COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort study using linked administrative data, 2020–2021.

Background: Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). Methods and findings: In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. Conclusion: In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada. Nathan C Nickel, Wanda Phillips-Beck and colleagues assess whether First Nations-led COVID-19 protective measures were associated with improved access to COVID-19 testing and vaccination compared to all other Manitobans. Author summary: Why was this study done?: Historically, pandemics have disproportionately affected marginalized groups, such as Indigenous Peoples, in a negative way. Evidence of the disporportionate burden of Coronavirus Disease 2019 (COVID-19) on First Nations people in the province of Manitoba, Canada, became clear when collection of Indigenous identifiers began in May 2020. First Nations organizations in Manitoba collaborated with the provincial government to develop and implement COVID-19 testing and vaccine administration strategies to improve access for First Nations people living in Manitoba. We wanted to know if First Nations-led efforts to improve access to COVID-19 protective measures were associated with higher COVID-19 testing rates, lower COVID-19 infection rates, and higher vaccination rates for First Nations people compared to other Manitobans. What did the researchers do and find?: We used a "Nations-based approach," meaning different Indigenous populations were not compared to one another in recognition of each population's unique characteristics. Instead, First Nations were compared to All Other Manitobans (AOM). We used whole-population data from the province of Manitoba to compare diagnostic testing, infection, and vaccination rates among Manitoba First Nations and AOM and examined how quickly vaccines were administered to each group once people were eligible to receive them. From this work, we found that while being prioritized, First Nations had higher testing rates, infection rates, and vaccination rates compared to AOM. As well, First Nations were vaccinated more quickly than AOM after becoming eligible for both first and second doses of the COVID-19 vaccine. What do these finding mean?: Our results suggest that First Nations-led advocacy and efforts to prioritize First Nations people for COVID-19 protective measures were associated with faster vaccine access and uptake by First Nations people and this may have prevented many severe illnesses and deaths. Availability of Indigenous identifiers through collaborative data sovereignty agreements has made this work possible, providing a clearer picture of the outcomes of First Nations' self-determination and public health sovereignty approaches. However, we did not have data on potential social and structural barriers to COVID-19 testing and vaccination faced by Indigenous and racialized people and this is an important area of future research. Broadly speaking, informative, inclusive, and participatory decision-making and policy creation are key to protecting health and preventing the spread of communicable illnesses among Indigenous populations. [ABSTRACT FROM AUTHOR]