ARCHIVED - Pan-canadian public health network council report and policy recommendations on the use of antivirals for prophylaxis during an influenza pandemic

Key Considerations and Expert Reviews

8. First Nations and Inuit Considerations

One of the most important responsibilities of any government is to ensure that the health of its most vulnerable groups is a key element of any plans for health promotion, disease prevention, and health protection. The health of First Nations and Inuit populations remains indisputably poorer than that of other Canadians and, when considering the value of antivirals for prophylaxis, requires unique consideration.

Preparation of this paper involved consultation with the Assembly of First Nations Health Technicians from each region, Inuit Tapiriit Kanatami, and Regional Medical Officers of Health from the First Nations and Inuit Health Branch of Health Canada.

Key Findings

A decision by F/P/T governments to stockpile antivirals for prophylaxis for all Canadians, for no one, or for a predetermined subset of Canadians is a hugely complex undertaking. In order to ensure the applicability and value of any antiviral prophylaxis strategy to First Nations and Inuit, and their active participation in its implementation, it is essential that their unique circumstances not be overlooked (see Annex 3.8).

Representatives of First Nations and Inuit communities were consulted during the Deliberative Dialogue sessions. It is important that leaders of these communities continue to be involved in the development of implementation strategies and pandemic response plans. Jurisdictional uncertainties as to roles and responsibilities of various governments in protecting the health of First Nations and Inuit need to be overcome to achieve this.

Remoteness of many First Nations and Inuit communities may compromise equitableal access to prophylaxis for these groups, due to lack of timely transportation of medical supplies, lack of adequate storage facilities, lack of trained human resources, and limited provision of educational materials. Delivering antivirals for prophylaxis to First Nations and Inuit will mean addressing these logistical realities.

First Nations and Inuit face unique health issues, due to increased rates of underlying disease, poverty, poor housing conditions, poor nutrition, a paucity of health care providers, and lack of adequate disease surveillance. The fact that they are at greater risk of morbidity and mortality during a pandemic should be factored into prophylaxis implementation strategies.

To respect cultural differences, any policy related to antivirals for prophylaxis needs to translate across linguistic, cultural, social and economic divides that exist between western style medicine and First Nations and Inuit approaches to health, including their traditional medicines.

Conclusions

The policy decision should include consideration, by governments at all levels, of its relevance to First Nations and Inuit and their unique circumstances, with the aim of ensuring fair treatment under the policy. When communicating their decisions to First Nations and Inuit leadership and providers of health, jurisdictions will need to take into account these unique circumstances.

To enable them to be effective local managers during a pandemic, it is important that these groups receive information to ensure that they are familiar with all aspects of the policy as well as the related preparedness planning and the implementation steps required.