Here's how community groups are getting COVID-19 vaccinations to Indigenous people in Canada's largest city

First Nations, Métis and Inuit adults are a priority group to be vaccinated against COVID-19 in Ontario, and Indigenous health and social service agencies are trying to get the word out to thousands of people spread across Toronto that it's their turn.  

"There has been a ton of focus on remote communities, which I think is extremely important, but we also know that rates of COVID ... are high in urban Indigenous people as well," said Dr. Lisa Richardson, an internal medicine specialist and Indigenous health leader at Women's College Hospital and University Health Network.

But Indigenous vaccine outreach in big cities like Toronto comes with a unique set of challenges.  

"It's certainly, like, a more dispersed population so it is definitely harder than going into one place where you know everyone within that community is Indigenous and everyone is eligible," she said. 

Over the last year, several Indigenous health and social services agencies have teamed up with Indigenous health-care providers, like Richardson, to do everything from COVID-19 testing and contact tracing to combating vaccine hesitancy to spreading the word that there are Indigenous-operated vaccine clinics where people can feel welcome and safe. 

Providing that level of "cultural safety" is critical for many Indigenous people because of a mistrust of health-care institutions, deeply rooted in atrocities such as experimentation on Indigenous children in residential schools to racist mistreatment in hospitals that continue to this day, said Steve Teekens, executive director of Na-Me-Res (Native Men's Residence), in Toronto. 

The very fact that Indigenous people are in the first phase of eligibility raises skepticism and fear for some, Teekens said. 

"[They think] 'why are we all of the sudden a priority? Usually we're never a priority, right? So why now?  Are we being experimented on again?' You know? So some of those notions are out there." 

Richardson said she views her role as building "vaccine confidence" rather than combating "vaccine hesitancy" because it's important to distinguish between mistrust stemming from historic wrongs and the kind of reluctance that's fuelled by misinformation promoted by anti-vaccination groups. 

The concept of vaccine confidence places the onus on the health-care system and providers to earn back the trust of Indigenous people, make them feel safe and take time to answer their questions without making them feel pressured or rushed, Richardson said.

Having health-care providers and community outreach workers who are Indigenous themselves answering those questions is also critical.  

"Every person I've spoken to who has initially had questions or concerns  — and I have vaccinated now hundreds of Indigenous people, [almost] everyone has actually had their vaccine," said Richardson, who is Anishinaabekwe.   

Social media, especially Facebook, has been a vital tool to provide factual information about the COVID-19 vaccine, as well as let Indigenous people in Toronto know where they can find Indigenous-operated clinics to get their shots, she said. 

Many Indigenous people have strong connections to one another, so word-of-mouth has also proven to be effective, she said. 

One of the city's Indigenous COVID-19 vaccination clinics, where Richardson works, is run by Anishnawbe Health Toronto, and is open to any Indigenous person, regardless of whether or not they are a patient there, said Joe Hester, the organization's executive director. 

"We create an environment that reflects our culture," which goes a long way in making people feel comfortable with the vaccine, Hester said.

For example, when people come to get vaccinated, they can take part in a smudging ceremony — a traditional burning of sage or tobacco — that is both a form of greeting and acceptance, but also represents cleansing of the mind, body and spirit, he said.  

So far, Hester estimates about 1500 people have received their first dose of the Pfizer-BioNTech vaccine at the once-a-week clinic. 

But because Indigenous people are disproportionately affected by poverty and precarious housing, Hester said, it's vital to expand the health centre's reach.  

"We want to reach out to the homeless population living rough here in the city, we want to get to congregate settings, where our people are in, for instance, housing projects, that kind of thing."

Anishnawbe Health has two mobile units ready to go, he said — but the deep-freeze storage limitations of the Pfizer-BioNTech vaccine make it difficult to transport. He's in discussion with Toronto Public Health to try to get the province to supply a more portable alternative.  

Vaccine supply is also an issue for Teekens, who runs another Indigenous vaccination clinic near the Na-Me-Res shelter called  Auduzhe Mino Nesewinong, which translates to "the place of healthy breathing." 

If the Ontario government really believes Indigenous adults are a priority group, they need to follow through with "a dependable, predictable source of vaccines," Teekens said. 

Right now, the Auduzhe Mino Nesewinong, which holds vaccine clinics twice a week, doesn't know how many doses they will have to offer in advance, he said. 

Teekens feels like Indigenous people living in the city have been "overlooked," while those living in remote communities have been prioritized — even though Toronto has the largest population of Indigenous people in the province and is also a COVID-19 hotspot.   

Dr. Janet Smylie, a Métis-Cree family physician at St. Michael's Hospital and Canada research chair in Advancing Generative Health Services for Indigenous Populations, also works at the Auduzhe Mino Nesewinong vaccine clinic. 

Smylie said she sees a "stark contrast" between the extensive planning for vaccine delivery to remote communities and what's been made available for Indigenous people living in urban environments. 

"It should never be set up that we have to compete against our relatives living in First Nations communities for vaccine," she said. 

CBC News requested a response to that concern from Ontario's health minister, but none was provided by deadline. 

Smylie estimates there are about 60,000 Indigenous people in Toronto eligible for the COVID-19 vaccine right now. 

The 2016 official census cited on the City of Toronto website counted about 46,000 Indigenous people living in the city — but that's widely believed to be a substantial underestimation.