Nili Kaplan-Myrth is a family doctor and anthropologist working in Ottawa.
Amy Tan is a palliative care and family physician in Calgary.
It has been a year since the COVID-19 pandemic began. To the credit of incredible scientific ingenuity, Canadians are now getting to line up for the COVID-19 vaccine. Across the country – from large urban hospitals in Edmonton, Winnipeg, Montreal, to inner-city Toronto and Vancouver shelters, to rural family medicine clinics in Brighton or Dartmouth and remote nursing outposts in Pangnirtuuq and Fort Simpson – the question on our minds is: who should get their jab as priority and how will it be delivered? Vaccination strategies vary from one region to another (even within a province or territory), which exacerbates existing geographic, racial, socioeconomic, and other disparities in access to healthcare across Canada.
In early 2021, aware that there are many voices that aren’t invited to decision-making tables, I, Nili, set out to assemble a group of healthcare experts and community representatives – family doctors, nurses, infectious disease experts, inner city health and addictions specialists, essential caregivers, patient advocates and disability activists – from across Canada to speak together about access to COVID-19 vaccines. I pitched the idea of a panel discussion to the Office of the Prime Minister. Although health is a provincial and territorial mandate, the challenges from this issue affect all Canadians, and it therefore seemed appropriate to talk about a national equity framework for delivering the COVID-19 vaccine. To my surprise and delight, the PMO accepted my request, and the federal Minister of Health, Patty Hajdu, offered to join in our conversation.
I didn’t have any special connections to the Prime Minister’s Office, nor did I have any reason to expect that they’d accept my proposal. I am a family doctor in Ottawa, outspoken since the pandemic began about issues affecting primary care and vocal in my advocacy for my patients. I’ve spoken on the radio, written articles, and reached out on social media, to address gaps and challenges in our healthcare system with a non-partisan, feminist, social equity focus. Although, early in the pandemic I was approached by the MPP for Ottawa Centre, Joel Harden, to participate in a town hall meeting about supports for primary care (we were without PPE and without financial support at the time), I’m not a representative from a hospital or medical organization. I put together the national panel as a grassroots initiative.
Health care workers are all exhausted, demoralized, and frustrated with empty rhetoric expressing the sentiment “we’re in this together.” Those of us who are out in the community, taking care of seniors, raising our own children, caring for patients and family members, advocating for people with disabilities, working in shelters, lobbying our politicians, know that our voices carry further as a chorus than as individuals. I spent six weeks recruiting the other panelists, colleagues I’d never met. I reached out to people I’d observed advocating for the health and wellbeing of Canadians – ensuring geographic, racial, and professional diversity of voices – and they responded enthusiastically. One of the few silver linings of the pandemic is that incredible healthcare experts and community advocates across the country have banded together, without political partisanship, driven by a shared sense of urgency. A couple of weeks before the panel, I asked Amie Varley to join me as co-moderator, happy to share that honour with an RN colleague. I also asked Dr. Alika Lafontaine, an Indigenous physician who has subsequently become CMA president-elect, to open the panel with a land acknowledgement.
On the day of the live-streamed panel discussion, February 11th 2021, all the participants signed into the WebEx platform an hour ahead of the start to chat about how we were all doing, acknowledging how wonderful it was to get to know each other as advocates through social media. Then, as casually as if she were our colleague down the hall, Minister Hajdu popped up on our screen, joining our conversation.
She pointed out that before the world became a place where we meet in virtual spaces, it would have been much more difficult to assemble a panel such as ours, let alone for the Minister of Health and Prime Minister to be able to sit back and speak to us for an hour. We were all anxious with anticipation as Prime Minister Trudeau’s face appeared on the screen moments before we were to go live.
“Count down from 10, then we start,” we were instructed by the PMO’s technician. Prime Minister Trudeau whispered to the panelists, “Wow, this is serious, a countdown!” and then we began.
As we were behind the camera, we could see the faces of all 14 speakers and Prime Minister Trudeau and Minister Hajdu throughout the event. The live-streamed view as seen by the public, however, was pinned to a close-up of the person speaking (as well whatever comments from the public popped up on the video as it was broadcast). It was surreal to sit there, Ms. Varley and I taking turns as we thanked and introduced the speakers and invited the Prime Minister and Minister to respond. I had emphasized ahead of time to the panelists that they would have exactly two minutes to speak. Worried that we’d go over our allotted time, warned ahead that the livestream would end at precisely 60 minutes, everyone had practiced, everyone was anxious. It threw us for a loop, therefore, when our Prime Minister and Minister Hajdu threw caution to the wind and gave longer than expected introductory comments and thoughtful responses to each of the speakers. We were seven or eight minutes behind schedule right away, but the PMO’s technician sent me a private message, “Don’t worry. The PM is happy to extend the time. We’ve got 75 minutes now instead of 60.”
You can watch the whole livestream at PSCP TV.
I think it is fair to say that when the event ended it felt to each of the participants that it was a truly incredible, unprecedented conversation. As one person wrote to me afterward, “We came together with passion, solutions and action. We each did so eloquently, respectfully, and with kindness.” It was a very human interaction, at times heart-wrenching (when Nancy Mike spoke, for example, I think we all felt a jolt of sadness), and sometimes humorous (very funny when the Prime Minister talked about how different clinical trials would be if men were the ones who got pregnant, and Minister Hajdu’s witty repartee).
For anyone who doesn’t have time to watch the whole recording, Dr Amy Tan and I have summarized it below.
In his final remarks, Prime Minister Trudeau said to us, “I demand that you continue to advocate.” and I responded, “I accept your demand.” We must continue in our advocacy, for our patients, our colleagues, our friends, our community, and our country.
Our national conversation with Prime Minister Trudeau and Minister Hajdu felt like a balm against the burnout that so many healthcare workers and others are struggling with right now. We need a dose of optimism to get through the hard days and weeks and months ahead of us.
The panel was the first of its kind, a grassroots initiative to come together as healthcare experts and advocates across the country. We can build on this discussion of vaccination. Prime Minister Trudeau and Minister Hajdu agreed that further conversations are required at a national level and acknowledged the need to collaborate again across professions.
Summary of the event:
The conversation was divided into three segments.
1) Strategic challenges and the need for local understanding and national standards
Panelists: Dr Lynora Saxinger, an infectious diseases specialist from Alberta; Dr Amy Tan, a palliative care specialist and anti-racism activist from British Columbia; Dr Elizabeth Muggah, a family doctor and president of the Ontario College of Family Physicians; Ms Nancy Mike, an Inuit nurse in remote Nunavut; Dr Courtney Howard, an emergency doctor in the Northwest Territories; and Dr Robyn MacQuarrie, an obstetrician in Nova Scotia.
- Need for a pan-Canadian vaccine registry and national “best practice” guidelines.
- Development of a federal coordinating table to improve cohesion, transparency, and public communication would address data/information fragmentation and break down professional silos to build a stronger healthcare system.
- An explicitly anti-racist framework is required to address systemic inequalities in access to COVID-19 vaccine.
- Family physicians and nurse practitioners – primary care, based on relationships of trust with populations – should be central to pandemic task forces, including COVID-19 vaccine rollout.
- Issues of access to COVID-19 vaccine in remote communities must be understood within the context of systemic inequalities in access to local, culturally safe healthcare.
- Domestic production of medications, including vaccines, is required to address supply chain issues, especially to rural and remote areas.
- The exclusion of women in clinical trials results in a dearth of vaccine guidelines re. pregnancy and lactation. As Prime Minister Trudeau responded, if men were the ones who became pregnant, we would include them in studies.
2) Patient and caregiver advocacy and issues of equity for marginalized populations in COVID-19 vaccination rollout
Panelists: Dr Jillian Horton, an addictions specialist in Manitoba; Ms. Maggie Keresteci, a community caregiver advocate in Ontario; Ms. Amy Ma, a patient advocate and disability rights expert in Quebec; Dr Vivian Stamatopoulos, a professor of health policy and leading advocate in Ontario for LTC residents and their families; and Dr Naheed Dosani, a palliative care physician who works with homeless populations in Ontario.
- The populations marginalized and made vulnerable by society must be prioritized for COVID-19 vaccine.
- Populations that face systemic discrimination in our healthcare system include (but are not limited to): people who are homeless, who struggle with addictions, Canadians in prisons, people who live with disabilities (in community and congregate settings), seniors (in community and congregate settings), essential caregivers, new immigrants/refugees, LGBTQ2+ Canadians, Indigenous people, and racialized Canadians. A national equity framework is required to guarantee the inclusion of otherwise marginalized voices, and/or the voices of the healthcare workers who are their advocates, on COVID-19 vaccine task forces.
3) Collaboration with interdisciplinary healthcare partners
Panelists: Ms. Kristin Watt, a pharmacist in Ontario; Mr Abiola Tijani, a personal support worker in Ontario; and Ms. Lehe Spiegelman, a midwife in British Columbia.
- We must leverage all interdisciplinary professionals who work in healthcare in terms of planning and roll-out of the vaccine. Pharmacists are prepared to participate in COVID-19 vaccination strategies, as a component of mass vaccination in the community.
- Personal support workers (PSW) have been heralded as healthcare heroes, but their safety and precarious employment situations have been largely overlooked by provincial and territorial governments. It is necessary not only to prioritize PSWs for COVID-19 vaccine, but also to address their working conditions and understand issues of vaccine hesitancy in the context of systemic racism and discrimination.
- Midwives in rural and remote communities have relationships of trust and play a central role in outreach to pregnant and lactating women and their families.
After each segment, Prime Minister Trudeau and Minister Hajdu responded to the issues raised. They acknowledged that systemic racism, discrimination, and geographic as well as socioeconomic barriers to accessing healthcare in Canada are ongoing significant concerns.