Asian, African, and South Asian peoples was 21.7, 8.7 and 8 times the infection rate for Caucasian Manitobans respectively.

Data from 50 Canadian federal prisons during the first wave demonstrated that people in federal prisons were greater than three times more likely to develop COVID-19 compared to the general population, despite being tested far less often.

Members of communities that experience marginalization are not homogenous and evidence shows that individuals who experience multiple forms of marginalization have worse health outcomes because they are subject to intersecting forms of subordination and oppression. This has proven to be true with COVID-19.

When compared to groups who are not subject to forms of marginalization, namely affluent Caucasian Canadians, populations who experience marginalization have experienced a disproportionate degree of job loss, income reduction, pre-existing mental and physical health deterioration, compromised education, food insecurity, domestic violence, and substance abuse during the pandemic.

Women and children have also suffered disproportionately during the pandemic. Indicators of domestic violence have increased profoundly across the country. For example, calls to Canada’s Assaulted Women’s Helpline have nearly doubled in number. Early data from the Children’s Hospital of Eastern Ontario also indicated that the prevalence of infant maltreatment injuries had more than doubled during the pandemic.

Ultimately, decisions made regarding early vaccine distribution, stay at home orders, cessation of non-essential work activities, school closures, and paid sick leave were less detrimental to wealthy, predominantly white, communities than others. Despite expert recommendations in the past that emphasized integrating equity into pandemic planning and response, and early recognition that populations experiencing marginalization were more at risk of COVID-19, people living in Canada have seen little in terms of equity-driven health, social, or economic policy-related responses. Specifically, Manitoba remains the only province to provide race-disaggregated data collection on COVID-19 infection rates and outcomes.

Could an equity-driven approach to the pandemic that prioritized adequate care and support to populations experiencing marginalization have changed outcomes? We know this approach holds potential. Consider the efficacy of “Operation Remote Immunity”, a vaccination program led by Ontario’s air ambulance service in collaboration with Nishnawbe Aski Nation, a political territorial organization representing 49, primarily remote, First Nations in northern Ontario. The program facilitated the administration of 25,000 vaccine doses across 31 northern Ontario Indigenous communities from January to April 2021. Communities involved in the program reached vaccination rates ranging from 70 to 94 percent. Despite the obstacles faced by these communities, they achieved success due to an effective needs-based, community-centred approach that prioritized equity in communities subject to historic oppression and subordination.

As we enter the fourth wave of the pandemic, we must immediately prioritize the care of people experiencing marginalization through an equity-driven, needs-based approach. Those who have already disproportionately borne the brunt of the pandemic should not have to bear it again. We have a once-in-a-generation opportunity to address the inequities in Canadian society that cause disproportionate suffering within communities experiencing marginalization.

Today, as the fourth wave looms, Canada’s physicians and surgeons must stand up at the ballot box and vote for candidates who will support nimble vaccination strategies that empower those who could not be vaccinated earlier, candidates who seek to mitigate the harms that many in Canada have suffered during lockdowns, and those who will work with populations experiencing marginalization to create better solutions. Now, not tomorrow, is when we must act and shape a more equitable future for all living within Canada.

Acknowledgement: The authors would like to acknowledge the contributions of Audrey Giles, PhD, at the University of Ottawa.