As Covid-19 vaccination rates rise across the Northwest Territories – with leaders and public health officials urging the vaccine is the best defence against Covid-19 – some eligible residents still haven’t received a shot.
Reasons for delaying or declining vaccination against Covid-19 are varied, complex, and sometimes deeply personal. Healthcare workers and leaders say the spread of misinformation about the vaccine is, however, a contributing factor.
Broadly, vaccination targets are slowly being met. On August 24, the NWT said 75 percent of the territory’s adults were fully vaccinated against Covid-19 – one of three targets for lifting many territorial pandemic restrictions.
But vaccination rates in communities vary.
In Kakisa – home to 36 residents, the NWT’s smallest community – every adult is fully vaccinated. Eleven of 30 communities or regions tracked by the territorial government have now reached at least 75-percent full vaccination of adults.
The Tłı̨chǫ region, though, has consistently had the lowest vaccination rates in the territory, followed by the Sahtu, which was the centre of an August Covid-19 outbreak connected to a hand games tournament.
A Tłı̨chǫ resident and healthcare worker in their twenties, who asked Cabin Radio that they not be named, said they chose to be vaccinated early in the territory’s vaccine rollout as they work with many community members, including Elders and children.
“It was the right thing to do to protect the community as well as try to keep Covid-19 out of the territory,” they said.
“Now that … the Delta variant is the main variant right now, it’s very scary.”
Initial vaccine uptake was slow in their community, the healthcare worker said. Some people were waiting to see the effects of a new vaccine. Others, they said, “just want to say no for the sake of saying no.”
Now, the worker said, people still declining vaccination are mostly younger residents. They blame misinformation: false, inaccurate, or misleading statements created or shared without the intention of causing harm.
Young people in the healthcare worker’s Tłı̨chǫ community read social media and “listen to their friends, or cousins, or family about false information,” they said.
Across Canada and the world, people aged 18 to 30 have lower Covid-19 vaccination rates compared to other age groups.
The healthcare worker said they heard concerns about the vaccine’s side effects. Some people worried it could contain an implantable tracking chip, a widespread claim that has been proven false.
People’s fears are valid, even if the information often is not, the worker said, and should not be dismissed. Distrust of the healthcare system and government, they said, may be a factor.
“I know a lot of Elders and adults, they’ve had some very negative experiences with the healthcare system,” they said. “I feel like trauma, and whatever experience that might have been negative for them, is stopping them from reaching out to the health centre – and a huge distrust in the government.”
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Lianne Mantla-Look is a registered nurse and patient engagement specialist at Hotıì ts’eeda, a research support unit hosted by the Tłı̨chǫ Government, who helped with the territory’s vaccine rollout.
“All it takes is one uncredited source to influence a small community,” she said.
In one NWT community, which Mantla-Look said she could not name for privacy reasons, misinformation about the Pfizer-BioNTech vaccine causing infertility “spread like wildfire.” As a result, she said, only one person between the ages of 12 and 17 in the community received their vaccination in the spring. (The NWT offers the Moderna vaccine to adults and Pfizer-BioNTech to children aged 12-17.)
According to the US Centers for Disease Control and Prevention, and other global authorities, there is no evidence Covid-19 vaccines cause problems related to current or future pregnancy.
Covid-19’s threat hits home
Vaccination rates are now increasing in the Tłı̨chǫ and Sahtu regions. Between August 7 and 28, full vaccination rates for Sahtu residents aged 12 and up rose from 59 to 69 percent. In the Tłı̨chǫ, that figure moved from 56 to 60 percent. Partial vaccination rates rose from 70 to 79 percent in the Sahtu and 64 to 68 percent in the Tłı̨chǫ.
Rebecca Nash is the Tłı̨chǫ Community Services Agency’s director of health and social services. Nash described a change in residents’ approach to the vaccine during an outbreak of Covid-19 at nearby Yellowknife’s NJ Macpherson School in May.
That outbreak closed two schools in Behchokǫ̀ and led to mandatory mask-wearing after students and staff attended a Yellowknife soccer tournament identified as an exposure site.
“It was a period of fear,” Nash said. “It hit closer to home and then that kind-of increased the vaccine demand.”
Mantla-Look said vaccination rates also rose when the territory reduced the isolation period for partially vaccinated travellers, and when fully vaccinated residents were told they no longer had to isolate after returning to the territory.
Behchokǫ̀ Chief Clifford Daniels, who has urged people in his community to get vaccinated against Covid-19, said after a resident passed away, some community members were concerned the death was due to the Covid-19 vaccine, which he said was not the case. Others, he said, are worried about how fast the vaccines were developed.
“There are people that are very hesitant,” the chief said, but he believes a recent Covid-19 case in Behchokǫ̀ and the territory’s first death related to Covid-19 may change minds.
“I think it’s hitting home,” Daniels said. “All these things I think might be a factor for possibly people getting the vaccine.”
In a sharing circle on Covid-19 vaccines hosted by CKLB in March, Cara Manuel, community wellness coordinator for the K’asho Got’ine Charter Community in Fort Good Hope, said she felt hesitant when the vaccine initially came to her community. Manuel described difficulty separating what was true and false amid a wealth of information and opinions online.
“I was unsure if I should get it,” she said. “I kind-of wanted to wait to see how well it goes.”
Manuel said when she was given the opportunity to get the vaccine, however, she “just went for it” because she wanted to protect others in her community. She said she was concerned about the effect Covid-19 could have after a 30-year-old man originally from Fort Good Hope was put into an induced coma after becoming seriously ill from Covid-19.
“It made it very realistic and it really hit home for a lot of us,” Manuel said.
Is it safe? That’s a ‘normal response’
Alana Kronstal, who manages social marketing and health promotion for the NWT government’s Department of Health and Social Services, spends time working to correct vaccine rumours and misinformation.
“One of our big challenges is to correct any misinformation about any shortcuts that people think may have happened in the approval process, which definitely did not occur,” Kronstal said.
Health Canada used the same safeguards and rigorous review process as for other vaccines, Kronstal said, but had a better system for approving Covid-19 vaccines. The federal government said the development of those vaccines progressed quickly due to advances in science and technology, international collaboration, and dedicated funding.
Dr AnneMarie Pegg, the territory’s medical director, said research related to the technology behind the Moderna and Pfizer-BioNTech vaccines – messenger RNA or mRNA – has been ongoing for more than 30 years. When the Covid-19 pandemic began, she said, that research had reached the point where it could be readily used to create a vaccine, so developers of mRNA Covid-19 vaccines weren’t starting from scratch.
“We’re able to put that technology together quickly not because it’s a brand-new technology but because it had been developed for some time,” she explained. “There was a lot of international political and scientific pressure, and cooperation, to get a vaccine developed. That’s normally not something that happens.”
Pegg said scientific research on Covid-19 has rapidly evolved and as recommendations change, that can be confusing.
“People who really have no problem with many other vaccines, that we would call sort-of long-standing standard vaccines – with this one, they have a few more questions,” she said. “I think that’s a normal response to a situation that’s really not ever been seen in our lifetime before.”
Ryan Shank chose to delay getting vaccinated against Covid-19 because he was concerned about the vaccine’s safety. The 28-year-old is from Hay River but moved to Calgary in April.
Shank said he is not an “anti-vaxxer,” and has received other vaccines, but was reluctant to get a Covid-19 vaccine because of how quickly they were developed and their lack of full approval from the US Food and Drug Administration, or FDA. The FDA has approved various Covid-19 vaccines for emergency use and last week fully approved the Pfizer-BioNTech Covid-19 vaccine for people aged 16 and older.
“I personally think that the Covid vaccine came out a little too quickly,” Shank said. “I understand that nowadays, with the technology and research and resources we have, things can be developed a lot more quickly than they were able to in the past … but I think six months to a year is still pretty quick.”
Shank said he has read a lot of information about Covid-19 vaccines, including from Health Canada and the World Health Organization, and has talked to friends who are healthcare workers. He said while he knows Covid-19 is real, he feels that governments and mainstream media have overstated its negative impact.
Shank recently chose to get vaccinated, he said, as it’s becoming a requirement in more places – something he doesn’t agree with.
Shank feels many people who are hesitant about getting vaccinated against Covid-19, but aren’t against all vaccines, are being misunderstood. Due to his stance, he said, members of his family have blocked him on social media.
“I believe the worst thing to come out of Covid, out of this whole thing,” he said, “is people are starting to get divided in terms of the vaccinated versus the non-vaccinated.”
A recent survey of 1,615 Canadian adults found that, of vaccinated respondents, 75 percent had “no sympathy” for unvaccinated people who contract Covid-19. Three quarters of respondents supported encouragement of vaccination through regulations like mandatory Covid-19 vaccination to enter public spaces.
Distrust of the healthcare system
In the North, health officials have long noted historical distrust of the medical system, which has been a challenge during the Covid-19 vaccine rollout.
In the sharing circle hosted by CKLB, Rielle Nakehk’o – a registered nurse who helped deliver the first round of vaccines in Yellowknife, Ndilǫ, and Dettah – said that distrust stems from the legacy of residential schools, racism and stereotyping, and a lack of continuity of care in many communities that rely on locum or short-term healthcare staff.
Canada’s history of medical experimentation and colonial policies affecting Indigenous people includes nutrition experiments in residential schools, experiments on Inuit involving skin grafts, and separating Indigenous people from their families to send them south for tuberculosis treatment. Some never returned.
The NWT government has acknowledged and pledged to address anti-Indigenous racism in its healthcare system.
The Tłı̨chǫ Community Services Agency – the only agency in the NWT to deliver both health and social services and education programs – says it incorporates Tłı̨cho values and has worked to improve cultural safety in the NWT’s healthcare system, including serving traditional food in facilities and establishing an Elder wellness program.
Concerns about potential medical experimentation flared when the NWT was among the first jurisdictions in Canada to receive shipments of Moderna’s vaccine in late 2020.
Kronstal, at the NWT Department of Health and Social Services, said some people questioned why the territory was getting Covid-19 vaccines earlier than other parts of Canada.
“Making the vaccine available to us first was an act of reconciliation in some respects, but it was also viewed as somewhat suspicious for some folks,” she said.
“That’s been a tough conversation that’s needed to happen and most effectively has happened as a one-on-one thing between trusted healthcare providers and individuals, or ourselves when we were knocking on doors.”
Kronstal said the NWT was prioritized because it has only a handful of intensive care beds and because Canada sought to avoid past mistakes where Indigenous communities were disproportionately impacted by pandemics.
A recent Statistics Canada survey of Covid-19 vaccination coverage in the three territorial capitals found that by April 12, 83.5 percent of non-Indigenous adults were at least partially vaccinated compared to 64.1 percent of Indigenous adults.
Of Indigenous respondents to that survey, 87 percent said they believe Covid-19 vaccines are safe. For non-Indigenous respondents, that figure rose to 96.8 percent. Among Indigenous respondents, 33.3 percent expressed distrust of the vaccines because they were “developed too quickly” compared to 15.2 percent of non-Indigenous respondents.
There is limited research on vaccine hesitancy specifically among Indigenous people. Vaccine hesitancy describes a spectrum of reluctance or refusal to get vaccinated despite the availability of vaccines, acknowledging reasons ranging from the inconvenience of accessing vaccines to a lack of confidence in their safety or effectiveness.
Veldon Coburn, an assistant professor in Indigenous studies at Ottawa University, has warned that much reporting on Indigenous vaccine hesitancy is “sensational” and “incorrect.”
Coburn says Indigenous people are not more vaccine-hesitant than non-Indigenous Canadians. He pointed to a 2011 survey of 821 First Nations people and Inuit that found 82 percent of First Nations and 75 percent of Inuit respondents felt vaccination of all children was “very important.”
How the NWT is responding
Tools deployed by the NWT government to address misinformation and concerns about Covid-19 vaccines include information booths, pop-up clinics in communities, and health officials’ regular appearances on CBC radio to answer questions.
Online, the territory has explainer videos and information sheets about Covid-19 vaccines in English, Denesuline, Gwich’in, Inuktitut, Inuinnaqtun, Sahtúot’ı̨nę Yatı̨́, Dene Zhatıé, and Tłı̨chǫ Yatıì, alongside a series of myth-busting posts and a Facebook Q&A session.
“Over the course of the pandemic, we’ve tried every avenue that we can think of,” Kronstal said, describing misinformation as an “ongoing battle.”
“We’re never going to convince people by just trading facts,” she said, “but by hearing people’s story and perspective and where their concerns are at, you can have real dialogue. And that’s where people feel heard, and you might be able to change their mind.”
Mantla-Look, a fluent Tłı̨chǫ speaker originally from Behchokǫ̀, worked alongside her mother – Elder Rosa Mantla, who has long promoted the Tłı̨chǫ language and culture – to answer questions about vaccines in the region.
The two tailored vaccine information to their audience by emphasizing the need to protect Elders and the ability to socially distance by going out on the land.
Mantla-Look said the inclusion of trusted community members in the territory’s vaccine rollout has made a difference, along with presenting information within a Tłı̨chǫ cultural context. She said more local Indigenous healthcare providers would improve trust and confidence in the healthcare system.
“I think that helped build trust in the community when we came,” Mantla-Look said. “Making the information available in people’s first language and cultural context definitely helped build relationships with trust.”
“I vaccinated a lot of Elders from my region. I’ve become the go-to person that’s giving needles that don’t hurt,” she said with a laugh, referencing an NNSL article.
The Dene Nation and Indigenous groups across the territory have urged community members to get vaccinated to protect themselves and others against Covid-19.
“I think that’s the right thing to do, for the community and for those we love,” Behchokǫ̀ Chief Daniels said.
Whatì Chief Alfonz Nitsiza said Tłı̨chǫ leaders have encouraged people with questions and concerns to get information from health professionals rather than social media.
Businesses and organizations across the NWT have offered discounts and prizes to people who are fully vaccinated to encourage vaccine uptake, from Air Tindi offering a lifetime of travel with the airline to a $10,000 cash draw hosted by the Yellowknife Chamber of Commerce.
In May, the NWT Association of Communities and territorial government launched a $100,000 fund for local vaccine promotion activities. That money has paid for nighttime pop-up clinics, youth vaccine ambassadors, on-the-land focused prizes, and takeout meals at vaccine clinics.
“We didn’t want to see some of our communities get left behind when borders opened again,” Sarah Brown, chief executive of the association of communities, told Cabin Radio.
“There were definitely some big differences between our major centres and our smaller communities.”
This reporting was supported by Journalists for Human Rights and the Misinformation Project with funding from the McConnell Foundation, the Rossy Foundation, and the Trottier Foundation.